"Just Listen … Really Listen": Expectations of Youth When Disclosing Mental Health Concerns with Parents.

Adolescence and emerging adulthood are developmental periods characterized by increased prevalence of mental health (MH) issues. Disclosure of MH issues to parents or other adults is important for youth to gain support and access professional MH care, but many youth do not disclose MH issues due to a myriad of reasons. In this study, we conducted five focus groups ( = 33) with adolescents and emerging adults to better understand their perceptions of disclosing MH issues to their parents.

Sepsis Mortality in Hospitalized Children With Cancer Is Associated With Lack of a Screening Tool.

Objective: Sepsis is associated with significant morbidity and mortality in pediatric hematology, oncology, and transplant (PHOT) patients. This study characterized PHOT patients who developed hospital-onset sepsis more than 12 hours after admission and identified risk factors for 30-day sepsis-attributable (SA) mortality.

Patients And Methods: We analyzed an existing multicenter database of sepsis collected prospectively over 5 years (2017-2021) as part of the Improving Pediatric Sepsis Outcomes Collaborative.

Delays to Antibiotics in the Emergency Department and Risk of Mortality in Children With Sepsis.

Importance: Pediatric consensus guidelines recommend antibiotic administration within 1 hour for septic shock and within 3 hours for sepsis without shock. Limited studies exist identifying a specific time past which delays in antibiotic administration are associated with worse outcomes.

Objective: To determine a time point for antibiotic administration that is associated with increased risk of mortality among pediatric patients with sepsis.

Design, Synthesis, and Investigation of the Pharmacokinetics and Anticancer Activities of Indenoisoquinoline Derivatives That Stabilize the G-Quadruplex in the Promoter and Inhibit Topoisomerase I.

G-quadruplexes are noncanonical four-stranded DNA secondary structures. is a master oncogene and the G-quadruplex formed in the promoter functions as a transcriptional silencer and can be stabilized by small molecules. We have previously revealed a novel mechanism of action for indenoisoquinoline anticancer drugs, dual-downregulation of MYC and inhibition of topoisomerase I.

Bundled Care to Reduce Sepsis Mortality: The Improving Pediatric Sepsis Outcomes (IPSO) Collaborative.

Objectives: We sought to improve utilization of a sepsis care bundle and decrease 3- and 30- day sepsis-attributable mortality, as well as determine which care elements of a sepsis bundle are associated with improved outcomes.

Methods: Children's Hospital Association formed a QI collaborative to Improve Pediatric Sepsis Outcomes (IPSO) (January 2017-March 2020 analyzed here). IPSO Suspected Sepsis (ISS) patients were those without organ dysfunction where the provider "intended to treat" sepsis.

Graduate students' perspectives on the role of faculty advisors in helping students with mental health problems.

Graduate students are more likely to experience mental illness than their peers in the general population. One potential source of support for personal issues and/or mental illness is a graduate student's faculty advisor. Although the relationship between faculty advisors and graduate students can positively influence the success and overall well-being of graduate students, graduate students may be reluctant to disclose mental health issues to their advisors.

Characteristics and Outcomes of Sepsis Presenting in Inpatient Pediatric Settings.

Objective: The pediatric sepsis literature lacks studies examining the inpatient setting, yet sepsis remains a leading cause of death in children's hospitals. More information is needed about sepsis arising in patients already hospitalized to improve morbidity and mortality outcomes. This study describes the clinical characteristics, process measures, and outcomes of inpatient sepsis cases compared with emergency department (ED) sepsis cases within the Improving Pediatric Sepsis Outcomes data registry from 46 hospitals that care for children.

More Accessible COVID-19 Treatment Through Monoclonal Antibody Infusion in the Emergency Department.

Introduction: Monoclonal antibody (MAB) infusion is the first treatment to manage coronavirus 2019 (COVID-19) in an outpatient setting. Yet increased risk of severe COVID-19 illness may occur from inequities in social determinants of health including access to quality healthcare. Given the safety-net nature of emergency departments (ED), a model that puts them at the center of MAB infusion may better reach underserved patients than models that require physician referral and distribute MAB at outpatient infusion centers.

Changes in Coagulation Testing During a National Shortage of Blue-Top Tubes.

Objectives: Manufacturer recalls and altered supply chains during the coronavirus disease 2019 (COVID-19) pandemic caused a nationwide shortage of blue-top tubes (BTTs). Most non-point-of-care coagulation tests use these tubes, leaving laboratories and health care facilities in short supply. The Department of Pathology and Laboratory Medicine at Cedars-Sinai Medical Center implemented interventions to conserve supply without sacrificing patient safety.

The Influence of Group Identification with Student Subgroups on Perceptions of Bystander Intervention to Prevent Sexual Assault.

College students can use bystander intervention tactics to prevent sexual assault within their communities. One's group memberships and group identification-conceptualized within social identity theory-could influence attitudes and behaviors related to bystander intervention. College students ( = 1,170) participated in an online survey measuring group membership with student subgroups, identification, and bystander intervention perceptions.

Association Between the First-Hour Intravenous Fluid Volume and Mortality in Pediatric Septic Shock.

Study Objective: To determine whether the receipt of more than or equal to 30 mL/kg of intravenous fluid in the first hour after emergency department (ED) arrival is associated with sepsis-attributable mortality among children with hypotensive septic shock.

Methods: This is a retrospective cohort study set in 57 EDs in the Improving Pediatric Sepsis Outcomes quality improvement collaborative. Patients less than 18 years of age with hypotensive septic shock who received their first intravenous fluid bolus within 1 hour of arrival at the ED were propensity-score matched for probability of receiving more than or equal to 30 mL/kg in the first hour.

Seasonal COVID-19 surge related hospital volumes and case fatality rates.

Background: Seasonal and regional surges in COVID-19 have imposed substantial strain on healthcare systems. Whereas sharp inclines in hospital volume were accompanied by overt increases in case fatality rates during the very early phases of the pandemic, the relative impact during later phases of the pandemic are less clear. We sought to characterize how the 2020 winter surge in COVID-19 volumes impacted case fatality in an adequately-resourced health system.

Emergency Department Management of Hypertension in the Context of COVID-19.

Purpose Of Review: This review describes the relationship between COVID-19 and hypertension (HTN), and considerations for emergency medicine providers in the management of hypertensive patients during the COVID-19 pandemic.

Recent Findings: Hypertensive patients with COVID-19 have a higher risk of severe disease/complications, hospitalizations, intensive care unit (ICU) admissions, and mortality than non-hypertensive patients. Studies have also shown the importance of consideration of various demographic factors (such as older age) and socioeconomic factors that may confound these relationships.

The Influence of Video-Modeled Sexual Assault Disclosure and Self-Efficacy Messages on Sexual Assault Disclosure Efficacy of Adolescent Girls.

Adolescent female victims of sexual assault must often disclose their victimization to trusted adults to seek positive physical and mental health outcomes; however, adolescent girls face unique barriers to disclosure, and they are less likely to disclose compared to adult women. Media interventions could be useful in motivating adolescent girls to feel more efficacious about disclosing sexual assaults. Self-efficacious messages in media that model disclosure behavior could motivate adolescent girls to feel more confident disclosing information about an assault and seeking positive health outcomes.

Babesiosis in the Emergency Department: A Case Report.

Background: Babesiosis, a tick-borne illness spread by Ixodes scapularis, is an emerging infectious disease in the Northeastern and upper Midwestern United States. Infection can present as a flu-like illness with anemia, thrombocytopenia, and jaundice. This disease can even be fatal in the immunocompromised or highly infected patient.

Metric Development for the Multicenter Improving Pediatric Sepsis Outcomes (IPSO) Collaborative.

Background: A 56 US hospital collaborative, Improving Pediatric Sepsis Outcomes, has developed variables, metrics and a data analysis plan to track quality improvement (QI)-based patient outcomes over time. Improving Pediatric Sepsis Outcomes expands on previous pediatric sepsis QI efforts by improving electronic data capture and uniformity across sites.

Methods: An expert panel developed metrics and corresponding variables to assess improvements across the care delivery spectrum, including the emergency department, acute care units, hematology and oncology, and the ICU.

Seroprevalence of antibodies to SARS-CoV-2 in healthcare workers: a cross-sectional study.

Objective: We sought to determine the extent of SARS-CoV-2 seroprevalence and the factors associated with seroprevalence across a diverse cohort of healthcare workers.

Design: Observational cohort study of healthcare workers, including SARS-CoV-2 serology testing and participant questionnaires.

Settings: A multisite healthcare delivery system located in Los Angeles County.

A randomized, noninferiority, controlled trial of two doses of intravenous subdissociative ketamine for analgesia in the emergency department.

Objective: This study aimed to determine if 0.15 mg/kg intravenous (IV) subdissociative ketamine is noninferior to 0.3 mg/kg in emergency department (ED) patients with acute pain.

Development of a Quality Improvement Learning Collaborative to Improve Pediatric Sepsis Outcomes.

Pediatric sepsis is a major public health problem. Published treatment guidelines and several initiatives have increased adherence with guideline recommendations and have improved patient outcomes, but the gains are modest, and persistent gaps remain. The Children's Hospital Association Improving Pediatric Sepsis Outcomes (IPSO) collaborative seeks to improve sepsis outcomes in pediatric emergency departments, ICUs, general care units, and hematology/oncology units.

Collaboration between patient organisations and a clinical research sponsor in a rare disease condition: learnings from a community advisory board and best practice for future collaborations.

Transparent collaborations between patient organisations (POs) and clinical research sponsors (CRS) can identify and address the unmet needs of patients and caregivers. These insights can improve clinical trial participant experience and delivery of medical innovations necessary to advance health outcomes and standards of care. We share our experiences from such a collaboration undertaken surrounding the SENSCIS clinical trial (NCT02597933), and discuss its impact during, and legacy beyond, the trial.

Identification of Functional Limitations and Discharge Destination in Patients With COVID-19.

Objectives: The objectives of this study were to identify functional limitations in patients with coronavirus 2019 (COVID-19) admitted to acute care hospitals; to evaluate functional limitations by demographic, medical, and encounter characteristics; and to examine functional limitations in relation to discharge destination.

Design: and Setting:This is a cross-sectional, retrospective study of adult patients with COVID-19 who were discharged from 2 different types of hospitals (academic medical center and a community hospital) within 1 health care system from January 1 to April 30, 2020.

Participants: Patients were identified from the Cedars-Sinai COVID-19 data registry who had a new-onset positive test for severe acute respiratory syndrome coronavirus 2.

Patient-Initiated Data: Our Experience with Enabling Patients to Initiate Incorporation of Heart Rate Data into the Electronic Health Record.

Background: Provider organizations increasingly allow incorporation of patient-generated data into electronic health records (EHRs). In 2015, we began allowing patients to upload data to our EHR without physician orders, which we henceforth call patient-initiated data (PAIDA). Syncing wearable heart rate monitors to our EHR allows for uploading of thousands of heart rates per patient per week, including many abnormally low and high rates.

Evaluating Pediatric Sepsis Definitions Designed for Electronic Health Record Extraction and Multicenter Quality Improvement.

Objectives: To describe the Children's Hospital Association's Improving Pediatric Sepsis Outcomes sepsis definitions and the identified patients; evaluate the definition using a published framework for evaluating sepsis definitions.

Design: Observational cohort.

Setting: Multicenter quality improvement collaborative of 46 hospitals from January 2017 to December 2018, excluding neonatal ICUs.