Institutional Variation in Specialty Palliative Care Consultation Among Patients With Persistent Critical Illness: A Cohort Study.

Background: Development of persistent critical illness (PerCI) necessitating prolonged ICU stays varies across hospitals. Specialty palliative care consultation may mitigate PerCI development by influencing the transition to comfort-directed care when appropriate.

Research Question: Do hospitals with the lowest rates of PerCI have higher use of specialty palliative care consultations during the first 3 days of admission to the ICU as compared with hospitals with the highest rates of PerCI?

Study Design And Methods: This was a retrospective cohort of veterans admitted to Veterans Affairs (VA) ICUs from October 2015 through December 2021.

Veteran Mental Health Emergency Care Utilization Following SARS-CoV-2 Infection.

Objective: To evaluate whether Veterans infected with SARS-CoV-2 have an elevated risk for needing mental health emergency care (MHEC) relative to uninfected comparators, as measured by emergency department or urgent care clinic utilization for a mental health diagnosis.

Data Sources/extraction: Data from Veterans Health Administration (VHA), VHA-paid, and Centers for Medicare & Medicaid-paid services were used to identify incident MHEC use within 1 year of infection for Veterans with a SARS-CoV-2 infection and matched comparators.

Study Design: This was a national, retrospective cohort study that leveraged a target trial emulation framework to examine long-term outcomes of SARS-CoV-2 infection among Veterans enrolled in VHA care.

Institutional support for navigating abortion bans in pulmonary and critical care: a multistate qualitative study.

Abortion bans enacted by numerous US states between 2022 and 2024 offered little guidance to health care systems on pragmatic implementation. Early studies identified meaningful impacts to obstetric and gynecological patients and clinicians and strategies for institutions to support clinicians in these specialties. There is widespread concern regarding the legal implications of these bans on all specialties, and the impact of institutional responses to abortion bans on clinicians outside of obstetrics and gynecology is unknown.

Target Trial Emulation of SARS-CoV-2 Infection Versus No Infection and Risk of Post-COVID-19 Conditions in the Omicron Variant Versus Prior Eras.

Background: Coronavirus disease 2019 (COVID-19) has been linked to the development of post-COVID-19 conditions (PCCs). We investigated whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases the risk of selected PCCs or death up to 1 year after infection, separately in the wild-type (WT), Alpha-transition, Delta, and Omicron eras and by vaccination status.

Methods: We used health records of the Veterans Health Administration to emulate a hypothetical target trial of SARS-CoV-2 infection versus no infection.

Accuracy of Intensivist Prognostications of Deterioration within the Intensive Care Unit and Development of Persistent Critical Illness: A Prospective Cohort Study.

Persistent critical illness (PerCI) is costly, increasing in incidence, and not reliably predicted with existing risk-prediction tools. To assess whether attending intensivists can identify patients at heightened risk of developing PerCI. We conducted a prospective longitudinal assessment from August 2020 to January 2023.

US Physicians' Perceived Impacts of Abortion Bans in Pulmonary and Critical Care Medicine.

Background: Eighteen US states implemented abortion bans between 2022 and 2024. Although emerging evidence shows bans have impacted obstetrics and gynecology, little is known about their impact on other specialties. We hypothesize that pulmonary and critical care medicine may be adversely impacted due to the time-sensitive, high-acuity needs of their patients.

The Impact of Applicant Sex on Pulmonary and Critical Care Medicine Fellowship Letters of Recommendation: A Multisite Study.

Letters of recommendation (LORs) are crucial for fellowship applications, but implicit biases can affect their quality. The aim of this study was to examine sex-based differences among multiinstitutional pulmonary and critical care medicine (PCCM) fellowship LORs. All 2021 PCCM fellowship applications submitted to five regional U.

Effectiveness of the 2023-to-2024 XBB.1.5 COVID-19 Vaccines Over Long-Term Follow-up : A Target Trial Emulation.

Background: Monovalent COVID-19 vaccines targeting the XBB.1.5 Omicron variant were introduced in September 2023.

Characterizing the Use of Time-Limited Trials in Patients With Acute Respiratory Failure: A Prospective, Single-Center Observational Study.

Importance: A time-limited trial (TLT) is a collaborative plan among clinicians, patients, and families to use life-sustaining therapy for a defined duration, after which the patient's response informs whether to continue care directed toward recovery or shift the focus toward comfort. TLTs are a promising approach to help navigate uncertainty in critical illness, yet little is known about their current use.

Objectives: To characterize TLT use in patients with acute respiratory failure (ARF).

Regional variation in financial hardship among US veterans during the COVID-19 pandemic.

Geographic variation in hardship, especially health-related hardship, was identified prior to and during the pandemic, but we do not know whether this variation is consistent among Veterans Health Administration (VHA)-enrolled veterans, who reported markedly high rates of financial hardship during the pandemic, despite general and veteran-specific federal policy efforts aimed at reducing hardship. In a nationwide, regionally stratified sample of VHA-enrolled veterans, we examined whether the prevalence of financial hardship during the pandemic varied by US Census region. We found veterans in the South, compared with those in other census regions, reported higher rates of severe-to-extreme financial strain, using up all or most of their savings, being unable to pay for necessities, being contacted by collections, and changing their employment due to the kind of work they could perform.

Responding to the ripple effects of sexual harassment: an emergency management framework.

Sexual harassment in academia is endemic driven by gender-based inequalities and sustained through organizational tolerance, and its impact extends beyond the primary victim(s). Applying principles of emergency management provides a framework for institutions to balance their obligations to the primary victim(s) while also acknowledging the need to restore the well-being and culture of secondary victims.

Mapping the process of ICU care delivery to improve treatment decisions in acute respiratory failure.

Evidence suggests system-level norms and care processes influence individual patients' medical decisions, including end-of-life decisions for patients with critical illnesses like acute respiratory failure. Yet, little is known about how these processes unfold over the course of a patient's critical illness in the intensive care unit (ICU). Our objective was to map current-state ICU care delivery processes for patients with acute respiratory failure and to identify opportunities to improve the process.

Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection.

Importance: Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations-that is, hospitalizations for conditions that can usually be effectively managed in ambulatory care settings.

Objective: To examine whether SARS-CoV-2 is associated with potentially preventable hospitalization in a nationwide cohort of US veterans.

The Association of Pregnancy With Outcomes Among Critically Ill Reproductive-Aged Women: A Propensity Score-Matched Retrospective Cohort Analysis.

Background: The maternal mortality rate in the United States is unacceptably high. However, the relative contribution of pregnancy to these outcomes is unknown. Studies comparing outcomes among pregnant vs nonpregnant critically ill patients show mixed results and are limited by small sample sizes.