Decrease Mortality Research Articles

Experiences of Parents of Children With Medical Complexity in the Pediatric Intensive Care Unit: A Scoping Review.

Medical advances and decreased mortality rates in the pediatric intensive care unit have increased the number of children surviving illnesses they may not have survived previously. The term child with medical complexity is poorly defined. The purposes of this scoping review were to examine the experiences of parents of children with medical complexity in the pediatric intensive care unit and describe strategies to help support these parents. Eight studies were eligible for inclusion. All were published from 2009 through 2021. One study was a quantitative observational study, 2 were mixed-methods studies, and 5 had a qualitative design. Parents experienced significant stress and depression. Sources of stress were parenting a child with complex chronic illness in the pediatric intensive care unit, uncertainty, communication between family members and clinicians, and lack of subspecialty communication. Strategies to assist parents included respecting parents' expertise and providing consistent and clear communication with family members and among subspecialty clinicians. This review is the first to examine the experiences of parents of children with medical complexity in the pediatric intensive care unit. The study was limited by lack of available research and lack of consensus for the definition of child with medical complexity. However, this review describes strategies that nurses may find useful when caring for parents of children with medical complexity.

Evaluation of the association between the optic nerve sheath diameter and extracorporeal life support time during cardiac surgery in newborns.

Congenital heart disease (CHD), a birth defect, is a major cause of neonatal mortality; however, improvements in surgical procedures and medical treatments have resulted in decreased mortality rates. Nonetheless, postoperative morbidity, particularly cerebral dysfunction, remains an issue in patients receiving extracorporeal life support (ECLS) for cardiac surgeries. Herein, we aimed to assess the association between optic nerve sheath diameter (ONSD) and ECLS time in newborns receiving ECLS for cardiac surgery. We enrolled 25 newborn patients who received ECLS for cardiac surgery at our hospital. ONSD was measured at four different time points during the surgery: baseline (T1), 15 min after cross-clamping (T2), after displacement of cross-clamping (T3) and at the end of the surgery (T4). Furthermore, the ECLS time, aortic cross-clamp time, and surgery time were recorded. The regression analysis revealed a significant association between ONSD and ECLS time, cross-clamp time and surgery time. The correlation analysis showed strong associations between baseline ONSD and ONSD at T2, T3, and T4. Moreover, ONSDs significantly increased at T2 compared with those at baseline during cardiac surgery. Our findings suggest an association between ONSD and ECLS time in newborns receiving ECLS for cardiac surgery. Monitoring ONSD may provide valuable information about intracranial pressure changes in these patients.

Sarcopenia increases mortality risk in liver transplantation: a systematic review and meta-analysis.

Liver transplantation is an efficacious treatment option for those with liver cirrhosis. However, the prognostic role of sarcopenia in these patients is unknown. Given this background, we conducted a systematic review and meta-analysis of the impact of sarcopenia on mortality in patients listed, evaluated and undergoing liver transplantation. Several databases were searched from the inception to December 2022 for observational studies regarding sarcopenia in liver transplant and mortality. We calculated the risk of mortality in sarcopenia vs. no sarcopenia using the most adjusted estimate available and summarizing the data as risk ratios (RRs) with their 95% confidence intervals (CIs). A random-effect model was considered for all analyses. Among 1135 studies initially considered, 33 articles were included for a total of 12,137 patients (mean age: 55.3 years; 39.4% females). Over a median of 2.6 years and after adjusting for a median of 3 covariates, sarcopenia increased the risk of mortality approximately 2-fold (RR: 2.01; 95% CI: 1.70-2.36). After accounting for publication bias, the re-calculated RR was 1.75 (95% CI: 1.49-2.06). The quality of the studies was generally low, as determined by the Newcastle Ottawa Scale. Sarcopenia was significantly linked with an increased risk of mortality in patients listed, evaluated, and undergoing a liver transplantation, indicating the need of interventional studies in this special population with the main aim to reverse this potential reversible condition and decrease mortality risk.

Drug adherence and treatment duration for denosumab and mortality risk among hip fracture patients.

Prescription of anti-osteoporotic medications (AOMs) after osteoporotic hip fracture may increase bone mineral density (BMD) and decrease mortality risk. However, few studies have been conducted on drug adherence and treatment duration for denosumab, a popular choice among AOMs. This study aimed to assess the impact of denosumab adherence and treatment duration on the mortality risk of hip fracture patients after surgery. We conducted a cohort study using nationwide population data from National Health Insurance Research Database (NHIRD) in Taiwan. Patients newly diagnosed with osteoporosis and hip fracture between 2008 and 2019 who used denosumab after surgery were included. We assessed drug adherence, treatment duration, and other parameters associated with patient outcomes. A total of 21,316 patients diagnosed with osteoporotic hip fractures were included. Compared with a > 7-month drug interval for denosumab, an interval of ≤ 7months led to lower all-cause mortality risk (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.57 ~ 0.64). Patients with denosumab treatment for over 1, 2, and 3years had lower all-cause mortality risk (HR&CI: 0.68 (0.64 ~ 0.73), 0.48 (0.43 ~ 0.53), 0.29 (0.26 ~ 0.33)) than those with treatment duration < 1year. Analysis after excluding short-term death yielded similar results. Analysis of causes of death also showed that good adherence and longer duration were associated with reduced mortality due to cancer and cardiovascular disease. Better drug adherence and longer duration of denosumab treatment are associated with lower all-cause mortality risk among hip fracture patients after surgery. Our study highlights the benefits of a proper time interval of denosumab administration. These findings provide important insight into management of osteoporotic hip fractures and may inform clinical practice and development of guidelines.

Beyond a decade: a comparative study of 15-year survival rates in screen-detected vs. symptomatic breast cancer patients in Hungary

BackgroundBreast cancer is the leading cancer in women globally. Despite decreasing mortality rates, largely due to early detection and modern treatment, the effectiveness of screening on long-term survival outcomes remains unclear.AimsThis study evaluates the 15-year survival outcomes of a national breast cancer screening program initiated in Hungary in 2002.MethodsUsing a prospectively maintained patient database, the study included individuals from the first 6 years of the program who underwent surgery for histologically confirmed breast cancer and had available follow-up information. Patients were categorized based on the method of breast cancer detection into two groups: those diagnosed during or 2 years after the population-based screening exam (Group A), and those who self-detected or sought medical attention for symptoms (Group B).ResultsOf the 309 patients who underwent breast cancer surgery, 208 were screen-detected (Group A) and 101 were symptomatic (Group B). The 15-year overall survival was 75.0% for Group A and 76.2% for Group B (p = 0.927). The 15-year disease-specific survival was 85.6% and 81.2% (p = 0.249), respectively. A statistically not significant positive trend in disease-free survival was observed in Group A (81.7% vs. 75.2%; p = 0.144).ConclusionsThe study underscores the importance of extended follow-up periods in evaluating the outcomes of breast cancer screening programs. While the screening program may not significantly enhance overall survival rates, it has demonstrated a reduction in the mastectomy rate and could potentially extend periods of disease-free survival. These findings contribute to the ongoing discourse about the long-term benefits of breast cancer screening programs.

The efficacy of government strategies to control the COVID-19 pandemic

PurposeThis study aims to explore the efficacy of government policy directions in mitigating the effects of the COVID-19 pandemic by employing a panel of 22 countries throughout the 2020-second quarter of 2022.Design/methodology/approachThe panel autoregressive distributed lag (ARDL) model is employed to examine this phenomenon and to investigate the long-run effects of government policy decisions on infection and mortality rates from the pandemic.FindingsThe study reveals the following key findings: (1) Income support and debt relief facilities and stringent standards of governments are associated with reduced infection and death rates. (2) The response of governments has resulted in decreased mortality rates while simultaneously leading to an unexpected increase in infection rates. (3) Containment and healthcare practices have led to a decrease in infection rates but an increase in mortality rates, presenting another counterintuitive outcome. Despite the expectation that robust government responses would decrease infection rates and that healthcare containment practices would reduce mortality, these results highlight a lack of health equity and the challenge of achieving high vaccination rates across countries.Research limitations/implicationsTo effectively combat the spread of COVID-19, it is crucial to implement containment health practices in conjunction with tracing and individual-level quarantine. Simply implementing containment health measures without these interconnected strategies would be ineffective. Therefore, policy implications derived from containment health measures should be accompanied by targeted, aggressive, and rapid containment strategies aimed at significantly reducing the number of individuals infected with COVID-19.Practical implicationsThis study concludes by suggesting the importance of implementing economic support in terms of income, and debt relief has played a crucial role in mitigating the spread of COVID-19 infections and reducing fatality rates.Social implicationsTo effectively combat the spread of COVID-19, it is crucial to implement containment health practices in conjunction with tracing and individual-level quarantine. Simply implementing containment health measures without these interconnected strategies would be ineffective. Therefore, policy implications derived from containment health measures should be accompanied by targeted, aggressive, and rapid containment strategies aimed at significantly reducing the number of individuals infected with COVID-19.Originality/valueThis research makes a unique contribution to the existing literature by investigating the impact of government responses on reducing COVID-19 infections and fatalities, specifically focusing on the period before COVID-19 vaccinations became available.

Endocrinology for the hepatologist.

Endocrinology for the hepatologist.

Utilization of intravascular imaging in elective non chronic total occlusion percutaneous intervention and chronic total occlusion percutaneous intervention: Trends in utilization and impact on in-hospital mortality

ObjectivesThe objectives of this retrospective study include outcomes associated with and without intravascular imaging in cases of elective single vessel (SV) CTO PCI and in non-CTO PCI. MethodWe explored the NIS database from October 1, 2015 to December 31, 2018 to identify 317,090 adult admissions with elective SV PCI. Admissions with STEMI and NSTEMI were excluded to identify elective cases only. Using the ICD 10 diagnosis code for CTO, we identified 33,345 admissions that underwent SV CTO PCI. We classified the remaining cases as SV non-CTO PCI. ResultsIntravascular imaging was utilized in 2930 (8.8%) cases in CTO PCI group and 23,710 (8.3%) cases in non-CTO PCI groups. The utilization of intravascular imaging (IVUS/OCT) significantly increased in elective SV CTO PCI, 6.4%–11.2%, p-trend<0.001 and non-CTO PCI group, 7.3%–9.0%, p-trend<0.001. There was no significance difference in mortality with and without intravascular imaging (combined IVUS/OCT vs no IVUS/OCT: 1.5% vs 1.3%, p = 0.195) in the CTO PCI group. But, in non-CTO PCI admissions, there was a significantly lower in-hospital mortality when intravascular imaging was used (0.7% vs 0.8%, p = 0.003). The cost of hospitalization was significantly higher when intravascular imaging was used in elective single vessel CTO PCI admissions, combined IVUS/OCT vs no IVUS/OCT: $27,427 vs $21,452, p < 0.001 and non-CTO PCI admissions, combined IVUS/OCT vs no IVUS/OCT: $23,620 vs $20,272, p < 0.001. ConclusionsIn conclusion, despite the cost, intravascular imaging use decrease mortality in non-CTO PCI groups but there is no difference in mortality in CTO PCI groups.

Patient satisfaction with nursing care and the role of nurses in the management of arterial hypertension

HTA is estimated to be the cause of about 7.1 million deaths per year worldwide, as well as the cause of about 64.3 million disabled for life-years. Purpose. Identification of best practices for improving the quality of nursing care in patients with high blood pressure. Comparison and analysis of patient satisfaction with nursing services. The use of a standard questionnaire among SR nurses in Peja, focused on the Department of Internal Medicine, and in the coronary unit in the role of nurses in the management of patients with hypertension; as well as their ability to educate these patients. For the realization of this paper, the partial research method was also used, which is carried out through questionnaires prepared and divided into descriptive and retrospective phases from the statistics obtained from the protocols of the Regional Hospital of Peja. Excel and SPSS programs. Results. Total of 50 nurses from the regional hospital of Peja participated in the research Specialist ambulances and 200 patients. From the analysis of the hypotheses, we came to the conclusion that the management of nursing care and the perception of nurses regarding the information and education of patients have a positive influence on the management of nursing care of patients with HTA, this is proven through the correlation (rho=0.625**, value and p=0.000). The results hypothesis show that good nursing care practices as guidance through brochures, determination of appropriate therapy and hospital support have positive impact on patient satisfaction and Hypertension disease management arterial with correlation (rho=0.767**, p value=0.000). Discussion. Well as in our country and in other countries, there is a lack of studies on the specific preparation of nurses and regulatory protection of NCD. Conclusion. Education programs improve care, reduce re-hospitalization and increase quality of life and functional status of patients, as well as decrease mortality from HTA.

Posterior Reversible Encephalopathy Syndrome Triggered by Obinutuzumab in a Patient with Chronic Lymphocytic Leukemia.

Posterior reversible encephalopathy syndrome (PRES) is a neurological disorder that can affect all age groups. It appears to have a higher incidence in the female population. Some common risk factors include hypertension, electrolyte abnormalities, sepsis, and chemotherapeutic medications such as Obinutuzumab. Our patient, who had chronic lymphocytic leukemia (CLL), presented with altered mental status. She was recently started on Obinutuzumab less than a week before this presentation. MRI findings were consistent with PRES, including diffuse vasogenic cerebral edema predominately throughout the bilateral parietal and occipital lobes associated with some edematous extension into the posterior part of bilateral frontal lobes. This case aims to highlight the importance of early diagnosis by appropriately identifying the MRI features of PRES to improve patient quality of life and decrease morbidity and mortality.

An Epidemiologic Study of the Incidence and Mortality of Abdominal Aortic Aneurysms in Koreans Aged ≥50 Years from 2009 to 2018 Based on a National Database.

Large-scale population studies of the incidence of and mortality from abdominal aortic aneurysm (AAA) are needed to develop healthcare policies and priorities. The aim of this study was to estimate the incidence of AAA and the all-cause mortality from it among Koreans aged ≥50 years from 2009 to 2018 using data from the Korean National Health Insurance System Database. The crude and standardized incidence and all-cause mortality of the disease among patients with unruptured AAA were calculated. A total of 73,933 AAA patients were identified. The overall incidence of AAA in adults ≥50 years during the study period was 37.5 per 100,000 population (49.7 per 100,000 in men and 26.8 per 100,000 in women), with an increase from 32.33 per 100,000 persons in 2009 to 46.85 per 100,000 in 2018. The crude all-cause mortality rate of patients with untreated AAA was 21.26/100 person-years in 2009 and 8.87/100 person-years in 2018, with decreasing trends observed both in men and women. This nationwide study showed that the incidence of AAA in Koreans aged ≥50 years in 2018 was 63.40 per 100,000 in men and 32.07 per 100,000 in women. The overall rates were 0.06% and 0.03%, respectively, with an increasing trend. Mortality has decreased in both treated and untreated patients. The observed increase in incidence suggests a rising burden of AAA in the Korean population, particularly among men. The decreasing mortality rates may indicate improvements in the management and treatment of AAA over the study period.

RETROSPECTIVE STUDY OF THE IMPACT OF ANTIRETROVIRAL THERAPY ON HIV/AIDS MORTALITY RATES

Antiretroviral therapy (ART) has transformed HIV/AIDS from a fatal disease to a manageable chronic condition. The correlation between adherence to ART regimens, immunological and virological markers, and mortality rates among patients with HIV/AIDS necessitates ongoing research. In this retrospective study, we reviewed the medical records of 120 HIV/AIDS patients treated with ART at a tertiary care center. We categorized patients into five ART regimens, assessed reported adherence, and analyzed the corresponding immunological and virological parameters. Furthermore, we evaluated the impact of these factors on mortality rates. The patient distribution was approximately uniform across the five ART regimens. Most patients (60%) demonstrated high adherence to their prescribed regimen. The average CD4 count was 436.83 cells/mm³, and the mean viral load was 73,950 copies/mL. High adherence levels were significantly associated with increased CD4 counts and reduced viral loads. Furthermore, improved immunological and virological outcomes and high adherence levels correlated with decreased mortality rates among the study population. Our study reinforces the importance of adherence to ART regimens in managing HIV/AIDS effectively and reducing associated mortality rates. It underscores the need for individualized regimen selection to optimize patient outcomes and for continued efforts to enhance adherence. Future research should explore strategies to improve adherence and understand the individual variations in response to different ART regimens.

The erectile and ejaculatory implications of the surgical management of rectal cancer.

Colorectal cancer is a significant cause of cancer-related deaths worldwide. Although advances in surgical technology and technique have decreased mortality rates, surviving patients often experience sexual dysfunction as a common complication. The development of the lower anterior resection has greatly decreased the use of the radical abdominoperineal resection surgery, but even the less radical surgery can result in sexual dysfunction, including erectile and ejaculatory dysfunction. Improving the knowledge of the underlying causes of sexual dysfunction in this context and developing effective strategies for preventing and treating these adverse effects are essential to improving the quality of life for postoperative rectal cancer patients. This article aims to provide a comprehensive evaluation of erectile and ejaculatory dysfunction in postoperative rectal cancer patients, including their pathophysiology and time course and strategies for prevention and treatment.

Competition-based mortality and tree losses. An essential component of net primary productivity

Even-aged stands can regenerate with many thousand seedlings per hectare before the density declines to just a few hundred trees per hectare 100 years later; management practices can lead to even lower tree numbers due to quality selection and thinning. In other words, during the development of unmanaged stands, the majority of individuals die naturally due to competition. Despite the far-reaching consequences for structural and genetic diversity, dead wood and fuel wood accumulation, we have only limited quantitative knowledge about the continuous mortality of trees and the wood volume loss over longer timespans.For this study, we used a unique set of 476 unmanaged, monospecific experimental plots of Norway spruce (Picea abies (L.) H. Karst.), silver fir (Abies alba Mill.), Scots pine (Pinus sylvestris L.), European larch (Larix decidua Mill.), Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco)), European beech (Fagus sylvatica L.), and oak (Quercus robur L. and Quercus petraea (Matt.) Liebl.) throughout Europe to analyze the competition-based mortality of trees and its dependency on age and site conditions.First, we show that the total stem volume production, standing stock, and mortality were continuously increasing until an age of 100–150 years. The accumulated competition-caused stem volume loss at that age amounted to 500–1000 m3 ha−1.Second, the net growth of the stands (share of the growth that is accumulated in the standing stock) strongly decreased with increasing age even when the gross growth was still high. The proportion of the net growth versus gross growth continuously decreased with increasing age regardless of site quality.Third, we show a degressive decrease of the annual relative tree number mortality rates from 0.05 to 0.20 in young down to 0.01–0.02 in mature stands. For some species, we found these rates to be site dependent with different directions of the site effect. The interplay of decreasing mortality rates and increasing average volume of the dead trees resulted in unimodal mortality curves over time of the annual mortality, peaking at 3–12 m3 ha−1 yr−1 at ages of about 75–150 years.Over the whole rotation, the average annual biomass loss from mortality ranged between 0.8 and 2.1 t ha−1 yr−1 with a carbon content of 0.4–1.1 t C ha−1 yr−1. We discuss the relevance of the results for measuring, understanding, modelling, and managing forest stands. Our results reveal that the withdrawal of forest management and setting aside (previously managed) forests over a rotation time of 100–150 years means that about one third of the total production in monospecific stands would flow to the debris pool rather than being exploited for carbon sequestration and related emission savings in harvested wood products. The mortality related loss fractions of above ground biomass we quantified in this study indicate the trade-off between wood production and setting aside forest to allow deadwood accumulation and associate changes in biodiversity.

Oncological and perioperative outcomes of surgery with or without metastasis-directed therapy as part of a multimodal treatment in men with de-novo oligometastatic prostate cancer.

To investigate the feasibility, safety, and oncological outcomes of Radical Prostatectomy (RP; either Robot-Assisted [RARP] or Open RP [ORP]) in oligometastatic prostate cancer (omPCa). Additionally, we assessed whether there was an added benefit of metastasis-directed therapy (MDT) in these patients in the adjuvant setting. Overall, 68 patients with omPCa (≤ 5 skeletal lesions at conventional imaging) treated with RP and pelvic lymph node dissection between 2006 and 2022 were included. Additional therapies (androgen deprivation therapy [ADT] and MDT) were administered according to the treating physicians' judgment. MDT was defined as metastasis surgery/radiotherapy within 6months of RP. We assessed Clinical Progression (CP), Biochemical Recurrence (BCR), post-operative complications and overall mortality (OM) of RP and the impact of adjuvant MDT + ADT versus RP + ADT alone. Median follow-up was 73months (IQR 62-89). RARP reduced the risk of severe complications after adjusting for age and CCI (OR 0.15; p = 0.02). After RP, 68% patients were continent. Median 90-days PSA after RP was 0.12ng/dL. CP and OM-free survival at 7years were 50% and 79%, respectively. The 7-years OM-free survival rates were 93 vs. 75% for men treated with vs. without MDT (p = 0.04). At regression analyses, MDT after surgery was associated with a 70% decreased mortality rate (HR 0.27, p = 0.04). RP appeared to represent a safe and feasible option in omPCa. RARP reduced the risk of severe complications. Integrating MDT with surgery in the context of a multimodal treatment might improve survival in selected omPCa patients.

Glyphosate and a glyphosate-based herbicide affect bumblebee gut microbiota.

Pollinator decline is one of the gravest challenges facing the world today, and the overuse of pesticides may be among its causes. Here, we studied whether glyphosate, the world's most widely used pesticide, affects the bumblebee gut microbiota. We exposed the bumblebee diet to glyphosate and a glyphosate-based herbicide and quantified the microbiota community shifts using 16S rRNA gene sequencing. Furthermore, we estimated the potential sensitivity of bee gut microbes to glyphosate based on previously reported presence of target enzyme. Glyphosate increased, whereas the glyphosate-based herbicide decreased gut microbiota diversity, indicating that negative effects are attributable to co-formulants. Both glyphosate and the glyphosate-based herbicide treatments significantly decreased the relative abundance of potentially glyphosate-sensitive bacterial species Snodgrasella alvi. However, the relative abundance of potentially glyphosate-sensitive Candidatus Schmidhempelia genera increased in bumblebees treated with glyphosate. Overall, 50% of the bacterial genera detected in the bee gut microbiota were classified as potentially resistant to glyphosate, while 36% were classified as sensitive. Healthy core microbiota have been shown to protect bees from parasite infections, change metabolism, and decrease mortality. Thus, the heavy use of glyphosate-based herbicides may have implications on bees and ecosystems.

Prevalence of unfavorable outcome in acute poisoning and associated factors at the University of Gondar comprehensive specialized hospital, Gondar, Northwest Ethiopia: a hospital-based cross-sectional study.

Acute poisoning is a medical emergency in which the toxic effects occur almost immediately, usually within hours from the time of exposure, and can result from exposure to excessive doses of any chemical. It is the common cause of emergency admission, which may result in morbidity and mortality. There are a lot of factors that are associated with an increased magnitude of mortality and complication. Therefore, this study was carried out to assess the clinical characteristics of patients, unfavorable outcomes of acute poisoning, and associated factors to improve the quality of care, resource utilization, and decrease mortality. This study aimed to assess the outcome and associated factors among acute poisoning patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia (2021). A prospective follow-up study was conducted from January 2021 to September 2021 at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia. Data were collected using a comprehensively organized and pretested interviewer-administered questionnaire. The data were entered using EPI data version 4.6.0 statistical software and then exported to Stata 14 for analysis. The data were analyzed for descriptive statistics. Statistical analysis was performed using bivariate and multivariate logistic regression models to identify factors associated with the unfavorable outcome of acute poisoning. The result is presented in the form of tables, figures, and text using frequencies and summary statistics such as mean, SD, median, IQR, and percentage. A total of 233 patients were included in the study. The prevalence of unfavorable poisoning outcomes in acute poisoning was 17.6% (95% CI: 13.2, 23.1). In the multivariate logistic regression analysis, known chronic medical comorbidities [AOR: 3.846 (1.619, 9.574); value of p: 0.014] and hospital stay of less than 48 h [AOR: 6.57 (2.03, 21.273); value of p: 0.002] were found to be independent factors associated with unfavorable outcomes in acute poisoning. The magnitude of unfavorable poisoning outcomes was high in patients with acute poisoning. Having known medical comorbid illness and short hospital stay of less than 48 h were found to be associated with unfavorable outcomes.

Knowledge, attitudes, and practices of the general population of Pakistan regarding typhoid conjugate vaccine: findings of a cross-sectional study.

Typhoid fever, a common enteric disease in Pakistan, caused by Salmonella typhi, is becoming an extended drug-resistant organism and is preventable through the typhoid conjugate vaccine (TCV). Public adherence to preventive measures is influenced by knowledge and attitude toward the vaccine. This study investigates the knowledge, attitudes, and practices of the general population of Pakistan toward TCV. The differences in mean scores and factors associated with typhoid conjugate vaccine knowledge, attitudes, and practices were investigated. A total of 918 responses were received with a mean age of 25.9 ± 9.6, 51% were women, and 59.6% had graduation-level education. The majority of them responded that vaccines prevent illness (85.3%) and decrease mortality and disability (92.6%), and typhoid could be prevented by vaccination (86.7%). In total, 77.7 and 80.8% considered TCV safe and effective, respectively. Of 389 participants with children, 53.47% had vaccinated children, according to the extended program on immunization (EPI). Higher family income has a higher odds ratio (OR) for willingness toward booster dose of TCV [crude odds ratio (COR) = 4.920, p-value <0.01; adjusted odds ratio (aOR) = 2.853, value of p <0.001], and negative attitude regarding the protective effect of TCV has less willingness toward the booster dose with statistical significance (COR = 0.388, value of p = 0.017; aOR = 0.198, value of p = 0.011). The general population of Pakistan had a good level of knowledge about the benefits of TCV, and attitude and practices are in favor of the usage of TCV. However, a few religious misconceptions are prevalent in public requiring the efforts to overcome them to promote the usage of vaccines to prevent the disease and antibiotic resistance.

The fundamental need for unifying phenotypes in sudden unexpected pediatric deaths.

A definitive, authoritative approach to evaluate the causes of unexpected, and ultimately unexplained, pediatric deaths remains elusive, relegating final conclusions to diagnoses of exclusion in the vast majority of cases. Research into unexplained pediatric deaths has focused primarily on sudden infant deaths (under 1 year of age) and led to the identification of several potential, albeit incompletely understood, contributory factors: nonspecific pathology findings, associations with sleep position and environment that may not be uniformly relevant, and the elucidation of a role for serotonin that is practically difficult to estimate in any individual case. Any assessment of progress in this field must also acknowledge the failure of current approaches to substantially decrease mortality rates in decades. Furthermore, potential commonalities with pediatric deaths across a broader age spectrum have not been widely considered. Recent epilepsy-related observations and genetic findings, identified post-mortem in both infants and children who died suddenly and unexpectedly, suggest a role for more intense and specific phenotyping efforts as well as an expanded role for genetic and genomic evaluation. We therefore present a new approach to reframe the phenotype in sudden unexplained deaths in the pediatric age range, collapsing many distinctions based on arbitrary factors (such as age) that have previously guided research in this area, and discuss its implications for the future of postmortem investigation.

Walking a Tightrope: Balancing Continuity for Long-Stay Patients and Wellness for Clinicians in an Ever-Evolving Landscape.

Walking a Tightrope: Balancing Continuity for Long-Stay Patients and Wellness for Clinicians in an Ever-Evolving Landscape.