BACKGROUND Despite estimates that waste constitutes up to 20% of healthcare expenditures in the United States, overuse of tests and therapies is significantly under‐recognized in medicine, particularly in pediatrics. The American Board of Internal Medicine Foundation developed the Choosing Wisely campaign, which challenged medical societies to develop a list of 5 things physicians and patients should question. The Society of Hospital Medicine (SHM) joined this effort in the spring of 2012. This report provides the pediatric workgroup's results. METHODS A workgroup of experienced and geographically dispersed pediatric hospitalists was convened by the Quality and Safety Committee of the SHM. This group developed an initial list of 20 recommendations, which was pared down through a modified Delphi process to the final 5 listed below. RESULTS The top 5 recommendations proposed for pediatric hospital medicine are: (1) Do not order chest radiographs in children with asthma or bronchiolitis. (2) Do not use systemic corticosteroids in children under 2 years of age with a lower respiratory tract infection. (3) Do not use bronchodilators in children with bronchiolitis. (4) Do not treat gastroesophageal reflux in infants routinely with acid suppression therapy. (5) Do not use continuous pulse oximetry routinely in children with acute respiratory illness unless they are on supplemental oxygen. CONCLUSION We recommend that pediatric hospitalists use this list to prioritize quality improvement efforts and include issues of waste and overuse in their efforts to improve patient care. Journal of Hospital Medicine 2013;8:479–485. © 2013 Society of Hospital Medicine

Results obtained over the past decade towards the preparation of multitopic carbohydrate architectures combining the molecular inclusion capabilities of cyclomaltooligosaccharide receptors (cyclodextrins, CDs) and the recognition properties of saccharide ligands towards biological receptors are discussed. The potential of these new sugar‐based “intelligent” transporters for site specific delivery of therapeutics is outlined.

The majority of pathogenic bacteria in CSF exhibit growth within 36 hours. Most growth from CSF cultures in febrile infants is treated as contamination. The epidemiology of meningitis has remained constant, with group B as the predominant pathogen, despite changes noted in the epidemiology of bacteremia in this population.

OBJECTIVE: To determine the comparative effectiveness of common pleural drainage procedures for treatment of pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia). DESIGN: Multicenter retrospective cohort study. SETTING: Forty children's hospitals contributing data to the Pediatric Health Information System. PARTICIPANTS: Children with complicated pneumonia requiring pleural drainage. MAIN EXPOSURES: Initial drainage procedures were categorized as chest tube without fibrinolysis, chest tube with fibrinolysis, video‐assisted thoracoscopic surgery (VATS), and thoracotomy. MAIN OUTCOME MEASURES: Length of stay (LOS), additional drainage procedures, readmission within 14 days of discharge, and hospital costs. RESULTS: Initial procedures among 3500 patients included chest tube without fibrinolysis (n = 1762), chest tube with fibrinolysis (n = 623), VATS (n = 408), and thoracotomy (n = 797). Median age was 4.1 years. Overall, 716 (20.5%) patients received an additional drainage procedure (range, 6.8–44.8% across individual hospitals). The median LOS was 10 days (range, 7–14 days across individual hospitals). The median readmission rate was 3.8% (range, 0.8%‐33.3%). In multivariable analysis, differences in LOS by initial procedure type were not significant. Patients undergoing initial chest tube placement with or without fibrinolysis were more likely to require additional drainage procedures. However, initial chest tube without fibrinolysis was the least costly strategy. CONCLUSION: There is variability in the treatment and outcomes of children with complicated pneumonia. Outcomes were similar in patients undergoing initial chest tube placement with or without fibrinolysis. Those undergoing VATS received fewer additional drainage procedures but had no differences in LOS compared with other strategies. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine