Association of Observation Stays with Clinical Outcomes and Costs in Medicare: An Instrumental Variable Analysis.

Background: Observation stays in Medicare have grown over the last 15 years, yet limited research exists on how observation may impact outcomes for older adults.

Objective: To examine the relationship of an observation stay with 30-day hospital returns, total acute care days post-discharge, mortality, and out-of-pocket costs, compared to an inpatient admission.

Design: Retrospective cohort study using instrumental variable analysis.

Thrombotic thrombocytopenic purpura in a patient with adult-onset Still's disease: report of a rare entity.

Adult-onset Still's disease (AOSD) is a rare, systemic inflammatory disorder characterised by daily fever, arthritis, a salmon-pink rash and leucocytosis. Thrombotic thrombocytopenic purpura (TTP) is included in the class of thrombotic microangiopathies and manifests clinically as microangiopathic haemolytic anaemia (MAHA), thrombocytopenia and ischaemic tissue injury secondary to microthrombi. TTP is caused by either an autoimmune, congenital or idiopathic deficiency of ADAMTS13 and carries a high mortality rate.

Median Arcuate Ligament Syndrome: Where Are We Today?

Median arcuate ligament syndrome, or celiac artery compression syndrome (eponym: Dunbar syndrome), has historically been attributed to pathophysiologic vascular compression causing downstream ischemic symptoms of the organs supplied by the celiac trunk. However, the more we learn about the histology, clinical presentation, and treatment outcomes, health care providers are increasingly correlating the symptoms of MALS with the long-term, repetitive compression of the celiac ganglion rather than the celiac trunk. This article provides a comprehensive review of current MALS literature, emphasizing the multidisciplinary approach these patients require in all phases of their care.

THE ROLE OF HEALTH POLICY IN IMPROVING HEALTH OUTCOMES AND HEALTH EQUITY.

Despite higher per-capita health care spending than any other country, the United States lags far behind in health outcomes. Additionally, there are significant health inequities by race, ethnicity, socioeconomic position, and rurality. One set of potential solutions to improve these outcomes and reduce inequities is through health policy.

Electronic Health Record Usability When Caring for Children With Medical Complexity.

Objectives: To evaluate usability of and clinician satisfaction with the electronic health record (EHR) in the context of caring for children with medical complexity (CMC) at a large academic pediatric hospital and to identify key areas for targeted improvements.

Methods: Cross-sectional study of pediatric faculty and advanced practice providers across several pediatric specialties using an online Research Electronic Data Capture survey. EHR usability was measured with 6 validated questions from the National Usability-Focused Health Information System Scale, and satisfaction with common EHR functionalities was measured with 6 original Likert-scale questions and 3 free-text questions.

Stevens-Johnson Syndrome From Combined Allopurinol and Angiotensin-Converting Enzyme Inhibitors: A Narrative Review.

Stevens-Johnson syndrome (SJS) is a severe and potentially debilitating skin reaction frequently related to medication use. Allopurinol and angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed medications for prevalent health conditions worldwide, and their interaction associated with SJS warrants further investigation. A comprehensive literature search was performed to investigate cases as studies related to SJS occurring in patients with concomitant use of allopurinol and ACE inhibitors.

Building clinician-parent partnerships to improve care for chronically critically Ill children: A pilot project.

Objective: Multicenter pilot to assess feasibility, acceptability, and educational value of videos for families and clinicians regarding unique inpatient challenges of pediatric chronic critical illness.

Methods: Videos were developed for 3 hospitalization timepoints: 1) chronic critical illness diagnosis, 2) transfers, 3) discharge. Parents of hospitalized children, and interdisciplinary clinicians, were recruited to watch videos and complete surveys.

Teprotumumab-trbw as a Novel Monoclonal Antibody for Thyroid Eye Disease: A Literature Review.

Thyroid eye disease (TED) can cause disfigurement and vision loss, most commonly in patients with Graves' disease. These symptoms are related to orbital inflammation subsequently cause proptosis and limited eye movement. Traditionally, TED is treated with corticosteroids to decrease inflammation and surgery once the disease stabilizes.

Variation in the Use of Targeted Temperature Management for Cardiac Arrest.

Targeted temperature management (TTM) is recommended for patients who do not respond after return of spontaneous circulation after cardiac arrest. However, the degree to which patients with cardiac arrest have access to this therapy on a national level is not known. Understanding hospital- and patient-level factors associated with receipt of TTM could inform interventions to improve access to this treatment among appropriate patients.

All human social groups are human, but some are more human than others: A comprehensive investigation of the implicit association of "Human" to US racial/ethnic groups.

All human groups are equally human, but are they automatically represented as such? Harnessing data from 61,377 participants across 13 experiments (six primary and seven supplemental), a sharp dissociation between implicit and explicit measures emerged. Despite explicitly affirming the equal humanity of all racial/ethnic groups, White participants consistently associated Human (relative to Animal) more with White than Black, Hispanic, and Asian groups on Implicit Association Tests (IATs; experiments 1-4). This effect emerged across diverse representations of Animal that varied in valence (, , , and ; experiments 1-2).

Gender Affirming Graft Only Vaginoplasty.

Objective: To describe our technique for performing gender affirming graft only vaginoplasty.

Methods: In graft only vaginoplasty, penile skin is used only for the external genitals, and the entire vaginal canal is created from a full thickness skin graft. The inner scrotum is excised and used as a skin graft to line the vaginal canal.

Pharmacy Intern Involvement in COVID-19 Immunization Practices in New York State.

Pharmacists and pharmacy interns were instrumental in vaccination efforts during the COVID-19 pandemic. Objectives: To identify pharmacy intern involvement in COVID-19 immunization practices in New York State (NYS) and explore interns' perceptions of experiences. A 34-item survey was developed and administered at 5 pharmacy programs in NYS.

Exit Rates of Accountable Care Organizations That Serve High Proportions of Beneficiaries of Racial and Ethnic Minority Groups.

Importance: The Medicare Shared Savings Program provides financial incentives for accountable care organizations (ACOs) to reduce costs of care. The structure of the shared savings program may not adequately adjust for challenges associated with caring for patients with high medical complexity and social needs, a population disproportionately made up of racial and ethnic minority groups. If so, ACOs serving racial and ethnic minority groups may be more likely to exit the program, raising concerns about the equitable distribution of potential benefits from health care delivery reform efforts.

Effects of the electronic health record on job satisfaction of academic pediatric faculty.

Objective(s): To evaluate the association of Electronic Health Record (EHR) skills and available support with job satisfaction for pediatric faculty at an academic institution. To identify key opportunities for improvement.

Study Design: Cross-sectional study of pediatric academic faculty physicians using a REDCap survey to inquire about faculty EHR skills, support services, and associations between EHR workflow and job satisfaction.

The Pandemic as a Portal: Reimagining Psychological Science as Truly Open and Inclusive.

Psychological science is at an inflection point: The COVID-19 pandemic has exacerbated inequalities that stem from our historically closed and exclusive culture. Meanwhile, reform efforts to change the future of our science are too narrow in focus to fully succeed. In this article, we call on psychological scientists-focusing specifically on those who use quantitative methods in the United States as one context for such conversations-to begin reimagining our discipline as fundamentally open and inclusive.

Adjusting Quality Measures For Social Risk Factors Can Promote Equity In Health Care.

Risk adjustment of quality measures using clinical risk factors is widely accepted; risk adjustment using social risk factors remains controversial. We argue here that social risk adjustment is appropriate and necessary in defined circumstances and that social risk adjustment should be the default option when there are valid empirical arguments for and against adjustment for a given measure. Social risk adjustment is an important way to avoid exacerbating inequity in the health care system.

The association between state-level abortion restrictions and maternal mortality in the United States, 1995-2017.

Objective: To explore the relationship between abortion restrictions and maternal mortality in the United States.

Study Design: This was a retrospective study examining maternal mortality in the United States from 1995 to 2017. We used the Global Health Data Exchange and the Centers for Disease Control and Prevention WONDER databases to extract maternal mortality data for all 50 states for each year from 1995 to 2017.

Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016.

Background: In 2015, there were approximately 40,000 new HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) is an effective strategy that reduces the risk of HIV acquisition; however, uptake among those who can benefit from it has lagged. In this study, we 1) compared the characteristics of patients who were prescribed PrEP with individuals newly diagnosed with HIV infection, 2) identified the specialties of practitioners prescribing PrEP, 3) identified metropolitan statistical areas (MSAs) within the US where there is relatively low uptake of PrEP, and 4) reported median amounts paid by patients and third-party payors for PrEP.

Maximizing Effectiveness of the Holistic Admission Process: Implementing the Multiple Mini Interview Model.

Background: Nursing programs have responsibility to become more holistic in admission practices, ensuring they admit applicants based on more than grades and test scores to determine the best fit for their program.

Problem: One frequently cited holistic admissions barrier is incorporating qualitative measurement of applicant characteristics through interviews. Finding the best interview model is a challenge, depending on a program's intent to learn about applicants.

Potential impact of data source and interoperability messaging on health information technology (HIT) users: a study series from the United States Department of Veterans Affairs.

Background: The promise of Health Information Exchange (HIE) systems rests in their potential to provide clinicians and administrative staff rapid access to relevant patient data to support judgement and decision-making. However, HIE systems can have usability and technical issues, as well as fail to support user workflow.

Objective: Share the findings from a series of studies that address HIE system deficiencies for an Electronic Health Record (EHR) viewer which accesses multiple data sources.

A Survey of Interventional Cardiologists' Attitudes and Beliefs About Public Reporting of Percutaneous Coronary Intervention.

Importance: Public reporting of procedural outcomes has been associated with lower rates of percutaneous coronary intervention (PCI) and worse outcomes after myocardial infarction. Contemporary data are limited on the influence of public reporting on interventional cardiologists' clinical decision making.

Objective: To survey a contemporary cohort of interventional cardiologists in Massachusetts and New York about how public reporting of PCI outcomes influences clinical decision making.