Case Report of a Novel Technique for Fecal Diversion

An estimated 100,000 individuals within the United States experience operations that result in a colostomy or ileostomy each year. Ostomy formation is used in surgery for operations involving several pathologies involving the small intestine or colon. Evidence shows that loop ileostomy or loop colostomy for fecal diversion effectively reduce the complications of anastomotic dehiscence. Anastomotic leak can cause significant morbidity and mortality. The role of temporary fecal diversion though a loop ileostomy or colostomy is vital in protecting tenuous anastomoses in the pelvis, immunocompromised patients, or those who are septic. 4 We present a case of a patient with a perforated colon cancer who required an innovative technique for fecal diversion.

Intermittent Hypoxia Alters the Circadian Expression of Clock Genes in Mouse Brain and Liver

At least one-third of adults in the United States experience intermittent hypoxia (IH) due to health or living conditions. The majority of these adults suffer with sleep breathing conditions and associated circadian rhythm disorders. The impact of IH on the circadian clock is not well characterized. In the current study, we used an IH mouse model to understand the impact of IH on the circadian gene expression of the canonical clock genes in the central (the brain) and peripheral (the liver) tissues. Gene expression was measured using a Quantitative Reverse Transcription Polymerase Chain Reaction (qRT-PCR). CircaCompare was used to evaluate the differential rhythmicity between normoxia and IH. Our observations suggested that the circadian clock in the liver was less sensitive to IH compared to the circadian clock in the brain.

Home Infusions for Inflammatory Bowel Disease are Safe: United States Experience and Patient Perspectives

Background Home-infusions (HI) for biologic medications are an option for inflammatory bowel disease (IBD) patients in the United States (US). We aimed to describe the population receiving HI and report patient experience with HI. Methods We conducted a retrospective cohort study in the Quintiles-IMSLegacy PharMetrics Adjudicated Claims Database from 2010-2016 to describe the population receiving infliximab and vedolizumab HI and determine predictors for an urgent/emergent visit post-HI. We then administered a cross-sectional survey to IBD-Partners Internet-based cohort participants to assess knowledge and experience with infusions. Results We identified claims for 11,892 conventional infliximab patients, 1,573 home infliximab patients, 438 conventional vedolizumab patients and 138 home vedolizumab patients. There were no differences in demographics or median charges with infliximab home and conventional infusions. Home vedolizumab infusions had a greater median charge than conventional vedolizumab infusion. Less than 4% of patients had an urgent/emergent visit post-HI. Charlson comorbidity index >0 (OR:1.95, 95% CI:1.01-3.77) and Medicaid (OR:3.01, 95%CI:1.53-5.94) conferred significantly higher odds of urgent/emergent visit post-HI. In IBD-Partners, 644 IBD patients responded; 56 received HI. The majority chose HI to save time and preferred HI to conventional infusions. Only 2 patients reported an urgent/emergent visit for HI-related problems. Conclusions HI appears to be safe in IBD patients receiving infliximab and vedolizumab. However, patients with fewer resources and more co-morbidities are at increased risk for an urgent/emergent visit post-HI. The overall patient experience with HI is positive. Expansion of HI may result in decreased therapy-related logistic burden for carefully selected patients.

The Surgeon’s Role in Addressing Racism and Achieving Health Equity

In the United States, the nation’s health is not an organic outcome. It is not a coincidence that certain groups of people living in the United States experience higher premature death rates or poorer health outcomes than others. For centuries, racial and ethnic as well as geographic differences in health outcomes have been part of the American landscape, so entrenched in society that many people fail to recognize that health inequities were intentionally derived. A national crisis tends to magnify inequities in our society, but even more alarming is the fact that as the country becomes more racially and ethnically diverse in the coming years, the health inequities are projected to worsen if we do not proactively and immediately address them. As we continue to grapple with the lasting impact of the pandemic, it is of vital importance that we utilize this time to acknowledge, understand, and seriously address the health inequities that have historically plagued the country for over 400 years. As the United States works overtime to stem the tide of the COVID-19 pandemic, it must also work equally hard to move in a more equitable, inclusive, and healthier direction, not only because of the more than 83 000 Americans dying prematurely each year but also because of the economic and national security toll it will have if not effectively addressed.

Are We Ready to Build Back “Healthier?” An Exploratory Analysis of U.S. State-Level Disaster Recovery Plans

As communities recover from disasters, it is crucial to understand the extent to which states are prepared to support the recovery of health systems and services. This need has been emphasized by the United States’ experience with COVID-19. This study sought to assess public health activities in state disaster recovery implementation plans. In this exploratory, descriptive study, state-wide disaster recovery implementation plans were collected from emergency management agency websites and verified (n = 33). We reviewed and coded the recovery plans to identify health-related activities. While 70% and 64% of reviewed plans included activities to address short-term healthcare and behavioral health needs, respectively, one-third or less of the plans included activities to address long-term healthcare and behavioral health needs. Further, plans have limited descriptions of health-related data collection, analysis, or data-driven processes. Additional evidence-informed public health requirements and activities are needed in disaster recovery implementation plans. State disaster recovery plans would benefit from additional description of public health roles, responsibilities, and activities, as well as additional plans for collecting and analyzing public health data to drive recovery decision making and activities. Plans should include approaches for ongoing evaluation of recovery activities.

Conscription Systems, Political Survival, and Battlefield Deaths

How do countries’ conscription systems affect their ability to fight wars? Scholars have devoted significant attention to understanding how domestic political concerns influence military strategy, but we do not yet know how these concerns are shaped by military labor policies. We argue that conscription systems determine how the human costs of war are distributed throughout society, and in turn, the government’s tolerance for battlefield casualties in pursuit of victory. Using new data on every country’s conscription policy from 1800 to the present, we demonstrate that countries with selective conscription experience more casualties than those with universal conscription or volunteer militaries. To examine the mechanism we theorize, we then conduct an in-depth case study of the United States’ experience during the Vietnam War. Using adifference-in-differences design and new data on all American deaths in Vietnam, we show that changes in county death rates after the introduction of the lottery reflect electoral considerations.

July Effect on Mortality and Complications in Patients With ARDS in US Teaching Hospitals

Background Each July, teaching hospitals in the United States experience an influx of new resident and fellow physicians. It has been theorized that this occurrence may be associated with increased patient mortality, complication rates, and health care resource use, a phenomenon known as the “July effect.” Objective To assess the existence of a July effect in clinical outcomes of patients with acute respiratory distress syndrome (ARDS) receiving mechanical ventilation in the intensive care unit in US teaching hospitals. Methods The National Inpatient Sample database was queried for all adult patients with ARDS who received mechanical ventilation from 2012 to 2014. Using a multivariate difference-in-differences (DID) model, differences in mortality, ventilator-associated pneumonia, iatrogenic pneumothorax, central catheter–associated bloodstream infection, and Clostridium difficile infection were compared between teaching and nonteaching hospitals during April-May and July-August. Results There were 70 535 and 43 175 hospitalizations meeting study criteria in teaching and nonteaching hospitals, respectively. Multivariate analyses revealed no differential effect on the rates of all-cause inpatient mortality (DID, 0.66; 95% CI, −0.42 to 1.75), C difficile infection (DID, 0.29; 95% CI, −0.19 to 0.78), central catheter–associated bloodstream infection (DID, 0.14; 95% CI, −0.04 to 0.33), iatrogenic pneumothorax (DID, 0.00; 95% CI, −0.25 to 0.24), ventilator-associated pneumonia (DID, 0.22; 95% CI, −0.05 to 0.49), and any complication (DID, 0.60; 95% CI, −0.01 to 1.20) for July-August versus April-May in teaching hospitals compared with nonteaching hospitals. Conclusion This study did not show a differential July effect on mortality outcomes and complication rates in ARDS patients receiving mechanical ventilation in teaching hospitals compared with nonteaching hospitals.

Areas for improvement in the tobacco excise policy in Ukraine

The article analyses the ways to improve tobacco excise taxation in Ukraine considering a respective EU Member States experience, consequences of national reforms held in previous years, as well as challenges and potential threats caused by the pandemic. A worsening economic situation and the recent decline in income compounded the existing problems related to tobacco taxation in Ukraine. The increase of excise tax rate on cigarettes by 20% annually till 2025 and an inconsistent decision on more than four times increase of excise tax rates on electronically heated tobacco products (EHTP) pose a risk of boosting illicit trade. The advance payment of excise tax on imported tobacco products, in turn, negatively affects finances of importers due to the working capital diversion. Following that, the priority steps with regard to the excise policy of Ukraine should be aimed at: 1) revision of the existing plan of increasing tax rates on cigarettes by slowing down the growth of tax burden and simultaneous expansion of the plan till 2028; 2) correcting the burdensome reform on excise taxation of EHTP to establish more liberalized tax regime 3) switching to payment of excise tax on imported tobacco products during customs clearance. The mentioned initiatives taking into account a strong need to improve a fiscal situation in Ukraine due to the spread of COVID-19 will reduce a negative impact of increasing excise tax rates and administration procedures on tobacco industry. They will also prevent the growth of illicit trade in tobacco products and thus will contribute to improving the efficiency of tax system and strengthening the confidence of business entities.