The Impact of the COVID-19 Outbreak on Intensive Care in Northern Saitama Japan

Background We examined and compared the actual impact of COVID-19 on local medical care in northern Saitama Japan, especially in intensive care units (ICUs), before (2019) and during (2020) the pandemic. Methods The impact of COVID-19 on emergency care responses was compared with acceptances and refusals in 2019 and 2020. We also examined the number of surgeries performed by ICU surgical departments. The impact on intensive care was examined regarding the numbers of incident reports and the severity percentage calculated from the integrated team medical care and safety system. We also compared the overtime work of physicians working. Results In 2019, there were 2,136 emergency patient requests, and 1,811 patients were received. In contrast, in 2020, there were 2,371 emergency patient requests, and 1,822 patients were accepted, representing a decrease of 76% (p = 0‧931). There were significantly more refusals in 2020, 303 (14‧1%) in 2019 and 506 (21‧3%) in 2020 (p = 0‧0004). In 2020, the number of surgeries increased in neurosurgery, cardiac surgeries, and vascular surgeries and over time increased in all surgical units. There were 396 incidents reported in ICUs in 2019; this increased significantly to 510 in 2020 (p = 0‧001). Conclusion Even though intensive care management was restricted, the number of patients and doctors’ overtime work increased compared to before the spread of COVID-19, and the surrounding environment led to an increase in the number of incidents. The environments in ICUs must be actively improved to prepare for an even more severe situation in the future.

Benefits of EPAs at risk? The influence of the workplace environment on the uptake of EPAs in EPA-based curricula

Introduction Entrustable Professional Activities (EPAs) have been applied differently in many postgraduate medical education (PGME) programmes, but the reasons for and the consequences of this variation are not well known. Our objective was to investigate how the uptake of EPAs is influenced by the workplace environment and to what extent the benefits of working with EPAs are at risk when the uptake of EPAs is influenced. This knowledge can be used by curriculum developers who intend to apply EPAs in their curricula. Method For this qualitative study, we selected four PGME programmes: General Practice, Clinical Geriatrics, Obstetrics & Gynaecology, and Radiology & Nuclear Medicine. A document analysis was performed on the national training plans, supported by the AMEE Guide for developing EPA-based curricula and relevant EPA-based literature. Interviews were undertaken with medical specialists who had specific involvement in the development of the curricula. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs. Results An important part of the variation in the uptake of EPAs can be explained by environmental factors, such as patient population, the role of the physician in the health-care system, and the setup of local medical care institutions where the training programme takes place. The variation in uptake of EPAs is specifically reflected in the number and breadth of the EPAs, and in the way the entrustment decision is executed within the PGME programme. Discussion Due to variation in uptake of EPAs, the opportunities for trainees to work independently during the training programme might be challenging. EPAs can be implemented in the curriculum of PGME programmes in a meaningful way, but only if the quality of an EPA is assessed, future users are involved in the development, and the key feature of EPAs (the entrustment decision) is retained.

Uncompensated Care: How Much is Too Much?

Texas is home to the largest uninsured population in the U.S. Such problems emerge, in large measure, from thestate’s rejection of Medicaid expansion. That decision has prevented Texas from receiving $100 billion in federalcash over a decade. Consequently, the number of uninsured residents either going without local medical care oroverloading adjacent communities is likely to increase. Therefore, this study seeks to explain the implicationsof Medicaid expansion in Denton county. This paper explores the effects of expanding Medicaid and how thatwould affect race, income, and Medicaid eligibility for indigent patients. The results of a Python–based simulationshow that, adjusting for Denton’s population growth at projected levels of uninsured, by 2020 the uncompensatedcare will cost Denton County $42,716,796. This number will continue to rise to a total of $61,462,134 as a resultof ceasing Medicaid expansion and getting rid of the individual mandate. These numbers are important as theyshow the rising costs of uncompensated care that are associated with an increase in population growth.