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BackgroundThere is growing interest in global health participation among emergency care doctors in the UK. The aim of this paper was to describe the demographics of members and fellows of the Royal College of Emergency Medicine involved in global health, the work they are involved in, as well as the benefits and barriers of this work.MethodsWe conducted a survey to include members and fellows of the Royal College of Emergency Medicine describing the context of their global health work, funding arrangements for global health work and perceived barriers to, and benefits of, global health work.ResultsThe survey collected 1134 responses of which 439 (38.7%) were excluded. The analysis was performed with the remaining 695 (61.3%) responses. Global health involvement concentrated around South Asia and Africa. Work contexts were mainly direct clinical service (267, 38%), curriculum development (203, 29%) and teaching short courses (198, 28%). Activity was largely self-funded, both international (539, 78%) and from UK (516, 74%). Global health work was not reported to contribute to appraisal by many participants (294, 42.3%). Funding (443, 64%) and protected time (431, 62%) were reported as key barriers to global health productivity.DiscussionParticipants largely targeted specialty development and educational activities. Lack of training, funding and supported time were identified as barriers to development. Galvanising support for global health through regional networks and College support for attracting funding and job plan recognition will help UK-based emergency care clinicians contribute more productively to this field.

Hypoxemia is used to stratify severity in acute respiratory failure (ARF) but is less useful in cyanotic congenital heart disease (CCHD) due to an inability to differentiate hypoxemia from lung injury versus cardiac shunting. Therefore, we aimed to determine whether variables related to respiratory mechanics were associated with outcomes to assist in stratifying ARF severity in pediatric CCHD. We performed a retrospective cohort study from a single cardiac intensive care unit enrolling children with CCHD with ARF requiring mechanical ventilation between 2011 and 2019. Time-averaged ventilator settings and oxygenation data in the first 24 h of ARF were screened for association with the primary outcome of 28-day mortality. Of 344 eligible patients, peak inspiratory pressure (PIP) and driving pressure (Δ P ) were selected as candidate variables to stratify ARF severity. PIP (OR 1.10, 95% CI 1.02–1.19) and Δ P (1.11, 95% CI 1.01–1.24) were associated with higher mortality and fewer ventilator-free days (VFDs) at 28 days after adjusting for age, severity of cardiac history, and FiO 2 . A three-level (mild, moderate, severe) severity stratification was established for both PIP (≤ 20, 21–29, ≥ 30) and Δ P (≤ 16, 17–24, ≥ 25), showing increasing mortality (both P  < 0.01), decreasing VFDs and increasing ventilator days in survivors (all P  < 0.05) across increasing pressures. Overall, we found that higher PIP and Δ P were associated with mortality and duration of ventilation across a three-level severity stratification system in pediatric CCHD with ARF, providing a practical method to prognosticate in subjects with multifactorial etiologies for hypoxemia.

Interprofessional teams in the pediatric cardiac ICU consolidate their management plans in pre-family meeting huddles, a process that affects the course of family meetings but often lacks optimal communication and teamwork. Cardiac ICU clinicians participated in an interprofessional intervention to improve how they prepared for and conducted family meetings. We conducted a pretest-posttest study with clinicians participating in huddles before family meetings. We assessed feasibility of clinician enrollment, assessed clinician perception of acceptability of the intervention via questionnaire and semi-structured interviews, and impact on team performance using a validated tool. Wilcoxon rank sum test assessed intervention impact on team performance at meeting level comparing pre- and post-intervention data. Totally, 24 clinicians enrolled in the intervention (92% retention) with 100% completion of training. All participants recommend cardiac ICU eams nd oved ones ommunicating to others and 96% believe it improved their participation in family meetings. We exceeded an acceptable level of protocol fidelity (>75%). Team performance was significantly (p < 0.001) higher in post-intervention huddles (n = 30) than in pre-intervention (n = 28) in all domains. Median comparisons: Team structure [2 vs. 5], Leadership [3 vs. 5], Situation Monitoring [3 vs. 5], Mutual Support [ 3 vs. 5], and Communication [3 vs. 5]. Implementing an interprofessional team intervention to improve team performance in pre-family meeting huddles is feasible, acceptable, and improves team function. Future research should further assess impact on clinicians, patients, and families.

ObjectiveThe Medical Maximizer-Minimizer Scale (MMS) assesses patient preferences for active vs. passive approaches to healthcare and predicts healthcare utilization and patient preferences in a variety of healthcare contexts. In two surveys, our objective was to determine the utility of the MMS for predicting patient preferences for both high and low-benefit care, the acceptability of recommendations related to low-benefit care, and patient satisfaction with their physician.MethodsWe conducted two online U.S. surveys, totaling 1,576 men and women age 18–84 (M=34; 52, both samples were majority White). The MMS was associated with the following outcomes: In Survey 1, participants indicated their medical preferences in 18 health scenarios that were constructed using medical expertise and Choosing Wisely®recommendations. In 8 scenarios the optimal approach was active intervention (e.g., colonoscopy at age 60) and in 10 scenarios an active intervention was notoptimal (e.g., full body CT scan in an asymptomatic healthy person). In Survey 2, participants indicated (1) whether they think too much medicine is a problem, (2) the acceptability of recommendations to take a less aggressive approach to imaging for low back pain and colorectal cancer screening in older adults, (3) their satisfaction with their primary physician, and (4) their perception of whether their physician is a minimizer or maximizer.ResultsIn Survey 1, MMS scores were significantly correlated with medical preferences in 16/18 scenarios (rs=.16-.39, ps≤.001). Maximizers were more likely than minimizers to want to receive active medical intervention across the 8 scenarios in which action was appropriate (r=.35, p<.001) and across the 10 scenarios for which action was inappropriate (r=-.57, p<.001). In Survey 2, maximizers were less likely than minimizers to believe that too much medicine is a problem (r=-.37, p<.001), and were less likely to believe recommendations about back imagining and colorectal cancer screening are acceptable (rs=-.34, -.36 respectively, both ps<.001). Maximizers were slightly more satisfied with their primary physician than minimizers (r=.10, p=.007) but the perceived agreement between one’s own MMS score and one’s physician’s maximizing-minimizing orientation was more strongly predictive of patient satisfaction (r=-.27, p<.001).ConclusionsRelative to minimizers, maximizers are more likely to prefer both high-benefit and low-benefit care and are more likely to believe that recommendations to take a less aggressive approach to testing are unacceptable. Maximizers may therefore be at risk for overutilizing low-value care (while minimizers may be at risk of underutilization). As a result, the MMS may be useful for targeting interventions to encourage appropriate use. The perceived match between patients’ and physicians’ maximizing-minimizing orientation may also have implications for patient satisfaction and shared decision making.

Meaningful connections between disciplines and discourses, human values and environmental issues, and the role and relationship of art to ecological concerns describe Eco-tistical Art, a daylong series of events and conversations that took place during the 2005 Annual Conference of the College Art Association. The event was organized by author and environmentalist Linda Weintraub, who applied the principles of ecosystems to the format of the initiative. The typical convention format of discrete papers and panels was exchanged for the alchemy of multiple voices and positions with planned and fortuitous exchanges. Gathered here in Art Journal is a series of \"field reports\"-texts by respondents to artists' projects and presentations, background information on historical and contemporary environmental resources, and images of selected artists' projects. This collection of speculations and observations poses significant questions about the practices of art in a world poised, as the artist Beaumont suggests, between the vestiges of an industrial revolution and emergent ideas of sustainability. With Linda Weintraub and the other participants in the forum, we extend our thanks to Creative Capital for its generous support of this initiative.

Lois Dean didn't have big plans for New Year's Day, but her unborn child did: He made his debut 10 days early to become the first baby born in Citrus County in 1991. Miss Dean, who lives in St. Petersburg, was spending the holidays with her boyfriend's mother in Citrus County when she went into labor Monday evening. \"It didn't take too long,\" she said. \"He wanted out.\"

State workers took shorter lunch breaks and worked overtime Wednesday to get food stamps into the hands of thousands of Floridians left frustrated and angry earlier this week when the welfare system's new $104-million computer crashed. The computer, which serves much of Florida's welfare services, crashed Tuesday after fading in and out Monday, disrupting work, said Beverly Finn, operational program administrator for economic services with the state Department of Health and Rehabilitative Services (HRS) in St. Petersburg. Wednesday morning, doors to HRS offices around the Tampa Bay area opened early, some to large crowds. HRS employees handed out benefits to people and and began adding new recipients to the list.

The victims suffered \"a multitude of types of causes of death,\" including being beaten and shot, sometime between late afternoon and 11 p.m., Sheriff Charles Dean said Saturday. He described the killings as \"brutal\" and \"execution style.\" \"He's a damned good carpenter,\" Schumann said. \"That's all he's ever done since he's been out of high school.\" A neighbor drove Schumann to Leesburg on Sunday to identify Wilson's body. \"I was really shaky,\" Schumann said. \"I didn't want to go, but there was no one else.\"