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PHM Top Ten 2015

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15 papers 0 to 25 followers
JoAnna K Leyenaar, Meng-Shiou Shieh, Tara Lagu, Penelope S Pekow, Peter K Lindenauer
No abstract text is available yet for this article.
May 2015: JAMA Pediatrics
Jeremy N Friedman, Carolyn E Beck, Julie DeGroot, Denis F Geary, Daniel J Sklansky, Stephen B Freedman
IMPORTANCE: Use of hypotonic intravenous fluids for maintenance requirements is associated with increased risk of hyponatremia that results in morbidity and mortality in children. Clinical trial data comparing isotonic and hypotonic maintenance fluids in nonsurgical hospitalized pediatric patients outside intensive care units are lacking. OBJECTIVE: To compare isotonic (sodium chloride, 0.9%, and dextrose, 5%) with hypotonic (sodium chloride, 0.45%, and dextrose, 5%) intravenous maintenance fluids in a hospitalized general pediatric population...
May 2015: JAMA Pediatrics
Yvonne W Wu, Michael W Kuzniewicz, Andrea C Wickremasinghe, Eileen M Walsh, Soora Wi, Charles E McCulloch, Thomas B Newman
IMPORTANCE: Exchange transfusion is recommended for newborns with total serum bilirubin (TSB) levels thought to place them at risk for cerebral palsy (CP). However, the excess risk for CP among these infants is unknown. OBJECTIVE: To quantify the risks for CP and CP consistent with kernicterus that are associated with high TSB levels based on the 2004 American Academy of Pediatrics exchange transfusion threshold (ETT) guidelines. DESIGN, SETTING, AND PARTICIPANTS: We enrolled 2 cohorts from a population of 525,409 infants in the Late Impact of Getting Hyperbilirubinemia or Phototherapy (LIGHT) birth cohort...
March 2015: JAMA Pediatrics
Katie A Meier, Eloise Clark, Cristina Tarango, Ranjit S Chima, Erin Shaughnessy
BACKGROUND: Pediatric hospital-acquired venous thromboembolism (VTE) is an increasingly prevalent and morbid disease. A multidisciplinary team at a tertiary children's hospital sought to answer the following clinical question: "Among hospitalized adolescents, does risk assessment and stratified VTE prophylaxis compared with no prophylaxis reduce VTE occurrence without an increase in significant adverse effects?" METHODS: Serial literature searches using key terms were performed in the following databases: Medline, Cochrane Database, CINAHL (Cumulative Index to Nursing and Allied Health), Scopus, EBMR (Evidence Based Medicine Reviews)...
January 2015: Hospital Pediatrics
Ron Keren, Samir S Shah, Rajendu Srivastava, Shawn Rangel, Michael Bendel-Stenzel, Nada Harik, John Hartley, Michelle Lopez, Luis Seguias, Joel Tieder, Matthew Bryan, Wu Gong, Matt Hall, Russell Localio, Xianqun Luan, Rachel deBerardinis, Allison Parker
IMPORTANCE: Postdischarge treatment of acute osteomyelitis in children requires weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). The catheters carry a risk for serious complications, but limited evidence exists on the effectiveness of oral therapy. OBJECTIVE: To compare the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered via the PICC or the oral route...
February 2015: JAMA Pediatrics
James C Gay, Rishi Agrawal, Katherine A Auger, Mark A Del Beccaro, Pirooz Eghtesady, Evan S Fieldston, Justin Golias, Paul D Hain, Richard McClead, Rustin B Morse, Mark I Neuman, Harold K Simon, Javier Tejedor-Sojo, Ronald J Teufel, J Mitchell Harris, Samir S Shah
OBJECTIVE: To assess readmission rates identified by 3M-Potentially Preventable Readmissions software (3M-PPRs) in a national cohort of children's hospitals. STUDY DESIGN: A total of 1 719 617 hospitalizations for 1 531 828 unique patients in 58 children's hospitals from 2009 to 2011 from the Children's Hospital Association Case-Mix Comparative database were examined. Main outcome measures included rates, diagnoses, and costs of potentially preventable readmissions (PPRs) and all-cause readmissions...
March 2015: Journal of Pediatrics
Sarah McNab, Trevor Duke, Mike South, Franz E Babl, Katherine J Lee, Sarah J Arnup, Simon Young, Hannah Turner, Andrew Davidson
BACKGROUND: Use of hypotonic intravenous fluid to maintain hydration in children in hospital has been associated with hyponatraemia, leading to neurological morbidity and mortality. We aimed to assess whether use of fluid solutions with a higher sodium concentration reduced the risk of hyponatraemia compared with use of hypotonic solutions. METHODS: We did a randomised controlled double-blind trial of children admitted to The Royal Children's Hospital (Melbourne, VIC, Australia) who needed intravenous maintenance hydration for 6 h or longer...
March 28, 2015: Lancet
Shawn L Ralston, Allan S Lieberthal, H Cody Meissner, Brian K Alverson, Jill E Baley, Anne M Gadomski, David W Johnson, Michael J Light, Nizar F Maraqa, Eneida A Mendonca, Kieran J Phelan, Joseph J Zorc, Danette Stanko-Lopp, Mark A Brown, Ian Nathanson, Elizabeth Rosenblum, Stephen Sayles, Sinsi Hernandez-Cancio
This guideline is a revision of the clinical practice guideline, "Diagnosis and Management of Bronchiolitis," published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:
November 2014: Pediatrics
David I Rappaport, Rebecca E Rosenberg, Erin E Shaughnessy, Joshua K Schaffzin, Katherine M O'Connor, Anjna Melwani, Lisa M McLeod
Comanagement of surgical patients is occurring more commonly among adult and pediatric patients. These systems of care can vary according to institution type, comanagement structure, and type of patient. Comanagement can impact quality, safety, and costs of care. We review these implications for pediatric surgical patients.
November 2014: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Suzanne Schuh, Stephen Freedman, Allan Coates, Upton Allen, Patricia C Parkin, Derek Stephens, Wendy Ungar, Zelia DaSilva, Andrew R Willan
IMPORTANCE: Routine use of pulse oximetry has been associated with changes in bronchiolitis management and may have lowered the hospitalization threshold for patients with bronchiolitis. OBJECTIVE: To examine if infants with bronchiolitis whose displayed oximetry measurements have been artificially elevated 3 percentage points above true values experience hospitalization rates at least 15% lower compared with infants with true values displayed. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, parallel-group trial conducted from 2008 to 2013 in a tertiary-care pediatric emergency department in Toronto, Ontario, Canada...
August 20, 2014: JAMA: the Journal of the American Medical Association
Jori F Bogetz, Alyssa L Bogetz, David Bergman, Teri Turner, Rebecca Blankenburg, Allison Ballantine
OBJECTIVE: To identify existing challenges and potential strategies for providing complex care training to future pediatricians from a national group of educators. METHODS: Data were collected from pediatric educators involved in complex care at the Pediatric Educational Excellence Across the Continuum national meeting. Participants completed an anonymous 15-item survey adapted from the Association of American Medical Colleges (AAMC) Best Practices for Better Care initiative and participated in a focus group to understand the challenges and potential solutions to pediatric complex care education...
November 2014: Academic Pediatrics
Michael W Kuzniewicz, Andrea C Wickremasinghe, Yvonne W Wu, Charles E McCulloch, Eileen M Walsh, Soora Wi, Thomas B Newman
BACKGROUND AND OBJECTIVES: Total serum bilirubin (TSB) levels ≥ 30 mg/dL are rare but potentially hazardous. A better understanding of their incidence, causes, and outcomes could help inform preventive efforts. METHODS: We identified infants born ≥ 35 weeks' gestational age from 1995-2011 in Kaiser Permanente Northern California (n = 525409) and examined the medical records of infants with a TSB ≥ 30 mg/dL to determine etiology and the occurrence of acute bilirubin encephalopathy...
September 2014: Pediatrics
Eric A Biondi, Matthew Mischler, Karen E Jerardi, Angela M Statile, Jason French, Rianna Evans, Vivian Lee, Clifford Chen, Carl Asche, Jinma Ren, Samir S Shah
IMPORTANCE: Blood cultures are often obtained as part of the evaluation of infants with fever and these infants are typically observed until their cultures are determined to have no growth. However, the time to positivity of blood culture results in this population is not known. OBJECTIVE: To determine the time to positivity of blood culture results in febrile infants admitted to a general inpatient unit. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, retrospective, cross-sectional evaluation of blood culture time to positivity...
September 2014: JAMA Pediatrics
Alan R Schroeder, Shawn L Ralston
Durations of intravenous antibiotic therapy for bacterial infections in hospitalized children sometimes extend well beyond clinical recovery and are often the primary determinants of length of stay. These durations, however, are not always based on solid evidence. Moreover, fixed durations are invariant to important individual factors. We review guidelines and the available evidence for durations of intravenous antibiotic therapy for meningitis, bacteremia, urinary tract infection, and osteomyelitis, conditions where intravenous antibiotics often extend beyond resolution of clinical symptoms...
September 2014: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Robyn Nolan, Brenda Luther, Paul Young, Nancy A Murphy
OBJECTIVE: To describe and compare during an acute hospitalization the perceptions of parents, pediatric interns, and pediatric hospitalists regarding the long-term health-related quality of life (HRQoL) of children with severe disabilities when not hospitalized and to identify treatment goals. METHODS: Parents of children with severe disabilities aged 5 to 18 years, as well as the intern and hospitalist caring for the child during acute hospitalizations at a tertiary care center in Salt Lake City, Utah, participated in this study...
November 2014: Academic Pediatrics
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