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Objectives: Emergency medical services (EMS) serves a critical role in the delivery of services to children with out-of-hospital emergencies. The EMS clinicians' initial field diagnoses, termed "impressions," facilitate focused patient assessments, guide the application of prehospital treatment protocols, and help determine transport destination. We sought to evaluate the concordance of the EMS clinician impression to a child's hospital-based diagnosis. Methods: We retrospectively studied de-identified pediatric (<18 years old) scene runs transported to the hospital and with available linked hospital data from the 2021 ESO Data Collaborative, a multi-agency prehospital electronic health record dataset. EMS impressions and primary emergency department or admission-based diagnoses were categorized into one of twenty-one major groups in the Diagnosis Grouping System. We identified the most common hospital-based discharge diagnoses and evaluated for the agreement between EMS impression and hospital-based diagnosis using Cohen's Kappa statistic. Results: We included 35,833 pediatric transports from the scene with linked prehospital and in-hospital data (median age 11 years, interquartile range, 3-15 years; 50.9% male). The most common categories for both EMS impressions and hospital-based diagnoses were as follows respectively: trauma (26.1%; 24.6%), neurologic diseases (18.9%; 16.4%), psychiatric and behavioral diseases and substance use disorder (11.8%; 11.6%), and respiratory diseases (11.1% and 9.5%). A total of 23,224 out of 35,833 patients, or 64.8%, had concordant EMS impressions and hospital-based diagnoses. There was high agreement between common EMS impression and in-hospital diagnoses (trauma 77.3%; neurologic diseases 70.3%; respiratory diseases 64.5%; and psychiatric, behavioral disease and substance use disorder 73.9%). Hospital-based diagnoses demonstrated moderate concordance with prehospital data (Cohen's κ = 0.59). Conclusions: We found moderate concordance between EMS primary impression and hospital diagnoses. The EMS encounter is brief and without capabilities of advanced testing, but initial impressions may influence the basis of the triage assignment and interventions during the hospital-based encounter. By evaluating EMS impressions and ultimate hospital diagnoses, pediatric protocols may be streamlined, and specific training emphasized in pursuit of improving patient outcomes. Future work is needed to examine instances of discordance and evaluate the impact on patient care and outcomes. [ABSTRACT FROM AUTHOR]

Paediatric patients with epilepsy are at risk of experiencing an acute increase in seizure frequency, called seizure clusters. These events can lead to life-threatening status epilepticus and can have lasting negative physical and psychosocial effects if treatment is not promptly administered; thus, treatment should be administrable at home or in an outpatient/ambulatory care setting. In the USA, there are three medications approved for this indication: diazepam rectal gel, midazolam nasal spray and diazepam nasal spray. Nasal sprays are the preferred route of administration, offering an easier to use and more socially acceptable alternative to rectal gel treatment. This article reviews the efficacy and safety of these treatments for paediatric patients experiencing seizure clusters, as well as important considerations for treatment choice. [ABSTRACT FROM AUTHOR]

The article discusses research which examined how nursing practices may have impacted central line-associated bloodstream infection (CLABSI) rates among intensive care unit (ICU) patients with COVID-19 during the first few months of the pandemic. Cited are the relationship between ICU COVID-19 patients with those with and without CLABSI, in terms of adherence, ICU incident reporting data on infusion and infusion medication errors and near misses, and study implications for nurse leaders.

Background: This report describes the U.S. Food and Drug Administration (FDA) experience in establishing a dedicated mailbox, and in publishing related guidance, to address concerns among interested parties regarding the conduct of clinical trials during the COVID-19 public health emergency (PHE). Methods: Six hundred and thirty-four mailbox inquiries were received from March 2020 through February 2022. Qualitative methods were used to provide a structured description of, and identify common themes among, these inquiries. Results: Most inquiries came from U.S.-based interested parties, including sponsors, industry trade associations, academic institutions, hospitals, clinics, research sites, trial participants, and individual persons. Approximately one-fifth of questions were related directly to COVID-19 (e.g., proposals for treatment); other inquiries were related to conduct of routine trial-related activities, and concerns were often focused on maintaining compliance with good clinical practice. In March 2020, FDA published a guidance titled Conduct of Clinical Trials of Medical Products During the COVID-19 Public Health Emergency; the document was subsequently revised eight times based in part on issues raised in mailbox inquiries. Conclusions: The dedicated mailbox enabled expedited communication among invested parties during the COVID-19 PHE; FDA also provided updates of the aforementioned guidance. These efforts supported the continuance of ongoing trials and the initiation of new trials during the PHE in accordance with good clinical practice guidelines, thereby helping to ensure the safety of trial participants while maintaining the quality of trial data. By soliciting and responding to trial-related inquiries and addressing corresponding needs and concerns, FDA improved transparency and communication. [ABSTRACT FROM AUTHOR]

Author's Synopsis: All adults, along with their loved ones and the medical care professionals who assist in their care, stand to benefit from having an advance care plan in place to guide their care at the end of their life or in the case of medical emergency, yet only about one-third of adults in the United States have made use of such documents, and that statistic has remained stable for years. This Article delves into the current state of advance care planning in the United States with a particular focus on advance health care directives and determines that, as it currently stands, states' systems neither support widespread usage of advance care planning tools nor ensure access to and compliance with the documents when the need arises. Accordingly, this Article proposes reform that would make use of state DMVs to increase usage of advance health care directive across all demographics, maximize accessibility to the documents by medical professionals, and, if applied in a way that encourages more uniformity between states, ensure compliance with the terms of the advance health care directives no matter where the medical emergency occurs. [ABSTRACT FROM AUTHOR]

May 11, 2023, marked the end of the federal COVID-19 Public Health Emergency (PHE). During the PHE, regulatory flexibilities allowed telehealth to more effectively connect physicians providing care and patients seeking it. This paper discusses the implications of the end of the PHE on telehealth coverage, payment, reimbursement, and licensure, and exposes inconsistencies and inequities in extant state regulations. [ABSTRACT FROM AUTHOR]

* Context.--Two major categories of laboratories performing nonwaived testing under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) are the Certificate of Accreditation (CoA) and Certificate of Compliance (CoC) laboratories. Accreditation organizations collect more detailed laboratory personnel information than the Centers for Medicare & Medicaid Services (CMS) Quality Improvement and Evaluation System (QIES). Objective.--To estimate total numbers of testing personnel and testing volumes in CoA and CoC laboratories, by laboratory type and state. Design.--We developed a statistical inference method by using the respective correlations between testing personnel counts and test volume by laboratory type. Results.--QIES reported 33 033 active CoA and CoC laboratories in July 2021. We estimated testing personnel to be 328 000 (95% CI, 309 000-348 000), which is supported by the count of 318 780 reported by the US Bureau of Labor Statistics. There were twice as many testing personnel in hospital laboratories as in independent laboratories (158 778 versus 74 904, P < .001). Independent laboratories had the highest test volume per person, which was twice as high as physician office laboratories (62 228 versus 30 102, P < .001). Hospital and independent laboratories comprised 34% of all CoA and CoC laboratories but performed the largest portion of testing (81%). Physician office laboratories, accounting for 44% of all CoA and CoC laboratories, performed a comparatively low proportion of total tests (9%). Conclusions.--Numbers of testing personnel vary considerably by laboratory type and across states. These data can provide valuable insight when assessing laboratory workforce training needs and planning for public health emergencies. [ABSTRACT FROM AUTHOR]

The Strategic National Stockpile (SNS) is a national system maintained by the US federal government to deliver medical supplies during emergencies. In the past, the SNS has been used to mitigate public health consequences of tragedies, such as Hurricane Katrina and Ebola outbreaks. However, challenges in maintaining and utilizing the SNS for patient safety are prevalent. This article canvasses ways in which the SNS is accessed and suggests needed changes in the wake of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Problem definition: Uncrewed aerial vehicles (UAVs) are transforming emergency service logistics applications across sectors, offering easy deployment and rapid response. In the context of emergency medical services (EMS), UAVs have the potential to augment ambulances by leveraging bystander assistance, thereby reducing response times for delivering urgent medical interventions and improving EMS outcomes. Notably, the use of UAVs for opioid overdose cases is particularly promising as it addresses the challenges faced by ambulances in delivering timely medication. This study aims to optimize the integration of UAVs and bystanders into EMS in order to minimize average response times for overdose interventions. Methodology/results: We formulate the joint operation of UAVs with ambulances through a Markov decision process that captures random emergency vehicle travel times and bystander availability. We apply an approximate dynamic programming approach to mitigate the solution challenges from high-dimensional state variables and complex decisions through a neural network-based approximation of the value functions (NN-API). To design the approximation, we construct a set of basis functions based on queueing and geographic properties of the UAV-augmented EMS system. Managerial implications: The simulation results suggest that our NN-API policy tends to outperform several noteworthy rule- and optimization-based benchmark policies in terms of accumulated rewards, particularly for situations that are primarily characterized by high request arrival rates and a limited number of available ambulances and UAVs. The results also demonstrate the benefits of incorporating UAVs into the EMS system and the effectiveness of an intelligent real-time operations strategy in addressing capacity shortages, which are often a problem in rural areas of the United States. Additionally, the results provide insights into specific contributions of each dispatching or redeployment strategy to overall performance improvement. Funding: This work was supported by the National Science [Grant 1761022]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0166 [ABSTRACT FROM AUTHOR]

Flashbulb memories (FBMs) refer to vivid and long-lasting autobiographical memories for the circumstances in which people learned of a shocking and consequential public event. A cross-national study across eleven countries aimed to investigate FBM formation following the first COVID-19 case news in each country and test the effect of pandemic-related variables on FBM. Participants had detailed memories of the date and others present when they heard the news, and had partially detailed memories of the place, activity, and news source. China had the highest FBM specificity. All countries considered the COVID-19 emergency as highly significant at both the individual and global level. The Classification and Regression Tree Analysis revealed that FBM specificity might be influenced by participants' age, subjective severity (assessment of COVID-19 impact in each country and relative to others), residing in an area with stringent COVID-19 protection measures, and expecting the pandemic effects. Hierarchical regression models demonstrated that age and subjective severity negatively predicted FBM specificity, whereas sex, pandemic impact expectedness, and rehearsal showed positive associations in the total sample. Subjective severity negatively affected FBM specificity in Turkey, whereas pandemic impact expectedness positively influenced FBM specificity in China and negatively in Denmark. [ABSTRACT FROM AUTHOR]

During public health emergencies, health communication materials to contain the outbreak are needed promptly, which prevents the use of standard approaches for getting feedback from the intended audience. We propose a strategy for rapidly obtaining community feedback on new health communication materials during the public health emergencies. We illustrate this with COVID-19 testing campaign in a Vietnamese–American enclave in the USA. The project included community-based COVID-19 testing and communication activities to increase the awareness of the testing centers and encourage frequent testing. Our strategy involves two main components: (i) use of a research team with an existing trust relationship with the community and that includes researchers from that community and (ii) co-design of communication materials using community-based gatekeepers and a cultural broker. We developed brochures and posters to increase the awareness of the COVID-19 testing services. The cultural broker and community-based partners identified salient message concepts and worked with the researchers to define the objectives and content of the materials, which were then reviewed by the entire team. In lieu of standard pretesting, we relied on feedback on mockups of the materials and subsequent revisions from the community-based gatekeepers and cultural broker. Our strategy strikes a balance between the need to urgently disseminate new materials and the need for community input. One key takeaway is that effective planning for public health emergencies must start long before the crisis occurs. [ABSTRACT FROM AUTHOR]

Objective: This project assessed college students' perceptions of social media conversations about COVID-19 in the United States. Participants: A total of 110 college students completed an online survey (N = 110) over two periods of time: April 2020 (n = 60) and September 2020 (n = 50). Method: Measurements included students' perceptions of sentiment, risk, blame, outrage, and opinion/behavioral intention. Results: Survey results showed that college students' attitudes and perceptions of these concepts on social media varied from April to September with negative sentiment, concern, uncertainty, and risk perception decreasing over time while blame and outrage increased over time. A sample of tweets was also examined for these constructs. Conclusions: This study provides important insight on college students' perceptions during a public health emergency and how they use social media as a tool for health information. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, Rhode Island implemented a telehealth waiver allowing telehealth parity. This study investigated (1) if telehealth allowed for patients who seek mental health services to maintain visit frequency and (2) if subpopulations were less likely to utilize telehealth. We used descriptive statistics to analyze the change in total number of visits, in-person visits from pre-waiver to post-waiver, and a multivariate linear regression to identify relationships between demographics and telehealth utilization. Participants were able to maintain the frequency of visits during the COVID-19 pandemic. Race/ethnicity, age, gender, employment status, and housing status were all statistically significant predictors of telehealth utilization. Telehealth aids in the continuing of care when in-person visits are not a viable option. Access to telehealth is crucial during public health emergencies and aids in maintaining visit frequency. Further research should be done to evaluate subgroups who are less likely to utilize telehealth. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, an urgent need existed for near–real-time data collection to better understand how individual beliefs and behaviors, state and local policies, and organizational practices influenced health outcomes. We describe the processes, methods, and lessons learned during the development and pilot testing of an innovative rapid data collection process we developed to inform decision-making during the COVID-19 public health emergency. We used a fully integrated mixed-methods approach to develop a structured process for triangulating quantitative and qualitative data from traditional (cross-sectional surveys, focus groups) and nontraditional (social media listening) sources. Respondents included students, parents, teachers, and key school personnel (eg, nurses, administrators, mental health providers). During the pilot phase (February–June 2021), data from 12 cross-sectional and sector-based surveys (n = 20 302 participants), 28 crowdsourced surveys (n = 26 820 participants), 10 focus groups (n = 64 participants), and 11 social media platforms (n = 432 754 503 responses) were triangulated with other data to support COVID-19 mitigation in schools. We disseminated findings through internal dashboards, triangulation reports, and policy briefs. This pilot demonstrated that triangulating traditional and nontraditional data sources can provide rapid data about barriers and facilitators to mitigation implementation during an evolving public health emergency. Such a rapid feedback and continuous improvement model can be tailored to strengthen response efforts. This approach emphasizes the value of nimble data modernization efforts to respond in real time to public health emergencies. [ABSTRACT FROM AUTHOR]

This focused ethnography examines the experiences of social work faculty members during the COVID-19 pandemic. Throughout the first year of the COVID-19 pandemic, we conducted participant observations of the pivot to distance learning, research and service, and overall responses of the social work community at a Research 1, public university. This article focuses on in-depth, zoom-recorded, individual interviews with 16 social work faculty members during the first year of the pandemic with follow-up communications 1 year later (n = 9). They characterized the pandemic as pervasive, sustained, isolating, changing, embedded within a deeply divided sociocultural context, and having a disparate impact related to faculty members' positionality. Many described feelings of disorientation, anxiety, fear, loss, grief, fatigue, and strained relationships. Faculty members also described a strengthening of social work's resiliency through innovative technology, embracing new opportunities to enact professional values of social and racial justice, and meaning making. They consider building on this resiliency moving forward, including in the face of future long emergencies. Their reflections on lessons learned during the COVID-19 pandemic suggest how we may become more resilient by tending to our collective trauma, balancing the benefits of online education with psychosocial needs, and examining how social work ethics interact with academic systems. [ABSTRACT FROM AUTHOR]

In another tumultuous term of the United States Supreme Court in 2022-2023 a series of critical cases implicate instant and forthcoming changes in multiple fronts that collectively shift the national public health law and policy environment. [ABSTRACT FROM AUTHOR]

This article seeks to understand the changes in federal health care policy that led to greater telehealth adoption during COVID-19 pandemic. For decades, telehealth was identified as a possibility for increasing health care access, but the policies needed for greater telehealth reimbursement were stalled until the public health emergency was declared. Applying the dynamic concepts within punctuated equilibrium theory (PET) model to traditional fee-for-service Medicare policy, the influential factors are identified and specify how policy change occurred as a response to the pandemic, resulting in swift and large-scale changes in Medicare telehealth reimbursement requirements and widespread telehealth adoption. The model also explains how the same forces that led to Medicare policy response are at work to maintain and broaden or contract and limit the future of telehealth reimbursement as the public health emergency recedes. [ABSTRACT FROM AUTHOR]

From its inception, the COVID-19 pandemic has been a disruptive force on U.S. health care and public health systems. President Biden's announced termination of the national public health emergency on May 11, 2023 portends a return to normalcy and relief for Americans from the greatest infectious disease scourge the nation has ever faced. In reality, closing out this pandemic presents a tempest of legal and practical complications. [ABSTRACT FROM AUTHOR]

Introduction: Medical emergency response teams optimally involve interdisciplinary expertise, including pharmacists. A pharmacist may make therapy recommendations, prepare medications, and act as a drug information resource, which are important skills for a postgraduate year one pharmacy resident (PGY1) to develop. Limited data exist evaluating current national practices for PGY1 emergency response. Objectives: The purpose of this study was to describe national practices for PGY1 emergency response. These data may help PGY1 programs identify potential best practices for self‐improvement. Methods: An anonymous survey was developed to describe PGY1 emergency response within the United States and electronically distributed to PGY1 residency program directors. The questionnaire included general demographic information along with questions involving pharmacist and pharmacy resident emergency response and training within their institution. A univariate analysis was performed to evaluate potential predictors of survey respondent confidence in PGY1 independent emergency response by the end of the residency year. Results: A total of 178 completed responses were obtained (response rate: 33.0%). The majority of respondents had both pharmacist and PGY1 response at their institution, with response to cardiopulmonary arrest being the most common. Of the 36 programs that did not have pharmacy resident involvement, the most common reason was due to lack of pharmacy response at their institution (61.1%). The majority of programs (68.3%) were confident in the ability for a PGY1 to independently respond by the end of their residency year. Only the number of emergency response by the end of the residency year was a predictor in their confidence of PGY1 independent response (p = 0.002). Conclusion: The majority of PGY1 programs had both pharmacist and pharmacy resident response to medical emergencies. The results of this survey may help PGY1 programs identify potential areas of improvement and help prospective residency candidates identify program characteristics that may best prepare them for emergency response. [ABSTRACT FROM AUTHOR]

The article focuses on the difficulties in finding clinical trials conducted under the Exception from Informed Consent (EFIC) rule, with only 110 trials identified since the regulation's inception, leading to a lack of transparency, which could be the cause of poor recruitment and early termination.

• The rate of lacrosse-related injuries has fluctuated, with injuries per 100,000 significantly increasing from 2000 to 2012 and significantly decreasing from 2012 to 2016. • Boys were more likely than girls to be injured by contact with a stick or another player and were more likely to injure their upper extremities. A larger proportion of girls sustained concussions or closed head injuries. • Injuries differed by age. Older youth players were less often injured by contact with the lacrosse stick or another player. • Our findings support the continued development and implementation of risk-mitigating rules targeting specific sex and age categories among youth lacrosse players. Lacrosse is one of the fastest-growing sports in the United States. Its rules regarding permitted contact differ by sex and age. There are no known studies using a nationally representative data set to analyze lacrosse injury patterns over several years by sex and age in the youth population. A retrospective analysis was performed using data from the National Electronic Injury Surveillance System for youth aged 11–18 years who were treated for lacrosse-related injuries in U.S. emergency departments from 2000 to 2016. Based on our review of the case narratives, we created and coded a new injury-mechanism variable. We generated national estimates from 6406 cases. An estimated 206,274 lacrosse-related injuries to youths aged 11–18 years were treated in U.S. emergency departments from 2000 to 2016. The rate of injuries per 10,000 significantly increased from 1.9 in 2000 to a peak of 5.3 in 2012 (p < 0.0001), followed by a significant decrease to 3.4 in 2016 (p = 0.020). Injury mechanism, body part injured, and diagnosis differed by sex. Boys were 1.62 times (95% confidence interval (95%CI): 1.25–2.09) more likely than girls to be injured by player-to-player contact. Girls were 2.21 times (95%CI: 1.96–2.49) more likely than boys to have non-contact injuries. Overall, as age increased, the percentage of injuries from lacrosse sticks decreased and player-to-player contact increased. Despite additional protective regulations in the sport, lacrosse is an important source of injury where we continue to see differences by sex and age. This study supports the continuation, modification, and addition of rules aimed at reducing lacrosse injury risk. [Display omitted] [ABSTRACT FROM AUTHOR]

BACKGROUND: Financial toxicity describes the harmful effect of individual treatment costs and fiscal burdens that have a compounding negative impact on outcomes in surgery. While this phenomenon has been widely studied in surgical oncology, the purpose of this study was to perform a novel exploration of the impact of financial toxicity in emergency general surgery (EGS) patients throughout the US. STUDY DESIGN: The Nationwide Readmissions Database for January and February 2018 was queried for all EGS patients aged 18 to 65 years. One-to-one propensity matching was performed with and without risk for financial toxicity. The primary outcome was mortality, and the secondary outcomes were venous thromboembolism (VTE), prolonged length of stay (LOS), and readmission within 30 days. RESULTS: There were 24,154 EGS patients propensity matched. The mortality rate was 0.2% (n = 39), and the rate of VTE was 0.5% (n = 113). With financial toxicity, there was no statistically significant difference for mortality (p = 0.08) or VTE (p = 0.30). The rate of prolonged LOS was 6.2% (n = 824), and the risk was increased with financial toxicity (risk ratio 1.24 [1.12 to 1.37]; p < 0.001). The readmission rate was 7.0% (n = 926), and the risk with financial toxicity was increased (risk ratio 1.21 [1.10 to 1.33]; p < 0.001). The mean count of comorbidities per patient per admission during readmission within 1 year with financial toxicity was 2.1 ± 1.9 versus 1.8 ± 1.7 without (p < 0.001). CONCLUSIONS: Despite little difference in the rate of mortality or VTE, EGS patients at risk for financial toxicity have an increased risk of readmission and longer LOS. Fewer comorbidities were identified at index admission than during readmission in patients at risk for financial toxicity. Future studies aimed at reducing this compounding effect of financial toxicity and identifying missed comorbidities have the potential to improve EGS outcomes. [ABSTRACT FROM AUTHOR]

Objectives. To identify and categorize US state legislation introduced between January 1, 2021, and May 20, 2022, that addresses emergency health authority. Methods. We adapted standard policy surveillance methods to collect and code state bills and enacted laws limiting or expanding the emergency public health authority of state and local officials and agencies. Results. State legislators introduced 1531 bills addressing public health authority; 191 of those were enacted in 43 states and the District of Columbia, including 17 expanding and 65 contracting emergency authority, 163 regulating use, and 30 preempting local use of specific measures such as mask mandates. Conclusions. State laws setting the scope and limits of emergency authority are crucial to effective public health response. These laws are changing in ways that threaten to reduce response capacity. Tracking changes in health law infrastructure is important for evaluating changes in health authority and ensuring that stakeholders recognize these changes. Public Health Implications. The COVID-19 pandemic called for quick, decisive action to limit infections, and when the next outbreak hits, new laws limiting health authority will make such action even more difficult. (Am J Public Health. 2023;113(3):288–296. https://doi.org/10.2105/10.2105/AJPH.2022.307214) [ABSTRACT FROM AUTHOR]

The article explores the legal foundations of state public health emergency powers, their uses and challenges in response to COVID-19 and post-pandemic reform proposals to improve state responses to future emergency threats. Topics discussed include political and judicial issues concerning freedoms of speech and association, due process, equal protection, separation of powers, preemption and local home rule, and strategies to reinforce health infrastructure or enhance public health powers.

Objectives. To systematically identify and analyze US state-level legislation concerning people who were undocumented during the COVID-19 pandemic, from January 2020 through August 2021. Methods. Using standard public health law research methods, we searched Westlaw's online database between November 2021 and January 2022 to identify legislation addressing COVID-19 and people who were undocumented. We abstracted relevant information, analyzed the data, and identified primary themes for each bill and resolution. Results. Sixty-six bills and resolutions, from 13 states, met the inclusion criteria. Legislation addressed 5 primary themes: eligibility and access to health-related services (n = 16), health and personal information (n = 10), housing assistance (n = 13), job security and employment benefits (n = 14), and monetary assistance (n = 13). Conclusions. Approximately one quarter of state legislatures introduced bills or resolutions regarding people who were undocumented and COVID-19. State-level laws are an important tool to mitigate the disproportionate impact of public health emergencies on vulnerable groups. Public Health Implications. As states shift attention away from the exigencies of COVID-19, this research provides insight into how law might be used to protect those who are undocumented throughout the full cycle of future public health emergencies. (Am J Public Health. 2022;112(12):1757–1764. https://doi.org/10.2105/AJPH.2022.307090) [ABSTRACT FROM AUTHOR]

This qualitative case study contributes to the international research project EScAPE (Evaluating Scientific Advice in a Pandemic Emergency) and aims to understand how state leaders mobilized science advice in pandemic response during 2020 and into the early months of 2021. North Carolina, a state in the southeastern United States, mobilized much of its pandemic science advice through the state's Department of Health and Human Services. A fluid relationship between advisors and the governor—credited as a crucial component of a science driven, balanced pandemic response—created an opaque hub of advising and power. I analyze three advisory processes apparent during early stages of pandemic response noting strengths in mutual respect and trust between advisors and policymakers, data transparency, and commitment to equitable vaccine distribution. The interpersonal dynamics that provided these "good" science advice outcomes are a result of the individuals involved but the dynamic is not guaranteed in government over time. Also, while North Carolina provided data transparency it is unclear how data trends connected to decisions. There is a general lack of transparency around the breadth and content of advice. Transparency of advisory mechanisms is important to maintain public trust in government. Deep partisanship in the United States and distrust between leaders of opposing parties underscores the need for states to develop strong institutions for science advise to policymakers in an emergency. This article closes with several recommendations. [ABSTRACT FROM AUTHOR]

Tixagevimab–cilgavimab is the only nonvaccine drug currently authorized in the United States for the prevention of COVID-19 infection in individuals who are moderately to severely immunocompromised or unable to receive COVID-19 vaccination. Tixagevimab–cilgavimab is composed of two monoclonal antibodies, tixagevimab and cilgavimab, which bind to the spike protein of the SARS-CoV-2 virus. This blocks the ability of the virus to infect cells. Tixagevimab–cilgavimab is administered as two intramuscular injections consisting of tixagevimab 300 mg (3 ml) and cilgavimab 300 mg (3 ml). After patient injections, the nurse monitors the patient for one hour in the clinic. Tixagevimab–cilgavimab has been well tolerated, with mild headache, fatigue, and cough being the most commonly reported side effects. [ABSTRACT FROM AUTHOR]

The article offers information on telehealth reimbursement and offers suggestions regarding telehealth public health emergency (PHE). Topics discussed include Medicare rules prior to the pandemic about coverage for telehealth, final rule on telehealth coverage for calendar year 2024, and recommendations for practices to permanently adopt telehealth.

The water pollution affecting human health is a crisis and big test, which tests the mainstream news media's ability and level of communication to respond to major public opinions and public emergencies. The contaminated water is a crisis and a major test, which tests the ability and level of communication of major news outlets to respond to important common views and emergencies. It aims to understand the perception and attitude of the international mainstream media towards China during the contaminated water. The work sorted out the mainstream media's reporting of China from the contaminated water to the present and selected the New York Times, The Times, and the Guardian as examples. We could understand the changes in China's international image during the water pollution through these mainstream media reports on China. The results show that these media reports on water pollution in China mainly focused on negative public opinion, which accounted for more than 70% of the total number of reports. Western developed countries such as the United Kingdom and the United States are out of consideration for their national interests. Using mainstream media to create public opinion that is not conducive to China, advocating "neo-colonialism", "China threat theory" and other false statements, trying to limit China's influence, due to the difference in cognitive habits and the influence of British and American media hegemony also affects the country The communication and understanding between the two have brought obstacles. [ABSTRACT FROM AUTHOR]

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies. [ABSTRACT FROM AUTHOR]

Objective: In 2020, the COVID-19 pandemic overburdened the US health care system because of extended and unprecedented patient surges and supply shortages in hospitals. We investigated the extent to which several US hospitals experienced emergency department (ED) and intensive care unit (ICU) overcrowding and ventilator shortages during the COVID-19 pandemic. Methods: We analyzed Health Pulse data to assess the extent to which US hospitals reported alerts when experiencing ED overcrowding, ICU overcrowding, and ventilator shortages from March 7, 2020, through April 30, 2021. Results: Of 625 participating hospitals in 29 states, 393 (63%) reported at least 1 hospital alert during the study period: 246 (63%) reported ED overcrowding, 239 (61%) reported ICU overcrowding, and 48 (12%) reported ventilator shortages. The number of alerts for overcrowding in EDs and ICUs increased as the number of COVID-19 cases surged. Conclusions: Timely assessment and communication about critical factors such as ED and ICU overcrowding and ventilator shortages during public health emergencies can guide public health response efforts in supporting federal, state, and local public health agencies. [ABSTRACT FROM AUTHOR]

The article discusses about the significant protection-inclusion tensions in research on medical emergencies. It further discusses that barriers to research in patient populations that have been historically labeled as vulnerable; promotion of inclusive research is an important part of the Institutional Review Board's (IRBs') scope and mission; ability to engage in decisions and provide informed consent is limited or absent; and the process of engaging and respecting potential participants.

Background: Twenty‐five percent of patients presenting to the emergency department (ED) for a respiratory or cardiovascular medical emergency develop clinically significant posttraumatic stress disorder (PTSD) symptoms. It is possible that development of PTSD symptoms in this cohort is associated with subsequent adverse physical health events. Our objective was to test whether clinically significant PTSD symptoms 30 days postdischarge are associated with increased risk for hospital readmission within 24 months after discharge among patients presenting to the ED for a respiratory or cardiovascular emergency. Methods: This was a prospective cohort study conducted between January 1, 2018, and December 31, 2020, at a U.S. academic medical center, including adult patients presenting with acute respiratory failure or cardiovascular instability requiring a potentially life‐sustaining intervention in the ED. PTSD symptoms 30 days postdischarge were measured using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders‐5. The primary outcome was all‐cause hospital readmission over the subsequent 24 months after hospital discharge from the index ED visit. Results: Of the 99 patients included, 73% (95% confidence interval [CI] = 63% to 81%) had a hospital readmission within 24 months. In a multivariable Cox proportional hazards model adjusting for potential confounders (e.g., age, severity of illness during index ED visit, preexisting comorbid conditions) presence of clinically significant PTSD symptoms at 30 days was independently associated with increased risk for all‐cause hospital readmission at 24 months (hazards ratio = 2.19, 95% CI = 1.30 to 3.69). These results remained statistically significant across multiple sensitivity analyses. Conclusions: Hospital readmission is common among survivors of acute respiratory failure and cardiovascular instability, and PTSD symptoms 30 days postdischarge are an independent predictor of hospital readmission. Survivors of medical emergencies may warrant follow‐up evaluation for PTSD symptoms, and future research is warranted to better understand the relationship between psychological trauma and hospital readmission. [ABSTRACT FROM AUTHOR]

Purpose: The Emergency Surgery Score (ESS) is a reliable point-based score that predicts mortality and morbidity in emergency surgery patients. However, it has been validated only in the U.S. patients. We aimed to prospectively validate ESS in a Greek patient population. Methods: All patients who underwent an emergent laparotomy were prospectively included over a 15-month period. A systematic chart review was performed to collect relevant preoperative, intraoperative, and postoperative variables based on which the ESS was calculated for each patient. The relationship between ESS and 30-day mortality, morbidity (i.e., the occurrence of at least one complication), and the need for intensive care unit (ICU) admission was evaluated and compared between the Greek and U.S. patients using the c-statistics methodology. The study was registered on "Research Registry" with the unique identifying number 5901. Results: A total of 214 patients (102 Greek) were included. The mean age was 64 years, 44% were female, and the median ESS was 7. The most common indication for surgery was hollow viscus perforation (25%). The ESS reliably and incrementally predicted mortality (c-statistics = 0.79 [95% CI 0.67–0.90] and 0.83 [95% CI 0.74–0.92]), morbidity (c-statistics = 0.83 [95% CI 0.76–0.91] and 0.79 [95% CI 0.69–0.88]), and ICU admission (c-statistics = 0.88 [95% CI 0.81–0.96] and 0.84 [95% CI 0.77–0.91]) in both Greek and U.S. patients. Conclusion: The correlation between the ESS and the surgical outcomes was statistically significant in both Greek and U.S. patients undergoing emergency laparotomy. ESS could prove globally useful for preoperative patient counseling and quality-of-care benchmarking. [ABSTRACT FROM AUTHOR]

The article discusses global climate change's impact on human physical and mental health. Topics covered include its boosting of respiratory and cardiovascular disease, injuries and premature deaths, its worsening of geographical food- and waterborne illnesses, and flooding incidents' increase of depression, anxiety, and post-traumatic stress disorder (PTSD) cases. Also noted are the importance of intervention strategies involving the community, and of medical training on climate change.

The article explores the role of rheumatologists in advocating for patients' health and well-being amidst the climate crisis which represents an emerging threat to the health of humanity and the planet. Topics covered include how the climate emergency can affect the health of rheumatic disease patients, and the ways in how rheumatologists and the American College of Rheumatology (ACR) can help in developing strategies to mitigate the effects of the climate emergency.

Objectives: Centers for Medicare and Medicaid Services requirements for Emergency Preparedness Planning (EPP) by hospice organizations significantly increased in 2017. This study seeks to assess the involvement of various hospice personnel in EPP before and since the onset of the novel coronavirus disease COVID-19 pandemic. Methods: A link to an anonymous online survey was sent to members of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association, targeting members involved in hospice care in the United States. A descriptive analysis of the data was performed. Results: Prior to the pandemic, 39.8% of respondents were "moderately" or "very" involved with the development and revisions of the Emergency Preparedness Plan. Since the beginning of the pandemic, this increased to 59%, which largely occurred among physicians. Clinical Nurse and Nurse Practitioner involvement in development/revisions remained low. Approximately 30% of respondents desired more involvement across the areas of EPP. Conclusion: The involvement of personnel of various disciplines is varied and the involvement of physicians appears to have increased with the onset of the COVID-19 pandemic. A notable portion of personnel desired more involvement across all aspects of EPP. More research is needed in this important but little-understood area. [ABSTRACT FROM AUTHOR]

Context: Reductions in population mobility can mitigate disease-related mortality. But do social distancing policies actually change population behavior and, if so, what factors condition policy effects? Methods: We leverage subnational variation in the stringency and timing of state-issued social distancing policies to test their ettects on mobility across 109 states in Brazil, Mexico, and the United States. We also explore how conventional predictors of compliance, including political trust, socioeconomic resources, health risks, and partisanship. modify these policy effects. Findings: In Brazil and the United States, stay-at-home orders and workplace closures reduced mobility, especially early in the pandemic. In Mexico, where federal intervention created greater policy uniformity, workplace closures produced the most consistent mobility reductions. Conventional explanations of compliance perform well in the United States but not in Brazil or Mexico, apart from those emphasizing socioeconomic resources. Conclusions: In addition to new directions for research on the politics of compliance, the article offers insights for policy makers on which measures are likely to elicit compliance. Our finding that workplace closure effectiveness increases with socioeconomic development suggests that cash transfers, stimulus packages, and other policies that mitigate the financial burdens of the pandemic may help reduce population mobility. [ABSTRACT FROM AUTHOR]

Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context. [ABSTRACT FROM AUTHOR]

Importance: Emergency research is challenging to do well as it involves time sensitive interventions in unstable patients. There is limited time to obtain informed consent from the patient or their legally authorized representative (LAR). Such research is permitted under exception from informed consent (EFIC) if specific criteria are met, including notification after enrollment. Some question whether the risks of EFIC outweighs its benefits. To date, there is limited empiric information about time to notification (TTN) and rates of withdrawal in such trials.Objective: To describe variation in TTN and rates of withdrawal among that patients enrolled in EFIC trials over a twelve-year period.Design: We performed post hoc descriptive analyses of data from five trials conducted under EFIC.Setting: Emergency medical services and receiving hospitals participating in the Resuscitation Outcomes Consortium in the United States and Canada.Participants: Patients with out-of-hospital cardiac arrest or life-threatening traumatic injury.Exposures: Notification strategies were specified at each site before initiation of enrollment by a local institutional review board. We monitored TTN within each site centrally throughout each study's enrollment period.Outcomes: TTN was defined as time from randomization to first-reported notification of patient or LAR of enrollment. Withdrawal was defined as patient or LAR opt out of ongoing participation at the time of notification.Results: Of 35,442 patients enrolled in five trials, 33,805 had cardiac arrest; and 1636 had traumatic injury. TTN varied overall and by patient outcome. Among those with cardiac arrest, TTN ranged from median (5%ile, 95%ile) of 6 (1,27) days to 28 (2, 53) days across sites. 0.3% of notified patients with cardiac arrest withdrew. Among those with traumatic injury, TTN ranged from 0 (0, 5) days to 36 (5, 68) days across sites. 7.7% of notified patients with traumatic injury withdrew.Conclusions and Relevance: There is large variation in TTN in trials conducted under EFIC for emergency research. This may be due to several factors. It may or may not be modifiable. Overall rates of withdrawal are low, which suggests current practices related to EFIC are acceptable to those who have participated in emergency research. [ABSTRACT FROM AUTHOR]

The article presents the professional policies approved by the American Society of Health System Pharmacists (ASHS) House of Delegates including the policies 2101-2112, 2113-2120, and 2121-2143 that were respectively approved in March, May, and June 2021. Policy topics covered include direct-to-consumer clinical genetic tests, pharmacogenomics, and universal influenza vaccination. Also noted is planned posting of the House of Delegates complete proceedings in the ASHA website.

Predictive data technology designed to contain the COVID-19 pandemic was not as successful as promised. Data-centric solutions to providing testing and tracing did little to limit the virus's spread in part because they served only the most visible parts of society. This Article argues for more robust solutions to protect individuals' privacy--whether those individuals are currently visible or invisible to pandemic technology--if pandemic technology is to provide the universal coverage necessary for a public health emergency, such as the COVID-19 pandemic. First, we contend that current pandemic data technology operates under rigid technical and social assumptions that thwart participation from all population groups. Second, we demonstrate that the organizations associated with pandemic data technology have financial incentives that could be in opposition to protecting anyone susceptible to the virus. Third, we consider how the need for someone to protect data to allow for medically necessary access to data could be an onramp for a pilot implementation of legal theory on information fiduciaries. Finally, we offer two tangible policy suggestions: conflict-of-interest notices released as open data and a public health fiduciary that has legal responsibility to protect data relevant to epidemiological outbreaks. A public health fiduciary working in the public interest would be more likely to gather sufficiently accurate data than would a fiduciary working within the organizations collecting data themselves. Technology has a vital role to play in managing the pandemic, but in the hands of some organizations, it may encourage behavior that counters public health goals. Trusted data technology solutions in conjunction with predictive epidemiology models could contribute to reducing the spread of the virus more holistically and with fewer privacy-related consequences. [ABSTRACT FROM AUTHOR]

The article discusses a study published in "Surgery Open Science," which showed the association of increased odds of having an emergent colorectal cancer (CRC) resection and other major adverse events and non-White race. The study assessed the association between race and the need for emergency surgery in a ten-year span. Findings include patients with increased odds of emergent surgeries, association of emergent admission and Medicaid, and greater rates of mortality in emergent patients.

The article discusses the Emergency Medical Treatment and Labor Act (EMTALA) is foundational to U.S. health care. In the wake of the Supreme Court's 24 June, 2022. Topics include the decision in Dobbs u. jackson Women's Health Organization, which eliminated the constitutional right to abortion and returned the regulation of abortion to state control, a key question is whether EMTALA will survive to serve as a bulwark against state laws.

The article explores Emergency Use Authorizations (EUAs) versus FDA (Food and Drug Administration) approval, noting how EUAs were used to make medical products, including diagnostic tests, treatments, masks and vaccines, more available during the COVID-19 pandemic. Particular focus is given to how EUA may benefit public health, or, put it at unnecessary risk. Additional topics discussed include the history of EUA in the U.S., FDA specified standards for the approval of COVID-19 vaccines, and the efficacy of Pfizer and Moderna's COVID-19 vaccines.