Live Tweeting the Top Articles session by @cjrussell and @corrieerin!

Starting with quarantine and mask jokes...and of course Zoom jokes!!! I think you are on mute @corrieerin

#PHM20Virtual #PHMTop10
The Journey to the #Top10

- 11,925 articles from 19 journals searched!
- 918 abstracts read!
- 163 articles reviewed!

#Top10Articles of the academic year selected by @CorrieErin and @cjrussellMD !

#PHM20Virtual #PHMTop10
First up: Potentially unnecessary testing and treatment of hypoglycemia in newborns:

“Glucose Profiles in Healthy Term Infants in the First 5 Days: The Glucose in Well Babies (GLOW) Study” by Dr. Deborah Harris et al. @JPeds

https://pubmed.ncbi.nlm.nih.gov/32381469/ 

#PHM20Virtual #PHMTop10
Glucose Profiles in Healthy Term Infants in the First 5 Days: The Glucose in Well Babies (GLOW)...

ACTRN: 12615000986572.

https://pubmed.ncbi.nlm.nih.gov/32381469/
Next Up: Another study looking at hypoglycemia in newborns:

“Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia” by Dr. Anne van Kempen et al. @NEJM

#PHM20Virtual #PHMTop10 #Sugar!!
Primary takeaway from these studies:

1. Many healthy newborns have episodes of hypoglycemia
2. Lower treatment threshold (36mg/dL vs 47mg/dL) did not affect psychomotor development at 18 months
3. Current treatment protocols may need to be reevaluated!

#PHM20Virtual
Next Up: The VIP Network used national QI initiatives to standardize, improve care of our patients.

“Reducing Variability in in the Infant Sepsis Evaluation (REVISE): A national Quality Initiative” by Dr. Eric Biondi et al. @AmerAcadPeds

https://pubmed.ncbi.nlm.nih.gov/31434688/ 

#PHM20Virtual
Reducing Variability in the Infant Sepsis Evaluation (REVISE): A National Quality Initiative -...

Reducing Variability in the Infant Sepsis Evaluation noted improvement in key aspects of febrile infant management. Similar projects may be used to improve care in other clinical conditions.

https://pubmed.ncbi.nlm.nih.gov/31434688/
Another study from VIP Network:

Pathway for Improving Inpatient Pediatric Asthma Care (PIPA): A Multicenter, National Study” By Dr. Sunitha Kaiser et al. @AAPJournals

https://pubmed.ncbi.nlm.nih.gov/32376727/ 

#PHM20Virtual
Takeaway from these studies:

1. National QI collaborations work!
2. QI able to decrease hospitalizations and LOS for febrile infants
3. Implementation of asthma pathways improve care

#PHM20Virtual #PHMTop10
This next study showed that risk stratification of febrile infants continues to be complicated:

“Performance of Modified Boston and Philadelphia Criteria for Invasive Bacterial Infections” by Lyons et al. @AAPJournals

https://pubmed.ncbi.nlm.nih.gov/32205466/ 

#PHM20Virtual #PHMTop10
Implications to practice:

1. The Modified Boston and Philadelphia criteria misclassify a large amount of infants
2. New criteria have been created that use CRP and PCT
3. No classifcation scheme is perfect

#PHM20Virtual #PHMTop10
Next Up: @chris_bonafide and @PRISNetwork show large variability in cont SpO2 overuse in B-litis.

“Prevalence of Continuous Pulse Oximetry Use in Hospitalized Children with Bronchiolitis Not Requiring Supplemental Oxygen” @JAMA_current

https://pubmed.ncbi.nlm.nih.gov/32315058/ 

#PHM20Virtual
Prevalence of Continuous Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not...

In a convenience sample of children hospitalized with bronchiolitis who were not receiving active supplemental oxygen administration, monitoring with continuous pulse oximetry was frequent and varied...

https://pubmed.ncbi.nlm.nih.gov/32315058/
Major Takeaways:

- There is wide variation in pulse oximetry overuse
- Over 1/2 hospitalized children with bronchiolitis remained on pulse ox when not requiring supplemental O2.
- Future work should focus on de-implementation strategies!

#PHM20Virtual #PHMTop10
Implications for Practice from @cjrussellMD

1. Stop putting kids who do not require O2 on continuous Pulse Ox
2. Take kids off continuous Pulse Ox when they are weaned from O2

#PHM20Virtual
Next study: Screening RBUS after 1st UTI not cost effective. Deferring screening until after 2nd UTI preferable..?

“Cost Effectiveness of Screening Ultrasound after a First Febrile Urinary Tract Infection in Children Ages 2-24 Months” Dr. Gaither et al. @JPeds

#PHM20Virtual
Major Takeaways from @CorrieErin:

1. There are many false positives with screening RBUS --> Over testing
2. Screening RBUS after 1st UTI is not cost effective
3. Deferring RBUS until after 2nd UTI may be preferrable

#PHM20Virtual #PHMTop10
And of course there is a cameo from UTI guru @safelydoingless!!! #PHM20Virtual #AlanTheUTIGuy
The next study used QI to⬇️amount of potentially unnecessary procedures at an institution

“A Quality Improvement Initiative to Reduce Gastrostomy Tube Placement in Aspirating Patients” by Dr. Maireade McSweeney et al. @AAPJournals

https://pubmed.ncbi.nlm.nih.gov/31996405/ 

#PHM20Virtual
Major Takeaways from @cjrussellMD:

1. Many kids with aspiration on VFSS can safely avoid G-tube placement
2. Implementation of guideline reduced G-tube placement by 50%!

#PHM20Virtual #PHMTop10
Next up: A study by @landriganc evaluated patient safety differences between residents working extended or non-extended shifts in the PICU.

“Effect on Patient Safety with a Resident Physician Schedule without 24-Hour Shifts” @NEJM

https://pubmed.ncbi.nlm.nih.gov/32579812/ 

#PHM20Virtual
Major Takeaways from @CorrieErin:

1. # of serious pt errors in PICUs ⬆️in residents working shifts <16 hours vs residents working shifts >24 hours.
2. When # of pts per res controlled for, no significant difference was found
3. Infrastructure needed for safety!

#PHM20Virtual
Next Up: Pt debrief interview by Med Students-->deeper self-reflection, learning

“The Patient Experience Debrief Interview: How Conversations with Hospitalized Families Influence Medical Student Learning and Reflection” by Dr. Ian Chua et al. @AcademicMedicine

#PHM20Virtual
Link to the previous article:

https://pubmed.ncbi.nlm.nih.gov/31365398/ 

#PHM20Virtual
The Patient Experience Debrief Interview: How Conversations With Hospitalized Families Influence...

Patient debrief interviews offer a unique approach to deepen self-reflection through direct dialogue and exploration of patient-caregiver experiences during hospitalization.

https://pubmed.ncbi.nlm.nih.gov/31365398/
Next Up: This study showed how health disparities affect the care patients receive

“Impact of Socioeconomic Status on Patients with Kawasaki Disease” by Dr. Audrey Dionne et al @JPeds

https://pubmed.ncbi.nlm.nih.gov/31229318/ 

#PHM20Virtual @PHMTop10
Impact of Socioeconomic Status on Outcomes of Patients with Kawasaki Disease - PubMed

Lower SES is associated with delayed treatment, prolonged LOS, and increased risk of large/giant CAA. Novel approaches to diagnosis and education are needed for children living in low-SES neighborh...

https://pubmed.ncbi.nlm.nih.gov/31229318/
Major Takeaways from @cjrussellMD

1. Patients in lowest SES quartile were more likely to be treated later, receive IVIG after 10 days of sx, and longer LOS.
2. We need to be aware of health disparities in our patients based on race and socioeconomic status

#PHM20Virtual
Lastly: This study showed that there is a disparity in income between female and male pediatricians.

“Gender Differences in Earnings of Early and Midcareer Pediatricians” by Dr. Mary Frintner et al. @AAPJournals

https://pubmed.ncbi.nlm.nih.gov/31506302/ 

#PHM20Virtual #GenderEquity #PHMTop10
Gender Differences in Earnings of Early- and Midcareer Pediatricians - PubMed

Early- to midcareer female pediatricians earned less than male pediatricians. This difference persisted after adjustment for important labor force, physician-specific job, and work-family character...

https://pubmed.ncbi.nlm.nih.gov/31506302/
Major takeaways from @cjrussellMD:

1. Gender inequity is real in Pediatrics
2. Demand transparency in pay inequities
3. Employers must work to decrease inequity in pay based on gender

#PHm20Virtual #GenderEquity #PHMTop10
What are the major future areas of research in PHM?? @CorrieErin highlights them:

#PHM20Virtual #PHMTop10
What a fantastic session!!!

A big thank you to @cjrussell and @CorrieErin for all of their hard work leading the session this year!

#PHM20Virtual #PHMTop10
You can follow @PHMConf.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled:
Those who think consciousness raising & movement building are disconnected, or even a distraction from electoral politics have not paid attention to the history of social change.In this thread, we
Read more
The 2020s will be known as the Remote Work decadeA few predictions of what is likely to emerge[ a thread ] Third Space: Office and Working from Home will
Read more
1/29: Have you ever had a concept explained to you that helps frame complex issues you’ve been wrestling with and opens your eyes to new possibilities? A concept that I
Read more
By continuing to use the site, you are consenting to the use of cookies as explained in our Cookie Policy to improve your experience.