Readiness of a U.S. Black community to address suicide.

Communities need to be ready to address increased suicide among Black Americans. The Community Readiness Model (CRM) provides an established assessment for marginalized communities facing suicide. CRM assessment of the Northeast Ohio Black community involved interviews with 25 representatives, analysis using rating scales, co-scoring, and calculation. Results include a marginal overall score and low to average scores for five dimensions: knowledge of efforts to address suicide, leadership, community climate, knowledge of suicide, and resources. The vague awareness readiness stage indicates the community is unclear about what can be done to address suicide and has not taken ownership of the issue. We highlight implications for mental health practice, prevention and funding campaigns, and consultation with community leadership for culturally informed prevention strategies targeting areas of lowest readiness. Future research should use expanded designs to examine readiness changes from intervention in this and other Black communities.

Family Presence During Trauma Resuscitation: Family Members' Attitudes, Behaviors, and Experiences.

BACKGROUND: The paradigm is shifting from separating family members from their children during resuscitation to one of patient- and family-centered care. However, widespread acceptance is still lacking. OBJECTIVE: To measure attitudes, behaviors, and experiences of family members of pediatric patients during the resuscitation phase of trauma care, including family members who were present and those who were not. METHODS: An observational mixed-methods study using structured interviews and focus groups was conducted at 3 level 1 pediatric trauma centers. Family members of children who met trauma team activation criteria (N = 126; 99 present, 27 not present) were interviewed; 25 also participated in focus groups. RESULTS: Mean attitude scores indicated a positive attitude about being present during the resuscitation phase of trauma care (3.65; SD, 0.37) or wanting to be present (3.2; SD, 0.60). Families present reported providing emotional support (94%) for their child and health care information (92%) to the medical team. Being present allowed them to advocate for their child, understand their child's condition, and provide comfort. Families in both groups felt strongly that the choice was their right but was contingent upon their bedside behavior. CONCLUSIONS: Study findings demonstrated compelling family benefits for presence during pediatric trauma care. This study is one of the first to report on family members who were not present. The practice of family presence should be made a priority at pediatric trauma centers.

Perioperative hypothermia in NICU infants: its occurrence and impact on infant outcomes.

Infants admitted to the neonatal intensive care unit (NICU) often require surgical intervention and maintaining normothermia perioperatively is a major concern. In our preliminary study of 31 normothermic infants undergoing operative procedures in the operating room (OR), 58% (N = 18) returned hypothermic while all 5 undergoing procedures in the NICU remained normothermic (P = .001). To describe perioperative thermal instability (temperatures lower than 36.0°C) and frequency of associated adverse events, support interventions, and diagnostic tests in infants undergoing operative procedures in the OR and the NICU. This prospective, case-control study included 108 infants admitted to the NICU who were sequentially scheduled for an operative procedure in the OR (50.93%; N = 55) or the NICU (49.07%; N = 53). Existing data from the medical record were collected about temperatures and frequency of adverse cardiovascular, respiratory, and metabolic events, associated support interventions, and diagnostic tests during the perioperative period. Analyses examined the relative risks and proportional differences in rates of hypothermia between the OR group and the NICU group and associated adverse events, support interventions, and diagnostic tests between hypothermic and normothermic infants. Hypothermia developed in 40% (N = 43) of infants during the perioperative period. The OR group had a higher rate of perioperative hypothermia (65.45%, N = 36; P < .001) and were 7 times more likely to develop perioperative hypothermia (P = .008) than the NICU group (13.21%, N = 7). Likewise, infants in the OR group were 10 times more likely to develop hypothermia during the intra- and postoperative periods than those in the NICU group (P = .001). The hypothermic group had significantly more respiratory adverse events (P = .025), were 6 times more likely to require thermoregulatory interventions (P < .001), 5 times more likely to require cardiac support interventions (P < .006), and 3 times more likely to require respiratory interventions (P = .02) than normothermic infants. Although infants undergoing operative procedures in the OR experienced significantly higher rates of hypothermia than those undergoing procedures in the NICU, both groups experienced unacceptable rates of clinical hypothermia. Hypothermic infants experienced more adverse events and required more support interventions during the intra- and postoperative periods than normothermic infants, thereby demonstrating the negative sequelae associated with thermal instability. As a result, a translational team of key stakeholders has been created to explore multifaceted strategies based on translation science to implement, embed, and sustain perioperative thermoregulation best practices for the infant, regardless of the operative setting.