Hospital pediatrics最新文献_第3页

Creation to Dissemination: A Roadmap for Health Equity Research. 从创作到传播：健康公平研究路线图》。

Hospital pediatrics Pub Date : 2024-10-01 DOI: 10.1542/hpeds.2024-007759

Michelle J White, Kristina Nazareth-Pidgeon, Mikelle Key-Solle, Abby Nerlinger, Victoria Parente

{"title":"Creation to Dissemination: A Roadmap for Health Equity Research.","authors":"Michelle J White, Kristina Nazareth-Pidgeon, Mikelle Key-Solle, Abby Nerlinger, Victoria Parente","doi":"10.1542/hpeds.2024-007759","DOIUrl":"10.1542/hpeds.2024-007759","url":null,"abstract":"Health equity is the point at which all individuals have an equal opportunity to experience optimal health and thriving. The current state of health care is far from this ideal as numerous populations experience health disparities: differences in health or health outcomes that negatively impact groups who experience systemic disadvantage. All research has the potential to widen, maintain, or close health disparities. This article focuses on key opportunities for hospitalists of all levels of research experience to conduct research that promotes health equity from project planning to disseminating results. During the planning phase, learning health equity research concepts, developing study designs in partnership with communities, and recognizing the limitations of secondary analyses are key strategies that promote health equity. Developing strategies for recruiting populations underrepresented in research helps ensure that disparities in health outcomes are identified. Rather than conducting descriptive research to identify disparities, research which aims to improve health outcomes for groups that have been marginalized is urgently needed. Study analyses should consider intersectionality and patient-centered outcomes. Finally, dissemination to both academic and community audiences, with careful attention to words and figures, can catalyze future directions, mitigate bias, and help ensure that marginalized communities benefit equitably from research findings.","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/PMC11422674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297535","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

Validation of Patients' Race, Ethnicity, and Language Data in a Pediatric Emergency Department. 验证儿科急诊室患者的种族、民族和语言数据。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2024-007774

Adam DeLong, Joan Bregstein, Danielle Steinberg, Gabriel Apfel, Sandhya S Brachio, Katherine R Schlosser Metitiri, Dodi Meyer, Harold Pincus, Katherine A Nash

引用次数: 0

Unit-based Pathways to Reduce InequitieS for familiEs speaking languages other than English (UPRISE). 以单位为基础的减少非英语家庭不公平现象的途径（UPRISE）。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2023-007569

Jennie N Magana-Soto, Monica O Ruiz, Daniel S Tawfik, Daniela Rey-Ardila, Alyssa Bonillas, Marina Persoglia-Bell, Felice Su, Kanwaljeet J S Anand

{"title":"Unit-based Pathways to Reduce InequitieS for familiEs speaking languages other than English (UPRISE).","authors":"Jennie N Magana-Soto, Monica O Ruiz, Daniel S Tawfik, Daniela Rey-Ardila, Alyssa Bonillas, Marina Persoglia-Bell, Felice Su, Kanwaljeet J S Anand","doi":"10.1542/hpeds.2023-007569","DOIUrl":"10.1542/hpeds.2023-007569","url":null,"abstract":"Objective: Health care inequities are common among individuals who speak languages other than English (LOE). Within our PICU, LOE families prefer communication via in-person interpreters (IPI). Spanish-speaking patient families are our largest LOE population; therefore, we sought to increase Spanish IPI utilization for medical updates in the PICU.Methods: A quality improvement initiative in a 36-bed PICU included: the addition of a dedicated weekday Spanish-speaking IPI, the creation of communication tools, staff education, optimized identification of LOE families, and development of a language dashboard across multiple Plan, Do, Study, Act cycles. The primary outcome was IPI utilization rates for daily medical updates.Results: Spanish IPI utilization for daily weekday medical updates among 442 Spanish-speaking patient families increased from a median of 39.4% at baseline to a new centerline median of 51.9% during implementation, exhibiting 66.3% (465 of 701) utilization in the final 6 months of implementation. The greatest sustained increases in Spanish IPI utilization occurred after PICU-based IPI implementation, staff education, electronic health record optimization, and a split work week between 2 PICU-based IPIs.Conclusions: This quality improvement initiative increased Spanish IPI utilization for daily weekday medical updates in the PICU across multiple Plan, Do, Study, Act cycles. Future work will adapt these interventions to other languages and other hospital-based units.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009636","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

Characteristics and Outcomes of Home-Ventilated Children Undergoing Noncardiac Surgery. 接受非心脏手术的居家通气儿童的特征和疗效。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2023-007671

Jia Liu, Anna Kordun, Steven J Staffa, Lauren Madoff, Robert J Graham

{"title":"Characteristics and Outcomes of Home-Ventilated Children Undergoing Noncardiac Surgery.","authors":"Jia Liu, Anna Kordun, Steven J Staffa, Lauren Madoff, Robert J Graham","doi":"10.1542/hpeds.2023-007671","DOIUrl":"10.1542/hpeds.2023-007671","url":null,"abstract":"Objectives: To determine the frequency of children with chronic respiratory failure (CRF) and home ventilator dependence undergoing surgery at a tertiary children's hospital, and to describe periprocedural characteristics and outcomes.Methods: We conducted a retrospective cohort study of patients with CRF and home ventilator dependence who underwent noncardiac surgery from January 1, 2013, to December 31, 2019. Descriptive statistics were used to report patient and procedural characteristics. Univariable and multivariable analyses were used to assess for factors associated with 30-day readmission.Results: We identified 416 patients who underwent 1623 procedures. Fifty-one percent of patients used transtracheal mechanical ventilation (trach/vent) support at the time of surgery; this cohort was younger (median age 5.5 vs 10.8 years) and more complex according to American Society of Anesthesiologists status compared with bilevel positive airway pressure-dependent patients. Postoperatively, compared with bilevel positive airway pressure-dependent patients, trach/vent patients were more likely to be admitted to the ICU with longer ICU length of stay (median 5 vs 2 days). Overall 30-day readmission rate was 12% (n = 193). Presence of chronic lung disease (adjusted odds ratio 1.65, 95% confidence interval 1.01-1.69) and trach/vent dependence (adjusted odds ratio 1.65, 95% confidence interval 1.02-2.67) were independently associated with increased odds for readmission.Conclusions: Children with CRF use anesthetic and surgical services frequently and repeatedly. Those with trach/vent dependence have higher hospital and ICU resource utilization. Although overall mortality for these patients is quite low, underlying diagnoses, nuances of technology dependence, and other factors for frequent readmission require further study to optimize resource utilization and outcomes.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019053","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

Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery. 新生儿护理室中新生儿低体温症的管理和临床结果。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2023-007699

Rebecca Dang, Anisha I Patel, Yingjie Weng, Alan R Schroeder, Janelle Aby, Adam Frymoyer

{"title":"Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery.","authors":"Rebecca Dang, Anisha I Patel, Yingjie Weng, Alan R Schroeder, Janelle Aby, Adam Frymoyer","doi":"10.1542/hpeds.2023-007699","DOIUrl":"10.1542/hpeds.2023-007699","url":null,"abstract":"Objectives: Neonatal hypothermia has been shown to be commonly detected among late preterm and term infants. In preterm and very low birth weight infants, hypothermia is associated with increased morbidity and mortality. Little is known about the clinical interventions and outcomes in hypothermic late preterm and term infants. This study fills this gap in the evidence.Methods: Single-center retrospective cohort study using electronic health record data on infants ≥35 weeks' gestation admitted to a newborn nursery from 2015 to 2021. Hypothermia was categorized by severity: none, mild (single episode, 36.0-36.4°C), and moderate or recurrent (<36.0°C and/or 2+ episodes lasting at least 2 hours). Bivariable and multivariable logistic regression examined associations between hypothermia and interventions or outcomes. Stratified analyses by effect modifiers were conducted when appropriate.Results: Among 24 009 infants, 1111 had moderate or recurrent hypothermia. These hypothermic infants had higher odds of NICU transfer (adjusted odds ratio [aOR] 2.10, 95% confidence interval [CI] 1.68-2.60), sepsis evaluation (aOR 2.23, 95% CI 1.73-2.84), and antibiotic use (aOR 1.73, 95% CI 1.15-2.50) than infants without hypothermia. No infants with hypothermia had culture-positive sepsis, and receipt of antibiotics ≥72 hours (surrogate for culture-negative sepsis and/or higher severity of illness) was not more common in hypothermic infants. Hypothermic infants also had higher odds of blood glucose measurement and hypoglycemia, slightly higher percent weight loss, and longer lengths of stay.Conclusions: Late preterm and term infants with hypothermia in the nursery have potentially unnecessary increased resource utilization. Evidence-based and value-driven approaches to hypothermia in this population are needed.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976902","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

The Impact of Visitor Identification Policies on Hospitalized Children and Families. 访客身份识别政策对住院儿童和家庭的影响。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2024-007909

Rachel Jon Welch, Karla Fredricks, Rachel Marek, Rathi Asaithambi, Marina Masciale

引用次数: 0

Increasing High-Value, Cost-Conscious Care Family Rounding Discussions Via an Educational Rounding Tool. 通过教育性查房工具增加高价值、有成本意识的护理家庭查房讨论。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2023-007628

William Frese, Jessica Ford-Davis, Keith Hanson, Monica Lombardo, Sprina Shen

{"title":"Increasing High-Value, Cost-Conscious Care Family Rounding Discussions Via an Educational Rounding Tool.","authors":"William Frese, Jessica Ford-Davis, Keith Hanson, Monica Lombardo, Sprina Shen","doi":"10.1542/hpeds.2023-007628","DOIUrl":"10.1542/hpeds.2023-007628","url":null,"abstract":"Objectives: Family-centered rounds (FCR) are an important time to engage in high-value, cost-conscious care (HV3C) discussions. However, research suggests HV3C conversations occur in a minority of FCRs. Best-practice support tools can improve provider performance, but no research has evaluated whether an HV3C-focused tool may increase pediatricians' HV3C FCR discussions. This study aimed to assess if an educational and practice-based HV3C Rounding Tool's introduction would increase providers' HV3C FCR performance and competence.Methods: This study involved a hospitalist teaching service at a tertiary-care hospital. Evidence-based HV3C Rounding Tool and Quick Reference interventions were designed for use on FCRs, using a validated tool to measure baseline and postintervention HV3C performance. Underlying family, nursing presence/participation, and other factors' impacts upon HV3C performance were also explored. Anonymous baseline and postintervention surveys compared providers' perceived competence and comfort engaging families in HV3C discussions, as well as the tools' usefulness.Results: Out of the 197 baseline and 157 intervention encounters recorded, the tools respectively increased from 3.8 to 5.8 HV3C performance measures addressed (P < .001), with 80% of performance measures showing significant improvement (P < .002). Aside from family presence for select performance measures, the tools had an independent, significant, positive effect upon HV3C performance. Users generally reported the tools as helpful and easy to use, noting significant increases in faculty role-modeling and trainee competence practicing HV3C.Conclusions: Introduction of HV3C Rounding and Quick Reference tools were generally perceived as helpful and beneficial, resulting in an increase of providers' HV3C discussions and care delivery during FCRs.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917643","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

Opioid Dosing Deviation and Dose Banding Development in Young Hospitalized Children. 住院幼儿阿片类药物剂量偏差和剂量带的发展。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2023-007619

Karina G Phang, Amy E Wahlquist, Genevieve Hayes, Corinne Corrigan, William T Basco, David G Bundy

{"title":"Opioid Dosing Deviation and Dose Banding Development in Young Hospitalized Children.","authors":"Karina G Phang, Amy E Wahlquist, Genevieve Hayes, Corinne Corrigan, William T Basco, David G Bundy","doi":"10.1542/hpeds.2023-007619","DOIUrl":"10.1542/hpeds.2023-007619","url":null,"abstract":"Background and objectives: Individualized, weight-based opioid dosing poses safety risks and contributes to inefficient medication delivery processes. Dose banding is a patient safety strategy to reduce dosing errors through standardized doses based on weight ranges. Study objectives were (1) determine the frequency of dosing deviation from reference ranges of common intravenous (IV) and oral opioid medications, (2) evaluate the differences in dosing deviations by age, and (3) determine the potential reduction in dose variation that could be achieved by dose banding.Methods: We conducted a cross-sectional analysis of hospitalized children ≥2 months to ≤24 months old who received IV morphine, oral methadone, or oral oxycodone at a single center. Dosing was categorized as no dosing deviation (within ±5% of the reference range), negative dosing deviation (>5% below the reference range), or positive dosing deviation (>5% above the reference range). Descriptive and bivariate analyses were conducted.Results: A total of 3361 opioid doses met the inclusion criteria. A total of 2663 (79.2%) had no dosing deviation, 214 (6.3%) demonstrated negative deviations, and 484 (14.4%) demonstrated positive deviations. Dosing deviations were more frequent among subjects ≥2 months to ≤6 months old for oral methadone and oxycodone (P < .0001) and more frequent among older age group for IV morphine (P < .0001). Dose banding has the potential to reduce the number of unique doses prescribed for all medications by 75% while eliminating unintended dosing deviations.Conclusions: A total of 20% of opioid doses prescribed to children ≤24 months of age are outside the recommended ranges. Dose banding represents a promising method for simplifying opioid prescribing in the pediatric inpatient setting.","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082091","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

Values Versus Value in Cost-Conscious Care. 注重成本的护理中的价值与价值之争。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2024-007842

Corrie E McDaniel, Priya N Jain

引用次数: 0

The Evolving Role of the Pediatric Resident Physician in Hospital Clinical Operations. 儿科住院医生在医院临床运作中不断演变的角色。

Hospital pediatrics Pub Date : 2024-09-01 DOI: 10.1542/hpeds.2023-007358

Preston Simmons, Jessica Hart, Samuel Gottlieb, Daniel Hyman, Nicole Washington

引用次数: 0