A National Analysis of General Pediatric Inpatient Unit Closures and Openings, 2011-2018.

Objectives: This paper provides an examination of: (1) the frequency and net rates of change for general pediatric inpatient (GPI) unit closures and openings nationally and by state; (2) how often closures or openings are caused by GPI unit changes only or caused by hospital-level changes; and (3) the relationship between hospital financial status and system ownership and GPI unit closures or openings.

Methods: This study used the Health Systems and Providers Database (2011-2018) plus 3 data sources on hospital closures. We enumerated GPI unit closures and openings to calculate net rates of change.

Comparing the Kids' Inpatient Database and National Inpatient Sample for Pediatric Research.

Objective: Pediatric researchers use Agency for Healthcare Research and Quality (AHRQ) Kids' Inpatient Database (KID) and National Inpatient Sample (NIS) to analyze the national resource use and outcomes of hospitalized children. Inherent KID-NIS sampling design differences may yield disparate findings. We compared discharge counts and length of stay (LOS) between KID and NIS for common and rare reasons for hospitalization.

A pediatric hospital-wide asthma severity score: Reliability and effectiveness.

Background: Asthma is a leading cause of pediatric hospitalization in the United States. Children hospitalized with asthma are often managed in different care settings during hospitalization, posing challenges to accurate communication among care providers about illness severity. Our objective was to study the feasibility, reliability, and safety of a new pediatric hospital-wide asthma severity score (HASS) across different care units within a single tertiary-care pediatric center.

Validation of the Hospital Asthma Severity Score (HASS) in children ages 2-18 years old.

Introduction: The Hospital Asthma Severity Score (HASS) was developed to communicate inpatient asthma severity between providers. The purpose of this prospective study was to validate the HASS against the Pediatric Respiratory Assessment Measure (PRAM) and spirometry for assessment of inpatient asthma exacerbation severity in patients 2-18 years old, at a single point-in-time.

Methods: This study was registered with clinicaltrials.

Medication Order Errors at Hospital Admission Among Children With Medical Complexity.

Objectives: We sought to characterize the nature and prevalence of medication order errors (MOEs) occurring at hospital admission for children with medical complexity (CMC), as well as identify the demographic and clinical risk factors for CMC experiencing MOEs.

Methods: Prospective cohort study of 1233 hospitalizations for CMC from November 1, 2015, to October 31, 2016, at 2 children's hospitals. Medication order errors at admission were identified prospectively by nurse practitioners and a pharmacist through direct patient care.

Comparison of Empiric Antibiotics for Acute Osteomyelitis in Children.

Objectives: Broad-spectrum antibiotics are commonly used for the empiric treatment of acute hematogenous osteomyelitis and often target methicillin-resistant (MRSA) with medication-associated risk and unknown treatment benefit. We aimed to compare clinical outcomes among patients with osteomyelitis who did and did not receive initial antibiotics used to target MRSA.

Methods: A retrospective cohort study of 974 hospitalized children 2 to 18 years old using the Pediatric Health Information System database, augmented with clinical data.

Issues Identified by Postdischarge Contact after Pediatric Hospitalization: A Multisite Study.

Background: Many hospitals are considering contacting hospitalized patients soon after discharge to help with issues that arise.

Objective: To (1) describe the prevalence of contactidentified postdischarge issues (PDI) and (2) assess characteristics of children with the highest likelihood of having a PDI.

Design, Setting, Patients: A retrospective analysis of hospital-initiated follow-up contact for 12,986 children discharged from January 2012 to July 2015 from 4 US children's hospitals.

Clinician Perceptions of the Importance of Hospital Discharge Components for Children.

Background: Discharging hospitalized children involves several different components, but their relative value is unknown. We assessed which discharge components are perceived as most and least important by clinicians.

Methods: March and June of 2014, we conducted an online discrete choice experiment (DCE) among national societies representing 704 nursing, physician, case management, and social work professionals from 46 states.

Nursing-led Home Visits Post-hospitalization for Children with Medical Complexity.

Purpose: Hospital discharge for children with medical complexity (CMC) can be challenging for families. Home visits could potentially benefit CMC and their families after leaving the hospital. We assessed the utility of post-discharge home visits to identify and address health problems for recently hospitalized CMC.

A framework of pediatric hospital discharge care informed by legislation, research, and practice.

To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process.

Long bone structure and strength depend on BMP2 from osteoblasts and osteocytes, but not vascular endothelial cells.

The importance of bone morphogenetic protein 2 (BMP2) in the skeleton is well known. BMP2 is expressed in a variety of tissues during development, growth and healing. In this study we sought to better identify the role of tissue-specific BMP2 during post-natal growth and to determine if BMP2 knockout affects the ability of terminally differentiated cells to create high quality bone material.

Adaptive and Injury Response of Bone to Mechanical Loading.

Bone responds to supraphysiological mechanical loads by increasing bone formation. Depending on the applied strain magnitude (and other loading parameters) the response can be either adaptive (mostly lamellar bone) or injury (mostly woven bone). Seminal studies of Hert, Lanyon, and Rubin originally established the basic "rules" of bone mechanosensitivity.

Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis.

Objectives: The primary aim of the study was to determine the changes, if any, in cardiac output (CO) and stroke volume (SV) in normal infants with RSV bronchiolitis. The secondary aim was to determine whether changes in CO (ΔCO) and SV (ΔSV) are associated with changes in respiratory rate (ΔRR).

Methods: Non-invasive CO recordings were obtained within 24 h of admission and discharge.

Anisotropic mechanical properties of ovine femoral periosteum and the effects of cryopreservation.

The mechanical properties of periosteum are not well characterized. An understanding of these properties is critical to predict the environment of pluripotent and osteochondroprogenitor cells that reside within the periosteum and that have been shown recently to exhibit a remarkably rapid capacity to generate bone de novo. Furthermore, the effects of cryopreservation on periosteal mechanical properties are currently unknown.

Multiscale mechanobiology of de novo bone generation, remodeling and adaptation of autograft in a common ovine femur model.

The link between mechanics and biology in the generation and the adaptation of bone has been studied for more than a century in the context of skeletal development and fracture healing. However, the interplay between mechanics and biology in de novo generation of bone in postnatal defects as well as healing of morcellized bone graft or massive cortical bone autografts is less well understood. To address this, here we integrate insights from our previously published studies describing the mechanobiology on both de novo bone generation and graft healing in a common ovine femoral defect model.

Major and minor centroidal axes serve as objective, automatable reference points to test mechanobiological hypotheses using histomorphometry.

Recent studies show that minor and major centroidal axes (CA) of long bone cross sections provide valuable predictions of prevailing loading patterns in age and treatment matched cohorts of animals. Furthermore, using CA, we recently showed that the degree of mineralization and area of woven bone laid down in the first two weeks after creation of a critical sized bone defect relate inversely and correlate significantly to loading patterns. Here, we aim to determine how closely independent measures of the spatial distribution of bone apposition determined using the major and minor CA as reference points correlate to those using anatomically defined axes as reference points.

Net change in periosteal strain during stance shift loading after surgery correlates to rapid de novo bone generation in critically sized defects.

In an ovine femur model, proliferative woven bone fills critically sized defects enveloped by periosteum within 2 weeks of treatment with the one-stage bone-transport surgery. We hypothesize that mechanical loading modulates this process. Using high-definition optical strain measurements we determined prevailing periosteal strains for normal and surgically treated ovine femora subjected ex vivo to compressive loads simulating in vivo stance shifting (n = 3 per group, normal vs.

Mechanical modulation of osteochondroprogenitor cell fate.

Mesenchymal cells are natural tissue builders. They exhibit an extraordinary capacity to metamorphize into differentiated cells, using extrinsic spatial and temporal inputs and intrinsic algorithms, as well as to build and adapt their own habitat. In addition to providing a habitat for osteoprogenitor cells, tissues of the skeletal system provide mechanical support and protection for the multiple organs of vertebrate organisms.

Management of parapneumonic effusions in pediatrics: current practice.

Pneumonia with associated complex pleural disease is a cause of significant morbidity among hospitalized children. The management of this patient population continues to be a challenge and varies even among single institutions. The article presented here reviews the management goals for pediatric patients hospitalized with complex parapneumonic effusions and provides updated summaries of both medical and surgical therapies.

Preventable adverse events in infants hospitalized with bronchiolitis.

Objective: To determine the incidence of preventable adverse events (AEs) and near misses (NMs) among infants hospitalized for bronchiolitis at a pediatric tertiary care hospital and the impact of these errors on hospital length of stay (LOS).

Methods: We studied 143 infants with bronchiolitis, ages 0 to 12 months, admitted from December 2002 to April 2003. Using prospective chart review and staff reports, we captured medical errors and AEs.

Office laboratory procedures, office economics, parenting and parent education, and urinary tract infection.

Four areas of pediatric office practice are again reviewed: office laboratory procedures, office economics, parenting and parent education, and urinary tract infection. Screening for celiac disease and the use of rapid antigen testing for extrapharyngeal group A Streptococcus infections are included in office laboratory procedures. Utilization of health care among patients with public insurance, electronic medical records, billing among pediatric residents, and satisfaction surveys are reviewed in office economics.