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Objective: Electronic health record (EHR) simulation with realistic test patients has improved recognition of safety concerns in test environments. We assessed if simulation affects EHR use patterns in real clinical settings., Materials and Methods: We created a 1-hour educational intervention of a simulated admission for pediatric interns. Data visualization and information retrieval tools were introduced to facilitate recognition of the patient's clinical status. Using EHR audit logs, we assessed the frequency with which these tools were accessed by residents prior to simulation exposure (intervention group, pre-simulation), after simulation exposure (intervention group, post-simulation), and among residents who never participated in simulation (control group)., Results: From July 2015 to February 2017, 57 pediatric residents participated in a simulation and 82 did not. Residents were more likely to use the data visualization tool after simulation (73% in post-simulation weeks vs 47% of combined pre-simulation and control weeks, P <. 0001) as well as the information retrieval tool (85% vs 36%, P < .0001). After adjusting for residents' experiences measured in previously completed inpatient weeks of service, simulation remained a significant predictor of using the data visualization (OR 2.8, CI: 2.1-3.9) and information retrieval tools (OR 3.0, CI: 2.0-4.5). Tool use did not decrease in interrupted time-series analysis over a median of 19 (IQR: 8-32) weeks of post-simulation follow-up., Discussion: Simulation was associated with persistent changes to EHR use patterns among pediatric residents., Conclusion: EHR simulation is an effective educational method that can change participants' use patterns in real clinical settings.

We report the case of a 55-year-old man with neurosyphilis that presented with features of herpes simplex encephalitis. Neurosyphilis is easily diagnosed and treated and should be included in the differential diagnosis of herpes simplex encephalitis.

Pediatric AIDS is increasing in frequency due to a rise in the number of human immunodeficiency virus type 1 (HIV-1)-infected women of childbearing age. Because outcome studies reveal that most children infected peripartum manifest HIV-1-related disease in the first year of life, intrauterine infection has been suspected. Fetal tissues from 23 second-trimester abortuses were examined. The presence of HIV-1 nucleic acid sequences was determined by the polymerase chain reaction and used to define infection of the fetus. By analysis of available tissues, 7 of 23 fetuses were infected, while control fetal tissue was negative. In situ hybridization for HIV-1 DNA showed that only 1 of 8 infected abortuses was positive, while all samples of noninfected tissues revealed no HIV-1 DNA. These studies indicate that maternofetal transmission of HIV-1 may occur in 30% of pregnancies (7/23) by the end of the second trimester.

Vancomycin instilled in an Ommaya reservoir was used to treat a reservoir-associated infection. Vancomycin concentrations in cerebrospinal fluid (CSF) were measured, and derivation of pharmacokinetic parameters allowed tailoring of dosing. First-order kinetics were observed. The calculated half-life of 3.52 h was less than reported by others, and the apparent volume of distribution (60 ml) was less than anticipated. The elimination constant was 0.197 h-1. Empiric dosing based on schedules suggested in the literature would have led to high peak and low mean concentrations of intrareservoir vancomycin. Patients with reservoir-associated infections have a variety of pathophysiologic conditions that can result in alteration of normal CSF dynamics. Pharmacokinetic analysis is useful to individualize dosing and to optimize therapy with intrareservoir vancomycin.

Coagulase-negative staphylococci, part of the normal skin flora, frequently colonize bioprosthetic devices and are the most common cause of peritonitis in patients undergoing peritoneal dialysis. Using the API STAPH-IDENT system (Analytab Products, Plainview, New York) and plasmid pattern analysis, we investigated the importance of chronic carriage of coagulase-negative staphylococci in the development of peritonitis due to these organisms. During a nine-month period, 182 surveillance cultures of pericatheter skin and anterior nares from 30 patients yielded 102 strains of coagulase-negative staphylococci. Twelve of these patients had 20 episodes of peritonitis due to these organisms. Staphylococcus epidermidis accounted for 75% of surveillance and 79% of peritonitis-associated strains. By plasmid pattern analysis of 47 surveillance and 16 peritonitis-associated strains, only three patients carried identical coagulase-negative staphylococci on two or more occasions, and only three patients developed peritonitis due to organisms cultured previously from body surface sites.