Background: Continuing data on racial bias in pulse oximeters and artificial intelligence has sparked calls for health systems to drive innovation against racial bias in healthcare device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions.
Research Question: How do healthcare purchasing professionals integrate equity concerns into purchasing decision-making?
Study Design And Methods: Between 8/2023-3/2024, we conducted semi-structured interviews via videoconferencing with healthcare purchasing professionals about purchasing processes for pulse oximeters and other devices-and whether and where equity concerns arise in decision-making. An abductive approach was used to analyze perspectives on how equity and disparity concerns are currently integrated into healthcare purchasing decision-making.
Objective: Rapid vital sign assessment, including temperature measurement, is critical among pediatric patients presenting to the emergency department (ED). While error rates in temporal thermometry are well documented, the potential for differential error rates by demographics are not well established. Our objective was to evaluate error rates of temporal thermometers by demographic variables, specifically race and age, among pediatric patients in the ED.
View Article and Find Full Text PDFCHEST Crit Care
September 2024
Background: Most patients discharged after hospitalization for severe pneumonia or acute respiratory failure receive follow-up care from primary care clinicians, yet guidelines are sparse.
Research Question: What do primary care clinicians consider to be ideal follow-up care after hospitalization for severe pneumonia or acute respiratory failure and what do they perceive to be barriers and facilitators to providing ideal follow-up?
Study Design And Methods: We conducted, via videoconferencing, semistructured interviews of 20 primary care clinicians working in diverse settings from five US states and Washington, DC. Participants described postdischarge visits, ongoing follow-up, and referrals for patients recovering from hospitalizations for pneumonia or respiratory failure bad enough to be hospitalized and to require significant oxygen support or seeking treatment at the ICU.
Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform.
View Article and Find Full Text PDFProne positioning for ⩾16 hours in moderate-to-severe acute respiratory distress syndrome (ARDS) improves survival. However, the optimal duration of proning is unknown. To estimate the effect of extended versus standard proning duration on patients with moderate-to-severe coronavirus disease (COVID-19) ARDS.
View Article and Find Full Text PDFPatients with diabetes represent almost 20% of all ICU admissions and might respond differently to high-dose early active mobilization. To assess whether diabetes modified the relationship between the dose of early mobilization on clinical outcomes in the TEAM trial. All TEAM trial patients were included.
View Article and Find Full Text PDFBackground: Pulse oximetry guides clinical decisions, yet does not uniformly identify hypoxemia. We hypothesized that nursing documentation of notifying providers, facilitated by a standardized flowsheet for documenting communication to providers (physicians, nurse practitioners, and physician assistants), may increase when hypoxemia is present, but undetected by the pulse oximeter, in events termed "occult hypoxemia."
Objective: To compare nurse documentation of provider notification in the 4 h preceding cases of occult hypoxemia, normal oxygenation, and evident hypoxemia confirmed by an arterial blood gas reading.
Importance: Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations-that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings.
Objective: To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans.
Purpose: Federal research grants provide support for the indirect costs (IDCs) of research infrastructure that are not specific to particular research projects but are nonetheless essential to enable research. Institutions independently negotiate IDC rates. The authors sought to identify whether inequities exist in negotiated IDC rates between historically Black colleges and universities (HBCUs) and other universities (non-HBCUs).
View Article and Find Full Text PDFAcute respiratory distress syndrome (ARDS) is associated with long-term impairments in brain and muscle function that significantly impact the quality of life of those who survive the acute illness. The mechanisms underlying these impairments are not yet well understood, and evidence-based interventions to minimize the burden on patients remain unproved. The NHLBI of the NIH assembled a workshop in April 2023 to review the state of the science regarding ARDS-associated brain and muscle dysfunction, to identify gaps in current knowledge, and to determine priorities for future investigation.
View Article and Find Full Text PDFObjective: Patients who survive critical illness endure complex physical and mental health conditions, referred to as post-intensive care syndrome (PICS). The University of Michigan's post-intensive cardiac care outpatient long-term outreach (PICCOLO) clinic is designed for patients recently admitted to the coronary care unit (CCU). The long-term goal of this clinic is to understand post-CCU patients' needs and design targeted interventions to reduce their morbidity and mortality post-discharge.
View Article and Find Full Text PDFBackground: Peer support is a promising intervention to mitigate post-ICU disability, however there is a paucity of rigorously designed studies.
Objectives: The objective of this study was to establish feasibility of an in-person, co-designed, peer-support model.
Methods: Prospective, randomised, adaptive, single-centre pilot trial with blinded outcome assessment, conducted at a university-affiliated hospital in Melbourne, Australia.
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