Hospital pediatrics最新文献

{"title":"Intrapleural TPA vs Normal Saline in Pediatric Empyema: A Comparative Study.","authors":"Mahya Sadat Mohammadi, Amir Hossein Dehghan, Mohammad Reza Modaresi, Seyed Hossein Mirlohi, Nazanin Karami, Rohola Shirzadi","doi":"10.1542/hpeds.2026-009645","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009645","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether intrapleural tissue plasminogen activator (TPA) reduces hospital length of stay (LOS) vs intrapleural normal saline in children with complicated parapneumonic effusion or empyema.</p><p><strong>Methods: </strong>A retrospective cohort study at a tertiary pediatric referral hospital in Iran, comparing children aged 1 month to 18 years treated during TPA unavailability (2012-2015; intrapleural saline, 40 mL, 1-hour dwell, daily ×3 days) with those treated after TPA became available (2015-2018; TPA 4 mg in 40 mL saline, same protocol). The primary outcome was hospital LOS, and the secondary outcomes were intensive care unit (ICU) stay, fever duration, chest-tube duration, and ICU admission. Multivariable linear regression was adjusted for baseline imbalances between cohorts.</p><p><strong>Results: </strong>Of 85 patients, 61 received TPA and 24 saline. The cohorts were comparable at baseline, except for higher pleural fluid adenosine deaminase and shorter time to first instillation in the saline group (medium and very large effects). The mean hospital LOS was 20.28 ± 5.53 days (TPA) vs 19.17 ± 3.60 days (saline). The unadjusted difference was 1.11 days (95% CI, -1.14 to 3.36; P = .366). The adjusted mean difference was 0.36 days (95% CI, -2.91 to 3.63; P = .826). Secondary outcomes showed similarly small differences, with CI ranges compatible with no clinically important effect.</p><p><strong>Conclusions: </strong>Intrapleural TPA showed no detectable benefit over saline in this retrospective comparison. The wide CI ranges indicate insufficient evidence to reject the null hypothesis and not equivalence. Our findings raise, but do not confirm, the hypothesis that mechanical lavage contributes to clinical improvement. Residual confounding and selection bias cannot be excluded. Adequately powered, prospective randomized trials are needed to establish the incremental value of fibrinolysis in children.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Guide to Dissemination and Implementation Science for Pediatric Hospitalists.","authors":"Jillian M Cotter, Christina Studts, Leigh Anne Bakel, Justin M Lockwood, Suchitra Rao","doi":"10.1542/hpeds.2026-009550","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009550","url":null,"abstract":"<p><p>In pediatric hospital medicine (PHM), effective interventions often fail to reach the bedside or are significantly delayed, contributing to gaps in quality, outcomes, and value. Dissemination and implementation (D&I) science addresses this evidence-to-practice gap by studying methods to promote the uptake, integration, and sustainment of evidence-based interventions in real-world settings. In this methodology article, we apply a PHM lens to D&I science, outlining when D&I is most useful and how it differs from quality improvement and traditional efficacy and effectiveness research. We introduce core D&I terminology and commonly used theories, models, and frameworks and describe key steps in conducting D&I studies, including identifying contextual barriers, selecting theory-informed implementation strategies, assessing appropriate implementation outcomes, applying rigorous study designs, and planning for dissemination and sustainment. We highlight practical tools and examples from PHM literature to support application in inpatient pediatric settings. We also discuss key limitations, including methodological complexity and challenges with measurement and reproducibility. By providing a pragmatic overview, this article aims to equip pediatric hospitalists and researchers with foundational D&I knowledge to accelerate translation of evidence into practice and improve care for hospitalized children.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"They Don't Know Me: Interpretive Continuity in the Transition to Adult Congenital Care.","authors":"Karl P McNamara","doi":"10.1542/hpeds.2026-009799","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009799","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehospitalist Models in Community Hospitals: Physician Coverage is Necessary but not Sufficient.","authors":"Charles R Woods","doi":"10.1542/hpeds.2026-009909A","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009909A","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on Gender Equity: A National Survey of Pediatric Hospital Medicine Division Leaders.","authors":"Lynn M McDaniel, Marieke Jones, Eleanor Sharp, Patricia Tran, Heather McKnight, Lauren Maskin, Harleena Kendhari, Kerri Machut, Hannah Sharpe, Jiafeng Li, Juliann L Kim","doi":"10.1542/hpeds.2026-009495","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009495","url":null,"abstract":"<p><strong>Objective: </strong>To assess pediatric hospital medicine (PHM) division leaders' perspectives on gender equity in their divisions and organizations.</p><p><strong>Methods: </strong>In 2025, we conducted a cross-sectional Research Electronic Data Capture survey distributed via email to 236 PHM division leaders. The survey consisted of 53 items on division and leader demographics, promotion, leadership, benefits, and gender-related experiences. Descriptive statistics summarized numeric responses, and qualitative content analysis identified emerging themes in free-text responses.</p><p><strong>Results: </strong>Responses from 125 PHM division leaders (53% response rate) were received. Leaders were predominately women (69%) and held PHM subboard certification (84%), with a median of 15 years of practice as a hospitalist. According to leaders, 76% of their faculty were women. No gender differences were reported in faculty rank or leadership roles. Compensation analysis by gender was reported by only 26% of responding institutions. Similarly, although wellness support was common, gender-stratified analyses of outcomes were rarely performed (19%). Mean paid parental leave offered to birth parents was 8 weeks. Qualitative analysis of leaders' suggestions to drive change toward gender equity revealed 6 major themes: (1) compensation transparency, (2) caregiver support, (3) career development, (4) countering gender bias through education and allyship, (5) fostering psychological safety, and (6) advancing institutional accountability.</p><p><strong>Conclusions: </strong>Division leaders reported gaps in gender equity practices alongside systemic challenges in PHM. Identified priorities include transparent compensation practices, caregiver-inclusive benefits, career pathways, and leadership accountability. As the first national assessment of PHM leaders' perceptions, these findings highlight opportunities to strengthen structural support for gender-equitable advancement for all clinicians.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Cytomegalovirus Testing Following Pennsylvania Hearing-Targeted Screening Legislation.","authors":"Sarah A Coggins, Samuel J Garber, Lori A Christ, Lisa R Drinker, Sagori Mukhopadhyay, Karen M Puopolo","doi":"10.1542/hpeds.2026-009758","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009758","url":null,"abstract":"<p><strong>Background: </strong>Congenital cytomegalovirus infection (cCMV) occurs in approximately 1/200 to 1/250 US newborns each year and can cause progressive sensorineural hearing loss. Since 2022, Pennsylvania law mandates cCMV testing for infants who fail newborn hearing screening.</p><p><strong>Objectives: </strong>To assess changes in cCMV testing rates and diagnosis before and after Pennsylvania hearing-targeted legislation.</p><p><strong>Methods: </strong>Retrospective cohort study of all live births at 3 university-affiliated birth centers. We identified all infants tested for CMV at 21 days of age or younger and analyzed cCMV testing rates in pre- (January 2018-June 2022) and post- (July 2022-December 2024) legislation eras using interrupted time-series analysis. We assessed other clinical signs associated with cCMV testing using standard statistics.</p><p><strong>Results: </strong>The study cohort included 85 324 infants. Among 54 909 born prelegislation, 3168 (5.8%) had cCMV testing; among 30 415 born postlegislation, 3197 (10.5%) were tested. cCMV testing rates increased significantly among term (by 3.2%) and preterm infants (by 15.5%) at the beginning of the postlegislation era (P = .003 and .001, respectively). Among 5224 infants with hearing-based criteria for screening, CMV testing increased from 36.7% prelegislation to 74.0% postlegislation (P < .001). In the postlegislation period, testing associated with isolated microcephaly increased, but isolated small for gestational age-associated testing decreased. Among 61 infants diagnosed with cCMV, 16 (26.2%) were identified based on hearing criteria alone (2.3/1000 infants prelegislation, 6.0/1000 infants postlegislation, P = .04).</p><p><strong>Conclusions: </strong>CMV testing and diagnosis based on hearing criteria alone increased significantly post passage of Pennsylvania hearing-targeted cCMV testing legislation, but infants tested for hearing criteria alone accounted for less than half of identified cCMV cases.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Cytomegalovirus: The Time for a Unified Approach Is Now.","authors":"Elizabeth Goetz, Julie Kessel","doi":"10.1542/hpeds.2026-009887","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009887","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Dr Woods: Telehospitalist Models in Community Hospitals: Physician Coverage is Necessary but not Sufficient.","authors":"Nathan M Money, Annalise Van Meurs, Matthew Steinfeldt","doi":"10.1542/hpeds.2026-009909B","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009909B","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Professional Billing Practices in a Pediatric Hospital Medicine Section.","authors":"Jimin Lee, Hadley Brighton, Nicole E Kelly, Snezana Nena Osorio, Erika McHugh, Erika L Abramson","doi":"10.1542/hpeds.2026-009612","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009612","url":null,"abstract":"<p><strong>Background: </strong>Professional billing translates clinical complexity and physician work into Current Procedural Terminology (CPT) codes and work relative value units (wRVUs), which inform reimbursement and resource planning. Pediatric hospital medicine (PHM) involves complex, cognitive, and time-intensive care, making accurate documentation and code selection essential. Baseline data in our PHM section suggested underuse of appropriate codes, contributing to undercapture of physician work. We aimed to increase wRVUs per patient-day by 25% over 12 months.</p><p><strong>Methods: </strong>We conducted a quality improvement initiative at an academic children's hospital from March 2024 to February 2025. Key drivers were billing knowledge, standardized documentation, workflows, and shared culture around billing. The primary outcome was wRVUs per patient-day; the secondary outcome was professional revenue. Process measures included targeted CPT code use. Balancing measures included coding, denial, or compliance concerns identified by the Revenue and Compliance team. Four Plan-Do-Study-Act cycles tested education, a billing guide, documentation tools, and billing data feedback. Statistical process control charts identified special cause variation.</p><p><strong>Results: </strong>We analyzed 23 772 CPT codes. Mean wRVUs per patient-day increased from 1.9 to 2.5, a 32% increase sustained through December 2025. Professional revenue increased 31% during intervention and 40% during sustainability. Use of level 3 initial inpatient care codes increased from 11% to 58%, level 3 subsequent inpatient care codes from 12% to 54%, and prolonged discharge codes from 13% to 42%. Neonatal intensive care and critical care code use increased. No denial or compliance concerns were identified.</p><p><strong>Conclusions: </strong>A section-wide quality improvement approach improved capture of physician work and professional revenue without billing or compliance concerns.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating OpenEvidence Across Pediatric Subspecialties: A Guideline-Anchored Expert Review.","authors":"R Brandon Hunter, Lauren M Hess, Douglas Wells, Duy M Dinh, Hani Abou Hatab, Mikael C Guzman-Karlsson, Sutapa Khatua, Denver Niles, Bradford Nguyen, Shawki Qasim, Marla Bk Sammer, Ila Singh, Sanjiv Mehta, Andy Tsai, Rajkumar Venkatramani, Jennifer Benjamin","doi":"10.1542/hpeds.2026-009588","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009588","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the quality, safety, and citation characteristics of OpenEvidence across pediatric subspecialties.</p><p><strong>Methods: </strong>Guideline-anchored clinical questions spanning high, moderate, and low evidence certainty across 6 pediatric subspecialties were submitted to OpenEvidence. Expert reviewer pairs independently scored responses using the validated Quality Analysis of Medical Artificial Intelligence (QAMAI) instrument (6-30 range, higher scores indicate better quality) and a modified Agency for Healthcare Research and Quality harm assessment (0-7 range, higher scores indicate more harm), followed by consensus reconciliation. Citation analysis examined overlap with guideline references, claim substantiation, and pediatric specificity. Response consistency was assessed across 5 repeated queries.</p><p><strong>Results: </strong>Seventeen questions were evaluated. The median QAMAI score was 27/30 (IQR, 24-29; \"very good\" quality). Potential harm was low (median 0/7, range 0-3), though 6 of 17 responses carried nonzero harm potential. OpenEvidence cited the primary guideline in 15 of 17 questions, yet only 17.6% of responses showed strong citation overlap (≥75% shared references) with the corresponding guidelines. OpenEvidence's citations reliably supported the claims they accompanied (88.2% with high substantiation), and 70.8% of reviewer assessments rated the evidence base as comparable in quality to that of the corresponding guidelines. In total, 35.3% of responses cited studies lacking pediatric specificity. Responses were clinically consistent across repeated queries (77.9% had no meaningful or only minor variation); no contradictory recommendations were observed.</p><p><strong>Conclusions: </strong>OpenEvidence produced high-quality responses with low expert-rated potential for harm across multiple pediatric subspecialties. The pediatric specificity of cited evidence warrants attention, reflecting the broader challenge of applying artificial intelligence tools that are trained on adult-predominant literature to pediatric populations.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}