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Background: Boston Medical Center (BMC), a safety-net hospital, treated a substantial portion of the Boston cohort that was sick with COVID-19. Unfortunately, these patients experienced high rates of morbidity and mortality given the significant health disparities that many of BMC’s patients face. Boston Medical Center launched a palliative care extender program to help address the needs of critically ill ED patients under crisis conditions. In this program evaluation our goal was to assess outcomes between those who received palliative care in the emergency department (ED) vs those who received palliative care as an inpatient or were admitted to an intensive care unit (ICU).Methods: We used a matched retrospective cohort study design to assess the difference in outcomes between the two groups.Results: A total of 82 patients received palliative care services in the ED, and 317 patients received palliative care services as an inpatient. After controlling for demographics, patients who received palliative care services in the ED were less likely to have a change in level of care (P

Abstract Background Recent studies suggest that the reported protective effects of statins (HMG-CoA reductase inhibitors) against community-acquired pneumonia (CAP) and sepsis in humans may be due to confounders and a healthy user-effect. To directly test whether statins are protective against Streptococcus pneumoniae, the leading cause of CAP, we examined the impact of prolonged oral simvastatin therapy at physiologically relevant doses in a mouse model of pneumococcal pneumonia. BALB/c mice were placed on rodent chow containing 0 mg/kg (control), 12 mg/kg (low simvastatin diet [LSD]; corresponds to 1.0 mg/kg/day), or 120 mg/kg (high simvastatin diet [HSD]; corresponds to 10 mg/kg/day) simvastatin for four weeks, infected intratracheally with S. pneumoniae serotype 4 strain TIGR4, and sacrificed at 24, 36, or 42 h post-infection for assessment of lung histology, cytokine production, vascular leakage and edema, bacterial burden and bloodstream dissemination. Some mice received ampicillin at 12-h intervals beginning at 48 h post-infection and were monitored for survival. Immunoblots of homogenized lung samples was used to assess ICAM-1 production. Results Mice receiving HSD had reduced lung consolidation characterized by less macrophage and neutrophil infiltration and a significant reduction in the chemokines MCP-1 (P = 0.03) and KC (P = 0.02) and ICAM-1 in the lungs compared to control mice. HSD mice also had significantly lower bacterial titers in the blood at 36 (P = 0.007) and 42 (P = 0.03) hours post-infection versus controls. LSD had a more modest effect against S. pneumoniae but also resulted in reduced bacterial titers in the lungs and blood of mice after 42 h and a reduced number of infiltrated neutrophils. Neither LSD nor HSD mice had reduced mortality in a pneumonia model where mice received ampicillin 48 h after challenge. Conclusions Prolonged oral simvastatin therapy had a strong dose-dependent effect on protection against S. pneumoniae as evidenced by reduced neutrophil infiltration, maintenance of vascular integrity, and lowered chemokine production in the lungs of mice on HSD. Statin therapy also protected through reduced bacterial burden in the lungs. Despite these protective correlates, mortality in the simvastatin-receiving cohorts was equivalent to controls. Thus, oral simvastatin at physiologically relevant doses only modestly protects against pneumococcal pneumonia.

ABSTRACT Baboons ( Papio hamadryas sp.) exhibit significant sexual dimorphism in body size. Sexual dimorphism is also exhibited in a number of circulating factors associated with risk of cardiometabolic disease. We investigated whether sexual dimorphism in body size and composition underlie these differences. We examined data from 28 male and 24 female outdoor group-housed young adult baboons enrolled in a longitudinal observational study of cardiometabolic disease risk factors. Animals were sedated with ketamine HCl (10 mg/kg) before undergoing venous blood draws, basic body measurements, and dual-energy X-ray absorptiometry body composition scans. Percentage glycated hemoglobin A1c (%HbA1c) was measured in whole blood. Serum samples were analyzed for glucose, insulin, C-peptide, high-density lipoprotein, and triglyceride concentrations. Males were heavier and had greater body length and lean tissue mass than females. Females had a greater body fat percentage relative to males (10.8 ± 6.4 vs. 6.9 ± 4.0, P = 0.01). Although C-peptide, fasting glucose, and %HbA1c did not differ between the sexes, females had greater fasting insulin and triglyceride compared to their male counterparts. Insulin and percentage body fat were significantly correlated in males ( r = 0.61, P = 0.001) and to a lesser extent in females ( r = 0.43, P = 0.04). Overall, relations between adiposity and fasting insulin and fasting triglyceride were stronger in males. After accounting for differences in percentage body fat, fasting insulin and triglyceride were no longer statistically different between males and females. Despite stronger correlations between relative adiposity and insulin and triglyceride in males, the higher fasting insulin and triglyceride of female baboons may be underlain by their greater relative body fat masses. Am J Phys Anthropol 153:9-14, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Outcomes: 1. Describe a novel model for providing integrated supportive oncology services in community settings 2. List process and outcome metrics associated with implementing community-based psychosocial and palliative care services An unmet need for palliative care and psychosocial oncology in community settings and a limited workforce to provide these services necessitates innovation. When faced with similar challenges, the field of psychiatry developed the Collaborative Care model. Collaborative Care uses a mix of onsite behavioral health workers and offsite psychiatrists, as well as a measurement-based approach, to provide evidence-based behavioral health care in community settings. At Dana-Farber Cancer Institute, we aim to increase access to palliative care and psychosocial services in our diverse community satellites by enhancing collaborative care. We developed the Supportive Oncology Collaborative (SOC), a clinical model that integrates onsite and virtual resources to create a cohesive team of palliative care clinicians, a psychiatrist, and social workers. We do not offer discreet palliative care, social work, or psychiatric services in the SOC, but rather provide a comprehensive team approach for each clinical concern. This model is currently implemented in two Dana-Farber Cancer Institute satellite locations, with plans to expand to three additional locations over the next 2 years. In this session, we will present information about Collaborative Care, how it was adapted into the SOC, and how this differs from standard care delivery models. We will identify 10 common reasons for referral (eg, pain, goals of care, behavioral health, coping with illness) and the interdisciplinary clinical pathways we have developed for each. We will share process metrics such as clinical volume, patient risk stratification, and proportion of high-risk patients presented for clinical discussion at interdisciplinary team meeting. We will share an evaluation plan based on patient goals and linked to referral indications. Finally, we will share case studies to demonstrate how care is provided in this model in alignment with the clinical pathways. [ABSTRACT FROM AUTHOR]