Measuring patient experience in a safety net setting: Lessons learned

Safety net providers have faced barriers in administering patient experience surveys due to a lack of resources and survey expertise, but this problem has received little attention in the literature. In this manuscript, we offer lessons learned from the administration of a patient experience survey at a mid-size behavioral health care agency serving a safety net population. Specifically, we discuss resource needs, methods of increasing response rate among transient populations, methods for engaging stakeholders and clinical staff in quality improvement initiatives, and considerations for responding to setbacks and challenges dynamically. We also offer insight on the effective dissemination of results within safety net organizations and discuss the role of organizational culture

Reflections on an Effort to Develop a Cross-Disability Consciousness Inclusive of People with Psychiatric Disabilities

While cross-disability consciousness developed in the United States and England in the 1970's, a similar consciousness failed to emerge in Israel until the late 1990s. Furthermore, even in countries with a long history of cross-disability collaboration, there is a tendency for people with psychiatric disabilities to remain excluded from the ensuing disability community. The present article had its origins in the course "From Personal Coping to Social Responsibility: Leadership Training for Social Change for People with Disability," initiated and funded by the Disability Rights Commission in Israel, and developed and implemented by Shatil, the Empowerment and Training Center for Social Change Organizations. An explicit goal of the course was the development in Israel of a cross-disability consciousness inclusive of people with psychiatric disabilities. In the present article, three course graduates and the course facilitators reflect upon the insights that emerged from the cross-disability discourse generated among participants, during the course and in the course, of joint writing about the course. Special emphasis is given to the dynamics and effects of the inclusion of a large sub-group of people with psychiatric disabilities in the cross-disability group

Pronounced benefits of JAK inhibition with baricitinib in COVID-19 pneumonia in obese but not lean subjects

Objective Obesity and age are strongly linked to severe COVID-19 pneumonia where immunomodulatory agents including Janus kinase inhibitors have shown benefits but the efficacy of such therapy in viral pneumonia is not well understood. We evaluated the impact of obesity and age on survival following baricitinib therapy for severe COVID-19. Methods A post hoc analysis of the COV-BARRIER multicentre double-blind randomised study of baricitinib versus placebo (PBO) with an assessment of 28-day mortality was performed. All-cause mortality by day 28 was evaluated in a Cox regression analysis (adjusted to age) in three different groups according to body mass index (BMI) (30 kg/m2) and age <65 years and ≥65 years. Results In the high BMI group (>25 kg/m2), baricitinib therapy showed a significant survival advantage compared with PBO (incidence rate ratio (IRR) for mortality by day 28 0.53 (95% CI 0.32 to 0.87)) and 0.66 (95% CI 0.46 to 0.94) for the respective 0.05). Conclusion The efficacy of baricitinib in COVID-19 pneumonia is linked to obesity suggesting that immunomodulatory therapy benefit is associated with obesity-associated inflammation

Comparing COVID-19 and Influenza Presentation and Trajectory

Background: COVID-19 is a newly recognized illness with a predominantly respiratory presentation. It is important to characterize the differences in disease presentation and trajectory between COVID-19 patients and other patients with common respiratory illnesses. These differences can enhance knowledge of pathogenesis and help in guiding treatment. Methods: Data from electronic medical records were obtained from individuals admitted with respiratory illnesses to Rambam Health Care Campus, Haifa, Israel, between October 1st, 2014 and October 1st, 2020. Four groups of patients were defined: COVID-19 (693), influenza (1,612), severe acute respiratory infection (SARI) (2,292), and Others (4,054). The variable analyzed include demographics (7), vital signs (8), lab tests (38), and comorbidities (15) from a total of 8,651 hospitalized adult patients. Statistical analysis was performed on biomarkers measured at admission and for their disease trajectory in the first 48 h of hospitalization, and on comorobidity prevalence. Results: COVID-19 patients were overall younger in age and had higher body mass index, compared to influenza and SARI. Comorbidity burden was lower in the COVID-19 group compared to influenza and SARI. Severely- and moderately-ill COVID-19 patients older than 65 years of age suffered higher rate of in-hospital mortality compared to hospitalized influenza patients. At admission, white blood cells and neutrophils were lower among COVID-19 patients compared to influenza and SARI patients, while pulse rate and lymphoctye percentage were higher. Trajectories of variables during the first 2 days of hospitalization revealed that white blood count, neutrophils percentage and glucose in blood increased among COVID-19 patients, while decreasing among other patients. Conclusions: The intrinsic virulence of COVID-19 appeared higher than influenza. In addition, several critical functions, such as immune response, coagulation, heart and respiratory function, and metabolism were uniquely affected by COVID-19