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Systemic juvenile idiopathic arthritis (SJIA) is a chronic autoinflammatory condition. The association with macrophage activation syndrome, and the therapeutic efficacy of inhibiting monocyte-derived cytokines, has implicated these cells in SJIA pathogenesis. To characterize the activation state (classical/M1 versus alternative/M2) of SJIA monocytes, we immunophenotyped monocytes using several approaches. Monocyte transcripts were analyzed by microarray and quantitative PCR. Surface proteins were measured at the single cell level using flow cytometry. Cytokine production was evaluated by intracellular staining and ELISA. CD14++CD16− and CD14+CD16+ monocyte subsets are activated in SJIA. A mixed M1/M2 activation phenotype is apparent at the single cell level, especially during flare. Consistent with an M2 phenotype, SJIA monocytes produce IL-1β after LPS exposure, but do not secrete it. Despite the inflammatory nature of active SJIA, circulating monocytes demonstrate significant anti-inflammatory features. The persistence of some of these phenotypes during clinically inactive disease argues that this state reflects compensated inflammation.

Several of the reasons parents identify for return visits are within the locus of control of the ED, and several could be addressed by improving regional health care coordination. Surveys based on these themes will quantitate the reasons for return visits and prioritize future strategies to address the perceived need for return visits.

The most commonly reported reasons for pediatric return visits were continued symptoms and lack of illness understanding. We plan to use these data to develop targeted interventions to decrease the perceived need for return visits.

Background Pediatrics residents perform a limited number of some procedures in the clinical setting and may benefit from procedure simulation workshops. Objective To examine (1) the number and types of procedures performed by pediatrics residents in the clinical setting, (2) the relationship between the number of procedures performed and self-reported procedural confidence and competence, and (3) the effect of a procedure simulation workshop on self-reported procedural confidence and competence. Methods Pediatrics residents at Lucile Packard Children's Hospital at Stanford attended a half-day procedure workshop, rotating between 6 procedure simulation stations: vascular access, airway management, bladder catheterization, chest tube placement, lumbar puncture, and umbilical lines. Residents completed a survey immediately before and after the workshop to self-assess procedural confidence and competence. Results Seventy-two residents participated in a procedure workshop. The average number of procedures performed increased significantly from intern to junior to senior year. A positive correlation was found between number of procedures performed and preworkshop confidence (P < .001, R2  =  0.86) and competence (P < .001, R2  =  0.88). For each procedure assessed, completion of the procedure simulation workshop resulted in a statistically significant (P < .001) increase in self-perceived confidence (14%–131%; average, 48%) and competence (12%–119%; average, 50%). Statistically significant (P < .05) increases remained when results for interns, juniors, and seniors were examined separately. Conclusion Procedure simulation workshops improve resident self-reported procedural confidence and competence, particularly for procedures that are least performed.