Does it seem strange to you that while on one hand we hear from multiple sources that a troubling number of adults and children are going hungry, but on the other hand data from the Centers for Disease Control and Prevention indicate that self reports of obesity by adults in 2014 in different ethnic groups ranged from 27% to 38% and approximately 17% of children and adolescents aged 2-19 years are obese per 2011-2012 data?

One might guess that this situation is simply that too many Americans can afford to overeat and their numbers overwhelm the data from a smaller segment of the population who are underweight because they can’t afford to feed themselves.

But this isn’t the case at all, because the obesity rates in our poorest counties are nearly 12% above the national median (“Obesity: The New Hunger” by Robert Paarlberg, Ph.D., The Wall Street Journal, May 10, 2016). So the question is why do we have so many overweight adults and children if we also have a hunger problem? The answer is very complicated and even more complicated because of how we define hunger.

While obesity is relatively easy to measure with a scale and a tape measure, hunger is a perception that is difficult, if not impossible, to quantify. Possibly in an attempt to create clarity for people like me who are confused by the coexistence of hunger and obesity, there has been a trend toward replacing “hunger” with the more techno-sounding buzz words, “food insecurity.”

According to Dr. Paarlberg, an adjunct professor of public policy at Harvard University, Cambridge, Mass., and author of “The United States of Excess: Gluttony and the Dark Side of American Exceptionalism” (New York, N.Y.: Oxford University Press, 2015), the United States Department of Agriculture calculates our national food insecurity quotient by way of an annual survey of a sample of households. Family members are asked questions such as whether “they had failed to eat or worried about running out of food for lack of money at any time in the previous 12 months.”

There are many reasons why a survey respondent might be concerned that he or she wouldn’t have enough to eat on a given day. It could have been poor planning on the part of the head of the household or a consequence of family chaos. And we have to assume that in some cases, it is simply because there wasn’t enough money to buy food that day. If it were only a matter of money, the solution would be easy. We could simply provide economically challenged families with more money to buy more food, but that is already being done through programs such as the Supplemental Nutrition Assistance Program (often referred to as food stamps or SNAP). But the coexistence of obesity and hunger suggests to me that more food isn’t the answer.

Part of the problem is that “food” is too broadly defined. Some foods are more likely to contribute to obesity than others, and some foods satiate more quickly than others. While some restrictions have been built into the SNAP program to encourage participants to eat a healthier diet, the fact that soda and candy can be bought with food stamps is a serious error that must be corrected. It may be time to take a harder look at tightening other guidelines to make the subsidized diet healthier.

Unfortunately, the last step in the process occurs in the home. A diet that discourages obesity often includes fresh fruits and vegetables that can be expensive and may not be appealing to a family accustomed to calorie-dense foods. And a healthy diet often requires preparation skills and time, both of which economically challenged families may not have.

All of this makes me wonder whether we should stop worrying so much about hunger in America and shift the focus of our nutritional support programs more toward obesity prevention. Of course, that is easy to say for someone like myself who is lean and can always find something in the refrigerator to eat. But let’s remember that while starvation and obesity can kill, hunger doesn’t.

The problem is that “hunger” and the less emotionally charged term “food insecurity” are potent motivators for legislators who control the funding of our critical nutritional support programs. It still makes sense politically to continue to talk about eliminating hunger. But we need to craft our programs so that they address the larger problem of obesity.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.”

Does it seem strange to you that while on one hand we hear from multiple sources that a troubling number of adults and children are going hungry, but on the other hand data from the Centers for Disease Control and Prevention indicate that self reports of obesity by adults in 2014 in different ethnic groups ranged from 27% to 38% and approximately 17% of children and adolescents aged 2-19 years are obese per 2011-2012 data?

One might guess that this situation is simply that too many Americans can afford to overeat and their numbers overwhelm the data from a smaller segment of the population who are underweight because they can’t afford to feed themselves.

But this isn’t the case at all, because the obesity rates in our poorest counties are nearly 12% above the national median (“Obesity: The New Hunger” by Robert Paarlberg, Ph.D., The Wall Street Journal, May 10, 2016). So the question is why do we have so many overweight adults and children if we also have a hunger problem? The answer is very complicated and even more complicated because of how we define hunger.

While obesity is relatively easy to measure with a scale and a tape measure, hunger is a perception that is difficult, if not impossible, to quantify. Possibly in an attempt to create clarity for people like me who are confused by the coexistence of hunger and obesity, there has been a trend toward replacing “hunger” with the more techno-sounding buzz words, “food insecurity.”

According to Dr. Paarlberg, an adjunct professor of public policy at Harvard University, Cambridge, Mass., and author of “The United States of Excess: Gluttony and the Dark Side of American Exceptionalism” (New York, N.Y.: Oxford University Press, 2015), the United States Department of Agriculture calculates our national food insecurity quotient by way of an annual survey of a sample of households. Family members are asked questions such as whether “they had failed to eat or worried about running out of food for lack of money at any time in the previous 12 months.”

There are many reasons why a survey respondent might be concerned that he or she wouldn’t have enough to eat on a given day. It could have been poor planning on the part of the head of the household or a consequence of family chaos. And we have to assume that in some cases, it is simply because there wasn’t enough money to buy food that day. If it were only a matter of money, the solution would be easy. We could simply provide economically challenged families with more money to buy more food, but that is already being done through programs such as the Supplemental Nutrition Assistance Program (often referred to as food stamps or SNAP). But the coexistence of obesity and hunger suggests to me that more food isn’t the answer.

Part of the problem is that “food” is too broadly defined. Some foods are more likely to contribute to obesity than others, and some foods satiate more quickly than others. While some restrictions have been built into the SNAP program to encourage participants to eat a healthier diet, the fact that soda and candy can be bought with food stamps is a serious error that must be corrected. It may be time to take a harder look at tightening other guidelines to make the subsidized diet healthier.

Unfortunately, the last step in the process occurs in the home. A diet that discourages obesity often includes fresh fruits and vegetables that can be expensive and may not be appealing to a family accustomed to calorie-dense foods. And a healthy diet often requires preparation skills and time, both of which economically challenged families may not have.

All of this makes me wonder whether we should stop worrying so much about hunger in America and shift the focus of our nutritional support programs more toward obesity prevention. Of course, that is easy to say for someone like myself who is lean and can always find something in the refrigerator to eat. But let’s remember that while starvation and obesity can kill, hunger doesn’t.

The problem is that “hunger” and the less emotionally charged term “food insecurity” are potent motivators for legislators who control the funding of our critical nutritional support programs. It still makes sense politically to continue to talk about eliminating hunger. But we need to craft our programs so that they address the larger problem of obesity.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.”

Does it seem strange to you that while on one hand we hear from multiple sources that a troubling number of adults and children are going hungry, but on the other hand data from the Centers for Disease Control and Prevention indicate that self reports of obesity by adults in 2014 in different ethnic groups ranged from 27% to 38% and approximately 17% of children and adolescents aged 2-19 years are obese per 2011-2012 data?

One might guess that this situation is simply that too many Americans can afford to overeat and their numbers overwhelm the data from a smaller segment of the population who are underweight because they can’t afford to feed themselves.

But this isn’t the case at all, because the obesity rates in our poorest counties are nearly 12% above the national median (“Obesity: The New Hunger” by Robert Paarlberg, Ph.D., The Wall Street Journal, May 10, 2016). So the question is why do we have so many overweight adults and children if we also have a hunger problem? The answer is very complicated and even more complicated because of how we define hunger.

While obesity is relatively easy to measure with a scale and a tape measure, hunger is a perception that is difficult, if not impossible, to quantify. Possibly in an attempt to create clarity for people like me who are confused by the coexistence of hunger and obesity, there has been a trend toward replacing “hunger” with the more techno-sounding buzz words, “food insecurity.”

According to Dr. Paarlberg, an adjunct professor of public policy at Harvard University, Cambridge, Mass., and author of “The United States of Excess: Gluttony and the Dark Side of American Exceptionalism” (New York, N.Y.: Oxford University Press, 2015), the United States Department of Agriculture calculates our national food insecurity quotient by way of an annual survey of a sample of households. Family members are asked questions such as whether “they had failed to eat or worried about running out of food for lack of money at any time in the previous 12 months.”

There are many reasons why a survey respondent might be concerned that he or she wouldn’t have enough to eat on a given day. It could have been poor planning on the part of the head of the household or a consequence of family chaos. And we have to assume that in some cases, it is simply because there wasn’t enough money to buy food that day. If it were only a matter of money, the solution would be easy. We could simply provide economically challenged families with more money to buy more food, but that is already being done through programs such as the Supplemental Nutrition Assistance Program (often referred to as food stamps or SNAP). But the coexistence of obesity and hunger suggests to me that more food isn’t the answer.

Part of the problem is that “food” is too broadly defined. Some foods are more likely to contribute to obesity than others, and some foods satiate more quickly than others. While some restrictions have been built into the SNAP program to encourage participants to eat a healthier diet, the fact that soda and candy can be bought with food stamps is a serious error that must be corrected. It may be time to take a harder look at tightening other guidelines to make the subsidized diet healthier.

Unfortunately, the last step in the process occurs in the home. A diet that discourages obesity often includes fresh fruits and vegetables that can be expensive and may not be appealing to a family accustomed to calorie-dense foods. And a healthy diet often requires preparation skills and time, both of which economically challenged families may not have.

All of this makes me wonder whether we should stop worrying so much about hunger in America and shift the focus of our nutritional support programs more toward obesity prevention. Of course, that is easy to say for someone like myself who is lean and can always find something in the refrigerator to eat. But let’s remember that while starvation and obesity can kill, hunger doesn’t.

The problem is that “hunger” and the less emotionally charged term “food insecurity” are potent motivators for legislators who control the funding of our critical nutritional support programs. It still makes sense politically to continue to talk about eliminating hunger. But we need to craft our programs so that they address the larger problem of obesity.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.”

We’ve made great progress treating people who are infected with HIV, but if they get cancer they’re less likely to get the care they need, a recent study found.

Researchers examined treatment for a variety of cancers, including upper gastrointestinal tract, colorectal, prostate, lung, head and neck, cervix, breast, anal and two blood cancers. With the exception of anal cancer, treatment rates differed significantly between HIV-infected people and those who weren’t infected, according to the study.

For example, 33 percent of patients with HIV and lung cancer failed to receive any treatment for the cancer compared with 14 percent of those who weren’t infected. Similarly, 44 percent of people who were HIV positive didn’t receive treatment for upper GI cancer versus 18 percent of those who weren’t infected with HIV. Twenty-four percent of men with prostate cancer who were HIV positive didn’t get treatment compared with 7 percent of non-HIV infected men.

Cancer treatment was defined as radiation, chemotherapy and/or surgery.

“To have made such great strides with treating HIV only to have them succumb to cancer is devastating,” said Dr. Gita Suneja, a radiation oncologist at the University of Utah’s Huntsman Cancer Institute in Salt Lake City and the lead author of the study. It was published online this month in the journal Cancer.

The study used the National Cancer Data Base to analyze treatment for adults younger than 65 who were diagnosed with any of the 10 most common cancers to affect HIV patients between 2003 and 2011. The study included 10,265 HIV-infected adults and 2.2 million without HIV.

The data base, which is sponsored by the American Cancer Society and the American College of Surgeons, captures roughly 70 percent of newly diagnosed cancer cases in the United States.

The study noted that more than a third of the patients with HIV had stage 4 cancer — cancer that has metastasized — when they were diagnosed, while only 19 percent of those without HIV did.

Improvements in antiretroviral therapy to treat HIV have helped reduce the incidence of cancers such as Kaposi sarcoma that are closely linked to AIDS, but rates for other cancers often associated with normal aging have increased among HIV patients. In addition, people with HIV have a higher incidence of some lifestyle-related cancers, such as lung cancer, which could be linked to higher rates of smoking. Cancer is now the second most common cause of death among HIV-infected people, behind AIDS-related causes.

HIV patients are more likely to be uninsured or underinsured, and lack of coverage can affect access to cancer care. But having insurance didn’t eliminate the problem: privately insured people with HIV were significantly more likely to be untreated for many cancers than were privately insured people without HIV, the study found.

“We know that people with Medicaid or who are uninsured receive subpar cancer treatment, and that’s a big public health issue,” said Suneja. “But even factoring that in, HIV-infected people are still less likely to receive cancer treatment. That means there are other drivers that we couldn’t measure in the study.”

Disparities in cancer treatment could exist for several reasons. For one thing, for most cancers there are no national treatment guidelines for HIV-infected patients, Suneja said. One of the few exceptions is anal cancer, the only cancer for which the study found little discrepancy in treatment among HIV-infected and non-infected patients. According to the research, the difference among those not receiving treatment was 4.8 percent for HIV patients versus 3.1 percent for others.

For other cancers, “the oncologist may pause and ask, ‘Does the HIV infection mean they shouldn’t get standard cancer treatment?’” Suneja added.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

We’ve made great progress treating people who are infected with HIV, but if they get cancer they’re less likely to get the care they need, a recent study found.

Researchers examined treatment for a variety of cancers, including upper gastrointestinal tract, colorectal, prostate, lung, head and neck, cervix, breast, anal and two blood cancers. With the exception of anal cancer, treatment rates differed significantly between HIV-infected people and those who weren’t infected, according to the study.

For example, 33 percent of patients with HIV and lung cancer failed to receive any treatment for the cancer compared with 14 percent of those who weren’t infected. Similarly, 44 percent of people who were HIV positive didn’t receive treatment for upper GI cancer versus 18 percent of those who weren’t infected with HIV. Twenty-four percent of men with prostate cancer who were HIV positive didn’t get treatment compared with 7 percent of non-HIV infected men.

Cancer treatment was defined as radiation, chemotherapy and/or surgery.

“To have made such great strides with treating HIV only to have them succumb to cancer is devastating,” said Dr. Gita Suneja, a radiation oncologist at the University of Utah’s Huntsman Cancer Institute in Salt Lake City and the lead author of the study. It was published online this month in the journal Cancer.

The study used the National Cancer Data Base to analyze treatment for adults younger than 65 who were diagnosed with any of the 10 most common cancers to affect HIV patients between 2003 and 2011. The study included 10,265 HIV-infected adults and 2.2 million without HIV.

The data base, which is sponsored by the American Cancer Society and the American College of Surgeons, captures roughly 70 percent of newly diagnosed cancer cases in the United States.

The study noted that more than a third of the patients with HIV had stage 4 cancer — cancer that has metastasized — when they were diagnosed, while only 19 percent of those without HIV did.

Improvements in antiretroviral therapy to treat HIV have helped reduce the incidence of cancers such as Kaposi sarcoma that are closely linked to AIDS, but rates for other cancers often associated with normal aging have increased among HIV patients. In addition, people with HIV have a higher incidence of some lifestyle-related cancers, such as lung cancer, which could be linked to higher rates of smoking. Cancer is now the second most common cause of death among HIV-infected people, behind AIDS-related causes.

HIV patients are more likely to be uninsured or underinsured, and lack of coverage can affect access to cancer care. But having insurance didn’t eliminate the problem: privately insured people with HIV were significantly more likely to be untreated for many cancers than were privately insured people without HIV, the study found.

“We know that people with Medicaid or who are uninsured receive subpar cancer treatment, and that’s a big public health issue,” said Suneja. “But even factoring that in, HIV-infected people are still less likely to receive cancer treatment. That means there are other drivers that we couldn’t measure in the study.”

Disparities in cancer treatment could exist for several reasons. For one thing, for most cancers there are no national treatment guidelines for HIV-infected patients, Suneja said. One of the few exceptions is anal cancer, the only cancer for which the study found little discrepancy in treatment among HIV-infected and non-infected patients. According to the research, the difference among those not receiving treatment was 4.8 percent for HIV patients versus 3.1 percent for others.

For other cancers, “the oncologist may pause and ask, ‘Does the HIV infection mean they shouldn’t get standard cancer treatment?’” Suneja added.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

We’ve made great progress treating people who are infected with HIV, but if they get cancer they’re less likely to get the care they need, a recent study found.

Researchers examined treatment for a variety of cancers, including upper gastrointestinal tract, colorectal, prostate, lung, head and neck, cervix, breast, anal and two blood cancers. With the exception of anal cancer, treatment rates differed significantly between HIV-infected people and those who weren’t infected, according to the study.

For example, 33 percent of patients with HIV and lung cancer failed to receive any treatment for the cancer compared with 14 percent of those who weren’t infected. Similarly, 44 percent of people who were HIV positive didn’t receive treatment for upper GI cancer versus 18 percent of those who weren’t infected with HIV. Twenty-four percent of men with prostate cancer who were HIV positive didn’t get treatment compared with 7 percent of non-HIV infected men.

Cancer treatment was defined as radiation, chemotherapy and/or surgery.

“To have made such great strides with treating HIV only to have them succumb to cancer is devastating,” said Dr. Gita Suneja, a radiation oncologist at the University of Utah’s Huntsman Cancer Institute in Salt Lake City and the lead author of the study. It was published online this month in the journal Cancer.

The study used the National Cancer Data Base to analyze treatment for adults younger than 65 who were diagnosed with any of the 10 most common cancers to affect HIV patients between 2003 and 2011. The study included 10,265 HIV-infected adults and 2.2 million without HIV.

The data base, which is sponsored by the American Cancer Society and the American College of Surgeons, captures roughly 70 percent of newly diagnosed cancer cases in the United States.

The study noted that more than a third of the patients with HIV had stage 4 cancer — cancer that has metastasized — when they were diagnosed, while only 19 percent of those without HIV did.

Improvements in antiretroviral therapy to treat HIV have helped reduce the incidence of cancers such as Kaposi sarcoma that are closely linked to AIDS, but rates for other cancers often associated with normal aging have increased among HIV patients. In addition, people with HIV have a higher incidence of some lifestyle-related cancers, such as lung cancer, which could be linked to higher rates of smoking. Cancer is now the second most common cause of death among HIV-infected people, behind AIDS-related causes.

HIV patients are more likely to be uninsured or underinsured, and lack of coverage can affect access to cancer care. But having insurance didn’t eliminate the problem: privately insured people with HIV were significantly more likely to be untreated for many cancers than were privately insured people without HIV, the study found.

“We know that people with Medicaid or who are uninsured receive subpar cancer treatment, and that’s a big public health issue,” said Suneja. “But even factoring that in, HIV-infected people are still less likely to receive cancer treatment. That means there are other drivers that we couldn’t measure in the study.”

Disparities in cancer treatment could exist for several reasons. For one thing, for most cancers there are no national treatment guidelines for HIV-infected patients, Suneja said. One of the few exceptions is anal cancer, the only cancer for which the study found little discrepancy in treatment among HIV-infected and non-infected patients. According to the research, the difference among those not receiving treatment was 4.8 percent for HIV patients versus 3.1 percent for others.

For other cancers, “the oncologist may pause and ask, ‘Does the HIV infection mean they shouldn’t get standard cancer treatment?’” Suneja added.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

More than 24,000 veterans who received examinations but were not diagnosed with traumatic brain injuries (TBIs) will be eligible for new medical examinations, the VA has announced. Due to confusing guidance documents, the original examinations were not conducted by a psychiatrist, physiatrist, neurosurgeon, or neurologist as mandated by VA policy. The 24,000 veterans may be eligible for additional benefits and service-connected compensation based on the results of the new examinations.

“Traumatic Brain Injury is a signature injury in veterans returning from the conflicts in Iraq and Afghanistan, and VA is proud to be an organization that sets the bar high for supporting these, and all, veterans,” said Secretary of Veterans Affairs Robert McDonald in a statement. “Providing support for veterans suffering from a TBI is a priority and a privilege, and we must make certain they receive a just and fair rating for their disabilities.”

The current VA policy dates to 2007 and requires that a specialist complete a TBI examination when VA does not have a prior diagnosis. However, given the rapidly changing science around TBI since 2007, the VA has issued multiple additional guidance documents. These additional guidance documents, the VA notes, “created confusion regarding the policy.” 

“We let these veterans down,” Secretary McDonald said. “That is why we are taking every step necessary to grant equitable relief to those affected to ensure they receive the full benefits to which they are entitled.”

Veterans will not be required to submit new claims and the VA has pledged to contact the identified patients to offer them a new examination. According to the VA > 13,000 veterans are already receiving 10% or higher service-connected compensation benefits for TBI.

More than 24,000 veterans who received examinations but were not diagnosed with traumatic brain injuries (TBIs) will be eligible for new medical examinations, the VA has announced. Due to confusing guidance documents, the original examinations were not conducted by a psychiatrist, physiatrist, neurosurgeon, or neurologist as mandated by VA policy. The 24,000 veterans may be eligible for additional benefits and service-connected compensation based on the results of the new examinations.

“Traumatic Brain Injury is a signature injury in veterans returning from the conflicts in Iraq and Afghanistan, and VA is proud to be an organization that sets the bar high for supporting these, and all, veterans,” said Secretary of Veterans Affairs Robert McDonald in a statement. “Providing support for veterans suffering from a TBI is a priority and a privilege, and we must make certain they receive a just and fair rating for their disabilities.”

The current VA policy dates to 2007 and requires that a specialist complete a TBI examination when VA does not have a prior diagnosis. However, given the rapidly changing science around TBI since 2007, the VA has issued multiple additional guidance documents. These additional guidance documents, the VA notes, “created confusion regarding the policy.” 

“We let these veterans down,” Secretary McDonald said. “That is why we are taking every step necessary to grant equitable relief to those affected to ensure they receive the full benefits to which they are entitled.”

Veterans will not be required to submit new claims and the VA has pledged to contact the identified patients to offer them a new examination. According to the VA > 13,000 veterans are already receiving 10% or higher service-connected compensation benefits for TBI.

More than 24,000 veterans who received examinations but were not diagnosed with traumatic brain injuries (TBIs) will be eligible for new medical examinations, the VA has announced. Due to confusing guidance documents, the original examinations were not conducted by a psychiatrist, physiatrist, neurosurgeon, or neurologist as mandated by VA policy. The 24,000 veterans may be eligible for additional benefits and service-connected compensation based on the results of the new examinations.

“Traumatic Brain Injury is a signature injury in veterans returning from the conflicts in Iraq and Afghanistan, and VA is proud to be an organization that sets the bar high for supporting these, and all, veterans,” said Secretary of Veterans Affairs Robert McDonald in a statement. “Providing support for veterans suffering from a TBI is a priority and a privilege, and we must make certain they receive a just and fair rating for their disabilities.”

The current VA policy dates to 2007 and requires that a specialist complete a TBI examination when VA does not have a prior diagnosis. However, given the rapidly changing science around TBI since 2007, the VA has issued multiple additional guidance documents. These additional guidance documents, the VA notes, “created confusion regarding the policy.” 

“We let these veterans down,” Secretary McDonald said. “That is why we are taking every step necessary to grant equitable relief to those affected to ensure they receive the full benefits to which they are entitled.”

Veterans will not be required to submit new claims and the VA has pledged to contact the identified patients to offer them a new examination. According to the VA > 13,000 veterans are already receiving 10% or higher service-connected compensation benefits for TBI.

After implementation of a quality improvement initiative to more effectively screen febrile children for urinary tract infections (UTIs) in the emergency department, catheterization rates dropped from 63% to 30% over a 6-month period, a study found.

The sustained drop prevented more than 350 young children from catheterization without increasing revisit rates or missing UTIs in the 39% of children who were followed in the care network. This was in a study that compared catheterization rates in 1,520 children aged 6-24 months in the year before the intervention and 828 children in the 6 months during the intervention.

“Although urine catheterization remains the gold standard in diagnosing UTIs, it is an invasive procedure that may be avoided in most patients who are being screened,” wrote Dr. Jane M. Lavelle of Children’s Hospital of Philadelphia (CHOP) and her associates. UTI screening by this method can be “painful, time consuming, and costly,” they added (Pediatrics. 2016 June 2. doi: 10.1542/peds.2015-3023).

©Fuse/thinkstockphotos.com

An alternative method to automatic catheterization is a two-step process already included as an option in American Academy of Pediatrics guidelines: Instead of collecting urine through catheterization just once for screening and culture, an emergency department first noninvasively collects urine with a urine bag for screening in those indicated with evidence-based risk factors, and then catheterizes only those who screen positive (Pediatrics. 2011;128[3]:595-610).

“Due to the predictive models’ higher sensitivity than specificity for screening, most urine samples will have a negative screen for pyuria or bacteriuria by urine dipstick or microscopy,” the authors wrote.

At baseline, CHOP’s ED was screening 63% of febrile children under age 24 months using catheterization, but screens were most commonly negative and only 4.3% had positive cultures. The authors therefore initiated a switch to the two-step method as a pilot run in one ED area before educating all ED personnel and expanding to the full department in the second month, using three cycles of Plan-Do-Study-Act protocol.

Children aged 6-24 months comprised approximately 20% of the ED’s more than 90,000 annual patients, and about 22% of these children presented with fever as the primary concern. Children with a history of genitourinary problems or immune deficiency were excluded.

The pilot ran in an “urgent care section of ED where there are typically more children with less complex medical histories and where ‘fever’ is a common complaint,” the investigators said. The staff completed a learning module with assessment and then received in-person and visual reminders of the procedure. Nurse feedback was then used to develop a nursing-specific educational module before expanding the intervention to all ED areas.

While 69% of 828 febrile young children still underwent screening during the 6-month intervention period, only 16% still underwent urethral catheterization as the initial screening step, typically because of strong clinical indications for a UTI. Another 14% underwent catheterization only after a positive urine screen from an initial noninvasive urine collection or because of an inability to get an adequate urine specimen with the bag. The reduction in catheterization dropped to 55% within 2 weeks of the intervention’s start and spread to other hospital departments. The drop to a 30% catheterization rate remained throughout 18 additional months of monitoring.

“Through online education modules, staff meetings, printed and EHR reminders, family involvement, team review of weekly data, individual and group feedback, and nurse scripting, the ED was able to achieve our aim of reducing catheterization rates among febrile young children ages 6-24 months by half over a 6-month period with sustained results,” Dr. Lavelle and her associates reported.

The research did not use external funding, and the researchers reported they had no financial disclosures.

After implementation of a quality improvement initiative to more effectively screen febrile children for urinary tract infections (UTIs) in the emergency department, catheterization rates dropped from 63% to 30% over a 6-month period, a study found.

The sustained drop prevented more than 350 young children from catheterization without increasing revisit rates or missing UTIs in the 39% of children who were followed in the care network. This was in a study that compared catheterization rates in 1,520 children aged 6-24 months in the year before the intervention and 828 children in the 6 months during the intervention.

“Although urine catheterization remains the gold standard in diagnosing UTIs, it is an invasive procedure that may be avoided in most patients who are being screened,” wrote Dr. Jane M. Lavelle of Children’s Hospital of Philadelphia (CHOP) and her associates. UTI screening by this method can be “painful, time consuming, and costly,” they added (Pediatrics. 2016 June 2. doi: 10.1542/peds.2015-3023).

©Fuse/thinkstockphotos.com

An alternative method to automatic catheterization is a two-step process already included as an option in American Academy of Pediatrics guidelines: Instead of collecting urine through catheterization just once for screening and culture, an emergency department first noninvasively collects urine with a urine bag for screening in those indicated with evidence-based risk factors, and then catheterizes only those who screen positive (Pediatrics. 2011;128[3]:595-610).

“Due to the predictive models’ higher sensitivity than specificity for screening, most urine samples will have a negative screen for pyuria or bacteriuria by urine dipstick or microscopy,” the authors wrote.

At baseline, CHOP’s ED was screening 63% of febrile children under age 24 months using catheterization, but screens were most commonly negative and only 4.3% had positive cultures. The authors therefore initiated a switch to the two-step method as a pilot run in one ED area before educating all ED personnel and expanding to the full department in the second month, using three cycles of Plan-Do-Study-Act protocol.

Children aged 6-24 months comprised approximately 20% of the ED’s more than 90,000 annual patients, and about 22% of these children presented with fever as the primary concern. Children with a history of genitourinary problems or immune deficiency were excluded.

The pilot ran in an “urgent care section of ED where there are typically more children with less complex medical histories and where ‘fever’ is a common complaint,” the investigators said. The staff completed a learning module with assessment and then received in-person and visual reminders of the procedure. Nurse feedback was then used to develop a nursing-specific educational module before expanding the intervention to all ED areas.

While 69% of 828 febrile young children still underwent screening during the 6-month intervention period, only 16% still underwent urethral catheterization as the initial screening step, typically because of strong clinical indications for a UTI. Another 14% underwent catheterization only after a positive urine screen from an initial noninvasive urine collection or because of an inability to get an adequate urine specimen with the bag. The reduction in catheterization dropped to 55% within 2 weeks of the intervention’s start and spread to other hospital departments. The drop to a 30% catheterization rate remained throughout 18 additional months of monitoring.

“Through online education modules, staff meetings, printed and EHR reminders, family involvement, team review of weekly data, individual and group feedback, and nurse scripting, the ED was able to achieve our aim of reducing catheterization rates among febrile young children ages 6-24 months by half over a 6-month period with sustained results,” Dr. Lavelle and her associates reported.

The research did not use external funding, and the researchers reported they had no financial disclosures.

After implementation of a quality improvement initiative to more effectively screen febrile children for urinary tract infections (UTIs) in the emergency department, catheterization rates dropped from 63% to 30% over a 6-month period, a study found.

The sustained drop prevented more than 350 young children from catheterization without increasing revisit rates or missing UTIs in the 39% of children who were followed in the care network. This was in a study that compared catheterization rates in 1,520 children aged 6-24 months in the year before the intervention and 828 children in the 6 months during the intervention.

“Although urine catheterization remains the gold standard in diagnosing UTIs, it is an invasive procedure that may be avoided in most patients who are being screened,” wrote Dr. Jane M. Lavelle of Children’s Hospital of Philadelphia (CHOP) and her associates. UTI screening by this method can be “painful, time consuming, and costly,” they added (Pediatrics. 2016 June 2. doi: 10.1542/peds.2015-3023).

©Fuse/thinkstockphotos.com

An alternative method to automatic catheterization is a two-step process already included as an option in American Academy of Pediatrics guidelines: Instead of collecting urine through catheterization just once for screening and culture, an emergency department first noninvasively collects urine with a urine bag for screening in those indicated with evidence-based risk factors, and then catheterizes only those who screen positive (Pediatrics. 2011;128[3]:595-610).

“Due to the predictive models’ higher sensitivity than specificity for screening, most urine samples will have a negative screen for pyuria or bacteriuria by urine dipstick or microscopy,” the authors wrote.

At baseline, CHOP’s ED was screening 63% of febrile children under age 24 months using catheterization, but screens were most commonly negative and only 4.3% had positive cultures. The authors therefore initiated a switch to the two-step method as a pilot run in one ED area before educating all ED personnel and expanding to the full department in the second month, using three cycles of Plan-Do-Study-Act protocol.

Children aged 6-24 months comprised approximately 20% of the ED’s more than 90,000 annual patients, and about 22% of these children presented with fever as the primary concern. Children with a history of genitourinary problems or immune deficiency were excluded.

The pilot ran in an “urgent care section of ED where there are typically more children with less complex medical histories and where ‘fever’ is a common complaint,” the investigators said. The staff completed a learning module with assessment and then received in-person and visual reminders of the procedure. Nurse feedback was then used to develop a nursing-specific educational module before expanding the intervention to all ED areas.

While 69% of 828 febrile young children still underwent screening during the 6-month intervention period, only 16% still underwent urethral catheterization as the initial screening step, typically because of strong clinical indications for a UTI. Another 14% underwent catheterization only after a positive urine screen from an initial noninvasive urine collection or because of an inability to get an adequate urine specimen with the bag. The reduction in catheterization dropped to 55% within 2 weeks of the intervention’s start and spread to other hospital departments. The drop to a 30% catheterization rate remained throughout 18 additional months of monitoring.

“Through online education modules, staff meetings, printed and EHR reminders, family involvement, team review of weekly data, individual and group feedback, and nurse scripting, the ED was able to achieve our aim of reducing catheterization rates among febrile young children ages 6-24 months by half over a 6-month period with sustained results,” Dr. Lavelle and her associates reported.

The research did not use external funding, and the researchers reported they had no financial disclosures.

Maternal immunization in the early third trimester (from 28 weeks’ gestation) may protect premature infants from pertussis, study results found.

This was the finding of an observational substudy of a larger multicenter, randomized, controlled vaccination trial of premature infants (the PUNS trial), which compared pertussis antibody concentrations before and after primary immunization in premature infants born to mothers who were or were not vaccinated with Repevax. Dr. Alison Kent of St George’s, University of London, and colleagues assessed the levels of the five vaccine antigens present in the maternal combination Repevax vaccine (pertussis toxoid, filamentous hemagglutinin, fimbriae types 2 and 3, diphtheria toxoid, tetanus toxoid, and inactivated poliovirus) in premature infants born to mothers who either received or did not receive Repevax from 28 weeks’ gestation. Antigen quantifications were conducted in these premature infants at approximately 2, 5, and 12 months of age.

©Jacopo Werther/Wikimedia Commons/Creative Commons Attribution 2.0

Thirty-one (19%) of the 160 premature infants in the substudy were born to mothers who had been vaccinated. Two months after their premature birth, infants born to vaccinated mothers had significantly higher concentrations of all five measured antigens, compared with those born to unvaccinated mothers (all P values less than .001). Although fewer infants were sampled at 5 months of age, significantly higher concentrations of filamentous hemagglutinin and diphtheria toxoid were still found in those born to vaccinated mothers (both P = .003). Data collected at the 12-month assessment indicated that only tetanus antibody concentrations remained significantly higher in those born to vaccinated mothers (P = .015). A positive correlation between the number of days from maternal vaccination to delivery was found for all measured antigens, with the exception of fimbriae types 2 and 3.

“The emergency introduction of a maternal immunization program to control a national pertussis outbreak serendipitously provided an opportunity to assess antibody concentrations to maternal vaccine antigens in premature infants,” Dr. Kent and associates noted in Pediatrics (June 2016 doi: 10.1542/peds.2015-3854). This unexpected opportunity resulted in evidence supporting a protective effect against pertussis in the early lives of infants born prematurely to mothers immunized in their early third trimester.

Pfizer and the National Institute for Health Research Clinical Research Network funded the study. Professor Heath and Dr. Ladhani disclosed conducting studies on behalf of St George’s, University of London funded by vaccine manufacturers without receiving personal payments or travel support. The other authors reported no conflicts of interest.

Maternal immunization in the early third trimester (from 28 weeks’ gestation) may protect premature infants from pertussis, study results found.

This was the finding of an observational substudy of a larger multicenter, randomized, controlled vaccination trial of premature infants (the PUNS trial), which compared pertussis antibody concentrations before and after primary immunization in premature infants born to mothers who were or were not vaccinated with Repevax. Dr. Alison Kent of St George’s, University of London, and colleagues assessed the levels of the five vaccine antigens present in the maternal combination Repevax vaccine (pertussis toxoid, filamentous hemagglutinin, fimbriae types 2 and 3, diphtheria toxoid, tetanus toxoid, and inactivated poliovirus) in premature infants born to mothers who either received or did not receive Repevax from 28 weeks’ gestation. Antigen quantifications were conducted in these premature infants at approximately 2, 5, and 12 months of age.

©Jacopo Werther/Wikimedia Commons/Creative Commons Attribution 2.0

Thirty-one (19%) of the 160 premature infants in the substudy were born to mothers who had been vaccinated. Two months after their premature birth, infants born to vaccinated mothers had significantly higher concentrations of all five measured antigens, compared with those born to unvaccinated mothers (all P values less than .001). Although fewer infants were sampled at 5 months of age, significantly higher concentrations of filamentous hemagglutinin and diphtheria toxoid were still found in those born to vaccinated mothers (both P = .003). Data collected at the 12-month assessment indicated that only tetanus antibody concentrations remained significantly higher in those born to vaccinated mothers (P = .015). A positive correlation between the number of days from maternal vaccination to delivery was found for all measured antigens, with the exception of fimbriae types 2 and 3.

“The emergency introduction of a maternal immunization program to control a national pertussis outbreak serendipitously provided an opportunity to assess antibody concentrations to maternal vaccine antigens in premature infants,” Dr. Kent and associates noted in Pediatrics (June 2016 doi: 10.1542/peds.2015-3854). This unexpected opportunity resulted in evidence supporting a protective effect against pertussis in the early lives of infants born prematurely to mothers immunized in their early third trimester.

Pfizer and the National Institute for Health Research Clinical Research Network funded the study. Professor Heath and Dr. Ladhani disclosed conducting studies on behalf of St George’s, University of London funded by vaccine manufacturers without receiving personal payments or travel support. The other authors reported no conflicts of interest.

Maternal immunization in the early third trimester (from 28 weeks’ gestation) may protect premature infants from pertussis, study results found.

This was the finding of an observational substudy of a larger multicenter, randomized, controlled vaccination trial of premature infants (the PUNS trial), which compared pertussis antibody concentrations before and after primary immunization in premature infants born to mothers who were or were not vaccinated with Repevax. Dr. Alison Kent of St George’s, University of London, and colleagues assessed the levels of the five vaccine antigens present in the maternal combination Repevax vaccine (pertussis toxoid, filamentous hemagglutinin, fimbriae types 2 and 3, diphtheria toxoid, tetanus toxoid, and inactivated poliovirus) in premature infants born to mothers who either received or did not receive Repevax from 28 weeks’ gestation. Antigen quantifications were conducted in these premature infants at approximately 2, 5, and 12 months of age.

©Jacopo Werther/Wikimedia Commons/Creative Commons Attribution 2.0

Thirty-one (19%) of the 160 premature infants in the substudy were born to mothers who had been vaccinated. Two months after their premature birth, infants born to vaccinated mothers had significantly higher concentrations of all five measured antigens, compared with those born to unvaccinated mothers (all P values less than .001). Although fewer infants were sampled at 5 months of age, significantly higher concentrations of filamentous hemagglutinin and diphtheria toxoid were still found in those born to vaccinated mothers (both P = .003). Data collected at the 12-month assessment indicated that only tetanus antibody concentrations remained significantly higher in those born to vaccinated mothers (P = .015). A positive correlation between the number of days from maternal vaccination to delivery was found for all measured antigens, with the exception of fimbriae types 2 and 3.

“The emergency introduction of a maternal immunization program to control a national pertussis outbreak serendipitously provided an opportunity to assess antibody concentrations to maternal vaccine antigens in premature infants,” Dr. Kent and associates noted in Pediatrics (June 2016 doi: 10.1542/peds.2015-3854). This unexpected opportunity resulted in evidence supporting a protective effect against pertussis in the early lives of infants born prematurely to mothers immunized in their early third trimester.

Pfizer and the National Institute for Health Research Clinical Research Network funded the study. Professor Heath and Dr. Ladhani disclosed conducting studies on behalf of St George’s, University of London funded by vaccine manufacturers without receiving personal payments or travel support. The other authors reported no conflicts of interest.

Now through December 31, all active SHM members can earn 2017–2018 dues credits and special recognition for recruiting new physician, physician assistant, nurse practitioner, pharmacist, or affiliate members. Active members will be eligible for:

• A $35 credit toward 2017–2018 dues when recruiting 1 new member
• A $50 credit toward 2017–2018 dues when recruiting 2–4 new members
• A $75 credit toward 2017–2018 dues when recruiting 5–9 new members
• A $125 credit toward 2017–2018 dues when recruiting 10+ new members

For each member recruited, referrers will receive one entry into a grand-prize drawing to receive complimentary registration to HM17 in Las Vegas. To be counted as a referral, the new member must:

• Be a brand-new member to SHM. (Past members whose membership has lapsed do not qualify.)
• Register as a physician, physician assistant, nurse practitioner, pharmacist, or affiliate member.
• Include an active member’s name in the “referred by” field on a printed application or the online join form.
• Join before December 31, 2016.

Note: SHM members are not eligible for dues credits through the Membership Ambassador Program for member referrals attributed to free memberships received as a result of HM17 registrations.

Now through December 31, all active SHM members can earn 2017–2018 dues credits and special recognition for recruiting new physician, physician assistant, nurse practitioner, pharmacist, or affiliate members. Active members will be eligible for:

• A $35 credit toward 2017–2018 dues when recruiting 1 new member
• A $50 credit toward 2017–2018 dues when recruiting 2–4 new members
• A $75 credit toward 2017–2018 dues when recruiting 5–9 new members
• A $125 credit toward 2017–2018 dues when recruiting 10+ new members

For each member recruited, referrers will receive one entry into a grand-prize drawing to receive complimentary registration to HM17 in Las Vegas. To be counted as a referral, the new member must:

• Be a brand-new member to SHM. (Past members whose membership has lapsed do not qualify.)
• Register as a physician, physician assistant, nurse practitioner, pharmacist, or affiliate member.
• Include an active member’s name in the “referred by” field on a printed application or the online join form.
• Join before December 31, 2016.

Note: SHM members are not eligible for dues credits through the Membership Ambassador Program for member referrals attributed to free memberships received as a result of HM17 registrations.

Now through December 31, all active SHM members can earn 2017–2018 dues credits and special recognition for recruiting new physician, physician assistant, nurse practitioner, pharmacist, or affiliate members. Active members will be eligible for:

• A $35 credit toward 2017–2018 dues when recruiting 1 new member
• A $50 credit toward 2017–2018 dues when recruiting 2–4 new members
• A $75 credit toward 2017–2018 dues when recruiting 5–9 new members
• A $125 credit toward 2017–2018 dues when recruiting 10+ new members

For each member recruited, referrers will receive one entry into a grand-prize drawing to receive complimentary registration to HM17 in Las Vegas. To be counted as a referral, the new member must:

• Be a brand-new member to SHM. (Past members whose membership has lapsed do not qualify.)
• Register as a physician, physician assistant, nurse practitioner, pharmacist, or affiliate member.
• Include an active member’s name in the “referred by” field on a printed application or the online join form.
• Join before December 31, 2016.

Note: SHM members are not eligible for dues credits through the Membership Ambassador Program for member referrals attributed to free memberships received as a result of HM17 registrations.

Rachel Lovins, MD, SFHM, CPE, is the chief of hospital medicine and vice chair of the Department of Medicine at Middlesex Hospital in Middletown, Conn. In 2015, she read about the Hospitalist Engagement Benchmarking Service, a new offering from SHM that assesses the engagement level of approximately 1,500 hospitalists nationwide. Soon thereafter, she enrolled her hospital medicine group.

The service provides a snapshot and benchmark comparison of physician attitudes toward a wide range of aspects, including organizational climate, care quality, effective motivation, burnout risk, and more.

Dr. Lovins recently shared her thoughts on the survey with The Hospitalist and explained how she and her team are using the results of the survey to improve the engagement of their hospitalist group. More than 80% of survey respondents indicated they will utilize the service again and plan to recommend the service to a colleague. Learn more and join the second cohort at www.hospitalmedicine.org/pmad3.

Question: How did you become aware of the Hospitalist Engagement Benchmarking Service?

Answer: Last year, I read a blog post written by practice management expert Leslie Flores, MHA, SFHM, about happiness. In the post, she shared information about the country of Bhutan and its Gross National Happiness Index. She proceeded to relate it to practice management, stressing the importance of “paying deliberate attention to hospitalist personal and professional well-being” to ensure sustainability in our field.

As she reflected on the implications of Bhutan’s happiness index and its relation to hospital medicine, she suggested having hospital medicine groups complete SHM’s Hospitalist Engagement Benchmarking Survey to know where they stood with their own happiness indices. As the chief of hospital medicine in my hospital, it truly resonated with me. (As an aside, I often joke that I do whatever Leslie says—because she is pretty much always right!)

Q: What factors inspired you to enroll your group in the service?

A: I’m a total believer in the philosophy of Leslie and her consulting partner, John Nelson, MD, MHM, that a healthy hospital medicine group needs a culture of ownership. If members don’t feel engaged, burnout and isolation are not far behind. Hospitalist work is not easy, and the hours can be long. If you don’t feel empowered, safe, and engaged, it’s going to be unhappy work and an unhappy group.

The leadership team in my program sincerely wants our members to feel satisfied professionally and personally at work. In addition to having a high-performing group, we want people to feel like they belong and that they have some control over what goes on in their daily practice.

Q: How would you describe your experience throughout the survey, including findings and follow-up?

A: I found the survey very easy. I supplied the emails of the participating hospitalists to SHM, and their team took care of the rest, including consistent follow-up. A few months after our group completed the survey, I received the results, which were extremely helpful. It was particularly interesting to see where we scored compared to other hospitalist groups.

Q: What were the main findings upon completion for your team at Middlesex Hospital? How did you implement the takeaways/changes following the service? What were/are the results?

A: I was happy to see that our group felt like they made a difference to our patients and the hospital and that the leadership provided good support. I was, however, discouraged that there were issues with perceived fairness in patient distribution and that our percentages for folks looking forward to and being excited by their jobs were somewhat low.

These two issues—and risk for burnout specifically—are part of our strategic plan moving forward. We need to find ways to make patient distribution more transparent and make people feel happier about coming to work, partially through quarterly “think tanks,” which we just started this year. Because of the results of this survey and another hospital survey, we created an anonymous internal survey to get more specific information. Through that, I was able to target some very specific issues and to reach out to members of the group to try and resolve them.

This is an ongoing process, and we have to keep working on it. It’s like a marriage; you can’t just sit back and assume a relationship will work out on its own. You have to constantly reassess your partner’s needs and be concerned about their happiness as well as your own. We certainly don’t do a perfect job meeting everyone’s needs, but we strive to do so. Having a tool that is validated and easy to use is extremely beneficial to us, and I will definitely use it again. I’d recommend it to anyone who manages a hospitalist group. TH

Brett Radler is SHM’s communications coordinator.

Rachel Lovins, MD, SFHM, CPE, is the chief of hospital medicine and vice chair of the Department of Medicine at Middlesex Hospital in Middletown, Conn. In 2015, she read about the Hospitalist Engagement Benchmarking Service, a new offering from SHM that assesses the engagement level of approximately 1,500 hospitalists nationwide. Soon thereafter, she enrolled her hospital medicine group.

The service provides a snapshot and benchmark comparison of physician attitudes toward a wide range of aspects, including organizational climate, care quality, effective motivation, burnout risk, and more.

Dr. Lovins recently shared her thoughts on the survey with The Hospitalist and explained how she and her team are using the results of the survey to improve the engagement of their hospitalist group. More than 80% of survey respondents indicated they will utilize the service again and plan to recommend the service to a colleague. Learn more and join the second cohort at www.hospitalmedicine.org/pmad3.

Question: How did you become aware of the Hospitalist Engagement Benchmarking Service?

Answer: Last year, I read a blog post written by practice management expert Leslie Flores, MHA, SFHM, about happiness. In the post, she shared information about the country of Bhutan and its Gross National Happiness Index. She proceeded to relate it to practice management, stressing the importance of “paying deliberate attention to hospitalist personal and professional well-being” to ensure sustainability in our field.

As she reflected on the implications of Bhutan’s happiness index and its relation to hospital medicine, she suggested having hospital medicine groups complete SHM’s Hospitalist Engagement Benchmarking Survey to know where they stood with their own happiness indices. As the chief of hospital medicine in my hospital, it truly resonated with me. (As an aside, I often joke that I do whatever Leslie says—because she is pretty much always right!)

Q: What factors inspired you to enroll your group in the service?

A: I’m a total believer in the philosophy of Leslie and her consulting partner, John Nelson, MD, MHM, that a healthy hospital medicine group needs a culture of ownership. If members don’t feel engaged, burnout and isolation are not far behind. Hospitalist work is not easy, and the hours can be long. If you don’t feel empowered, safe, and engaged, it’s going to be unhappy work and an unhappy group.

The leadership team in my program sincerely wants our members to feel satisfied professionally and personally at work. In addition to having a high-performing group, we want people to feel like they belong and that they have some control over what goes on in their daily practice.

Q: How would you describe your experience throughout the survey, including findings and follow-up?

A: I found the survey very easy. I supplied the emails of the participating hospitalists to SHM, and their team took care of the rest, including consistent follow-up. A few months after our group completed the survey, I received the results, which were extremely helpful. It was particularly interesting to see where we scored compared to other hospitalist groups.

Q: What were the main findings upon completion for your team at Middlesex Hospital? How did you implement the takeaways/changes following the service? What were/are the results?

A: I was happy to see that our group felt like they made a difference to our patients and the hospital and that the leadership provided good support. I was, however, discouraged that there were issues with perceived fairness in patient distribution and that our percentages for folks looking forward to and being excited by their jobs were somewhat low.

These two issues—and risk for burnout specifically—are part of our strategic plan moving forward. We need to find ways to make patient distribution more transparent and make people feel happier about coming to work, partially through quarterly “think tanks,” which we just started this year. Because of the results of this survey and another hospital survey, we created an anonymous internal survey to get more specific information. Through that, I was able to target some very specific issues and to reach out to members of the group to try and resolve them.

This is an ongoing process, and we have to keep working on it. It’s like a marriage; you can’t just sit back and assume a relationship will work out on its own. You have to constantly reassess your partner’s needs and be concerned about their happiness as well as your own. We certainly don’t do a perfect job meeting everyone’s needs, but we strive to do so. Having a tool that is validated and easy to use is extremely beneficial to us, and I will definitely use it again. I’d recommend it to anyone who manages a hospitalist group. TH

Brett Radler is SHM’s communications coordinator.

Rachel Lovins, MD, SFHM, CPE, is the chief of hospital medicine and vice chair of the Department of Medicine at Middlesex Hospital in Middletown, Conn. In 2015, she read about the Hospitalist Engagement Benchmarking Service, a new offering from SHM that assesses the engagement level of approximately 1,500 hospitalists nationwide. Soon thereafter, she enrolled her hospital medicine group.

The service provides a snapshot and benchmark comparison of physician attitudes toward a wide range of aspects, including organizational climate, care quality, effective motivation, burnout risk, and more.

Dr. Lovins recently shared her thoughts on the survey with The Hospitalist and explained how she and her team are using the results of the survey to improve the engagement of their hospitalist group. More than 80% of survey respondents indicated they will utilize the service again and plan to recommend the service to a colleague. Learn more and join the second cohort at www.hospitalmedicine.org/pmad3.

Question: How did you become aware of the Hospitalist Engagement Benchmarking Service?

Answer: Last year, I read a blog post written by practice management expert Leslie Flores, MHA, SFHM, about happiness. In the post, she shared information about the country of Bhutan and its Gross National Happiness Index. She proceeded to relate it to practice management, stressing the importance of “paying deliberate attention to hospitalist personal and professional well-being” to ensure sustainability in our field.

As she reflected on the implications of Bhutan’s happiness index and its relation to hospital medicine, she suggested having hospital medicine groups complete SHM’s Hospitalist Engagement Benchmarking Survey to know where they stood with their own happiness indices. As the chief of hospital medicine in my hospital, it truly resonated with me. (As an aside, I often joke that I do whatever Leslie says—because she is pretty much always right!)

Q: What factors inspired you to enroll your group in the service?

A: I’m a total believer in the philosophy of Leslie and her consulting partner, John Nelson, MD, MHM, that a healthy hospital medicine group needs a culture of ownership. If members don’t feel engaged, burnout and isolation are not far behind. Hospitalist work is not easy, and the hours can be long. If you don’t feel empowered, safe, and engaged, it’s going to be unhappy work and an unhappy group.

The leadership team in my program sincerely wants our members to feel satisfied professionally and personally at work. In addition to having a high-performing group, we want people to feel like they belong and that they have some control over what goes on in their daily practice.

Q: How would you describe your experience throughout the survey, including findings and follow-up?

A: I found the survey very easy. I supplied the emails of the participating hospitalists to SHM, and their team took care of the rest, including consistent follow-up. A few months after our group completed the survey, I received the results, which were extremely helpful. It was particularly interesting to see where we scored compared to other hospitalist groups.

Q: What were the main findings upon completion for your team at Middlesex Hospital? How did you implement the takeaways/changes following the service? What were/are the results?

A: I was happy to see that our group felt like they made a difference to our patients and the hospital and that the leadership provided good support. I was, however, discouraged that there were issues with perceived fairness in patient distribution and that our percentages for folks looking forward to and being excited by their jobs were somewhat low.

These two issues—and risk for burnout specifically—are part of our strategic plan moving forward. We need to find ways to make patient distribution more transparent and make people feel happier about coming to work, partially through quarterly “think tanks,” which we just started this year. Because of the results of this survey and another hospital survey, we created an anonymous internal survey to get more specific information. Through that, I was able to target some very specific issues and to reach out to members of the group to try and resolve them.

This is an ongoing process, and we have to keep working on it. It’s like a marriage; you can’t just sit back and assume a relationship will work out on its own. You have to constantly reassess your partner’s needs and be concerned about their happiness as well as your own. We certainly don’t do a perfect job meeting everyone’s needs, but we strive to do so. Having a tool that is validated and easy to use is extremely beneficial to us, and I will definitely use it again. I’d recommend it to anyone who manages a hospitalist group. TH

Brett Radler is SHM’s communications coordinator.

The FP diagnosed molluscum contagiosum and recognized that some of the larger lesions on the scalp were related to the patient’s altered immune status. Molluscum contagiosum is a viral skin infection that produces pearly papules that often have central umbilication. This skin infection is most commonly seen in children, but can also be transmitted sexually among adults. The number of cases in adults increased in the 1980s in the United States, probably as a result of the HIV/AIDS epidemic. Since the introduction of highly active antiretroviral therapy (HAART), the number of molluscum contagiosum cases in HIV/AIDS patients has decreased substantially. However, the prevalence of molluscum contagiosum in patients who are HIV-positive may still be as high as 5% to 18%.

The FP encouraged the patient to take her antiretroviral medication as prescribed and suggested that she return to her HIV specialist to see if her therapeutic regimen required any adjustments. He also offered her cryotherapy, with a follow-up appointment one month later. The patient agreed to the cryotherapy, which was performed with a cryogun using a bent tip spray. The patient’s eye was protected using a tongue depressor, while her eyelid was sprayed with liquid nitrogen.

At the follow-up visit, the molluscum lesions had improved and a second round of cryotherapy was performed. Although it was not offered to this patient, topical imiquimod is another treatment option for molluscum contagiosum. This treatment has not, however, been approved by the Food and Drug Administration for this diagnosis.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Molluscum contagiosum. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:743-748.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

The FP diagnosed molluscum contagiosum and recognized that some of the larger lesions on the scalp were related to the patient’s altered immune status. Molluscum contagiosum is a viral skin infection that produces pearly papules that often have central umbilication. This skin infection is most commonly seen in children, but can also be transmitted sexually among adults. The number of cases in adults increased in the 1980s in the United States, probably as a result of the HIV/AIDS epidemic. Since the introduction of highly active antiretroviral therapy (HAART), the number of molluscum contagiosum cases in HIV/AIDS patients has decreased substantially. However, the prevalence of molluscum contagiosum in patients who are HIV-positive may still be as high as 5% to 18%.

The FP encouraged the patient to take her antiretroviral medication as prescribed and suggested that she return to her HIV specialist to see if her therapeutic regimen required any adjustments. He also offered her cryotherapy, with a follow-up appointment one month later. The patient agreed to the cryotherapy, which was performed with a cryogun using a bent tip spray. The patient’s eye was protected using a tongue depressor, while her eyelid was sprayed with liquid nitrogen.

At the follow-up visit, the molluscum lesions had improved and a second round of cryotherapy was performed. Although it was not offered to this patient, topical imiquimod is another treatment option for molluscum contagiosum. This treatment has not, however, been approved by the Food and Drug Administration for this diagnosis.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Molluscum contagiosum. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:743-748.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

The FP diagnosed molluscum contagiosum and recognized that some of the larger lesions on the scalp were related to the patient’s altered immune status. Molluscum contagiosum is a viral skin infection that produces pearly papules that often have central umbilication. This skin infection is most commonly seen in children, but can also be transmitted sexually among adults. The number of cases in adults increased in the 1980s in the United States, probably as a result of the HIV/AIDS epidemic. Since the introduction of highly active antiretroviral therapy (HAART), the number of molluscum contagiosum cases in HIV/AIDS patients has decreased substantially. However, the prevalence of molluscum contagiosum in patients who are HIV-positive may still be as high as 5% to 18%.

The FP encouraged the patient to take her antiretroviral medication as prescribed and suggested that she return to her HIV specialist to see if her therapeutic regimen required any adjustments. He also offered her cryotherapy, with a follow-up appointment one month later. The patient agreed to the cryotherapy, which was performed with a cryogun using a bent tip spray. The patient’s eye was protected using a tongue depressor, while her eyelid was sprayed with liquid nitrogen.

At the follow-up visit, the molluscum lesions had improved and a second round of cryotherapy was performed. Although it was not offered to this patient, topical imiquimod is another treatment option for molluscum contagiosum. This treatment has not, however, been approved by the Food and Drug Administration for this diagnosis.

Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux, EJ. Molluscum contagiosum. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:743-748.

To learn more about the Color Atlas of Family Medicine, see: www.amazon.com/Color-Family-Medicine-Richard-Usatine/dp/0071769641/

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking on this link: usatinemedia.com

Aedes aegypti mosquito
Photo courtesy of
Muhammad Mahdi Karim

Two compounds have shown activity against the Zika virus, according to Biotech Biotron, a company that develops compounds to fight viral diseases such as HIV and hepatitis C. The two compounds from its library killed the Zika virus in vitro, as determined by an independent USA laboratory facility.

“These early results are encouraging,” Michelle Miller, PhD, of Biotron, said. “Identification of these active compounds in our library is a starting point for designing potent drugs against Zika.”

At present, there is no approved vaccine or treatment for Zika virus, whose common symptoms include fever, rash, joint pain, and conjunctivitis.

While the symptoms are generally mild, Zika infection during pregnancy has been associated with microcephaly and other severe brain defects in the newborn.

In addition, Zika infection may be associated with an increased risk of Guillain-Barré syndrome, which is being investigated by the Centers for Disease Control and Prevention.

Biotron is planning to carry out more tests on the Zika virus to determine whether the compounds are likely to be safe and effective in humans.

The Zika virus is primarily spread by infected mosquitoes. But exposure to an infected person’s blood or other body fluids may also result in transmission.

Aedes aegypti mosquito
Photo courtesy of
Muhammad Mahdi Karim

Two compounds have shown activity against the Zika virus, according to Biotech Biotron, a company that develops compounds to fight viral diseases such as HIV and hepatitis C. The two compounds from its library killed the Zika virus in vitro, as determined by an independent USA laboratory facility.

“These early results are encouraging,” Michelle Miller, PhD, of Biotron, said. “Identification of these active compounds in our library is a starting point for designing potent drugs against Zika.”

At present, there is no approved vaccine or treatment for Zika virus, whose common symptoms include fever, rash, joint pain, and conjunctivitis.

While the symptoms are generally mild, Zika infection during pregnancy has been associated with microcephaly and other severe brain defects in the newborn.

In addition, Zika infection may be associated with an increased risk of Guillain-Barré syndrome, which is being investigated by the Centers for Disease Control and Prevention.

Biotron is planning to carry out more tests on the Zika virus to determine whether the compounds are likely to be safe and effective in humans.

The Zika virus is primarily spread by infected mosquitoes. But exposure to an infected person’s blood or other body fluids may also result in transmission.

Aedes aegypti mosquito
Photo courtesy of
Muhammad Mahdi Karim

Two compounds have shown activity against the Zika virus, according to Biotech Biotron, a company that develops compounds to fight viral diseases such as HIV and hepatitis C. The two compounds from its library killed the Zika virus in vitro, as determined by an independent USA laboratory facility.

“These early results are encouraging,” Michelle Miller, PhD, of Biotron, said. “Identification of these active compounds in our library is a starting point for designing potent drugs against Zika.”

At present, there is no approved vaccine or treatment for Zika virus, whose common symptoms include fever, rash, joint pain, and conjunctivitis.

While the symptoms are generally mild, Zika infection during pregnancy has been associated with microcephaly and other severe brain defects in the newborn.

In addition, Zika infection may be associated with an increased risk of Guillain-Barré syndrome, which is being investigated by the Centers for Disease Control and Prevention.

Biotron is planning to carry out more tests on the Zika virus to determine whether the compounds are likely to be safe and effective in humans.

The Zika virus is primarily spread by infected mosquitoes. But exposure to an infected person’s blood or other body fluids may also result in transmission.

Premature infant in NICU

A retrospective, multicenter study of 972 very-low-birth-weight (VLBW) infants treated in 6 US neonatal intensive care units (NICUs) has shown that platelet transfusions do not significantly affect the incidence of intraventricular hemorrhage (IVH).

Thrombocytopenia is a risk factor for IVH, but investigators found no correlation between its severity and risk for IVH. Nor did they find platelet transfusions to have a significant effect on the incidence of IVH.

To describe platelet transfusion practices in US NICUs, senior author Martha Sola-Visner, MD, of Boston Children’s Hospital in Massachusetts, and colleagues studied NICU admissions from January 1, 2006, to December 31, 2007. They collected the last data on December 4, 2008.

Of the 972 VLBW infants, 231 (23.8%) received at least 1 platelet transfusion. And more males received transfusions (61%) than females.

Infants who received transfusions were more premature at 26.3 weeks’ gestation age compared with 28.8 weeks for those who did not receive transfusions, P<0.001.

Transfused infants were also smaller, with a mean birth weight of 805 g compared with 1113 g in the group that did not receive a transfusion, P<0.001.

Platelet transfusions

The 231 transfused infants received a total of 1002 platelet transfusions, with a mean of 4.3 per infant (range 1 to 63 transfusions).

Forty-one percent of infants had transfusions during the first 7 days of life only, amounting to 281 transfusions; 32.9% had transfusions after the first 7 days only, and 26.4% had transfusions during both periods. Seven hundred twenty-one transfusions were administered after day 7.

Almost two thirds of the transfusions, 65.4% or 653 of 998 transfusions, were given to infants who had a pre-transfusion platelet count of at least 50,000/μL.

The investigators poined out that this finding “was in contrast to UK NICUs,” where transfusions are administered at a median platelet count of 27,000/μL. 

Illness severity

The investigators found significant differences among NICU sites in terms of clinical markers for transfusions.

Overall, 189 VLBW infants had platelet counts less than 100,000/μL in the first 7 days of life for a total of 402 days. And at least 1 platelet transfusion was given on 212 of those days. Of these, 198 transfusions (93.4%) had a marker of severe illness or bleeding.

On the other hand, of the 190 patient days without a transfusion, 113 (59.5%) had at least 1 of these markers (P<0.001).

Thrombocytopenia and IVH risk

The investigators evaluated the risk for IVH based on the lowest platelet count before the diagnosis of IVH was made.

They found that infants with thrombocytopenia were at higher risk for IVH, with a hazard ratio of 2.17 for any platelet count less than 150,000/μL (P<0.001).

Nevertheless, for the 314 infants with at least 1 platelet count less than 150,000/μL during the first 7 days of life, they found no association between severity of thrombocytopenia and the risk for subsequent IVH (P=0.70).

Transfusion and IVH risk

To determine whether platelet transfusions protected VLBW infants from IVH during their first 7 days of life, the investigators performed a Cox regression analysis in 756 infants.

They found that 134 infants (17.7%) had an IVH, including 62 (8.2%) with grade III or IV. So in the unadjusted model, they found a significant association between platelet transfusion and subsequent IVH, P=0.004.

However, when they adjusted the model for clinical covariates, only infants with grade III or IV IVH had a significantly greater risk with platelet transfusion, P=0.01.

Clinical covariates included sex, gestational age less than 28 weeks, 5-minute Apgar score less than 7, antenatal corticosteroid treatment, and pregnancy-induced hypertension as an indication for delivery.

The investigators also adjusted the model for clinical covariates and nadir platelet count of less than 15,000/μL. In this model, platelet transfusion became nonsignificant, even for IVH of grade III or IV.

The investigators noted that the degree to which their results are generalizable to infants with more severe thrombocytopenia is unclear, since infants in this analysis often had transfusions at platelet levels between 50,000/μL and 150,000/μL. They also collected the data approximately 8 years ago, and transfusion practices may have changed since then.

The 6 NICU study sites included Boston Children’s Hospital, Boston, Massachusetts; University of Iowa Children’s Hospital, Iowa City, Iowa; and 4 NICUs affiliated with Intermountain Health Care in Utah.

The investigators published their findings in JAMA Pediatrics.

Premature infant in NICU

A retrospective, multicenter study of 972 very-low-birth-weight (VLBW) infants treated in 6 US neonatal intensive care units (NICUs) has shown that platelet transfusions do not significantly affect the incidence of intraventricular hemorrhage (IVH).

Thrombocytopenia is a risk factor for IVH, but investigators found no correlation between its severity and risk for IVH. Nor did they find platelet transfusions to have a significant effect on the incidence of IVH.

To describe platelet transfusion practices in US NICUs, senior author Martha Sola-Visner, MD, of Boston Children’s Hospital in Massachusetts, and colleagues studied NICU admissions from January 1, 2006, to December 31, 2007. They collected the last data on December 4, 2008.

Of the 972 VLBW infants, 231 (23.8%) received at least 1 platelet transfusion. And more males received transfusions (61%) than females.

Infants who received transfusions were more premature at 26.3 weeks’ gestation age compared with 28.8 weeks for those who did not receive transfusions, P<0.001.

Transfused infants were also smaller, with a mean birth weight of 805 g compared with 1113 g in the group that did not receive a transfusion, P<0.001.

Platelet transfusions

The 231 transfused infants received a total of 1002 platelet transfusions, with a mean of 4.3 per infant (range 1 to 63 transfusions).

Forty-one percent of infants had transfusions during the first 7 days of life only, amounting to 281 transfusions; 32.9% had transfusions after the first 7 days only, and 26.4% had transfusions during both periods. Seven hundred twenty-one transfusions were administered after day 7.

Almost two thirds of the transfusions, 65.4% or 653 of 998 transfusions, were given to infants who had a pre-transfusion platelet count of at least 50,000/μL.

The investigators poined out that this finding “was in contrast to UK NICUs,” where transfusions are administered at a median platelet count of 27,000/μL. 

Illness severity

The investigators found significant differences among NICU sites in terms of clinical markers for transfusions.

Overall, 189 VLBW infants had platelet counts less than 100,000/μL in the first 7 days of life for a total of 402 days. And at least 1 platelet transfusion was given on 212 of those days. Of these, 198 transfusions (93.4%) had a marker of severe illness or bleeding.

On the other hand, of the 190 patient days without a transfusion, 113 (59.5%) had at least 1 of these markers (P<0.001).

Thrombocytopenia and IVH risk

The investigators evaluated the risk for IVH based on the lowest platelet count before the diagnosis of IVH was made.

They found that infants with thrombocytopenia were at higher risk for IVH, with a hazard ratio of 2.17 for any platelet count less than 150,000/μL (P<0.001).

Nevertheless, for the 314 infants with at least 1 platelet count less than 150,000/μL during the first 7 days of life, they found no association between severity of thrombocytopenia and the risk for subsequent IVH (P=0.70).

Transfusion and IVH risk

To determine whether platelet transfusions protected VLBW infants from IVH during their first 7 days of life, the investigators performed a Cox regression analysis in 756 infants.

They found that 134 infants (17.7%) had an IVH, including 62 (8.2%) with grade III or IV. So in the unadjusted model, they found a significant association between platelet transfusion and subsequent IVH, P=0.004.

However, when they adjusted the model for clinical covariates, only infants with grade III or IV IVH had a significantly greater risk with platelet transfusion, P=0.01.

Clinical covariates included sex, gestational age less than 28 weeks, 5-minute Apgar score less than 7, antenatal corticosteroid treatment, and pregnancy-induced hypertension as an indication for delivery.

The investigators also adjusted the model for clinical covariates and nadir platelet count of less than 15,000/μL. In this model, platelet transfusion became nonsignificant, even for IVH of grade III or IV.

The investigators noted that the degree to which their results are generalizable to infants with more severe thrombocytopenia is unclear, since infants in this analysis often had transfusions at platelet levels between 50,000/μL and 150,000/μL. They also collected the data approximately 8 years ago, and transfusion practices may have changed since then.

The 6 NICU study sites included Boston Children’s Hospital, Boston, Massachusetts; University of Iowa Children’s Hospital, Iowa City, Iowa; and 4 NICUs affiliated with Intermountain Health Care in Utah.

The investigators published their findings in JAMA Pediatrics.

Premature infant in NICU

A retrospective, multicenter study of 972 very-low-birth-weight (VLBW) infants treated in 6 US neonatal intensive care units (NICUs) has shown that platelet transfusions do not significantly affect the incidence of intraventricular hemorrhage (IVH).

Thrombocytopenia is a risk factor for IVH, but investigators found no correlation between its severity and risk for IVH. Nor did they find platelet transfusions to have a significant effect on the incidence of IVH.

To describe platelet transfusion practices in US NICUs, senior author Martha Sola-Visner, MD, of Boston Children’s Hospital in Massachusetts, and colleagues studied NICU admissions from January 1, 2006, to December 31, 2007. They collected the last data on December 4, 2008.

Of the 972 VLBW infants, 231 (23.8%) received at least 1 platelet transfusion. And more males received transfusions (61%) than females.

Infants who received transfusions were more premature at 26.3 weeks’ gestation age compared with 28.8 weeks for those who did not receive transfusions, P<0.001.

Transfused infants were also smaller, with a mean birth weight of 805 g compared with 1113 g in the group that did not receive a transfusion, P<0.001.

Platelet transfusions

The 231 transfused infants received a total of 1002 platelet transfusions, with a mean of 4.3 per infant (range 1 to 63 transfusions).

Forty-one percent of infants had transfusions during the first 7 days of life only, amounting to 281 transfusions; 32.9% had transfusions after the first 7 days only, and 26.4% had transfusions during both periods. Seven hundred twenty-one transfusions were administered after day 7.

Almost two thirds of the transfusions, 65.4% or 653 of 998 transfusions, were given to infants who had a pre-transfusion platelet count of at least 50,000/μL.

The investigators poined out that this finding “was in contrast to UK NICUs,” where transfusions are administered at a median platelet count of 27,000/μL. 

Illness severity

The investigators found significant differences among NICU sites in terms of clinical markers for transfusions.

Overall, 189 VLBW infants had platelet counts less than 100,000/μL in the first 7 days of life for a total of 402 days. And at least 1 platelet transfusion was given on 212 of those days. Of these, 198 transfusions (93.4%) had a marker of severe illness or bleeding.

On the other hand, of the 190 patient days without a transfusion, 113 (59.5%) had at least 1 of these markers (P<0.001).

Thrombocytopenia and IVH risk

The investigators evaluated the risk for IVH based on the lowest platelet count before the diagnosis of IVH was made.

They found that infants with thrombocytopenia were at higher risk for IVH, with a hazard ratio of 2.17 for any platelet count less than 150,000/μL (P<0.001).

Nevertheless, for the 314 infants with at least 1 platelet count less than 150,000/μL during the first 7 days of life, they found no association between severity of thrombocytopenia and the risk for subsequent IVH (P=0.70).

Transfusion and IVH risk

To determine whether platelet transfusions protected VLBW infants from IVH during their first 7 days of life, the investigators performed a Cox regression analysis in 756 infants.

They found that 134 infants (17.7%) had an IVH, including 62 (8.2%) with grade III or IV. So in the unadjusted model, they found a significant association between platelet transfusion and subsequent IVH, P=0.004.

However, when they adjusted the model for clinical covariates, only infants with grade III or IV IVH had a significantly greater risk with platelet transfusion, P=0.01.

Clinical covariates included sex, gestational age less than 28 weeks, 5-minute Apgar score less than 7, antenatal corticosteroid treatment, and pregnancy-induced hypertension as an indication for delivery.

The investigators also adjusted the model for clinical covariates and nadir platelet count of less than 15,000/μL. In this model, platelet transfusion became nonsignificant, even for IVH of grade III or IV.

The investigators noted that the degree to which their results are generalizable to infants with more severe thrombocytopenia is unclear, since infants in this analysis often had transfusions at platelet levels between 50,000/μL and 150,000/μL. They also collected the data approximately 8 years ago, and transfusion practices may have changed since then.

The 6 NICU study sites included Boston Children’s Hospital, Boston, Massachusetts; University of Iowa Children’s Hospital, Iowa City, Iowa; and 4 NICUs affiliated with Intermountain Health Care in Utah.

The investigators published their findings in JAMA Pediatrics.