In the child with gastroenteritis that is unable to tolerate oral fluids, are there effective alternatives to intravenous hydration?

Nasogastric hydration is an effective alternative to intravenous hydration when oral hydration fails

What factors predict length of stay in a neonatal unit: a systematic review

Objective In the UK, 1 in 10 babies require specialist neonatal care. This care can last from hours to months depending on the need of the baby. The increasing survival of very preterm babies has increased neonatal care resource use. Evidence from multiple studies is crucial to identify factors which may be important for predicting length of stay (LOS). The ability to predict LOS is vital for resource planning, decision-making and parent counselling. The objective of this review was to identify which factors are important to consider when predicting LOS in the neonatal unit. Design A systematic review was undertaken which searched MEDLINE, EMBASE and Scopus for papers from 1994 to 2016 (May) for research investigating prediction of neonatal LOS. Strict inclusion and exclusion criteria were applied. Quality of each study was discussed, but not used as a reason for exclusion from the review. Main outcome measure Prediction of LOS in the neonatal unit. Results 9 studies were identified which investigated the prediction of neonatal LOS indicating a lack of evidence in the area. Inherent factors, particularly birth weight, sex and gestational age allow for a simple and objective prediction of LOS, which can be calculated on the first day of life. However, other early occurring factors may well also be important and estimates may need revising throughout the baby's stay in hospital. Conclusions Predicting LOS is vital to aid the commissioning of services and to help clinicians in their counselling of parents. The lack of evidence in this area indicates a need for larger studies to investigate methods of accurately predicting LOS

The multistate model used here to describe the neonatal care pathway.

<p>All babies begin in the birth state before following transitions (arrows) throughout the model until reaching death or discharge.</p

Number of babies to enter and visit each state within the multistate model.

<p>Number of babies to enter and visit each state within the multistate model.</p

Probabilities of 24 week babies receiving each level of care or who have died or been discharged estimated from the multistate model with an adjustment for gestational age.

<p>Probabilities of 24 week babies receiving each level of care or who have died or been discharged estimated from the multistate model with an adjustment for gestational age.</p

The probability of babies, adjusted for gestational age, receiving each level of care, or who have died or been discharged, over time.

<p>The probability of babies, adjusted for gestational age, receiving each level of care, or who have died or been discharged, over time.</p

Hazard ratios of each transition by gestational age.

<p>The hazard ratio compares back to the baseline of 27 weeks gestational age for that transition.</p

A qualitative study of medical educators’ perspectives on remediation: Adopting a holistic approach to struggling residents

<p><b>Introduction:</b> During residency, some trainees require the identification and remediation of deficiencies to achieve the knowledge, skills and attitudes necessary for independent practice. Given the limited published frameworks for remediation, we characterize remediation from the perspective of educators and propose a holistic framework to guide the approach to remediation.</p> <p><b>Methods:</b> We conducted semistructured focus groups to: explore methods for identifying struggling residents; categorize common domains of struggle; describe personal factors that contribute to difficulties; define remediation interventions and understand what constitutes successful completion. Data were analyzed through conventional content analysis.</p> <p><b>Results:</b> Nineteen physicians across multiple specialties and institutions participated in seven focus groups. Thirteen categories emerged around remediation. Some themes addressed practical components of remediation, while others reflected barriers to the process and the impact of remediation on the resident and program. The themes were used to inform development of a novel holistic framework for remediation.</p> <p><b>Conclusions:</b> The approach to remediation requires comprehensive identification of individual factors impacting performance. The intervention should not only include a tailored learning plan but also address confounders that impact likelihood of remediation success. Our holistic framework intends to guide educators creating remediation plans to ensure all domains are addressed.</p

Summary statistics of babies born at 24⁺⁰ to 31⁺⁶ weeks gestational age and discharged between 2011 and 2014.

<p>Summary statistics of babies born at 24⁺⁰ to 31⁺⁶ weeks gestational age and discharged between 2011 and 2014.</p

Probabilities of 31 week babies in each level of care or who have died or been discharged estimated from the multistate model with a categorical term for gestational age.

<p>Note that everyone has at least one day of care.</p