Hospital pediatrics最新文献_第2页

The Complex Impact of Health Literacy Among Parents of Children With Medical Complexity. 医疗知识对复杂病症患儿家长的复杂影响。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2024-008003

Aline V Desmarais, Katharine Kevill, Alexander F Glick

引用次数: 0

Clinician Perspectives on Decision Support and AI-based Decision Support in a Pediatric ED. 儿科急诊室临床医生对决策支持和基于人工智能的决策支持的看法。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2023-007653

Sriram Ramgopal, Michelle L Macy, Ashley Hayes, Todd A Florin, Michael S Carroll, Anisha Kshetrapal

{"title":"Clinician Perspectives on Decision Support and AI-based Decision Support in a Pediatric ED.","authors":"Sriram Ramgopal, Michelle L Macy, Ashley Hayes, Todd A Florin, Michael S Carroll, Anisha Kshetrapal","doi":"10.1542/hpeds.2023-007653","DOIUrl":"https://doi.org/10.1542/hpeds.2023-007653","url":null,"abstract":"Background: Clinical decision support (CDS) systems offer the potential to improve pediatric care through enhanced test ordering, prescribing, and standardization of care. Its augmentation with artificial intelligence (AI-CDS) may help address current limitations with CDS implementation regarding alarm fatigue and accuracy of recommendations. We sought to evaluate strengths and perceptions of CDS, with a focus on AI-CDS, through semistructured interviews of clinician partners.Methods: We conducted a qualitative study using semistructured interviews of physicians, nurse practitioners, and nurses at a single quaternary-care pediatric emergency department to evaluate clinician perceptions of CDS and AI-CDS. We used reflexive thematic analysis to identify themes and purposive sampling to complete recruitment with the goal of reaching theoretical sufficiency.Results: We interviewed 20 clinicians. Participants demonstrated a variable understanding of CDS and AI, with some lacking a clear definition. Most recognized the potential benefits of AI-CDS in clinical contexts, such as data summarization and interpretation. Identified themes included the potential of AI-CDS to improve diagnostic accuracy, standardize care, and improve efficiency, while also providing educational benefits to clinicians. Participants raised concerns about the ability of AI-based tools to appreciate nuanced pediatric care, accurately interpret data, and about tensions between AI recommendations and clinician autonomy.Conclusions: AI-CDS tools have a promising role in pediatric emergency medicine but require careful integration to address clinicians' concerns about autonomy, nuance recognition, and interpretability. A collaborative approach to development and implementation, informed by clinicians' insights and perspectives, will be pivotal for their successful adoption and efficacy in improving patient care.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355872","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

Potential Bias in Social Work Consultations in the Pediatric Inpatient Setting. 儿科住院环境中社工咨询的潜在偏差。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2023-007637

Natalie R Segev, Meghan L Fanta, Stacey Litman, Andrew F Beck, Ndidi I Unaka

{"title":"Potential Bias in Social Work Consultations in the Pediatric Inpatient Setting.","authors":"Natalie R Segev, Meghan L Fanta, Stacey Litman, Andrew F Beck, Ndidi I Unaka","doi":"10.1542/hpeds.2023-007637","DOIUrl":"10.1542/hpeds.2023-007637","url":null,"abstract":"Background and objectives: Failure to thrive, brief resolved unexplained event, accidental ingestion, and drowning admissions commonly involve social work (SW) consultation. Care team biases likely influence SW consultation decisions. We examined whether SW consultations varied by patient race for these diagnoses.Methods: We conducted a retrospective cohort study of children <6 years of age admitted for failure to thrive, brief resolved unexplained event, accidental ingestion, and drowning between July 1, 2012 and June 30, 2020 at a single, academic, standalone children's hospital in an urban environment. The outcome was SW consultation; the predictor was patient race. We used multivariable logistic regression, adjusting for ethnicity, language, insurance, and diagnosis. We completed a supplemental chart review of a random sample of 10% of patients with SW consultation to determine the reasons that consultations were placed.Results: We included 1199 unique patients; 64% identified as white, and 22% identified as Black. Black patients had 1.61 times higher adjusted odds of SW consultation compared with white patients (95% confidence interval 1.14-2.29). Publicly insured, compared with privately insured, patients had 6.10 times higher adjusted odds of SW consultation (95% confidence interval 4.28-8.80). Upon supplemental chart review, Black patients had SW consultations that focused more often on abuse, neglect, and safety; this was also found for publicly insured patients. There was parity in consultation for resource needs across groups.Conclusions: Black children were more likely than white children to receive SW consultation during hospitalization, as were publicly insured children compared with their privately insured peers; in supplemental review, this was not due to differences in consultations for resource needs. The standardization of SW consultation may promote equitable care.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120822","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

Are Child Access Prevention Laws Associated With Fewer Pediatric Firearm Injuries? 防止儿童接触枪支法是否会减少儿童枪支伤害？

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2022-007057

Emily G Wilson, Mathew J Gregoski, Elizabeth R Oddo, William R Barfield, Matthew A Dow, Robert F Murphy, Sara S Van Nortwick

{"title":"Are Child Access Prevention Laws Associated With Fewer Pediatric Firearm Injuries?","authors":"Emily G Wilson, Mathew J Gregoski, Elizabeth R Oddo, William R Barfield, Matthew A Dow, Robert F Murphy, Sara S Van Nortwick","doi":"10.1542/hpeds.2022-007057","DOIUrl":"10.1542/hpeds.2022-007057","url":null,"abstract":"Objective: Firearm injuries are the leading cause of death for children in the United States. Child access prevention (CAP) laws have been passed in some states. This study examines characteristics of children with firearm injuries in states with different types of CAP laws.Methods: The Pediatric Health Information System database was reviewed to identify all pediatric firearm injury patients between 2016 and 2021. Hospital data were categorized based on state laws as (1) no CAP laws (2) some CAP laws or (3) strict CAP laws. CAP laws that specifically outlined criminal liability for the negligent storage of firearms were considered a strict restriction, whereas any other form of CAP law was considered some restriction. χ-squared and independent-samples median testing were performed to compare restriction levels.Results: Between 2016 and 2021, 12 853 firearm injuries were recorded in the Pediatric Health Information System database. In states with strict CAP laws, patients were significantly older (P < .001) and had a significantly higher household income (P < .001) compared with patients in states with no CAP laws. Gender, race, and the number of firearm injuries differed between the 3 restriction levels. There were less firearm injuries observed than expected in cities with strict CAP laws.Conclusions: CAP laws are associated with a higher age and household income of pediatric firearm injury patients. Given the disparities seen between cities, a federal CAP law may best protect children nationwide.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11422673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126797","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

Partnering With Patients and Families to Champion Deimplementation and Reduce Low-Value Care. 与患者和家属合作，倡导去执行化，减少低价值护理。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2024-007917

Melanie Buba, Carsten Krueger, Peter J Gill

引用次数: 0

Pre- and Post-admission Care for Children Hospitalized With Skin and Soft Tissue Infections. 为皮肤和软组织感染住院儿童提供入院前和入院后护理。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2023-007621

Lisa Rickey, Matt Hall, Jay G Berry

{"title":"Pre- and Post-admission Care for Children Hospitalized With Skin and Soft Tissue Infections.","authors":"Lisa Rickey, Matt Hall, Jay G Berry","doi":"10.1542/hpeds.2023-007621","DOIUrl":"10.1542/hpeds.2023-007621","url":null,"abstract":"Background and objectives: Although skin and soft tissue infections (SSTIs) are among the most common indications for pediatric hospitalization, little is known about outpatient care received for SSTI before and after hospitalization. We assessed peri-hospitalization care for SSTI, including antibiotic exposures and their impact on hospital length of stay (LOS).Methods: This is a retrospective cohort study of 1229 SSTI hospitalizations in 2019 from children aged 1-to-18 years enrolled in Medicaid from 10 US states included in the Merative Marketscan Medicaid database. We characterized health service utilization (outpatient visits, laboratory and diagnostic tests, antibiotic exposures) 14 days before and 30 days after hospitalization and evaluated the effects of pre-hospitalization care on hospital LOS with linear regression.Results: Only 43.1% of children hospitalized with SSTI had a preceding outpatient visit with a SSTI diagnosis, 69.8% of which also filled prescription for an antibiotic. Median LOS for SSTI admission was 2 days (interquartile range 1-3). Pre-hospitalization visits with a diagnosis of SSTI were associated with a 0.7 day reduction (95% confidence interval: 0.6-0.81) in LOS (P < .001), but pre-hospital antibiotic exposure alone had no effect on LOS. Most children (81.7%) filled antibiotic prescriptions after hospital discharge and 74.5% had post-discharge ambulatory visits.Conclusions: Although most children did not receive pre-admission care for SSTI, those that did had a shorter hospitalization. Further investigation is necessary on how to optimize access and use of outpatient care for SSTI.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297540","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

Improving Antibiotic Use in Pediatric Preseptal Cellulitis Using a Clinical Practice Guideline. 利用《临床实践指南》改善小儿隐窝前蜂窝织炎的抗生素使用。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2023-007581

Brennen J Cooper, Michelle L Mitchell, Svetlana Melamed, Melodee Liegl, Amy Y Pan, Alina G Burek

{"title":"Improving Antibiotic Use in Pediatric Preseptal Cellulitis Using a Clinical Practice Guideline.","authors":"Brennen J Cooper, Michelle L Mitchell, Svetlana Melamed, Melodee Liegl, Amy Y Pan, Alina G Burek","doi":"10.1542/hpeds.2023-007581","DOIUrl":"10.1542/hpeds.2023-007581","url":null,"abstract":"Objectives: The purpose of this study was to evaluate the impact of a clinical practice guideline (CPG) on antibiotic use and resource utilization for pediatric preseptal cellulitis.Methods: This retrospective quasiexperimental study included patients between the age of 2 months and 17 years admitted for preseptal cellulitis between January 2013 and December 2023. The preseptal cellulitis CPG was implemented in December 2020 using a multifaceted strategy that included buy-in from key stakeholders, education of frontline providers, the official CPG launch, and stakeholder check-ins. The primary outcome was the use of broad-spectrum antibiotics, including dual/triple therapy and methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics. The secondary outcome was resource utilization including blood testing and imaging. Outcomes were compared pre- and post-CPG implementation using the Fisher exact test and logistic regressions.Results: Of 236 patients meeting inclusion criteria, 175 and 61 patients composed the pre- and post-CPG cohorts, respectively. Median age (interquartile range) was 4.0 (1.8-8.3) years and 46% of the population were female. Post-CPG implementation changes in empirical antibiotic use included decreases in broad-spectrum use from 100% to 66% (P < .001), dual/triple therapy from 47% to 16% (P < .001), and MRSA active agents from 86% to 26% (P < .001). There was a decrease in complete blood count and blood culture orders from 75% to 57% (P = .014) and 32% to 18% (P = .047), respectively.Conclusions: Use of broad-spectrum antibiotics, including dual/triple therapy and MRSA active antibiotics for the treatment of pediatric preseptal cellulitis, decreased after CPG implementation.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156186","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

A Logic Model Approach to Trauma-Informed Care. 创伤知情护理的逻辑模型方法。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2024-007832

Pratima R Shanbhag, Sarah Zawaly, Elizabeth Lanphier, Anita Shah

引用次数: 0

Predictors of Abnormal Renal Ultrasonography in Children With Urinary Tract Infection. 尿路感染儿童肾脏超声波检查异常的预测因素

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2023-007557

Catharine Leahy, Keith A Hanson, Janki Desai, Alvaro Alvarez, Shane C Rainey

{"title":"Predictors of Abnormal Renal Ultrasonography in Children With Urinary Tract Infection.","authors":"Catharine Leahy, Keith A Hanson, Janki Desai, Alvaro Alvarez, Shane C Rainey","doi":"10.1542/hpeds.2023-007557","DOIUrl":"10.1542/hpeds.2023-007557","url":null,"abstract":"Background and objectives: The 2011 American Academy of Pediatrics guidelines recommended a renal and bladder ultrasound (RBUS) after the first febrile urinary tract infection (UTI) in infants. Abnormal RBUS findings may be due to inflammation from the acute UTI or from vesicoureteral reflux (VUR), which may require a voiding cystourethrogram (VCUG) to diagnose, increasing health care costs. Our objective was to evaluate the effect of timing of imaging relative to the acute illness on abnormal dilation on RBUS and VCUG findings.Methods: Multicenter, retrospective study of patients aged 2 to 24 months presenting with first UTI and RBUS from January 1, 2015, to December 31, 2019. Demographics, isolated pathogen, and timing of RBUS and VCUG relative to urine culture date were recorded and compared.Results: A total of 227 patients were included. On multivariable logistic regression, increased time in days to RBUS was associated with decreased odds of abnormal dilation (adjusted odds ratio, 0.980; P = .018) in those patients meeting culture criteria for UTI (for each additional day of delay in obtaining RBUS, the adjusted odds of detecting dilation decreased by ∼2%). There was no significant association between timing of imaging and VUR on VCUG. Additionally, 32% of patients underwent RBUS who did not meet UTI culture criteria but had similar rates of abnormal dilation and VUR to those meeting UTI culture criteria.Conclusions: Increased time to RBUS led to decreased odds of abnormal dilation, suggesting that delaying RBUS may lead to fewer false-positive results, which may limit unnecessary additional testing and reduce health care costs. Additionally, a significant number of patients who did not meet UTI culture criteria underwent RBUS but had similar results to those meeting criteria, suggesting that the previous colony-forming unit definition for UTI may be suboptimal.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141319","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

Procalcitonin Use After Clinical Practice Guideline and QI Intervention for Febrile Infants. 发热婴儿临床实践指南和 QI 干预后的降钙素使用情况。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2024-007906

Alaina Shine, Mersine Bryan, Marshall Brown, Paul L Aronson, Corrie E McDaniel

引用次数: 0