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Although the number of people incarcerated in the United States has grown dramatically, research on how incarceration affects individuals and the communities they return to has lagged behind. This may be because of the unique challenges of doing research within carceral systems and the relatively small number of investigators who are competent to undertake these efforts. We provide a primer for investigators with limited experience conducting research in carceral settings and highlight considerations and recommendations that may aid those conducting health research with incarcerated persons. We follow this with an illustrative case example exemplifying how the considerations apply to recent health research that our team conducted on mental illness prevalence in a large regional jail. Understanding how to effectively conduct research with criminal justice populations and systems is the first step in beginning to understand the effects of mass incarceration as a driver of health disparities and health inequity. [ABSTRACT FROM AUTHOR]

Background: The SEP-1 measures have tied financial reimbursement to the treatment of patients with severe sepsis and septic shock. The purpose of this study was to assess the impact of a SEP-1 initiative on the utilization of broad-spectrum combination therapy (BSCT) in the emergency department (ED)., Methods: This was an IRB-approved, retrospective evaluation of adult patients who received vancomycin plus an antipseudomonal beta-lactam for a urinary tract infection (UTI) or skin or soft tissue infection (SSTI) in the ED. The primary outcome was the proportion of patients in which use of BSCT was considered appropriate based on clinical criteria. Secondary outcomes included door to antibiotic order time, door to administration time, proportion of patients continued on BSCT upon admission, duration of BSCT, and in-hospital mortality., Results: A total of 400 patients were included in the analysis. Following SEP-1 implementation, appropriate use of BSCT decreased by 12%, with 54% of patients in the pre-SEP-1 group meeting clinical criteria compared to 42% in the post-SEP-1 group (p = 0.028). In the subgroup of patients with a suspected UTI the appropriate use of BSCT declined by 25% (40% vs 15%, p = 0.005). The median door to first antibiotic administration time was not significantly different between groups (63 min vs 61 min, p = 0.091)., Conclusions: The implementation of the SEP-1 mandated measures was associated with an increase in the unnecessary use of BSCT. Additionally, no difference was seen in time to antibiotic administration. The results of this study demonstrate the negative impact that the SEP-1 mandate may have on antimicrobial utilization within the ED., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Antifibrinolytics have demonstrated a mortality benefit in trauma patients when utilized early after injury. In line with recent literature, the authors hypothesize that early tranexamic acid (TXA) administration will decrease overall blood product administration at 24 hr. This is a retrospective cohort evaluation of 65 trauma patients admitted and discharged between May 1, 2015, and December 31, 2017, who received packed red blood cells (PRBCs) and TXA within 3 hr following injury. The primary outcome was overall PRBC utilization at 24 hr when TXA was administered less than 1 hr of injury compared with 1-3 hr of injury. A subgroup analysis compared PRBC usage at 24 hr when PRBC to TXA administration time was less than 30 min compared with 30 min or more. During the study time, 15 patients received TXA early, less than 1 hr from injury, and 50 patients received TXA within 1-3 hr of injury. Patients received a median of 7 units of PRBCs in the early group and 8 units in the standard group (p = .64) at 24 hr. Patients who received TXA less than 30 min after first PRBC received a median of 6 units at 24 hr compared with 9 units when PRBC to TXA time was 30 min or more (p = .014). There was no difference in PRBCs at 24 hr in patients who received TXA early compared with 1-3 hr from injury. There was a significant increase in PRBC requirement at 24 hr when patients received TXA 30 min or more from first PRBC. Further inquiry into the optimal timing of TXA administrated is needed.