BACKGROUND Pediatric surge planning is critical in the setting of decreasing pediatric inpatient capacity. We describe a statewide assessment of pediatric inpatient bed capacity, clinical care therapies, and subspecialty availability during standard and disaster operations in Massachusetts. METHODS To assess pediatric (<18 years old) inpatient bed capacity during standard operations, we used Massachusetts Department of Public Health data from May 2021. To assess pediatric disaster capacity, therapies, and subspecialty availability in standard and disaster operations, we performed a state-wide survey of Massachusetts hospital emergency management directors from May to August 2021. From the survey, we calculated additional pediatric inpatient bed capacity during a disaster and clinical therapy and subspecialty availability during standard and disaster operations. RESULTS Of 64 Massachusetts acute care hospitals, 58 (91%) completed the survey. Of all licensed inpatient beds in Massachusetts (n = 11 670), 19% (n = 2159) are licensed pediatric beds. During a disaster, 171 pediatric beds could be added. During standard and disaster operations, respiratory therapies were available in 36% (n = 21) and 69% (n = 40) of hospitals, respectively, with high flow nasal cannula being most common. The only surgical subspecialist available in the majority of hospitals (>50%) during standard operations is general surgery (59%, n = 34). In a disaster, only orthopedic surgery could additionally provide services in the majority hospitals (76%; n = 44). CONCLUSIONS Massachusetts pediatric inpatient capacity is limited in a disaster scenario. Respiratory therapies could be available in more than half of hospitals in a disaster, but the majority of hospitals lack surgical subspecialists for children under any circumstance.
Abstract Objective While emergency medicine ( EM ) physicians treat the majority of pediatric EM ( PEM ) patients in the United States, little is known about their PEM experience during training. The primary objective was to characterize the pediatric case exposure and compare to established EM residency training curricula among EM residents across five U.S. residency programs. Methods We performed a multicenter medical record review of all pediatric patients (aged < 18 years) seen by the 2015 graduating resident physicians at five U.S. EM training programs. Resident‐level counts of pediatric patients were measured and specific counts were classified by the 2016 Model of Clinical Practice of Emergency Medicine ( MCP ) and Pediatric Emergency Care Applied Research Network ( PECARN ) diagnostic categories. We assessed variability between residents and between programs. Results A total of 36,845 children were managed by 68 residents across all programs. The median age was 6 years. The median number of patients per resident was 660 with an interquartile range of 336. The most common PECARN diagnostic categories were trauma, gastrointestinal, and respiratory disease. Thirty‐two core MCP diagnoses (43% of MCP list) were not seen by at least 50% of the residents. We found statistically significant variability between programs in both PECARN diagnostic categories (p < 0.01) and MCP diagnoses (p < 0.01). Conclusion There is considerable variation in the number of pediatric patients and the diagnostic case volume seen by EM residents. The relationship between this case variability and competence upon graduation is unknown; further investigation is warranted to better inform program‐specific curricula and to guide training requirements in EM .
Highlights•Increased postprandial GLP-1 triggers higher insulin levels after bariatric surgery•Bariatric surgery does not change enteroendocrine cell identity or hormone content•Increased nutrient flow to the distal gut after surgery enhances GLP-1 secretionSummaryBariatric surgery is widely used to treat obesity and improves type 2 diabetes beyond expectations from the degree of weight loss. Elevated post-prandial concentrations of glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and insulin are widely reported, but the importance of GLP-1 in post-bariatric physiology remains debated. Here, we show that GLP-1 is a major driver of insulin secretion after bariatric surgery, as demonstrated by blocking GLP-1 receptors (GLP1Rs) post-gastrectomy in lean humans using Exendin-9 or in mice using an anti-GLP1R antibody. Transcriptomics and peptidomics analyses revealed that human and mouse enteroendocrine cells were unaltered post-surgery; instead, we found that elevated plasma GLP-1 and PYY correlated with increased nutrient delivery to the distal gut in mice. We conclude that increased GLP-1 secretion after bariatric surgery arises from rapid nutrient delivery to the distal gut and is a key driver of enhanced insulin secretion.Graphical abstract
Abstract Purpose In this descriptive report, we describe a unique trial of pharmacist participation in a multidisciplinary pediatric emergency department disaster simulation exercise. With the number of disasters increasing worldwide, the role of pharmacists in disaster response is of particular interest to the profession. Summary This observational study describes pharmacist participation in a disaster simulation exercise. An evaluation tool was developed to assess participants’ performance in the following domains: communication, pharmacotherapy, problem solving/decision making, and teamwork/organization. The observers used a rating scale of “concise/prompt,” “needs improvement,” or “not done” to evaluate performance on each objective. The participants’ self-perceived knowledge of disaster response was assessed with pre- and postsimulation surveys using Likert scales. Five simulation exercises were held from June to October 2019, with 2 pharmacists participating in each simulation. Within the problem solving/decision making and communication domains, pharmacists were concise/prompt 66% of the time, while they were concise/prompt for 88.8% and 92.5% of tasks in the teamwork/organization and pharmacotherapy domains, respectively. Surveys of self-perceived knowledge revealed that while only 10% of pharmacists felt “moderately prepared” prior to the simulation exercise, 80% of pharmacists felt moderately prepared to care for patients during a disaster event after the simulation exercise. Conclusion This report describes a unique approach of including emergency department–trained pharmacists in disaster simulation exercises to enhance their professional development, improve team dynamics in a mass casualty scenario, and increase their own reported level of preparedness to effectively manage a surge in critically ill pediatric patients.
Mammalian RPRD proteins bind the phosphorylated CTD of RNA pol II with different affinities. Structural elucidation and characterization of their CTD interaction domains reveal the basis of RPRD binding preferences and a role in directing CTD dephosphorylation.
The ASEAN Single Window (ASW) is a digital platform that aims to connect and integrate national single windows across ASEAN. This article examines some of the challenges that would first need to be overcome before this initiative can become a reality.
We aimed to characterize the demographics, diagnoses, and management of transferred patients who were directly discharged from the emergency department (ED) or admitted less than 24 hours.We conducted a retrospective, cross-sectional study of patients classified as interfacility ED transfers over a 12-month period in the Pediatric Health Information System database, an administrative database of 42 tertiary care pediatric US hospitals. The primary study outcomes were ED resource utilization at the receiving facility with a focus on children who were discharged directly from the ED or admitted less than 24 hours.Overall, 24,905 interfacility transfers were identified, accounting for 1.3% of the ED volume of these academic pediatric centers. Of these, 24.7% were discharged directly from the ED and 17.0% were admitted for less than 24 hours. Among those directly discharged from the ED, the 3 most common complaints were orthopedic problems, nonsurgical abdominal pain, and viral gastroenteritis; 20.7% received no medical or procedural intervention. Among those admitted for less than 24 hours, the 3 most common complaints were orthopedic problems, traumatic head injury, and gastrointestinal conditions.A significant proportion of interfacility transfers to academic pediatric EDs is discharged directly from the ED or is admitted for less than a day. These patients and their clinical outcomes provide insight into the educational needs and medical capabilities of referring hospitals and clinicians.
