Hospital pediatrics最新文献

{"title":"Discrimination as a Social Determinant of Health in Transgender and Gender-Expansive Adolescents.","authors":"Sophie Lieberman, Emma Gerstenzang, Anna Kiesnowski, Aditi Vasan","doi":"10.1542/hpeds.2024-008203","DOIUrl":"10.1542/hpeds.2024-008203","url":null,"abstract":"<p><p>Travis, a 17-year-old transgender boy, was admitted to an inpatient general pediatrics service for pyelonephritis and was also found to have severe constipation and weight loss. Detailed history revealed avoidance of eating, drinking, or urinating during daytime hours to avoid bathroom use at school, precipitating his presentation. His case was complicated by discomfort with genitourinary examination and constipation therapies. Through this case, we explore discrimination as a root cause for health disparities and adverse outcomes among transgender and gender-expansive (TGE) youth. We discuss how clinician discomfort, lack of knowledge, and inability to provide trauma-informed care may exacerbate patients' gender dysphoria and contribute to negative experiences with the health care system. We also discuss the minority stress model as a framework to understand health disparities and describe the current federal- and state-level legal landscape with regard to TGE youth and their activities of daily living, including their access to school facilities, participation in athletics, and access to health care. We propose concrete action steps that hospital clinicians and health systems can take to increase access to care and improve health outcomes for TGE youth, with a focus on affirmation, family and clinician support for children, and advocacy.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"693-699"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592539","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":"Implementation Frameworks, Strategies, and Outcomes in Optimizing Central Venous Access Device Practice in Neonates: A Scoping Review.","authors":"Elouise R Comber, Deanne August, Linda N Nguyen, Sabrina de Souza, Amanda Judith Ullman, Joshua Byrnes, Samantha Keogh","doi":"10.1542/hpeds.2024-008248","DOIUrl":"10.1542/hpeds.2024-008248","url":null,"abstract":"<p><strong>Background and objectives: </strong>Central venous access devices (CVADs) are critical for neonatal care, but inconsistent CVAD practices remain a challenge and impact clinical outcomes. This scoping review aimed to determine which implementation frameworks, strategies, and outcomes are reported for neonates with CVADs.</p><p><strong>Methods: </strong>EMBASE, CINAHL (EBSCO), PubMed, Web of Science, and Cochrane Library (CENTRAL) databases were searched. All included studies examined were relevant to study aims, published from 2012 to August 2024, and in English. Two reviewers independently screened each study to determine inclusion eligibility, with a third resolving conflicts. The Mixed Methods Appraisal Tool was used to assess study quality.</p><p><strong>Results: </strong>Of the 2176 studies identified, 44 studies were included, predominantly performed in intensive care units (n = 41; 93%), at a single site (n = 39; 89%), and over a 1- to 5-year period (n = 33; 75%). \"Quality improvement\" was the most popular implementation framework (n = 27; 61%). Implementation strategies commonly cited were health professional education (n = 35; 80%), audits and surveillance (n = 34; 77%), and bundles (n = 29; 66%). Multiple implementation strategies were often used simultaneously (n = 43; 98%), and effectiveness and implementation outcomes were combined (n = 20; 45%). Infection was the most commonly reported outcome (n = 37; 84%), and intervention compliance was reported in 50% of studies (n = 22).</p><p><strong>Conclusions: </strong>Current implementation frameworks for CVAD practice are largely driven by unstructured quality improvement initiatives, focusing on a limited range of strategies for health care professionals. Broader, outcome-focused approaches to implementation research in neonatal CVAD practice have not been completed to date.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e404-e415"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683333","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":"The Evolving PHM Workforce: Shortages and Opportunities.","authors":"Alexandra Kilinsky, Jennifer Reese","doi":"10.1542/hpeds.2025-008420","DOIUrl":"10.1542/hpeds.2025-008420","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e382-e385"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048702","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 Discharge Medication Education: Consideration of Health Literacy and Language.","authors":"Stephanie S Squires, Alaina K Kipps, Sheila Gamuciello, Xiao Chen, Kwai Mak, Whitney Chadwick","doi":"10.1542/hpeds.2024-008092","DOIUrl":"10.1542/hpeds.2024-008092","url":null,"abstract":"<p><strong>Background and objectives: </strong>Medication errors occur frequently to children after recent hospital discharge, with known risk factors of medical complexity, low parental literacy, and parental preferred language other than English (LOE). Focus groups with parents of children with medical complexity at our hospital identified our discharge medication list as needing improvement. Therefore, our team set out to provide a low health literacy, language-concordant discharge medication adherence aid (MAA) to more than 95% of patients discharging from our acute care cardiology unit (ACCU).</p><p><strong>Methods: </strong>We formed a multidisciplinary group and developed an intervention whereby each patient's bedside nurse would generate a low health literacy, language-concordant discharge MAA and assessed the weekly average of patients discharged with an MAA in their preferred language via medical record review as our primary outcome measure, with subset analysis of MAA provision by preferred language to monitor implementation. Statistical process control charts were used to assess the impact of interventions over time.</p><p><strong>Results: </strong>During the intervention, the weekly average of patients discharged with an MAA increased from a baseline of 21% in May 2022 to 75% and was sustained from July 2022 through October 2023. There was comparable percentage of LOE patients (76%; 94 of 123) to English-preferred patients (74%; 459 of 622) who received a discharge MAA.</p><p><strong>Conclusions: </strong>Over a 6-month period, we implemented a language-concordant and patient-friendly MAA for 75% of discharging families from the ACCU. Piloting the intervention first with a small group of nurses improved our success during both the intervention and sustainability period.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e350-e359"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585153","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 Drs Andrist and Laventhal: If It Were That Simple, We Would Have Done It Already: Perspectives From the Sandwich Generation of Inpatient Physicians.","authors":"Robert M Kliegman","doi":"10.1542/hpeds.2025-008622B","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008622B","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":"15 8","pages":"e421"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761679","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":"Insights Into the Pediatric Hospital Medicine Workforce: 2024 Data and Recent Trends for Programs.","authors":"H Barrett Fromme, Kelsey Jackson, Jill A Cook, Krista L Birnie, Sasha Alcon, Elizabeth C Kuhn, Marie Dawlett, Thomas B Mike","doi":"10.1542/hpeds.2025-008335","DOIUrl":"10.1542/hpeds.2025-008335","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to describe the current work models in Pediatric Hospital Medicine (PHM) programs in the United States and compare them with 2021 models.</p><p><strong>Methods: </strong>In 2024, the American Academy of Pediatrics Section on Hospital Medicine (AAP SOHM) conducted a cross-sectional survey of individuals identifying as physician leaders of programs. The survey was adapted from the 2021 SOHM study by the chair and co-chair of the AAP SOHM Workforce Task Force, then it was refined by the University of Chicago Survey Lab and the remaining members of the Task Force. Respondents were recruited through societal membership and listservs. This article reports the responses by PHM division/program leaders. Results, when possible, were compared with those of the 2021 data.</p><p><strong>Results: </strong>A total of 219 leaders completed the survey. They represented diverse program types, including various combinations of program models (university, community, and hybrid). The median number of hours for a 1.0 clinical full-time equivalent (FTE) was 1800, down from 1849 in 2021. Community programs had higher annual hours/FTE (1867 vs 1756 for university-based; P < .001) and more in-house night coverage. Approximately 40% of programs provided an incentive for less-desirable shifts. Only 4.9% of programs require PHM certification/eligibility for employment. Most (67.6%) report a staffing shortage. Respondents' concerns about the future of the field included salary, night coverage, and the Accreditation Council for Graduate Medical Education residency curriculum changes.</p><p><strong>Conclusion: </strong>Total annual hours are stable to decreasing, and most programs do not require board certification/board eligibility for employment. Notable differences remain for hours/year by site type, and undesirable shifts are not consistently incentivized.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"623-629"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049019","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":"Caregiver-Perceived Determinants of Asthma Morbidity in Early Childhood: A Qualitative Study.","authors":"Jordan Tyris, Kavita Parikh","doi":"10.1542/hpeds.2024-008252","DOIUrl":"10.1542/hpeds.2024-008252","url":null,"abstract":"<p><strong>Background: </strong>Social determinants of health are linked to asthma health inequities starting in early childhood. We sought to contextualize this quantitative evidence by characterizing caregiver-perceived determinants of asthma morbidity among young children.</p><p><strong>Methods: </strong>Caregivers of children aged less than 5 years hospitalized with asthma participated in semi-structured interviews. The Asthma and Allergy Foundation of America (AAFA) health disparities framework incorporates 10 determinants that informed interview guide development, spanning upstream (racism/discrimination, policies/governance, culture, economic stability, education) to downstream (physical environment, social environment, health care services, individual behaviors, genes/biology). Asthma providers were interviewed for triangulation. Interviews were analyzed using content analysis, and themes were organized by AAFA determinants.</p><p><strong>Results: </strong>25 caregivers and 6 providers were interviewed. Children had a median age of 3 years (interquartile range, 2-4 years), were often male (n = 18; 72%), and frequently experienced adverse community-level social determinants of health (n = 14; 60%). Four themes were identified: (1) uncertainty if children aged less than 5 years with asthma symptoms have asthma; (2) downstream determinants including asthma knowledge and access to asthma care, caregivers' behaviors, children's environments, and family history of asthma/atopy are relevant to children's asthma morbidity; (3) upstream, structural determinants are often considered irrelevant to children's asthma morbidity; and (4) asthma impacts families' socioeconomic potential and quality of life.</p><p><strong>Conclusion: </strong>Caregivers perceived downstream determinants (health care, environment, individual behaviors) as key contributors to young children's asthma morbidity and raised the uncertainty with diagnosing asthma in early childhood. Standardizing the diagnosis of asthma and improving access to guideline-based asthma care may be one family-centered approach to optimizing asthma health equity in early childhood.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e360-e370"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676014","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":"Population-Level Changes in Infant Outcomes Associated With State \"Eat Sleep Console\" Initiative.","authors":"Lijing Ouyang, Munish Gupta, Shanna Cox, Wanda Barfield, Jean Y Ko, Lisa Pollack, Jiajia Chen, Tiffany Riehle-Colarusso, Elisha M Wachman, Hafsatou Diop","doi":"10.1542/hpeds.2024-008258","DOIUrl":"10.1542/hpeds.2024-008258","url":null,"abstract":"<p><strong>Objective: </strong>Massachusetts implemented the \"Eat, Sleep, Console\" (ESC) initiative to manage neonatal abstinence syndrome (NAS) through its state Perinatal-Neonatal Quality Improvement Network (PNQIN) starting in 2017. This study examined the population-level changes in infant outcomes associated with the implementation of the initiative.</p><p><strong>Methods: </strong>We used Massachusetts' Pregnancy to Early Life Longitudinal (PELL) Data System, a population-based data system linking live birth certificates and fetal death records to corresponding hospital discharge records for birthing women and infants over time. Our study included full-term, normal-weight singletons with NAS, based on recorded diagnosis codes, born in Massachusetts from 2012 to 2019. Interrupted time-series analysis assessed the changes in birth hospitalization length of stay (LOS) and costs, as well as monthly rates of 30-, 60- and 90-day infant readmissions before (2012-2016) and after (2018-2019) initiative implementation. Analyses were conducted in 2024.</p><p><strong>Results: </strong>We identified 5857 infants with NAS; the majority were non-Hispanic white (85.2%) and were covered by public insurance (89.7%). Implementation of the initiative was associated with decreased average total cost of birth hospitalizations (-$5763, 95% CI = -$9705, -$1820). Although not significantly associated with initiative implementation, there was a downward trend in LOS during both the pre-initiative and post-initiative periods. No significant difference was found in infant readmissions.</p><p><strong>Conclusions: </strong>Implementation of the ESC initiative was associated with a population-level decrease in the average total cost of birth hospitalizations for infants with NAS. Future research may explore the drivers of cost reductions and assess differences by demographic subgroups.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e371-e376"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733719","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":"An Organizational Psychology Approach to Understanding Overuse in Pediatric Hospital Medicine.","authors":"Lyubina Yankova, Monisha Sachdev, Nirali Butala, Alexa Allotta, Rachel Osborn, David Berg, Jaspreet Loyal","doi":"10.1542/hpeds.2025-008340","DOIUrl":"10.1542/hpeds.2025-008340","url":null,"abstract":"<p><strong>Background: </strong>Medical overuse in pediatrics is estimated to cost $27 million yearly and carries physical and emotional harms. Despite guidelines promoting high-value care, practice has changed minimally, and studies have focused on individual behaviors. We aimed to learn the perspectives of pediatric hospitalists on overuse and apply an organizational psychology framework as a novel way of understanding this issue.</p><p><strong>Methods: </strong>This was a qualitative study interviewing pediatric hospitalists at 2 sites. Interviews were conducted until thematic saturation was reached. Transcripts were coded using grounded-theory methodology and themes were identified. An organizational psychologist reviewed emerging themes and recommended applying the levels of analysis framework, a method for diagnosing institutional issues by examining group and system factors.</p><p><strong>Results: </strong>There were 16 study participants (69% female, 31% male). The following themes influenced physicians toward overuse: (1) at the individual level, fear and risk-aversion, particularly among early-career faculty; (2) at the interpersonal level, the emphasis on maintaining positive interactions and relationships with other clinicians; (3) at the group level, the desire to align with peers; (4) at the intergroup level, using previous interactions with members of a group (such as parents and consultants) to inform the contemporary dynamic; and (5) at the system level, institutional factors and competing priorities, such as patient throughput demands and a focus on errors of omission.</p><p><strong>Conclusions: </strong>Overuse is driven by influence of the individual's membership within a group or system and their interactions with other groups. Interventions should target complex group dynamics and systems pressures contributing to overuse.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"676-685"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555253","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":"Point-of-Care Ultrasound in Pediatric Hospital Medicine: A National Survey.","authors":"Kevin Weinberger, Mary Esther M Rocha, Colleen Keough, Shelley Kumar, Ricardo Quinonez, Erik Su, Adam Cohen","doi":"10.1542/hpeds.2024-008287","DOIUrl":"10.1542/hpeds.2024-008287","url":null,"abstract":"<p><strong>Objective: </strong>To assess the current use, barriers, facilitators, and clinical applications of point-of-care ultrasonography (POCUS) within pediatric hospital medicine (PHM) groups across the United States, aiming to identify opportunities for broader implementation.</p><p><strong>Methods: </strong>Using the Pediatric Research in Inpatient Setting (PRIS) Network, we conducted an anonymous, multicenter, cross-sectional survey targeting PHM groups in both academic children's hospitals and community settings. Descriptive and inferential statistics were used to identify the proportion of PHM divisions using POCUS, the associated characteristics of these groups, their current POCUS applications, and the barriers and facilitators for POCUS implementation.</p><p><strong>Results: </strong>Of the 97 sites surveyed, 56% (n = 54) responded. Of these, 17% (n = 9) reported having a POCUS program. There was no significant difference in POCUS implementation among PHM divisions concerning geographic location, practice setting, number of beds, or faculty. Programs utilizing POCUS identified the following as principle uses: diagnosis of pleural effusions, pneumonia, pericardial effusions, bladder volume, and skin and soft tissue infections and performance of lumbar punctures. Among PHM groups with a POCUS program, 100% had a trained POCUS leader, 78% had dedicated equipment for their division, and 67% had available institutional training for their PHM group. The top barriers identified by PHM groups without a POCUS program included a lack of local POCUS experts, lack of equipment, and cost of equipment.</p><p><strong>Conclusion: </strong>In 2024, more than 1 in 6 PHM divisions responding to this survey actively incorporated POCUS in the care of patients. These applications are diverse and applicable across common inpatient diagnoses.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"686-692"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601831","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}