Objective:To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.Methods:We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We a

/pdf/guidelines-for-family-centered-care-in-the-neonatal-3kja37jlgs.pdf

Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU.

Literacy has recently emerged as a key item on the research agenda in medicine and public health. Researchers and practitioners are grappling with evidence that the reading ability of the average adult falls well below the reading level of educational materials, directives, forms, and informed-consent documents commonly used in the health field. The threats to effective communication and efficacious care have spurred interest in exploring strategies for more effective communication. In addition, increased attention to literacy may be driven by legal concerns for adequate protection of human subjects and ethical concerns for patient autonomy in informed-consent procedures. Methodological strides made since 1992, particularly in the form of new tools for rapid literacy measurement, have enabled a number of researchers to explore links between the literacy level of patients and health outcomes that will have critical policy implications. These investigations can best be undertaken through collaborative efforts between educators who understand the learning process and health professionals who understand the protocols used in health care and public health education. Findings will serve to enrich policy and practice.

https://files.eric.ed.gov/fulltext/ED508707.pdf

Health and Literacy: A Review of Medical and Public Health Literature

Emergency medicine is largely a communicative activity, and medical mishaps that occur in this context are too often the result of vulnerable communication processes. In this year-long qualitative study of two academic emergency departments, an interdisciplinary research team identified four such processes: triage, testing and evaluation, handoffs, and admitting. In each case, we found that narrative rationality (the patient's story) was consistently subjugated to technical rationality (actionable lists). Process changes are proposed to encourage caregivers to either reconsider their course of action or request additional contextual information. A heightened awareness of the bias for technical over narrative rationality and a better recognition of uncertainty in emergency medicine communication are important first steps toward anticipating potential failures and ensuring patient safety.

Communication in emergency medicine: Implications for patient safety

This study presents a literature review of 107 papers on lean healthcare to evaluate its evolution by updating previous literature reviews and to propose a classification and analysis of the papers reviewed. The literature classification was performed based on six parameters: research method, country, healthcare area, implementation, lean tools and methods and results. From the analysis performed, this paper presents a quantitative analysis of the state of the art concerning lean healthcare and indicates current research trends, based on the stage of evolution of the area, that may guide further studies on the subject. An example is lean healthcare expansion to other countries, such as Brazil and the Netherlands. Another aspect is the application of lean healthcare in hospital as a whole, not limited to a specific setting. Finally, a few studies detail the lean implementation process and use infrequently applied tools, present the barriers and main critical factors found in the lean implementation.

Lean healthcare: review, classification and analysis of literature

Emergency departments (EDs) are high pressure health care settings involving complex interactions between staff members in providing and organising patient care Without good communication and cooperation amongst members of the ED team, quality of care is at risk This study examined the problem-solving, medication advice-seeking and socialising networks of staff working in an Australian hospital ED A social network survey (Response Rate = 94%) was administered to all ED staff (n = 109) including doctors, nurses, allied health professionals, administrative staff and ward assistants Analysis of the network characteristics was carried out by applying measures of density (the extent participants are concentrated), connectedness (how related they are), isolates (how segregated), degree centrality (who has most connections measured in two ways, in-degree, the number of ties directed to an individual and out-degree, the number of ties directed from an individual), betweenness centrality (who is important or powerful), degree of separation (how many ties lie between people) and reciprocity (how bi-directional are interactions) In all three networks, individuals were more closely connected to colleagues from within their respective professional groups The problem-solving network was the most densely connected network, followed by the medication advice network, and the loosely connected socialising network ED staff relied on each other for help to solve work-related problems, but some senior doctors, some junior doctors and a senior nurse were important sources of medication advice for their ED colleagues Network analyses provide useful ways to assess social structures in clinical settings by allowing us to understand how ED staff relate within their social and professional structures This can provide insights of potential benefit to ED staff, their leaders, policymakers and researchers

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Understanding communication networks in the emergency department

The Emergency Department

Some individuals do not return to baseline health following SARS-CoV-2 infection, leading to a condition known as long COVID. The underlying pathophysiology of long COVID remains unknown. Given that autoantibodies have been found to play a role in severity of SARS-CoV-2 infection and certain other post-COVID sequelae, their potential role in long COVID is important to investigate. Here, we apply a well-established, unbiased, proteome-wide autoantibody detection technology (T7 phage-display assay with immunoprecipitation and next-generation sequencing, PhIP-Seq) to a robustly phenotyped cohort of 121 individuals with long COVID, 64 individuals with prior COVID-19 who reported full recovery, and 57 pre-COVID controls. While a distinct autoreactive signature was detected that separated individuals with prior SARS-CoV-2 infection from those never exposed to SARS-CoV-2, we did not detect patterns of autoreactivity that separated individuals with long COVID from individuals fully recovered from COVID-19. These data suggest that there are robust alterations in autoreactive antibody profiles due to infection; however, no association of autoreactive antibodies and long COVID was apparent by this assay.

/pdf/autoantigen-profiling-reveals-a-shared-post-covid-signature-1nb3we3b.pdf

Autoantigen profiling reveals a shared post-COVID signature in fully recovered and long COVID patients.

Background. COVID-19 oral treatments require initiation within 5 days of symptom onset. Although antigen tests are less sensitive than RT-PCR, rapid results could facilitate entry to treatment. As SARS-CoV-2 variants and host immunity evolve, it is important to characterize the use case for rapid antigen tests for treatment entry. Methods. We collected anterior nasal swabs for BinaxNOW and RT-PCR testing and clinical data at a walk-up, community site in San Francisco, California between January and June 2022. SARS-CoV-2 genomic sequences were generated from positive samples and classified according to subtype and variant. Monte Carlo simulations were conducted to estimate the expected proportion of SARS-CoV-2 infected persons who would have been diagnosed within 5 days of symptom onset using RT-PCR versus BinaxNOW testing. Results. Among 25,309 persons tested with BinaxNOW, 2,952 had concomitant RT-PCR. 1321/2952 (44.7%) were SARS-CoV-2 RT-PCR positive. We identified waves of predominant omicron BA.1, BA.2, BA.2.12, BA.4, and BA.5 among 720 sequenced samples. Among 1,321 RT-PCR positive samples, 938/1321 (71%) were detected by BinaxNOW; 95% (774/817) of those with Ct value <30 were detected by BinaxNOW. BinaxNOW detection was consistent over lineages. In analyses to evaluate entry to treatment, BinaxNOW detected 82.7% (410/496, 95% CI: 79-86%) of persons with COVID-19 within 5 days of symptom onset. In comparison, RT-PCR (24-hour turnaround) detected 83.1% (412/496 95% CI: 79-86%) and RT-PCR (48-hour turnaround) detected 66.3% (329/496 95% CI: 62-70%) of persons with COVID-19 within 5 days of symptom onset. Conclusions. BinaxNOW detected high viral load from anterior nasal swabs consistently across omicron sublineages emerging between January and June of 2022. Simulations support BinaxNOW as an entry point for COVID-19 treatment in a community field setting.

Field assessment of BinaxNOW antigen tests as COVID-19 treatment entry point at a community testing site in San Francisco during evolving omicron surges

Aditi Saxena

Papers

The Emergency Department

Autoantigen profiling reveals a shared post-COVID signature in fully recovered and long COVID patients.

Field assessment of BinaxNOW antigen tests as COVID-19 treatment entry point at a community testing site in San Francisco during evolving omicron surges