Key Points Question Is low-dose intradermal influenza vaccine a suitable alternative to regular dose intramuscular vaccine? Findings In this systematic review and meta-analysis including 30 studies with a total of 177 780 participants, the seroconversion rates of low doses of intradermal influenza vaccine vs the 15-µg intramuscular dose for each of the H1N1, H3N2, and B strains were not statistically significantly different. Seroprotection rates for the 9-µg and 15-µg intradermal doses were not statistically significantly different from the 15-µg intramuscular dose, except for the 15-µg intradermal dose for the H1N1 strain, which was significantly higher. Meaning These findings suggest that a low-dose intradermal influenza vaccine may be a suitable alternative to standard-dose intramuscular vaccine.

Objective: To evaluate the implementation phase of a community paramedic program focused on individuals experiencing homelessness (IEH) in Calgary, Alberta, Canada with a high prevalence of mental health and substance use disorders. Methods: A manual chart review was performed to characterise patients of the City Centre Team (CCT). A survey was performed of health professionals and partners for allied agencies that interacted with the CCT in the first 6 months of program implementation. Findings: There were 832 patient events involving 365 unique patients. Mental health and substance use disorders accounted for 75% of the events. The survey results were positive with 85% agreeing that the CCT reduced the reliance on emergency services. Conclusion: The community paramedics address the health and social needs of IEH while working in a multidisciplinary setting. The CCT is an innovative program that can inform future health service design in similar settings.

BACKGROUND: ARDS is an inflammatory condition of the lungs and is a common condition in adult ICUs. The resources required and costs of care for patients with ARDS are significant because of the severity of the illness and extended ICU lengths of stay.RESEARCH QUESTION: What are the costs associated with ARDS?STUDY DESIGN AND METHODS: We systematically searched the literature through April 29, 2021, for articles relevant to ARDS and costs. MEDLINE, Embase, Central, and EconLit databases were searched, and articles that reported on cost data from an original publication in adult patients with ARDS were included. Two authors independently assessed articles for inclusion and extracted data elements related to costs, methodology, health-care system type, economic perspective, and clinical data. Publication quality was assessed using a modified version of the Quality of Health Economic Studies Instrument.RESULTS: Four thousand six hundred sixty-three publications were found, of which 110 were included for full-text review (k ¼ 0.72). A total of 22 publications (49,483 patients) were suitable for data extraction. The publications represented a broad range of health-care systems, economic perspectives, costing methodology, and time frames. Mean inpatient costs ranged from $8,476 (2021 US dollars [USD]) to $547,974 (2021 USD) and were highest in publications of lower quality and in American health systems and were associated with trauma cohorts. Outpatient costs were highest in publications with higher readmission rates, longer durations of follow-up, and in American health systems.INTERPRETATION: A wide range of costing data is available for ARDS. A comprehensive synthesis of this literature frames the reasons for this and allows estimates to reflect the context in which they were assessed. This information will be of value to researchers and administrators interested in the economics of caring for patients with ARDS.

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