Surge capacity and capability of intensive care units across a large healthcare system: An operational blueprint for regional integration.

OBJECTIVE: Many hospitals were unprepared for the surge of patients associated with the spread of coronavirus disease 2019 (COVID-19) pandemic. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system. SETTING: A large academic medical center in the Cleveland metropolitan area, with a network of 10 regional hospitals throughout Northeastern Ohio with a daily capacity of more than 500 intensive care unit (ICU) beds. RESULTS: At the beginning of the pandemic, an equitable delivery of healthcare services across the healthcare system was developed. This distribution of resources was implemented with the potential needs and resources of the individual ICUs in mind, and epidemiologic predictions of virus transmissibility. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system. We also describe an additional level of surge capacity, which is available to well-integrated institutions called "extension of capacity." This refers to the ability to immediately have access to the beds and resources within a hospital system with minimal administrative burden. CONCLUSIONS: Large integrated hospital systems may have an advantage over individual hospitals because they can shift supplies among regional partners, which may lead to faster mobilization of resources, rather than depending on local and national governments. The pandemic response of our healthcare system highlights these benefits.

Using wastewater-based analysis to monitor the effects of legalized retail sales on cannabis consumption in Washington State, USA.

AIMS: To perform a wastewater-based analysis to explore the impact of newly legalized retail cannabis sales on its use and to determine if this approach could estimate the size of the legal market place, which began 1 August 2014 in the study area. DESIGN: Laboratory study of raw wastewater samples collected and analyzed over the 3-year period from 2014 to 2016. SETTING AND PARTICIPANTS: Samples obtained from the two wastewater treatment plants that serviced a municipality of 200 000 people in the state of Washington, USA. MEASUREMENTS: Quantitative analysis of 24-hour composite influent samples for the metabolite of the active ingredient in cannabis, 11-nor-9-Carboxy-Δ9-tetrahydrocannabinol (THC-COOH) were performed by liquid chromatography coupled to mass spectrometry. FINDINGS: Wastewater estimates for THC-COOH increased by 9% per quarter, suggesting a doubling in cannabis consumption from 1 December 2013 to 31 December 2016. State-sold THC increased at nearly 70% per quarter, while stores operated from 1 August 2014 to 31 December 2016. Estimating the proportion of the total cannabis market supplied by state-regulated cannabis from these data is not currently achievable. CONCLUSION: A wastewater-based measure of cannabis consumption suggests a significant increase in consumption in Washington, USA following legalization, and that legal sales appear to have displaced a large portion of the illicit market.

A web-based cultural competency training for medical students: a randomized trial.

BACKGROUND: The objectives of this research were to compare a Web-based curriculum with a traditional lecture format on medical students' cultural competency attitudes using a standardized instrument and to examine the internal consistency of the standardized instrument. METHODS: In 2010, we randomized all 180 1st-year medical students into a Web-based (intervention group) or a lecture-based (control group) cultural competency training. The main outcome was the overall score on the Health Belief Attitudes Survey (1 = lowest, 6 = highest). We examined internal consistency with factor analysis. RESULTS: No differences were observed in the overall median scores between the intervention (median 5.2; 25th percentile [Q1] 4.9, 75th percentile [Q3] 5.5) and the control groups (median 5.3, Q1 4.9, Q3 5.6) (P = 0.77). The internal consistency of the 2 main subcomponents was good (Cronbach's alpha = 0.83) to acceptable (Cronbach's alpha = 0.69). CONCLUSIONS: A Web-based and a lecture-based cultural competency training strategies were associated with equally high positive attitudes among 1st-year medical students. These findings warrant further evaluation of Web-based cultural competency educational interventions.