Objective-To implement comprehensive screening for child behavior and social determinants of health in an urban pediatric practice, and explore rates of referrals, and follow-up for positive screens.Method-Quality improvement (QI) methodology was used to implement routine screening using an adapted version of the Survey of Well Being of Young Children (SWYC), a child behavior and social screen, for all children ages 6 months to 10 years. Rates of screen administration and documentation were assessed for 18 months. Medical records of a convenience sample (N=349) were reviewed to track referrals and follow-up for positive screens. A secondary analysis explored associations between reported parental concern for their child's behavior, and both child behavior symptoms and social stressors.Results-Over 18 months, 2,028 screens were administered. Screening rates reached 90% after introducing a tablet for screening. Provider documentation of screens averaged 62%. In the

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Optimizing lipid control could further enhance clinical outcomes after myocardial infarction.

Community-acquired bacterial meningitis (CABM) morbidity and mortality remains high in those infected. Rapid diagnosis and treatment is paramount to reducing mortality and improving outcome. This retrospective cohort study aims to assess the time from presentation to diagnosis and treatment of vaccine preventable CABM as well as identify possible factors associated with delays in diagnosis and antibiotic administration. A retrospective chart review was conducted of individuals who presented to Columbia University Irving Medical Center (CUIMC), Children’s Hospital of New York (CHONY), Mount Sinai Medical Center, and Weill Cornell Medical Center with BM due to Haemophilus influenzae type B, Streptococcus pneumoniae, and Neisseria meningitidis between January 1, 2012 and December 31, 2017. Diagnosis was delayed by more than 8 hours in 13 patients (36.1%) and 5 individuals (13.9%) had a delay of 4 hours or more from presentation to the administration of antibiotics with appropriate CNS coverage. All of these patients were also initially misdiagnosed at an outpatient clinic, outside hospital, or emergency department. This retrospective study identified febrile and/or viral infections not otherwise specified and otitis media as the most common misdiagnoses underlying delays from presentation to diagnosis and to antibiotic treatment in those with BM.

Aims. Based on a multicenter cohort of people with anti‐NMDA receptor encephalitis (anti‐NMDARE), we describe seizure phenotypes, electroencephalographic (EEG) findings, and anti‐seizure treatment strategies. We also investigated whether specific electrographic features are associated with persistent seizures or status epilepticus after acute presentation.Methods. In this retrospective cohort study, we reviewed records of children and adults with anti‐NMDARE between 2010 and 2014 who were included in the Rare Epilepsy of New York City database, which included the text of physician notes from five academic medical centers. Clinical history (e.g., seizure semiology) and EEG features (e.g., background organization, slowing, epileptiform activity, seizures, sleep architecture, extreme delta brush) were abstracted. We compared clinical features associated with persistent seizures (ongoing seizures after one month from presentation) and status epilepticus, using bivariate and multivariable analyses.Results. Among the 38 individuals with definite anti‐NMDARE, 32 (84%) had seizures and 29 (76%) had seizures captured on EEG. Electrographic‐only seizures were identified in five (13%) individuals. Seizures started at a median of four days after initial symptoms (IQR: 3–6 days). Frontal lobe‐onset focal seizures were most common (n=12; 32%). Most individuals (31/38; 82%) were refractory to anti‐seizure medications. Status epilepticus was associated with younger age (15 years [9–20] vs. 23 years [18–27]; p=0.04) and Hispanic ethnicity (30 [80%] vs. 8 [36%]; p=0.04). Persistent seizures (ongoing seizures after one month from presentation) were associated with younger age (nine years [3–14] vs. 22 years [15–28]; p<0.01). Measured electrographic features were not associated with persistent seizures.Conclusions. Seizures associated with anti‐NMDARE are primarily focal seizures originating in the frontal lobes. Younger patients may be at increased risk of epileptogenesis and status epilepticus. Continuous EEG monitoring helps identify subclinical seizures, but specific EEG findings may not predict the severity or persistence of seizures during hospitalization.