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In This Issue of JAMA Pediatrics

from ArchPedi - 01 May 13

JAMA Pediatrics Hospital Medicine Theme Issue JAMA Pediatrics Hospital Medicine Theme Issue

from ArchPedi - 01 May 13

The hospital is a site of increasingly complex and resource-intensive care for children. It is also a clinical setting that in recent years has undergone major changes in the organization, delivery, and financing of care, with reduction in resident work hours, requirements for greater attending oversight of trainees, increased scrutiny of clinical outcomes, new payment models that shift financial risk to health care providers, and new delivery models that attempt to provide greater value for mon

About This Journal

from ArchPedi - 01 May 13

Application of Business Model Innovation to Enhance Value in Health Care Delivery Application of Business Model Innovation

from ArchPedi - 01 May 13

Faced with the need to improve quality, health care enterprises have used principles from highly reliable industries to make tactical progress. As the health care system faces growing challenges to transform itself, we propose business model innovation as a strategic framework for improving the delivery of health care. We believe that this approach will unify the domains of quality (safety, effectiveness, efficiency, timeliness, patient centeredness, and equity) with the need to enhance value by

Association Between Parental Preference and Head Computed Tomography in Children With Minor Blunt Head Trauma

from ArchPedi - 01 May 13

Natale et al recently reported that race/ethnicity is independently associated with head computed tomography (CT) use among children with minor blunt head trauma. They showed parental anxiety as an important factor influencing head CT orders in non-Hispanic white children regardless of brain injury risk. In a Japanese pediatric cohort of patients with minor blunt head trauma, we conducted a study with similar objectives attempting to identify factors that influence a physician's decision to orde

Decreasing Hospital Length of Stay for Bronchiolitis by Using an Observation Unit and Home Oxygen Therapy Decreasing Hospital LOS for Bronchiolitis

from ArchPedi - 01 May 13

ImportancePediatric observation units (OUs) offer the opportunity to safely and efficiently care for common illnesses previously cared for in an inpatient setting. Home oxygen therapy (HOT) has been used to facilitate hospital discharge in patients with hypoxic bronchiolitis. It is unknown how implementation of a hospitalwide bronchiolitis treatment protocol promoting OU-HOT would affect hospital length of stay (LOS).ObjectiveTo test the hypothesis that using OU-HOT for bronchiolitis would decre

Family-Centered Advance Care Planning for Teens With Cancer ACP for Teens With Cancer

from ArchPedi - 01 May 13

ImportanceAdvance care planning (ACP) prepares patients and their families for future health care decisions; however, the needs of adolescent oncology patients for participation in ACP have not been well studied.ObjectiveTo examine the efficacy of family-centered ACP.Design and SettingTwo-group randomized controlled trial in a pediatric oncology program.ParticipantsSixty adolescents aged 14 to 21 years with cancer and their surrogates or families were enrolled in the study between January 17, 20

H. I. E.

from ArchPedi - 01 May 13

You are G-tube, trach-dependent,deaf, blind, devastated, orphaned, forgotten,and 2 years old today.You are an incredible teacher.You arecerebral palsy,septic shock,multidrug-resistant organisms,broad-spectrum antibiotics,pulmonary edema,acute renal failure,fluid resuscitation,epinephrine,chest compressions,epinephrine,sinus tachycardia.I wonder . . . do you dream?Of peppermint breezes and thrumming valleys,burning bushes and albino woods,bottomless sun and twisting caverns,marshmallow clouds and

If Your Child Is Hospitalized: The Hospital Health Care Team

from ArchPedi - 01 May 13

If your child needs to be in the hospital, it can be a stressful and confusing experience. In many hospitals, there are multiple people involved in the care of each pediatric patient, and it can be challenging for parents to keep track of who is who. I outline the typical medical and nursing team members, and suggest ways to interact with your child's hospital health care team.

Influence of Obesity on Clinical Outcomes in Hospitalized Children A Systematic Review Obesity and Outcomes in Hospitalized Children

from ArchPedi - 01 May 13

ImportanceObesity is prevalent among hospitalized children. Knowledge of the relationship between obesity and outcomes in hospitalized children will enhance nutrition assessment and provide opportunities for interventions.ObjectiveTo systematically review the existing literature concerning the impact of obesity on clinical outcomes in hospitalized children.Evidence AcquisitionPubMed, Web of Science, and EMBASE databases were searched for studies of hospitalized children aged 2 to 18 years with i

Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery A Systematic Review Factors Affecting Outcomes in Pediatric Surgery

from ArchPedi - 01 May 13

ImportanceAnalyses of volume-outcome relationships in adult surgery have found that hospital and physician characteristics affect patient outcomes, such as length of stay, hospital charges, complications, and mortality. Similar investigations in children's surgical specialties are fewer in number, and their conclusions are less clear.ObjectiveTo review the evidence regarding surgeon or hospital experience and their influence on outcomes in children's surgery.Evidence ReviewA MEDLINE and EMBASE s

Multi-institutional Profile of Adults Admitted to Pediatric Intensive Care Units Adults in Pediatric Intensive Care Units

from ArchPedi - 01 May 13

ImportanceGrowing numbers of persons with childhood-onset chronic illnesses are surviving to adulthood. Many use pediatric hospitals for their inpatient needs. To our knowledge, the prevalence and characteristics of adult pediatric intensive care unit patients have not been reported.ObjectivesTo estimate the proportion of adults admitted to pediatric intensive care units (PICUs), characterize them, and compare them with older adolescents.DesignOne-year cross-sectional analysis.SettingPediatric i

Neurodevelopmental Outcomes of Extremely Low-Gestational-Age Neonates With Low-Grade Periventricular-Intraventricular Hemorrhage Outcomes of Neonates With Ventricular Hemorrhage

from ArchPedi - 01 May 13

ImportanceLow-grade periventricular-intraventricular hemorrhage is a common neurologic morbidity among extremely low-gestational-age neonates, yet the outcomes associated with this morbidity are not fully understood. In a contemporary multicenter cohort, we evaluated the impact of such hemorrhages on early (18-22 month) neurodevelopmental outcomes of extremely premature infants.ObjectiveTo compare neurodevelopmental outcomes at 18 to 22 months' corrected age for extremely low-gestational-age inf

Nurse Staffing and NICU Infection Rates Nurse Staffing and NICU Infection Rates

from ArchPedi - 01 May 13

ImportanceThere are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights.ObjectiveTo study the adequacy of NICU nurse staffing in the United States using national guidelines and analyze its association with infant outcomes.DesignRetrospective cohort study. Data for 2008 were collected by web survey of staff nurses. Data for 200

Pediatric Hospital Medicine

from ArchPedi - 01 May 13

Pediatric Hospital Medicine, 2013. Cassio Lynm, MA, CMI.

Pediatric Hospital Medicine and Education Why We Can't Stand Still Pediatric Hospital Medicine and Education

from ArchPedi - 01 May 13

Pediatric hospital medicine (PHM), as it is known now, has arrived. It is no longer merely a movement, nor is it only a reaction to residency work-hour restrictions or a call for heightened attention to safety for increasingly acute and complex hospitalized children. It is a well-defined field of pediatrics, dedicated to improving the care of hospitalized children, both at the point of care and through systemwide transformations. It requires a specialized knowledge base and skill set to practice

Picture of the Month—Diagnosis

from ArchPedi - 01 May 13

Picture of the Month—Quiz Case

from ArchPedi - 01 May 13

A 17-year-old boy presented to our hospital with a 4-week history of pain and restriction of movement in his left shoulder. Two weeks prior to presentation, he had developed a skin lesion on the anterior aspect of the same shoulder. At that point, radiographs of the shoulder (Figure 1) and chest (Figure 2) were obtained. It was assumed that he had a superficial skin infection, which prompted treatment with amoxicillin–clavulanate potassium without improvement.

Prognostic Significance of Low-Grade Intraventricular Hemorrhage in the Current Era of Neonatology Prognostic Significance of Low-Grade IVH

from ArchPedi - 01 May 13

Cranial ultrasonography (CUS) is performed routinely in extremely preterm infants admitted to the neonatal intensive care unit (NICU), and periventricular-intraventricular hemorrhages (PIVHs) are found in approximately 30% of infants born at less than 29 weeks' gestation. Compared with infants with no hemorrhages, infants with intraventricular hemorrhages leading to ventricular dilatation (grade 3 in the Papile classification) or infants with intraparenchymal hemorrhages (grade 4) clearly have h

Risk Factors for Peripherally Inserted Central Venous Catheter Complications in Children Risk Factors for PICC Complications in Children

from ArchPedi - 01 May 13

ImportancePeripherally inserted central venous catheters (PICCs) are prone to infectious, thrombotic, and mechanical complications. These complications are associated with morbidity, so data are needed to inform quality improvement efforts.ObjectivesTo characterize the epidemiology of and to identify risk factors for complications necessitating removal of PICCs in children.DesignCohort study.SettingJohns Hopkins Children's Center, Baltimore, Maryland.ParticipantsHospitalized children who had a P

Suctioning and Length of Stay in Infants Hospitalized With Bronchiolitis Suctioning in Bronchiolitis

from ArchPedi - 01 May 13

ImportanceHospitalizations of infants for bronchiolitis are common and costly. Despite the high incidence and resource burden of bronchiolitis, the mainstay of treatment remains supportive care, which frequently includes nasal suctioning.ObjectiveTo examine the association between suctioning device type and suctioning lapses greater than 4 hours within the first 24 hours after hospital admission on length of stay (LOS) in infants with bronchiolitis.DesignRetrospective cohort study. Data were ext

Tackling Taboo Topics How to Have Effective Advanced Care Planning Discussions With Adolescents and Young Adults With Cancer Tackling Taboo Topics

from ArchPedi - 01 May 13

How can we clinicians talk about important but scary topics with patients and their parents? More specifically, for adolescents and young adults with cancer, how can we best engage them in advanced care planning (ACP) in a timely manner, especially in light of the reluctance by patients, families, and clinicians to open up this conversation? These are important questions: if the disease advances and the adolescent or young adult patient is no longer able to participate in decision making, then t

The Reason I Am

from ArchPedi - 01 May 13

I have forgotten the painI have forgotten the woundsThe pain of unsleeping nightsThe wounds of failed exams;I am a physician nowI am the patients' hopeTheir teardrops move me.I became a reason for the suffering childrenI became a champion for my friendsA strange, tired but amazing child for my parentsAn eternal busy motherAnd, for sure, a hard-to-understand wife.All of these because I chose to be a physician,And I swore to be skilled in my jobBecause I like my career, I like childrenAnd I want t

In This Issue of JAMA Pediatrics

from ArchPedi - 01 Apr 13

A Control Model to Evaluate Pharmacotherapy for Allergic Rhinitis in Children Model for Allergic Rhinitis Pharmacotherapy

from ArchPedi - 01 Apr 13

ImportanceAlthough the question of whether early diagnosis and treatment of pediatric allergic rhinitis (AR) improve disease control is important, a more crucial question is whether we can evaluate the effect of treatment on disease control using an impairment-risk model.ObjectiveTo conduct a systematic review evaluating application of a control model based on domains of impairment and risk (similar to that used for asthma) in pharmacotherapy for children with AR.Evidence AcquisitionWe searched