Comparison of Referral Rates and Costs Using Fibrosis-4 and Enhanced Liver Fibrosis (ELF) Testing Strategies for Initial Evaluation of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in a Veteran Population.

Background: Global metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence is estimated at 30% and projected to reach 55.7% by 2040. In the Veterans Affairs (VA) healthcare system, an estimated 1.

A deep learning approach for predicting severity of COVID-19 patients using a parsimonious set of laboratory markers.

The SARS-CoV-2 virus has caused tremendous healthcare burden worldwide. Our focus was to develop a practical and easy-to-deploy system to predict the severe manifestation of disease in patients with COVID-19 with an aim to assist clinicians in triage and treatment decisions. Our proposed predictive algorithm is a trained artificial intelligence-based network using 8,427 COVID-19 patient records from four healthcare systems.

Cost-effectiveness of three different strategies for the treatment of first recurrent Clostridium difficile infection diagnosed in a community setting.

Objective: A significant portion of patients with Clostridium difficile infections (CDI) experience recurrence, and there is little consensus on its treatment. With the availability of newer agents for CDI and the added burdens of recurrent disease, a cost-effectiveness analysis may provide insight on the most efficient use of resources.

Design: A decision-tree analysis was created to compare the cost-effectiveness of 3 possible treatments for patients with first CDI recurrence: oral vancomycin, fidaxomicin, or bezlotoxumab plus vancomycin.

Rapid Diagnosis of Infection in the Critically Ill, a Multicenter Study of Molecular Detection in Bloodstream Infections, Pneumonia, and Sterile Site Infections.

Objective: Early identification of causative microorganism(s) in patients with severe infection is crucial to optimize antimicrobial use and patient survival. However, current culture-based pathogen identification is slow and unreliable such that broad-spectrum antibiotics are often used to insure coverage of all potential organisms, carrying risks of overtreatment, toxicity, and selection of multidrug-resistant bacteria. We compared the results obtained using a novel, culture-independent polymerase chain reaction/electrospray ionization-mass spectrometry technology with those obtained by standard microbiological testing and evaluated the potential clinical implications of this technique.

Simulation-based training for emergency medicine residents in sterile technique during central venous catheterization: impact on performance, policy, and outcomes.

Objectives: Central line-associated bloodstream infection (CLABSI) is a preventable nosocomial infection. Simulation-based training in sterile technique during central venous catheter (CVC) placement for emergency medicine (EM) residents, and its effect on changing the medical intensive care unit (MICU) practice of routine replacement of CVCs placed under sterile technique in the emergency department (ED), has not been evaluated.

Methods: Emergency medicine residents received simulation-based sterile technique training during CVC placement between May 2008 and September 2010.

Cost-effectiveness of a FISH assay for the diagnosis of melanoma in the USA.

Objective: The authors evaluated the cost-effectiveness of a FISH assay in melanoma diagnosis in the USA.

Method: A model was developed simulating the addition of FISH to the diagnosis of suspected melanoma. A decision analytic module simulated diagnosis using microscopic assessment alone versus addition of FISH (sensitivity: 92%; specificity: 94%).

Economics of cancer biomarkers.

Cancer accounts for approximately 13% of all deaths worldwide, and in 2010 the estimated total cost of cancer in the USA was more than US$263 billion. Biomarker use for screening, monitoring, diagnosis and treatment optimization has the potential to improve patient outcomes and reduce costs associated with inappropriate (or suboptimal) therapeutic regimens. Since a new technology may have additional initial cost, a policy question arises regarding whether the improvement in outcomes is attained at a 'reasonable' additional cost compared with existing technology.

Cost-effectiveness of a fourth-generation combination immunoassay for human immunodeficiency virus (HIV) antibody and p24 antigen for the detection of HIV infections in the United States.

Purpose: The US Food and Drug Administration recently approved the first 4th-generation HIV test. This study evaluated the cost-effectiveness of the 4th-generation assay versus a 3rd-generation test in screening for HIV infections in the United States.

Methods: An exploratory microsimulation model was developed that follows hypothetical individuals and simulates the course of HIV/AIDS, treatment with highly active antiretroviral therapy, and transmissions.

The economic impact and cost-effectiveness of urinary neutrophil gelatinase-associated lipocalin after cardiac surgery.

Background: Acute kidney injury (AKI) is common after cardiac surgery, and expeditious recognition with specific biomarkers may help improve outcome.

Objective: Because the economic impact of a biomarker-based diagnostic strategy is unknown, we assessed the cost-effectiveness of using urinary neutrophil gelatinase-associated lipocalin (NGAL) for the diagnosis of AKI after cardiac surgery compared with current diagnostic methods.

Methods: A decision analysis model was developed using the societal perspective to evaluate the cost-effectiveness of NGAL.

Association between critical care physician management and patient mortality in the intensive care unit.

Background: Critically ill patients admitted to intensive care units (ICUs) are thought to gain an added survival benefit from management by critical care physicians, but evidence of this benefit is scant.

Objective: To examine the association between hospital mortality in critically ill patients and management by critical care physicians.

Design: Retrospective analysis of a large, prospectively collected database of critically ill patients.

Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit.

Objective: Numerous factors can cause delays in transfer to an intensive care unit for critically ill emergency department patients. The impact of delays is unknown. We aimed to determine the association between emergency department "boarding" (holding admitted patients in the emergency department pending intensive care unit transfer) and outcomes for critically ill patients.

Prioritizing the organization and management of intensive care services in the United States: the PrOMIS Conference.

Objective: Adult critical care services are a large, expensive part of U.S. health care.

Falling towers, crumbling levees, and viral mutations.

Hurricanes Katrina and Rita destroyed an entire beloved city and shattered a large part of the US Gulf Coast. Unlike the destruction of 9/11, it is difficult to say at the time of this writing whether or not this region will ever be fully restored. In light of these and other man-made and natural disasters, the world needs to revisit its approach to disaster planning and preparedness to insure that we can best meet the needs of those likely to be affected by future calamities.

Physician and nurse satisfaction with an Electronic Medical Record system.

Electronic Medical Records (EMRs) are intended to support clinical activity, improve efficiency, and reduce error. Reluctance to use EMRs may exist among clinicians. The purpose of this study was to assess physician and nurse satisfaction with an Emergency Department (ED) EMR.

Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update.

Objective: To provide the American College of Critical Care Medicine with updated guidelines for hemodynamic support of adult patients with sepsis.

Data Source: Publications relevant to hemodynamic support of septic patients were obtained from the medical literature, supplemented by the expertise and experience of members of an international task force convened from the membership of the Society of Critical Care Medicine.

Study Selection: Both human studies and relevant animal studies were considered.