COVID-19 vaccination status should not be used in triage tie-breaking

This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status.

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Relationship between the time of day lung transplantation is performed during 24-hours shifts and short-term survival

10.26226/morressier.57108e2fd462b80290b4a68c ◽

2016 ◽

Author(s):

Johannes Menger

Keyword(s):

Lung Transplantation ◽

Time Of Day ◽

Short Term ◽

Term Survival ◽

Short Term Survival

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Influence of age and shock severity on short-term survival in patients with cardiogenic shock

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuaa035 ◽

2021 ◽

Author(s):

Jacob C Jentzer ◽

Benedikt Schrage ◽

David R Holmes ◽

Salim Dabboura ◽

Nandan S Anavekar ◽

...

Keyword(s):

Cardiogenic Shock ◽

Mayo Clinic ◽

Older Patients ◽

Cox Proportional Hazards ◽

Circulatory Support ◽

Short Term ◽

Term Survival ◽

Risk Of Death ◽

Coronary Syndrome ◽

Short Term Survival

Abstract Aims Cardiogenic shock (CS) is associated with poor outcomes in older patients, but it remains unclear if this is due to higher shock severity. We sought to determine the associations between age and shock severity on mortality among patients with CS. Methods and results Patients with a diagnosis of CS from Mayo Clinic (2007–15) and University Clinic Hamburg (2009–17) were subdivided by age. Shock severity was graded using the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages. Predictors of 30-day survival were determined using Cox proportional-hazards analysis. We included 1749 patients (934 from Mayo Clinic and 815 from University Clinic Hamburg), with a mean age of 67.6 ± 14.6 years, including 33.6% females. Acute coronary syndrome was the cause of CS in 54.0%. The distribution of SCAI shock stages was 24.1%; C, 28.0%; D, 33.2%; and E, 14.8%. Older patients had similar overall shock severity, more co-morbidities, worse kidney function, and decreased use of mechanical circulatory support compared to younger patients. Overall 30-day survival was 53.3% and progressively decreased as age or SCAI shock stage increased, with a clear gradient towards lower 30-day survival as a function of increasing age and SCAI shock stage. Progressively older age groups had incrementally lower adjusted 30-day survival than patients aged <50 years. Conclusion Older patients with CS have lower short-term survival, despite similar shock severity, with a high risk of death in older patients with more severe shock. Further research is needed to determine the optimal treatment strategies for older CS patients.

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Parenteral Nutrition and Oxidant Load in Neonates

Nutrients ◽

10.3390/nu13082631 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2631

Author(s):

Kandeepan Karthigesu ◽

Robert F. Bertolo ◽

Robert J. Brown

Keyword(s):

Parenteral Nutrition ◽

Storage Temperature ◽

Oral Feeding ◽

Published Data ◽

Short Term ◽

Antioxidant Defences ◽

Term Survival ◽

Nutrient Sources ◽

Short Term Survival

Neonates with preterm, gastrointestinal dysfunction and very low birth weights are often intolerant to oral feeding. In such infants, the provision of nutrients via parenteral nutrition (PN) becomes necessary for short-term survival, as well as long-term health. However, the elemental nutrients in PN can be a major source of oxidants due to interactions between nutrients, imbalances of anti- and pro-oxidants, and environmental conditions. Moreover, neonates fed PN are at greater risk of oxidative stress, not only from dietary sources, but also because of immature antioxidant defences. Various interventions can lower the oxidant load in PN, including the supplementation of PN with antioxidant vitamins, glutathione, additional arginine and additional cysteine; reduced levels of pro-oxidant nutrients such as iron; protection from light and oxygen; and proper storage temperature. This narrative review of published data provides insight to oxidant molecules generated in PN, nutrient sources of oxidants, and measures to minimize oxidant levels.

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LACK OF ASSOCIATION BETWEEN 99MTC-PYP HEART TO CONTRALATERAL RATIO AND SHORT-TERM SURVIVAL IN PATIENTS REFERRED FOR TRANSTHYRETIN CARDIAC AMYLOIDOSIS EVALUATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02762-5 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1404

Author(s):

Trejeeve Martyn ◽

Joshua Saef ◽

Muzna Hussain ◽

Ossama Abou Hassan ◽

Eoin Donnellan ◽

...

Keyword(s):

Cardiac Amyloidosis ◽

Short Term ◽

Term Survival ◽

Short Term Survival

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A registry study on radial head arthroplasties in the Netherlands: Indications, types and short-term survival

Shoulder & Elbow ◽

10.1177/1758573220987843 ◽

2021 ◽

pp. 175857322098784

Author(s):

Arno A Macken ◽

Ante Prkić ◽

Koen LM Koenraadt ◽

Iris van Oost ◽

Anneke Spekenbrink-Spooren ◽

...

Keyword(s):

Radial Head ◽

Implant Survival ◽

Short Term ◽

Term Survival ◽

Arthroplasty Register ◽

Common Indication ◽

Radial Head Arthroplasty ◽

Kaplan Meier ◽

Short Term Survival

Background This study aims to use the Dutch Arthroplasty Register data to report an overview of the contemporary indications and implant designs, and report the short-term survival of radial head arthroplasty. Methods From the Dutch Arthroplasty Register, data on patient demographics, surgery and revision were extracted for radial head arthroplasties performed from January 2014 to December 2019. Implant survival was calculated using the Kaplan–Meier method. Results Two hundred fifty-eight arthroplasties were included with a median follow-up of 2.2 years. The most common indication was a fracture of the radial head (178, 69%). One hundred thirty-nine (68%) of the prostheses were of bipolar design, and the most commonly used implant type was the Radial Head System (Tornier; 134, 51%). Of the 258 included radial head arthroplasties, 16 were revised at a median of six months after surgery. Reason for revision was predominantly aseptic loosening (9). The overall implant survival was 95.8% after one year, 90.5% after three years and 89.5% after five years. Discussion For radial head arthroplasties, acute trauma is the most common indication and Radial Head System the most commonly used implant. The implant survival is 89.5% after five years.

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