International adoptees represent a group of children with unique health care needs. Data from published studies, along with the recent experience of the Yale International Adoption Clinic, suggest that the risk of serious infections in adoptees is low, although infections associated with institutionalization still occur commonly. Interpretation of these data must be undertaken with caution, however, since many, if not most, international adoptees are not evaluated in specialty clinics. Thus, prospective studies designed to minimize selection and referral bias are needed in order to accurately define the risk of infectious and noninfectious diseases in all international adoptees

The most common cause of hypercalcemia in the emergency department (ED) is malignancy-associated hypercalcemia (MAH), which can be caused by direct bone resorption from bone metastases, vitamin D secreting malignancies, and increased parathyroid hormone (PTH) or PTH-related protein (PTHrP) levels. Malignancy-associated hypercalcemia is associated with a very poor prognosis, with half of the patients dying within a month of diagnosis. Management consists of adequate hydration, bisphosphonate therapy, and correction of other abnormal electrolyte levels. Currently, no therapies have demonstrated an effect on mortality and are therefore viewed only as a means of stabilizing the patient until the underlying condition can be treated. All MAH patients should receive an oncology consult as soon as possible so they are able to receive treatment for the causative malignancy and increase their chance of survival.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

IntroductionBurnout syndrome is a prolonged response to chronic emotional and interpersonal stressors and is becoming an increasing concern in the medical community. Burnout in emergency medicine (EM) pharmacists has not been previously assessed.ObjectivesTo identify the prevalence of burnout among EM pharmacists, in addition to demographic, professional, seasonal, and job‐related associations.MethodsPharmacists practicing greater than 50% of their time in the emergency department (ED) setting were invited through the American College of Clinical Pharmacy Emergency Medicine Practice and Research Network listserv to complete a survey at three separate, 4‐week, time periods (July 2018, October 2018, and April 2019). The survey contained the Maslach Burnout Inventory for Medical Personnel to detect burnout. Questions regarding personal and job‐specific demographics were asked. Descriptive statistics were used to report demographics and burnout dimensions in each period. Spearman's rank correlation and univariate and multivariate analyses were performed to identify predictors of burnout and potential associations.ResultsA total of 485 surveys were completed across all periods (116 [July], 207 [October], 162 [April]) and response rates were 18.4%, 31.6%, and 22.7%, respectively. Burnout was identified in 69.8%, 67.1%, and 68.5% of respondents with no difference between periods. A majority of participants had high depersonalization scores (50.6‐76.3%) during the three survey periods.Younger age, more ED visits per year, level I trauma center designation, and lower percentage of direct patient care time were associated with increased odds of burnout in the July 2018 period. Intent to leave one's current position or the specialty of EM and consideration of a job with different hours had positive correlations with burnout.ConclusionsBurnout is prevalent in a majority of EM pharmacists throughout the year. It is difficult to identify exact predictors of burnout; however, potential contributors include age, trauma center designation, patient volumes, and direct patient care time.