The impact of candidemia on excess mortality, increased length of stay, and the burden of cost of hospitalization underscores the need for improved means of prevention and treatment of candidemia in adults and children.

Serum S-100beta levels in healthy children have a moderate inverse correlation with age. After traumatic brain injury in children, the acute assessment of serum S-100beta levels seems to be associated with outcome.

Objective: To test the hypothesis that discharge disposition for adolescents admitted to medical hospitals after attempting suicide varies as a function of hospital type and geographic region. Results: Care for 32 655 adolescents who attempted suicide was provided in adult hospitals (83% of hospitalizations), children's units in general hospitals (10%), and children's hospitals (4%). More than half (66%) of medical hospitalizations ended with discharge to home, 21% with transfer to a psychiatric, rehabilitation, or chronic care (P/R/C) facility, 10% with transfer to a skilled nursing facility, intermediate care facility, or short-term acute care hospital facility, and 2% with death or departure against medical advice. After adjustment for individual patient characteristics, children's units were 44% more likely than adult hospitals to transfer adolescent patients to a P/R/C facility (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.07-1.94). Patients cared for outside the Northeast were significantly less likely to be transferred to a P/R/C facility (South: OR, 0.79; 95% CI, Midwest: OR, 0.63; 95% CI, West: OR, 0.29; 95% CI,. Conclusions:Most adolescents admitted to a medical hospital after a suicide attempt are discharged to home, and the likelihood of transfer to another facility appears to be influenced by the geographic location of the admitting hospital and whether it caters to children.Arch Pediatr Adolesc Med. 2005;159:860-866

6534 Background: Identifying effective, scalable strategies to ensure patient adherence to oral anticancer agents (OACAs) is a major challenge. Previous studies have shown widely variable rates of adherence, and suboptimal adherence is associated with decreased effectiveness and higher costs. A small but growing literature supports digital health behavioral interventions across a variety of chronic illnesses, including in cancer. In particular, conversational agents—or technologies that mimic human conversation using text or spoken language—have shown early promise in supporting behavior change, but have yet to be rigorously tested in the context of OACAs. Methods: A rapid cycle prototyping approach led to the development of ‘Penny’ – a bidirectional, conversational agent that engages patients via text messaging, and leverages natural language processing and machine learning to learn from clinical interactions. Core functionalities include: (1) real-time dosing instructions, (2) motivational reminders, and (3) symptom monitoring with self-management support. We conducted a four-month usability study between December 24, 2017 and May 1, 2018 in a large academic cancer center. At monthly intervals for the first 12 weeks of follow-up, research staff conducted qualitative interviews with participants to evaluate usability and acceptance. Results: 11 patients with gastrointestinal neuroendocrine cancer on capecitabine and temozolomide were approached regarding the study. Of these, 10 agreed to participate (ages 45 to 71). Overall, participant satisfaction was high with a Net Promoter Score of 100. Reliability of Penny’s algorithmic branching to provide accurate dosing information and symptom triage was also high: symptoms were accurately graded 100% of the time, and there was appropriate self-management advice or provider triage 100% of the time. Average daily adherence (based on self-report) was 98%. Participants reported that 3 emergency room visits were avoided during the study period. Conclusions: In preliminary testing, a mobile phone-based conversational agent was a usable and acceptable means of supporting OACA adherence. Expanded study testing patient safety and efficacy is underway.

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