This large multicenter study validates the Bacterial Meningitis Score prediction rule in the era of conjugate pneumococcal vaccine as an accurate decision support tool. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The Bacterial Meningitis Score may be helpful to guide clinical decision making for the management of children presenting to emergency departments with CSF pleocytosis.

In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results.

Objective. To design and implement a demonstration project to teach interprofessional teams how to recognize and engage in difficult conversations with patients. Design. Interdisciplinary teams consisting of pharmacy students and residents, student nurses, and medical residents responded to preliminary questions regarding difficult conversations, listened to a brief discussion on difficult conversations; formed ad hoc teams and interacted with a standardized patient (mother) and a human simulator (child), discussing the infant's health issues, intimate partner violence, and suicidal thinking; and underwent debriefing. Assessment. Participants evaluated the learning methods positively and a majority demonstrated knowledge gains. The project team also learned lessons that will help better design future programs, including an emphasis on simulations over lecture and the importance of debriefing on student learning. Drawbacks included the major time commitment for design and implementation, sustainability, and the lack of resources to replicate the program for all students. Conclusion. Simulation is an effective technique to teach interprofessional teams how to engage in difficult conversations with patients.Keywords: simulation, standardized patients, interprofessional teams, communication INTRODUCTIONGraduates from health professional schools are expected to have competencies well beyond knowledge of drugs and diseases. A 2003 Institute of Medicine (IOM) report highlighted the need for health professional students to be educated to deliver patient-centered care, employ evidence-based practice, apply quality improvements, use informatics and practice in interdisciplinary teams as a way to improve patient safety.1 The 2007 Accreditation Council for Pharmacy Education (APCE) Accreditation Standards and Guidelines for the Professional Program in Pharmacy aligned the IOM report recommendations in terms of changes for pharmacy education. Specifically, the ACPE Standards state that graduates must be competent to deliver patient-centered care and to communicate and collaborate with patients, their caregivers, physicians, nurses, and other health care providers. Additionally, the Standards highlight the importance of students developing critical-thinking and problem-solving skills.The Pharmaceutical Care section of the 2007 Center for the Advancement of Pharmaceutical Education (CAPE) Guidelines includes educational outcomes related to communication with patients, caregivers, and other health professionals. Specifically, the CAPE Guidelines state that students should develop competency in fostering collaborative relationships that embodies teambased care, demonstrates a caring and respectful attitude, and communicates information in a way that patients and healthcare professionals understand in order to communicate ''clearly, accurately, compassionately, confidently, and persuasively. '' 3 The ACPE Standards encourage working with actual or simulated patients and health care professionals whenever possible during the ins...

Objectives: Changes in health care delivery and graduate medical education have important consequences for the workforce in pediatric emergency medicine (PEM). This study compared career preparation and potential attrition of the PEM workforce with the prior assessment from 1998.Methods: An e-mail survey was sent to members of the American Academy of Pediatrics (AAP) Section on EM and to non-AAP members board certified in PEM. Information on demographics, practice characteristics and professional activities, career preparation, future plans, and burnout (using two validated screening questions) was analyzed using standard descriptive statistics.Results: Of 2,120 surveys mailed, 895 responses were received (40.8% response). Over half (53.7%) of respondents were female, compared with 44% in 1998. The majority (62.9%) practiced in the emergency department (ED) of a free-standing children's hospital. The distribution of professional activities was similar to that reported in 1998, with the majority of time (60%) spent in direct patient care. Half indicated involvement in research, and almost half had dedicated time for other activities, including emergency medical services (7.3%), disaster (6.9%), child abuse (5.0%), transport (3.6%), toxicology (2.3% of respondents), and other (13.6%); additionally, 21.3% had dedicated time for quality/safety. Respondents were highly satisfied (95.6%) with fellowship preparation for clinical care, but less satisfied with preparation for research (49.2%) and administration (38.7%). However, satisfaction with nonclinical training was higher for those within 10 years of medical school graduation. Forty-six percent plan to change clinical activity in the next 5 years, including reducing hours, changing shifts, or retiring. Overall, 11.9% of all respondents, including 20.1% of women and 2.6% of men (p < 0.001), report currently working part time. Large majorities endorsed feeling burned out at work (88.5%) or more callous toward people as a result of work (67.5%) at least monthly, with one in five reporting such feelings at least weekly.Conclusions: While satisfaction with fellowship preparation for professional activities in PEM is improving, gaps remain in training in nonclinical skills. Symptoms of burnout are prevalent, and there is likely to be substantial attrition of PEM providers in the near future.ACADEMIC EMERGENCY MEDICINE 2016;23:48-54

Adherence to medication regimen and follow-up appointments in victims of suspected sexual abuse who are provided HIV prophylaxis is poor. The medications are associated with several side effects, but rarely do the side effects prohibit their use. Given difficulties with compliance, potential adverse effects of medications, and the high cost of treatment, care should be taken in offering prophylaxis to only those at increased risk for transmission of disease.