The Brooklyn Hospital Center is a 464-licensed-bed, full-service community teaching hospital located in Downtown Brooklyn, New York City. The hospital was founded in 1845. It is affiliated with the Mount Sinai Health System, and serves a diverse population from a wide range of ethnic backgrounds..
Early recognition of pediatric deterioration is difficult because age-dependent physiology and compensation mask early shock and safety risks. This narrative review compares vital-sign (VS) biomarkers (heart rate, respiratory rate, blood pressure, oxygen saturation, temperature) with laboratory markers and clinical indicators. We searched Embase, Pubmed, and guideline repositories to August 2025 for pediatric studies from emergency, inpatient, and critical-care settings. We summarized accuracy, timeliness, and implementation issues, prioritizing cohort and implementation evaluations. Age-adjusted, repeated, and continuous analyses of VS—especially multivariate approaches such as shock index pediatric age-adjusted and heart-rate-characteristics analytics—outperformed single thresholds, often anticipating ICU transfer or sepsis by hours. Laboratory biomarkers provided diagnostic specificity for defined syndromes but were slower and unsuitable for continuous surveillance. Composite scores (e.g., PEWS, ED-PEWS, National PEWS) showed moderate to high discrimination yet performed best when integrated with trends and standardized escalation pathways. VS biomarkers, leveraged as dynamic trends and combined with context, enable earlier, safer detection of pediatric deterioration than static thresholds or isolated laboratory tests. Priorities include validating continuous models beyond NICUs, ensuring equity and calibration across different ages and comorbidities, and testing wearable sensors and EHR-embedded alerts in pragmatic trials that measure timeliness, unintended harms, and patient-centered outcomes. Not applicable.
PURPOSE:Professional identity formation (PIF) is the internal process of identifying with one's profession by developing the knowledge, values, and beliefs held by those in the field. Despite the growth of pharmacy residency programs, limited research exists on PIF in this group. We conducted a scoping review to explore the current understanding of PIF in pharmacy residents and identify gaps in this area. SUMMARY:In January 2025, databases were searched for relevant publications that addressed pharmacy resident PIF in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews methodology. Seven publications were included in this review. The final synthesis was organized around 4 major themes identified in the literature: (1) the role of preceptors; (2) facilitators of PIF; (3) barriers to PIF; and (4) program initiatives. CONCLUSION:This scoping review provides an initial overview of PIF in pharmacy residents, much of which overlaps with what is known about pharmacy students. Given the limited familiarity with PIF and the critical role of preceptors in this process, faculty development and preceptor training remain key areas for growth. Future research focusing specifically on pharmacy residents and their process of PIF is needed.
Incomplete Kawasaki disease (KD) in infants often presents without classic clinical features, increasing the risk of delayed diagnosis and coronary complications. We report a previously healthy 9-month-old male who presented to an emergency department with a 15-day history of fever and dry cough, despite amoxicillin therapy for presumed pneumonia. On arrival, the infant was febrile and tachycardic, with stable hemodynamics and a benign finding of physical examination. Laboratory evaluation showed high values of inflammatory markers. The persistent fever and high values of inflammatory markers despite the antimicrobial therapy prompted consideration of incomplete KD as an alternative diagnosis. This diagnosis was confirmed by multiple coronary artery aneurysms shown on an echocardiogram. His fever was resolved by the use of intravenous immunoglobulin, methylprednisolone, and high-dose aspirin. This case highlights the importance of maintaining a high index of suspicion for incomplete KD in infants with persistent fever and evolving inflammatory findings, despite appropriate antimicrobial therapy.
ABSTRACT Bacterial species in the Enterobacterales order are commonly encountered causative organisms in hospital-acquired infections. Furthermore, the incidence of carbapenem-resistant Enterobacterales (CRE) is a growing threat worldwide. Eravacycline (ERV) is a broad-spectrum fluorocycline antibiotic with activity against Enterobacterales, including CRE, and is approved for the treatment of complicated intra-abdominal infections (cIAI) in the United States and Europe. We conducted a subpopulation analysis of a previously published real-world study evaluating the efficacy of eravacycline for the treatment of infections involving Enterobacterales. Adult patients who received eravacycline for ≥72 h for any infection type involving an Enterobacterales organism were included. The primary outcome was clinical success, and secondary outcomes comprised 30-day all-cause and in-hospital mortality, 30-day microbiological and symptomatic recurrence, and 30- and 60-day hospital readmission. A total of 155 patients were eligible for inclusion. The primary causative organisms were Klebsiella pneumoniae (34.2%), Escherichia coli (32.9%), and Enterobacter cloacae (31.3%), and 23.9% were CRE. A majority of infections (77.4%) were polymicrobial. The most common infection types were intra-abdominal (34.8%), skin and soft tissue (25.2%), and pneumonia (17.4%). The predominant rationale for ERV use was consolidation of the antibiotic regimen (56.8%), and the median (interquartile range) ERV duration was 6.0 days (3.3–12.0). Clinical success was observed in 84.5% of patients. The 30-day all-cause and infection-related mortality were 13.5% and 8.4%, respectively. Microbiological recurrence was low (1.3%), and the 30-day hospital readmission rate was 16.9%. Eravacycline was well-tolerated, with 8.3% of patients experiencing treatment-emergent adverse events (TEAE) and 0.6% resulting in discontinuation of ERV.IMPORTANCEAs the incidence of infections caused by carbapenem-resistant Enterobacterales (CRE) continues to rise globally, novel therapeutic approaches are necessary to combat these difficult-to-treat infections. While β-lactams remain the mainstay of therapy for these patients, increasing rates of metallo-β-lactamase-producing organisms render nearly all β-lactam antibiotics ineffective. Furthermore, >15% of carbapenem-resistant Enterobacterales are non-carbapenemase-producing, circumventing the benefits provided by co-administration of β-lactamase inhibitors. Eravacycline (ERV) is a promising non-β-lactam antibiotic with a broad spectrum of activity, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, and carbapenem-resistant Enterobacterales. Few data exist on the real-world use of eravacycline for the treatment of Enterobacterales infections specifically. In this study, we assessed the safety and effectiveness of eravacycline for the treatment of Enterobacterales infections in a real-world setting. These findings suggest that eravacycline may be a viable therapeutic agent for these infections, expanding our treatment options for multidrug-resistant (MDR) pathogens.
