Hospital pediatrics最新文献_第10页

Mechanical Ventilation for Children Approaching End of Life: A PHIS Study, 2010-2019. 接近生命终点的儿童机械通气：2010-2019年的一项PHIS研究。

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-007999

Deirdre F Puccetti, Steven J Staffa, Jeffrey P Burns

{"title":"Mechanical Ventilation for Children Approaching End of Life: A PHIS Study, 2010-2019.","authors":"Deirdre F Puccetti, Steven J Staffa, Jeffrey P Burns","doi":"10.1542/hpeds.2024-007999","DOIUrl":"10.1542/hpeds.2024-007999","url":null,"abstract":"Objective: To determine the prevalence of invasive and noninvasive mechanical ventilation (IMV and NIV) for children who die in the hospital, to assess for change over time, and to determine the association between mode(s) of ventilation and hospital resource utilization.Methods: Multicenter retrospective cohort of 37 children's hospitals in the United States participating in Pediatric Health Information Systems Database. Included 41 091 hospitalizations for patients 0 to 21 years who died in hospital January 2010 to December 2019. Univariate and multivariate logistic regression examined IMV and NIV use clustered by hospital, adjusting for demographic and clinical characteristics. χ2, Kruskal-Wallis tests and multivariable regression models measured associations between mode of ventilation and resource utilization.Results: Over the decade, the percentage exposed to any IMV remained unchanged (∼88.5%), whereas any NIV increased 7.1% (18.8% to 25.9%), with wide interhospital variability in NIV use. Exposure to both IMV + NIV increased 6.0% (16.8% to 22.8%). Compared with only IMV, only NIV had lower odds of ICU admission and death, shorter ICU length of stay (LOS), similar hospital LOS, and lower costs. Both IMV + NIV had higher odds of ICU admission, longer duration of IMV, lower likelihood of ICU death, longer ICU and hospital LOS, and higher costs than IMV alone.Conclusions: For children who died in the hospital in the past decade, use of NIV has increased without a reciprocal decrease in IMV, because of an increase in exposure to both IMV + NIV, a combination associated with high hospital resource utilization.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":"14 12","pages":"1035-1043"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773316","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}

引用次数: 0

Factors Associated With Nirsevimab Uptake in Healthy Newborns. 健康新生儿吸收 Nirsevimab 的相关因素

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-007986

Elena Aragona, Veronika Shabanova, Jaspreet Loyal

引用次数: 0

Economic Evaluations of Health Care Interventions in Pediatric Hospital Care. 儿科医院医疗保健干预的经济评估。

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-007802

Myla E Moretti, Sanjay Mahant

{"title":"Economic Evaluations of Health Care Interventions in Pediatric Hospital Care.","authors":"Myla E Moretti, Sanjay Mahant","doi":"10.1542/hpeds.2024-007802","DOIUrl":"10.1542/hpeds.2024-007802","url":null,"abstract":"The hospital medicine movement thrives in a health care environment committed to providing high-quality, safe, and value-based care. Hospitalists and hospitals continually grapple with many decisions regarding adopting new interventions and deadopting established ones. These decisions span the gamut from tests, treatments, and supportive care, to care models. Traditionally, the choice to adopt one intervention over another is commonly thought of in terms of its direct impact on patient outcomes, benefits, and harms. However, the evolving landscape of health care, characterized by increasing constraints on resources necessitates a broader perspective, one that includes a thorough consideration of the economic implications. The goal is not to minimize costs but rather to maximize value, outcomes achieved for money spent. Economic evaluations of health care interventions can provide this information by quantifying value and assisting health care providers, hospitals, and health systems in deciding which intervention to adopt. Economic evaluations deal with both inputs (ie, costs) and outputs (ie, consequences). Few economic evaluations in pediatric hospital medicine have been published, and many clinicians are unfamiliar with them. This paper discusses the economic evaluation of health care interventions with special attention to the pediatric hospitalist and hospital care. The paper aims to give readers an understanding of the key concepts underlying economic evaluations.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e536-e541"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591951","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}

引用次数: 0

Quality Improvement to Identify and Address Food Insecurity During Pediatric Hospitalizations. 提高质量，识别并解决儿科住院期间的食物不安全问题。

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-007926

Cristin Q Fritz, Gabrielle C Lyons, Amber R Monaghan, Joseph R Starnes, Sarah Hart, Caroline B Khanna, David P Johnson

{"title":"Quality Improvement to Identify and Address Food Insecurity During Pediatric Hospitalizations.","authors":"Cristin Q Fritz, Gabrielle C Lyons, Amber R Monaghan, Joseph R Starnes, Sarah Hart, Caroline B Khanna, David P Johnson","doi":"10.1542/hpeds.2024-007926","DOIUrl":"10.1542/hpeds.2024-007926","url":null,"abstract":"Objectives: Hospitalized children represent a vulnerable population with high rates of unidentified food insecurity (FI). We aimed to improve FI screening for eligible families from 0% to 60%. Secondarily, we sought to provide location-based food resources to families that screened positive.Methods: In February 2021, we developed a multidisciplinary team and used the Model for Improvement to improve routine FI screening for eligible children on 1 inpatient unit at a single institution. Our primary measure was the overall percentage of eligible families screened for FI. Our secondary measure was the percentage of families with FI who received food resource information. Statistical process control charts were used to analyze the impact of our interventions.Results: A total of 8850 families were eligible for screening during the project period. The percentage of eligible families screened for FI increased from 0 to a mean of 77%, exceeding our goal, with special cause variation noted by 5 centerline shifts. The most impactful interventions were expansion of screening to patients admitted to all services and making FI screening questions required nursing admission documentation. Eleven percent of families screened positive for FI. Provision of resources increased from 56% with manual resource insertion into the after-visit summary to 100% with special cause variation associated with automated resource provision for positive screens.Conclusions: Integrating FI screening into the nursing admission workflow with automated resource provision for positive screens is a feasible approach to integrating FI screening into routine clinical practice during pediatric hospitalizations.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"963-972"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Testing and Treatment Thresholds for Pediatric Pneumonia in the Emergency Department. 急诊科小儿肺炎的检测和治疗阈值。

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-007848

Alexandra T Geanacopoulos, James R Rudloff, Sriram Ramgopal, Mark I Neuman, Michael C Monuteaux, Susan C Lipsett, Todd A Florin

{"title":"Testing and Treatment Thresholds for Pediatric Pneumonia in the Emergency Department.","authors":"Alexandra T Geanacopoulos, James R Rudloff, Sriram Ramgopal, Mark I Neuman, Michael C Monuteaux, Susan C Lipsett, Todd A Florin","doi":"10.1542/hpeds.2024-007848","DOIUrl":"10.1542/hpeds.2024-007848","url":null,"abstract":"Background: Clinical prediction models for pediatric community-acquired pneumonia (CAP) may standardize management. Understanding physician risk thresholds is important for model implementation. We aimed to elucidate physician-derived thresholds for chest radiograph performance and empirical antibiotic treatment of CAP among children presenting to the emergency department with respiratory illness before and after knowledge of results of a validated clinical prediction model.Methods: Pediatric emergency physicians were surveyed through the American Academy of Pediatrics Pediatric Emergency Medicine Collaborative Research Committee and provided 8 clinical vignettes for children with respiratory symptoms. Respondents were asked to indicate their probability of radiographic CAP and choose whether they would obtain a chest radiograph or give empirical antibiotics before and after being provided with the probability of radiographic CAP based on a validated prediction model. We used logistic regression to establish testing and treatment thresholds, defined as the disease probability at which half of physicians acted.Results: Two-hundred and eight (44.3%) of 469 physicians completed the survey. Most were attending physicians (96.0%) practicing in a freestanding children's hospital (76.8%). Testing and treatment thresholds for CAP were 17.6% (95% confidence interval [CI] 16.4% to 18.8%) and 66.1% (95% CI 60.1% to 72.5%), respectively, before knowledge of the model-estimated probability. With knowledge of the prediction model, testing and treatment thresholds were 13.5% (95% CI 12.3% to 14.7%) and 58.0% (95% CI 53.2-62.8).Conclusions: We elucidated physician thresholds for testing and treatment of CAP, which may be integrated into future pneumonia risk models to improve acceptability and incorporation into practice.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"992-1000"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatric Hospital Utilization During Medical Stabilization for Patients With Eating Disorders. 饮食失调症患者在医疗稳定期的儿科住院率。

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-007874

Carly E Milliren, McGreggor Crowley, Rebecca S Zhang, Elana M Bern, Tracy K Richmond

{"title":"Pediatric Hospital Utilization During Medical Stabilization for Patients With Eating Disorders.","authors":"Carly E Milliren, McGreggor Crowley, Rebecca S Zhang, Elana M Bern, Tracy K Richmond","doi":"10.1542/hpeds.2024-007874","DOIUrl":"10.1542/hpeds.2024-007874","url":null,"abstract":"Background and objective: Few studies have examined pediatric hospital utilization across the spectrum of eating disorder (ED) diagnoses among hospitalized patients. We describe sociodemographic and clinical characteristics, hospital utilization, and enteral tube feeding and examine factors associated with hospital utilization among patients with EDs.Methods: Using data from the Pediatric Health Information System, we included patients aged 4 to 20 years with primary ED diagnoses hospitalized from 2018 to 2022. We examined sociodemographic factors, length of stay, costs, and enteral tube feeding by ED diagnosis. Adjusted regression models compared hospital utilization by diagnosis, adjusting for sociodemographic and clinical factors.Results: Among N = 10 279 hospitalizations from 49 hospitals, anorexia nervosa (AN) was most common (70.9%), followed by avoidant restrictive food intake disorder (ARFID) (15.6%). Mean age was 15.1 years (SD = 2.5), and most were female (86.6%), of white non-Hispanic race (70.9%), with private insurance (70.1%), with 63.9% occurring after the coronavirus disease 2019 pandemic onset. Median (interquartile range) length of stay was 8.0 days (7.0), and hospital costs were $18 099 ($15 592). A total of 18.8% received enteral tube feeding, with significant hospital variation. In adjusted models, compared with AN, ARFID, binge disorders, and unspecified feeding and ED had shorter stays, whereas hospital costs were lower for binge disorders, and enteral feeding was more likely for ARFID.Conclusions: Our findings indicate long and costly hospitalizations, especially for AN, with implications for hospital and treatment capacity, highlighting the need for earlier diagnosis and treatment to prevent the need for hospitalization.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"982-991"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576845","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}

引用次数: 0

Extravasation Identification and Management in Neonates and Pediatrics: A Cross Sectional Survey. 新生儿和儿科外渗的识别与处理：横断面调查

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2023-007698

Linda N Nguyen, Mari Takashima, Jacqueline Cunninghame, Deanne August, Amanda Ullman

{"title":"Extravasation Identification and Management in Neonates and Pediatrics: A Cross Sectional Survey.","authors":"Linda N Nguyen, Mari Takashima, Jacqueline Cunninghame, Deanne August, Amanda Ullman","doi":"10.1542/hpeds.2023-007698","DOIUrl":"10.1542/hpeds.2023-007698","url":null,"abstract":"Objective: To explore current practice and guidelines surrounding the identification and management of extravasation injuries in Australian and New Zealand neonatal and pediatric settings.Methods: Between February and September 2023, an internet-based descriptive cross-sectional survey was distributed to Australian and New Zealand neonatal and pediatric clinicians using exponential nondiscriminative snowball sampling. Survey data domains included demographics, extravasation identification, management, local guidelines, and resources.Results: Of the 141 responses, the majority of respondents were registered nurses (n = 96, 68.1%), with greater than 20 years of experience (n = 51, 36.2%). Over two-thirds of respondents had no extravasation identification and management training (n = 98, 69.5%). Half of the respondents (n = 70, 49.6%) reported that increased presentation of risk factors did not alter monitoring frequency. Extravasations were primarily associated with the hand and wrist region (n = 118, 43.7%). Maintenance fluids, antibiotics and parenteral nutrition accounted for extravasation events. Acute management practices (immediate cessation of infusion) showed consistency (n = 124, 87.9%), whereas varying degrees of adoption were observed for aspirating the residual fluid. The majority of respondents (n = 119, 84%) reported the absence of a formal grading scale for extravasation severity.Conclusions: Clinicians reported challenges and inconsistencies in neonatal and pediatric extravasation injury identification and management. This underscores the need for effective monitoring and identification, standardized management practices, and education to minimize the burdens of extravasation for patients, families, and the health care system.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"1026-1034"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629984","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}

引用次数: 0

Progress and Potential: Addressing Food Insecurity in Caregivers of Hospitalized Children. 进步与潜力：解决住院儿童看护者的粮食不安全问题。

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-008061

Michael Lugo, Meghan Fanta, Anita Shah

引用次数: 0

Developing Educational Programs: Insights From a Night Curriculum Initiative. 制定教育计划：夜间课程计划的启示。

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-008121

Marta King, Annie Suydam

引用次数: 0

Nirsevimab Administration During the Birth Hospitalization. 分娩住院期间使用 Nirsevimab。

Hospital pediatrics Pub Date : 2024-12-01 DOI: 10.1542/hpeds.2024-007911

Shayda Daneshvari, Philip Lee, Sheri L Nemerofsky

引用次数: 0