Medicine's clinical understanding of reactive infectious mucocutaneous eruption (RIME) has evolved over time. It was previously described as Mycoplasma pneumoniae-induced rash and mucositis (MIRM), and before that as a variant of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Here, we summarize the current understanding of best practices for RIME diagnosis and management.
In medicine, professional experiences and work environment can impact physician satisfaction and well-being. Little is known about these experiences in pediatric hospital medicine.
The objective of this study was to examine self-reported factors associated with professional experience, career development, and career satisfaction, and to compare aspects of these domains between men and women.
This was a cross-sectional survey study of 1096 pediatric hospitalists performed in 2021. Our survey tool included novel and previously published questions. Responses were collected via an online survey platform and summarized using descriptive statistics, including frequency distributions and measures of central tendency. A multivariable logistic regression was used to examine associations between variables and career satisfaction.
Five hundred and sixty-five respondents (52.3% response rate) completed the survey with 70.6% women. Over three-quarters (77.4%) reported career satisfaction, and 71.9% would choose Pediatric Hospital Medicine (PHM) again. Work-life balance was positively associated with career satisfaction, while perception of gender-specific bias decreased career satisfaction. Satisfaction with mentoring was reported by 88% of respondents with a mentor. Positive aspects of professional experience included peer relationships and support. However, 29.7% experienced gender discrimination, 26.5% were treated with disrespect by colleagues, and 40% perceived gender biases in the professional environment—women more than men on most measures.
Satisfaction with career, peer relationships, and mentoring was high; however, opportunities to improve the professional experience exist, including addressing potential mentorship gaps and discrimination. This study adds insights into career satisfaction in PHM.
Behavioral escalation events have become commonplace in the acute care setting. Disruptive patient behaviors contribute to workplace injuries and can compromise patient care and safety. Despite frequently encountering behavioral escalation, limited research exists on hospitalists' practices and perspectives when addressing disruptive behaviors.
To explore hospitalists' experiences and perspectives when navigating behavioral escalation events in adult acute care settings.
We conducted a rapid qualitative study on February 10, 2023, with four semi-structured virtual focus groups involving 27 hospital medicine participants across 19 US hospitals via the Hospital Medicine Reengineering Network (HOMERuN). Discussions examined hospitalist experiences with behavioral escalation and perspectives on response strategies.
Our rapid qualitative study identified four key themes. (1) Many hospitals lack strategies to identify patients or situations at risk of behavioral escalation. (2) Interdisciplinary collaboration is considered essential, yet dedicated response teams are often unavailable. (3) Lack of standardized approaches to disruptive behaviors and inadequate hospitalist training in de-escalation may lead to varied responses. (4) Limited proactive measures to anticipate escalation and inconsistent use of EHR behavioral alerts may unintentionally stigmatize patients.
Behavioral escalation events in the acute care setting pose significant risks to patient and staff safety while disrupting healthcare delivery. Participants highlighted limited strategies to anticipate behavioral escalation, inconsistent interdisciplinary team response structures, and minimal opportunity for debriefing or event review. Focus groups emphasized the need for systems that support team-based de-escalation training and incorporate bias and equity considerations into behavioral response practices.
Continuous pulse oximetry monitoring in stable children with bronchiolitis not requiring supplemental oxygen has been identified as a low-value practice. However, little is known about how parents and other caregivers experience efforts to deimplement this practice.
This study investigated caregivers' experiences during their child's recent hospitalization for bronchiolitis on units involved in a deimplementation trial.
We conducted semi-structured qualitative interviews with 15 caregivers of children hospitalized with bronchiolitis at 11 hospitals participating in deimplementation strategies to reduce unnecessary continuous pulse oximetry monitoring as part of the Eliminating Monitoring Overuse (EMO) trial. Interviews were recorded, transcribed, and coded using an integrative analytic approach.
Caregivers were a mean (SD) 31.1 (5.7) years old, predominantly female (93.3%), white (73.3%), and Non-Hispanic (86.7%). Previous hospitalization experiences and prior knowledge and training influenced caregiver perceptions of the value of monitoring. Participants did not discuss noticing changes in monitoring practices in interviews.
Findings suggest that tailored education about monitoring may lessen caregiver concerns.
Timely postdischarge visits reduce readmissions, but the impact of telemedicine follow-up remains unclear. The coronavirus disease 2019 (COVID-19) pandemic rapidly expanded telemedicine, offering a unique opportunity to assess its impact on outcomes.
Evaluate the association between telemedicine versus in-person follow-up and 30-day outcomes before, during, and after the COVID-19 pandemic.
Retrospective cohort study of adults discharged from the Medicine Service across 21 hospitals (2017–2023). Telemedicine (video/telephone) versus in-person visits within 7 days of discharge were compared. The primary outcome was 30-day nonelective readmission. Secondary outcomes included 30-day all-cause readmission, emergency department (ED) visits, and mortality. Competing risk and Cox regression models were used, with inverse probability of treatment weighting to address differences.
Among 137,765 patients (mean age 67.5 years, 49.1% female), 59.2% received telemedicine follow-up. Pre-pandemic, 28.2% had telemedicine visits, associated with higher 30-day nonelective readmission risk (adjusted hazard ratio [aHR]: 1.23, 95% confidence interval [CI]: 1.19–1.28, p < .01) and mortality (aHR: 1.87, 95% CI: 1.71–2.05, p < .01). During COVID-19, telemedicine was associated with lower nonelective readmission risk (aHR: 0.92, 95% CI: 0.88–0.97, p < .01), fewer ED visits (aHR: 0.88, 95% CI: 0.84–0.92, p < .01), and no difference in mortality (aHR: 1.10, 95% CI: 0.98–1.24, p = .11). Post-COVID-19, readmission and ED visit risks were similar, though mortality was higher in the telemedicine group (aHR: 1.33, 95% CI: 1.20–1.49, p < .01).
Telemedicine follow-up was associated with favorable outcomes during the pandemic, supporting its use as an alternative to in-person care. Pre- and postpandemic differences likely reflect patient selection. A hybrid follow-up model may optimize access and outcomes in postdischarge care.
With a resurgence of vaccine-preventable diseases and increasing vaccine disinformation, vaccine hesitancy is a serious threat to public health around the world. Through an empathetic approach to vaccine conversations, sharing a strong recommendation, and using strategies like motivational interviewing, clinicians can partner with patients and families to improve vaccine confidence. Extending evidence-based approaches to vaccine communication and immunization delivery across patient populations can improve vaccination coverage from infancy through old age. Talking about and administering vaccines in hospital settings expands opportunities to address vaccine hesitancy and increase vaccination uptake.
To decrease symptoms of physiological infant reflux, nonpharmacological techniques named “reflux precautions” are taught to families. Reflux precautions do not have a universal definition but can include burping, holding an infant upright pre- and postfeed, smaller and more frequent feedings, and elevating the head of the bed. Despite a lack of consensus on what constitutes reflux precautions, and a paucity of research, physicians and other providers continue to recommend them. In recommending reflux precautions, we pathologize normal physiology, sending mixed messages to families. Routine recommendation of reflux precautions for infant reflux is a Thing We Do for No Reason™.
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