Social Needs in the Prehospital Setting (SNIPS): EMS Attitudes Toward Addressing Patient Social Needs.

Introduction: There has been interest in utilizing EMS to address patients' social determinants of health, which are thought to be the cause of many unnecessary transports, particularly for "super-utilizing" patients. However, existing research is limited regarding EMS clinicians' understanding of social determinants of health and attitudes toward potential interventions. Methods: This cross-sectional study was conducted using an internet-based survey of EMS clinicians across the United States with multiple methods of recruitment. Descriptive statistics and Chi Square Tests analyzed the data. Results: A total of 1,112 EMTs and paramedics completed the survey with 43.4% reporting familiarity with the term, "social determinants of health," and 87.7% screening positive for burnout. Greater than 60% reported willingness to use proposed interventions to address patient social needs. Those who reported familiarity with the term, "social determinants of health," were more likely to indicate willingness to utilize interventions and to believe they were responsible for addressing their patients' social needs. Burnout had no effect on clinicians' willingness to use resources. Discussion: Respondents showed substantial interest in using the proposed resources to address patient social needs, suggesting that EMS clinicians may be receptive to expanding their scope of responsibility to include socioeconomic interventions. EMS clinicians familiar with the term "social determinants of health" were more likely to believe they were responsible for addressing patient social needs and more willing to use interventions, suggesting a potential benefit to more education on the topic. Burnout among EMS clinicians may not be a barrier to implementing such interventions. Conclusion: Our survey suggests that EMS clinicians may be interested in helping to address their patients' social needs. EMS clinicians should be offered education on social determinants of health in their initial training and through continuing education. Partnerships with human services agencies will be important to ensure the effectiveness of prehospital interventions.

Validation of a Clinical Prediction Rule for Distinguishing Bacterial and Aseptic Meningitis in Pediatric Patients.

Introduction The treatments and prognosis of bacterial meningitis differ greatly from those of aseptic meningitis, making early identification and differentiation essential. Several different clinical prediction rules have been developed to distinguish bacterial meningitis from aseptic meningitis. We sought to validate one clinical prediction rule for pediatric patients utilizing a centralized data warehouse that collects daily data from 184 hospitals across the United States. Methods We retrospectively collected data on all patients aged 29 days to 14 years who presented to Hospital Corporation of America (HCA) Healthcare hospitals from January 1, 2016, to May 31, 2021, with a diagnosis of meningitis. Our study replicated the original study of the meningitis score for emergencies (MSE) for the pediatric clinical prediction rule and assigned 3 points for procalcitonin (PCT) >1.2 ng/dL, 2 points for CSF protein >80 mg/dL, and 1 point for each of the other variables of C-reactive protein (CRP) >40 mg/L and CSF absolute neutrophil count >1000 cells per mm3. Patients were categorized either as having bacterial or aseptic meningitis. Using the clinical prediction rule, a calculation of the sensitivity, specificity, positive predictive value, negative predictive value, and receiver operating characteristic (ROC) curve was performed. Results The optimum test characteristic was found to have a score of ≥ 3, showing a sensitivity of 92.86% (95% CI, 83.3-100), a specificity of 65.22% (95% CI, 51.5-79), a positive predictive value of 61.90% (95% CI, 47.2-76.6), and a negative predictive value of 93.75% (95% CI, 85.4-100). The ROC curve from this study showed an area under the curve (AUC) of 0.7892 (95% CI, 0.681-0.897). Conclusion Our study validated a high sensitivity for distinguishing bacterial meningitis from aseptic meningitis, suggesting the clinical prediction rule has clinical utility as a predictive screening tool. Although the original MSE advised a cutoff score of ≥1, our study suggests that a score ≥3 would give the best test performance.

Isolated tubal torsion following bilateral tubal ligation: A case report and literature review.

A 44-year-old woman with a history of bilateral tubal ligation presented with severe abdominal pain and nausea, and despite unremarkable imaging was subsequently found to have a torsed, necrotic fallopian tube without associated ovarian pathology. Isolated torsion of the fallopian tube without ovarian involvement is rare. A systematic literature review found 8 case reports of isolated tubal torsion in patients with a history of tubal ligation. This paper describes one presentation of this rare pathology and identifies findings common among the 8 case reports identified in the literature.

Lactococcus lactis bacteraemia in a patient on probiotic supplementation therapy.

A 59-year-old woman presented with fever and malaise and was found to have Lactococcus lactis bacteraemia. L. lactis infection is rare in humans with few reported cases, with most associated with dairy food product ingestion. The patient reported use of a multistrain over-the-counter probiotic supplement. After isolation of L. lactis from blood culture, the patient was treated empirically with ertapenem and amoxicillin and displayed clinical improvement. She remained well after completion of antibiotic regimen and discontinued probiotic supplementation use. We review the clinical presentation of L. lactis infection including diagnosis, identification and treatment.

Policy and advocacy for informal caregivers: How state policy influenced a community initiative.

With a growing proportion of elderly in the global population, the role of 'informal caregivers' gains importance. Informal caregivers are unpaid family members or friends who provide assistance to home-dwelling adults with health-related needs or limitations. Internationally, informal caregivers provide important medical support to those with a variety of diseases. While informal caregivers will remain vital to the growing aging population's pursuit of healthy aging, they often suffer from 'caregiver burnout,' a state of physical, emotional, and mental exhaustion caused by their caregiving work. Policy and legislation are needed to diminish the burden on caregivers and to help assure that resources are allocated for these caregivers. We describe an initiative aimed at providing appropriate social support for caregivers by partnering among local organizations, hospitals, and health authorities.