No clear guidelines exist for the management of infants #60 days old with urinary tract infection (UTI), although this condition represents a significant percentage of serious bacterial infection in this age group. We examined patterns of UTI management in infants #60 days at a tertiary care children's hospital and hypothesized that younger infants would be hospitalized longer. METHODS:We reviewed electronic health records of infants age #60 days with diagnostic codes of UTI or fever hospitalized from January 2013 to January 2017 with urine culture obtained and UTI diagnosis documented. Outcomes were duration of parenteral antibiotic therapy, length of stay (LOS), and hospital readmission.RESULTS: One hundred ninety-three infants met criteria. Median age at admission was 37 days (interquartile range [IQR]: 22-48). Median duration of parenteral antibiotics was 59 hours (IQR 43-114) and median LOS was 71 hours (IQR 57 127). Infants age #28 days, with fever duration $24 hours, irritability or lethargy on initial examination, and bacteremia received longer parenteral therapy and had longer LOS. In multivariate analysis, age, irritability or lethargy, and presence of bacteremia remained independently related to parenteral therapy duration and LOS. CONCLUSIONS:In young infants with UTI, patients aged #28 days had longer duration of IV antibiotic therapy and LOS, independent of other clinical characteristics of their illness. The duration of parenteral therapy and LOS was relatively short, although significant variability still existed.

OBJECTIVES: Management of infants aged ≤60 days with urinary tract infections (UTI) is challenging. We examined renal imaging in infants aged ≤60 days with UTI at a tertiary care children’s hospital to identify the impact of standardizing renal ultrasound (RUS) interpretation. METHODS: We retrospectively studied infants aged ≤60 days hospitalized for UTI or fever with urine culture and renal imaging obtained and final diagnosis of UTI. RUS initially had noncriterion-based (NCB) interpretation by experienced pediatric radiologists. For this study, a single pediatric radiologist used a criterion-based (CB) hydronephrosis grading system to reinterpret films initially classified as “abnormal” on the NCB reading. We compared final renal imaging results between NCB and CB groups. RESULTS: Of 193 infants, 180 (93%) had inpatient RUS with 114 (63%) abnormal NCB interpretation. Of those with initially abnormal NCB interpretation, 85 OF 114 (75%) had minor and 29 OF 114 (25%) had significant abnormality by CB reinterpretation. In follow-up, the CB “minor abnormality” group showed 25% abnormal renal imaging, whereas the “significant abnormality” group showed 77% abnormal renal imaging with 54% having high-grade reflux on a voiding cystourethrogram (VCUG). Patients with CB inpatient RUS minor abnormality showed 3% abnormal RUS at follow-up, but 13% showed high-grade reflux on VCUG. CONCLUSIONS: Standardized RUS interpretation in young infants with UTI improved the accuracy of identification of abnormalities on follow-up renal imaging. In patients with CB minor abnormality on inpatient RUS, our results suggest limited utility of follow-up RUS; however, follow-up VCUG remained useful to identify high-grade reflux.

The game is highly modifiable, as other measurable, specialty-specific behaviors can be easily substituted for a particular competency, and additional assessment outcomes can be used.The Assessment and the ACGME Competencies game provided an engaging and interactive way to provide comparisons of multiple assessment tools in the context of the ACGME competency outcomes in a short period of faculty development time. Kristen K. Patton, MD Setting and ProblemResidents play an important role in the clinical education of medical students, and residents teaching in the ambulatory setting face unique challenges to sustain clinical quality and efficiency. Residents-asTeachers (RAT) programs have emerged to support residents in their education role(s), but the programs are increasingly at risk as residents' curricular time is NEW IDEAS allocated to other programmatic requirements. To prepare residents to teach in the ambulatory setting, we developed a ''just-in-time'' approach that stimulates workplace-based training of teachers. InterventionTeaching tokens provide just-in-time learning focused on efficient teaching behaviors to enhance the ambulatory educational experience. Tokens are optional paper reminders jointly selected by students and their resident preceptors to stimulate resident teaching. Each token identifies a specific focus followed by specific teaching behaviors to support that focus, with an extra line for resident/student co-generated strategies (FIGURE). Token teaching behaviors were derived from a literature review of ambulatory precepting strategies. Initially, tokens focused on strategies that promote meaningful student contributions to patient care and support teachers' clinical efficiency while aligning with student and resident competencies. These strategies included (1) priming learners and framing the patient visit; (2) incorporating students into systems-based practice; (3) using effective microteaching techniques (eg, the ''One-Minute Preceptor''); and (4) integrating the consideration of social determinants of health into teaching and care.Prior to introducing teaching tokens into the RAT curriculum, we piloted the intervention with ambulatory preceptors (n ¼ 9) and their assigned medical students at 3 teaching sites affiliated with the Medical College of Wisconsin. Preceptors and students were oriented to the purpose and process of the tokens, and they were asked to use tokens for at least 1 clinic session. Based on feedback from this pilot, we refined the token content, determined an optimal strategy for token distribution, and designed an orientation for implementation within the Waukesha Family Medicine Residency Program. The teaching token orientation was then incorporated into an existing RAT workshop for postgraduate year 1 through 3 residents. During this 20-minute session, residents received a brief presentation on the teaching tokens, including the background, purpose, and process for use in an ambulatory clinic. Residents divided into dyads and triads to practice using the tokens. ...

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