Pediatric Hospital Medicine : Textbook of In-Patient Management. This item is unavailable.Pediatric Hospital Medicine : Textbook of In-Patient Management

Interest in the care of hospitalized children has grown in recent years. An increase in the number of pediatric hospitalists and fellowship programs to train them provides a new system of care and new research opportunities to study the effectiveness of that system. Pediatric Hospital Medicine has the distinction of being the first textbook to focus exclusively on inpatient pediatric medicine. The editors state that the goals of their book are "to identify the core skills and body of knowledge needed by the pediatric hospitalist." (The term "hospitalist" is defined in the preface of the book as "a clinician spending at least 25% of his or her time on an inpatient service.") The book is divided into three major areas. The first area includes issues of concern to pediatric hospitalists: definition, developing and staffing a service, evidence-based medicine, clinical practice guidelines, and inpatient billing, among others. In the second area, a systems-based approach is used to define relevant clinical topics. This is extensive in scope, covering areas such as cardiology, neurology, gastroenterology, nephrology, infectious diseases, and disorders in other major systems, as well as care for the term newborn and surgical issues. The third area focuses on issues specific to pediatric inpatients, including a well-written section on the care of children with complex, chronic diseases (appropriate for the patient population being cared for in hospitals today) and sections covering sedation, pain, and nutrition. Discussions of gastrostomy tubes, long-term central venous catheters, tracheotomies, and pediatric home care are germane to the care of hospitalized children with complex health care needs; the text provides a good overview for the inpatient physician. Despite its clear strengths, Pediatric Hospital Medicine suffers from equally clear limitations, one of which is particularly problematic. The body of evidence on which pediatric hospitalists rely is small but rapidly expanding; care of inpatients relies on the application of the best currently available literature. Pediatric Hospital Medicine omits several studies of considerable importance to pediatric inpatient care, and these omissions shed light on the difficulties implicit in such a book. Pediatric inpatients often present with complex and rare conditions, which must be approached with both the extensive background knowledge a general book can supply and an awareness of the most current literature, which a print source by its very nature cannot provide. The problems associated with keeping a textbook current with new information are not unique to this book, but they may be more problematic when physicians are caring for inpatients. Another challenge faced by many pediatric hospitalists is the physician's need to be an excellent diagnostician. The section of the book on common presenting signs, symptoms, differential diagnosis, and "pearls" is adequate for the care of the typical pediatric patient with a common diagnosis, but it lacks a detailed discussion of the evaluation of many more unusual problems. Despite these limitations, Pediatric Hospital Medicine offers an important first look at how to approach the care of the hospitalized child. The strength of the book is in its coverage of topics specific to the work of a pediatric hospitalist. Pediatric hospitalists, hospitalists who occasionally look after children, general pediatricians, family practitioners, residents, medical students, and nurse practitioners in inpatient medicine will undoubtedly find this book a welcome addition to the complement of books they currently use. Rajendu Srivastava, M.D., M.P.H.
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