Use of substances to cope during the COVID-19 pandemic among transgender and gender diverse adults.

Background: Studies have found changes in substance use during the COVID-19 pandemic in specific populations. Transgender and gender diverse (TGD) individuals have experienced greater distress compared to cisgender individuals during the pandemic; however, there is little research on substance use among TGD individuals during this sensitive time period.Objectives: The objective of this study is to examine distress from COVID-19 and coping via substance use including alcohol, cannabis, tobacco, and non-medical use of prescription drugs (NMUPD) among TGD adults.Method: An online survey assessing substance use, general psychiatric symptoms, and COVID-19 anxiety was completed by 342 TGD individuals (16.4% transfeminine, 19.6% transmasculine, 64.0% Gender Diverse) in June/July 2020. Chi-square and structural equation modeling (SEM) analyses examined the connections between distress, coping, and substance use.Results: Seventy-one percent of participants reported no changes in substance use since the start of the pandemic and 22% reported an increase in substance use. Increased substance use was associated with alcohol (p < .001), cannabis (p < .001), and combustible tobacco (p < .001) use in the prior three months. SEM showed significant direct effects between distress and substance use coping, substance use coping and recent drug use, and an indirect effect of distress on recent drug use through substance use coping (ß = .31, p = .001).Conclusion: Results highlight the risk of substance use to cope with COVID-19-related stress in a large sample of a minoritized population with mental health disparities. Transmasculine and gender diverse participants were especially likely to report using substances to cope.

Patient misidentification in a pediatric emergency department: patient safety and legal perspectives.

Emergency departments across the nation are faced with ever-increasing high volumes, overcrowding, and patient acuity. Along with these growing trends, the Joint Commission on the Accreditation of Healthcare Organizations is instituting new patient safety initiatives to reduce patient medical errors in the hospital setting. The emergency department is one area under great scrutiny with patient identification as primary concern. This article discusses a case study involving patient misidentification in the pediatric emergency department and reviews the legal and safety programs implemented at a children's hospital to improve patient safety outcomes.

Pediatric triage: a 2-tier, 5-level system in the United States.

Emergency care continues to be a challenge for the pediatric population. Pediatric emergency department (ED) visits have escalated to over 12.5 million/y. To provide quality care, the provider must strive to meet ED efficiency, patient safety, and federal regulations. One of the most critical and challenging areas is pediatric triage. International healthcare systems in Canada and Australia have designed national triage systems to address the needs of patient acuity, improve patient safety, and enhance customer satisfaction. The United States continues to have various triage systems that include 3-level, 4-level, and 5-level systems in a variety of ED settings. This paper describes a pediatric triage system in the United States with a 2-tier process for high volume and 5 levels of acuity for time to treatment with over 30,000 ED visits per year.

Kids speak: effective communication with the school-aged/adolescent patient.

Caring for school-aged and adolescent children presents unique challenges to the acute healthcare provider. In today's healthcare industry, children should be informed and should participate in the medical decision-making process. Thus, the art of successful school-aged and adolescent communication is vital in today's economically driven market. Practitioners evaluating pediatric patients must immediately establish a rapport and trust--not only with the parents, but also with the child--through effective communication techniques. Effective communication skills and challenges are discussed, along with current research trends to improve patient-provider relations.