Now in its Second Edition, this text focuses exclusively on the management of hospitalized pediatric patients from admission to discharge. It is an excellent resource for residency programs, hospitalist fellowships, and continuing education for physicians whose practice includes the management of hospitalized newborns and children. Because pediatric hospital care is provided by a wide variety of healthcare professionals and in many different hospital settings, this text provides a framework for unified management and effective and efficient care. This edition includes new sections on emergency medicine and psychiatric hospitalization and expanded coverage of management of children with complex and chronic conditions.

Children with medical complexity (CMC) require increased number and length of hospitalizations, and increased need for care coordination.1-3 Many complex children with neuromuscular diseases have scoliosis, or a deformity of the spine. Often, scoliosis in these patients affects multiple organ systems and requires spinal fusion surgery to repair the deformity and decrease the likelihood of further organ damage.4,5 While it is well-known that spinal fusion surgery is costly and a high-risk procedure, little research has evaluated the perioperative process of spinal fusion patients. Furthermore, few care pathways exist for medically complex patients undergoing spinal fusions.6 This study examines the pre-, peri-, and post-operative experiences of families of patients undergoing spinal fusion surgery at Boston Children’s Hospital. Providers, organization, leadership and teamwork, and overall outcomes are assessed by this qualitative study. Initial data suggest that a pathway improving coordination and communication, especially among interactions with the surgical coordinator, should be implemented to improve scheduling of surgery and appointments throughout the perioperative process

INTRODUCTION: Negative pressure wound therapy (NPWT) has proved to be a powerful tool in facilitating the healing of difficult wounds of a variety of etiologies. The pediatric experience with NPWT has been limited because of concerns about vascular compression and pain associated with treatment. METHOD: A retrospective review (2004-2014) was conducted at Shriners Hospital for Children-Boston to evaluate the therapeutic effect of NPWT on children with difficult wounds due to burns or soft-tissue trauma. Information was collected on patient demographics, wound size and depth, burn injury etiology, length of hospital stay, number of operating room visits, and other treatment procedures. NPWT was instituted in the operating room under general anesthesia using a commercially available system. NPWT was not initiated until all necrotic material had been removed from the wounds. A negative pressure varying between -50 and -125 mmHg was applied to the wound as continuous suction, with younger children being prescribed the lower negative pressures. NPWT dressings were changed every 5-7 days in the operating room. When wounds were clean and granulated, they were closed with split-thickness skin grafts. RESULTS: Twenty-nine children with an average age of 9.43 +/- 1.95 years (range 2 months to 18 years) were treated with NPWT. The average total wound size was 24.8 +/- 8.9% (range 0%-95%) of the body surface in patients who had suffered burns and non-burn injuries. Injury mechanisms were categorized as hot liquid (2 children), contact with hot object (4 children), electricity (7 children), flame (9 children), and other non-burn injuries such as abrasion and degloving (7 children). Over 90% of the patients required central venous or bladder catheters. Perceived benefits of the treatment included reduced numbers of dressing changes and more rapid wound granulation. There were no episodes of bleeding associated with NPWT. All patients healed their wounds, were successfully grafted, and survived. CONCLUSION: NPWT has a useful role in the pediatric burn unit in facilitating wound healing and improving quality of life. A significant correlation between the size of third-degree burn wounds and the number of negative pressure therapies suggests that NPWT may be more effective in treating complicated burn wounds. Overall, NPWT appears safe and effective when applied to well-debrided wounds, and the treatment does not seem to be associated with excessive bleeding or discomfort in children.

El internado es una pieza fundamental en la carrera de Medicina, donde se le permite al estudiante poder desempeñarse y poner en práctica lo aprendido durante 06 años de estudios universitarios y rotaciones clínicas. El presente trabajo, fue realizado en los servicios de hospitalización y emergencia del Centro Médico Naval “Cirujano Mayor Santiago Távara” en el período de Junio de 2021 – Marzo 2022, donde se llevo a cabo el internado médico. Es una documentación de 30 casos recopilados, los cuales fueron atendidos en el período de tiempo mencionado con anterioridad, en las áreas de emergencia, consultorio externo y salas de hospitalización en los servicios de Ginecología y Obstetricia, Pediatría, Medicina Interna y Cirugía General respectivamente. Objetivo: Describir y hacer un análisis crítico a propósito de los casos clínicos a que estuve expuesto como interno de medicina y que contribuyeron a mi formación con aprendizajes significativos. Metodología: Trabajo descriptivo y analítico de la experiencia clínica obtenida durante el internado médico Conclusiones: El internado médico fue una culminación satisfactoria del pregrado, en el cual se pudo poner en práctica la parte académica, a la par de la humana, velando siempre por el bienestar del paciente. Todo conocimiento adquirido es importante pues nos sirven para mejorar como personal de salud y como personas. / The internship is a fundamental piece in the Medicine career, where the student is allowed to perform and put into practice what they have learned during 06 years of university studies and clinical rotations. The present work was carried out in the hospitalization and emergency services of the Naval Medical Center "Cirujano Mayor Santiago Távara" in the period of June 2021 - March 2022, where the medical internship was carried out. It is a documentation of 30 cases compiled, which were treated in the period of time mentioned above, in the emergency areas, outpatient clinic and hospitalization rooms in the Gynecology and Obstetrics, Pediatrics, Internal Medicine and General Surgery services, respectively. Objective: To describe and make a critical analysis of the clinical cases to which I was exposed as a medical intern and that contributed to my training with significant learning. Methodology: Descriptive and analytical work of the clinical experience obtained during the medical internship. Conclusions: The medical internship was a satisfactory culmination of the undergraduate degree, in which the academic part could be put into practice, along with the human part, always ensuring the well-being of the patient. All knowledge acquired is important because it helps us to improve as health personnel and as people. / Trabajo de Suficiencia Profesional

El año del internado es un año particularmente importante ya que es el séptimo y último año de la carrera de medicina. Durante este año todo el aprendizaje de los años previos se pone en práctica. Este trabajo consiste en una recopilación de 30 casos clínicos los cuales fueron atendidos en el Hospital Nacional Dos De Mayo y Centro Materno Infantil de Lurín en los servicios de Emergencia, Pediatría y Ginecología durante un período del internado que se realizó de junio de 2021 a febrero de 2022. Objetivo: describir y hacer un análisis crítico a propósito de los casos clínicos a que estuve expuesta como interna de medicina y que contribuyeron a mi formación con aprendizajes significativos. Metodología: trabajo descriptivo y analítico de la experiencia clínica obtenida durante el internado médico Resultados principales o hallazgos: describir el número de casos, con herramientas de análisis estadístico descriptivo. Resumir los aprendizajes significativos más relevantes que se obtuvieron. Conclusiones: el internado médico fue una culminación satisfactoria después de seis años de estudios donde se pudo poner en práctica los conocimientos adquiridos como el realizar una anamnesis ordenada, tener una actitud crítica frente a la información que recibe del paciente, estar atenta a los síntomas y signos, realizar un examen físico completo y exhaustivo, ejecutar algunos procedimientos tales como curaciones, suturas, atención de parto, atención del recién nacido, entre otros. / The ‘Internship’ year is of particular importance as it’s the seventh and final year of a medical degree. During this time, all the learning of the previous years is put into practice. This dissertation consists of a compilation of 30 clinical cases which were carried out at the Hospital Nacional Dos De Mayo and Centro Materno Infantil de Lurín in Emergency, Paediatric and Gynaecological services during an internship period which was undertaken from June 2021 to February 2022. / Trabajo de Suficiencia Profesional

This heuristic research project examines my personal use of art making as a form of self-care while interning in a pediatric hospital. The review of the literature investigates the concept of self-care and the use of art making as a therapeutic outlet for working art therapists, for professionals in the healthcare field, and for art therapy students working specifically in hospital settings. The literature suggests that self-care is a necessary process, that self-care is not just for the physical self, but also for one’s mental health. The literature also indicates that art therapists have found that art making as a specific self-care modality is demanded. The research then contains my own personal use and record of art making as a way to support myself while working as an art therapy trainee at Children’s Hospital Los Angeles. I gave myself the structure of making response art once a week on site for 15 weeks. The data includes said weekly art responses, as well as any written responses or observations made during art making. The patterns I found pertain to similarity in the materials used, the visuals created, and the contexts of each image. By actively making response artwork, I was able to deepen my understanding of the importance of art making for the art therapist. In addition, this research highlights the importance and responsibility that comes with self-care as an art therapist, and additionally, heuristic research in art making as a form of active self-care could be especially beneficial for the art therapy student.