Assessing school nurses' knowledge and comfort in caring for children returning to school after pediatric critical illness.

Japanese encephalitis (JE) is a mosquito-borne flavivirus infection endemic to much of Asia and the Western Pacific. Although most infections are asymptomatic, less than 1% progress to clinical disease, typically presenting as acute encephalitis. The case fatality rate ranges from 20 to 30%, and up to half of survivors develop long-term neurological or psychiatric sequelae. While uncommon among travelers from non-endemic regions, risk increases with prolonged rural exposure or lack of vaccination. Immunocompromised individuals, including those with hematologic malignancies, may experience severe and rapidly progressive diseases. Awareness of this rare but life-threatening infection is essential when evaluating returning travelers with acute encephalopathy. A 70-year-old Lao male living in the California Central Valley with a history of multiple myeloma, hypertension, and congestive heart failure presented with progressive confusion and weakness after travel to rural Laos. His trip exceeded the recommended duration, and his Japanese encephalitis virus (JEV) vaccination status was unknown. On admission, he was febrile and encephalopathic with new-onset rigidity. Computed tomography showed chronic calcifications consistent with prior neurocysticercosis, while magnetic resonance imaging revealed bilateral frontal and left insular cortical hyperintensities without thalamic involvement. Cerebrospinal fluid analysis conducted 9days after his cognitive decline showed elevated protein without pleocytosis, and infectious and autoimmune panels were negative. Despite empiric antibiotics and supportive care, his condition deteriorated to coma, requiring intubation. Serologic testing later confirmed recent JEV infection with positive Immunoglobulin G (IgG) and low-titer Immunoglobulin M (IgM). After multidisciplinary discussions, comfort care was initiated, and he died in inpatient hospice. This case illustrates the diagnostic challenge of acute encephalopathy in immunocompromised travelers. Myeloma-related immune dysfunction, as suggested by his lack of pleocytosis, likely contributed to impaired viral clearance, leading to rapid progression. The absence of typical thalamic lesions and the presence of frontal and insular involvement represent an uncommon neuroimaging pattern in JE. Pre-existing neurocysticercosis may have further worsened neurologic outcomes, as prior studies suggest JEV co-infection can lead to worse prognosis. Our case highlights the importance of having a broad differential in an undifferentiated patient and the value of investigating a patient's history holistically. Imported JE should be considered in travelers returning from endemic regions, particularly those who are immunocompromised. A detailed travel history, broad infectious workup, and recognition of atypical imaging findings are key to diagnosis. Vaccination and mosquito precautions remain the most effective preventive measures against this often-fatal disease.

The ENd-of-life deciSion-making dURing Extracorporeal life support (ENSURE) survey aimed to assess current clinical practices and perspectives on end-of-life decisions for patients on extracorporeal life support (ECLS) across Europe. Understanding the challenges surrounding ECLS withdrawal may help mitigate moral distress in this complex decision-making process. The survey covered 20 questions to be assessed online and was composed of two sections: the first dealt with general questions on hospital details, ICU profile, ECLS provision, and participants' profession, and the second part was designed to elicit clinical questions, institutional protocols, management, and palliative care provision. For most of the questions, multiple-choice answers were provided. The survey was translated into 31 native European languages and captured respondents' actual practices, institutional protocols, management approaches, and palliative care provision related to ECLS discontinuation. Critically ill patients on ECLS when treatment goals are no longer achievable. None. Responses from 570 participants across 28 European countries showed that physicians (99%), nurses (63%), and relatives (54%) are commonly involved in ECLS end-of-life discussions. Although 49% of institutions offer clinical ethics committee access and 12% provide clinical ethicists, 24% lack any ethics support for challenging decisions. When ECLS goals fail, 41% of respondents reported discontinuing ECLS with comfort care, with Northern and Western Europeans most likely to report this practice (54% and 59%). Southern and Eastern Europeans more often reported limiting life-sustaining treatments without stopping ECLS (42% and 46%). Differences could also be observed for professionals with different religious backgrounds. The ENSURE survey highlights significant regional and cultural variations in reported ECLS discontinuation practices across Europe, likely influenced by clinicians' diverse backgrounds and institutional contexts. These differences, alongside limited ethics and palliative care support, underscore the need for structured interventions to enhance consistency and reduce moral distress in end-of-life decision-making for ECLS patients.

Rates of advance care planning (ACP) are lower and preferences for life-prolonging treatment are higher among Black compared to White older adults. We examined whether these differences persisted during the COVID-19 pandemic. Between February 2021 and September 2022, we conducted a cross-sectional COVID-19-focused survey of seriously ill adults ≥ 65 years in 10 primary care clinics participating in a clinical trial of two ACP interventions. Logistic regression models examined associations between COVID-19 related ACP discussion (defined as discussions with family, friends, or doctors about COVID-related medical care) and treatment preferences if very sick with COVID-19 (life-prolonging treatment, comfort care, trial of life-prolonging with transition to comfort care if no improvement) overall and by race, controlling for baseline characteristics. Among 428 participants (55.9% Black, 44.2% White; mean age 74.6), 25% reported discussing COVID-19 treatment preferences with family/friends and 6% with doctors. Most reported no change in willingness to participate in ACP due to the pandemic, though increased willingness was more common among Black than White participants (22.4% vs. 14.0%, p = 0.016). Despite this, COVID-19-related ACP discussion did not differ by race (family/friends: 22.7% vs. 28.3%, p = 0.19; doctors: 6.9% vs. 4.8%, p = 0.37). Most seriously ill older adults preferred a time-limited trial of life-prolonging treatment (71% White, 56.2% Black); though preferences varied by race (p < 0.0001); Black participants compared to White participants more often preferred life-prolonging treatment (28.5% vs. 10.3%). In adjusted models, race was not associated with COVID-19-related ACP discussion (OR 0.72, 95% CI 0.44-1.18), while preferences for life-prolonging treatments predicted greater COVID-19 related ACP discussion (OR 1.98, 95% CI 1.14-3.44). In contrast to pre-pandemic ACP research, no racial differences were observed in COVID-19-related ACP discussion, though differences in treatment preferences persisted. These findings underscore the need for culturally responsive, context-sensitive ACP approaches among seriously ill older adults.

Despite efforts to implement disabilities curriculum into the four years of undergraduate medical education (UME), the absence of a mandated, comprehensive, longitudinal curriculum likely contributes to health disparities experienced by people with disabilities (PWD). We examine the impact of the first mandated four-year medical school disabilities curriculum on five cohorts of allopathic medical students' knowledge, confidence, and attitudes regarding care for PWD. During academic years (AY) 2020-2021 through 2023-2024, seven mandatory disability-specific interventions were interspersed throughout the UME program. Since curricula were developed over the four-year period, it was not possible for every student to experience all seven curricular interventions; collective survey respondents per session ranged from 58 to 899. Session content included: apparent and non-apparent disabilities; ableism, bias, and stigma; functional limitations, barriers, and accommodations; impact of bias on physical and sexual health; and supporting the transition of PWD from pediatric to adult care. Students were assessed objectively and subjectively at four timepoints and completed a reflective essay. The Wilcoxon matched-pairs signed-ranks test was used to assess differences between pre- and post-session survey results. In AY 2023-2024, a validated attitudes survey was administered before and after a fourth-year intervention; students demonstrated statistically significant improvement in several areas. Optional eighth (n = 57) and ninth sessions (n = 8) were piloted to practice hands-on safe patient-transfer protocols and hone communication with patients with intellectual and developmental disabilities, respectively. Qualitative inductive content analysis was used to evaluate the essay question. Five cohorts (n = 899) demonstrated statistically significant increases in knowledge and confidence in various disabilities-related areas. Essays from two cohorts (n = 423) expressed commitment to addressing healthcare disparities and unconscious bias, promoting effective communication, and providing empathetic care to PWD. Validated student attitude surveys of one cohort (n = 58) demonstrated significant increases in recognizing the quality of life of PWD, comfort around a person who is blind or deaf, and comfort performing a physical exam on a patient who uses a wheelchair. Objectively and subjectively, medical students who engaged in curricular sessions reported increased knowledge and comfort caring for PWD, and many demonstrated statistically significant improvements in their perceived confidence in supporting PWD. This is the first mandated four-year UME disabilities curriculum to be published.

Anesthetic Outcomes: Postoperative Nausea and Vomiting in Laparoscopic Gynecological Surgery Patients Who Had General Anesthesia With an Enhanced Recovery After Surgery (ERAS) Technique.

Delivery of geriatric oncology training to medical oncology residents - Is opportunistic learning good enough?

To explore how nurses comfort pediatric hematology-oncology (PHO) patients, examine nurses' confidence and educational preparation in providing comfort, and inform recommendations for enhancing new nurses' readiness. Seventeen PHO nurses in the southeastern United States were recruited through professional networks and PHO-focused organizations to complete an anonymous online survey. PHO nurses completed a survey with 12 closed and 4 open-ended questions. Open-coding content analysis was used to derive themes about how nurses comfort PHO patients. Demographic data were analyzed using descriptive statistics. A conceptual model described how nurses comfort PHO patients through dynamic individualized care using the approaches of preparation, comforting presence, listening, and distraction. More experienced nurses appeared to be more likely to identify listening as a comforting approach. Nurses who were more confident using comfort approaches appeared to be more likely to use them. Comfort care is a particular priority when caring for a PHO patient. Understanding nurses' readiness to provide comfort and how they approach this key aspect of PHO care strengthens patient care and nursing practice transitions. There are opportunities to increase education and readiness for this nursing role.

Competency in the pediatric genital examination is critical, but physician comfort and ability are often limited. Contributing factors include lack of standardized teaching, inconsistent training, and the examination's sensitive nature. These gaps may lead to missed signs of abuse or misinterpreted findings. A trauma-informed approach emphasizing patient safety, empowerment, and healing may help address these challenges. We conducted a qualitative study to explore pediatricians' experiences and identify barriers, facilitators, and recommendations. We interviewed 7 pediatricians in an ambulatory setting at an academic hospital in New York City. Data were analyzed thematically, with transcripts coded by the research team. Themes focused on provider experiences, barriers, and recommendations. Barriers included limited training, time constraints, discomfort, and fear of causing trauma. Pediatricians suggested building rapport, empowering patients, standardizing examinations, and ensuring cultural sensitivity. Trauma-informed strategies may improve provider comfort, examination frequency, and patient care.

Real-World Clinical Outcomes in Melanoma Patients Treated at a Single-Center Tumor Infiltrating Lymphocyte (TIL) Therapy Program Using Commercial Lifileucel.

To explore the clinical efficacy and safety of dexmedetomidine hydrochloride for preoperative sedation in children undergoing emergency facial trauma cosmetic suturing. A total of 200 children with facial trauma admitted to the Emergency Surgery Department of our hospital from January to June 2025 were retrospectively enrolled and assigned to two groups for different sedation interventions. The study group received preoperative intranasal dexmedetomidine hydrochloride spray, while the control group received routine comfort care. The UMSS Sedation Scale was used to assess sedation level objectively, and rescue dosing protocols were implemented for sedation failure. Statistical analyses were performed using SPSS 30.0 software, with a two-tailed P-value ≤ 0.05 and 95% confidence intervals (CIs) considered statistically significant. A total of 100 cases were included in both the study group and the control group, with no baseline differences between the two groups (P > 0.05). The sedation failure rate in the study group was 8.0% (8/100), and all 8 cases achieved effective sedation after rescue dosing with one additional spray (15μg for 10.7-19.4 kg, 25 μg for 19.4-28.0 kg) intranasal dexmedetomidine hydrochloride; no sedation failure was observed in the control group. No serious adverse reactions were observed in either group. Preoperative and intraoperative cooperation in the study group was significantly better than that in the control group, and the incidence of agitation was significantly lower (P < 0.01), 95%CI: 0.0-0.2. No serious adverse reactions were observed in either group. Preoperative heart rate, respiratory rate, oxygen saturation, and mean arterial pressure were comparable between the two groups (P > 0.05). Intraoperatively, the study group maintained more stable vital signs, with significantly lower heart rate and mean arterial pressure than the control group (P < 0.05), 95%CI for heart rate: 8.2-15.7; 95%CI for mean arterial pressure: 5.1-10.3, all within normal physiological ranges. Preoperative intranasal dexmedetomidine hydrochloride is an effective and safe regimen for improving intraoperative cooperation, stabilizing vital signs, reducing agitation, and enhancing cosmetic suture quality and family satisfaction in children with emergency facial trauma.

A subset of patients with anterior circulation large-vessel occlusion (LVO) stroke progressed to malignant middle cerebral artery infarction (mMCAi) despite successful recanalization following endovascular treatment. This study investigated whether full medical support (FMS) could improve functional outcomes beyond reducing mortality in this population. In this retrospective cohort study, consecutive patients from hospital-based stroke registry (May 2015 to August 2021) with anterior LVO stroke who developed mMCAi despite successful recanalization were included. Patients were stratified into two groups on the basis of the intensity of postprocedural care: the FMS group (aggressive neurocritical care) and the non-FMS group (limited medical support or comfort care). The primary outcome was survival without severe disability, defined as a modified Rankin Scale (mRS) score of 0-4 at 90days. Secondary outcomes included ordinal shift analysis of the mRS, rates of functional independence (mRS 0-2 and 0-3), and 90-day mortality. Among 114 eligible patients, 65 were assigned to the FMS group and 49 to the non-FMS group. The FMS group demonstrated a significantly higher rate of the primary outcome (46.2% vs. 6.1%; P < 0.001) along with a markedly lower 90-day mortality (23.1% vs. 81.6%; P < 0.001) compared with the non-FMS group. After adjustment for age, gender, and confounders, FMS remained independently associated with increased odds of achieving mRS 0-4 [adjusted odds ratio (aOR), 5.88; 95% confidence interval (CI) 1.31-26.40; P = 0.021) and with reduced mortality (aOR, 0.14; 95% CI 0.05-0.42; P < 0.001), while no statistically significant difference was observed in the proportion of patients achieving an mRS of 0-2 or in those achieving an mRS of 0-3. In patients who developed mMCAi after successful recanalization, FMS is associated with a greater likelihood of survival without severe disability (mRS 0-4). These findings suggest that withdrawal of aggressive medical care in this population should be approached with caution.

Introduction. Pediatric burns are a frequent cause of emergency department attendance and hospitalization and may result in acute pain, infection, delayed healing, and long-term sequelae such as hypertrophic scarring and functional impairment. Early management aims to limit burn progression, optimize the wound microenvironment, and reduce the burden of painful dressing changes for children and families. First aid behaviors and the choice of first-line topical agents and dressings vary widely, and traditional treatments such as silver sulfadiazine have been challenged by newer dressings designed to improve comfort and support outpatient care. Methods. We conducted a scoping review in accordance with PRISMA-ScR guidance to map evidence on conservative, non-surgical topical agents and dressings used as first-line treatment for minor-to-moderate pediatric burns (age &lt;18 years). We searched PubMed/MEDLINE, Embase, CINAHL, and the Cochrane Library and screened titles/abstracts and full texts in duplicate. We included comparative and non-comparative studies reporting outcomes related to healing, infection, pain, dressing burden, resource use, and scar endpoints. Findings were synthesized descriptively without meta-analysis or risk-of-bias appraisal. Results. From 2,397 records, 38 studies met eligibility criteria. Designs were heterogeneous (randomized trials, prospective/retrospective cohorts, pilots, observational analyses, and case-based reports) and were conducted across multiple countries. Interventions included first aid and analgesic adjuncts; silver sulfadiazine compared with alternative topical agents and dressings; advanced silver-impregnated systems (eg, hydrofiber/foam dressings); biosynthetic or synthetic membranes and biomaterials (eg, Suprathel®, Biobrane®); hyaluronic acid–based protocols; nanocellulose dressings; gel-based or bioactive treatments; and other innovative dressings. Across comparative studies in superficial-to-partial thickness burns, several advanced dressings were associated with fewer dressing changes and lower procedural pain while achieving comparable or faster re-epithelialization than silver sulfadiazine. Effects on infection, length of stay, and scar outcomes were variable and often limited by inconsistent definitions and follow-up. Discussion. The mapped literature indicates that selected advanced dressings may provide clinically meaningful advantages by reducing dressing-change frequency and procedural pain, potentially facilitating outpatient management in appropriate cases. However, certainty is constrained by heterogeneity in burn depth assessment, variation in debridement and analgesia pathways, and inconsistent outcome reporting, with limited long-term scar and functional data. Future studies should adopt standardized, patient-centered pediatric outcomes (healing, infection definitions, validated pain/itch measures, and scar assessments) and pragmatic comparative designs to inform internationally applicable care pathways.

Continuous care provided by the same midwife throughout the maternity journey may have significant benefits for labor outcomes and women's childbirth experiences. This single-blind randomized controlled trial, conducted in a public hospital in Türkiye between October 2024 and February 2025, investigated the effects of continuous midwifery care on labor pain, duration, comfort, and the perception of respectful maternity care. A total of 85 women were randomly assigned to either an intervention group (n = 43), receiving care from the same midwife during the prenatal, intrapartum, and postnatal periods, or a control group (n = 42), where care was provided by different midwives. Findings revealed that women in the intervention group experienced significantly lower pain during labor, shorter labor durations, and greater comfort. Additionally, their perceptions of respectful maternity care were markedly more positive than those in the control group (p < .001). These results suggest that continuity of midwifery care enhances both clinical and experiential outcomes for women. Implementing midwife-led continuity of care models in Türkiye could contribute to more personalized, comfortable, and respectful childbirth experiences, ultimately improving maternal satisfaction and well-being.

To report the outcomes of a population of fetuses and neonates with life-limiting (LL) or life-threatening (LT) diagnoses leading to adverse prognoses cared for by a service of perinatal palliative care (PPC), the Percorso Giacomo (PG). This is a single center retrospective cohort study of all fetuses and neonates prenatally or postnatally diagnosed with LL or LT conditions whose families opted to continue the pregnancy at IRCCS Policlinico di Sant'Orsola in Bologna, Italy, from 2013 to 2025. There were 83 fetuses and/or neonates including 64 diagnosed prenatally and 19 postnatally with annual significant increments in number. All families encountered the PG team. Overall, the cohort demonstrated a very high cumulative rate of comfort care plan (90%) with high rate of redirection of goals of care from intensive to palliative. PG showed a significant growth over 13 years suggesting the strong need of a service of PPC. The continuity of care provided by PG facilitated parental decision-making process towards redirection of goals of care. The outcomes observed provided valuable insights related to the wide range of prognoses for each diagnosis that will enable more informed counseling in the future.

Approximately two-thirds of children naturally fear medical procedures, with their subjective experience being more influential than the actual severity of the intervention. Procedural stress can lead to anticipatory anxiety, distrust, and post-traumatic stress symptoms, making effective management crucial. This article presents a comprehensive approach to pediatric procedural comfort care through the 7P model for trauma-free care. Key strategies include building trust through age-appropriate communication, using "helpful language" that redirects attention away from pain and anxiety, implementing distraction techniques, and ensuring adequate pain management through topical anesthetics and local anesthesia. Parents play a vital role as active partners in care. The 3R model (Regulate, Relate, Reason) provides a structured approach for managing highly anxious children. Implementing procedural comfort care requires specific competencies including child-centered communication and emotion regulation skills. Investment in team training and educational programs is essential for widespread implementation and preventing long-term medical trauma in pediatric patients.

End-of-life decision-making in neonates with surgical necrotizing enterocolitis (NEC) is complex and varies between clinicians depending on their interpretation of clinical variables. This study aimed to create transparency in this variability and assess its impact on the use of Behavioral Artificial Intelligence Technology (BAIT) as a tool to inform clinical decision making. Attendees of multidisciplinary team meetings where the decision between surgery and comfort care was made for a neonate with surgical NEC were asked to interpret clinical variables required for BAIT. Variability in interpretation was analyzed using standard deviations, and assessed for correlation with variability in BAIT predictions using Spearman's rank correlation. Linear mixed effects models were used to assess the influence of demographics on these predictions and Spearman's rank correlation evaluated association with personal treatment preference, aiming to identify factors contributing to inter-rater differences. The largest variations were observed in the interpretation of growth since birth (SD = 0.29), congenital comorbidities (SD = 0.26), and hemodynamics (SD = 0.23). Variability in variable interpretation correlated to variability in BAIT predictions (ρ = 0.782, p < 0.001). Clinicians' specialty was the primary factor contributing to these variations, and there was a significant association between treatment preference and model prediction (ρ = 0.552, p < 0.001). The decision-making process is highly complex and influenced by personal factors. BAIT can offer transparency into these variations and serve as a reflective tool for clinicians, enabling more informed and consistent decision-making for surgical NEC.

PurposeThis study explored the experiences of physicians and nurses providing end-of-life care in Korean acute care hospitals. It aimed to identify the challenges faced in caring for dying patients and to suggest strategies for improving hospital-based end-of-life care.MethodsA qualitative exploratory design was employed using focus group interviews. Eleven healthcare professionals (five physicians and six nurses) working in tertiary or general hospitals participated in the study between July and August 2018. The interviews were conducted using a semi-structured guide covering seven thematic areas. All sessions were audio-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke’s framework.ResultsSix major themes emerged (1) communication with patients and families, (2) physical care for dying patients, (3) psychological and spiritual support, (4) hospital environment and system constraints, (5) moral distress and emotional burden on healthcare providers, and (6) suggestions for improvement. The participants described difficulties in open communication, limited resources for comfort care, emotional strain from invasive treatment at the end of life, and the absence of standardized institutional protocols. They emphasized the need for structured communication training, multidisciplinary collaboration, and integration of palliative care principles into acute care practice.ConclusionPhysicians and nurses play a pivotal yet emotionally demanding role in providing end-of-life care in acute hospitals. Institutional reforms, including education, protocol development, and supportive environments, are essential to ensuring dignified, patient-centered care and sustain healthcare providers in their professional roles.

Electroclinical correlates of seizures and episodic dystonia in a neonate with primary coenzyme Q10 deficiency due to COQ4 mutations

Abstract: "In the Wake" is a meditative, nonlinear essay about a son's presence during his father's final days in the comfort care unit of a hospital, reflecting on the nontraditional nature of his grief, the complicated history of his relationship with an ex-lover, and the profound, physical, and historical dimensions of Black mourning.