Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE): Trial of Fentanyl versus Fentanyl

Objectives This article observes the mean daily dose of fentanyl required for adequate sedation in critically ill, mechanically ventilated children randomized to receive dexmedetomidine or placebo.Methods We conducted Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE), a multicenter, double-blind, randomized, placebo-controlled, dose-escalating trial. We enrolled children aged 35 weeks postmenstrual to 17 years (inclusive) admitted across 13 pediatric multidisciplinary and cardiac intensive care units. Adequate sedation was based on a State Behavioral Score and Richmond Agitation-Sedation Scale of -1 or lower. Only the first two dexmedetomidine dosing cohorts opened for enrollment, due to early trial closure during the coronavirus 2019 pandemic. Thirty children were randomized over 13 months and included in the analyses.Results Demographic and baseline characteristics were not different between dexmedetomidine and placebo cohorts. Similarly, mean daily fentanyl use was not different, using an unadjusted mixed regression model that considered treatment, time, and a treatment-by-time interaction. Adverse events and safety events of special interest were not different between cohorts.Conclusion The DOSE trial revealed that dexmedetomidine added to fentanyl does not impact safety and may not spare fentanyl use in critically ill children, although the trial did not meet its recruitment goals, due to early closure during the coronavirus 2019 pandemic. More rigorous inpatient pediatric trials like DOSE that study critically ill, mechanically ventilated children are needed. Despite the many obstacles faced, the DOSE trial presents challenges from which the greater research community can learn and use to optimize future therapeutic trials in children.

Automated Fact-Checking of Articles Related to Neurodevelopmental Disorders

False claims or Fake News related to the health care or medicine field on Social Media have garnered increasing amounts of interest, especially in the aftermath of the COVID-19 pandemic. False claims about the pan-demic which spread on social media have contributed to vaccine hesitancy and lack of trust in the advise of medical professionals. If not detected and disproved early, such claims can complicate future pandemic responses. We focus on false claims in the field of Neurodevelopmental Disorders (NDDs), which is an umbrella term for a group of disorders that includes Autism, ADHD, Cerebral Palsy, etc. In this paper we present our approach to automated systems for fact-checking medical articles related to NDDs. We also present an annotated dataset of 116 web pages which we use to test our model and present our results. © 2022 IEEE.

COVID-19, Telemedicine and Emergency Department Referrals: Patient Presentations and Follow-up Times to a Community Mental Health Team

Introduction: The COVID-19 pandemic caused changes to how healthcare services are utilised and delivered. Objective(s): We examine the impact of COVID-19 on the pattern of emergency patient presentations referred on to the community mental health team and the impact of utilising telemedicine on time to follow-up. Method(s): We retrospectively reviewed all clinical records of patients currently attending our service. We identified presentations to the emergency department (N=119) who were subsequently referred on for mental health follow-up. Result(s): Patients being referred to our team from emergency departments were significantly younger during, mean age 33.1 years (SD=12.3) compared to before the pandemic, mean age 40.0 years (SD=14.5), p=0.006 and a higher proportion were new patients during, 55.8%, compared to pre-pandemic period 33.3%, p=0.015. There was also a higher proportion of patients presenting with suicidal ideation and lower proportions of affective, psychosis and suicidal/self-injurious acts during the pandemic period compared to before, p=0.006. The ratio of female to male patients on the other hand were similar during both periods, p=0.853. There appeared to be no difference in median time to follow-up pre and during the pandemic (6.0 vs 5.5 days, p=0.995). Further analysis also found no significant impact on time to follow-up upon implementing telemedicine consultations, with median days to initial follow-up of 6 days pre-pandemic, 4.5 days during pandemic + prior to telemedicine and 6.5 days during pandemic + telemedicine, p=0.602. Conclusion(s): This study provides preliminary data on the impact of COVID-19 on mental health emergency presentations and utilization of telemedicine on time to follow-up by CMHTs.

Polyfunctional T-cell impairment to SARS-CoV-2 coronavirus in solid organ transplant recipients with acute COVID-19 infection

Purpose: The emerged COVID-19 pandemic caused by SARS-CoV-2 has paralyzed the world, due to its high infectivity and fatal outcomes, especially among more vulnerable individuals. While description of protective humoral and T-cell immune responses has been reported among immunocompetent (IC) individuals, its characterization and determinants of poorer outcomes among the at-risk Solid Organ Transplant (SOT) patient population has not been thoroughly investigated. Methods: SARS-CoV-2-specific serological and functional T-cell immune responses against main immunogenic antigens were tracked in 28 SOT recipients during acute infection and over the following 40 days of convalescence and were compared to 16 IC patients admitted with similar moderate/severe COVID-19. Results: We show a more severe polyfunctional T-cell and serological impairment in SOT at the infection onset as compared to IC individuals, especially against membrane antigen. Worse clinical outcomes (need of mechanical ventilation or death) more frequently occurred within SOT and were associated with a significantly impaired Th1 polarized immune response to antigens spike and membrane. Nonetheless, SOT achieved robust serological and functional Th1 and Th2 immune responses at convalescence, similarly to those of IC patients. Conclusions: Our data show a delay of serological and functional T-cell immune activation to SARS-CoV-2 in SOT, which may entail poorer clinical outcomes.

Spanish Heart Transplant Registry. 32nd Official Report of the Heart Failure Association of the Spanish Society of Cardiology

Introduction and objectives: The present report updates the main characteristics and outcomes of heart transplants in Spain to 2020. Methods: We describe the main features of recipients, donors, surgical procedure, and immunosuppression in 2020. We also analyze the temporal trends of these characteristics and outcomes (survival) for the period 2011 to 2019. Results: In 2020, 278 heart transplants were performed (7.3% decrease vs 2019). The findings in 2020 confirmed previous observations of an increase in pretransplant sternotomy, a slight decrease in urgent transplants carried out with ventricular assist devices, a slight decrease in donor age, an increase in the use of allografts with previous arrest, and a decrease in ischemia time. Survival continued to improve in recent triennia, reaching 82.0% at 1 year in the period 2017 to 2019. Conclusions: The slight decrease in the number of heart transplants performed in 2020 in Spain, most likely due to the SARS-CoV-2 pandemic, did not change the main characteristics of the procedure. No change was observed in the tendency to improved survival. Full English text available from:www.revespcardiol.org/en © 2021 Sociedad Española de Cardiología

Improving medication reconciliation in ambulatory cancer care

Background: Adverse drug events are common in ambulatory oncology where care spans multiple providers and medication documentation is often poor. We undertook a QI project with the aim of having 30% of patients have a best possible medication history (BPMH) or medication reconciliation (MedRec) documented within 30 days of starting systemic therapy. Methods: An Electronic Medical record-Integrated Tool (EMITT) was developed to facilitate documentation. 2 Plan-Do-Study-Act (PDSA) cycles have been completed to date;PDSA 1 consisted of piloting EMITT in 3 clinics run by physician champions. PDSA 2 which consisted of expanding pharmacy support and addition of a 4 clinic was impacted by care changes related to COVID. The proportion of patients with BPMH/MedRec documented in EMITT was calculated monthly for each period (PDSA 1, PDSA 2 pre-COVID and PDSA 2 post-COVID). The balancing measure of time to complete an entry was evaluated through a time motion study. Results: Between 9/9/2019 and 31/5/2020, 9.4% (233/2488) of patients had BPMH/MedRec completed;Table shows proportion of patients by month. BPMH and MedRec were most frequently performed by pharmacists followed by pharmacy students and nurses. On average, it took 5.5 minutes to complete an entry (n = 10;median number of medications per patient = 12.3). Conclusions:BPMH was documented more often than MedRec. While some usage was sustained, the changes to care as a result of COVID-19 negatively impacted ambulatory medication reconciliation. Future PDSA cycles will involve engaging patients in MedRec and extending EMITT to all ambulatory cancer clinics where medication management is a major component of care.