Comparing estimated expenses before ($74,217) and after ($15,378) minus program costs ($31,720), yielded estimated savings of $27,119 per family in the year following admission. These findings extend the benefit of the program beyond clinical improvement, to outcomes important to both families and insurers.

The SCARED shows promise as a measure of anxiety in pediatric pain. Important caveats for its usage and areas in need of additional research are discussed. Of importance in pediatric pain is improving current approaches for measuring school anxiety in this population.

Background The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. Methods We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient’s age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. Results The median age in the sample of 7487 consecutive patients was 84 years (IQR 81–87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). Conclusion Knowledge about a patient’s frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

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Alternative administration method successfully eliminated overly short and excessively long records. Utility is potentially increased by greatly reducing both short records that often lack reliability and validity, as well as long records that consume an excessive amount of examiner administration and scoring time. Psychometric properties and the ability to apply parametric statistics are likely increased across variables given that the distribution of R is more normal. Re-administration due to inadequate R is almost never needed. Results are consistent with the conclusion that this alternative procedure reduces examiner variability by offering simple, but explicit instructions for encouraging sufficient productivity. Overall variability of R produced using the refined alternative procedure was significantly less than that produced using the traditional CS method, although more in line with Exner's (2003) normative expectations. Suggests that when using the alternative method, R becomes less of a confound for all other scores that are moderately to highly correlated with R. Also demonstrated that the reduced variability of R and the reduced number of less useful short and long records are generalized to clinical samples. Additional research (Reese, Viglione, & Giromini, 2014) provides support for these conclusions with child clinical samples.

The Clinical Assessment Program and Teflaro Utilization Registry (CAPTURE) is a multicenter study, assessing the contemporary use of ceftaroline fosamil in patients with community-acquired bacterial pneumonia (CABP) or acute bacterial skin and skin structure infection. This article discusses the data collected from 528 evaluable patients with CABP, from 39 sites in the United States, between August 2011 and April 2013. The majority of patients (51%) were elderly (aged ≥ 65 years), most of whom were treated in general hospital wards (70%). Approximately one quarter of elderly patients had ≥ 2 comorbidities (26%), the most common of which was structural lung disease (51%). The majority of elderly patients received ceftaroline fosamil as second-line therapy (85%), concurrently with other antibiotics (61%). Similar patterns of ceftaroline fosamil usage were noted in younger patients (aged < 65 years). Fifteen patients died (3%), 10 of whom were elderly. The overall clinical success of ceftaroline fosamil was 81% for elderly patients with CABP and 82% for younger patients. These data suggest that ceftaroline fosamil is a potentially effective treatment option for CABP in the elderly.

This study examined the effect of parent anxiety on treatment acceptability and retention of diagnostic feedback. Mothers (N = 187) of children ages 2 to 14 years recruited primarily through online parenting groups were randomly assigned to one of four vignettes that varied on ambiguity of diagnostic label (low vs. high) and ambiguity of diagnostic feedback (low vs. high). Participants completed measures of state and trait anxiety, retention of feedback, and treatment acceptability. Mothers reporting high trait anxiety endorsed greater treatment acceptability (F = 11.57, p = .001, η p 2 = .09). Those reporting high state anxiety retained more information, t(84.96) = −5.35, p < .001, Cohen’s d = .99. A significant interaction emerged between trait anxiety and diagnostic label on parent satisfaction (F = 4.95, p = .028, η p 2 = .04). Results suggest that parent anxiety may affect retention and likelihood of pursuing treatment. Future research is needed to investigate whether differences in parent anxiety translate into meaningful differences in their pursuit of treatment.

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes.