Implementation and evaluation of an electronic consult program at a large academic health system.

Background: Although the benefits of eConsults in increasing access and lowering unnecessary utilization have been well described, the development of a successful program can be challenging.

Objective: We sought to share the experiences of a large academic health system in implementing and evaluating a high-volume electronic consultation (eConsult) program across 34 adult and pediatric medical and surgical specialties.

Methods: Using a multi-method approach, we collected qualitative and quantitative data on operational and process outcomes to describe adoption of eConsults, and survey data to capture satisfaction and experience among referring and specialist clinicians.

Trends in Utilization of Electronic Consultations Associated With Patient Payer and Language Among US Academic Medical Centers During the COVID-19 Pandemic.

Importance: Electronic consultations (eConsultations) are increasingly used to obtain specialist guidance, avoiding unnecessary face-to-face patient visits for certain clinical questions. During the COVID-19 pandemic, when in-person care was limited, eConsultations may have helped clinicians obtain specialist input to guide patient care.

Objective: To understand how the use of eConsultations changed during the COVID-19 pandemic and whether trends in eConsultation utilization differed based on patient's payer and primary language.

Neighbourhood walking tours for physicians-in-training.

Social and economic factors have a profound impact on patient health. However, education about these factors has been inconsistently incorporated into residency training. Neighbourhood walking tours may help physician-residents learn about the social determinants of health (SDoH).

Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study.

Objective: To identify county characteristics associated with high versus low well-being among high-poverty counties.

Design: Observational cross-sectional study at the county level to investigate the associations of 29 county characteristics with the odds of a high-poverty county reporting population well-being in the top quintile versus the bottom quintile of well-being in the USA. County characteristics representing key determinants of health were drawn from the Robert Wood Johnson Foundation County Health Rankings and Roadmaps population health model.

Characteristics, outcome and risk factors for mortality of paediatric patients with ICU-acquired candidemia in India: A multicentre prospective study.

Background: The epidemiology, clinical profile and outcome of paediatric candidemia vary considerably by age, healthcare settings and prevalent Candida species. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap.

Do pregnant women living in higher well-being populations in the USA experience lower risk of preterm delivery? A cross-sectional study.

Objective: To determine if preterm birth, defined as gestational age <37 weeks, is lower for women living in counties with higher well-being, after accounting for known individual risk factors.

Design: Cross-sectional study of all US births in 2011.

Participants: We obtained birth data from the National Center for Health Statistics which included 3 938 985 individuals.

Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study.

Background: Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae.

Methods: The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections.

The State of Education and Training for Antimicrobial Stewardship Programs in Indian Hospitals-A Qualitative and Quantitative Assessment.

: To understand the role of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in Indian healthcare organizations. : Mixed method approach using quantitative survey and qualitative interviews was applied. Through key informants, healthcare professionals from 69 hospitals (public & private) were invited to participate in online survey and follow up qualitative interviews.

Association of the Overall Well-being of a Population With Health Care Spending for People 65 Years of Age or Older.

Importance: New US health care payment models have increasingly incentivized health care systems to promote health and reduce health care spending at the population level, with Medicare beneficiaries representing one of the largest populations affected by new payment models. Identifying novel strategies to promote health and reduce health care spending is necessary.

Objective: To assess whether the overall well-being of a population is associated with health care spending for people 65 years of age or older.

The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study.

Background: The threat posed by antibiotic resistance is of increasing concern in low- and middle-income countries (LMICs) as their rates of antibiotic use increase. However, an understanding of the burden of resistance is lacking in LMICs, particularly for multidrug-resistant (MDR) pathogens.

Methods: We conducted a retrospective, 10-hospital study of the relationship between MDR pathogens and mortality in India.

Identifying county characteristics associated with resident well-being: A population based study.

Background: Well-being is a positively-framed, holistic assessment of health and quality of life that is associated with longevity and better health outcomes. We aimed to identify county attributes that are independently associated with a comprehensive, multi-dimensional assessment of individual well-being.

Methods: We performed a cross-sectional study examining associations between 77 pre-specified county attributes and a multi-dimensional assessment of individual US residents' well-being, captured by the Gallup-Sharecare Well-Being Index.

Candida auris candidaemia in Indian ICUs: analysis of risk factors.

Objectives: To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses a global threat.

Methods: We performed a subgroup analysis of a previously reported study of 27 Indian ICUs. The clinical data of candidaemia cases due to C.

Bridging the Response to Mass Shootings and Urban Violence: Exposure to Violence in New Haven, Connecticut.

We have described self-reported exposure to gun violence in an urban community of color to inform the movement toward a public health approach to gun violence prevention. The Community Alliance for Research and Engagement at Yale School of Public Health conducted community health needs assessments to document chronic disease prevalence and risk, including exposure to gun violence. We conducted surveys with residents in six low-income neighborhoods in New Haven, Connecticut, using a neighborhood-stratified, population-based sample (n = 1189; weighted sample to represent the neighborhoods, n = 29 675).

Population Well-Being Measures Help Explain Geographic Disparities In Life Expectancy At The County Level.

Geographic disparities in life expectancy are substantial and not fully explained by differences in race and socioeconomic status. To develop policies that address these inequalities, it is essential to identify other factors that account for this variation. In this study we investigated whether population well-being-a comprehensive measure of physical, mental, and social health-helps explain geographic variation in life expectancy.

Multilocus sequence analysis reveals high genetic diversity in clinical isolates of Burkholderia cepacia complex from India.

Burkholderia cepacia complex (Bcc) is a complex group of bacteria causing opportunistic infections in immunocompromised and cystic fibrosis (CF) patients. Herein, we report multilocus sequence typing and analysis of the 57 clinical isolates of Bcc collected over the period of seven years (2005-2012) from several hospitals across India. A total of 21 sequence types (ST) including two STs from cystic fibrosis patient's isolates and twelve novel STs were identified in the population reflecting the extent of genetic diversity.

Incidence, characteristics and outcome of ICU-acquired candidemia in India.

Purpose: A systematic epidemiological study on intensive care unit (ICU)-acquired candidemia across India.

Method: A prospective, nationwide, multicentric, observational study was conducted at 27 Indian ICUs. Consecutive patients who acquired candidemia after ICU admission were enrolled during April 2011 through September 2012.

PCT as a Prognostic Marker in Cardiac Patients with Neutropenic Sepsis: Two Case Reports.

Procalcitonin (PCT) is an innovative and highly specific marker for diagnosis of clinically relevant bacterial infection and sepsis. PCT supports early diagnosis and Clinical decision making. A retrospective study of two classical cases of neutropenic sepsis with elevated PCT levels in cardiac ICU was done.

Eruptive squamous cell carcinomas after vemurafenib therapy.

Background: Vemurafenib is an oral BRAF inhibitor recently approved for the treatment of metastatic melanoma. Patients treated with this medication have been reported to have the occurrence of squamous cell carcinoma (SCC) and/or actinic keratosis (AK).

Objective: We report the case of a patient treated with vemurafenib for papillary thyroid carcinoma who subsequently developed multiple SCCs and AK of the skin.

Spontaneous biliary peritonitis in children.

Pediatric Spontaneous Bile duct perforation is a rare clinical condition with only around 150 cases reported worldwide. Early management gives excellent prognosis but the condition often presents a diagnostic dilemma. Hepato-biliary Technetium-99m-iminodiacetic acid scintiscan is the diagnostic investigation of choice but its availability in third world countries is limited.

Cervical dysgenesis with transverse vaginal septum with imperforate hymen in an 11 year old girl presenting with acute abdomen.

This case highlights the importance of careful evaluation of girls presenting with imperforate hymen as this is accompanied by other female reproductive tract anomalies. It is of utmost importance that a correct timely diagnosis is made so that the right treatment can be chosen with the perspective of future fertility. Cervical dysgenesis associated with vaginal septum and imperforate hymen has not been reported in literature so far.

Postnatally acquired dengue in a neonate--a case report.

Dengue was earlier a disease of children. But with increasing incidence in adults, dengue is increasingly encountered in infants and sometimes in neonates. The usual mode of transmission in neonates is vertical.