Half Century Since SIDS: A Reappraisal of Terminology.

After a sudden infant death, parents and caregivers need accurate and open communication about why their infant died. Communicating tragic news about a child's death to families and caregivers is difficult. Shared and consistent terminology is essential for pediatricians, other physicians, and nonphysician clinicians to improve communication with families and among themselves. When families do not have complete information about why their child died, pediatricians will not be able to support them through the process and make appropriate referrals for pediatric specialty and mental health care. Families can only speculate about the cause and may blame themselves or others for the infant's death. The terminology used to describe infant deaths that occur suddenly and unexpectedly includes an assortment of terms that vary across and among pediatrician, other physician, or nonphysician clinician disciplines. Having consistent terminology is critical to improve the understanding of the etiology, pathophysiology, and epidemiology of these deaths and communicate with families. A lack of consistent terminology also makes it difficult to reliably monitor trends in mortality and hampers the ability to develop effective interventions. This report describes the history of sudden infant death terminology and summarizes the debate over the terminology and the resulting diagnostic shift of these deaths. This information is to assist pediatricians, other physicians, and nonphysician clinicians in caring for families during this difficult time. The importance of consistent terminology is outlined, followed by a summary of progress toward consensus. Recommendations for pediatricians, other physicians, and nonphysician clinicians are proposed.

Work-Life Balance, Burnout, and Physician Wellness.

Work-life balance, burnout, and physician wellness have become an important focus over the last 20 years in the field of medicine. Significant work design and cultural changes are to blame for these newly recognized aspects of a physician's career and life as a whole. Unique aspects of the work environment in the United States not only contribute to these issues in the field of medicine, but also affect the US workforce at large. Stagnant responses from governmental bodies and private organizations have allowed the issue to worsen over time. Now with added attention from some leaders, both inside and outside the health care industry, along with the increasing body of research to guide these changes, there is hope for the necessary cultural change to address work-life balance, burnout, and physician wellness. Studies are available to identify the negative contributing factors, establish evidence-based prevention strategies, and help physicians to find their ideal work-life balance, avoid burnout, and achieve overall wellness. This article seeks to provide a brief background in the area of work-life balance, burnout, and physician wellness. It will also review key points of the current literature and provide a combination of solutions suggested by experts in the field.

Atypical presentation of a mediastinal mass in an adolescent: Critical care considerations.

OBJECTIVE: To describe the clinical course and treatment of a large mediastinal mass with unusual presentation and critical lower airway compression in an adolescent. DESIGN: Case report. SETTING: Pediatric intensive care unit in a tertiary care, academic children's hospital. PATIENTS: A previously well 15-yr-old boy presented to an outside physician with a 2-mo history of widening of his fingernail beds, progressing within a month of admission to fatigue, weight loss, progressive cough, and dyspnea on exertion. One week before admission, he developed facial swelling, headache, and large neck, chest, and abdomen veins. At the time of admission, he was hypoxic and had a large mediastinal mass with severe lower airway compromise, right-sided atelectasis and pleural effusion, as well as significant right atrial compression on chest computed tomography. INTERVENTION: The patient was placed in the pediatric intensive care unit and underwent emergent tube thoracostomy and drainage of the pleural effusion in the upright position, using a local anesthetic. RESULTS: : The patient developed mild reexpansion pulmonary edema with worsening hypoxia, which was managed using bilevel positive airway pressure. Pleural fluid was nondiagnostic, as was bone marrow aspirate and biopsy done in similar fashion on day 2. The patient then underwent a fine-needle biopsy in the operating room, also nonintubated and upright, which diagnosed non-Hodgkin's lymphoma, nodular sclerosing type. Treatment for tumor lysis syndrome and chemotherapy were initiated, and he progressively improved. CONCLUSIONS: Mediastinal mass with true critical airway and vascular compromise is often discussed but infrequently seen in the pediatric intensive care unit. This case shows not only unusual associated signs of lymphoma (clubbing and caput medusae) but more importantly the rapid identification and thoughtful management of the patient's respiratory compromise. This case serves to remind the pediatric intensivist of alternative ways to provide analgesia safely in such patients for lifesaving as well as diagnostic invasive procedures.