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Anastasis

Anastasis 23,485

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2 hours ago, jimmyjazz said:

Do you agree that there is some concern about vaccine penetration X efficacy? 

My thinking is basically:

1) Get a vax to market ASAP, prioritized to high risk individuals.

2) Roll it out in waves based on risk profiling.

3) Continuously collect surveillance data to red flag any safety issues as they emerge.

 

I will line up for a shot from PFE or MRNA as soon as they call my number. Sure concerns about efficacy.  We don't know one way or the other until the data are read out. Penetration? Everybody that is in my close circle will be lined up. I am more than willing to shame anyone who is not, with rare exceptions. 

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I'd just like to point out that neither myself nor any of my fellow nurses, fellow advanced nurse practitioners, and other healthcare providers ever swore an oath that we would lay down our lives for

Bama Chick
Bama Chick

Welp, it finally happened. I snapped in public today. I went into work for a bit this morning because I’m trying to figure out the safest way to host physicians we are recruiting given our CV-19 sit

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I don't really know what to say anymore tbh. What happened last night is hard to put into words for anyone who hasn't worked in a hospital healthcare setting. Just unreal. Everyone is getting fucked.

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Anastasis

Anastasis 23,485

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2 hours ago, Bama Chick said:

Branded Tamiflu costs between $175-250 without insurance currently.

It was launched in 1999 and I couldn’t find anything on the Google about its launch price.

The cost-effectiveness of Tamiflu has long been a topic of debate. It's not particularly low cost, nor effective. Not really a great example in this discussion.

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Bookman

Bookman 4,642

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On 10/14/2020 at 10:11 PM, Hmbre97 said:

What I originally came into this thread for was after seeing the outbreaks occuring on some CFB teams now, I wonder if the non-mask wearing freedom patriots will start to purposefully avoid going to the doctor when sick to avoid confirming they are covid positive. As whipped up as some of that bunch is, I wonder if any of them would literally risk dying to avoid admitting they were wrong? Sorta in the same vein that Herman Cain's twitter account still posts covid hoax shit despite the account owner dying from covid.

Do not underestimate the pride of stupid people.

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Oh hey, we have a pretty cool hospital here in Austin. Mostly because of the people who work there.

https://thehospitalleader.org/lessons-from-the-pandemic-building-covid-19-centers-of-excellence/

Quote

Lessons from the Pandemic: Building COVID-19 Centers of Excellence

By Kirsten Nieto, MD, Read G. Pierce, MD, Christopher Moriates, MD, SFHM, Elizabeth Schulwolf, MD |  October 13, 2020 |  2 

This article is part of a series in The Hospital Leader written by members of the Division of Hospital Medicine at Dell Medical School at The University of Texas in Austin, exploring lessons learned from the coronavirus pandemic and outlining an approach for creating COVID-19 Centers of Excellence.

Like most of America, March brought more madness than we anticipated. The scope of the COVID-19 pandemic and the extent of our unpreparedness caught us all off-guard. In the face of rapidly changing public health directives, social and political mandates, scientific recommendations, and care delivery demands, hospitalists sprung to action. We improvised, adapted, and repurposed existing communication tools; refashioned multidisciplinary meetings; drew on community, outpatient, and subspecialty provider relationships; and crafted new data collection systems.

Our Division of Hospital Medicine at Dell Medical School (DMS) and our partner hospital, Dell Seton Medical Center (DSMC), applied these principles of quality science, patient safety, and complex systems redesign to build a care delivery model for COVID-19: a COVID center of excellence (COVID COE). Dell Seton Medical Center is part of the regional Seton hospital system in Central Texas, and a member of the national Ascension network. Our aim in this blog series is to engage existing ideas about the COE model, describe what this model entails for COVID-19, and share lessons learned in its development.

Any COE should achieve outstanding results for a defined population. Our DMS/DSMC patients with COVID-19 experienced impressive early outcomes. As our community’s only safety-net hospital, our patients presented with high risk for excessive morbidity and mortality. According to Vizient, our clinical acuity and complexity of care reached record highs from April to June 2020. Among our first 269 COVID-19 admissions, 9.8% were expected to die; only 4.1% did, resulting in a mortality index (observed-to-expected mortality) of 0.42. For all hospitals in Vizient, the average mortality index for COVID-19 patients was 0.89, and for academic centers it was 0.92. We achieved similar results for length of stay, with a local index of 0.86 compared to 1.11 for all hospitals.

These outcomes led us to carefully explore what structures, processes, and behaviors enabled this level of performance. A number of elements emerged that we believe are essential in building a COVID COE. Over the coming weeks, we will explore each of these in more depth. Through a series of articles in The Hospital Leader, we hope to generate – and share – what worked and the many lessons learned. In particular, our goal is to invite dialog around the essential functions of a COVID-19 Center of Excellence.

We will explore the domains we believe essential to a COVID COE model:

Cohort a large proportion of patients with COVID-19, across the full spectrum and complexity of illness

Adapt staffing models and develop novel workflows to optimally manage the specific needs of COVID-19 patients

Integrate key specialties into routine multidisciplinary conferences focused on COVID-19 care

Create structures to rapidly adjudicate and integrate emerging science into standardized clinical care delivery, including access to and discipline around selecting and deploying clinical and basic science trials within the organization’s bandwidth

Foster a culture of collaboration and a commitment to extremely rapid (days to weeks) learning cycles

Ingrain nimble, multi-directional communication rituals among frontline clinicians and across the organization

Integrate learners into every possible facet of the COVID-19 care model

We aim to describe specific structures and practices for each of these facets, and to discuss the metrics which optimally assess individual and community health impact, including risk-adjusted mortality, length of stay, patient satisfaction, and return to health – especially for populations facing systemic health disparities during the pandemic. We also will reference pertinent literature.

Importantly, we believe the benefits of a COE model extend beyond impacts on patients and community and support satisfaction among physicians, nurses, and other members of the healthcare workforce through development of better organizational structures and a deeper sense of community, purpose, self-efficacy, and pride. Additionally, we anticipate COVID COEs will generate new leadership roles and quality improvement opportunities for hospitalists and other hospital-based clinicians.

This series will feature articles every couple of weeks written by members of our Division of Hospital Medicine at Dell Medical School. These providers cared for COVID-19 patients along with us and proactively led initiatives to improve care. From our collective experience the COVID-19 Center of Excellence model emerged. Together, with the insights of our colleagues from across the country, we can all plot a path forward built on a stronger foundation of excellence – for the next wave and for the long term.

 

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SizzleChest

SizzleChest 8,284

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Posted (edited)
15 hours ago, Anastasis said:

My thinking is basically:

1) Get a vax to market ASAP, prioritized to high risk individuals.

2) Roll it out in waves based on risk profiling.

3) Continuously collect surveillance data to red flag any safety issues as they emerge.

 

I will line up for a shot from PFE or MRNA as soon as they call my number. Sure concerns about efficacy.  We don't know one way or the other until the data are read out. Penetration? Everybody that is in my close circle will be lined up. I am more than willing to shame anyone who is not, with rare exceptions. 

Same.  No adenovirus vaxx for me.  Post vaccination, I will still wear a mask and social distance in public through 2021.  Have always been strict about hand washing.

Edited by SizzleChest
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BradInATX

BradInATX 9,208

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15 minutes ago, 4th&Five said:

 

Seems like Fauci knows that the optics of Trump firing him would be terrible and is in give-no-effs mode at this point. Surely he has to know he's fired the day after if Trump wins re-election. I wonder if he and Biden have an agreement in place for Fauci to stay on with his administration. Fauci has definitely gotten more bold towards Trump lately.

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Guest Lobo

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i think automobile fatalities work the same way.  The most you test the cars ahead of time, the more people will die later that day in car accidents.  

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cactusflinthead

cactusflinthead 27,602

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22 hours ago, hayden_horn said:

yeah, but there is a ton of disingenuous votes in that 87%. i agree we should keep politics out of dt. i'm going to focus more on doing so, by moving political posts to the fucking political board. like you, i don't have time to read every post on every thread, but if i go back 10 pages in this thread alone, that we mods have retitled as "featuring lots of politics," there are plenty of political posts, either direct in your face political bullshit, or gaslighting. 

i simply do not understand the desire to talk about politics outside the politics board. 

if yall (not you, blacklab, but the rest of the board) really want politics out of dt, i'll fucking do it. i'll force you back into the cloak room. but many of you fled it for some reason, so you can come over here and code-talk, bait your political enemies into talking politics, so you can point your finger and yell "no politics!" it's a fucking beating.  

Does that mean that this is news again?

I'll be glad to post actual fucking news.

 

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Brisketexan

Brisketexan 105,329

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Oh I see, it got put in here. Don't let the title fool you. It's still NO POLITICS in the DT Covid thread. 
That's news that will never pass muster over there. 

Here’s what I don’t get....fear is for pussies, and even wearing a mask shows that you’re a super pussified libtard. But that EXACT same crowd says you’re insane if you leave the house without a .45 in a shoulder holster and a backup .380 in your boot because MS-13 and thugs are gonna kill is all.

Their entire worldview is governed by fear....and the first time that fear makes the slightest bit of sense....they can’t process it.

We are Stupidistan.
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Neonmoon

Neonmoon 38,130

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3 minutes ago, TexEx15 said:

 

This is a great step. I know people will freak out because of the death possibility, but the article states the participants will be exposed to a diluted dose of the virus, thus they will less likely develop anything severe. 

Quote

The experiment will take place in a quarantine ward of a north London hospital. After inhaling a diluted dose of the virus, the trial participants will be closely monitored, thus enabling scientists and doctors to better understand the disease and how a vaccine can fight it.

 

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Guest Lobo

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God bless these young folks.  Let's quit shitting on the younger generations considering stupid people aged 45-70 spread this through our nation like selfish assholes.  

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Al Bundy's Napoleon Hand

Al Bundy's Napoleon Hand 13,587

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Art of the Deal

https://www.forbes.com/sites/danielcassady/2020/10/19/the-us-has-thrown-out-faulty-ventilators-russia-sent-as-pandemic-aid/

"But the Aventa-M ventilators were never used – they required an electrical voltage not compatible in the U.S., which means they couldn’t be used in the hospitals without an adapter that wasn’t readily available, Buzzfeed News reported, and just a few weeks later, the same model ventilator burst into flames in Russia, killing six people."

"In exchange for the April shipment, the U.S. sent $5.6 million in medical supplies to Russia over the following two months, including 200 ventilators – the shipment Russia sent the U.S. was worth around $1 million."

 

 

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Horn Under a Bad Sign

Horn Under a Bad Sign 20,488

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2 hours ago, Al Bundy's Napoleon Hand said:

Art of the Deal

https://www.forbes.com/sites/danielcassady/2020/10/19/the-us-has-thrown-out-faulty-ventilators-russia-sent-as-pandemic-aid/

"But the Aventa-M ventilators were never used – they required an electrical voltage not compatible in the U.S., which means they couldn’t be used in the hospitals without an adapter that wasn’t readily available, Buzzfeed News reported, and just a few weeks later, the same model ventilator burst into flames in Russia, killing six people."

"In exchange for the April shipment, the U.S. sent $5.6 million in medical supplies to Russia over the following two months, including 200 ventilators – the shipment Russia sent the U.S. was worth around $1 million."

 

 



You would think that one of the first things experienced international business travelers would check is "will the adapter be compatible here?"  I mean, it's a consideration everywhere you fucking go with a laptop. 

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Hugo Stiglitz

Hugo Stiglitz 23,367

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8 minutes ago, pyrohornIII said:

Are we not seeing cases because they aren't being reported or because the reports are being manipulated?   Just seems really quiet now with cases in rural areas.   Anyone seen anything on the trustworthiness of DSHS numbers?  

Could also be b/c fewer people are going to get tested when they get sick, they’re trying to ride it out. 

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NameAlreadyInUse

NameAlreadyInUse 5,120

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So my company has for the last several months been giving us weekly updates on our companies various offices, their status as to who can go into the office and who can't, and that has included a date of January 4, which is the earliest that anyone could be required to come back into the office.  They just sent us an update, and our new date is July 15.  I expect that tech companies in the PNW like Amazon and Microsoft have done something similar.  That's more than a year of rent of office space that is basically not going to be used. Looks like the tech companies are starting to figure out that even if a vaccines was approved tomorrow, it's going to be a good long while before we start to get back to normal.  

I keep thinking it didn't have to be this way, and I have to say I'm pretty much frustrated and angry every time I allow myself to dwell on it.  Can't wait for this story line to get completed.  

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hayden_horn

hayden_horn 11,365

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10 minutes ago, NameAlreadyInUse said:

So my company has for the last several months been giving us weekly updates on our companies various offices, their status as to who can go into the office and who can't, and that has included a date of January 4, which is the earliest that anyone could be required to come back into the office.  They just sent us an update, and our new date is July 15.  I expect that tech companies in the PNW like Amazon and Microsoft have done something similar.  That's more than a year of rent of office space that is basically not going to be used. Looks like the tech companies are starting to figure out that even if a vaccines was approved tomorrow, it's going to be a good long while before we start to get back to normal.  

I keep thinking it didn't have to be this way, and I have to say I'm pretty much frustrated and angry every time I allow myself to dwell on it.  Can't wait for this story line to get completed.  

agreed, dude. if i take a couple moments to reflect on it, the anger becomes unhealthy.

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Brisketexan

Brisketexan 105,329

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1 minute ago, hayden_horn said:

agreed, dude. if i take a couple moments to reflect on it, the anger becomes unhealthy.

Yep.  I managed to find the right phrase when visiting with our kids the other night -- "some situations are just to be endured, not to be enjoyed."  There's no going around, over, or under this -- just THROUGH.  We'll get there.  And we'll get there....when we get there.  There IS another side.  So, head down, and carry on.

Sigh.

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