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1.
WMJ ; 122(2): 105-109, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37141473

RESUMO

INTRODUCTION: The management of young infants with skin and soft tissue infection is not well-defined. METHODS: We performed a survey study of pediatric hospital medicine, emergency medicine, urgent care, and primary care physicians to assess the management of young infants with skin and soft tissue infection. The survey included 4 unique scenarios of a well-appearing infant with uncomplicated cellulitis of the calf with the combination of age ≤ 28 days vs 29-60 days and the presence vs absence of fever. RESULTS: Of 229 surveys distributed, 91 were completed (40%). Hospital admission was chosen more often for younger infants (≤ 28 days) versus older infants regardless of fever status (45% vs 10% afebrile, 97% vs 38% febrile, both P < 0.001). Younger infants were more likely to get blood, urine, and cerebrospinal fluid studies (P < 0.01). Clindamycin was chosen in 23% of admitted younger infants compared to 41% of older infants (P < 0.05). CONCLUSIONS: Frontline pediatricians appear relatively comfortable with outpatient management of cellulitis in young infants and rarely pursued meningitis evaluation in any afebrile infants or older febrile infants.


Assuntos
Infecções dos Tecidos Moles , Lactente , Humanos , Criança , Recém-Nascido , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologia , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/complicações , Febre , Estudos Retrospectivos
2.
Hosp Pediatr ; 12(2): e67-e72, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34984444

RESUMO

OBJECTIVES: The purpose of this study was to minimize unnecessary laboratory services for hospitalized neonates with hyperbilirubinemia by revising a local clinical practice pathway (CPP). METHODS: A retrospective cohort study was performed to compare the number of laboratory tests and blood draws in patients hospitalized with neonatal hyperbilirubinemia before and after implementation of a revised CPP. The study included infants with neonatal hyperbilirubinemia <14 days old admitted after their birth hospitalization between April 2017 and October 2019. Primary outcome measures included the total number of blood draws and the number of laboratory tests obtained per patient and length of stay. Secondary outcome measures included 7-day readmission rate, charges, and discharge bilirubin level. RESULTS: The median number of blood draws per patient after implementation of the CPP decreased to 2 (interquartile range [IQR], 2-3) compared with 3 (IQR, 2-3) before implementation (Poisson model-based estimated mean difference, 1.1; 95% confidence interval, 1.0-1.3; P = .018). The median number of laboratory tests per patient after implementation decreased from 4 (IQR, 3-6) to 3 (IQR, 2-4; Poisson model-based estimated mean difference, 1.3; 95% confidence interval, 1.2-1.5; P < .0001). There was no significant change in length of stay, readmission rate, charges, or discharge bilirubin level. CONCLUSIONS: Implementation of a revised CPP was associated with a significant decrease in the number of blood draws and laboratory tests per patient for infants admitted to the hospital for neonatal hyperbilirubinemia.


Assuntos
Hiperbilirrubinemia Neonatal , Icterícia Neonatal , Hospitalização , Humanos , Lactente , Recém-Nascido , Icterícia Neonatal/diagnóstico , Icterícia Neonatal/terapia , Estudos Retrospectivos
3.
WMJ ; 121(4): 301-305, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36637842

RESUMO

INTRODUCTION: Pediatric hospital medicine physicians receive little formal training in communicating with interfacility referring clinicians. We sought to improve pediatric hospital medicine physician confidence and communication scores by 10% during patient triage calls from interfacility referring providers via a continuing professional development initiative. METHODS: We conducted a single-center 10-month quality improvement project. Confidence was assessed via survey before and after the initiative. A novel self- and peer-evaluation tool was used to assess accepting pediatric hospital medicine physician communication on recorded calls. Call assessment scores were measured at baseline, cycle 1, and cycle 2. Interventions included group discussion and development of a scripting flowsheet. RESULTS: Twenty pediatric hospital medicine physicians participated and completed a total of 203 call assessments. From baseline to post-initiative, general confidence communicating with referring clinicians increased by 13% (mean ranks 11.8, 16.8, respectively), and specific confidence communicating when there is a difference of opinion increased significantly by 37% (mean ranks 9.8, 19.2, P < 0.001). Interfacility transfer conversation evaluation scores increased by 11%. DISCUSSION: Our initiative improved accepting physician's confidence and communication evaluation scores using self- and peer-evaluation, group reflection, and a scripting flowsheet. Self- and peer-evaluation of recorded calls can be an effective intervention for building physician confidence in communicating with referring clinicians.


Assuntos
Autoavaliação Diagnóstica , Médicos , Criança , Humanos , Inquéritos e Questionários , Triagem , Comunicação
5.
Hosp Top ; 99(1): 44-47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33357127

RESUMO

Pediatric Hospital Medicine (PHM) is a growing subspecialty with a broad scope. The Covid-19 pandemic demands flexible staffing models. Advanced practice providers (APPs) can be a valuable addition to hospital medicine teams, although there is no established training program for APPs within PHM. The authors' purpose is to describe how one institution rapidly established a PHM APP team by collaborating with experienced APPs working in other areas of the hospital. This APP team cared for 16% of the average daily census during the pilot period with no significant difference in length of stay compared to traditional teams.


Assuntos
Prática Avançada de Enfermagem/estatística & dados numéricos , Hospitais Pediátricos/tendências , Prática Avançada de Enfermagem/tendências , COVID-19/enfermagem , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Equipe de Assistência ao Paciente , Projetos Piloto , Capacidade de Resposta ante Emergências/normas , Capacidade de Resposta ante Emergências/estatística & dados numéricos
6.
WMJ ; 117(3): 130-132, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30193023

RESUMO

INTRODUCTION: Eosinophilic meningitis is an infrequently encountered condition. Baylisascaris procyonis (raccoon roundworm) infection, rarely diagnosed in North America, is a known cause of eosinophilic meningitis, often producing death or permanent neurologic damage. CASE REPORT: We recently encountered a toddler with geophagia and probable exposure to raccoon feces, who presented with eosinophilic meningitis and encephalitis, and was diagnosed with B procyonis infection and possible Toxocara co-infection. His marked peripheral eosinophilia and neurologic symptoms rapidly responded to corticosteroid and albendazole therapy. DISCUSSION: Since B procyonis infection is infrequently encountered, its diagnosis in the proper clinical and epidemiologic setting may not always be considered, resulting in a delay of appropriate therapy. Our patient, diagnosed and treated early in his course, demonstrated rapid clinical and laboratory improvement with anti-inflammatory and antiparasitic therapy. CONCLUSION: In cases of eosinophilic meningitis, infection with B procyonis should be routinely considered to allow timely institution of effective therapy for this unusual but potentially fatal or debilitating infection.


Assuntos
Infecções por Ascaridida/complicações , Infecções por Ascaridida/diagnóstico , Meningoencefalite/parasitologia , Corticosteroides/uso terapêutico , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Infecções por Ascaridida/tratamento farmacológico , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Lactente , Masculino , Meningoencefalite/tratamento farmacológico , Guaxinins
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