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Emergency rooms were not built for mental health care

April 26, 2024
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Morning Rounds Writer and Podcast Producer
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h5n1 bird flu

Early tests in milk suggest U.S. bird flu outbreak in cows is widespread

ANGELA WEISS/AFP VIA GETTY IMAGES

After being struck by how much H5N1 virus he'd seen in milk from cows infected with the bird flu, veterinary epidemiologist Andrew Bowman took matters into his own hands, collecting 150 commercial milk products from around the Midwest to test the samples. He found viral RNA in 58 of them, he told STAT's Megan Molteni. When his colleague, influenza virologist Richard Webby, tested four other positive milk samples for signs of active viral replication, he didn't find anything. He used one of the very same samples to cook his own dinner.

The Food and Drug Administration continues to work on its own national survey of the milk supply, but "the fact that you can go into a supermarket and 30% to 40% of those samples test positive, that suggests there's more of the virus around than is currently being recognized," said Webby. Read more from Megan on the latest data that shows how widespread the outbreak might be.


mental health

How the U.S. could take mental health care out of the E.R.

If you're having a heart attack, a hospital emergency room is a great place to be. But if you're having a mental health emergency? "You've got to sit in this room, maybe they won't give you water, maybe you're not wearing clothes. It's loud, it's bright, there's a lot of noise, there's other sick people freaking out, and it's just too much," said one patient who lives in Cambridge, Mass. And standard hospital protocols often make patients feel like they lack agency, he added.

The E.R. has become America's default front door to psychiatric crisis care, despite rarely being designed or equipped to serve that role. But conditions across the country may be ripe for change. Advocates see the launch of 988 — like 911 but for mental health emergencies — as an opportunity to spotlight the massive unmet mental health need and build a system of care around it. Read more from STAT contributor Grace Rubenstein on the early initiatives to build these systems, in the sixth and final story in a series on the U.S. mental health system. 


antimicrobial resistance

Antimicrobial-resistant hospital infections are still higher than pre-pandemic levels

Levels of hospital-related infections resistant to last-resort antibiotics remain at least 12% higher than before the pandemic, according to a study abstract to be presented at the European Society of Clinical Microbiology and Infectious Diseases Global Congress this weekend. Resistant infections are a pressing concern among scientists and policy-makers, as they're associated with millions of deaths worldwide each year.

Researchers from the the U.S. National Institute of Allergy and Infectious Diseases analyzed data on resistant infections from 120 hospitals between 2018 and 2022, examining three key periods before the pandemic, during its peak, and after the peak. Hospital infections increased 32% during peak pandemic — much more than those acquired in the community. And while the overall rate of antimicrobial-resistant infections went back down after the height of the pandemic, the rate of those acquired at hospitals remained high. More research is needed to know what's driving this and how to stop it, the study authors wrote.



first opinion

Real doctor-to-doctor conversations could improve prior authorization

ADOBE

When an insurance company doctor calls spine surgeon Matthew Walker to ask about a procedure he's requested, to determine whether they'll cover the costs for the patient, it often feels like talking to a brick wall, Walker writes. He can tell that the distant voice — a physician, yes, but rarely a surgeon, nevermind a spine surgeon — is simply fulfilling a box-checking exercise so that coverage can be denied.

Given this perspective, you might assume that Walker is in favor of abolishing prior authorization, which requires this doctor-to-doctor "conversation." But in a new First Opinion essay, Walker says he's not against it at all. He simply wishes that those "peer-to-peer" conversations took place with a true peer. "Spine surgeon to spine surgeon, oncologist to oncologist, physical therapist to physical therapist," he writes. Read more from Walker on how he believes prior authorization could be improved.


research

Scientists known for using computer science in biology set sights on Goldilocks drugs

University of Washington professor David Baker made a name for himself when his lab built a powerful protein-folding prediction system, one step toward designing better drug candidates using artificial intelligence. Now, the lab has turned its sights on a prized class of so-called macrocycle drug candidates, Goldilocks molecules that are just the right size. They can be taken orally and pass through membranes, reaching important proteins inside the cell — but can also target receptors that usually require bigger molecules like antibodies. 

Many of these drugs are derived from compounds found in nature, like bacteria or fungi. But Baker's new research, published yesterday in Science, details a computational method to quickly compile hordes of candidates. The library "is a huge expansion of what would have existed previously," one expert told STAT's Brittany Trang. Read more on how Baker's team once again used AI to push the boundaries of drug discovery.


als

Former NFL player with ALS writes a memoir with his eyes

Amyotrophic lateral sclerosis, or ALS, is a merciless disease with few available treatments, despite advocacy from patients and caretakers and promising work from scientists. Just last month, the community received the crushing news that Amylyx's drug Relyvrio failed to beat placebo treatment in a study after it had already received FDA authorization. Perhaps it was the long shadow of that disappointment that made it so heartening to read an interview with former NFL player Steve Gleason, in the New York Times' "By the Book" column, about his experience writing his almost 300-page memoir with technology that lets him type with his eye movements.

It was an emotional, grueling experience to write the book, Gleason said. "I type so slowly that the wonderful idea that was so vivid and clear eventually slipped into the fog as I trudged and typed." But if the beautiful way he spoke about reading and listening to audiobooks with his children outside in the sun is any indication of the writing in the book, those ideas were surely captured. I highly recommend the interview.


More around STAT
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What we're reading

  • How 'vampire facials' at an unlicensed spa left three women with HIV, Washington Post

  • Vertex offers limited access to a cystic fibrosis drug in South Africa — and may undercut a court case, STAT
  • Mandatory reporting laws meant to protect children get another look, KFF Health News
  • Solving academic medical centers' existential crisis, STAT

Thanks for reading! See you next week,


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