Management of the Acutely Unwell Child Nearly one-quarter of the world’s population are children aged 0–14 years, with this proportion rising to almost 50% in some countries. Children account for nearly one-fifth of all emergency department visits in the USA and U.K., with an increasing trend of emergency admissions requiring intensive care. Data from emergency departments in England and the U.S. report that approximately 20% of individuals are aged 14 y and u...

Medical News & Perspectives  Quick Uptakes January 11, 2023 Swab the Throat as Well as the Nose? The Debate Over the Best Way to Test for SARS-CoV-2 Rita Rubin JAMA. Published online January 11, 2023. doi:10.1001/jama.2022.23311 Three times over 5 days. That’s the most recent advice from the US Food and Drug Administration (FDA), posted in December 2022, about how often asymptomatic people should take rapid antigen tests to make sur...

Editorial  January 12, 2023 Lack of Benefit of Fluvoxamine for COVID-19 Adarsh Bhimraj, Jason C. Gallagher JAMA. Published online January 12, 2023. doi:10.1001/jama.2022.23954 The COVID-19 pandemic caught society unprepared. The lack of therapeutic agents for coronaviruses led to a scramble to investigate approved medications for repurposing against SARS-CoV-2.1 Successes were achieved with immunomodulatory agents for the inflammatory di...

Antibiotic Review Kit for Hospitals Antibiotic overuse is a growing problem in healthcare. Antimicrobial resistance has a significant impact on global public health, and its effects are similar to that of malaria and HIV. Antimicrobial resistance caused nearly 4.95 million deaths in 2019. In addition, antimicrobial resistance has significant economic consequences on healthcare systems.  Human antibiotic consumption is the primary cause of antimicrobial resi...

Prehospital Bundle of Care Associated With Mortality Decrease in Septic Shock Over 50 million people worldwide suffer from sepsis every year. Sepsis causes nearly 11 million deaths and is responsible for one-third to half of all in-hospital deaths. The mortality rate for sepsis ranges from 10 to 20%. For septic shock, the most serious form of sepsis, the mortality rate can range from 50 to 60%.  Guidelines recommend early recognition, severity assessment an...

EDITORIAL Constancy of Purpose for Improving Patient Safety — Missing in Action Donald M. Berwick N Engl J Med 2023; 388:181-182DOI: 10.1056/NEJMe2213567 The 20th-century statistician and quality scholar W. Edwards Deming proposed the “14 Points for Top Leaders” — a checklist of management principles for executives who wish to nurture improvement in complex systems. First on his list was “constancy of purpose for improvement.”1 In Deming’s view, when leaders s...

Obesity and Critical Care Nutrition A panel discussion with an international group of experts in the care of obese patients in the critical care setting evaluated best practices in malnutrition screening and assessment, estimation of energy needs for obese patients, the risks and management of sarcopenic obesity, the importance of tailored nutrition, and the role of immunonutrition.  Patients in the ICU are often overweight and/or obese, with obesity r...

Effect of Daily Written Updates for Families of ICU Patients ICU patients are often too ill to make decisions for themselves and need family members or surrogates to make medical decisions on their behalf. Surrogates may have to use substituted judgment when the critically ill patient has left no advanced directives. In such a situation, the surrogate may have to make decisions by considering what the patient would have done in a similar situation. This can cause u...

Editorial  December 16, 2022 Long-term Follow-up After Critical COVID-19: REMAP-CAP Revisited Michael L. Barnett, Paul E. Sax JAMA. Published online December 16, 2022. doi:10.1001/jama.2022.23700 The year 2020 was a grim and uncertain time for any clinician caring for inpatients with COVID-19, especially those with critical illness. In an era of modern medicine in which the range of options for many conditions can seem limitless, this novel v...

Editorial  December 27, 2022 The Relationship Between Income and Child Health: New Data for an Old Question Janet Currie, Hannes Schwandt JAMA. 2022;328(24):2402-2403. doi:10.1001/jama.2022.22245 Researchers have been using statistical methods to investigate the link between health and income in both adults and children since individual-level data allowing them to do so first became available.1-3 However, previous investigators were forc...