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Background: Accurately documenting pediatric atopic dermatitis (AD) severity is important, but research tools, such as Eczema Area and Severity Index (EASI), are too time consuming for clinical settings. Product of the Physician Global Assessment and affected percentage of body surface area (PGA3BSA) is a new, rapid measure of psoriasis severity.Objective: To evaluate an Investigator Global Assessment and body surface area product (IGA3BSA) as an easy-to-use severity measure for pediatric AD.Methods: Patient-reported and objective disease severity measures were collected from 195 caretaker/ child dyads (child age range, 5-17 years) with almost clear (Validated Investigator Global Assessment for AD [vIGA] of 1) to severe (vIGA of 4) AD. Data were assessed with Spearman coefficients and plots. Severity strata were proposed by using an anchoring approach based on the EASI.Results: IGA3BSA correlates better with the EASI than IGA alone (r = 0.924 vs r = 0.757, P \ .001). Bland-Altman plot indicates high and consistent agreement between IGA3BSA and the EASI. Suggested severity strata for IGA3BSA are 0-30, mild; 30.1-130, moderate; and 130.1-400, severe (k = 0.760). Limitations:The patient cohort was predominantly from the midwestern United States.Conclusions: IGA3BSA (using the vIGA) is a simple measure that correlates well with the EASI in patients with mild to severe pediatric AD. Future work is needed to affirm reliability across IGA scales and responsiveness to change.

Our study underscores the strong association between presence of a DNR order and mortality. Further studies are necessary to better understand the presence and timing of DNR orders in hospitalized older adults.

OBJECTIVES:To evaluate physician knowledge and perceptions about the American Board of Internal Medicine/ American Geriatrics Society (ABIM/AGS) Choosing Wisely recommendations regarding percutaneous endoscopic gastrostomy (PEG) in individuals with advanced dementia. DESIGN: Multicenter, mixed-mode, anonymous questionnaire. SETTING: Three tertiary and four community hospitals in New York. PARTICIPANTS: Internal medicine physicians (N = 168). MEASUREMENTS: Physician knowledge and perceptions regarding PEG tubes in individuals with advanced dementia. RESULTS: Ninety-nine percent of physicians reported having cared for someone with advanced dementia; 95% had been involved in the PEG decision-making process; 38% were unsure whether the ABIM/AGS Choosing Wisely recommendations advise for or against PEG tubes in advanced dementia. Physicians who agreed that there is enough evidence to recommend against PEG placement for individuals with advanced dementia were more likely to know the ABIM/AGS Choosing Wisely recommendations (71% vs 28%, P < .001). Fifty-two percent felt in control of the PEG placement decision, and 27% expressed concerns about potential litigation. The most common factor influencing physicians was patient or decision-maker request (70%); 63% stated that families request PEG placement even when physician would not recommend it. Only 4% of the physicians would choose to have a PEG tube if they had advanced dementia. CONCLUSION: Despite the scientific evidence supporting the ABIM/AGS Choosing Wisely recommendations against the use of PEG tubes in individuals with advanced dementia, numerous incentives for placement complicate the decision for PEG placement. In today's healthcare environment, it is incumbent upon healthcare practitioners to be aware of the available evidence and to provide leadership to guide this complex decision-making process to promote true person-centered care. J Am Geriatr Soc 66:64-69, 2018.

A multicomponent intervention of geographic cohorting, multidisciplinary approach, PES, and staff education may offer a new paradigm in the management of hospitalized older adults with cognitive impairment.

Although initiatives have increased awareness of the challenges, implementation of geriatric-focused practices in intensive care is inconsistent.

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