VA-ECMO was able to be weaned in 44/61 patients (72%); 54/61 patients (89%) had at least one major complication. Prior to VA-ECMO initiation, no statistically significant differences between survivors and non-survivors could be determined. After VA-ECMO initiation, only 24-hour nadir lactate and 48-hour nadir lactate levels were significantly different between survivors and non-survivors (1.50 mmol/L vs 3.20 mmol/L p=0.001; and 1.20 mmol/L vs. 1.90 mmol/L p=0.001 respectively). For mortality prediction, 24- and 48-hour nadir lactate levels had AUROCs of 0.775 and 0.782, respectively. CONCLUSIONS VA-ECMO is associated with acceptable survival rates but significant morbidity. Nadir lactate levels in the first 24 and 48 hours after VA-ECMO initiation may be useful in predicting early survival. INTRODUCTION Care for many children with medical complexity (CMC) is fragmented, leading to increased family dissatisfaction and stress. We evaluated the impact of an Advanced-Practice Nurse and Care Coordination Assistant model medical care coordination program (MCCP) for CMC at an urban tertiary pediatric hospital on caregivers' perceptions of several health care indicators. METHOD A retrospective pre-post survey was administered to parents of CMC enrolled in an MCCP for a minimum of 6 months. Questions were grouped into four domains quality of life, caregiver satisfaction, care coordination, and caregiver self-efficacy. https://www.selleckchem.com/products/poly-l-lysine.html Mean scores of questions in each domain were compared from before program enrollment with those at the time of survey completion, using paired sample t tests. RESULT There was an increase in the mean score in all four domains. DISCUSSION Parents of CMC experience an Advanced-Practice Nurse and Care Coordination Assistant model MCCP to be effective in improving the navigation of and satisfaction with their child's health care environment. INTRODUCTION Short sleep duration and quality are problems for many youth, and are associated with difficulties in executive function. Our purpose was to describe subjective and objective sleep characteristics and their associations with executive function, stress and coping, adjustment, and self-management in youth with type 1 diabetes (T1D). METHOD Youth with T1D (N = 40; mean age, 13.4 ± 1.9 years; 60% female; 77.1% non-Hispanic white; diabetes duration, 7.1 ± 4.6 years; and hemoglobin A1c, 8.2 ± 1.2%) wore an actigraph and a continuous glucose monitor for 3-7 days and completed questionnaires. Descriptive and bivariate analyses were conducted. RESULTS Sleep variability was associated with stress and depressive symptoms, as well as more glucose variability. Consistent rest-activity rhythm timing was associated with fewer trait anxiety symptoms. Robust rhythms were associated with better diabetes self-management. DISCUSSION Providers should routinely assess sleep habits in youth, especially those with T1D. Improving consistency in sleep timing and sleep duration may be a potential therapeutic target to improve diabetes clinical outcomes. INTRODUCTION Adolescents with chronic diseases have to cope with a number of challenges in their transition to independence and need to learn self-management. The purpose of this study was to understand the life journey of adolescents and their caregivers. METHOD Face-to-face interviews were conducted with 13 adolescents with chronic diseases (e.g., type 1 diabetes, cystic fibrosis, attention deficit hyperactivity disorder, epilepsy) and 13 caregivers (N = 26). Verbal methods were complemented with visual materials. Behavioral models and grounded theory principles guided the analysis of the data. RESULTS Participants were grouped according to an "archetype" based on the strategy they adopted to manage their chronic diseases. A life journey map was developed having the stages of transition. DISCUSSION This study proposed a new perspective to the life journey, transition stages, and personal archetypes from a patient-centered approach. We argued the need of a multidimensional approach and outlined the differences of archetypes and transition stages. INTRODUCTION Depression is prevalent among adolescents with chronic illness. However, little is known about how depression affects chronic illness over time. This review aimed to synthesize longitudinal relationships between depression and disease control, self-management behaviors, illness-related morbidity, and quality of life. METHOD Four databases were searched, including PubMed, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and EMBASE. Inclusion criteria were cohort studies examining depression among adolescents aged 10-21 years with a chronic illness and studies published in English. Study quality was appraised using the Newcastle-Ottawa scale and data was synthesized by the outcome. RESULTS Of the 3,463 articles identified, 11 were included in the review. For adolescents with diabetes, increased depressive symptoms predicted decreased metabolic control and monitoring, medication adherence, quality of life, and increased hospitalization. Studies on cystic fibrosis, congenital heart disease, sickle cell disease, and juvenile idiopathic arthritis were limited but demonstrated that depressive symptoms affected the quality of life, disability, pain, and hospitalization rates/costs. DISCUSSION Evidence supports the need for mental health care strategies suitable for adolescents with chronic illness. Future research is needed to examine the effects of depressive symptoms across diversified chronic illness populations. Pulmonary aspiration of gastric contents is one of the most terrible complications following general anesthesia. It is important for patients to prevent this complication by obeying the preoperative fasting protocol strictly. At present, it has been reported by many studies that bedside ultrasound, as a non-invasive and convenient method, could be used to evaluate gastric contents qualitatively and quantitatively. With the advantages of reliability, accuracy and repeatability, it can greatly reduce the risk of aspiration and ensure patients' life security. But most of the data were acquired from the healthy volunteers. For the gastrointestinal disorder, the pregnant women, obesity, children, the elderly and diabetes patients, the accuracy and reliability of ultrasound to predict the risk of aspiration remains to be identified by more further studies. For these patients with increasing risk of aspiration, I-AIM (Indication, Acquisition, Interpretation, Medical decision-making) framework plays an important role in ensuring the safety of patients.