Reduction In Need Research Articles

The Effect of Gray Ramus Communicans Nerve Block on Radicular Pain in Patients With Lumbosacral Radicular Pain Who Underwent Transforaminal Epidural Block

Lumbosacral radicular pain (LRP) is usually caused by herniation of intervertebral discs and is characterized by pain arising in the back and radiating to the lower extremities. The current study evaluated the efficacy of gray ramus communicans nerve block (GRCNB) in decreasing LRP in patients with intervertebral disc herniation who underwent transforaminal epidural block. Thirty patients with magnetic resonance imaging indicating a disc herniation on the L4-L5 level participated in this study. All patients were randomly divided into two groups: one whose members underwent GRCNB (n=15) after transforaminal epidural block, and a second group (n=15) whose members underwent only transforaminal epidural block on L4-L5 on the affected side. Follow-up after the procedure ran for a period ranging from 6 to 10 months (mean=8.2±2.1 months) for radicular pain score and the need for analgesics. The mean age of the patients was 54.8±18.4 years (range: 30-65 years). LRP duration in all patients before the procedure was 6-24 months (mean: 12±10.9 months), and there was no significant difference between the two groups. A greater reduction in the numerical rating scale (NRS) one week, 1, and 6 months after the procedure was observed in the group with GRCNB compared to the other group. The reduction in need for analgesics one week, 1, and 6 months after the procedure was statistically significant in the group with GRCNB compared to the group without GRCNB. No major complications were observed in any of the patients in either group. GRCNB is effective in reducing radicular pain and the need for analgesics in patients with lumbosacral radicular pain.

Cost-Effectiveness of Axicabtagene Ciloleucel Versus Mosunetuzumab in Relapsed/Refractory Follicular Lymphoma in the US

Introduction Anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapies, including axicabtagene ciloleucel (axi-cel), and CD20 × CD3 T-cell-engaging bispecific monoclonal antibodies, such as mosunetuzumab (mosun), are novel therapies for 3L+ relapsed/refractory (r/r) follicular lymphoma (FL) that have recently been approved by the US Food and Drug Administration. This analysis assessed the cost-effectiveness of axi-cel compared to mosun in r/r 3L+ FL from a US third-party payer perspective. Methods A three-state (progression-free [PF], progressed disease [PD], and death) partitioned-survival model was used to compare the two treatments over a lifetime horizon in a hypothetical cohort of US adults (age ≥18) receiving 3L+ treatment for r/r FL. ZUMA-5 (NCT03105336) and GO29781 (NCT02500407) trial data were used to inform progression-free survival (PFS) and overall survival (OS) for axi-cel and mosun, respectively. Survival curves for axi-cel were estimated using an exponential distribution for both PFS and OS. In the base case analysis, 40% of axi-cel patients alive at 5 years were assumed to experience long-term remission (i.e., functional cure), and therefore followed general population mortality adjusted by a standardized mortality ratio. This assumption was informed by the literature. Mosun survival was modeled via hazard ratios (HRs) applied to axi-cel exponential survival curves. For PFS, the HR value was estimated via a matching indirect comparison to adjust for differences between the trial populations. As a conservative assumption, a HR of 1.0 was used to model mosun OS due to lack of published results. The mosun arm did not include the cure assumption at 5 years because long-term remission is not expected with monoclonal antibodies in r/r FL. Health state utilities (HSU), healthcare resource use (HCRU), and treatment pattern inputs were obtained from literature. Costs for treatment and administration, adverse event management, monitoring resource use, HCRU, and end-of-life were included in the model. Key model outcomes included discounted (at 3% per year) total and incremental costs, life years (LYs), and quality adjusted life years (QALYs), as well as incremental cost-effectiveness ratios (ICERs). Scenario analyses were conducted on the cure assumption and all input parameters were individually varied by ±20% of their base case values in one-way sensitivity analysis (OWSA) to assess parameter uncertainty. Results Axi-cel use led to increases of 1.51 LY and 1.80 QALY (Table 1) compared to mosun. Progression-free survival for axi-cel patients was 7.11 LY compared to 1.80 LY for mosun, which resulted in a PF state cost increase of $215,045 primarily driven by the one-time cost of axi-cel treatment. Conversely, axi-cel costs were $63,000 less than mosun in the PD state, as patients spent less time with PD and had lower costs for subsequent treatment lines. Total incremental costs for axi-cel were $151,425, resulting in an ICER of $84,016/QALY gained. Analysis of lower cure fractions indicated cost-effectiveness across a wide range of values. Additionally, the OWSA indicated the most impactful inputs for the ICER were mean patient age, the relative dose intensity (RDI) of mosun, PF and PD HSUs, and PD HCRU. Inputs with the largest impact on total incremental costs were RDI, HCRU, and CAR-T infusion hospitalization duration. Conclusions Axi-cel is cost-effective versus mosun in r/r 3L+ FL at an ICER of $84,016/QALY gained, which is far lower than the commonly-cited US willingness-to-pay threshold of $150,000/QALY. This analysis demonstrates the value of using axi-cel, reflecting the aggregate benefits of a one-time therapy, reduction in need for subsequent treatment lines, and population segment experiencing effective cure.

Selective Deep Lobe Parotidectomy vs Total Parotidectomy for Patients With Benign Deep Lobe Parotid Tumors

Limited literature exists on surgical outcomes after selective deep lobe parotidectomy (SDLP) with preservation of superficial lobe for patients with benign deep lobe tumors. To compare the following factors for SDLP vs total parotidectomy for patients with benign tumors in the deep lobe: postoperative complications, including facial nerve paresis or paralysis, Frey syndrome, first bite syndrome, cosmetic defect, sialocele formation, and wound infection; and tumor control and recurrence. This case series included 273 adults who underwent SDLP (n = 177) or total parotidectomy (n = 96) at a single tertiary care institution for benign parotid tumors located in the deep lobe or deep lobe and parapharynx from January 1, 2000, to December 31, 2020. Selective deep lobe parotidectomy vs total parotidectomy. Incidence of postoperative complications and tumor recurrence. Among 273 patients (SDLP, 177 [65%]; 122 women [69%]; median age at surgery, 58 years [IQR, 46-67 years]; total parotidectomy, 96 [35%]; 57 women [59%]; median age at surgery, 59 years [IQR, 40-68 years]), the most common tumor was pleomorphic adenoma (SDLP, 128 of 177 [72%]; total parotidectomy, 62 of 96 [65%]). An abdominal dermal fat graft was less commonly performed for patients who underwent SDLP than those who underwent total parotidectomy (2 of 177 [1%] vs 20 of 96 [21%]; difference, -20% [95% CI, -28% to -11%]). The rate of great auricular nerve preservation was higher in the SDLP group than in the total parotidectomy group (84 of 102 [82%] vs 20 of 34 [59%]; difference, 24% [95% CI, 5%-42%]). No meaningful difference in length of hospital stay was found. The percentage of patients with House-Brackmann grade I immediately after surgery was 48% (85 of 177) in the SDLP group and 21% (20 of 96) in the total parotidectomy group (difference, 28% [95% CI, 16%-40%]). There were no clinically meaningful differences in rates of hematoma, sialocele, seroma, ear numbness, wound infection, or unplanned return to emergency department or operating room. The SDLP group reported a lower rate of Frey syndrome than the total parotidectomy group (1 of 137 [1%] vs 12 of 78 [15%]; difference, -15% [95% CI, -23% to -7%]), as well as a lower rate of facial contour defect (28 of 162 [17%] vs 25 of 84 [30%]; difference, -13% [95% CI, -24% to -1%]) and a higher rate of first bite syndrome (34 of 148 [23%] vs 7 of 78 [9%]; difference, 14% [95% CI, 5%-23%]). The percentage of patients with House-Brackmann grade I at their first follow-up visit was 67% (118 of 177) in the SDLP group compared with 49% (47 of 96) in the total parotidectomy group (difference, 17% [95% CI, 4%-30%]). There was no clinically meaningful difference in House-Brackmann grade after 1 year. Findings of this case series study suggest that SDLP can be considered an effective and even superior technique for management of benign tumors in the deep parotid lobe. Advantages associated with SDLP include reduction in need for reconstruction for facial contour defect and reduction in complications, such as immediate facial nerve weakness and Frey syndrome. The incidence of first bite syndrome was higher in the SDLP group. Tumor control was not compromised by SLDP.

The prevalence and perceived effectiveness of using a medication-swallowing lubricant in aged care facilities across Australia.

To explore the extent of use and perceived effectiveness of using a medication lubricant that is specifically designed to help people who struggle to swallow their solid medications whole. Health care workers of varying professional levels in aged care facilities (ACFs) across Australia who are involved in medication administration were invited to participate in a structured online survey. Of the 355 health care workers who completed the survey, 48% had used the medication lubricant to aid administration of whole and/or crushed solid oral dosage forms, and of these 89% agreed with the statement that "it is effective method to facilitate medication swallowing in residents." The main benefits of using the medication lubricant were considered to be easier medication administration to residents (49%), reduction in need for crushing of medications (34%), and better adherence with medications (33%). This study showed that using a medication lubricant for aged care residents may facilitate the process of medication administration for health care workers, which they perceive to improve residents' adherence with medications. Serious complications associated with solid dosage form modification may also be decreased by using a medication lubricant, as the need for modifying medications is reduced. Therapeutic Goods Administration (TGA)-approved medication lubricants could therefore be a valuable tool to aid the medication administration for patients who have difficulties swallowing medications. Future research may consider the clinical efficacy and acceptability of medication lubricants specifically for people with swallowing difficulties.

Effective reduction of need for non-steroid anti-inflammatory drugs on background of intra-artular introduction of sodium hyauloranate in patients with gonarthrosis

Introduction. Osteoarthritis (OA) in the Russian Federation is still not included in the list of socially significant diseases, despite the fact that this pathology limits the level of physical activity of the population more than diseases of the cardiovascular system, visual impairment and diabetes. European experts emphasize the relevance of research to develop methods to improve the effectiveness of viscosupplementary therapy in OA. The purpose of the study. To evaluate the efficacy, safety and long-term results of treatment of gonarthrosis with sodium hyaluronate.Materials and methods. The study included 180 patients with gonarthrosis with insufficient efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) on demand and oral symptomatic slow-acting drugs against osteoarthritis (SYSADOA). The patients were randomized into three groups. Group 1: 50 patients who received sodium hyaluronate (Ripart®; Ingal, Russia) intra-articularly. Group 2: 30 patients received intra-articular SYSADOA (bioactive concentrate of small marine fish). The control group consisted of 100 patients who received drugs of the SYSADOA group intramuscularly.Results. An effective reduction in pain both at rest and during movement was achieved in most patients of all groups, but the treatment groups differed statistically significantly in the speed of achieving the clinical effect and its duration. In the 1st group, a significant decrease in the VAS pain index was observed already at the 1st week and by the 3rd month it was –49.1 % (p < 0.001). In the comparison and control groups, the indicators of speed, the degree of pain reduction, and the duration of the effect of therapy were also significant (p ≤ 0.050). But the effectiveness of therapy in these groups was statistically significantly lower than in patients of group 1 (p ≥ 0.050). It should be emphasized that the intra-articular administration of sodium hyaluronate provided a significant reduction in the need for patients to additionally take NSAIDs. After 3 months of therapy, only 5 patients (10 %) of this group continued to take NSAIDs (p < 0.001); 20 – completely stopped taking NSAIDs (40 %) and 25 (50 %) reduced the dose of NSAIDs taken, the duration of the effect lasted up to 12 months.Conclusions. In our study, sodium hyaluronate demonstrated high efficiency in reducing pain in patients with gonarthrosis and contributed to a significant decrease in the need for patients to take NSAIDs for 12 months.

144 Foundations of Emergency Medicine Resident as Teacher Experience

144 Foundations of Emergency Medicine Resident as Teacher Experience

Recent Advances in Sickle-Cell Disease Therapies: A Review of Voxelotor, Crizanlizumab, and L-glutamine.

Sickle-cell disease (SCD) is an inherited hemoglobinopathy, causing lifelong complications such as painful vaso-occlusive episodes, acute chest syndrome, stroke, chronic anemia, and end-organ damage, with negative effects on quality of life and life expectancy. Within the last five years, three new treatments have been approved: L-glutamine in 2017 and crizanlizumab and voxelotor in 2019. We conducted a literature search of these three medications, and of the 31 articles meeting inclusion criteria, 6 studied L-glutamine, 9 crizanlizumab, and 16 voxelotor. Treatment with L-glutamine was associated with decrease in pain crises, hospitalizations, and time to first and second crises, with a decrease in RBC transfusion rate. Barriers to filling and taking L-glutamine included insurance denial, high deductible, and intolerability, especially abdominal pain. Crizanlizumab was associated with a reduction in pain crises and time to first crisis, with reduction in need for opioid use. Adverse effects of crizanlizumab include headache, nausea, insurance difficulty, and infusion reactions. Voxelotor was associated with increased hemoglobin and decreased markers of hemolysis. Barriers for voxelotor use included insurance denial and side effects such as headache, rash, and diarrhea. These three medications represent exciting new therapies and are generally well-tolerated though price and insurance approval remain potential barriers to access. Other studies are ongoing, particularly in the pediatric population, and more real-world studies are needed. The objective of this article is to evaluate post-approval studies of crizanlizumab, voxelotor, and L-glutamine in SCD, with a focus on real-world efficacy, side effects, and prescribing data.

Safety and feasibility of neoadjuvant chemotherapy as a surgical bridge for acute left-sided malignant colorectal obstruction: a retrospective study

BackgroundFor colorectal cancer, preoperative (neoadjuvant) chemotherapy is more effective than postoperative chemotherapy because it not only eradicates micrometastases more effectively but also reduces the risk of incomplete intraoperative resection and tumor cell shedding. For the treatment of acute left-sided malignant colorectal obstruction, colorectal stents as well as stoma are being used to relieve the obstructive colorectal cancer, and as a bridge to surgery, allowing easy mobilization and resection of the colon. Neoadjuvant chemotherapy combined with self-expandable metal stents (SEMS) or neoadjuvant chemotherapy combined with decompressing stoma (DS) can be used as a bridge to elective surgery (BTS) as an alternative to emergency surgery in patients with acute left-sided malignant colorectal obstruction, but its benefit is uncertain. The purpose of this study was to evaluate the safety and feasibility of neoadjuvant chemotherapy as a bridge to surgery in the treatment of acute left-sided malignant colorectal obstruction.MethodsData from patients who were admitted with acute left-sided malignant colorectal obstruction between January 2012 and December 2020 were retrospectively reviewed, and patients with gastrointestinal perforation or peritonitis were excluded. We performed one-to-two propensity score matching to compare the stoma requirement, postoperative complications, and other short-term oncological outcomes between the neoadjuvant chemotherapy group and surgery group.ResultsThere were no differences in intraoperative blood loss, operative time, one-year postoperative mortality, and postoperative tumor markers between the two groups. The 1-year recurrence-free survival (RFS) rates of neoadjuvant chemotherapy group and surgery group were 96.8 and 91.3% (p = 0.562). The neoadjuvant chemotherapy group was able to reduce stoma rate 1 year after surgery (p = 0.047). Besides, the neoadjuvant group significantly reduced postoperative bowel function time (p < 0.001), postoperative hospital stay (p < 0.001), total hospital stay (p = 0.002), postoperative complications (p = 0.017), reduction in need to stay in the intensive care unit (ICU) (p = 0.042).ConclusionsNeoadjuvant chemotherapy as a bridge to elective surgery in patients with acute left-sided malignant colorectal obstruction is safe and has many advantages. Prospective multicenter studies with large samples are needed to further evaluate the feasibility of neoadjuvant chemotherapy.

457 Single Vs Biplane 3d Augmented Overlay Guidance To Assist Congenital Cardiac Catheterisation Interventions

Introduction: Patients with congenital heart disease (CHD) undergoing cardiac catheterisation procedures often require higher radiation and contrast usage as it is often difficult to track catheter movement through complex anatomy. On a prior study, we showed reduction in need for radiation exposure and contrast usage using a fused single plane fluoroscopy display augmented by 3D magnetic resonance imaging (MRI) and Computed Tomography (CT) models. Recently, a biplane fusion overlay system was made available, which was hypothesised to be of higher benefit as congenital interventions are traditionally performed on a biplane system.

P379 Trends in Colectomy Rates and Biologic use over a, 30-year period: What has changed?

Abstract Background Novel medications including the introduction of biologic therapies in the last decade have expanded treatment options for patients with ulcerative colitis (UC). Large studies in the USA and Europe have shown colectomy rates in UC patients are reducing over the past two decades. Methods We performed a single-centre retrospective study of our prospectively maintained IBD database. Our aim was to look at changes in colectomy rates in patients with UC over the past three decades and need for biologic therapy. Basic demographics, need for biologic therapy and colectomy rates were collected. Need for colectomy and biologic therapy within, 10 years of diagnosis was determined across three groups dependent on decade of diagnosis. Results 2229 patients with confirmed UC were included in our study. Median age at diagnosis was, 37 years [range, 4.9 -92.6]., 1210 [54.28%] were male., 595 patients were diagnosed between, 1990–2000, 795 between, 2000–2010 and, 790 between, 2010–2020. A total of, 366 (16.4%) patients had a colectomy during follow-up and, 363 (16.3%) were treated with biologic therapies. We found rates of colectomy within, 10 years of diagnosis have significant dropped over the past three decades. From, 1990 -2000, 595 patients were diagnosed with UC and, 131 [22%] patients had colectomies, in, 2000-2010, 794 patients were diagnosed with UC and, 135 [17%] had a colectomy and between, 2010-2020, 784 patients were diagnosed with UC and, 55 [7%] had a colectomy [p = &amp;lt;, 0.001]. We found a significant increase in use of biologic therapy within the first, 10-years of diagnosis over the last three decades increasing from, 0.2% to, 5.3% to, 22.7% over the past decade [p = &amp;lt;, 0.001]. Conclusion Management of UC has changed over the past three decades including the introduction of multiple biologic therapies and the use of therapeutic drug monitoring has allowed a more personalised approach to management of UC. We can see from this study changes in the management of UC over the past decade have resulted in significant reduction in need for colectomy and an increase in the use of biologics.

Use of Tranexamic Acid in Bleeding Control of Transabdominal and Transvaginal Hysterectomy.

Hysterectomy is one of the most common gynecology surgeries. This study aimed to compare perioperative bleeding in transabdominal and transvaginal hysterectomy. This prospective, double-blind, randomized, controlled clinical trial was performed on 80 patients undergoing hysterectomy referred to Shahid Beheshti Hospital, Isfahan, Iran. Patients were divided into two groups of 40; the first group (T) received 1 g intravenous tranexamic acid (TXA) for 20 min preoperatively. The second group (S) received 10 cc normal saline as placebo. Blood samples were taken before and 12 h after surgery for assessment of hemoglobin, hematocrit, and platelet count, the prothrombin time, activated partial thromboplastin time, and serum creatinine as well as volume of blood transfusion. There were no significant differences between the two groups in heart rate, diastolic blood pressure (BP), systolic BP, and mean arterial pressure before, during, and after surgery (P > 0.05). There was no significant difference in blood variables before and after surgery (P > 0.05) except the platelet count that was in the normal range in both groups after surgery (P = 0.022). The mean volume of blood transfused in the case group was significantly lower than the control group during surgery (P = 0.008) and 12 h after surgery (P = 0.01). The prophylactic administration of TXA results in a significant reduction in need for blood transfusion and the duration of surgery. Given the lower risks of using TXA compared to the other drugs, it is recommended in hysterectomy to control bleeding.

Early goal directed therapy versus a protocolized resuscitation care in early management of septic shock

ABSTRACT Objective Multicenter studies showed that early goal directed therapy (EGDT) did not improve outcome in patients with septic shock compared with undefined usual care. The aim of this study was to evaluate the efficacy of a protocolized resuscitation care compared to traditional EGDT in early management of septic shock on short-term mortality. Design A randomized controlled trail. Setting Emergency Department and Critical Care Units of Alexandria main university hospital. Patients 100 adult patients of both genders with septic shock. Methods All patients received early fluid resuscitation, empirical broad-spectrum antibiotic therapy and mechanical ventilation if indicated. Then, they were randomly assigned into two groups: Early goal directed therapy (EGDT) group (n = 50) and Protocolized resuscitation care (PRC) group (n = 50). Results EGDT group showed 20% reduction in need for vasopressor than PRC group with significant difference (p = 0.001). PRC group showed lower mortality rate than EGDT group but with no significant difference (p = 0.405). There were no differences in ICU stay, mechanical ventilation days and duration of vasopressor (p= 0.091, 0.243, 0.372 respectively). Conclusion A Protocolized resuscitation care may be beneficial as compared to EGDT in early management of septic shock with a non-significant trend to decrease mortality.

The timing of administering aspirin and nitroglycerin in patients with STEMI ECG changes alter patient outcome

BackgroundBoth chewed aspirin and sublingual nitroglycerin are fast acting medications and reach therapeutic levels within a few minutes. Current guidelines for managing acute coronary syndrome (ACS) do not recognize the importance of the order or timing of administering aspirin and nitroglycerin. This retrospective study aimed to examine if there was any benefit to the timing of giving aspirin before or after nitroglycerin in cases of ACS.MethodsFrom the large National Emergency Medical Services Information System (NEMSIS) 2017 Version database, 2594 patients with acute coronary syndrome were identified (based on chest pain and their ECG finding) that received aspirin plus nitroglycerin in prehospital settings. Based on which medication was given first, the patients were separated in 2 groups: an aspirin-first and a nitroglycerin-first group. The 2246 patients who received aspirin first were further stratified based on the time between administration of aspirin and the first dose of nitroglycerin. The other 348 patients who received nitroglycerin first were similarly stratified.ResultsIn patients with STEMI ischemia, giving nitroglycerin 10 min after aspirin dosing (compared to giving them simultaneously) leads to a greater than 20% reduction in need for additional nitroglycerin, a greater than 7% decrease in subjective pain experienced by the patient and reduced need for additional opioids. The aspirin-first group in total, had a 39.6% decrease in subjective pain experience after giving additional nitroglycerin compared to nitroglycerin-first group.ConclusionIn patients with ACS, this study found that giving nitroglycerin 10 min after aspirin was associated with a reduction in subjective pain scores, as well as a reduced need for additional nitroglycerin or opioids. Future prospective trials examining the timing of aspirin vs. nitroglycerin are needed to confirm these findings.

Assessment of post-operative analgesia in modified radical mastectomy patients using surgical wound irrigation with 0.25% bupivacaine

Modified Radical Mastectomy is the widely followed treatment for operable breast cancers. Among the methods used to alleviate pain, irrigation of wound with 0.25% Bupivacaine is one of the under-utilized methods with good efficiency compared to other drugs.To evaluate the role of local irrigation of 0.25% bupivacaine in alleviating the post-operative pain. This observational study was conducted among 60 female patients who underwent Modified Radical Mastectomy in a tertiary care teaching hospital between January 2017 and July 2018. Thirty (30) patients were randomly allotted to control group, where the routine post-operative pain management was followed. Another 30 were randomly allotted to study group where, before closure of the wound, a 20G scalp vein set was used along the length of the incision with multiple punctures in it for continuous irrigation with 0.25% Bupivacaine. Post operatively Visual analogue scale was used to measure the pain sensation at every six hours for 24 hours. The adverse effects like pain, hematoma, wound dehiscence, infection was noted on all the post-operative days.Both the groups were similar with respect to basic parameters measured. There was a significant reduction in need for rescue analgesia in the study group. There was a significant difference in mean VAS score between both groups from 6 hour of surgery. Post-operative nausea and vomiting was significantly less in the study group. Irrigation of wound with 0.25% Bupivacaine is found to reduce the pain sensation with minimal side effects without systemic compromise.

Convalescent plasma for COVID-19: a meta-analysis, trial sequential analysis, and meta-regression

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibodies, particularly those preventing interaction between the viral spike receptor-binding domain and the host angiotensin-converting enzyme 2 receptor, may prevent viral entry into host cells and disease progression. MethodsWe performed a systematic review, meta-analysis, trial sequential analysis (TSA), and meta-regression of RCTs to evaluate the benefit of convalescent plasma for COVID-19. The primary outcome was 28–30 day mortality. Secondary outcomes included need for mechanical ventilation and ICU admission. Data sources were PubMed, Embase, MedRxiv, and the Cochrane library on July 2, 2021. ResultsWe identified 17 RCTs that recruited 15 587 patients with 8027 (51.5%) allocated to receive convalescent plasma. Convalescent plasma use was not associated with a mortality benefit (24.7% vs 25.5%; odds ratio [OR]=0.94 [0.85–1.04]; P=0.23; I2=4%; TSA adjusted confidence interval [CI], 0.84–1.05), or reduction in need for mechanical ventilation (15.7% vs 15.4%; OR=1.01 [0.92–1.11]; P=0.82; I2=0%; TSA adjusted CI, 0.91–1.13), or ICU admission (22.4% vs 16.7%; OR=0.80 [0.21–3.09]; P=0.75; I2=63%; TSA adjusted CI, 0.0–196.05). Meta-regression did not reveal association with titre of convalescent plasma, timing of administration, or risk of death and treatment effect (P>0.05). Risk of bias was high in most studies. ConclusionsIn patients with COVID-19, there was no clear mortality benefit associated with convalescent plasma treatment. In patients with mild disease, convalescent plasma did not prevent either the need for mechanical ventilation or ICU admission. Clinical trial registrationCRD42021234201 (PROSPERO).

The Impact of COVID-19 on Villages: Results from a National Survey

ABSTRACT Villages are consumer-driven organizations that promote aging-in-place. This study documents the effects of the COVID-19 pandemic on Villages and explores variation in response by age of the organization, size of the membership, staffing model, and geographic location. In summer, 2020, we distributed an online survey to executive administrators of 286 Villages in the network. During the pandemic, over 75% of Villages were seen as more or equally valuable for members. Seventy-seven percent of Villages offered virtual socialization events. Most Villages reported a decrease in service requests, given reductions in need for transportation. New services of food and medication delivery were initiated. There is much variation between organizations, but findings suggest that Villages that are older, have more members, and bigger budgets had more capacity and cushion; and although they took a negative hit in income and participation, it was a smaller hit proportionately, compared to younger and smaller Villages. Villages have demonstrated adaptability and creativity. They kept their operations running, provided services, and offered social connection. Vulnerabilities have been exposed: memberships have dropped for many and some members have not been able to participate as before the pandemic. Many lessons learned can help future developments of the Village model.

Safety and Efficacy of Recombinant Factor VIIa (NovoSeven) Use during ECMO Support in Patients after Cardiac Surgery

Background: Acute postoperative bleeding in cardiac surgical patients is a major cause of morbidity and mortality. Substitution of coagulatory factors may not always provide optimal hemostasis and off label, use of recombinant FVIIa has been proposed. When on ECMO, extra care must be taken during coagulatory substitution as clotting of the system may cause cardiovascular complications and possible ECMO failure, leading to death. In this paper, we examined the safety and efficacy of rFVIIa during ECMO support in postoperative cardio-surgical patients. Methods: We retrospectively examined all patients receiving rFVIIa postoperatively from December 2005 and January 2020. Clinical characteristics, demographics, bleeding, thrombotic complications, mortality, and rFVIIa administration were analyzed. Results: A total of 74 patients received rFVIIa postoperatively due to uncontrollable bleeding after cardiac surgery on our ICU. Of these patients, 23 patients were on ECMO treatment. Twelve patients received rFVIIa during, but not prior to the initiation of ECMO therapy. Six patients (50%) were male; mean age was 46 years (30-72 years). Eleven patients (91.7%) were on venoarterial ECMO, one patient was on central ECMO (8.3%). Dose of administered rFVIIa was corrected for body weight; mean dosage was 82μg/kg. We saw a significant reduction in need for red packed cells, fresh frozen plasma and thrombocyte transfusion after rFVIIa administration. There was no impact on the functionality of the ECMO system, especially regarding the oxygenator after rFVIIa administration. One patient suffered a stroke due thromboembolism (8.3%). One patient developed late thromboembolism in the leg (8.3%), and two cases of pulmonary embolism (16.7%) were recorded. Overall survival was 25% and there was no significant difference in survival between ECMO and non-ECMO patients. Weaning from ECMO could be achieved successfully in 41.7% of our patients. Conclusion: Recombinant Factor VIIa is an effective agent in reducing blood loss during ongoing ECMO therapy in patients with refractory bleeding. Although no direct relation between rFVIIa application and thromboembolic events could be established, its use should be done with the utmost care and in selected patients. However, rFVIIa therapy did not impact ECMO function in our cohort.

Dynamic compaction of crushed concrete fill, full-scale test at Jätkäsaari, Helsinki

Concrete waste in the form of crushed concrete can be utilized in street and road structures. Today, a significant amount of concrete waste generated by various demolition and other activities is not fully utilized in infrastructure projects within Helsinki; as a result, a portion of concrete waste generated in the city is be transported to other sites outside the Helsinki metropolitan area. In Helsinki, large-scale land reclamation projects have been implemented, and this trend will continue in the near future. Utilization of concrete waste as fill material in land reclamation projects will reduce the need to transport concrete waste outside the Helsinki metropolitan area, with a concurrent reduction in need to transport blasted rock to the land reclamation sites. This will promote reuse and recycling of waste and will reduce heavy traffic and CO2 emissions. Crushed concrete has not been previously tested in Finland as a fill material in land reclamation projects subjected to deep compaction methods. In 2018-2019 suitability of crushed concrete for land reclamation purposes was tested in a full-scale dynamic compaction test. The objective of the test was to assess the degree of compaction produced by dynamic compaction, determine the compression rate of compacted layers under pre-loading embankment, and measure environmental impacts of the fill material. The pilot structure was implemented in Tritoninpuisto (Triton Park) located in the southern part of Jatkasaari. Crushed concrete with varying grain size was compacted using the dynamic compaction method. All materials compacted well. Results of the pilot study indicate that dynamic compaction can be applied to densify crushed concrete fill material for land reclamation. Settlement plates on the top and the bottom of the pilot structure were used to monitor short-term settlement during dynamic compaction and long-term settlement after completion of the work. Long-term settlement was minor after compaction and placement of a pre-loading embankment. Implemented study has indicated that compacted crushed concrete is a suitable material for land reclamation in street and park areas.

Reduction of Need for Treatment and Length of Hospital Stay Following Institution of a Neonatal Abstinence Syndrome Rooming-In Program in Ontario, Canada

PurposeTo assess the impact of a rooming-in program for babies at risk of Neonatal Abstinence Syndrome (NAS) in one community hospital centre, in Belleville, Ontario. Design and methodsThis retrospective chart review was conducted at Belleville General Hospital. The hospital developed a rooming-in program for newborns at risk of NAS in July 2015. Charts on all infants born to mothers using opioids in the 24 months prior to and after the implementation of our program, who met the inclusion criteria, were examined. ResultsThe study consisted of 15 babies in the Special Care Nursery (SCN) group and 19 babies in the rooming-in group. Rooming-in is associated with a reduction in the need for treatment with morphine [rooming-in group (1/19, 5.3%), SCN group (14/15, 93.3%), p < 0.01], shorter length of stay in hospital [rooming-in group (days = 5), SCN group (days = 20), p < 0.01], improved exclusive breast and/or breast milk-feeding rates [rooming-in group (17/19,89.5%), SCN group (1/15,6.7%), p < 0.01] and lower total hospital cost [rooming-in group ($6458.00), SCN group ($17,851.00), p < 0.01]. ConclusionOur study demonstrates that rooming-in programs for babies born to mothers using opioids has benefits in terms of quality of care and health care resource utilization. Practical implicationsThese findings show that rooming-in can be successfully implemented in a community hospital.

Reduction of Need for Treatment and Length of Hospital Stay Following Institution of a Neonatal Abstinence Syndrome Rooming-in Program

Reduction of Need for Treatment and Length of Hospital Stay Following Institution of a Neonatal Abstinence Syndrome Rooming-in Program