Articles: child.
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Accuracy of pathogen diagnostic codes for acute hematogenous musculoskeletal infections in children.
Administrative databases are powerful tools for pediatric research but lack patient-level microbiology results. This study aimed to determine the accuracy of pathogen discharge diagnosis codes for children hospitalized with acute hematogenous musculoskeletal infections (MSKIs). Medical records for 244 children hospitalized with acute hematogenous MSKIs were manually reviewed to determine which bacterial pathogen, if any, was identified for each MSKI based on microbiology results obtained during the hospitalization. ⋯ Discharge diagnostic codes correctly matched the microbiology results in 89.3% of encounters. Sensitivity and specificity for Staphylococcus aureus discharge diagnostic codes were 88.6% and 96.4% respectively for methicillin-susceptible S. aureus and 92.9% and 99.5% for methicillin-resistant S. aureus. Pathogen discharge codes are reliable surrogates that accurately reflect the microbiology results for children with MSKIs.
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Endometrial cancer is the most prevalent gynecologic cancer in the United States and has rising incidence and mortality. Endometrial intraepithelial neoplasia or atypical endometrial hyperplasia (EIN-AEH), a precancerous neoplasm, is surgically managed with hysterectomy in patients who have completed childbearing because of risk of progression to cancer. Concurrent endometrial carcinoma (EC) is also present on hysterectomy specimens in up to 50% of cases. ⋯ If on subsequent pathology, EC is identified, the patient should be referred to a GO for further treatment considerations and counseling. Determining the optimal treatment for patients with EIN-AEH is nuanced and, within the military health care system, is complicated by varied access to expert management by a GO subspecialist. Military beneficiaries with this diagnosis present a unique challenge and warrant a standardized approach to maximize clinical outcomes.
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J Pain Symptom Manage · Jan 2025
Association of Palliative Care Timing with End-of-Life Quality in Children with Heart Disease.
Children with heart disease are at risk for early mortality and parents often perceive suffering at end-of-life (EOL). Involvement of pediatric palliative care (PPC) is a proposed quality measure at the EOL in children with cancer, and early PPC involvement is associated with other quality measures. The impact of early PPC involvement on EOL quality is unknown in children with heart disease. ⋯ Our findings may indicate that quality indicators extrapolated from pediatric oncology do not apply to children with heart disease, as they have notably different disease trajectories and intervention options. We recommend defining high-quality EOL care indicators for children with heart disease as a priority.