Minnesota Hospitals' Plans for Implementing Statewide Guidance on Allocation of Scarce Critical Care Resources During the COVID-19 Pandemic.

Objectives: To assess hospitals' plans for implementing Minnesota's statewide guidance for allocating scarce critical care resources during the COVID-19 pandemic.

Patients And Methods: Individuals from 23 hospitals across Minnesota were invited to complete a 25-item survey between July 20, 2020, and September 18, 2020 to understand how hospitals in the state intended to operationalize statewide clinical triage instructions for scarce resources (including mechanical ventilation) and written ethics guidance on the allocation of critical care resources in the event crisis standards of care triggered triage.

Results: Of individuals invited from 23 hospitals, 14 hospitals completed the survey (60.

The Minnesota Critical Care Working Group 1: Monitoring and coordinating statewide critical care surge response in the COVID-19 pandemic, March 2020 through July 1, 2021.

Background: In response to the COVID-19 pandemic and as part of the statewide healthcare coalition response the Minnesota Critical Care Working Group (CCWG), composed of Interprofessional leaders from the state's nine largest health systems was established and entrusted to plan and coordinate critical care support for Minnesota from March 2020 through July1, 2021.

Research Question: Can a statewide Critical Care Working Group develop contingency and crisis level surge strategies and indicators in response to the COVID-19 pandemic while evolving into a highly collaborative team?

Study Design And Methods: CCWG members (Intensivists, ethicists, nurses, MDH and MHA leaders) met by audio video conferencing as often as daily assessing COVID and non-COVID hospitalization data, developed surge indicators reflecting contingency versus crisis conditions, and planned responses collaboratively. A foundation of collaboration and teamwork developed which facilitated an effective statewide response.

The Minnesota Critical Care Working Group 2: Crisis conditions during the COVID-19 Pandemic, July 2021 through March 2022.

Background: At the request of the Statewide Healthcare Coordination Center, the Minnesota Critical Care Working Group (CCWG) and ethics subgroup (EWG), composed of interprofessional leaders from Minnesota's nine largest health systems were asked to plan and coordinate critical care operations during the COVID-19 pandemic, including the 2021 Fall surge.

Research Question: Can a statewide Working Group collaboratively analyze real time evidence to identify crisis conditions and engage state leadership to implement care processes?

Study Design And Methods: CCWG/EWG met via video conferencing during the Fall 2021 severe surge to analyze evidence and plan for potential crisis care conditions. Five sources of evidence informed their actions including group consensus on operating conditions; Federal Tele-Tracking data; MOCC patient placement data; and two surveys created and distributed to hospitals and healthcare professionals.

A 62-Year-Old Woman With Cough, Dyspnea, and Diffuse Lung Nodules.

A 62-year-old woman came to our hospital with worsening cough and dyspnea over the preceding week, during which time she had been treated with azithromycin and prednisone for suspected pneumonia. She had no fever, chills, or sweats, but her cough had become productive of clear to blood-tinged phlegm during the interval. Medical history was significant for insulin-dependent diabetes mellitus and OSA.

Decision-Making for Hospitalized Incarcerated Patients Lacking Decisional Capacity.

Importance: Incarcerated patients admitted to the hospital face threats to their rights to privacy and self-determination in medical decision-making. Little is known about medical decision-making processes for hospitalized incarcerated persons who lack decisional capacity.

Objective: To characterize the prevalence of incapacity among hospitalized incarcerated patients and describe the decision-making processes, including who served as surrogate decision-makers, involvement of prison employees in medical decisions, and ethical concerns emerging from the patients' care.

The Faces of Financial Toxicity: A Qualitative Interview Study of Financial Toxicity in Advanced Cancer Patients in Phase I Oncology Trials.

Objective: To characterize the financial toxicity experienced by advanced cancer patients enrolled in phase I oncology trials.

Patients And Methods: We conducted structured interviews with cancer patients participating in phase I clinical trials. Using a thematic analysis approach, we identified recurring themes in patients' experiences of financial toxicity resulting from trial participation.

Triage Procedures for Critical Care Resource Allocation During Scarcity.

Importance: During the COVID-19 pandemic, many US states issued or revised pandemic preparedness plans guiding allocation of critical care resources during crises. State plans vary in the factors used to triage patients and have faced criticism from advocacy groups due to the potential for discrimination.

Objective: To analyze the role of comorbidities and long-term prognosis in state triage procedures.

Academic Physician Specialists' Approaches to Counseling Patients Interested in Unproven Stem Cell and Regenerative Therapies-A Qualitative Analysis.

Objective: To explore the experiences, approaches, and challenges of physicians consulting patients about experimental stem cell and regenerative medicine interventions (SCRIs).

Participants And Methods: From August 21, 2018, through July 30, 2019, semistructured interviews of 25 specialists in cardiology, ophthalmology, orthopedics, pulmonology, and neurology were conducted and qualitatively analyzed using modified grounded theory.

Results: All specialists used informational approaches to counsel patients, especially orthopedists.

Liver transplantation for acute liver failure in a SARS-CoV-2 PCR-positive patient.

Current guidelines recommend deferring liver transplantation (LT) in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection until clinical improvement occurs and two PCR tests collected at least 24 hours apart are negative. We report a case of an 18-year-old, previously healthy African-American woman diagnosed with COVID-19, who presents with acute liver failure (ALF) requiring urgent LT in the context of SARS-CoV-2 polymerase chain reaction (PCR) positivity. The patient was thought to have acute Wilsonian crisis on the basis of hemolytic anemia, alkaline phosphatase:bilirubin ratio <4, AST:ALT ratio >2.

Academic physician specialists' views toward the unproven stem cell intervention industry: areas of common ground and divergence.

Background And Aims: Premature commercialization of unproven stem cell interventions (SCIs) has received significant attention within the regenerative medicine community. Patients considering SCIs may encounter misinformation and seek out guidance from their physicians who are trusted brokers of health information. However, little is known about the perspectives of academic physician specialists toward the SCI industry.

Statutes Governing Default Surrogate Decision Making for Mental Health Treatment.

Objective: The authors sought to describe state-to-state variations in the scope of statutory authority granted to default surrogates who decide on mental health treatment for incapacitated patients.

Methods: The authors investigated state statutes delineating the powers of default surrogates to make decisions about mental health treatment. Statutes in all 50 U.