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Telemedicine utilization increased significantly in the United States during the COVID-19 pandemic. However, there is concern that disadvantaged groups face barriers to access based on single-center studies. Whether there has been equitable access to telemedicine services across the US and during later parts of the pandemic is unclear. This study retrospectively analyzes outpatient medical encounters for patients 18 years of age and older using Healthjump–a national electronic medical record database–from March 1 to December 31, 2020. A mixed effects multivariable logistic regression model was used to assess the association between telemedicine utilization and patient and area-level factors and the odds of having at least one telemedicine encounter during the study period. Among 1,999,534 unique patients 21.6% had a telemedicine encounter during the study period. In the multivariable model, age [OR = 0.995 (95% CI 0.993, 0.997); p<0.001], non-Hispanic Black race [OR = 0.88 (95% CI 0.84, 0.93); p<0.001], and English as primary language [OR = 0.78 (95% CI 0.74, 0.83); p<0.001] were associated with a lower odds of telemedicine utilization. Female gender [OR = 1.24 (95% CI 1.22, 1.27); p<0.001], Hispanic ethnicity or non-Hispanic other race [OR = 1.40 (95% CI 1.33, 1.46);p<0.001 and 1.29 (95% CI 1.20, 1.38); p<0.001, respectively] were associated with a higher odds of telemedicine utilization. During the COVID-19 pandemic, therefore, utilization of telemedicine differed significantly among patient groups, with older and non-Hispanic Black patients less likely to have telemedicine encounters. These findings are relevant for ongoing efforts regarding the nature of telemedicine as the COVID-19 pandemic ends. [ABSTRACT FROM AUTHOR]

Objective: Surgeon procedural volume for complex cardiac procedures have become important quality metrics. The objective is to determine the association of surgeon and hospital case volume on patient outcomes after an aortic root replacement for aortic root aneurysms.Methods: From 2009 to 2014, 4629 Medicare patients underwent an aortic root replacement for a root aneurysm. Procedures were performed by 1276 surgeons at 718 hospitals. Patients with endocarditis, aortic rupture, or Type-A dissection were excluded. Procedural volume was defined as mean number of cases performed each year during the study period. The impact of hospital and surgeon volume on adjusted 30-day mortality was analyzed as a continuous variable using adjusted logistic regression with cubic splines.Results: After an aortic root replacement, we observed a nonlinear reduction in the adjusted odds ratio for 30-day mortality as surgeon and hospital volume increased. Surgeons that performed approximately five cases/year and hospitals that completed approximately five cases/year had the greatest reduction in the odds of perioperative death. Patients treated at high-volume hospitals (≥4.5 cases/year) had a lower risk for 30-day postoperative stroke (hazard ratio [HR] = 0.51, p = .008), myocardial infarction (HR = 0.49, p = .016), hemodialysis (HR = 0.44, p = .005), and reoperation (HR = 0.48, p = .003). Additionally, patients treated with high-volume surgeons (≥9 cases/year) had lower risk for stroke (HR = 0.65, p = .005), hemodialysis (HR = 0.65, p = .03), sepsis (HR = 0.62, p = .03), and reoperation (HR = 0.67, p = .004).Conclusion: Among Medicare patients undergoing an aortic root replacement, there is a strong inverse relationship between annualized surgeon and hospital case volume and postoperative outcomes. Procedural volume is an important quality metric for this high-risk procedure. [ABSTRACT FROM AUTHOR]

Importance: After a decline in cardiovascular mortality for nonelderly US adults, recent stagnation has occurred alongside rising income inequality. Whether this is associated with underlying economic trends is unclear.Objective: To assess the association between changes in economic prosperity and trends in cardiovascular mortality in middle-aged US adults.Design, Setting, and Participants: Retrospective analysis of the association between change in 7 markers of economic prosperity in 3123 US counties and county-level cardiovascular mortality among 40- to 64-year-old adults (102 660 852 individuals in 2010).Exposures: Mean rank for change in 7 markers of economic prosperity between 2 time periods (baseline: 2007-2011 and follow-up: 2012-2016). A higher mean rank indicates a greater relative increase or lower relative decrease in prosperity (range, 5 to 92; mean [SD], 50 [14]).Main Outcomes and Measures: Mean annual percentage change (APC) in age-adjusted cardiovascular mortality rates. Generalized linear mixed-effects models were used to estimate the additional APC associated with a change in prosperity.Results: Among 102 660 852 residents aged 40 to 64 years living in these counties in 2010 (51% women), 979 228 cardiovascular deaths occurred between 2010 and 2017. Age-adjusted cardiovascular mortality rates did not change significantly between 2010 and 2017 in counties in the lowest tertile for change in economic prosperity (mean [SD], 114.1 [47.9] to 116.1 [52.7] deaths per 100 000 individuals; APC, 0.2% [95% CI, -0.3% to 0.7%]). Mortality decreased significantly in the intermediate tertile (mean [SD], 104.7 [38.8] to 101.9 [41.5] deaths per 100 000 individuals; APC, -0.4% [95% CI, -0.8% to -0.1%]) and highest tertile for change in prosperity (100.0 [37.9] to 95.1 [39.1] deaths per 100 000 individuals; APC, -0.5% [95% CI, -0.9% to -0.1%]). After accounting for baseline prosperity and demographic and health care-related variables, a 10-point higher mean rank for change in economic prosperity was associated with 0.4% (95% CI, 0.2% to 0.6%) additional decrease in mortality per year.Conclusions and Relevance: In this retrospective study of US county-level mortality data from 2010 to 2017, a relative increase in county-level economic prosperity was significantly associated with a small relative decrease in cardiovascular mortality among middle-aged adults. Individual-level inferences are limited by the ecological nature of the study. [ABSTRACT FROM AUTHOR]

Introduction: One‐year post‐transplant survival is a significant quality measure for solid organ transplant programs in the United States. It is not known whether the use of this metric is associated with changes in life‐sustaining clinical practices that would delay mortality for solid organ recipients until just beyond the one‐year time point. Methods: We compared trends in mortality in the time period immediately preceding the one‐year post‐transplant mark compared to the period immediately after using second‐order Cox proportional hazard regression models. Results: Among recipients of heart, liver, and lung transplantation, mortality did not decrease significantly in the period immediately before day 365 or increase in the 14 days thereafter. There was an increased adjusted hazard of mortality in the 30 days following day 365 among lung transplant recipients (HR 1.33, 95% CI 1.03‐1.72, P =.03) with a 0.76% absolute mortality rate (94 deaths) in month 12 following lung transplantation and a 1.14% absolute mortality rate in month 13 (113 deaths). Conclusion: Although we did not find evidence that life‐sustaining treatment is routinely continued until just beyond the one‐year mark in heart and liver transplantation recipients, there was an unexpected increased risk of mortality in the 30 days following day 365 among lung transplant recipients. [ABSTRACT FROM AUTHOR]

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, we conducted a systematic review of 58 public administration studies of organizational socialization. Organizational socialization is the process of mutual adaptation between an organization and its new members. Our findings demonstrate a growing but geographically disparate interest in this issue. Public administration studies contribute to this research area with novel insights into the determinants of organizational socialization and its effects on employees' public service motivation, Eurocrats' support of supranational institutions, person--organization fit, and differences in the socialization of male and female public employees. The review also shows that the effects of organizational socialization on the homogenization of employees' attitudes should not be exaggerated, especially relative to other homogenizing factors such as attraction or selection effects. The reviewed articles are methodologically eclectic, with a recent but growing interest in longitudinal designs. There are also weaknesses in the operationalization of organizational socialization. We conclude with an agenda for future studies on organizational socialization in public administration research. [ABSTRACT FROM AUTHOR]

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: • Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. • Funding is frequently characterised as a mixed system of charitable, public and private payers. • The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest. [ABSTRACT FROM AUTHOR]

Classic instrumental variable techniques involve the use of structural equation modeling or other forms of parameterized modeling. In this paper we use a nonparametric, matching-based instrumental variable methodology that is based on a study design approach. Similar to propensity score matching, though unlike classic instrumental variable approaches, near/far matching is capable of estimating causal effects when the outcome is not continuous. Unlike propensity score matching, though similar to instrumental variable techniques, near/far matching is also capable of estimating causal effects even when unmeasured covariates produce selection bias. We illustrate near/far matching by using Medicare data to compare the effectiveness of carotid arterial stents with cerebral protection versus carotid endarterectomy for the treatment of carotid stenosis. [ABSTRACT FROM AUTHOR]

The article presents a study on the effect of community wealth on the use of cardiac-resynchronization therapy with defibrillation (CRT-D) for heart failure patients in the U.S. The study used data on 22,205 patient stays from the National Cardiovascular Data Registry. Findings suggest that patients treated at hospitals in affluent communities were more likely to receive CRT-D, and that health policy targeting insurance coverage alone may be ineffective in resolving inequities in care.

The article discusses a study which examines the national trends in types and rates of coronary revascularization from 2001-2008 at hospitals in the U.S. It evaluates the annual rates for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) reported in the nationwide inpatient sample of the Healthcare Cost and Utilization Project, in addition to Medicare data on claims for outpatient hospital care. It discusses the findings on the 26 percent decrease of CABG and the maintenance of utilization rates for PCI by 2008.

The mid-1990s saw the rise of a new sub-genre of political magazine in the United States: the “third-wave” feminist periodical. A key feature of these publications is that they promote reclaiming and repoliticizing activities traditionally associated with the domestic sphere, particularly knitting. This paper critically examines and historically contextualizes the discourses on the “new” knitting in the letters to the editor, editorials, articles, and advertisements of third-wave feminist periodicals and argues that contemporary feminist craft cultures sit at a politically ambiguous nexus of privilege, complicity, and resistance. By historicizing third-wave periodicals' promotion of knitting, this paper sheds light on changing ways in which the domestic sphere has figured within the broader history of US feminism and suggests that, despite their appeals to the “new,” these periodicals are very much in conversation with what is, to some extent, an imagined feminist “past.” [ABSTRACT FROM AUTHOR]

Low-value health care services that provide little or no benefit to patients are common, potentially harmful, and costly. Nearly half of the patients in the United States will receive at least 1 low-value test or procedure annually, creating risk of avoidable complications from subsequent cascades of care and excess costs to patients and society. Reducing low-value care is of particular importance to cardiovascular health given the high prevalence and costs of cardiovascular disease in the United States. This scientific statement describes the current scope and impact of low-value cardiovascular care; reviews existing literature on patient-, clinician-, health system-, payer-, and policy-level interventions to reduce low-value care; proposes solutions to achieve meaningful and equitable reductions in low-value care; and suggests areas for future research priorities. [ABSTRACT FROM AUTHOR]

The article summarizes several issues published in the journal in 2005, grouped by specific topics. The topics are categorized in various divisions in infection and sepsis, ventilator-associated pneumonia, ethics, hematology and hemostasis, intensive care unit organization and scoring, and brain injury.

Presents a study to examine the costs and effectiveness of several different options for automated external defibrillator deployment in the United States commercial air transportation system. Context; Objective; Design, setting, and subjects; Main outcome measures; Results; Conclusion.

Discusses the implications of type II errors in statistical tests for environmental regulations in the United States. Examination of the policies of the U.S. Environmental Protection Agency; Statistical techniques for hazardous waste compliance monitoring; Use of Monte Carlo simulation.

The article focuses on advisers of the U.S. National Science Foundation (NSF). NSF mediates the relationship between science and government. NSF has attempted to maintain flexibility in replying on the project grants to support the basic research. NSF was founded in the year 1950 and is only federally-charted agency specifically charged with support of basic research and education in science. The formal structure of NSF has four components, the National Science Board, the director, the staff and the advisory. To permit a detailed survey of NSF advisers, samples of 25 advisers each from 1954,1958,1962,1966 and 1970 were selected and additional data on them were gathered. The analysis compared these advisers with the population of American scientists as reported in the National Register of Scientific Manpower (NR). Over time the median age of NSF advisers has fluctuated much more than that of NR. NR medians are affected by changes in both actual age distribution of scientists.

Background: Extreme-heat events are increasing as a result of climate change. Prior studies, typically limited to urban settings, suggest an association between extreme heat and cardiovascular mortality. However, the extent of the burden of cardiovascular deaths associated with extreme heat across the United States and in different age, sex, or race and ethnicity subgroups is unclear.Methods: County-level daily maximum heat index levels for all counties in the contiguous United States in summer months (May-September) and monthly cardiovascular mortality rates for adults ≥20 years of age were obtained. For each county, an extreme-heat day was identified if the maximum heat index was ≥90 °F (32.2 °C) and in the 99th percentile of the maximum heat index in the baseline period (1979-2007) for that day. Spatial empirical Bayes smoothed monthly cardiovascular mortality rates from 2008 to 2017 were the primary outcome. A Poisson fixed-effects regression model was estimated with the monthly number of extreme-heat days as the independent variable of interest. The model included time-fixed effects and time-varying environmental, economic, demographic, and health care-related variables.Results: Across 3108 counties, from 2008 to 2017, each additional extreme-heat day was associated with a 0.12% (95% CI, 0.04%-0.21%; P=0.004) higher monthly cardiovascular mortality rate. Extreme heat was associated with an estimated 5958 (95% CI, 1847-10 069) additional deaths resulting from cardiovascular disease over the study period. In subgroup analyses, extreme heat was associated with a greater relative increase in mortality rates among men compared with women (0.20% [95% CI, 0.07%-0.33%]) and non-Hispanic Black compared with non-Hispanic White adults (0.19% [95% CI, 0.01%-0.37%]). There was a greater absolute increase among elderly adults compared with nonelderly adults (16.6 [95% CI, 14.6-31.8] additional deaths per 10 million individuals per month).Conclusions: Extreme-heat days were associated with higher adult cardiovascular mortality rates in the contiguous United States between 2008 and 2017. This association was heterogeneous among age, sex, race, and ethnicity subgroups. As extreme-heat events increase, the burden of cardiovascular mortality may continue to increase, and the disparities between demographic subgroups may widen. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of intensive care unit (ICU) beds in preventing death from the severe respiratory illness associated with COVID-19. However, the availability of ICU beds is highly variable across the US, and health care resources are generally more plentiful in wealthier communities. We examined disparities in community ICU beds by US communities' median household income. We found a large gap in access by income: 49 percent of the lowest-income communities had no ICU beds in their communities, whereas only 3 percent of the highest-income communities had no ICU beds. Income disparities in the availability of community ICU beds were more acute in rural areas than in urban areas. Policies that facilitate hospital coordination are urgently needed to address shortages in ICU hospital bed supply to mitigate the effects of the COVID-19 pandemic on mortality rates in low-income communities. [ABSTRACT FROM AUTHOR]

The author presents his comments on a study by A.P. Amin et al on the likelihood that U.S. percutaneous coronary intervention (PCI) patients in 2004 through 2010 received a drug-eluting stent (DES) despite the presence of clinical predictors suggesting a low pretreatment risk of subsequent target-vessel revascularization (TVR). He notes how the use pattern of DES in the past 9 years shows how far away the system is from embracing value-based medical decision making consistently.

BACKGROUND: Climate change is causing an increase in extreme heat. Individuals with cardiovascular disease are at high risk of heat-related adverse health effects. How the burden of extreme heat--associated cardiovascular deaths in the United States will change with the projected rise in extreme heat is unknown. METHODS: We obtained data on cardiovascular deaths among adults and the number of extreme heat days (maximum heat index ≥90 °F [32.2 °C]) in each county in the contiguous United States from 2008 to 2019. Based on representative concentration pathway trajectories that model greenhouse gas emissions and shared socioeconomic pathways (SSP) that model future socioeconomic scenarios and demographic projections, we obtained county-level projected numbers of extreme heat days and populations under 2 scenarios for the midcentury period 2036 to 2065: SSP2-4.5 (representing demographic projections from a "middle-of-the-road" socioeconomic scenario and an intermediate increase in emissions) and SSP5-8.5 (demographic projections in an economy based on "fossil-fueled development" and a large increase in emissions). The association of cardiovascular mortality with extreme heat was estimated with a Poisson fixed-effects model. Using estimates from this model, the projected number of excess cardiovascular deaths associated with extreme heat was calculated. RESULTS: Extreme heat was associated with 1651 (95% CI, 921-2381) excess cardiovascular deaths per year from 2008 to 2019. By midcentury, extreme heat is projected to be associated with 4320 (95% CI, 2369-6272) excess deaths annually, which is an increase of 162% (95% CI, 142-182) under SSP2-4.5, and 5491 (95% CI, 3011-7972) annual excess deaths, which is an increase of 233% (95% CI, 206-259) under SSP5-8.5. Elderly adults are projected to have a 3.5 (95% CI, 3.2-3.8) times greater increase in deaths in the SSP2-4.5 scenario compared with nonelderly adults. Non-Hispanic Black adults are projected to have a 4.6 (95% CI, 2.8-6.4) times greater increase compared with non-Hispanic White adults. The projected change in deaths was not statistically significantly different for other race and ethnicity groups or between men and women. CONCLUSIONS: By midcentury, extreme heat is projected to be associated with a significantly greater burden of excess cardiovascular deaths in the contiguous United States. [ABSTRACT FROM AUTHOR]

Keywords: antiarrhythmic drugs; arrhythmias; atrial fibrillation; supraventricular tachycardia; ventricular tachycardia EN antiarrhythmic drugs arrhythmias atrial fibrillation supraventricular tachycardia ventricular tachycardia 937 939 3 04/20/20 20200317 NES 200317 Antiarrhythmic drugs (AADs) are widely prescribed to treat both ventricular and supraventricular arrhythmias. Arrhythmia diagnoses were combined into meaningful categories including atrial fibrillation and flutter; ventricular tachycardia and fibrillation; and supraventricular tachycardia. Antiarrhythmic drugs, arrhythmias, atrial fibrillation, supraventricular tachycardia, supraventricular tachycardia, ventricular tachycardia. [Extracted from the article]

The article estimates the incidence rate of cardiac arrest among hospitalized patients in the U.S. treated with a resuscitation response. The experiment used weighted averages to come up with the rate for national hospital cardiac arrest. Results show that an estimated 200,000 treated cardiac arrests occur among hospitalized patients in the U.S. each year and the rate is believed to be increasing. The data is considered significant for developing strategies to improve patient hospital care.

Purpose Left ventricular assist devices (LVADs) have emerged as an important therapy for advanced heart failure, with an increasing number of patients receiving these devices worldwide. However, recurrent hospitalizations among LVAD recipients lead to a significant resource burden on health care systems. In this study we evaluated the rate of hospitalizations of LVAD patients in the United States (US) and the change in this rate over the last decade. Methods We utilized a large, retrospective administrative claims dataset (OPTUM),that contains health care claims of 60 million people in the US. Using ICD and CPT codes, we identified patients on durable LVAD support between the years 2008 and 2016, and evaluated hospitalization rates of these patients. Results A total of 3082 LVAD patients were included in this analysis (76% males, mean age 57.6 ± 14 years). Overall, 16% patients had at least one hospital admission at 1 month post implant, 91% patients were hospitalized at least once during the first year after implant and 98% of the patients were hospitalized at least once during the first 2 years post implant (figure A). The mean rate of hospitalization per patient year was 1.13. During the years 2008 to 2016 the rate of hospitalizations remained stable (Figure B). Conclusion The hospitalization rate among LVAD recipients remains high, with no significant change in this rate over the last decade despite advances in technology. [ABSTRACT FROM AUTHOR]