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Importance: Management of maternal cardiac arrest (MCA) requires understanding the unique physiology of pregnancy and modifications to life support. Health care professionals have historically demonstrated inadequate knowledge and skills necessary to treat MCA., Objective: To evaluate the effect of Obstetric Life Support (OBLS) education on health care professionals' cognitive performance, skills, and self-efficacy in managing MCA., Design, Setting, and Participants: In this single-masked randomized clinical trial, 46 health care professionals, including emergency medical service and hospital staff representing diverse specialties, were randomized to intervention or control groups at a single academic medical center in Farmington, Connecticut between May 1, 2022, and July 23, 2023., Intervention: The intervention group received OBLS education, which included a blended learning curriculum with simulation-based training on common maternal medical emergencies that lead to MCA. Participants were assessed for knowledge, confidence, and skills (eg, megacode scores as team leaders during MCA simulations). Intervention participants were compared with control group participants who received no OBLS education., Main Outcomes and Measures: The primary outcome was cognitive scores. Secondary outcomes included megacode scores rated by experienced OBLS instructors masked to assignment groups, combined assessment pass rates, and cognitive and confidence scores at baseline and 6 and 12 months after education. Data were analyzed from January 2024 to May 2024., Results: Forty-six participants (mean [SD] age, 41.1 [16.2] years; 24 [52%] women) were randomized. Despite most participants holding certification in basic and advanced cardiac life support, significant between-group differences were identified in knowledge, skills, and confidence. Mean (SD) cognitive scores were 79.5% (9.4%) in the intervention group vs 63.4% (12.3%) in the control group (P < .001). Mean (SD) megacode skills were higher in the intervention vs control group (91.0% [5.0%] vs 61.0% [12.0%], P < .001), as were confidence scores (72.7 [13.3] vs 56.2 [17.9] points, P = .002). Combined assessment pass rates were 90% in the intervention group compared with 10% in the control group (P < .001)., Conclusions and Relevance: In this randomized clinical trial, OBLS education significantly improved health care professionals' knowledge, skills, and confidence in managing MCA. These findings underscore the urgent need for implementation of a standardized MCA curriculum nationwide, especially as the US continues to face unacceptably high maternal mortality rates., Trial Registration: ClinicalTrials.gov Identifier: NCT05355519.

Objective: Asian Americans include heterogeneous subpopulations with unique burden as the only racial group with cancer as the leading cause of death. The purpose of the study was to identify differences in clinical stage and survival of patients with lung cancer between Asian Americans and its subgroups relative to other racial groups., Methods: Patients with lung cancer from 2016 National Cancer Database were divided into East Asian, Southeast Asian, South Asian subgroups based on geographic origins, and a composite Asian American group with White non-Hispanic, Black, and Hispanic comparison groups. Columnar z score analysis with adjusted residuals was employed and the terms underrepresented and overrepresented were utilized to describe significant statistical findings., Results: A total of 825,448 patients were analyzed. Asian Americans were underrepresented relative to White non-Hispanics in all clinical stages except IIIB and IV. In clinical stage IV, Asian Americans (51.0%), East Asians (47.2%), Southeast Asians (57.4%), and South Asians (52.2%) were overrepresented relative to White non-Hispanics (42.2%) and Southeast Asians were overrepresented relative to East Asians and South Asians. For survival across all stages, Asian Americans were overrepresented relative to White non-Hispanics and Blacks, but in clinical stage IV, Southeast Asians (17.9%) were underrepresented relative to East Asians (26.0%) and South Asians (26.6%)., Conclusions: This is the first study to address lung cancer disparity in Asian American subgroups employing a novel analytical approach. Asian American subgroups demonstrated more advanced lung cancer diagnosis yet higher survival compared with White non-Hispanics, Blacks, and/or Hispanics with differences between subgroups. Interplay of complex factors may contribute to Asian American health disparities., Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (© 2024 The Author(s).)

Introduction: Food insecurity (FI) has been associated with adverse health outcomes and increased healthcare expenditures. Many families experienced reduced access to food during the coronavirus disease 2019 (COVID-19) pandemic. A 2019 study revealed that the pre-pandemic prevalence of FI at an urban, tertiary care hospital's emergency department (ED) was 35.3%. We sought to evaluate whether the prevalence of FI in the same ED patient population increased during the COVID-19 pandemic., Methods: We performed a single-center, observational, survey-based study. Surveys assessing for FI were administered to clinically stable patients presenting to the ED over 25 consecutive weekdays from November-December 2020., Results: Of 777 eligible patients, 379 (48.8%) were enrolled; 158 (41.7%) screened positive for FI. During the pandemic, there was a 18.1% relative increase (or 6.4% absolute increase) in the prevalence of FI in this population (P=0.040; OR=1.309, 95% CI 1.012-1.693). The majority (52.9%) of food-insecure subjects reported reduced access to food due to the pandemic. The most common perceived barriers to access to food were reduced food availability at grocery stores (31%), social distancing guidelines (26.5%), and reduced income (19.6%)., Conclusion: Our findings suggest that nearly half of the clinically stable patients who presented to our urban ED during the pandemic experienced food insecurity. The prevalence of FI in our hospital's ED patient population increased by 6.4% during the pandemic. Emergency physicians should be aware of rising FI in their patient population so that they may better support patients who must choose between purchasing food and purchasing prescribed medications.

Purpose: Traditional approaches to blueprint creation may focus on fine-grained detail at the expense of important foundational concepts. The purpose of this study was to develop a method for constructing an assessment blueprint to guide the creation of a new post-test for a two-day prehospital emergency medical services training program., Methods: In order to create the blueprint, we first determined the proportions of the total classroom and home-study minutes associated with the lower- and higher-order cognitive objectives of each chapter of the textbook and the two-day classroom activities during training courses conducted from January to April 2015. These proportions were then applied to a 50-question test structure in order to calculate the number of desired questions by chapter and content type., Results: Our blueprint called for the test to contain an almost even split of lower- and higher-order cognitive questions. One-best-answer multiple choice items and extended matching-type items were written to assess lower- and higher-order cognitive content, respectively., Conclusion: We report the first known application of an assessment blueprint to a prehospital professional development education program. Our approach to blueprint creation is computationally straightforward and could be easily adopted by a group of instructors with a basic understanding of lower- and higher-order cognitive constructs. By blueprinting at the chapter level, as we have done, item-writers should be more inclined to construct questions that focus on important central themes or procedures.

Objective: Bicycle helmet use has become an important measure of the effectiveness of bicycle safety programs and the effectiveness of helmet legislation. Accounts of analytical comparisons of observation site selection methods are scarce. This report addresses this gap by reporting the relative effectiveness and costs of two alternative approaches to the selection of observation sites for helmet use counts., Methods: The community based (COBA) method of site selection entailed asking community informants to identify locations frequented by young bicycle riders. In the bicycle club/map (CLMA) method, site selections were based on recommendations from club members of sites at which cyclists were likely to be found and through examination of maps, keying on local features. These alternative site selection methods were compared in terms of their overall and cost effectiveness in locating youth riders., Results: Despite fewer observer hours and fewer sites in a sparsely populated rural county, the COBA method yielded greater numbers of riding youth and from 1.9 to 4.6 times more youth riders per observer hour than did the CLMA method in two densely populated suburban counties. In addition, costs per youth rider observed associated with the COBA method were 2.9 to 7.0 times lower than those associated with the CLMA method., Conclusions: Community based site identification is both more efficient in locating youth riders and more cost effective.