Journal of general internal medicine
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On April 17, 2020, the State of New York (NY) implemented an Executive Order that requires all people in NY to wear a face mask or covering in public settings where social distancing cannot be maintained. Although the Centers for Disease Control and Prevention recommended face mask use by the general public, there is a lack of evidence on the effect of face mask policies on the spread of COVID-19 at the state level. ⋯ The Executive Order on face mask use in NY led to a significant decrease in both daily numbers of COVID-19 confirmed cases and deaths. Findings from this study provide important evidence to support state-level policies that require face mask use by the general public.
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Medicaid, which provides health insurance to low-income Americans, is a joint federal-state partnership that manifests as 50 unique state programs. States have policy flexibility to design programs within federal parameters. However, Medicaid also requires funding flexibility to encourage states to maintain services during times of crisis when more people need Medicaid. ⋯ In turn, during economic expansions, states should shoulder relatively more costs of Medicaid. Although the current FMAP boost provided under the Families First Coronavirus Response Act has reduced strain on state Medicaid programs, it does not account for the severity of state-specific downturns and is limited to the current emergency. Instead of ad hoc, across-the-board FMAP boosts to respond to each crisis, Congress should pass legislation making automatic adjustments based on changes in state unemployment rates.
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As the SARS-CoV-2 pandemic continues, little guidance is available on clinical indicators for safely discharging patients with severe COVID-19. ⋯ Our data suggest that neither persistent fever, oxygen requirement, nor laboratory marker derangement was associated with need for acute care in the 30-day period after discharge for severe COVID-19. These findings suggest that physicians need not await the normalization of laboratory markers, resolution of fever, or discontinuation of oxygen prior to discharging a stable or improving patient with COVID-19.
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Observational Study
A Patient Portal-Based Commitment Device to Improve Adherence with Screening for Colorectal Cancer: a Retrospective Observational Study.
Despite significant investment in colorectal cancer (CRC) screening, 40% of US adults are not up-to-date. Commitment devices, which are psychologically tailored approaches to enforce health goals, may be an effective method to increase CRC screening. ⋯ The ability to self-order screening kits may act as a commitment device that increases CRC screening. Scalable tools leveraging existing patient portals such as this can complement existing CRC outreach strategies.
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The language of gratitude and of heroism, pervasive in public discourse about essential workers, is well-intended but belies a problematic blurring of the difference between gifts, contracts, and professionalism. "Heroism," a term frequently invoked by society, usually describes the giving of oneself beyond reasonable boundaries. This noble concept affirms our essential connections to each other. However, labeling someone's labor as a gift can make givers feel obligated exceed both contracts and professionalism. ⋯ Professionalism goes beyond special circumstances to address ongoing commitments to others. When the language of gifts, heroism, or professionalism are used to promote the ongoing performance of dangerous, excessive work, however, they become instruments of injustice and burnout. The experiences of the COVID pandemic can help identify the proper scope of gift-giving, heroism and professionalism - which cement our social bonds - while avoiding misuses of these terms, in order to improve the safety and fairness of the work environment.