Continuous Access Research Articles

Measures to Support Ukrainian Refugees' Education

The aggression of Russia in Ukraine concerning the conflict has displaced more than 4 million Ukrainians, many of whom are women and children, who are now refugees in other countries. This remains one of the biggest challenges in providing continued access to education. Schools all across Europe have embraced the challenge of receiving many students from Ukraine into their institutions. Some key actions taken for their educational needs are as follows: Ukrainian assistants and translators, the arrival of Ukrainian language teachers, provision of Ukrainian books, online learning, a welcome point at the schools, trauma-sensitive education to tutors, social inclusion through extra curriculum activities, grants from local and state level, inter-municipal and with Ukraine authority for reports, transfer certificates, bridging programs and no document required for school enrollment. Counseling, as well as anti-bullying programs, must also be strengthened to provide safe settings for refugee youths to be successful academically and psychologically during this tremendous transformation. That said, the task has not been easy. Still, European education systems have shown empathy and operational flexibility in tackling this challenge to ensure that the academic needs of young displaced Ukrainians are not compromised.

Advanced Practice Providers in Pediatric Surgery: A 10-Year Analysis of Clinical Productivity

Introduction: Advanced practice providers (APPs) are integral to nonsurgical and surgical fields. In surgical settings, APPs work autonomously alongside surgeons to enhance continuity of care. While small-scale studies across various surgical specialties have explored APP utilization, literature specific to the pediatric population is limited. This study assesses the impact of increased APP utilization on productivity within one of the largest pediatric surgery departments in the United States. Methods: Data was sourced from the Surgery Department Executive Committee (SDEC) annual reports. Descriptive analyses were performed to delineate trends in clinical volumes, OR cases, gross charges, work relative value units (wRVUs), and provider full-time equivalents (FTEs) between October 2011 and September 2023. Secondary analyses were performed from 2016 to 2023, after APP roles were refined in each division. Results: Since 2012, an upward trend is observed in total clinic visits, total OR cases, and OR cases per MD. In 2016, APPs saw 1 clinic patient for every 2.2 seen by MDs, decreasing to a 1:1 ratio by 2023. The MD surgical conversion rate has increased by 20.5% since 2016, while the conversion rate per total clinic volume has decreased by 7.3% over the same period. Total wRVUs and gross charges increased across the department and per provider, despite fewer overall providers since 2021. Conclusion: Increased utilization of APPs within the department of surgery may enhance procedural productivity for surgeons while ensuring continued patient access to care. This study highlights the importance of developing care models that optimize the full skillset of APPs.

Machine learning downscaling of GRACE/GRACE-FO data to capture spatial-temporal drought effects on groundwater storage at a local scale under data-scarcity

The continued threat from climate change and human impacts on water resources demands high-resolution and continuous hydrological data accessibility for predicting trends and availability. This study proposes a novel threefold downscaling method based on machine learning (ML) which integrates: data normalization; interaction of hydrometeorological variables; and the application of a time series split for cross-validation that produces a high spatial resolution groundwater storage anomaly (GWSA) dataset from the Gravity Recovery and Climate Experiment (GRACE) and its successor mission, GRACE Follow-On (GRACE-FO). In the study, the relationship between the terrestrial water storage anomaly (TWSA) from GRACE and other land surface and hydrometeorological variables (e.g., vegetation coverage, land surface temperature, precipitation, and in situ groundwater level data) is leveraged to downscale the GWSA. The predicted downscaled GWSA datasets were tested using monthly in situ groundwater level observations, and the results showed that the model satisfactorily reproduced the spatial and temporal variations in the GWSA in the study area, with Nash-Sutcliffe efficiency (NSE) correlation coefficient values of 0.8674 (random forest) and 0.7909 (XGBoost), respectively. Evapotranspiration was the most influential predictor variable in the random forest model, whereas it was rainfall in the XGBoost model. In particular, the random forest model excelled in aligning closely with the observed groundwater storage patterns, as evidenced by its high positive correlations and lower error metrics (Mean Absolute Error (MAE) of 54.78 mm; R-squared (R²) of 0.8674). The downscaled 5 km GWSA data (based on random forest) showed a decreasing trend in storage associated with variability in the rainfall pattern. An increase in drought severity during El Niño lengthened the full recovery time of groundwater based on historical storage trends. Furthermore, the time lag between the occurrence of precipitation and recharge was likely controlled by the drought intensity and the spatial recharge characteristics of the aquifer. Projected increases in drought severity could further increase groundwater recovery times in response to droughts in a changing climate, resetting storage to a new tipping condition. Therefore, climate change adaptation strategies must recognise that less groundwater will be available to supplement the surface water supply during droughts.

Long-Term Results of the Atrial Septal Defect Occluder ASSURED Trial for Combined Pivotal/Continued Access Cohorts

BackgroundThe GORE CARDIOFORM ASD Occluder (GCA, W. L. Gore & Associates) was approved in 2019 for ostium secundum atrial septal defect (ASD) closure. ObjectivesThis study sought to report the combined pivotal and continued access cohorts of the ASSURED (Safety and Efficacy Study of Transcatheter Closure of Ostium Secundum ASDs) trial results through 36 months. MethodsThis prospective, multicenter, single-arm trial evaluated procedural and clinical outcomes of ASD closure with the GCA. The primary endpoints were 6-month closure success following device implantation and composite clinical success (deployment/retention of device, safety, and closure). Technical and procedure success, safety, clinically significant new arrhythmia (CSNA) secondary endpoints, and wire frame fracture (WFF, with fluoroscopy) at 6 and 36 months were evaluated. ResultsOf 569 patients (median age of 10.4 years and median weight of 35.0 kg) who underwent attempted secundum ASD closure, 526 were technical successes. The mean stop-flow ASD diameter was 17.6 ± 5.3 mm. All 478 patients with 6-month imaging achieved closure success. Composite clinical success at 6 and 36 months was achieved in 87.6% (468/534) and 84.0% (351/418) of patients, respectively. Technical failure occurred in 8.1% (43/548), 30-day device- or procedure-related serious adverse event in 3.9% (21/534), and 6-month device events in 2.8% (15/534) of patients. At 30 days, 21 of 569 patients (3.7%) had CSNA. At 6 months, 138 of 436 (31.7%) patients had WFFs and 105 of 185 (56.8%) at 36 months (without sequelae). ConclusionsIn this large congenital ASD device trial, the GCA had acceptable results. WFFs, although common, did not result in any clinical sequelae. The unique features, size range, and safety profile expand the options for secundum ASD closure. (Safety and Efficacy Study of Transcatheter Closure of Ostium Secundum ASDs [ASSURED]; NCT02985684)

The Evolution of Illiberalism: Necropolitical Economies and a Democratic Antidote

ABSTRACT: Illiberal regimes exhibit a political economy in which people's continued access to welfare protections depends on loyalty to incumbent politicians. Their politicians' invocation of xenophobic tropes suggests a clear boundary between loyal lives that matter to the regime and those that do not, yet some illiberal regimes have come to promote a materialist necropolitics, devaluing human life not only outside the imagined boundaries of the demos, but also within it. By adopting approaches that explicitly recognize the value of individual human life, democracies can successfully hold on to societal buy-in to democratic forms of government even amid the spread of illiberalism.

Fasting horses perioperatively decreases manure production and increases time to manure output postoperatively: a controlled randomized trial.

To compare 3 perioperative feeding regimens and their effect on anesthetic complications, manure output, and colic proportion in healthy horses. 45 horses presenting for elective orthopedic procedures were randomly assigned to 1 of 3 groups: not fasted (NF; continuous access to hay perioperatively), fasted muzzled (FM; 10-hour preoperative fast with slow refeeding postoperatively and muzzle placement), or fasted not muzzled (FNM; same as FM without muzzle placement). Anesthetic protocol was standardized. Outcomes compared between groups included anesthesia time, arterial oxygenation, duration of hypotension, perioperative manure output, time to first passage of manure postoperatively, pain scores, and colic proportion. Comparisons were made with a mixed model and Fisher exact test with statistical significance considered at P ≤ .05. No differences were seen in pain scores, oxygenation, hypotension, or colic between groups. Groups FM and FNM had a significantly greater mean reduction in postoperative manure weight (-81% and -70%; P = .003) and number of manure piles (-63% and -55%; P = .005) compared to group NF (-39% and -22%; P < .001; weight and piles, respectively). Mean ± SD minutes to passage of manure postoperatively was significantly shorter in group NF (238 ± 13 minutes) than groups FM (502 ± 174 minutes; P < .001) and FNM (444 ± 171 minutes; P = .003). Horses with continuous access to hay prior to and following recovery from anesthesia passed more manure and passed manure sooner after surgery than their fasted counterparts without detrimental effect on anesthetic parameters and postoperative complications. Continuous access to hay perioperatively supports manure production in healthy horses without increase in anesthetic complications.

USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES TO IMPROVE PRACTICAL SKILLS OF ANESTHESIOLOGISTS

The aim – to explore the role of information and communication technologies in the professional development of anesthesiologists, focusing on simulation training, electronic medical records, telemedicine, and electronic learning resources. Materials and Methods. A review of scientific literature, along with an analysis of publications in medical journals and databases such as PubMed, Scopus, and Google Scholar, to identify key trends and results of using of information and communication technologies in anesthesiology was conducted. Results. Simulation training allows anesthesiologists to practice complex clinical scenarios in a safe environment, significantly enhancing their readiness for real emergency situations. Electronic medical records simplify access to patient data, ensuring the accuracy and continuity of medical information, which is crucial for preoperative preparation and postoperative care. Telemedicine opens new possibilities for consultation and training, allowing anesthesiologists to receive advice from colleagues worldwide and participate in remote learning sessions. Electronic learning resources provide continuous access to the latest knowledge, research, and clinical guidelines, fostering ongoing professional development. Conclusion. The integration of information and communication technologies in the training and practice of anesthesiologists enhances the quality of medical care, patient safety, and the professional development of specialists.

Effects of early life stress paired with adolescent alcohol consumption on two-bottle choice alcohol drinking behaviors in mice.

In humans, early life stress (ELS) is associated with an increased risk for developing both alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD). We previously used an infant footshock model that produces stress-enhanced fear learning (SEFL) in rats and mice and increases aversion-resistant alcohol drinking in rats to explore this shared predisposition. The goal of the current study was to extend this model of comorbid PTSD and AUD to male and female C57BL/6J mice. Acute ELS was induced using 15 footshocks on postnatal day (PND) 17. In adulthood, alcohol drinking behavior was tested in one of three two-bottle choice drinking paradigms. In continuous access, mice were given 24 h access to 5% or 10% ethanol and water for five consecutive drinking sessions each. In limited access drinking in the dark, mice were given 2 h of access to 15% ethanol and water across 15 sessions 3 h into the dark cycle. In intermittent access, mice were presented with 20% ethanol and water Monday, Wednesday, and Friday, for four consecutive weeks. In a fifth week of intermittent access drinking, increasing concentrations of quinine (10 mg/L, 100 mg/L, and 200 mg/L) were added to the ethanol to test aversion-resistant drinking. Intermittent access drinking was tested with and without a period of adolescent drinking (PND 35). Infant footshock did not alter drinking in the continuous or limited access tasks. Adult consumption and preference were lower in the intermittent access task when adolescent drinking was included and there were ELS-induced differences in consumption of quinine-adulterated ethanol in females. Our results demonstrate that infant footshock followed by a period of adolescent drinking is a viable model of comorbid PTSD and AUD in rats and mice.

BNST GluN2D-containing NMDARs contribute to ethanol intake but not negative affective behaviors in female mice.

Alcohol use disorder (AUD) is a chronic, relapsing disease, highly comorbid with anxiety and depression. The bed nucleus of the stria terminalis (BNST) and Crh+ neurons in this region play a key role in chronic ethanol-induced increases in volitional intake, hypothesized to be driven by emergent negative affective behaviors. Excitatory N-methyl-d-aspartate receptors (NMDARs) are a major target of ethanol, and chronic ethanol exposure has been shown to regulate NMDAR function and expression. Specifically, GluN2D subunit-containing NMDARs have emerged as a target of interest due to their limited distribution and potential roles in affective behavior. Male and female mice underwent a home cage chronic drinking forced abstinence model (CDFA) to assess the impact of 1 day or 2 weeks of ethanol abstinence on BNST synaptic transmission and BNST Grin gene expression. Constitutive and conditional BNST GluN2D knockout mice were used to assess the impact of GluN2D deletion on continuous access ethanol intake as well as negative affect behaviors, using the open field, elevated zero maze, and forced swim tasks. We report here that excitatory transmission undergoes time-dependent upregulation in BNST Crh+ cells. Further, knockdown of dorsal BNST (dBNST) GluN2D expression significantly decreases ethanol intake in female, but not male, mice. While BNST Grin2b expression was significantly increased in protracted abstinence following CDFA, no differences in Grin2d expression were observed in the dBNST or dBNST Crh+ neurons. Finally, we find that deletion of GluN2D fails to alter negative affect in ethanol-naïve female mice. These data suggest a role for BNST GluN2D-containing NMDARs in ethanol drinking but not ethanol abstinence, highlighting sex differences and behavioral specificity. Overall, these data further suggest roles for BNST synaptic signaling in volitional ethanol intake that are partially independent of actions on affective behavior.

Anxiety and risk-taking behavior maps onto opioid and alcohol polysubstance consumption patterns in male and female mice.

Polysubstance use is prevalent in the population but remains understudied in preclinical models. Alcohol and opioid polysubstance use is associated with negative outcomes, worse treatment prognosis, and higher overdose risk; but underlying mechanisms are still being uncovered. Examining factors that motivate use of one substance over another in different contexts in preclinical models will better our understanding of polysubstance use and improve translational value. Here we assessed baseline anxiety-like and locomotive behavior and then measured voluntary consumption of multiple doses of alcohol and fentanyl in group housed male and female mice using our novel Socially Integrated Polysubstance (SIP) system. Fifty-six male (n=32) and female (n=24) adult mice were housed in groups of 4 for one week with continuous access to food, water, two doses of ethanol (5% and 10%) and two doses of fentanyl (5 ug/ml and 20 ug/ml). Our analyses revealed sex differences across multiple domains - female mice consumed more liquid in the dark cycle, had higher activity, a higher preference for both ethanol and fentanyl over water, and their fentanyl preference increased over the seven days. We then used machine-learning techniques to reveal underlying relationships between baseline behavioral phenotypes and subsequent polysubstance consumption patterns, where anxiety-and risk-taking-like behavioral phenotypes mapped onto discrete patterns of polysubstance use, preference, and escalation. By simulating more translationally relevant substance use and improving our understanding of the motivations for different patterns of consumption, this study contributes to the developing preclinical literature on polysubstance use with the goal of facilitating better treatment outcomes and novel therapeutic strategies.

Hospital commitments to address diagnostic errors: An assessment of 95 US hospitals.

Diagnostic errors are a leading cause of patient harm. In 2022, the Leapfrog Group published a report containing 29 evidence-based practices that hospitals can adopt to reduce diagnostic errors. To understand the extent to which US hospitals have already implemented these practices, we conducted a national pilot survey of Leapfrog-participating hospitals. To reduce respondent burden, we divided the 29 practices across two surveys: one focused on organizational culture and structure (Domain 1), and the second focused on the diagnostic process itself (Domain 2). A total of 95 hospitals from 23 states responded to one or both surveys. On average, hospitals reported implementing 9 of the 16 practices (56%) in Domain 1 and 8 of the 13 practices (62%) in Domain 2. The rate of practice implementation varied greatly, with some hospitals implementing as few as threepractices in their domain. The most commonly implemented practices were ensuring access to medical interpreters, continuous access to radiologists, ensuring staff and patients can report diagnostic errors and concerns, and having a formal process to identify and notify patients when diagnostic errors occur. The least implemented practices included convening a multidisciplinary team focused on diagnostic safety and quality, a CEO commitment to diagnostic excellence, conducting diagnosis-focused risk assessments, and training clinicians to optimize clinical reasoning in the diagnostic process. The findings suggest large and important implementation gaps for practices related to diagnostic excellence and can inform new initiatives to promote diagnostic excellence in US hospitals.

Could the minimum intervention oral care framework help improve the quality of oral health delivery and access to NHS primary dental care?

Access to NHS primary dental care services is a perennial issue in the UK. Two aspects must be considered when measuring access to dental care: ‘entry access', which relates to service availability resulting in realised initial or continued access; and ‘effective access', the delivery of effective, equitable and efficient care, which manifests as equitable and optimal outcomes of care. It is proposed that the minimum intervention oral care (MIOC) delivery framework provides a person-focused, prevention-based, susceptibility/needs-related, team-delivered approach to ensuring effective access to primary oral and dental care. A theory of change model could identify the key barriers to overcome the implementation of the MIOC approach, involving all key stakeholders in primary oral and dental care delivery.

Unveiling the potency of FDA-approved oxidopamine HBr for cervical cancer regulation and replication proteins.

Cervical Cancer remains a women's health concern worldwide and ranks among the most prevalent cancers, particularly in developing countries. Many women are diagnosed with cervical cancer, with a substantial number succumbing to the disease even after the availability of vaccines and drugs. The tumour microenvironment often exhibits immune evasion, including suppression of T-cell activity and altered cytokine, impacting the efficacy of therapeutic interventions and highlighting the need for treatments to modulate the immune response. Despite efforts to promote HPV vaccination and regular screenings, it causes many deaths, underscoring the urgent need for continued research, healthcare access, and rapid drug development or repurposing. In this study, we identified various proteins involved in cervical cancer cell cycle regulation and DNA replication proteins, performed the multitargeted docking with an FDA-approved library, and identified Oxidopamine HBr as a multitargeted drug. Studies extended with pharmacokinetics and compared with the standard values followed by DFT, which supported the compound as a multitargeted inhibitor. Further, the docked complexes were taken for the interaction fingerprints, and it was identified that there are many 9 polar, 5 hydrophobic, 2 aromatic, and 2 basic residues. We extended our studies for 100ns MD Simulation in water, and the computations explored the deviation and fluctuations under 2Å and many intermolecular interactions; the same trajectory files were used for the MM\GBSA studies. All the studies have supported the Oxidopamine HBr as a cervical cancer multitargeted inhibitor-however, experimental studies are needed before human use.

Operant ethanol self-administration behaviors do not predict sex differences in continuous access home cage drinking

Understanding sex differences in disease prevalence is critical to public health, particularly in the context of alcohol use disorder (AUD). The goal of this study was to understand sex differences in ethanol drinking behavior and define the precise conditions under which sex differences emerge. Consistent with prior work, C57BL/6J females drank more than males under continuous access two-bottle choice conditions. However, using ethanol self-administration - where an operant response results in access to an ethanol sipper for a fixed time period - we found no sex differences in operant response rates or ethanol consumption (volume per body weight consumed, as well as lick behavior). This remained true across a wide range of parameters including acquisition, when the ethanol sipper access period was manipulated, and when the concentration of the ethanol available was scaled. The only sex differences observed were in total ethanol consumption, which was explained by differences in body weight between males and females, rather than by sex differences in motivation to drink. Using dimensionality reduction approaches, we found that drinking behavior in the operant context did not cluster by sex, but rather clustered by high and low drinking phenotypes. Interestingly, these high and low drinking phenotypes in the operant context showed no correlation with those same categorizations in the home cage context within the same animals. These data underscore the complexity of sex differences in ethanol consumption, highlighting the important role that drinking conditions/context plays in the expression of these differences.

An inactivated SARS-CoV-2 vaccine based on a Vero cell culture-adapted high-titer virus confers cross-protection in small animals

Rapidly waning immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires continued global access to affordable vaccines. Globally, inactivated SARS-CoV-2 vaccines have been widely used during the SARS-CoV-2 pandemic. In this proof-of-concept study we adapted an original-D614G SARS-CoV-2 virus to Vero cell culture as a strategy to enhance inactivated vaccine manufacturing productivity. A passage 60 (P60) virus showed enhanced fitness and 50-fold increased virus yield in a bioreactor compared to the original-D614G virus. It further remained susceptible to neutralization by plasma from SARS-CoV-2 vaccinated and convalescent individuals, suggesting exposure of relevant epitopes. Monovalent inactivated P60 and bivalent inactivated P60/omicron BA.1 vaccines induced neutralizing responses against original-D614G and BA.1 viruses in mice and hamsters, demonstrating that the P60 virus is a suitable vaccine antigen. Antibodies further cross-neutralized delta and BA.5 viruses. Importantly, the inactivated P60 vaccine protected hamsters against disease upon challenge with original-D614G or BA.1 virus, with minimal lung pathology and lower virus loads in the upper and lower airways. Antigenicity of the P60 virus was thus retained compared to the original virus despite the acquisition of cell culture adaptive mutations. Consequently, cell culture adaptation may be a useful approach to increase yields in inactivated vaccine antigen production.

Patient held medical records in public hospitals in Bulawayo

The purpose of the study was to examine the use and handling of PHMRs by patients and the clinical staff at public hospitals in the Bulawayo Province. The study employed a qualitative research methodology in which open ended questionnaires were used to collect data. Data were collected from doctors, nurses, records clerks and patients at 2 of the 4 targeted major public hospitals in Bulawayo, giving a total of 150 participants. This study revealed that PHMRs contained vital patient health information such as diagnosis, patient name, and prescribed medications. PHMRs did not have an official uniform structure, and patients used whatever booklets that were affordable to them. In some cases, patients used pieces of paper, although this was not encouraged. PHMRs were considered as legal records that are admissible in courts of law on the basis of them being authenticated by dating, officially stamped and signed by the attending medical practitioner. However, there were cases of unlawful manipulation of PHMRs through editing by patients, and in some cases, documentation incompleteness of the PHMR. The study further found out that the biggest challenge faced in the use of PHMRs was their loss by patients, which negatively impacted health care service delivery. The study recommends that patients be continuously educated about the importance of, and effectively managing their PHMRs for the purposes of continued health care delivery and accessibility. The study further recommended the use of structured hospital-designed booklets that patients can purchase at the hospital. This would avoid the use of any type of book/booklets and pieces of paper. The Ministry of Health and Child Health Care in Zimbabwe needs to consider introducing personalised electronic health records as alternatives to physical PHMRs.

Deep brain stimulation for major depressive disorder: continued access or abandonment? Comment to Glannon [1]

Deep brain stimulation for major depressive disorder: continued access or abandonment? Comment to Glannon [1]

Point-of-use filtration units as drinking water distribution system sentinels

Municipal drinking water distribution systems (DWDSs) and associated premise plumbing (PP) systems are vulnerable to proliferation of opportunistic pathogens, even when chemical disinfection residuals are present, thus presenting a public health risk. Monitoring the structure of microbial communities of drinking water is challenging because of limited continuous access to faucets, pipes, and storage tanks. We propose a scalable household sampling method, which uses spent activated carbon and reverse osmosis (RO) membrane point-of-use (POU) filters to evaluate mid- to long-term occurrence of microorganisms in PP systems that are relevant to consumer exposure. As a proof of concept, POU filter microbiomes were collected from four different locations and analyzed with 16S rRNA gene amplicon sequencing. The analyses revealed distinct microbial communities, with occasional detection of potential pathogens. The findings highlight the importance of local, and if possible, continuous monitoring within and across distribution systems. The continuous operation of POU filters offers an advantage in capturing species that may be missed by instantaneous sampling methods. We suggest that water utilities, public institutions, and regulatory agencies take advantage of end-of-life POU filters for microbial monitoring. This approach can be easily implemented to ensure drinking water safety, especially from microbes of emerging concerns; e.g., pathogenic Legionella and Mycobacterium species.

Enhancing Vehicle Navigation and Safety through Integration of Pre-Recorded Maps with Vehicle Control Unit

Powerful navigation and safety systems are vital to ensuring autonomous (DV) or semi-autonomous vehicles continue well in varied environmental conditions. However, in such a world those who depend on that internet connectivity to navigate their car would have problems in areas where network reliability is less than perfect. The purpose of this work is to investigate the feasibility and advantages of combining offline mapping with locally sensed positioning systems for better vehicle navigation and safety. While connected to the internet, vehicles cache offline maps and use local sensor information (such as GPS) from their inertial navigation system or computer vision without needing continuous access. The research outlines a hardware-software architecture with embedded offline map data storage, edge-based road following algorithms and an integration mechanism to advanced driving assistance systems (ADAS). In the evaluation of performance, accuracy assessments with online mapping systems are considered for offline maps and how these can have implications on end driver usability as well impacts on real-world autonomous driving technologies. The results suggest that offline mapping and on-board sensor-based localization would be able to improve vehicle contextual navigation performance in diverse driving scenarios.

Grief and bereavement support amidst palliative care in the paediatric intensive care unit

ABSTRACT In paediatric intensive care units (PICUs), advanced medical care meets deeply emotional human experiences. This review examines grief and bereavement support in PICUs, emphasising its significance in extending palliative care beyond end-of-life scenarios. A comprehensive literature search of PubMed and Google Scholar from 2014 to 2023 yielded 50 relevant studies. The findings illustrate the unique challenges in PICUs, such as children’s limited communication abilities, parental distress and emotional burden on healthcare providers. Our review revealed the multifaceted nature of grief in PICUs, including anticipatory and complicated grief, and its profound impact on families and siblings of PICU patients. We identified diverse emotional, psychological, cultural and spiritual support needs that underscored the importance of continuous bereavement care and access to resources. Current support practices, including counselling, support groups, memorial services and interdisciplinary teamwork, are explored. Challenges such as resource limitations, healthcare providers’ emotional toll and communication barriers are discussed. The study also highlights emerging trends such as digital tools, innovative therapies and policy changes to enhance holistic, family-centred care in PICUs.