BACKGROUND AND OBJECTIVE: Despite the American Academy of Pediatrics' recommendations against pediatric use of creatine and testosterone boosters, research suggests that many young teenagers take these dietary supplements. Our objective was to determine to what extent health food stores would recommend and/or sell creatine and testosterone boosters to a 15-year-old boy customer.
Objective We describe the design, implementation, and validation of an online, publicly available tool to algorithmically triage patients experiencing severe acute respiratory syndrome coronavirus (SARS-CoV-2)-like symptoms. Methods We conducted a chart review of patients who completed the triage tool and subsequently contacted our institution's phone triage hotline to assess tool- and clinician-assigned triage codes, patient demographics, SARS-CoV-2 (COVID-19) test data, and health care utilization in the 30 days post-encounter. We calculated the percentage of concordance between tool- and clinician-assigned triage categories, down-triage (clinician assigning a less severe category than the triage tool), and up-triage (clinician assigning a more severe category than the triage tool) instances. Results From May 4, 2020 through January 31, 2021, the triage tool was completed 30,321 times by 20,930 unique patients. Of those 30,321 triage tool completions, 51.7% were assessed by the triage tool to be asymptomatic, 15.6% low severity, 21.7% moderate severity, and 11.0% high severity. The concordance rate, where the triage tool and clinician assigned the same clinical severity, was 29.2%. The down-triage rate was 70.1%. Only six patients were up-triaged by the clinician. 72.1% received a COVID-19 test administered by our health care system within 14 days of their encounter, with a positivity rate of 14.7%. Conclusion The design, pilot, and validation analysis in this study show that this COVID-19 triage tool can safely triage patients when compared with clinician triage personnel. This work may signal opportunities for automated triage of patients for conditions beyond COVID-19 to improve patient experience by enabling self-service, on-demand, 24/7 triage access.
Although 1.35 million children visit emergency departments for sports-related injuries each year in the United States, athletic bodies lack a systematic approach for monitoring injury risk and adopting interventions to curtail injuries. 1 Rather than using randomized clinical trials or other evidence-based approaches to evaluate interventions, the decision-making process for adopting interventions is characterized by protracted debates that overweigh subjective factors, such as how sports have traditionally been played. 2,3 The magnitude of this problem merits serious attention; more than 46.5 million children participate in team sports in the United States alone. 1 Two underappreciated factors contribute to this situation: behavioral biases that distort and delay intervention decisions and a lack of data. In this Viewpoint, we draw lessons from behavioral economics, as well as prior sports injury intervention debates, to offer prescriptions for improving the decision-making processes for sports injury prevention.The debate in the early 2000s regarding introducing protective eyewear in girls' lacrosse epitomizes the challenge of implementing changes. In the early 2000s, many coaches and administrators were opposed to mandating protectiveeyewear,arguingthatitsusewouldpromoteaggressive play and increase the risk of injury. 2 Skeptics also fearedthatadoptingeyewearprotectionwouldundermine the character of girls' lacrosse and blur the distinction between girls' lacrosse, a low-contact sport, and boys' lacrosse, a high-contact sport. 2 After years of debate, US Lacrosse mandated eyewear use for girls' lacrosse in 2005; following this change, eye injuries decreased by 84%, with noassociatedincreaseintheroughnessofplay. 2 Similardebates have occurred across youth sports. 3 In controversial changes to reduce head injuries, US Soccer recommended a ban on heading of the ball for players younger than 10 years, US Hockey banned checking for youth 12 years and younger, and Pop Warner Football limited physical contact in practices and eliminated kickoff returns, the most dangerous play in US football. 3 Despite decades of sports injury prevention efforts, both injury data and evidence of the efficacy of protective gear and other interventions are surprisingly limited. Protective gear is typically initially adopted by selfselected volunteers and followed by mandates in different jurisdictions based on subjective perceptions of risk rather than empirical evidence. Injury data are rarely compiled in a systematic way, and calls for mandatory injury reporting remain rare. 3 Compounding this problem is the challenge of compiling accurate statistics for injuries, such as concussions, that require subjective assessments for diagnosis.
Background: In-hospital rapid response teams are critical to the prompt management of neonatal emergencies occurring in hospital delivery rooms. However, structural obstacles that exist within health care facilities may hinder the successful implementation of these teams. This study examined the prevalence of structural obstacles potentially impeding neonatal rapid response team movements between neonatal intensive care units and delivery rooms in hospitals with pediatric residency programs across the United States.
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