Pediatric Intensive Care Units (PICUs) provide multidisciplinary care to critically ill children and their families. Grief is present throughout the trajectory of illness and can peak around the time of death or non-death losses. The objective of this study was to assess how PICUs around the world implement grief and bereavement care (GBC) as part of an integrated model of care. This is a multicenter cross-sectional, prospective survey study. Questionnaires with multiple-choice and open-ended questions focusing on unit infrastructure, personnel, policies, limited patient data, and practices related to GBC for families and health care professionals (HCPs) were completed by on-site researchers, who were HCPs on the direct care of patients. PICU fulfillment of GBC goals was evaluated using a custom scoring based on indicators developed by the Initiative for Pediatric Palliative Care (IPPC). We compared average total and individual items fulfillment scores according to the respective country's World Bank income. Patient characteristics and details of unit infrastructure were also evaluated as potential predictors of total GBC fulfillment scores. Statistical analysis included multilevel generalized linear models (GLM) with a Gaussian distribution adjusted by child age/gender and clustering by center, using high income countries (HICs) as the comparative reference. Additionally, we applied principals of content analysis to analyze and summarize open-ended answers to contextualize qualitative data. The study included 34 PICUs from 18 countries: high-income countries (HICs): 32.4%, upper middle-income countries (UMICs): 44.1%, low middle-income and low-income countries (LMI/LICs): 23.5%. All groups reported some compliance with GBC goals; no group reported perfect fulfillment. We found statistically significant differences in GBC fulfillment scores between HICs and UMICs (specifically, HCP grief support), and between HICs and LMICs (specifically, family grief support and HCP grief support). PICUs world-wide provide some GBC, independent of income, but barriers include lack of financial support, time, and training, overall unit culture, presence of a palliative care consultation service, and varying cultural perceptions of child death. Disparities in GBC for families and HCPs exist and were related to the native countries' income level. Identifying barriers to support families and HCPs, can lead to opportunities of improving GBC in PICUs world-wide.

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serovars Typhi and Paratyphi are known to cause enteric fever. Multidrug resistance in and has emerged as a cause of concern. To evaluate antimicrobial susceptibility patterns of Salmonella enteric serovar Typhi () and obtained from blood culture.: All isolates obtained from blood cultures of clinically suspected cases of enteric fever coming to microbiology laboratory, Nirmal hospital, from January 2015 to September 2017 were included in the study. Antimicrobial susceptibility patterns were determined using commercial antimicrobial disks chloramphenicol (30 μg), nalidixic acid (30 μg), ampicillin (10 μg), azithromycin (15 μg), cotrimoxazole (1.25/23.75 μg), ciprofloxacin (5 μg), and ceftriaxone (30 μg). Antimicrobial susceptibility testing was performed in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines of respective year by KirbyBauer disc diffusion method.: Total 330 isolates of salmonella are there out of that 298 is . 32 are Salmonella para A, while 1 is of Salmonella para B. Enteric fever cases pick month are April, May, June and July. Sensitivity to first line drugs are > 80%, Nalidixic acid resistant Salmonella (NARS) are 79%, while Multi drug resistant (resistant to ampicillin, chloramphenicol and co-trimoxazole all three)Salmonella are 3%.: Periodic evaluation of antibiotic susceptibility pattern is necessary to see changing pattern of antibiotics. Evaluation of Nalidixic acid resistant Salmonella and periodic evaluation of multi drug resistant Salmonella is also important as emergence of MDR strain is observed in our study.

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