Life-saving Treatment Research Articles

Daily life without cranial bone protection while awaiting cranioplasty: a qualitative study

PurposeDecompressive craniectomy is occasionally performed as a life-saving neurosurgical intervention in patients with acute severe brain injury to reduce refractory intracranial hypertension. Subsequently, cranioplasty (CP) is performed to repair the skull defect. In the meantime, patients are living without cranial bone protection, and little is known about their daily life. This study accordingly explored daily life among patients living without cranial bone protection after decompressive craniectomy while awaiting CP.MethodsA multiple-case study examined six purposively sampled patients, patients’ family members, and healthcare staff. The participants were interviewed and the data were analyzed using qualitative content analysis.ResultsThe cross-case analysis identified five categories: “Adapting to new ways of living,” “Constant awareness of the absence of cranial bone protection,” “Managing daily life requires available staff with adequate qualifications,” “Impact of daily life depends on the degree of recovery,” and “Daily life stuck in limbo while awaiting cranioplasty.” The patients living without cranial bone protection coped with daily life by developing new habits and routines, but the absence of cranial bone protection also entailed inconveniences and limitations, particularly among the patients with greater independence in their everyday living. Time spent awaiting CP was experienced as being in limbo, and uncertainty regarding planning was perceived as frustrating.ConclusionThe results indicate a vulnerable group of patients with brain damage and communication impairments struggling to find new routines during a waiting period experienced as being in limbo. Making this period safe and reducing some problems in daily life for those living without cranial bone protection calls for a person-centered approach to care involving providing contact information for the correct healthcare institution and individually planned scheduling for CP.

A clinical audit of red blood cell transfusion practices at a district hospital in South Africa.

Red blood cell (RBC) transfusion is one of the most critical and expensive lifesaving treatment modalities. A clinical audit is a valuable instrument to determine whether transfusion practices align with the guidelines and identify knowledge deficiencies. The study aimed to evaluate the RBC transfusion practices and patient outcomes at the National District Hospital in Bloemfontein, South Africa, and to determine adherence to transfusion guidelines. A retrospective descriptive study was conducted. All blood transfusion registers in the hospital were used to identify transfusion episodes during the study period. Files were retrieved from the admissions office and information captured on a paper-based datasheet. The appropriateness of the transfusion and adherence to the South African transfusion guidelines were evaluated using specific criteria. Of the 118 transfusion episodes during the study period, 78 files were retrieved and 76 included in the study. The patients' median age was 47 years (interquartile range [IQR]: 32-66 years), with human immunodeficiency viruses (HIV) (n= 34; 44.7%) being the most common comorbid condition. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL (IQR: 3.95 g/dL - 5.5 g/dL). The audit revealed that in 68.4% (n= 52) of the cases, the guidelines were applied appropriately. The study described the blood transfusion practices and identified shortcomings when compared with the standard clinical guidelines.Contribution:The study highlights the importance of applying rationale, caution and consideration of the specific patient profile when performing transfusions.

Gaps in Education: A Cross-Sectional Survey Study of Knowledge of Advanced Lifesaving Interventions among Canadian Lifeguards.

Objective: The aim of this study was to assess lifeguards' knowledge retention of airway management, oxygen administration, and ventilation interventions following certification and employer-provided training. Methods: This cross-sectional study was conducted using an online survey administered between February and May 2024. A total of 1322 responses from Canadian lifeguards certified in airway management and oxygen administration were deemed eligible for analysis. The survey included 15 knowledge assessment questions, with data analyzed based on lifeguard experience and the date of last certification or in-service training. Results: The mean knowledge assessment score was 10.4 ± 2.2 (69.3 ± 14.6%), with the highest scores in the airway management category and the lowest in the oxygen administration category. Lifeguard experience significantly increased knowledge retention, whereas recertification showed no significant impact, and employer-provided training significantly decreased knowledge retention. Conclusions: The findings underscore the importance of lifeguarding experience in knowledge retention among lifeguards. Optional airway management and oxygen administration recertification, coupled with inconsistent in-service training, have created significant gaps in lifeguard education. This study identifies the need for regular, competency-based training delivered by qualified facilitators. Addressing these gaps is crucial for enhancing the effectiveness of lifeguards in emergency response and ensuring high-quality care for drowning victims.

Posttraumatic hydrocephalus as a complication of decompressive craniectomy-same old story, new perspectives.

Decompressive craniectomy (DC) serves as a vital life-saving intervention, demonstrating efficacy in reducing intracranial pressure (ICP). However, its efficacy hinges on meticulous surgical execution, perioperative management, and vigilance toward potential complications. The incidence of complications associated with DC plays a pivotal role in determining its superiority over medical management for patients experiencing intracranial hypertension following traumatic brain injury (TBI). Severe cases often require more intensive therapy, prolonged mechanical ventilation, and vasopressor treatment. Identifying the optimal moment for early extubation and minimizing vasopressor use is crucial to reducing the risk of complications, including PTH. Our study aims to highlight the potential risks associated with prolonged mechanical ventilation and long-term vasopressor administration. The collected data were demographics, the craniectomy size, the distance from the midline of the craniectomy, the presence or absence of hydrocephalus, duration of mechanical ventilation and vasopressor treatment, and outcome at 30 days. Seventy-two patients with a mean age of 44.2 (range 5-83) were included in the study, with a median craniectomy size of 119.3 cm2. In our series, craniectomy areas ranged between 30 and 207.5 cm2 and had a similar decrease in midline shift in all cases. We did not observe any associations between the surface of craniectomy and the complication rate (p = 0.6302). There was no association between craniectomy size and mortality rate or length of hospital stay. The most common complication of decompressive craniectomy in our study group was posttraumatic hydrocephalus, with an incidence of 13.8%. Our results showed that craniectomy size did not independently affect PTH development (p = 0.5125). Still, there was a strong correlation between prolonged time of vasopressor treatment (p = 0.01843), period of mechanical ventilation (p = 0.04928), and the development of PTH. This study suggests that there is no clear correlation between craniectomy size, midline shift reduction, and survival rate. An extended period of vasopressor treatment or mechanical ventilation is linked with the development of posttraumatic hydrocephalus. Further studies on larger series or randomized controlled studies are needed to better define this correlation.

Exhaustion of T cells after renal transplantation.

Renal transplantation is a life-saving treatment for patients with end-stage renal disease. However, the challenge of transplant rejection and the complications associated with immunosuppressants necessitates a deeper understanding of the underlying immune mechanisms. T cell exhaustion, a state characterized by impaired effector functions and sustained expression of inhibitory receptors, plays a dual role in renal transplantation. While moderate T cell exhaustion can aid in graft acceptance by regulating alloreactive T cell responses, excessive exhaustion may impair the recipient's ability to control viral infections and tumors, posing significant health risks. Moreover, drugs targeting T cell exhaustion to promote graft tolerance and using immune checkpoint inhibitors for cancer treatment in transplant recipients are areas deserving of further attention and research. This review aims to provide a comprehensive understanding of the changes in T cell exhaustion levels after renal transplantation and their implications for graft survival and patient outcomes. We discuss the molecular mechanisms underlying T cell exhaustion, the role of specific exhaustion markers, the potential impact of immunosuppressive therapies, and the pharmaceutical intervention on T cell exhaustion levels. Additionally, we demonstrate the potential to modulate T cell exhaustion favorably, enhancing graft survival. Future research should focus on the distinctions of T cell exhaustion across different immune states and subsets, as well as the interactions between exhausted T cells and other immune cells. Understanding these dynamics is crucial for optimizing transplant outcomes and ensuring long-term graft survival while maintaining immune competence.

Buprenorphine/naloxone initiation in the emergency department: a series of vignettes

BackgroundOpioid drug overdose deaths are at an all-time high. Buprenorphine, a medication used to treat opioid use disorder, has dramatic effects on mortality after overdose as well as engagement with outpatient treatment programs. Recent regulatory changes have eased barriers to prescription, yet buprenorphine is infrequently prescribed from the emergency department. Objectives: Emergency physicians see patients who would benefit from this medication on a regular basis. We aim to illustrate how buprenorphine can be initiated from the emergency department. DiscussionUsing a series of six cases, the use of buprenorphine for common presentations of patients with opioid use disorder (OUD) is described. ConclusionsWe present a series of clinical vignettes in order to increase emergency physicians’ familiarity and comfort with the use of buprenorphine/naloxone in the treatment of OUD. Patients with OUD treated with buprenorphine/naloxone are less likely to die from overdose and more likely to engage in long-term treatment. Emergency departments are well suited to initiate buprenorphine/naloxone for patients who are ready for change and eligible for medications for OUD. Now that barriers to prescribing have been removed, emergency clinicians should seek out patients with opioid use disorder who may benefit from this life-saving treatment, initiated either in the ED or at home.

Modified by the Innovative Drugs and Strategies-Pattern of Selected Indications for Pediatric Liver Transplantation.

Liver transplantation (LTx) constitutes a major life-saving routine treatment for children with end-stage liver disease. However, the analysis of LTx registries in children provides much information about changes in the indication profiles in the recent years. The article provides a comprehensive review about the successes, hopes, and challenges related to changing indications for LTx in children based on the literature review and our own experience. Retrospective review of the indications for LTx at a tertiary referral pediatric hospital was also presented. In the context of the new therapies that have emerged, the need for LTx has decreased in patients with chronic hepatitis B and C infection and tyrosinemia type 1. In primary hyperoxaluria type 1, new RNAi-based therapy has eliminated the requirement for LTx (both isolated or combined). There is a hope that introduction of ileal bile acid transporter (IBAT) blockers reduces the need for LTx in patients with Alagille syndrome or progressive familial intrahepatic cholestasis. The number of children qualified for LTx with urea cycle disorders (UCDs) as a prophylaxis of neurodevelopmental impairment is increasing.

Simulation-Based Enhancement of Patient Safety During Intrahospital Transport of Trauma Patients With COVID-19: A Helipad Scenario.

Trauma resulting from accidents, violence, or war claims over five million lives annually, with traffic accidents and falls being predominant causes. The COVID-19 pandemic has posed unprecedented challenges in trauma care. Even though the number of injuries decreased during the lockdown period, the transportation of trauma patients became even more challenging due to concerns aboutinfection control and the need for enhanced protective measures. This simulation workshop was conducted in a controlled environment to test and refine protocols for the safe transport of trauma patients with COVID-19. Our goal was to develop comprehensive guidance on the intrahospital transportation of these patients, ensuring the highest level of patient care and safety. We detail a five-step approach from preparation to the pre-landing, initial assessment, patient transfer, and patient handover phases, emphasizing adherence to protocols, equipment readiness, and personal protective equipment (PPE) use. The primary issues we encountered were related to time management, the decision-making process for applying lifesaving procedures in an open environment, and the risk of cross-infection. The workshop underscored the importance of swift and coordinated care, balancing life-saving interventions with efficient transport to a definitive care facility.

Crossing national borders for transplantation: A focused evaluation of deceased donor lung exports from the United States

Organ transplantation is a life-saving treatment for end-stage organ failure patients, but the United States (US) faces a shortage of available organs. US policies incentivize identifying recipients for all recovered organs. Technological advancements have extended donor organ viability, creating new opportunities for long-distance transport and international sharing. We aimed to assess organ exports from deceased US donors to candidates abroad, a component of allocation policy allowed without suitable domestic candidates. Based on the national Scientific Registry of Transplant Recipients data from January 2014 to September 2023, 388 342 organs were recovered for transplantation, with 511 (0.13%) exported. Most exported organs were lungs (80%). Exported lung donors were older (41 vs 34 years, P < .001), more likely hepatitis C positive (22% vs 4%, P < .001), and more likely donors after circulatory death (20% vs 7%, P < .001). Lungs that were eventually exported were offered to more US potential transplant recipients (median = 65) than those kept in the US (median = 21 and 41 for lungs recovered by nonexporting and exporting organ procurement organizations, respectively; P < .001). Our study highlights the necessity for further research and clear policy initiatives to balance the benefits of cross-border sharing while considering potential opportunities for more aggressive organ allocation within the US.

Towards equitable renal care: Strategies for enhancing kidney transplantation in Africa

Chronic kidney disease (CKD) is defined as the presence of kidney damage persisting for 3 months or more. Kidney transplantation stands as a vital intervention for individuals grappling with end-stage renal disease (ESRD) in Africa, offering the promise of extended life and improved quality of life. However, numerous challenges hinder its widespread implementation across the continent. This paper explored kidney transplantation in Africa, aiming to illuminate key strategies for bridging gaps and building pathways to enhanced renal care. There is a disproportionate burden of CKD on the region's population. Therefore, there is a critical need for early diagnosis and intervention. This paper outlines comprehensive strategies for improving kidney transplantation in Africa. Results indicate that financial support systems, infrastructure enhancement, public awareness campaigns, and legal frameworks are essential for addressing renal care barriers. Active measures such as government subsidy programs, international funding collaboration, and engagement with community leaders are highlighted as effective approaches. Drawing from global standards and best practices, the paper shows the importance of tailored approaches that address Africa's unique socio-economic and healthcare landscape. By leveraging collaborative efforts, regulatory frameworks, and public engagement, African nations can overcome barriers to kidney transplantation and pave the way for equitable access to life-saving treatment.

BRAIN TUMOR CLASSIFICATION USING INCEPTIONRESNET-V2 AND TRANSFER LEARNING APPROACH

Brain, a highly intricate organ within the central nervous system, plays a fundamental role in information processing, cognition, motor control, and consciousness. Brain tumors pose severe threats to brain function and overall human well-being. Timely detection of these tumors is imperative for life-saving interventions. A dataset comprising four categories: no tumors, meningioma tumors, glioma tumors, and pituitary tumors was regarded in this research. The employed of the InceptionResNet-V2 architecture combined with Transfer Learning and data augmentation proposed to obtain optimal results on brain tumor classification types. Transfer learning act as fine tuning, enabling the model to acquire fundamental low-level image features from a comprehensive dataset. It then leverages higher-level features to become more tailored to the specific training data. This method is employed to improve the model's adaptability to the training data. The InceptionResNet-V2 architecture utilized in the evaluation using test data, in Scenario 1, achieved 94.18% accuracy. Scenario 2, which combined augmentation with InceptionResNetV2, showed an improvement in accuracy to 95.10%. Furthermore, in Scenario 3, the combination of InceptionResNetV2 with Transfer Learning and augmentation resulted in an impressive accuracy of 96.63%, demonstrating its effectiveness in brain tumor classification. Transfer learning aligns the model by acquiring low-level image features and utilizing higher-level features to improve adaptability to the training data.

A Novel Mixed Finite/Infinite Dimensional Port–Hamiltonian Model of a Mechanical Ventilator

Mechanical ventilation is a life-saving treatment for critically ill patients who are struggling to breathe independently due to injury or disease. Globally, per year, there has always been a large number of individuals who have required mechanical ventilation. The COVID-19 pandemic brought to light the significance of mechanical ventilation, which played a significant role in sustaining COVID-19-infected critically ill patients who could not breathe on their own. The pandemic drew the attention of the world to the shortage of ventilators globally. Some of the challenges to providing an adequate number of ventilators include: increased demand for ventilators, supply chain disruptions, manufacturing constraints, distribution inequalities, financial constraints, maintenance and logistics difficulties, training and expertise shortages, and the lack of design and development of affordable mechanical ventilators that satisfy the stipulated requirements. This research work presents the formulation of a detailed Port–Hamiltonian model of a mechanical ventilator integrated with the human respiratory system. The interconnection and coupling conditions for the various subsystems within the mechanical ventilator and the coupling between the mechanical ventilator and the human respiratory system are also presented. Structure-preserving discretization is provided alongside numerical simulations and results. The obtained results are found to be comparable to results presented in the literature. Future work will include the design of suitable controllers for the system.

Liver transplantation in acute and acute-on-chronic liver failure

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) are diseases with arapidly progressive course and high mortality. Apart from treating the underlying triggers and intensive care measures, there are very limited therapeutic options for either condition. Liver transplantation is often the only life-saving treatment, but it cannot always be employed due to contraindications and severe disease progression. ACLF is characterized by underlying liver cirrhosis and typical triggers such as bacterial infections, bleeding, or alcohol binges. ALF occurs in previously healthy livers, usually as aresult of purely hepatotoxic events. Disease differences are also reflected in the course and regulations of liver transplantation. Newer prognostic parameters and prioritization programs for ACLF can help improve both waiting list mortality and outcomes after transplantation.

Liver transplantation consideration and evaluation: a life-saving treatment in acute-on-chronic liver failure

With the rising prevalence of chronic liver disease worldwide, the incidence and prevalence of acute-on-chronic liver failure (ACLF) are increasing and attribute to higher morbidity, mortality, and healthcare costs. Many of such patients die without being considered for the lifesaving treatment option of liver transplantation. The underutilization of liver transplantation as a therapeutic option in the setting of ACLF, is due to multiple reasons; with the heterogeneity of ACLF and the lack of universal definition being the key players. Liver transplantation listing and allocation are based on MELD score. As of now, we do not know where MELD score stands in regard to defining ACLF and the prognostication of such patients. This insight is very important for the efficient identification of potential liver transplantation candidates in the setting of ACLF. This review paper investigates the role of liver transplantation in the setting of ACLF. In light of recent evidence, MELD score is not the perfect model in the setting of ACLF either. The safety of liver transplantation, either deceased donor or living donor, among ACLF patients has been debated. The short-term mortality rate of ACLF patients has created a need for a standard liver transplant selection criterion for these patients. Based on published literature, we find that three commonly used ACLF definitions may be used in combination to define the sensitivity, specificity, and futility of ACLF and we propose an algorithm to best identify patients for urgent liver transplantation in the setting of ACLF. Moreover, we discuss the data on the safety of liver transplantation in the setting of ACLF. Future validation of this multifaceted approach could bridge the gap between ACLF patients and appropriately guided medical intervention.

Meta-long Papyrus: Meta-analysis of mid to long-term outcomes of PK Papyrus covered stent.

Although covered stents (CS) represent a potentially life-saving intervention for coronary perforation (CAP), their application has expanded to other contexts, including coronary aneurysms (CAA). However, data regarding mid- and long-term outcomes of CS in these settings scenarios remains limited. This meta-analysis aims to evaluate major adverse cardiac events (MACE) from discharge through long-term follow-up in patients undergoing percutaneous coronary intervention with the new generation polyurethane-covered cobalt-chromium PK Papyrus CS. We conducted a meta-analysis of data from three observational trials that included long-term follow-up of patients who underwent PK Papyrus CS implantation: Papyrus-Spain, SOS PK Papyrus, and PAST-PERF registry. 332 patients underwent PK Papyrus CS implantation, 236 (71.1%) for CAP, 70 (21.1%) for CAA and 26 (7.8%) for other indications. After a mean follow-up of 16.2 months, the MACE was 14.3%, with Target Lesion Revascularization (TLR) being the most frequent (8.5%), followed by stent thrombosis (ST), 3.3% and cardiac death (CD), 2.6%. Comparing CAP and CAA subgroups, the MACE rate in CAA was significantly higher than CAP (21.4% vs 9.7%, p < 0.01), primary driven by ST (CAA: 8.6% vs CAP: 1.3%; p = 0.0015). The clinical outcomes following PK Papyrus CS implantation are deemed acceptable, considering the challenging scenarios and the existing alternative treatments. However, MACE rates in patients with CAA who received Papyrus PK CS were significantly higher than in those with CAP, underscoring the importance of meticulous patient selection and optimization of CS in these complex patients and coronary anatomies.

Injury severity bias in missing prehospital vital signs: Prevalence and implications for trauma registries

BackgroundVital signs are important factors in assessing injury severity and guiding trauma resuscitation, especially among severely injured patients. Despite this, physiological data are frequently missing from trauma registries. This study aimed to evaluate the extent of missing prehospital data in a hospital-based trauma registry and to assess the associations between prehospital physiological data completeness and indicators of injury severity. MethodsA retrospective review was conducted on all adult trauma patients brought directly to a level 1 trauma center in Toronto, Ontario by paramedics from January 1, 2015, to December 31, 2019. The proportion of missing data was evaluated for each variable and patterns of missingness were assessed. To investigate the associations between prehospital data completeness and injury severity factors, descriptive and unadjusted logistic regression analyses were performed. ResultsA total of 3,528 patients were included. We considered prehospital data missing if any of heart rate, systolic blood pressure, respiratory rate or oxygen saturation were incomplete. Each individual variable was missing from the registry in approximately 20 % of patients, with oxygen saturation missing most frequently (n = 831; 23.6 %). Over 25 % (n = 909) of patients were missing at least one prehospital vital sign, of which 69.1 % (n = 628) were missing all four of these variables. Patients with incomplete data were more severely injured, had higher mortality, and more frequently received lifesaving interventions such as blood transfusion and intubation. Patients were most likely to have missing prehospital physiological data if they died in the trauma bay (unadjusted OR: 9.79; 95 % CI: 6.35–15.10), did not survive to discharge (unadjusted OR: 3.55; 95 % CI: 2.76–4.55), or had a prehospital GCS less than 9 (OR: 3.24; 95 % CI: 2.59–4.06). ConclusionIn this single center trauma registry, key prehospital variables were frequently missing, particularly among more severely injured patients. Patients with missing data had higher mortality, more severe injury characteristics and received more life-saving interventions in the trauma bay, suggesting an injury severity bias in prehospital vital sign missingness. To ensure the validity of research based on trauma registry data, patterns of missingness must be carefully considered to ensure missing data is appropriately addressed.

Nasogastric tube feeding under physical restraint of children and young people with mental disorders: a comprehensive audit and case series across paediatric wards in England

ObjectiveTo estimate the number of patients on paediatric wards in England who received nasogastric tube (NGT) feeding under physical restraint from April 2022 to March 2023, identify the demographics and...

Medicaid Expansion and Restriction Policies for Hepatitis C Treatment

Hepatitis C can be cured with direct-acting antivirals (DAAs), but Medicaid programs have implemented fibrosis, sobriety, and prescriber restrictions to control costs. Although restrictions are easing, understanding their association with hepatitis C treatment rates is crucial to inform policies that increase access to lifesaving treatment. To estimate the association of jurisdictional (50 states and Washington, DC) DAA restrictions and Medicaid expansion with the number of Medicaid recipients with filled prescriptions for DAAs. This cross-sectional study used publicly available Medicaid documents and claims data from January 1, 2014, to December 31, 2021, to compare the number of unique Medicaid recipients treated with DAAs in each jurisdiction year with Medicaid expansion status and categories of fibrosis, sobriety, and prescriber restrictions. Medicaid recipients from all 50 states and Washington, DC, during the study period were included. Multilevel Poisson regression was used to estimate the association between Medicaid expansion and DAA restrictive policies on jurisdictional Medicaid DAA prescription fills. Data were analyzed initially from August 15 to November 15, 2023, and subsequently from April 15 to May 9, 2024. Jurisdictional Medicaid expansion status and fibrosis, sobriety, and prescriber DAA restrictions. Number of people treated with DAAs per 100 000 Medicaid recipients per year. A total of 381 373 Medicaid recipients filled DAA prescriptions during the study period (57.3% aged 45-64 years; 58.7% men; 15.2% non-Hispanic Black and 52.2% non-Hispanic White). Medicaid nonexpansion jurisdictions had fewer filled DAA prescriptions per 100 000 Medicaid recipients per year than expansion jurisdictions (38.6 vs 86.6; adjusted relative risk [ARR], 0.56 [95% CI, 0.52-0.61]). Jurisdictions with F3 to F4 (34.0 per 100 000 Medicaid recipients per year; ARR, 0.39 [95% CI, 0.37-0.66]) or F1 to F2 fibrosis restrictions (61.9 per 100 000 Medicaid recipients per year; ARR, 0.62 [95% CI, 0.59-0.66]) had lower treatment rates than jurisdictions without fibrosis restrictions (94.8 per 100 000 Medicaid recipients per year). Compared with no sobriety restrictions (113.5 per 100 000 Medicaid recipients per year), 6 to 12 months of sobriety (38.3 per 100 000 Medicaid recipients per year; ARR, 0.65 [95% CI, 0.61-0.71]) and screening and counseling requirements (84.7 per 100 000 Medicaid recipients per year; ARR, 0.87 [95% CI, 0.83-0.92]) were associated with reduced treatment rates, while 1 to 5 months of sobriety was not statistically significantly different. Compared with no prescriber restrictions (97.8 per 100 000 Medicaid recipients per year), specialist consult restrictions was associated with increased treatment (66.2 per 100 000 Medicaid recipients per year; ARR, 1.05 [95% CI, 1.00-1.10]), while specialist required restrictions were not statistically significant. In this cross-sectional study, Medicaid nonexpansion status, fibrosis, and sobriety restrictions were associated with a reduction in the number of people with Medicaid who were treated for hepatitis C. Removing DAA restrictions might facilitate treatment of more people diagnosed with hepatitis C.

Implementing evidence-based restrictive neonatal intensive care unit platelet transfusion guidelines.

Platelet transfusions are life-saving treatments for specific populations of neonates. However, recent evidence indicates that liberal prophylactic platelet transfusion practices cause harm to premature neonates. New efforts to better balance benefits and risks are leading to the adoption of more restrictive platelet transfusion guidelines in neonatal intensive care units (NICU). Although restrictive guidelines have the potential to improve outcomes, implementation barriers exist. We postulate that as neonatologists become more familiar with the data on the harm of liberal platelet transfusions, enthusiasm for restrictive guidelines will increase and barriers to implementation will decrease. Thus, we focused this educational review on; (1) the adverse effects of platelet transfusions to neonates, (2) awareness of platelet transfusion "refractoriness" in thrombocytopenic neonates and its association with poor outcomes, and (3) the impetus to find alternatives to transfusing platelets from adult donors to NICU patients.

Impact of the COVID-19 pandemic on mechanical ventilation cases and mortality rates in non-SARS-CoV-2 patients: A nationwide analysis in Spain

BackgroundThe COVID-19 pandemic has presented unprecedented challenges for healthcare systems globally, impacting critical care resources and patient outcomes. Understanding its multifaceted effects is crucial for future crisis response. ObjectiveAnalyze the repercussions of the COVID-19 pandemic on mechanical ventilation cases and mortality among non-SARS-CoV-2 patients. MethodsA nationwide database encompassing all patients receiving mechanical ventilation in Spain was used to compare the number of cases and clinical outcomes during COVID-19 (March 2020 - December 2021) to pre-pandemic cases (May 2018 - February 2020). Univariate and multivariate analyses were employed. ResultsCOVID-19 significantly reduced access to ventilation for non-COVID-19 patients. A 16 % decrease (12,099 fewer patients) was observed during the pandemic compared to pre-pandemic times. This reduction affected all analyzed conditions except self-inflicted injuries, coinciding with a rise in overall mortality risk (34.5% vs 35.6 %, OR 1.09, 95 %CI 1.06–1.12). The increased mortality was consistent across diverse admission types, including cancer (37.1% vs. 41.5 %, OR 1.18, 95 %CI 1.09–1.29), hemorrhagic strokes (55.4% vs. 56.6 %, OR 1.07, 95 %CI 1.02–1.20), acute myocardial infarction (35.6% vs. 38 %, OR 1.11, 95 %CI 1.01–1.21), non-SARS-CoV-2 pneumonia (44.5% vs. 45.8 %, OR 1.12, 95 %CI 1.02–1.24), septic shock (54.7% vs. 56.3 %, OR 1.10, 95 %CI 1.06–1.15), and prolonged ventilation (≥96 h) (37% vs. 38.2 %, OR 1.10, 95 %CI 1.06–1.10). ConclusionsThe findings underscore the profound impact of the COVID-19 pandemic on critical care utilization and patient outcomes among non-SARS-CoV-2 patients. As healthcare systems strive to mitigate future crises, these insights emphasize adaptable strategies for equitable access to life-saving treatments.