Social and structural factors drive health disparities in children. Hospitalization of a child is stressful for families, especially for low-income families who may experience exacerbation of food insecurity and other financial hardships. There is a need to evaluate interventions to support low-income families after hospitalization to improve child health and family well-being and ultimately to reduce health disparities.
In this randomized control trial (RCT), we will compare the effectiveness of a post-discharge financial support intervention with standard resources on the primary outcomes of food insecurity and urgent healthcare reutilization over 12 months among low-income families of hospitalized children.
Families are eligible to participate if their child is hospitalized on our main Hospital Medicine unit between September 2024 and July 2025, <18 years old, and enrolled in our institution's Medicaid accountable care organization. Our planned sample size is 400, with a 3:1 control to intervention randomization. The intervention is monthly $100 gift cards to a grocery store chain, provided for 12 months after hospital discharge. Intervention and control participants are offered standard resources (i.e., social work referral) as needed. We will assess food insecurity through longitudinal surveys and urgent healthcare reutilization with claims data. Our secondary outcomes include family-centered measures, primary care utilization, and cost.
We expect to complete primary analyses in the spring of 2027.
In this RCT, we will evaluate the effectiveness of a post-discharge financial support intervention among low-income families. Findings may inform future high-value interventions, programs, and policies to support low-income families and children.
Antibiograms are important tools to guide empirical antibiotic selection. Aggregate antibiograms for children can provide guidance when local data are scarce (e.g., unavailable, insufficient isolates) and support regional and national comparisons; however, aggregate reporting is limited.
To examine antibiotic susceptibility patterns for children and to compare patterns of resistance by isolate source and geographic region.
A request for submission of the most recent institutional antibiogram was sent to 51 US children′s hospitals in April 2023. Data elements were transcribed and standardized to facilitate aggregate analysis. Aggregate antibiograms were generated, and logistic regression was performed to examine regional differences in susceptibilities.
We received 46 institutional antibiograms. Antibiograms varied in presentation including the number and types of bacteria and antibiotics, reporting by specimen source (e.g., urine) and location (i.e., hospital unit). Staphylococcus spp. were the most frequently reported Gram-positive bacteria. Of the more than 35,000 Staphylococcus aureus isolates, 35.4% were identified as methicillin resistant and nearly 80% were susceptible to clindamycin. Escherichia coli and Klebsiella spp. were the most frequently reported Gram-negative bacteria with 85.4% and 84.1% of isolates, respectively, demonstrating susceptibility to cefazolin. Regional differences in susceptibilities were observed. For example, S. aureus isolates from hospitals located in the Southern region of the United States had the lowest susceptibility to oxacillin.
This study provides regional and national data on pediatric antibiotic susceptibilities at US children′s hospitals. Many opportunities exist for the use and reporting of aggregate antibiograms to enhance antimicrobial stewardship processes and monitor changes in antimicrobial resistance.
A 77-year-old female with a 2-month history of ascites, a right hepatic flexure mass, and peritoneal carcinomatosis presented with worsening abdominal distension, weakness and encephalopathy. Bedside ultrasound showed dense loculated ascites and hyperechoic fluid (Video 1). Abdominal computed tomography (CT) images were reviewed to ensure ultrasound findings were not cystic renal masses or dilated bowel loops (Figure 1). During the paracentesis, thick, gelatinous ascitic fluid repeatedly clogged the 8 F catheter, resulting in procedure termination after aspiration of 150 mL of fluid (Video 2).
Mucinous ascites most often results from low- or high-grade mucinous appendiceal tumors and much less often from other sites such as ovarian teratomas, colorectal tumors, urachus, and pancreatic tumors.1 The term pseudomyxoma peritonei (PMP) is used when mucinous deposition follows the phenomena of “redistribution,” with selective deposition in specific sites in the greater omentum, liver capsule, and pericolic gutters.1 Mucinous deposits along serosal surfaces can result in “scalloping” of the liver or spleen on CT and ultrasound.2 The appearance of the ascitic fluid on ultrasound is often echogenic and septated.2
Ascitic fluid may not provide additional diagnostic information, aside from fluid characteristics, as large quantities of acellular mucin may limit cytologic evaluation. Diagnosis and staging require peritoneal biopsy for histologic grading and identifying the primary tumor site.1, 2 Large volume paracentesis for palliation of mucinous ascites can be difficult due to fluid viscosity and laparoscopic surgical drainage may provide palliative relief in cases such as ours.
The authors declare no conflict of interest.
Informed consent for this case presentation was obtained from the patient's designated medical decision maker.
The authors have nothing to report.
Internists routinely replete potassium to a high-goal serum level of ≥4 mmol/L in patients with acute myocardial infarction to reduce the risk of ventricular arrhythmias and mortality. Recent literature demonstrates that a potassium goal of >3.5 mmol/L likely coincides with the lowest risk of mortality. Based on these data, internists should individualize potassium goals rather than routinely aiming for a high-goal serum level of ≥4 mmol/L.
Workplace violence (WPV) in healthcare is a growing crisis, and hospital-based approaches are urgently needed. We review two recently published efforts and describe our own pathway to address WPV. Sahota et al. implemented a specialized team and leveraged individualized care plans for high-risk patients, while Littlefield et al. took a policy-driven approach, enabling administrative discharge of disruptive patients. Our pathway utilized patient-centered anticipatory guidance, staff de-escalation training, and a behavioral emergency response. All three approaches illustrate that WPV prevention must move beyond reactive protocols and pivot to proactive, patient-informed solutions.
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