Pregnant women with COVID-19 face increased chances for stillbirths compared with uninfected women, and that risk spiked to four times higher after the delta variant emerged, new government data show. [US News 11.19.2021]

The federal Centers for Disease Control and Prevention released a report Friday that examined 1.2 million deliveries in 736 hospitals nationwide from March 2020 through September 2021.

Stillbirths were rare overall, totaling 8,154 among all deliveries. But the researchers found that for women with COVID-19, about 1 in 80 deliveries resulted in stillbirth. Among the uninfected, it was 1 in 155.

Among those with COVID-19, stillbirths were more common in people with chronic high blood pressure and other complications, including those in intensive care or on breathing machines.

“These findings underscore the importance of COVID-19 prevention strategies, including vaccination before or during pregnancy,’’ CDC researcher Carla DeSisto and co-authors said.

There’s no information on how many had received COVID-19 shots, although the authors noted that the U.S. vaccination rate among pregnant people after delta emerged this past summer was 30%.

More details here>

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With about 1 in 5 healthcare workers leaving medicine since the pandemic began, The Atlantic explored numerous reasons why providers are leaving healthcare, coming up with at least seven key reasons. [Becker's Hospital  Review 11.18.2021]

The U.S. healthcare sector has lost nearly half a million workers since February 2020, according to estimates from the Bureau of Labor Statistics. Eighteen percent of healthcare staff have quit since the pandemic began, while 12 percent have been laid off, according to survey research company Morning Consult. Of the remaining workers, 31 percent have thought about leaving their employer, according to Morning Consult.  

"Physicians are some of the most resilient people out there," Sheetal Rao, MD, a primary care physician who left her job last October, told The Atlantic. "When this group of people starts leaving en masse, something is very wrong."

Excluding those who have left the field because of layoffs or conditions linked to long COVID, below are seven reasons healthcare workers are exiting the field, per The Atlantic: 

1. Many healthcare workers believed vaccines would ease the traumas endured in initial surges. However, plateauing vaccination rates, lifted mask mandates and the delta variant undid such hopes. The unrealized promise of "some sort of normalcy has made the feelings of exhaustion and frustration worse," Amanda Bettencourt, PhD, president-elect of the American Association of Critical-Care Nurses and assistant professor at Philadelphia-based University of Pennsylvania School of Nursing, told The Atlantic. 

2. COVID-19 patients may be more difficult to deal with now. Currently, most are unvaccinated, and while some didn't have a choice in the matter, those who did are often belligerent. Some resist basic medical procedures, while others have assaulted nurses and yelled for treatments the FDA hasn't authorized for COVID-19 treatment. Americans initially applauded its healthcare heroes; now, "we're at war with a virus and its hosts are at war with us," Cassandra Werry, RN, an intensive care nurse in Idaho, told The Atlantic. 

3. These experiences inflict deep psychological scars. "We want to be rooting for our patients," Artec Durham, RN, told The Atlantic. "But anyone I know who's working in COVID has zero compassion remaining, especially for people who chose not to get the vaccine." That's why Mr. Durham became a travel nurse, which is time-limited and more lucrative. He still provides care but is emotionally detached, unsettled by his own numbness. For a healthcare provider, being shaken by a patient's death comes with the territory, but becoming unmoved is almost worse, The Atlantic reported.

4. Many said they left medicine because of how their institutions acted amid the pandemic. Several workers told The Atlantic that hospitals cut salaries, benefits and raises; forced staff to work more shifts; denied paid time off or reduced hours; failed to provide sufficient personal protective equipment; and downplayed the severity of their experiences. "I've been a nurse 45 years and I've never seen this level of disaffection between clinicians and their employers," said Gerard Brogan, RN, director of the California Nurses Association and director of nursing practice at National Nurses United. Dubbed "the Great Resignation," the same is true for nearly every industry, with record numbers of Americans leaving their jobs this April, July and August.

5. Between 35 and 54 percent of U.S. nurses and physicians already felt burned out before the pandemic, according to the National Academies of Sciences, Engineering and Medicine. Now, amid the pandemic, many have been pushed to simply resign. 

6. Hospitals are also flooded by non-COVID patients who delayed care amid the pandemic and require more intensive care. "It doesn't feel great between surges," Esther Choo, MD, emergency physician at Portland-based Oregon Health and Science University, told The Atlantic. "Something always replaces COVID."

7. Healthcare workers want to help patients, and their inability to adequately do so is taking its toll. Providers aren't exiting the field because they can't handle their jobs — they're quitting because they can't handle being unable to do their jobs. 

Full article here>

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Nearly one in five patients with cirrhosis were prescribed opioids during outpatient visits, more often than not by a primary care physician (PCP), according to a national analysis of over 10 million ambulatory visits.

From 2006 to 2016, 17% of all outpatient visits for patients with cirrhosis resulted in an opioid prescription, usually a refill, reported Anna Lee, MD, of the University of California Los Angeles, during a presentation at the virtual American Association for the Study of Liver Diseases (AASLD) meeting. 

Download PDF of article here.

Full article here

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Increased stress, isolation and burnout among patients and clinicians amid the pandemic shed light on a widespread lack of mental health resources. Many hospitals and health systems quickly pivoted their mental health strategies to meet this growing need.

Becker's interviewed healthcare leaders across the country about what their organization is doing in response to current mental health trends.

Editor's note: Responses were lightly edited for brevity.

Question: What mental healthcare trends is your hospital seeing? How has demand changed since the pandemic started?

Ben Weinstein, MD. Chair of the Department of Psychiatry and Behavioral Health at Houston Methodist: We have seen significant fluctuations in the demand for emergency psychiatric services. During COVID-19 surges, people stayed away from the emergency departments and then flooded the EDs when the COVID-19 peak subsided. Just like in general healthcare, the delay in mental healthcare results in an increase in acuity. Patients are more ill and more desperate. Everyone in the community is impacted, especially healthcare workers.

Editor's note: Responses were lightly edited for brevity.

Question: What mental healthcare trends is your hospital seeing? How has demand changed since the pandemic started?

Ben Weinstein, MD. Chair of the Department of Psychiatry and Behavioral Health at Houston Methodist: We have seen significant fluctuations in the demand for emergency psychiatric services. During COVID-19 surges, people stayed away from the emergency departments and then flooded the EDs when the COVID-19 peak subsided. Just like in general healthcare, the delay in mental healthcare results in an increase in acuity. Patients are more ill and more desperate. Everyone in the community is impacted, especially healthcare workers.

Download a PDF of the article here

Visit this page for the full article> 

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Ellume has expanded its recall of rapid at-home COVID-19 antigen tests to about 2 million tests, the Food and Drug Administration said in an update this week. Ellume last month recalled certain lots of its COVID-19 Home Test due to an increased chance of false-positive results. FDA has classified the recall as a Class I recall, the most serious type.

“The FDA is continuing to work with Ellume to assess the company’s corrective actions, such as additional manufacturing checks and other corrective steps, to address the reason for the manufacturing issue, and to help ensure that it is resolved and will not recur,” the agency said.

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...findings support other reports of lead-contaminated turmeric in the United States (1,2) and highlight the diverse pathways through which children can be exposed to lead. They underscore the importance of a multidisciplinary approach and communication between health care providers and health department staff members in identifying potential links among lead poisoning cases, and the need for health care facilities to be prepared to respond to cases of lead poisoning. [CDC 11.12.2021] 

The national blood lead reference level had been 5 μg/dL but was lowered to 3.5 μg/dL in October 2021 (3). There is no safe BLL in children (4); BLLs once thought to pose little to no risk have shown to be risk factors for reading problems, intellectual delays, school failure, attention deficit-hyperactivity disorder, and antisocial behavior (3,5–7). Whereas the impact of lead exposure might be irreversible, exposure is preventable.¶,** Clinicians and public health professionals should be aware of risks outside traditional lead exposures (e.g., paint, dust, and contaminated soil). Adulteration of turmeric has reportedly been a source of lead exposure in other countries (1), where lead is purposefully added to enhance weight and color (2). Referrals for lead-risk assessments should emphasize same-day assessments when possible to reduce continued exposure to and absorption of lead. Public health officials and health care providers should work together to ensure the sources of lead exposure have been identified and controlled before chelation therapy is started. Health care providers who are unfamiliar with chelation therapy should consult with their regional pediatric environmental health specialty unit or poison control center for assistance.

Download PDF of full CDC article here

For full CDC article, click here. 

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This is good news! Few people will delay in taking care of their health. As more people rely on #telemedicine during the pandemic, 2/3 larger employers providing health coverage say they’ve made changes to telemedicine benefits, often affecting where & how people could access virtual care and what services are covered.

Kaiser Family Foundation 11.11.2021

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Perceiving, acknowledging and undoing the many ways medicine has contributed to racial injustice can be a daunting task for health care organizations. And while developing a plan for doing this is a good first step, putting that plan into action in training future physicians can be fraught with false starts and failed objectives.

AMA Equity Plan 2021-2023

Embedding equity into medicine requires planning and honesty. To meet this moment, the AMA has developed a plan to advance racial and social justice.

Read the Strategy

In a plenary presentation, “Operationalizing Racial Justice,” at ChangeMedEd^® 2021, AMA Senior Vice President and Chief Health Equity Officer Aletha Maybank, MD, MPH, provided a survey of the forces in the U.S. that have inhibited a reckoning with racism in medicine. She also outlined the roles of individuals and organizations in improving health equity and the key steps organizations need to take to ensure a successful and thorough transition to a racially just health care system.

ChangeMedEd is the AMA Accelerating Change in Medical Education initiative’s national conference, which brings together innovative leaders from institutions across the medical education continuum to reimagine the way future physicians are trained.

Make honesty your foundation

The AMA this year released a strategic plan to embed racial justice and advance health equity. The plan recognizes the harmful effects of the AMA’s past, targets the systemic inequities in the health care system and other social institutions, and charts a path toward a more promising and equitable future for patients and physicians alike.

The AMA’s plan centers on a three-year road map with five strategic approaches. Dr. Maybank focused on three of them to help other organizations get their health equity aspirations out of the abstract and into action.

Embed racial justice everywhere

One of the AMA’s approaches is to embed racial and social justice throughout its systems, policies, practices and culture. And while those might seem like macro-level issues, they all play out on the level of individuals.

“Most of us have good intentions about the impact of the decisions that we're making,” Dr. Maybank said. “We tend to focus on the parameters definitely around diversity and inclusion—great, important to do. We’ll talk about how are we engaging with communities—[also] important to do.”

But what often isn’t discussed is how to transform ourselves—our minds and hearts—to “work towards changing the structures and the systems that are in place within our institutions that are perpetually harming and driving these inequities,” Dr. Maybank said.

Learn more about health equity education on the AMA Ed Hub™, which features CME from the AMA Center for Health Equity and curated education from collaborating organizations. Resources include AMA STEPS Forward™ open-access toolkits, AMA Journal of Ethics^® articles and podcasts and the “Prioritizing Equity” video series.

Push upstream, and keep pushing

Addressing the determinants of health inequities requires shifting one’s gaze to structural drivers and also empowering physicians and their employers to dismantle structural racism.

Medical education is crucial to this in several ways. One is by adopting a public health framework, which includes supporting the 10 essential public health services.

Another is by eliminating race-based clinical algorithms and teaching about their historical public health implications. Conversations about race-based medicine, Dr. Maybank noted, often center on the impact they have on individual patients. But they may fail to ask about the public health implications that result from so many patients having been prevented from accessing care for so long.

Related Coverage

City-level data reveals health inequities are far from inevitable

Foster racial healing

Charting a new course for a health system and a community requires promoting pathways for truth, reconciliation and transformation.

The AMA, for its part, recently removed the bust of Nathan Smith Davis, MD—commonly thought of as the association’s founder—from public view and placed it in the organization’s archive. Dr. Davis actively worked to exclude Black and women physicians from membership in the AMA in the mid- to late-19th century.

“These are not easy decisions, but again, I think if we're really committed to this space of equity—not harming [but] valuing, caring for people … we have the opportunity to do better and differently,” Dr. Maybank said.

Watch a recent “Prioritizing Equity” panel discussion with leaders from the AMA, American Academy of Pediatrics and the American Psychiatric Association on moving beyond apology toward restorative justice.

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An AHRQ-funded resource–"Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care How-To-Implement Toolkit"—is available to help primary care teams reduce the number of patients on long-term opioid therapy for chronic pain. The evidence-based toolkit offers a quality improvement roadmap for redesigning patient care without practice facilitators or other external support. It helps clinical staff develop standardized workflows, track key measures and use electronic health record tools and registries. ###

A federal appeals court in New Orleans has suspended a COVID-19 vaccination requirement announced by President Joe Biden's administration for private employers with more than 100 employees, according to The Washington Post. [Becker's Health Review 11.7.2021) 

What is ahead for Illinois and other states? 

The U.S. Court of Appeals for the Fifth Circuit issued the decision Nov. 6 after a group of plaintiffs — including Louisiana, Utah, Texas, South Carolina and Mississippi — filed a lawsuit Nov. 5 questioning the Occupational Safety and Health Administration's authority in issuing the rule. 

In the decision, a panel of three judges wrote there is "cause to believe there are grave statutory and constitutional issues with the mandate."

The court's decision — which is not a ruling on policy merits — temporarily stops the vaccination requirement while the court does a more thorough review. The Justice Department has until 5 p.m. Nov. 8 to respond to the lawsuit's request for a more permanent freeze of the requirement.

Louisiana Attorney General Jeff Landry issued a statement praising the Fifth Circuit's decision, describing it as "a win for the liberty of job creators and their employees." He said the court's action "not only halts Biden from moving forward" but also "commands the judicious review we sought." 

OSHA issued an emergency temporary standard Nov. 4 outlining COVID-19 vaccination requirements for employers with 100 or more employees. The standard is expected to cover 84 million private-sector workers and two-thirds of the U.S. private-sector workforce. 

OSHA said businesses covered by the emergency temporary standard must put in place a mandatory COVID-19 vaccination policy, unless they adopt a policy requiring employees to be vaccinated or undergo regular testing and wear a face covering at work. Under the standard, employers also must provide paid time off to workers to get inoculated and provide paid leave to employees to recover from any side effects.

In an interview Nov. 7 on ABC , U.S. Surgeon General Vivek Murthy, MD, defended the vaccination requirement.

"The President and the administration wouldn't have put these requirements in place if they didn't think that they were appropriate and necessary, and the administration is certainly prepared to defend them," he told "This Week" co-anchor Martha Raddatz, adding that there is a history of vaccination requirements in the U.S.

But the emergency temporary standard has received some pushback from states and business groups, which are concerned about disruptions during the holiday season.

In addition to the Fifth Circuit case in Louisiana, a coalition of 11 states sued President Biden's administration Nov. 5 in the U.S. Court of Appeals for the Eighth Circuit over the rule for private businesses.

CMS has also announced a separate vaccination rule expected to cover 17 million healthcare workers at healthcare facilities participating in Medicare and Medicaid programs. The CMS regulation preempts state laws and other federal regulation requirements for all facilities that are regulated by CMS' Conditions of Participation.

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