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Ideas and Opinions | 
Thomas Rea, MD, MPH; and Mickey Eisenberg, MD, PhD
The survival of patients who have sudden cardiac arrest may differ markedly among communities. The Institute of Medicine recently evaluated the causes for such disparities and issued a “call to action” for improvement. The authors discuss the steps that should help bring about the improvements needed.
Topics: sudden cardiac death, institute of medicine (u.s.)
Ideas and Opinions | 
Adrian F. Hernandez, MD, MHS; Rachael L. Fleurence, PhD; and Russell L. Rothman, MD, MPP
Growing complexity and administrative burdens are making clinical trials less attractive to clinicians, health systems, sponsors, and patients. To address these challenges, the Patient-Centered Outcomes Research Institute created the National Patient-Centered Clinical Research Network (PCORnet), a “network of networks” to facilitate research that addresses important clinical questions. The authors discuss ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness), which will compare 2 different aspirin doses in high-risk patients with a history of heart disease while simultaneously testing PCORnet's capacity to accomplish its core mission.
Topics: aspirin, heart diseases, patient-centered care, comparative effectiveness research, compare 1 trial, clinical research, myocardial infarction, hemorrhage, cerebrovascular accident, ischemic stroke, follow-up, electronic medical records
Ideas and Opinions | 
Lindsay M. Jaacks, PhD; Mohammed K. Ali, MBChB, MSc, MBA; John Bartlett, MD; Gerald S. Bloomfield, MD, MPH; William Checkley, MD; Thomas A. Gaziano, MD, MSc; Douglas C. Heimburger, MD, MS; Sandeep P. Kishore, MD, PhD; Racquel E. Kohler, PhD, MSPH; Kasia J. Lipska, MD, MHS; Olivia Manders, MA; Christine Ngaruiya, MD, DTM&H; Robert Peck, MD, MS; Melissa Burroughs Pena, MD, MS; David A. Watkins, MD, MPH; Karen R. Siegel, PhD, MPH; and K.M. Venkat Narayan, MD, MSc, MBA
Noncommunicable diseases (NCDs) are among the leading causes of death and disability throughout the world. In September 2014, U.S. researchers met to discuss the challenges and opportunities in conducting global NCD research. This essay summarizes 4 strategies for moving forward on a global NCD research agenda.
Topics: communicable diseases, investments, mentors, world health, united states national institutes of health, disability
Ideas and Opinions | 
Jonathan Purtle, DrPH, MSc; John A. Rich, MD, MPH; Joel A. Fein, MD, MPH; Thea James, MD; and Theodore J. Corbin, MD, MPP
Violently injured patients are at risk for reinjury, violence perpetration, and posttraumatic stress; however, they have traditionally received in-hospital care that addresses only their physical injuries. The authors describe the organizational components of multidimensional, hospital-based violence intervention programs; evidence of the success of such initiatives; and how the Affordable Care Act may affect them.
Topics: hospitals, violence prevention
Ideas and Opinions | 
Arif H. Kamal, MD, MHS; Jennifer M. Maguire, MD; and Diane E. Meier, MD
The United States is currently in the midst of a national crisis in providing accessible and responsive palliative care due to a shortage of professionals trained to provide this care. The authors suggest one possible approach for dealing with this crisis.
Topics: palliative care, workforce
Reviews | 
Jennifer H. Han, MD, MSCE*; Nancy Sullivan, BA*; Brian F. Leas, MS, MA*; David A. Pegues, MD; Janice L. Kaczmarek, MS; and Craig A. Umscheid, MD, MSCE
The cleaning of hard surfaces in hospital rooms is critical for reducing health care–associated infections. This review describes the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. Key informants were interviewed, and a systematic search for publications since 1990 was done with the use of several bibliographic and gray literature resources. Studies examining surface contamination, colonization, or infection with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci were included. Eighty studies were identified—76 primary studies and 4 systematic reviews. Forty-nine studies examined cleaning methods, 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation. Only 5 studies were randomized, controlled trials, and surface contamination was the most commonly assessed outcome. Comparative effectiveness studies of disinfecting methods and monitoring strategies were uncommon. Future research should evaluate and compare newly emerging strategies, such as self-disinfecting coatings for disinfecting and adenosine triphosphate and ultraviolet/fluorescent surface markers for monitoring. Studies should also assess patient-centered outcomes, such as infection, when possible. Other challenges include identifying high-touch surfaces that confer the greatest risk for pathogen transmission; developing standard thresholds for defining cleanliness; and using methods to adjust for confounders, such as hand hygiene, when examining the effect of disinfecting methods.
Topics: disinfection, patients' rooms, therapeutic touch, healthcare associated infections, pathogenic organism, microbial colonization, touch sensation, contextual factors
In this issue, Han and colleagues' systematic review identifies gaps in the evidence base for hospital environmental cleaning. Unlike near-universal acceptance of the importance of hand hygiene, the prevailing view of the contribution of the inanimate health care environment to the spread of health care–associated infections swings back and forth. The editorialists underscore the need for carefully designed studies to help us understand the magnitude of contribution of the inanimate environment to the pathogenesis of these infections.
Topics: healthcare associated infections
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