Last data update: Jun 24, 2024. (Total: 47078 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Ramanathan T [original query] |
---|
Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: a prospective, multinational, multicentre, observational study.
Reyes LF , Murthy S , Garcia-Gallo E , Irvine M , Merson L , Martin-Loeches I , Rello J , Taccone FS , Fowler RA , Docherty AB , Kartsonaki C , Aragao I , Barrett PW , Beane A , Burrell A , Cheng MP , Christian MD , Cidade JP , Citarella BW , Donnelly CA , Fernandes SM , French C , Haniffa R , Harrison EM , Ho AYW , Joseph M , Khan I , Kho ME , Kildal AB , Kutsogiannis D , Lamontagne F , Lee TC , Bassi GL , LopezRevilla JW , Marquis C , Millar J , Neto R , Nichol A , Parke R , Pereira R , Poli S , Povoa P , Ramanathan K , Rewa O , Riera J , Shrapnel S , Silva MJ , Udy A , Uyeki T , Webb SA , Wils EJ , Rojek A , Olliaro PL . ERJ Open Res 2022 8 (1) Due to the large number of patients with severe coronavirus disease 2019 (COVID-19), many were treated outside the traditional walls of the intensive care unit (ICU), and in many cases, by personnel who were not trained in critical care. The clinical characteristics and the relative impact of caring for severe COVID-19 patients outside the ICU is unknown. This was a multinational, multicentre, prospective cohort study embedded in the International Severe Acute Respiratory and Emerging Infection Consortium World Health Organization COVID-19 platform. Severe COVID-19 patients were identified as those admitted to an ICU and/or those treated with one of the following treatments: invasive or noninvasive mechanical ventilation, high-flow nasal cannula, inotropes or vasopressors. A logistic generalised additive model was used to compare clinical outcomes among patients admitted or not to the ICU. A total of 40440 patients from 43 countries and six continents were included in this analysis. Severe COVID-19 patients were frequently male (62.9%), older adults (median (interquartile range (IQR), 67 (55-78) years), and with at least one comorbidity (63.2%). The overall median (IQR) length of hospital stay was 10 (5-19)days and was longer in patients admitted to an ICU than in those who were cared for outside the ICU (12 (6-23) days versus 8 (4-15) days, p<0.0001). The 28-day fatality ratio was lower in ICU-admitted patients (30.7% (5797 out of 18831) versus 39.0% (7532 out of 19295), p<0.0001). Patients admitted to an ICU had a significantly lower probability of death than those who were not (adjusted OR 0.70, 95% CI 0.65-0.75; p<0.0001). Patients with severe COVID-19 admitted to an ICU had significantly lower 28-day fatality ratio than those cared for outside an ICU. |
Legal literacy for public health practitioners
Yassine BB , Menon AN , Ramanathan Holiday T , Penn M . Public Health Rep 2021 137 (2) 370-374 Public health and law are inextricably intertwined. Law is the foundation of governmental public health practice, delineating the duties and authority to protect and promote conditions necessary for population health. 1 Law is also a social and structural determinant of health, because laws shape the physical, social, and economic environments that directly impact population health. 2 Public health laws at all levels of government enshrine public health strategies, are critical to addressing emerging issues, and are the means through which interventions are implemented and enforced. |
Health information blocking: Responses under the 21st Century Cures Act
Black JR , Hulkower RL , Ramanathan T . Public Health Rep 2018 133 (5) 610-613 Interoperability, or the easy, secure exchange of electronic health information (EHI), is now vital to health care and public health functions, including disease and laboratory reporting.1 Conversely, “information blocking,” or activities that interfere with collecting, using, and exchanging EHI, can seriously harm public health.2 The 21st Century Cures Act (the Act), signed into law on December 13, 2016, establishes a legal framework to: address the use and exchange of health data through health information technology (HIT), strengthen interoperability, and prevent information blocking, among other health-related initiatives.3,4 Before the Act, information blocking was not defined or well understood and could not be effectively prevented, leaving interoperability unprotected. The Act defined these concepts and incorporated them into Title IV of the Public Health Service Act (PHSA) under “Delivery.” This article describes the issues involved in information blocking, including the federal actions taken to identify the problem, prohibit it, and impose civil penalties for engaging in it, as well as the implications for interoperability. |
Transitioning from paper to digital: State statutory and regulatory frameworks for health information technology
Schmit C , Sunshine G , Pepin D , Ramanathan T , Menon A , Penn M . Public Health Rep 2017 132 (5) 33354917722994 OBJECTIVES: In all health system sectors, electronic health information (EHI) is created, used, released, and reused. We examined states' efforts to address EHI uses in law to provide an understanding of the EHI legal environment. METHODS: Attorney researchers used WestlawNext to search for EHI-related statutes and regulations of the US states, US territories, and the District of Columbia in effect as of January 2014. The researchers independently catalogued provisions by the EHI use described in the law. Researchers resolved discrepancies through peer review meetings and recorded the consensus codes for each law. RESULTS: This study identified 2364 EHI-related laws representing 49 EHI uses in 54 jurisdictions. A total of 18 EHI uses were regulated by ≥10 jurisdictions. More than 750 laws addressed 2 or more EHI uses. Jurisdictions varied by the number of EHI laws in effect, with a mean of 44 laws. Texas had the most EHI laws (n = 145). Hawaii and South Carolina had the fewest (n = 14 each). CONCLUSIONS: The EHI legal landscape is complex. The large quantity and diversity of laws complicate legal analysis, likely delay implementation of public health solutions, and might be detrimental to the development of emerging health information technology. Research is needed to understand the effect of EHI-related laws. |
Legal epidemiology: The science of law
Ramanathan T , Hulkower R , Holbrook J , Penn M . J Law Med Ethics 2017 45 69-72 The importance of legal epidemiology in public health law research has undoubtedly grown over the last five years. Scholars and practitioners together have developed guidance on best practices for the field, including: placing emphasis on transdisciplinary collaborations; creating valid, reliable, and repeatable research; and publishing timely products for use in decision-making and change. Despite the energy and expertise researchers have brought to this important work, they name significant challenges in marshalling the diverse skill sets, quality controls, and funding to implement legal epidemiology activities. The Centers for Disease Control and Prevention (CDC) has worked to develop cross-cutting research and translation on issues of national priority in legal epidemiology, and has explored ways to overcome some of these challenges. As such, this article describes a case study of the use of law to characterize states' prior authorization policies regarding medication used to treat attention-deficit/hyperactivity disorder (ADHD), a central component of a broader effort to improve behavior therapy options for young children with ADHD. This article highlights the types of legal epidemiology work we have undertaken, the application of this work to an emerging public health problem, and the lessons learned in creating impactful research for the field. |
Policy surveillance: A vital public health practice comes of age
Burris S , Hitchcock L , Ibrahim J , Penn M , Ramanathan T . J Health Polit Policy Law 2016 41 (6) 1151-1173 Governments use statutes, regulations, and policies, often in innovative ways, to promote health and safety. Organizations outside government, from private schools to major corporations, create rules on matters as diverse as tobacco use and paid sick leave. Very little of this activity is systematically tracked. Even as the rest of the health system is working to build, share, and use a wide range of health and social data, legal information largely remains trapped in text files and pdfs, excluded from the universe of usable data. This article makes the case for the practice of policy surveillance to help end the anomalous treatment of law in public health research and practice. Policy surveillance is the systematic, scientific collection and analysis of laws of public health significance. It meets several important needs. Scientific collection and coding of important laws and policies creates data suitable for use in rigorous evaluation studies. Policy surveillance addresses the chronic lack of readily accessible, nonpartisan information about status and trends in health legislation and policy. It provides the opportunity to build policy capacity in the public health workforce. We trace its emergence over the past fifty years, show its value, and identify major challenges ahead. |
Impact of laws aimed at healthcare-associated infection reduction: a qualitative study
Stone PW , Pogorzelska-Maziarz M , Reagan J , Merrill JA , Sperber B , Cairns C , Penn M , Ramanathan T , Mothershed E , Skillen E . BMJ Qual Saf 2015 24 (10) 637-44 BACKGROUND: Healthcare-associated infections (HAIs) are preventable. Globally, laws aimed at reducing HAIs have been implemented. In the USA, these laws are at the federal and state levels. It is not known whether the state interventions are more effective than the federal incentives alone. OBJECTIVE: The aims of this study were to explore the impact federal and state HAI laws have on state departments of health and hospital stakeholders in the USA and to explore similarities and differences in perceptions across states. METHODS: A qualitative study was conducted. In 2012, we conducted semistructured interviews with key stakeholders from states with and without state-level laws to gain multiple perspectives. Interviews were transcribed and open coding was conducted. Data were analysed using content analysis and collected until theoretical saturation was achieved. RESULTS: Ninety interviews were conducted with stakeholders from 12 states (6 states with laws and 6 states without laws). We found an increase in state-level collaboration. The publicly reported data helped hospitals benchmark and focus leaders on HAI prevention. There were concerns about the publicly reported data (eg, lack of validation and timeliness). Resource needs were also identified. No major differences were expressed by interviewees from states with and without laws. CONCLUSIONS: While we could not tease out the impact of specific interventions, increased collaboration between departments of health and their partners is occurring. Harmonisation of HAI definitions and reporting between state and federal laws would minimise reporting burden. Continued monitoring of the progress of HAI prevention is needed. |
The role of law in supporting secondary uses of electronic health information
Ramanathan T , Schmit C , Menon A , Fox C . J Law Med Ethics 2015 43 Suppl 1 48-51 Law establishes the foundation for the "secondary use" of electronic health information (EHI) for public health purposes. Federal law, state law, and legal tools, such as contracts and policies, support data exchange between providers, facilities, and public health departments. This article describes the legal landscape surrounding secondary use of EHI. |
Legal mechanisms supporting accountable care principles
Ramanathan T . Am J Public Health 2014 104 (11) e1-e4 Public health and private providers and facilities may shape the future of the US health system by engaging in new ways to deliver care to patients. "Accountable care" contracts allow private health care and public health providers and facilities to collaboratively serve defined populations. Accountable care frameworks emphasize health care quality and cost savings, among other goals. In this article, I explore the legal context for accountable care, including the mechanisms by which providers, facilities, and public health coordinate activities, avoid inefficiencies, and improve health outcomes. I highlight ongoing evaluations of the impact of accountable care on public health outcomes. |
Law as a tool to promote healthcare safety
Ramanathan T . Clin Gov 2014 19 (2) 172-180 PURPOSE: The purpose of this paper is to inform healthcare providers and healthcare facility leadership about the statutory, administrative, criminal, and tort law implications related to preventable harms from unsafe injection practices. DESIGN/METHODOLOGY/APPROACH: Review of legal theory and precedents. FINDINGS: The law can address disputes over unsafe injection practices in a variety of ways. Administrative agencies may hold a provider or facility responsible for preventable harms according to specific statutory and regulatory provisions governing licensure. State courts can compensate victims of certain actions or inactions based on tort law, where a breach of a legal duty caused damages. Prosecutors and the public can turn to criminal law to punish defendants and deter future actions that result in disability or death. RESEARCH LIMITATIONS/IMPLICATIONS: The state law findings in this review are limited to legal provisions and court cases that are available on searchable databases. Due to the nature of this topic, many cases are settled out of court, and those records are sealed from the public and not available for review. PRACTICAL IMPLICATIONS: Preventable harm continues to occur from unsafe injection practices. These practices pose a significant risk of disease or even death for patients and could result in legal repercussions for healthcare providers and facility leadership. ORIGINALITY/VALUE: This article reviews emerging law and potential legal implications for health care and public health related to unsafe medical practices related to needle, syringe, and vial use. |
Improved diagnosis of Strongyloides stercoralis using recombinant antigen-based serologies: a community-wide study in northern Argentina
Krolewiecki AJ , Ramanathan R , Fink V , McAuliffe I , Cajal SP , Won K , Juarez M , Di Paolo A , Tapia L , Acosta N , Lee R , Lammie P , Abraham D , Nutman TB . Clin Vaccine Immunol 2010 17 (10) 1624-30 ![]() BACKGROUND: The serodiagnosis of Strongyloides stercoralis infection by enzyme linked immunosorbent assays based on crude antigen (CrAg-ELISA), while useful, has been limited by the reliance on crude parasite extracts. Newer techniques such as the luciferase immunoprecipitation systems assay (LIPS) based on a 31-kDa recombinant antigen (termed NIE) from S. stercoralis and/or the recombinant antigen S. stercoralis immunoreactive antigen (SsIR), or the NIE-ELISA have shown promise in controlled settings. We compared each of these serologic assays in individuals from both endemic and non-endemic regions of the world. METHODS: A comprehensive stool evaluation (sedimentation concentration, Baermann with charcoal cultures, Agar plate, and Harada-Mori) and 4 different serologic techniques using CrAg-ELISA or recombinant NIE-ELISA as well as LIPS using NIE alone or in combination with a second recombinant antigen (NIE/SsIR-LIPS), were compared among individuals with parasitologically proven infection (n=251) and healthy controls from non-endemic regions of the world (n=11). Accuracy was calculated for each assay. RESULTS: The prevalence of S. stercoralis infection was 29.4% among Argentinean stool samples (n=228). Sedimentation concentration and Baermann were the most sensitive stool-based methods. NIE-LIPS showed the highest sensitivity (97.8%) and specificity (100%) of the serologic assays. The calculated negative predictive value was highest for both the NIE-LIPS and CrAg-ELISA (> 97%) irrespective of disease prevalence. No cross reactivity with soil transmitted helminthes was noted. CONCLUSIONS: NIE-LIPS compares favorably against the current CrAg-ELISA and stool evaluation, providing additional accuracy and ease of performance in the serodiagnosis of S. stercoralis infections irrespective of disease prevalence. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Jun 24, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure