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Tag: er

  • On Set for ‘The Pitt’ Season Two: Noah Wyle and the Cast Finally Lift the Curtain

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    Warning: This article contains spoilers about plot points of The Pitt season two, premiering in January.

    The first thing I see are the scrubs, waiting for me on the golf cart. I’ve just checked into the Warner Bros. lot, site of the immersive 18,000-square-foot set for The Pitt, HBO Max’s Emmy-nominated medical drama. Currently in production on season two, the show favors a comprehensive, 360-degree filmmaking style, wherein crew members or background actors might find themselves accidentally passing through a shot. Anyone hanging around for the day must blend in so as not to disrupt the flow. We drive from the WB gate to the production offices, where I change, then head to stage 22 and walk inside. It’s a hot day in Burbank, but the California sun fades like a distant memory as the cool AC and fluorescent lighting of the Pittsburgh Trauma Medical Center take instant effect.

    The vivid realism is palpable, but one reason why The Pitt has caught on so strongly. The 15-episode first season, which aired this past winter and depicted an especially chaotic day inside the hospital (with each episode covering about an hour), evolved into a streaming phenomenon, ranking among the top 10 shows on Nielsen’s ratings charts and cultivating a rabid online fan base. Starring ER’s Noah Wyle as a senior attending physician grieving the loss of his mentor, The Pitt recalled beloved medical dramas of a past TV era while forging boldly ahead, poignantly speaking to the perilous state of American health care post-COVID and spotlighting both the everyday heroism and the human flaws of the medical workers keeping the system afloat.

    Created by R. Scott Gemmill, the show is up for 13 Emmys, including for best drama and best actor (Wyle), a major achievement that was celebrated by the cast and crew while they’d just started getting to work on season two—which will be set approximately 10 months after season one, over Fourth of July weekend. In other words, they went back to work under very different circumstances. “Last season, I came in with about a month’s notice, moved to America for the first time, had no idea what was going on,” says Shabana Azeez, who plays the wide-eyed medical student Dr. Javadi. “So this time, people looked familiar. Maybe they looked prettier to me because I loved them already.”

    “Will the show have enough dramatic engine and built-in aggregate tension—and will the characters be just as gripping as what we gave the audiences last year? I hope so,” Wyle tells me from The Pitt’s waiting-room set, which is empty for the day. “You can’t do a major catastrophe every season without it feeling like a hospital is not plotted in reality. Hopefully, it’s the characters, the interactions, the behaviors, the nobility—the quotidian detail of the show that people really responded to.”

    Inside this hospital, I’m first shuffled into video village. Typically on a set, this means going to a faraway room where crew members watch takes and give notes over headsets. Not here—it’s a makeshift system going from zone to zone (whichever is both unoccupied and safely out of the filming range), with the director John Cameron, writer Cynthia Adarkwa, and others crammed together. A “rate your pain” chart and a masking policy sign hover above us, lest we forget this room is usually used for fictional patient evaluations. They’re early in the process of shooting episode four, beginning the day with a long dialogue scene, the cameras roving between simultaneous conversations. The Pitt moves fast, but you also see the actors taking advantage of the authenticity of their space. Their movements are fluid from take to take.

    “The set is the secret hero,” says Katherine LaNasa, a longtime character actor who was just nominated for her first Emmy for her portrayal of the indefatigable Nurse Dana. “It’s why the acting seems so good. You can actually really live in it.”

    It’s almost torture to be a fan of The Pitt and watch a juicy scene like this out of context. At one point, Dana asks Wyle’s Dr. Robby if he’d like to pull Dr. Langdon (Patrick Ball) out of triage to help him out. “We are doing just fine without him,” Robby replies. This should pique any regular viewer’s interest, since season one ended with Robby refusing to forgive Langdon after discovering the young doctor had stolen doses of lorazepam and Librium. Season two takes place both on Langdon’s first day out of rehab and, Wyle tells me, on Robby’s last day at the hospital before taking a lengthy break.

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    David Canfield

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  • Thousands of children are landing in the ER after ingesting melatonin without supervision

    Thousands of children are landing in the ER after ingesting melatonin without supervision

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    Melatonin products have become increasingly popular among U.S. adults and a new report from the U.S. Centers for Disease Control and Prevention says about 11,000 children have landed in the emergency room in recent years after ingesting it while unsupervised.File video above: Chronic misuse of melatonin creating health concernsMelatonin is a hormone produced by the brain in response to darkness and regulates the body’s natural sleep-wake cycle, or circadian rhythm. Melatonin supplements, often sold as flavored gummies, can help someone struggling to fall asleep due to jet lag or sleep-wake disorders commonly seen in shift workers.For the new report, researchers from the CDC and U.S. Consumer Product Safety Commission identified cases involving children age 5 and younger who were taken to the emergency department between 2019 and 2022 after ingesting melatonin without supervision.Based on nearly 300 identified cases, the researchers estimated that 10,930 emergency department visits occurred during that time period, accounting for about 7% of all ER visits in the U.S. for unsupervised medication exposures in infants and young children.More than half of accidental ingestions involved children between 3 and 5 years old and the majority of visits did not involve additional medications.While the type of melatonin ingested was not specified during most visits, the report shows that children had almost always swallowed the product. Based on emergency department visits where the dosage form was specified, researchers estimated that melatonin gummies were involved in nearly 5,000 cases.Melatonin is a supplement and is not regulated by the U.S. Food and Drug Administration. A recent study published in the journal JAMA found that 25 products labeled as melatonin gummies contained dangerous levels of the hormone while other contained no melatonin and contained only cannabidiol, or CBD.”These discrepancies in ingredients or strength could pose additional risk” to children, the CDC researchers wrote.Among emergency department visits with documentation of the melatonin container, about three-quarters involved bottles — suggesting that young children were able to open the bottles or that the bottles were not closed properly.The researchers said it is important for adults who take these products and live in homes with young children to consider buying melatonin products with child-resistant packaging.Meanwhile, the surveillance data used in the report comes with limitations, including a lack of “narrative” information recorded during emergency department visits. For example, the intended age of a melatonin product was not specified in nearly half of visits, therefore the involvement of a specific product type might be higher than reported.Analyzing cases of unsupervised melatonin ingestion in young children during emergency department visits also underestimates the frequency of melatonin ingestions by children 5 and under, the researchers said.The use of melatonin by U.S. adults soared since the early 2000s, the CDC noted. The rise coincided with a 420% increase in emergency department visits for unsupervised melatonin ingestion by infants and young children between 2009 and 2020.The new report says that the vast majority of unsupervised melatonin ingestions did not result in hospitalization.However, more research is needed to determine if supervised use of melatonin for children is safe or needed. The use of melatonin appears “to be safe for most children for short-term use,” according to the National Center for Complementary and Integrative Health, a department of the National Institutes of Health, but it points out that it is unclear how much melatonin is suitable for children and whether its benefits outweigh its possible risks.In general, melatonin side effects documented in children include drowsiness, headaches, agitation and increased bed-wetting or urination in the evening, according to the NCCIH. There is also the potential for harmful interactions with drugs sometimes prescribed for children’s allergic reactions.The researchers for the latest study did not specify whether the children included in the surveillance data experienced any side effects.Parents should always consult their pediatrician before giving their children melatonin, according to Dr. Cora Collette Breuner, a professor in the department of pediatrics at Seattle Children’s Hospital at the University of Washington.”I also tell families, this is not something your child should take forever. Nobody knows what the long-term effects of taking this is on your child’s growth and development,” Breuner previously told CNN.”Taking away blue-light-emitting smartphones, tablets, laptops and television at least two hours before bed will keep melatonin production humming along, as will reading or listening to bedtime stories in a softly lit room, taking a warm bath, or doing light stretches.”CNN’s Sandee LaMotte contributed to this report.

    Melatonin products have become increasingly popular among U.S. adults and a new report from the U.S. Centers for Disease Control and Prevention says about 11,000 children have landed in the emergency room in recent years after ingesting it while unsupervised.

    File video above: Chronic misuse of melatonin creating health concerns

    Melatonin is a hormone produced by the brain in response to darkness and regulates the body’s natural sleep-wake cycle, or circadian rhythm. Melatonin supplements, often sold as flavored gummies, can help someone struggling to fall asleep due to jet lag or sleep-wake disorders commonly seen in shift workers.

    For the new report, researchers from the CDC and U.S. Consumer Product Safety Commission identified cases involving children age 5 and younger who were taken to the emergency department between 2019 and 2022 after ingesting melatonin without supervision.

    Based on nearly 300 identified cases, the researchers estimated that 10,930 emergency department visits occurred during that time period, accounting for about 7% of all ER visits in the U.S. for unsupervised medication exposures in infants and young children.

    More than half of accidental ingestions involved children between 3 and 5 years old and the majority of visits did not involve additional medications.

    While the type of melatonin ingested was not specified during most visits, the report shows that children had almost always swallowed the product. Based on emergency department visits where the dosage form was specified, researchers estimated that melatonin gummies were involved in nearly 5,000 cases.

    Melatonin is a supplement and is not regulated by the U.S. Food and Drug Administration. A recent study published in the journal JAMA found that 25 products labeled as melatonin gummies contained dangerous levels of the hormone while other contained no melatonin and contained only cannabidiol, or CBD.

    “These discrepancies in ingredients or strength could pose additional risk” to children, the CDC researchers wrote.

    Among emergency department visits with documentation of the melatonin container, about three-quarters involved bottles — suggesting that young children were able to open the bottles or that the bottles were not closed properly.

    The researchers said it is important for adults who take these products and live in homes with young children to consider buying melatonin products with child-resistant packaging.

    Meanwhile, the surveillance data used in the report comes with limitations, including a lack of “narrative” information recorded during emergency department visits. For example, the intended age of a melatonin product was not specified in nearly half of visits, therefore the involvement of a specific product type might be higher than reported.

    Analyzing cases of unsupervised melatonin ingestion in young children during emergency department visits also underestimates the frequency of melatonin ingestions by children 5 and under, the researchers said.

    The use of melatonin by U.S. adults soared since the early 2000s, the CDC noted. The rise coincided with a 420% increase in emergency department visits for unsupervised melatonin ingestion by infants and young children between 2009 and 2020.

    The new report says that the vast majority of unsupervised melatonin ingestions did not result in hospitalization.

    However, more research is needed to determine if supervised use of melatonin for children is safe or needed. The use of melatonin appears “to be safe for most children for short-term use,” according to the National Center for Complementary and Integrative Health, a department of the National Institutes of Health, but it points out that it is unclear how much melatonin is suitable for children and whether its benefits outweigh its possible risks.

    In general, melatonin side effects documented in children include drowsiness, headaches, agitation and increased bed-wetting or urination in the evening, according to the NCCIH. There is also the potential for harmful interactions with drugs sometimes prescribed for children’s allergic reactions.

    The researchers for the latest study did not specify whether the children included in the surveillance data experienced any side effects.

    Parents should always consult their pediatrician before giving their children melatonin, according to Dr. Cora Collette Breuner, a professor in the department of pediatrics at Seattle Children’s Hospital at the University of Washington.

    “I also tell families, this is not something your child should take forever. Nobody knows what the long-term effects of taking this is on your child’s growth and development,” Breuner previously told CNN.

    “Taking away blue-light-emitting smartphones, tablets, laptops and television at least two hours before bed will keep melatonin production humming along, as will reading or listening to bedtime stories in a softly lit room, taking a warm bath, or doing light stretches.”

    CNN’s Sandee LaMotte contributed to this report.

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  • Moms in the ER

    Moms in the ER

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    Maybe the ancient ritual will help. Checked on her two hrs ago. Got worried and went back to check on her again since she went to the hospital friday. Now im waiting in the ER as the condition i found her in was much worse. Anybody got some cat memes i can disassociate with? Ill update later today.

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  • Even With Insurance, ERs Can Cost a Bundle

    Even With Insurance, ERs Can Cost a Bundle

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    Jan. 4, 2023 – If you’ve gone to the emergency room recently, you likely know how much such a visit can cost. A new study by researchers at the Kaiser Family Foundation finds that even for people with private insurance who are employed by large companies, the average out-of-pocket cost of an ER visit can exceed their savings.

    In 2019, the study shows, patients enrolled in big companies’ health plans paid an average of $646 in copays and deductibles for each ER visit. A quarter of visits cost more than $907 out of pocket, and another quarter cost under $128.

    About half of households can’t afford to pay the average deductible in an employer-sponsored insurance plan, the report notes. And more than a third of U.S. adults are unable to afford a $400 medical expense without borrowing. 

    While it’s not known how many people don’t go to an emergency room because of the anticipated cost, almost half of U.S. adults report that they’ve delayed care due to costs, according to a recent Kaiser survey.

    One problem that people often face when deciding whether to visit an ER is that they don’t know how serious their condition is and what emergency care will cost, says Hope Schwartz, lead author of the report.

    “When they go to the [ER], they don’t always know what their diagnosis will be and what their treatment costs will be. What we highlighted is that those costs could be very high or very low, and there’s no way to tell beforehand,” she says.

    What Costs So Much?

    Based on the paid claims data used in the study, health plans and patients paid a combined average of $2,453 for an ER visit. A quarter of visits cost $970 or less, and a quarter cost $3,043 or more.

    Emergency room claims include professional fees and facility fees. The facility fees, which cover the cost of a hospital maintaining an ER 24/7, made up 80% of total costs, including a portion of doctors’ claims as well as laboratory and imaging fees. 

    But doctors’ claims for evaluation and management services were the largest part of costs, averaging $1,134 per visit. Procedures and treatments cost over $1,100 per visit, on average, while the average imaging claim cost $483, and the average cost for lab work was $230. 

    Over half of visits generated imaging claims, and about half of visits included lab claims.

    The Kaiser Family Foundation report also looked at the costs of several common ER diagnoses. The most expensive diagnosis was appendicitis, which cost nearly twice as much as heart attacks, partly because it often led to surgery in the emergency room. On average, a visit for appendicitis cost $9,535, of which $1,717 was an out-of-pocket expense.

    In addition, the researchers examined lower-cost diagnoses that generally do not require imaging or extensive treatment in the ER. These included upper respiratory tract infections ($1,535 total, $523 out of pocket), skin and soft tissue infections ($2,005 total, $572 out of pocket), and urinary tract infections ($2,726 total, $683 out of pocket). 

    While these diagnoses can sometimes require admission to the hospital, in otherwise healthy adults they are typically evaluated with basic lab tests, and patients are discharged with prescriptions, according to the report.

    Complexities of Billing

    ER visits are given codes to help show how complex the task or service was during the billing process. These codes have five levels. 

    Less complex visits require straightforward medical decision-making, such as rashes or medication refills. Patients with level 5 codes require highly complex decision-making and include life- or limb-threatening conditions, such as severe infections or heart attacks.

    The less complex visits cost $592, on average, with patients responsible for $205 of that. For the most complex visits, the health plan covered $3,015, on average, or eight times the cost of the lowest-coded visits. 

    On average, patients paid $840 out of pocket for the most complex visits — four times the average costs for the less complex visits.

    One reason for the rise in spending for ER visits is a national shift to higher-level ER billing codes, says Schwartz, who is a Kaiser Family Foundation health policy fellow and a medical student, “There has been good work done showing that [ER] visits are increasingly being billed as a level 4 or 5, whereas in previous years, they might have been billed as a level 3.

    “Whether a hospital bills a level 4 or a level 5 code for your visit can make a really big difference in how much you pay. And if you come in not knowing what services you’re going to get, you don’t know if you’re going to get a level 3, 4, or 5 code, and the costs increase pretty quickly,” she says. 

    Costs Vary by Region

    The report includes an analysis of emergency room costs in the 20 largest metropolitan areas in the U.S. Overall, the researchers found, San Diego had the most expensive ER visits. Emergency rooms in San Diego charged about twice as much per visit, on average, as those in Baltimore.

    While there were expensive areas all across the country, many of the costliest places were in Texas, Florida, California, Colorado, and New York. The report noted that the most expensive regions for ER care did not align with the regions that had the most expensive health care overall. 

    “These comparisons suggest that our findings are not solely related to overall high health care prices in these areas and may reflect other factors, including the age and medical complexity of the population or differences in local norms and practice patterns,” the report says.

    Healthier People

    In addition to these geographical differences, the incidence of emergency room visits by those with employers’ insurance differed from that of the general population.

    During the study year, the report found, 12% of the insured had at least one ER visit — a percentage that didn’t vary for any age group under 65, including children. (No patients 65 or older were included in the study.) 

    By comparison, a government survey shows that in 2019, 21% of all U.S. adults 18 to 44 had one or more emergency room visits. Among those 45 to 64, 20% made at least one ER visit.

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