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Background: Lacking causal treatment options in most cases, severe IgE-mediated food allergies (IgE-FA) are associated with a high burden of disease due to permanent risk of anaphylactic reactions after accidental allergen ingestion. To date, only few data comparing health resources and burden of disease between the pediatric and adult population are available. Objective: Our survey aimed to assess the care situation of pediatric and adult patients with severe, self-reported physician-diagnosed IgE-FA. Methods: The survey was conducted via an online questionnaire consisting of 32 items covering participant demographics, comorbidities, triggers, utilization of health resources, current management and burden of disease of FA, according to age groups (

Postoperative mortality in Africa is twice that of wealthier countries. The SMARTER trial underscores this critical issue and aims to address the high mortality rates by harnessing a readily available resource requiring minimal funding. Conducted in Mbale, Uganda, this innovative trial trained family members to monitor basic vital signs following surgery. This task is usually performed by healthcare workers who are often a limited resource in low- and middle-income settings. Although the results demonstrate a potential for increasing the capacity to rescue in the postoperative period, there is a need for further research to assess real-world effectiveness. Any improvement in patient monitoring would be limited by the system's capacity to respond effectively to escalations made by family members and the possible inaccuracy of their monitoring. Intervening earlier in the preoperative pathway can reduce the need to rescue postoperatively, but the SMARTER intervention has the potential to contribute to the larger effort needed to reduce surgical deaths globally in resource-limited settings., Competing Interests: Declaration of interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Burn survivors report limited resources as they transition to their communities after initial hospitalization. The aim of this project is to review literature that identifies resources provided to burn survivors and their supporters after discharge to their communities., Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to examine the following literature databases: PubMed, EMBASE, Web of Science, PsycInfo, and CINAHL. The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set for burn injury provided a framework to categorize resource content., Results: Of the 637 articles screened, 27 met inclusion criteria. Data extraction identified resources categorized into the following ICF components: Body Functions, Activities and Participation, and Environmental Factors., Conclusion: This review uses a conceptual framework to provide an overview of current published resources to support burn survivors following hospitalization. The identified resources addressed content such as health professionals, programs, psychological functioning after burn injury, scar management, and virtual resources. Based on the ICF framework, some gaps in resource content were noted such as pain, thermoregulation, interpersonal relationships, and self-care. Findings reveal relative strengths and gaps in resources, which can be used to better support burn survivors following hospitalization., Competing Interests: Declaration of Competing Interest No authors have any competing interests or financial benefits. Dr. Ryan has received contracted research from Mediwound. The remaining authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd and International Society of Burns Injuries. All rights reserved.)

Objective: This study aims to build a multistate model and describe a predictive tool for estimating the daily number of intensive care unit (ICU) and hospital beds occupied by patients with coronavirus 2019 disease (COVID-19). Material and methods: The estimation is based on the simulation of patient trajectories using a multistate model where the transition probabilities between states are estimated via competing risks and cure models. The input to the tool includes the dates of COVID-19 diagnosis, admission to hospital, admission to ICU, discharge from ICU and discharge from hospital or death of positive cases from a selected initial date to the current moment. Our tool is validated using 98,496 cases positive for severe acute respiratory coronavirus 2 extracted from the Aragón Healthcare Records Database from July 1, 2020 to February 28, 2021. Results: The tool demonstrates good performance for the 7- and 14-days forecasts using the actual positive cases, and shows good accuracy among three scenarios corresponding to different stages of the pandemic: 1) up-scenario, 2) peak-scenario and 3) down-scenario. Long term predictions (two months) also show good accuracy, while those using Holt-Winters positive case estimates revealed acceptable accuracy to day 14 onwards, with relative errors of 8.8%. Discussion: In the era of the COVID-19 pandemic, hospitals must evolve in a dynamic way. Our prediction tool is designed to predict hospital occupancy to improve healthcare resource management without information about clinical history of patients. Conclusions: Our easy-to-use and freely accessible tool (https://github.com/peterman65) shows good performance and accuracy for forecasting the daily number of hospital and ICU beds required for patients with COVID-19.

Objectives: Coronavirus Disease 2019 has presented extreme difficulties to healthcare resource allocation worldwide. Health resources, particularly during a pandemic, are limited even in developed countries. The main challenge for healthcare professionals is to be able to ration resources in an ethical manner. Therefore, this leads to ethical considerations that we aim to discuss in this paper, based on which, recommendations can be made for reference by healthcare management, policymakers, and public health practitioners. Study design: This is a discussion paper. Methods: A brief review of the major principles as they relate to the notion of rationing in a pandemic was conducted. We organized an ethical discussion from public health perspectives based on these major principles. Results: Prior to deciding the principles to adopt, a transparent and robust guideline for rationing must be established. There are four considerations that need to be made: transparency, consistency, inclusiveness, and accountability. There does not exist a “perfect” principle to adopt during rationing. However, in the authors' opinion, the most obvious principles that would be unsuitable during a healthcare crisis would be the equal worth and prioritarian principles. This leaves the equity principle, utilitarian and urgent need principles. Conclusion: The recommendation of this discussion paper is to adopt multiple principles according to the situation of each country or even the particular hospital.

Objectives: To measure the effect of social distancing on reducing daily deaths, infections and hospital resources needed for coronavirus disease 2019 (COVID-19) patients during the first wave of the pandemic in Nordic countries. Methods: The observations of social distancing, daily deaths, infections along with the needed hospital resources for COVID-19 patient hospitalizations including the numbers of all hospital beds, beds needed in ICUs and infection wards, nursing staffs needed in ICUs and infection wards were collected from the Institute for Health Metrics and Evaluation (IHME) by the University of Washington. The observations of social distancing were based on the reduction in human contact relative to background levels for each location quantified by cell phone mobility data collected from IHME. The weighted data per 100,000 population gathered in a 40-day period of the first wave of the pandemic in Denmark, Finland, Iceland, Norway and Sweden. Statistical technique of panel data analysis is used to measure the associations between social distancing and COVID-19 indicators in long-run. Results: Results of dynamic long-run models confirm that a 1% rise in social distancing by reducing human contacts may decline daily deaths, daily infections, all hospital beds needed, beds/nurses needed in ICUs and beds/nurses needed in infection wards due COVID-19 pandemic by 1.13%, 15.26%, 1.10%, 1.17% and 1.89%, respectively. Moreover, results of error correction models verify that if the equilibriums between these series are disrupted by a sudden change in social distancing, the lengths of restoring back to equilibrium are 67, 62, 40, 22 and 49 days for daily deaths, daily infections, all hospital beds needed, nurses/beds needed in ICUs and nurses/beds needed in infection wards, respectively. Conclusion: Proper social distancing was a successful policy for tackling COVID-19 with falling mortality and infection rates as well as the needed hospital resources for patient hospitalizations in Nordic countries. The results alert governments of the need for continuously implementing social distancing policies while using vaccines to prevent national lockdowns and reduce the burden of patient hospitalizations.

Resumen: Diferentes modelos de cuidado en contexto de cronicidad y multimorbilidad incorporan a la comunidad, sistema de salud, práctica clínica, políticas sanitarias, prevención y promoción de salud. Entre estos se señala el rol facilitador del equipo de salud en el automanejo, siendo las personas protagonistas de su proceso. El abordaje de la multimorbilidad se realiza mayormente desde un enfoque centrado en el riesgo y la enfermedad, limitando la exploración de los recursos de las personas y su entorno. Incorporar un enfoque de salud positiva puede aportar a una mayor integralidad. El propósito de este artículo es proponer un abordaje desde el modelo sinérgico de salud, integrando la salutogénesis y el modelo de activos, para facilitar el automanejo promoviendo la capacidad de agencia de las personas. Se presentan potenciales áreas de aplicación de estos modelos en el contexto de multimorbilidad, fomentando condiciones de salud y bienestar en las personas y sus familias. Abstract: Different models of care in context of chronicity and multimorbidity include community, health system, clinical practice, health policies, prevention, and health promotion. Among these, the role of the health team as a facilitator of self-management is pointed out, being people the protagonists of their process. Multimorbidity approach is mostly carried out from a risk and disease focused point of view, which limits the exploration of resources of people and their environment. Incorporating a positive health approach can contribute to a greater comprehensiveness. The purpose of this article is to propose an approach from the synergy model of health, integrating salutogenesis and health assets model, to help facilitate self-management promoting people's agency capacity. Potential areas of application of these models are presented to work in the context of multimorbidity, promoting health and well-being conditions in people and their families.

Objective: As health-related social needs (HRSN) screening increases, attention to families' resource preferences lags. This study of a pediatric primary care intervention (DULCE) with reliable HRSN screening and resource connection explored whether resources adequately addressed families' needs and, when HRSN persisted, families' reasons for declining resources., Methods: This retrospective cohort, mixed-methods study analyzed data from 989 families that received care at seven pediatric clinics implementing DULCE in three states. DULCE screens for seven HRSN around the 1-month and 4-month well-child visits; we calculated the percent of initial and ongoing positive screens. For positive rescreens, we calculated the percent that had all eligible or wanted resources and that were interested in further resources. We also analyzed case notes, which elicited families' resource preferences, and explored demographic characteristics associated with ongoing HRSN., Results: Half of enrolled families (508 of 989) initially screened positive for HRSN; 124 families had positive rescreens; 26 expressed interest in further assistance. Most families with ongoing concrete supports needs accessed all eligible resources (60-100%); 20-58% had everything they wanted. Fewer families with ongoing maternal depression and intimate partner violence accessed all eligible resources (48% and 18%, respectively); most reported having all wanted resources (76% and 90%, respectively). Families declined resources due to lack of perceived need, the HRSN resolving, or families addressed HRSN themselves. White families were more likely to rescreen positive., Conclusions: Pediatric medical homes must honor family-centered decision-making while empowering families to accept beneficial resources. Health care systems should advocate for resources that families need and want., Competing Interests: Declaration of Competing Interest PF and MCA were members of the DULCE National Team, which supported scaling DULCE to more communities., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: Neuroendoscopic surgeries require specialized equipment, which may not be universally available or equitably distributed in most neurosurgical units of resource-limited healthcare systems. This review reports on the use of locally available resources to perform safe ventricular endoscopic surgeries in patients with hydrocephalus and cystic craniopharyngioma in a resource-limited healthcare system., Methods: This study described the use of locally available resources to perform intraventricular endoscopic surgeries and retrospectively reviewed a 3-year outcome of these surgeries. A 24F, 2-way Foley catheter was used as an endoscopic working sheet. A transparent 9-mm nasotracheal tube served as a retractor and a peel-away sheath. An intravenous fluid administration set was used for irrigation. Finally, a metallic stylet of an external ventricular drain was used for third ventricular floor or cyst wall fenestration., Results: There were 21 intraventricular endoscopic surgeries performed consisting of endoscopic third ventriculostomy (ETV), septostomy, cystostomy, and intraventricular biopsy. Four patients died, with 1 death directly related to intraoperative hemorrhage. Most (3/21) of the complications were postoperative cerebrospinal fluid leakage and partial wound dehiscence. Of the 17 surviving patients, the ETV success rate was 82.4% (14/17). Logistic regression analysis revealed that patient age, etiology, Endoscopic Third Ventriculostomy Success Score, and procedure performed were not predictive of ETV success or mortality., Conclusions: Patients accessing neurosurgical care in resource-limited healthcare systems can benefit from safe and successful intraventricular endoscopy. However, this may require the innovative use of locally available resources that can be adapted to local neurosurgical needs., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Labor induction increased in the United States after the publication of A Randomized Trial of Induction Versus Expectant Management (ARRIVE) in 2018. During this trial, investigators found that elective induction at 39 weeks in low-risk nulliparous women led to similar perinatal outcomes when compared to expectant management. However, other researchers have since linked rising labor induction rates to worse hospital- and population-level outcomes. It is possible that elective induction of labor has a neutral effect on patients who are induced while at the same time lessening hospital capacity to care for other maternity patients, which leads to a negative effect on patient outcomes overall. During a trial, this represents a form of negative spillover, in which an intervention indirectly harms the comparison group and leads to overestimation of intervention benefit. Although further research is needed, evidence from ARRIVE and subsequent studies provides preliminary support for this possibility., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2024 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Resumen: La pandemia de COVID-19 ha supuesto un desafío tanto clínico como jurídico y bioético. Se desarrollan estos tres pilares fundamentales en el abordaje de la priorización de recursos sanitarios en pandemia: criterios clínicos, marco legal correspondiente y principios éticos aplicables. Inicialmente se aplicaron criterios clínicos para identificar a los pacientes con mejor pronóstico de supervivencia, combinando una evaluación clínica y el uso de variables de pronóstico a corto y largo plazo. Sin embargo, la decisión de priorizar la atención de un paciente sobre otro tiene una carga jurídico-política, que presenta el riesgo de caer en la discriminación ya que están en juego derechos fundamentales. Los criterios de priorización deben basarse en principios que reflejen como filosofía vehicular la que hemos asumido constitucionalmente como Estado social y democrático de Derecho, que no responde al utilitarismo, sino al personalismo. Cualquier filosofía de distribución de recursos tiene que tener presente la perspectiva científica, constitucional y, con ellas, las de los derechos fundamentales y los principios bioéticos. En la priorización de los recursos deberían consolidarse principios éticos como el respeto a la dignidad de las personas, el principio de necesidad (igual necesidad, igual acceso al recurso), el principio de equidad (que aconseja priorizar a los grupos de población más vulnerables), la transparencia (fundamental en la confianza de la sociedad) y el principio de reciprocidad (que exige proteger a los sectores de la población que asumen más riesgos), entre otros. Abstract: The COVID-19 pandemic has been a clinical challenge, but also a legal and bioethical one. These three fundamental pillars are developed in the approach to prioritizing health resources in pandemic, clinical criteria, corresponding legal framework and applicable ethical principles. Initially, clinical criteria were applied to identify patients with the best survival prognosis, combining a clinical evaluation and the use of short-term and long-term prognostic variables. But the decision to prioritize the care of one patient over another has a legal–political burden, which poses a risk of falling into discrimination since fundamental rights are at stake. The prioritization criteria must be based on principles that reflect as a vehicle philosophy that which we have constitutionally assumed as a social and democratic State of Law, which did not respond to utilitarianism but to personalism. Any philosophy of resource distribution must bear in mind the scientific and constitutional perspective and, with them, those of fundamental rights and bioethical principles. In the prioritization of resources, ethical principles must be consolidated such as respect for the human dignity, the principle of necessity (equal need, equal access to the resource), the principle of equity (which advises prioritizing the most vulnerable population groups), transparency (fundamental in society's trust) and the principle of reciprocity (which requires protecting the sectors of the population that take more risks), among others.

Summary: Background: Tinnitus prevalence studies report large variability across countries that might be due to inconsistent research methods. Our study aimed to report a single Pan-European estimate for tinnitus prevalence and investigate the effect of individual and country-level characteristics on prevalence. We explored the relationships of healthcare resource use and hearing difficulty with tinnitus symptoms. Methods: Between 2017-2018, a cross-sectional European Tinnitus Survey (ETS) was conducted in 12 European Union nations (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain), using a standardised set of tinnitus-related questions and response options in country-specific languages. We recruited 11,427 adults aged ≥18 years. Findings: Prevalence of any tinnitus was 14·7% (14·0% in men and 15·2% in women), ranging from 8·7% in Ireland to 28·3% in Bulgaria. Severe tinnitus was found in 1·2% participants (1·0% in men and 1·4% in women), ranging from 0·6% in Ireland to 4·2% in Romania. Tinnitus prevalence significantly increased with increasing age and worsening of hearing status. Healthcare resource use for tinnitus increased with increasing tinnitus symptom severity. Interpretation: This is the first multinational report of Pan-European tinnitus prevalence using standardised questions. The overall prevalence estimates refine previous findings, although widespread inter-country heterogeneity was noted. The results indicate that more than 1 in 7 adults in the EU have tinnitus. Extrapolating to the overall population, approximately 65 million adults in EU28 have tinnitus, 26 million have bothersome tinnitus and 4 million have severe tinnitus. Funding: National Institute for Health Research, European Union's Horizon 2020, Medical Research Council, and GENDER-Net Co-Plus Fund.

Objectives: One of the many challenges public health practitioners have faced during the COVID-19 pandemic is deciding on the optimal allocation of limited healthcare resources. The current paper addresses the normative question of how medical resources can be optimally distributed during the current pandemic. Methods: As an article of short communication, an ethical analysis from the moral perspectives of distributive justice was conducted. Results: As multiple moral considerations must be analyzed to construct an ethically grounded and systematic allocation system, conflicting notions regarding efficiency, equity, and distributive justice are considered. Several practical recommendations were derived by leveraging the values of utilitarian, egalitarian, and prioritarian approaches to the proposed normative question. Conclusions: Transparent, equitable, and consistent allocation mechanisms underpinned by the ethical values and recommendations presented in this paper should inform prioritization guidelines when medical resources are stretched.

Objective: Vascular surgeons work long, unpredictable hours with repeated exposure to high-stress situations. Inspired by general surgery acute care surgery models, we sought to organize the care of vascular emergencies with the implementation of a vascular acute care surgery (VACS) model. Within this model, a surgeon is in-house without elective cases and assigned for consultations and urgent operative cases on a weekly basis. This study examined the impact of a VACS model on postoperative mortality and surgeon efficiency., Methods: This was a retrospective cohort analysis of institutional Vascular Quality Initiative data from July 2014 to July 2023. Patients undergoing lower extremity bypass, peripheral vascular intervention, or amputation were included. There was a washout period from January 2020 to January 2022 to account for COVID-19 pandemic practice abnormalities. Patients were separated into pre- or post-VACS groups. The primary clinical outcomes were 30-day and 2-year mortality. Secondary clinical outcomes included 30-day complications and 30-day and 1-year major adverse limb events (MALE). Separate analyses of operating room data from July 2017 to February 2024 and fiscal data from fiscal year 2019 to fiscal year 2024 were conducted. A washout period from January 2020 to January 2022 was applied. Efficiency outcomes included monthly relative value units (RVUs) per clinical fraction full-time equivalent (cFTE) and daytime (0730-1700, Monday-Friday) operating room minutes. Patient factors and operative efficiency were compared using appropriate statistical tests. Regression modeling was performed for the primary outcomes., Results: There were 972 and 257 patients in the pre- and post-VACS groups, respectively. Pre-VACS patients were younger (66.8 ± 12.0 vs 68.7 ± 12.7 years; P = .03) with higher rates of coronary artery disease (34.6% vs 14.8%; P < .01), hypertension (88.4% vs 82.2%; P = .01), and tobacco history (84.4% vs 78.2%; P = .02). Thirty-day mortality (2.4% pre-vs 0.8% post-VACS; P = .18) and Kaplan-Meier estimation of 2-year mortality remained stable after VACS (P = .07). VACS implementation was not associated with 30-day mortality but was associated with lower 2-year mortality hazard on multivariable Cox regression (hazard ratio [HR], 0.5; 95% confidence interval [CI], 0.3-0.9; P = .01). Operative efficiency improved post-VACS (median, 850.0; interquartile range [IQR], 765.7-916.3 vs median, 918.0; IQR, 881.0-951.1 RVU/cFTE-month; P = .03). Daytime operating minutes increased (469.1 ± 287.5 vs 908.2 ± 386.2 minutes; P < .01), whereas non-daytime minutes (420.0; IQR, 266.0-654.0 vs 469.5; IQR, 242.0-738.3 minutes; P = .40) and weekend minutes (129.0; IQR, 0.0-298.0 vs 113.5; IQR, 0.0-279.5 minutes; P = .59) remained stable., Conclusions: A VACS model leads to improvement in surgeon operative efficiency while maintaining patient safety. The adoption of a vascular acute care model has a positive impact on the delivery of comprehensive vascular care., Competing Interests: Disclosures A.J.D. has received an educational grant from Gore Medical., (Copyright © 2024. Published by Elsevier Inc.)

Background: Maternal morbidity and mortality is rising in the United States. Previous studies focus on patient attributes, and most of the national data are based on research performed at urban tertiary care centers. Although it is well understood that nurses affect patient outcomes, there is scant evidence to understand the nurse work system, and no studies have specifically studied rural nurses. The authors sought to understand the systems-level factors affecting rural obstetric nurses when their patients experience clinical deterioration., Methods: The research team used a qualitative descriptive approach, including a modified critical incident technique, in interviews with bedside nurses (n = 7) and physicians (n = 4) to understand what happens when patients experience clinical deterioration. Physicians were included to better understand the systems in which nurses work. Clinicians were interviewed at three rural hospitals in New England, with a mean births per year of 190., Findings: Six systems-level factors/themes were identified: (1) shortages of resources; (2) need for teamwork; (3) physicians' multiple conflicting and simultaneous responsibilities, such as seeing patients in the office while women labor on the hospital floor; (4) need for all team members to be at the top of their game; (5) process issues during high-acuity patient transfer, including difficulty finding available beds at tertiary care centers; and (6) insufficient policies that take low-resource contexts into account, such as requiring two registered nurses to remove emergency medications from the medication cabinet., Conclusion: Rural nurses need policies and protocols that are written with their hospital context in mind. Hospitals may need outside support for content expertise, but policies should be co-created with clinicians with rural practice experience., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

In Australia and internationally, there are increasing calls for the use of strengths-based methodologies, to counter the dominant deficit discourse that pervades research, policy, and media relating to Indigenous health and wellbeing. However, there is an absence of literature on the practical application of strengths-based approaches to quantitative research. This paper describes and empirically evaluates a set of strategies to support strengths-based quantitative analysis.A case study about Aboriginal and Torres Strait Islander child wellbeing was used to demonstrate approaches to support strengths-based quantitative analysis, in comparison to the dominant deficit approach of identifying risk factors associated with a negative outcome. Data from Wave 8 (2015) of the Australian Longitudinal Study of Indigenous Children were analysed. The Protective Factors Approach is intended to enable identification of factors protective against a negative outcome, and the Positive Outcome Approach is intended to enable identification of factors associated with a positive health outcome. We compared exposure-outcome associations (prevalence ratios and 95% confidence intervals (CIs), calculated using Poisson regression with robust variance) between the strengths-based and deficit approaches.In this case study, application of the strengths-based approaches retains the identification of statistically significant exposure-outcome associations seen with the standard deficit approach. Strengths-based approaches can enable a more positive story to be told, without altering statistical rigour. For Indigenous research, a strengths-based approach better reflects community values and principles, and it is more likely to support positive change than standard pathogenic models. Further research is required to explore the generalisability of these findings.

To determine the appropriate components for a community-based intervention for early childhood development, a broad series of stakeholder interviews was completed in a three-month period (January–March 2019) and a systematic review of their responses was performed. Additionally, 11 citywide assessment reports for child equity were reviewed and added to the information matrix. We performed this population-based assessment in San Francisco, a dense urban environment with roughly 43,000 children under the age of 5. The city has high rates of income inequity, with roughly half of the children considered to be living in low-income or poverty conditions. Interviews were conducted with 34 stakeholders representing various sectors, including community organizations, government, healthcare, and academia. Nine main concerns surrounding low-income families and children (LIFC) living in San Francisco were extracted from stakeholder interviews. The concerns were divided into subcategories based on a socioecological health model. City-funded, community-based, family resource centers were an identified space for performing an early childhood health intervention supporting LIFC. Furthermore, any proposed intervention to support LIFC must be implemented with a culturally tailored focus, as a one-size-fits-all, clinic-based model is not desired. Community-engaged and culturally specific activities are requested and required for effectively promoting early childhood development in an urban environment. In this article we propose that additional work towards implementing community-based interventions with support from the clinic are needed.

Competing Interests: We declare no competing interests.

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Intraoperative brain smear is an easy, rapid, and cost-effective technique for immediate diagnosis of brain tumors. Earlier studies have gauged its application on limited number of samples, but its diagnostic accuracy especially in low-resource settings, where its practice would be extremely helpful, is still undetermined. To investigate the diagnostic accuracy of intraoperative brain smear in resource-limited settings for diagnosis of brain tumors., Methods: A systematic search was conducted on PubMed, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase for all articles utilizing intraoperative brain smears that were extracted. Studies from low- and middle-income countries (LMICs) with test performance characteristics were selected and subsequent values were summarized using a hierarchical summary receiver operating characteristic (ROC) curve via STATA and pooled using a random-effects model on MetaDiSc 2.0., Results: Twelve studies consisting of 1124 patients were identified. Six studies included both adult and pediatric population groups, while 4 investigated adults and 2 included pediatric patients. The pooled diagnostic odds ratio (OR) was calculated to be 212.52 (CI: [104.27-433.13]) of Bivariable pooled specificity and sensitivity were 92% (CI: [86%-96%]) and 96% (CI: [93%-98%]), respectively., Conclusions: Our study shows that intraoperative brain smear is not only an accurate and sensitive diagnostic modality in resource-rich settings, but it is also equally useful in resource-limited settings, making it an ideal method for rapid diagnosis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

It is estimated that 96% of infants with hypoxic-ischaemic encephalopathy (HIE) are born in resource-limited settings with no capacity to provide the standard of care that has been established for nearly 15 years in high-resource countries, which includes therapeutic hypothermia (TH), continuous electroencephalographic monitoring and magnetic resonance imaging (MRI) in addition to close vital signs and haemodynamic monitoring. This situation does not seem to be changing; however, even with these limitations, currently available knowledge can help improve the care of HIE patients in resource-limited settings. The purpose of this systematic review was to provide, under the term "HIE Code", evidence-based recommendations for feasible care practices to optimise the care of infants with HIE and potentially help reduce the risks associated with comorbidity and improve neurodevelopmental outcomes. The content of the HIE code was grouped under 9 headings: (1) prevention of HIE, (2) resuscitation, (3) first 6h post birth, (4) identification and grading of encephalopathy, (5) seizure management, (6) other therapeutic interventions, (7) multiple organ dysfunction, (8) diagnostic tests and (9) family care., (Copyright © 2024 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity in many countries, and it has high rate of hospital readmissions due to recurrent exacerbations of the disease. Many previous studies have suggested further examination of the factors that contribute to hospital readmissions of COPD patients. However, evidence on the effects of nurse staffing by registered nurses (RNs) on the readmission of COPD patients is lacking in Korea. The aim of our study was to evaluate the effects of nurse staffing on hospital readmissions of COPD patients. Methods: We used National Health Insurance claim data from 2002 to 2012. A total of 1,070 hospitals and 339,379 hospitalization cases were included in the analysis. We divided the number of RNs per 100 beds and the proportion of RNs on staff to one of three groups (Q1: low; Q2: moderate; Q3: high). A generalized estimating equation model was used to evaluate the associations between readmission and nurse staffing. Results: A higher number of RNs was associated with lower readmission rates of 8.9% (Q2) and 7.9% (Q3) respectively. A similar effect was observed as the proportion of RNs among the total nursing staff gradually increased, resulting in lower readmission rates of 7.7% (Q2) and 8.3% (Q3). Conclusions: Our results suggest notable positive effects of nurse staffing by RNs on patient outcomes. In addition, the magnitude of impact differed between different sizes of hospitals. Thus, human resource planning to solve staffing shortages should carefully consider the qualitative aspects of the nursing staff composition.

Background: Estimating multiple sclerosis (MS) prevalence and incidence, and assessing the utilisation of disease-modifying therapies (DMTs) and healthcare resources over time is critical to understanding the evolution of disease burden and impacts of therapies upon the healthcare system., Methods: A retrospective population-based study was used to determine MS prevalence and incidence (2003-2019), and describe utilisation of DMTs (2009-2019) and healthcare resources (1998-2019) among people living with MS (pwMS) using administrative data in Alberta., Results: Prevalence increased from 259 (95% confidence interval [CI]: 253-265) to 310 (95% CI: 304, 315) cases per 100,000 population, and incidence decreased from 21.2 (95% CI: 19.6-22.8) to 12.7 (95% CI: 11.7-13.8) cases per 100,000 population. The proportion of pwMS who received ≥1 DMT dispensation increased (24% to 31% annually); use of older platform injection therapies decreased, and newer oral-based, induction, and highly-effective therapies increased. The proportion of pwMS who had at least one MS-related physician, ambulatory, or tertiary clinic visits increased, and emergency department visits and hospitalizations decreased., Conclusions: Alberta has one of the highest rates of MS globally. The proportion of pwMS who received DMTs and had outpatient visits increased, while acute care visits decreased over time. The landscape of MS care appears to be rapidly evolving in response to changes in disease burden and new highly-effective therapies., Competing Interests: Declaration of competing interest The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KV, KM, SAH, HL, LR, TW, and SK are members of the Alberta Real World Evidence Consortium, an academic entity at the University of Alberta and University of Calgary that conducts research including investigator-initiated industry-funded studies. EB, JM, PS, and MK declare no competing interests. All authors of this study had complete autonomy over the content and submission of the manuscript, as well as the design and execution of the study., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Nearly half of patients transferred from non-trauma to trauma centres have minor injuries. The transfer of patients with minor injuries to trauma centres is not associated with any known patient benefit and represents an opportunity to reduce healthcare costs and improve patient experience. In this study, we evaluated the relationship between hospital resources and overtriage, with the objective of identifying targets for system-level intervention., Methods: We conducted a population-based cohort study of adults, age ≥ 16, presenting with minor injuries to non-trauma centres in Ontario, Canada (2009-2020). The primary outcome was overtriage, defined as transfer to a trauma centre. Hierarchical logistic regression was used to evaluate the association between hospital resources and a patient's likelihood of being overtriaged, adjusting for case-mix., Results: amongst 165,302 patients with minor injuries, 15,641 (9.5 %) were transferred to a trauma centre (overtriage). Presence of a CT scanner, surgical support, or intensive care unit had no impact on a patient's likelihood of overtriage. Relative to community hospitals, presentation to a teaching hospital was independently associated with greater odds of overtriage (OR 2.97, 95 % CI: 1.26-7.00). Accounting for case-mix and resources, the median difference in a patient's odds of overtriage varied 3.7-fold across non-trauma centres (MOR 3.76)., Conclusions: There is significant variability in overtriage across non-trauma centres, even after adjusting for case-mix and hospital resources. These finding suggests that some centres have developed processes to minimize overtriage independent of available resources. Broad implementation of these processes may represent an opportunity for system-wide quality improvement., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Understand the patient experience of a pilot medical student-based patient navigator (PN) program. (2) Assess areas of improvement for further development as a model for expansion., Methods: This was a cross-sectional study assessing patients' subjective experience of medical student navigators for rheumatological conditions. Current student navigators contacted enrolled patients by phone with both structured and free-response questions., Results: 44 of 71 patients completed the questionnaire. 84% reported a satisfaction of ≥ 4 on a 5 point Likert scale. > 80% of patients felt that the program helped them better care for their health, feel more understood by their medical team, and feel cared for by their healthcare team. Medical student navigators were able to assist with most patient requests., Conclusions: Patients enrolled in our medical student PN program expressed high levels of satisfaction and felt better able to access health resources with the help of a navigator., Practice Implications: Employing medical students as PNs may serve as a mutually beneficial intervention providing early clinical exposure to students while furthering patient access to care. Other institutions may benefit from similarly structured interventions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: We highlight the importance of undertaking value assessments for health system inputs if allocative efficiency is to be achieve with health sector resources, with a focus on low- and middle-income countries. However, methodological challenges complicated the application of current economic evaluation techniques to health system input investments., Methods: We undertake a review of the literature to examine how assessments of investments in health system inputs have been considered to date, highlighting several studies that have suggested ways to address the methodological issues. Additionally, we surveyed how empirical economic evaluations of health system inputs have approached these issues. Finally, we highlight the steps required to move toward a comprehensive standardized framework for undertaking economic evaluations to make value assessments for investments in health systems., Results: Although the methodological challenges have been illustrated, a comprehensive framework for value assessments of health system inputs, guiding the evidence required, does not exist. The applied literature of economic evaluations of health system inputs has largely ignored the issues, likely resulting in inaccurate assessments of cost-effectiveness., Conclusions: A majority of health sector budgets are spent on health system inputs, facilitating the provision of healthcare interventions. Although economic evaluation methods are a key component in priority setting for healthcare interventions, such methods are less commonly applied to decision making for investments in health system inputs. Given the growing agenda for investments in health systems, a framework will be increasingly required to guide governments and development partners in prioritizing investments in scarce health sector budgets., (Copyright © 2023 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Treatment of heart failure with reduced ejection fraction (HFrEF) has benefitted from a proliferation of new medications and devices. These treatments carry important clinical benefits, but also come with costs relevant to payers, providers, and patients. Patient out-of-pocket costs have been implicated in the avoidance of medical care, nonadherence to medications, and the exacerbation of health care disparities. In the absence of major health care policy and payment redesign, high-quality HFrEF care delivery requires transparent integration of cost considerations into system design, patient-clinician interactions, and medical decision making., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The aim of this study was to examine psychiatric resource utilization, medical costs and clinical outcomes for patients with schizophrenia who received either first-generation or second-generation long-acting injectable (LAI) antipsychotics. A retrospective cohort study was conducted using data from Taiwan's National Health Insurance Research Database (NHIRD). Patients who began either first-generation or second-generation LAI treatment between 2015 and 2017 were enrolled and followed for three years. The data were evaluated using survival analysis and Cox proportional hazards regression models. Our findings demonstrated that both first- and second-generation LAI therapies led to notable reductions in the frequency of psychiatric hospitalizations and the duration of hospital stays when compared to the initial measurements. Additionally, the second-generation LAI group exhibited significantly lower rates of psychiatric emergencies and hospitalizations, as well as shorter hospital stays, compared to the first-generation LAI group. However, it is worth noting that the second-generation LAI group incurred higher pharmacy fees despite these favorable outcomes. The utilization of both first- and second-generation LAIs can enhance medication adherence and decrease the risk of acute exacerbation in patients with schizophrenia. These findings hold significant implications for schizophrenia management and the efficient allocation of healthcare resources., Competing Interests: Declaration of Competing Interest The authors declare there are no conflicts of interest. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objectives: This study aimed to understand current treatment patterns and healthcare resource utilization (HRU) of women with locally advanced or metastatic breast cancer (advanced breast cancer [ABC]) in Taiwan overall and within the subgroup of patients who were postmenopausal women with no previous systemic therapy in the ABC setting., Methods: A chart review of anonymized data on patient characteristics, treatment patterns, and HRU was conducted via an online physician survey including 118 patient charts from women ≥ 18 years old with hormone receptor positive/human epidermal growth receptor negative ABC, diagnosed between 2015 and 2017., Results: The mean age of all patients was 56.6 years (range 29-83). Among the 118 patients, the most common first-line systemic therapy group after diagnosis of ABC was endocrine-based therapy (39.0%) or endocrine therapy (ET) plus chemotherapy (ChT) combinations (38.1%). In the postmenopausal subgroup (n = 56), ET-based therapy was the most common (44.6%). Oncologist visits, at annual rate of 9.20 (95% confidence interval 8.81-9.60), and hospitalizations, at annual rate of 1.08 (95% confidence interval 0.96-1.22), were key drivers of HRU. Of the 118 patients, the 72 with at least one ChT agent in their first-line regimen had an annual hospitalization rate of 1.4 versus 0.45 admissions compared with the 46 patients on first-line ET-based therapy., Conclusions: Current treatment patterns suggest an unmet need for new medications that lead to reduction in high rate of ChT use. Results can inform future evaluations of new ABC treatments that estimate the health economic impact of their adoption in Taiwan., (Copyright © 2023 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Objetivo: Mostrar un ejemplo de la interpretación engañosa del concepto «público» y «privado» con datos sencillos sobre la dotación y la actividad hospitalaria en España. Material y métodos: Se utilizan datos de la Encuesta de Establecimientos Sanitarios con Régimen de Internado (EESCRI) del año 2002 para Cataluña y se comparan los resultados de dotación (hospitales y camas) y de actividad (altas, estancias, estancia media, índice de ocupación e índice de rotación) como resultado de recategorizar las variables (dependencia funcional y financiación), en función del concepto público y privado. Resultados: La dotación, actividad y los índices hospitalarios básicos dan una imagen muy diferente sobre la asistencia pública o privada según cuál sea la variable de clasificación utilizada. Conclusiones: Es necesario precisar mejor los conceptos y las variables utilizadas en el estudio del sistema sanitario y mejorar las fuentes de información para adaptarlas a las nuevas realidades de gestión de los servicios existentes.Objective: To give an example of the misleading interpretations of the concepts «public and private» when dealing with simple data from hospital resources and activities in Spain. Material and methods: Data comes from the survey of hospitals (EESCRI) for the year 2002 in Catalonia. Using the figures corresponding to resources (number of centers and beds) and activities (discharges, stays, mean stay, occupancy, and rotation) comparisons are made among different variables (managing authority and funding source) reclassified, according to the concepts of public and private. Results: The figures on resources and activities offer a very different portrait about the public or private nature of the care provided, according to the variables being used for classification. Conclusions: It is necessary to specify the concepts and variables to be used when analyzing the performance of health services and to improve the information sources in order to adapt them to the new management forms of the health services.

Objectives: Evaluating the efficiency of health resource allocations is critical to improving China's rural three-level health service network., Study Design: This was a prospective panel data study., Methods: Based on panel data of the medical and health resources of 31 provinces within rural China, collected from 2003 to 2020, this study uses a three-stage Data Envelopment Analysis-Malmquist index to analyze the evolution of efficiency and productivity., Results: The efficiency and productivity of county and county-level medical and health institutions rank highest, followed by township hospitals, whereas village clinics are shown to be in great need of improvement. A decline in technical advancement appears as a crucial factor exacerbating loss of factor productivity., Conclusions: Policy makers should further optimize the efficiency of medical resource allocation and promote the coordinated development of rural health in China., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Emergency medical services (EMS) contribute to the vital role of providing health care to an individual by delivering time-sensitive, episodic treatment to patients with acute illnesses. Understanding which factors impact EMS utilization can help guide policies and allocate resources more effectively. Increasing primary care access has often been touted to decrease unnecessary emergency care utilization., Objectives: This study seeks to determine whether a relationship exists between access to primary care and EMS utilization., Methods: Using data from the National Emergency Medical Services Information System, Area Health Resources Files, and County Health Rankings and Roadmaps, U.S. county-level data were analyzed to determine whether increased access to primary care (and insurance coverage) was associated with decreased EMS utilization., Results: Higher primary care availability is associated with less EMS utilization only when insurance coverage in the community surpassed 90%., Conclusions: Insurance coverage can play an important role in decreasing EMS utilization and may also impact the effect of increased primary care physician availability on EMS utilization in a region., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: Since the removal of US troops from Afghanistan in 2021, the United States welcomed Afghan evacuees through Operation Allies Welcome. Using cell phone accessibility, the CDC Foundation worked with public-private partners to protect evacuees from the spread of COVID-19 and provide accessibility to resources., Study Design: This was a mixed methods study., Methods: The CDC Foundation activated its Emergency Response Fund to accelerate public health components of Operation Allies Welcome, including testing, vaccination, and COVID-19 mitigation and prevention. The CDC Foundation began the provision of cell phones to evacuees to ensure access to public health and resettlement resources., Results: The provision of cell phones provided connections between individuals and access to public health resources. Cell phones provided means to supplement in-person health education sessions, capture and store medical records, maintain official resettlement documents, and assist in registration for state-administered benefits., Conclusions: Phones provided necessary connectivity to friends and family for displaced Afghan evacuees and higher accessibility to public health and resettlement resources. As many evacuees did not have access to US-based phone services upon entry, provision of cell phones and plans for a fixed amount of service time provided a helpful start in resettlement while also being a mechanism to easily share resources. Such connectivity solutions helped to minimize disparities among Afghan evacuees seeking asylum in the United States. Provision of cell phones by public health or governmental agencies can help to provide equitable resources to evacuees entering the United States for social connection, healthcare resources, and resources to assist in the process of resettlement. Further research is needed to understand the generalizability of these findings to other displaced populations., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objetivo: Describir los recursos asistenciales utilizados en pacientes hospitalizados por neumonía por Legionella durante un brote ocurrido en Alcoy y compararlos con los empleados en otras neumonías. Métodos y resultados: Mediante un protocolo, se analiza y compara a 177 pacientes con neumonía por Legionella con 180 pacientes ingresados por otras neumonías, y se describe su tratamiento y los recursos empleados. La claritromicina fue el antibiótico más utilizado en ambos grupos. La estancia hospitalaria fue similar, pero los requerimientos de ventilación mecánica y cuidados intensivos fueron superiores para Legionella. La hospitalización domiciliaria se utilizó con éxito en un 15,6% de los pacientes con Legionella y en un 11,3% de los demás. El uso de oxigenoterapia domiciliaria al alta fue menor para Legionella (7,8%) que para el resto de neumonías (16,7%). Conclusiones: Se destaca la mayor necesidad de ventilación mecánica en la neumonía por Legionella y los buenos resultados de la hospitalización domiciliaria dentro de los nuevos sistemas de gestión.Objective: To describe the health resources used in patients hospitalized with Legionella pneumonia during an outbreak of Legionnaire's disease in Alcoy (Spain), and to compare them with those used in other forms of pneumonia. Methods and results: Using a clinical protocol, 177 Legionella pneumonia patients were compared with 180 patients hospitalized for other types of pneumonia. Data on therapy and the resources used were collected. The most common antibiotic treatment in both groups was clarithromycin, but intensive care and mechanical ventilation requirements were greater in Legionella pneumonia. Home-based hospital care was successfully used in 15.6% of patients with Legionella pneumonia and in 11.3% of those with other types of pneumonia. Home oxygen therapy after discharge was less frequent in the Legionella pneumonia group (7.8%) than in the group with non-Legionella pneumonia (16.7%). Conclusions: Notable results were the greater requirement for mechanical ventilation in Legionella pneumonia and the good results obtained by home-based hospital care within current helath care management.

Background: Considering limited resources for follow-up due to COVID-19, we used biodegradable stents (BPBS) for a range of biliopancreatic diseases., Aims: This observational multicenter study aimed to evaluate technical safety and give first insights into clinical utility., Methods: Technical success, clinical success, and necessity of follow-up visits for BPBS placed at three Austrian tertiary care hospitals between April 2020 and January 2021 were retrospectively analyzed., Results: 63 stents were deployed in 60 patients. Main indications were prophylaxis of post-ERCP pancreatitis (PEP; n = 30/63; 48%) and bridging of prolonged waiting times to cholecystectomy (n = 21/63; 33%). Median time to surgery was 47 days (range: 136 days). The technical success rate was 94% (n = 59/63; 95% CI [0.84, 0.98]). Technical difficulties primarily arose with dislocations. Clinical success was achieved in 90% (n = 57/63; 95% CI [0.80, 0.96]). Clinical failure despite successful deployment was caused by papillary bleeding (1 patient) and cholestasis (1 patient). Both required reinterventions. No follow-up visits were needed in 97% of cases (n = 57/59; 95% CI [0.88, 1.00])., Conclusion: Biodegradable stents could help conserve health care resources without compromising treatment standards for PEP prophylaxis, which is particularly valuable in times of restricted resources. First insights into feasibility as bridging to cholecystectomy indicate a favorable safety profile., Competing Interests: Conflict of interest The authors declare that they have no conflicts of interest., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)