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Buchanan talks about her son who had been in hospital for 500 days. Before he could be discharged, she and her husband had to undergo extensive training on all his medical care and equipment. They learned what acronyms such as \"PIP\" and \"PEEP\" meant on his ventilator; they learned what all the alarms were telling us and how to troubleshoot them. They learned how to give him oxygen and life-saving breaths with a resuscitation bag while calling 911 if required. However, all the newly acquired knowledge and skills did little to alleviate the overwhelming sense of dread and fear that they could not do it. When theirson was discharged from the ICU, they had a 24/7 hotline to respiratory therapists trained on his ventilator. If they had a question, they could contact a specialist on call at the hospital.

Chanchlani et al examine the indirect effects of COVID-19 on the health of children and young people. As of June 21, 2020, 6,982 individuals in Canada aged 19 years and younger, hereafter referred to as children and young people, had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, leading to 98 hospital admissions and 20 intensive care admissions, but no deaths. Aside from cases of pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS), for which understanding is still developing worldwide, children and young people have been more mildly affected by coronavirus disease 2019 (COVID-19) than adults. Countries that have seen substantial disruption to usual medical services and widespread public health measures related to COVID-19 are likely to see both immediate and long-term indirect effects of the pandemic on health. The potential adverse effects on children and young people's health may be underappreciated. Moreover, the limited access to primary and secondary health care, the parental fear of seeking health care, the closures of daycare and schools, employment and financial instability, and the greater risk of exposure to adverse childhood experiences are discussed.

Alzheimer's disease biomarkers are important for early diagnosis in routine clinical practice and research. Three core CSF biomarkers for the diagnosis of Alzheimer's disease (Aβ42, T-tau, and P-tau) have been assessed in numerous studies, and several other Alzheimer's disease markers are emerging in the literature. However, there have been no comprehensive meta-analyses of their diagnostic performance. We systematically reviewed the literature for 15 biomarkers in both CSF and blood to assess which of these were most altered in Alzheimer's disease. In this systematic review and meta-analysis, we screened PubMed and Web of Science for articles published between July 1, 1984, and June 30, 2014, about CSF and blood biomarkers reflecting neurodegeneration (T-tau, NFL, NSE, VLP-1, and HFABP), APP metabolism (Aβ42, Aβ40, Aβ38, sAPPα, and sAPPβ), tangle pathology (P-tau), blood–brain-barrier function (albumin ratio), and glial activation (YKL-40, MCP-1, and GFAP). Data were taken from cross-sectional cohort studies as well as from baseline measurements in longitudinal studies with clinical follow-up. Articles were excluded if they did not contain a cohort with Alzheimer's disease and a control cohort, or a cohort with mild cognitive impairment due to Alzheimer's disease and a stable mild cognitive impairment cohort. Data were extracted by ten authors and checked by two for accuracy. For quality assessment, modified QUADAS criteria were used. Biomarker performance was rated by random-effects meta-analysis based on the ratio between biomarker concentration in patients with Alzheimer's disease and controls (fold change) or the ratio between biomarker concentration in those with mild cognitive impariment due to Alzheimer's disease and those with stable mild cognitive impairment who had a follow-up time of at least 2 years and no further cognitive decline. Of 4521 records identified from PubMed and 624 from Web of Science, 231 articles comprising 15 699 patients with Alzheimer's disease and 13 018 controls were included in this analysis. The core biomarkers differentiated Alzheimer's disease from controls with good performance: CSF T-tau (average ratio 2·54, 95% CI 2·44–2·64, p<0·0001), P-tau (1·88, 1·79–1·97, p<0·0001), and Aβ42 (0·56, 0·55–0·58, p<0·0001). Differentiation between cohorts with mild cognitive impairment due to Alzheimer's disease and those with stable mild cognitive impairment was also strong (average ratio 0·67 for CSF Aβ42, 1·72 for P-tau, and 1·76 for T-tau). Furthermore, CSF NFL (2·35, 1·90–2·91, p<0·0001) and plasma T-tau (1·95, 1·12–3·38, p=0·02) had large effect sizes when differentiating between controls and patients with Alzheimer's disease, whereas those of CSF NSE, VLP-1, HFABP, and YKL-40 were moderate (average ratios 1·28–1·47). Other assessed biomarkers had only marginal effect sizes or did not differentiate between control and patient samples. The core CSF biomarkers of neurodegeneration (T-tau, P-tau, and Aβ42), CSF NFL, and plasma T-tau were strongly associated with Alzheimer's disease and the core biomarkers were strongly associated with mild cognitive impairment due to Alzheimer's disease. Emerging CSF biomarkers NSE, VLP-1, HFABP, and YKL-40 were moderately associated with Alzheimer's disease, whereas plasma Aβ42 and Aβ40 were not. Due to their consistency, T-tau, P-tau, Aβ42, and NFL in CSF should be used in clinical practice and clinical research. Swedish Research Council, Swedish State Support for Clinical Research, Alzheimer's Association, Knut and Alice Wallenberg Foundation, Torsten Söderberg Foundation, Alzheimer Foundation (Sweden), European Research Council, and Biomedical Research Forum.

Boarding is the practice of holding patients in the emergency department (ED) or a temporary location after the decision to admit or transfer has been made. Previous literature suggests that ED Length of Stay (LOS), prolonged in boarded patients, is linked to worse outcomes. We conducted a systematic review and meta-analysis (SR/MA) to evaluate the differences in mortality and hospital LOS in ED-boarding (EDB) and non-ED boarding (non-EDB) critically ill patients in U.S. EDs. A systematic search was performed with medical librarians using major health science databases from 2012 through December 2024. Eligible studies included observational or randomized trials involving adults comparing EDB and non-EDB groups in U.S. EDs. Only full-text English-language articles were included. Outcomes were mortality and hospital LOS. We used random-effects meta-analysis to compare the outcomes. Heterogeneity was assessed with the I2 value while publication bias was assessed via the funnel plot. We identified 3139 studies and included 17, comprising 407,178 ED patients: 194,814 (48 %) EDB and 212,364 (52 %) non-EDB. 87.4 % of patients came from urban academic Emergency Departments with a resuscitation unit or team. Median ED LOS was 6.5 h (IQR 5.18–8.1) for EDB and 4.2 h (IQR 2.38–5.75) for non-EDB (p < 0.01). EDB patients had similar all-cause mortality (OR 1.06, 95 % CI 0.94–1.19, I2 = 69 %, p = 0.38) and hospital LOS (mean difference 0.38 days, 95 % CI -0.75-1.50, I2 = 61 %, p = 0.51). Funnel plot suggested publication bias favoring higher mortality in EDB. Our SR/MA suggested that EDB was associated with a non-statistically significant increase in mortality and hospital LOS compared to non-EDB. High heterogeneity and inconsistent boarding definitions were also noted. •Boarding refers to holding patients in a temporary location after an admission or transfer decision.•A systematic review of 17 U.S.-based studies (407,178 patients) evaluated outcomes in critically ill ED-boarding patients.•A systematic review and meta-analysis of 17 U.S.-based studies (407,178 patients) evaluated outcomes in critically ill ED-boarding patients.•EDB was associated with a non-statistically significant increase in mortality and hospital LOS compared to non-EDB.•Limitations include publication bias, study heterogeneity, and a study population primarily from academic EDs.

The risk of young-onset colorectal adenomas and cancer (yCRAC) in adults less than 50 years of age is increasing. We conducted a systematic review and meta-analysis of epidemiologic studies to identify lifestyle and clinical risk factors associated with yCRAC risk. We searched Medline, EMBASE, and Cochrane Database of Systematic Reviews for studies which: used an epidemiologic study design, involved individuals with yCRAC, evaluated at least 1 lifestyle or clinical factor, and applied multivariable regression approaches. We critically appraised the quality of included studies and calculated pooled measures of association (e.g. odds ratio [OR]) and 95% confidence intervals (CI) using random-effects models. We identified 499 articles in our search with 9 included in a narrative synthesis and 6 included in a meta-analysis. We found in the pooled analysis that smoking and alcohol consumption were lifestyle factors associated with yCRAC, as were clinical factors including obesity elevated blood glucose, elevated blood pressure, and elevated triglycerides. We identified lifestyle and clinical risk factors associated with risk of yCRAC, which have potential implications for informing preventive efforts and modifying screening to target at-risk populations.

To develop a digital psychological intervention program for organ donor families based on Intervention Mapping. Using Intervention Mapping, the program was developed through literature review, questionnaire surveys, and qualitative interviews, and then reviewed and refined by an expert panel. The quantitative survey results showed 25.81% of 155 participants had co-occurring symptoms of post-traumatic stress, depression, and anxiety; trait mindfulness was negatively correlated with these symptoms (r=-0.423/-0.479/-0.463, p<0.001). Qualitative findings were organized into five themes: organ donation awareness, psychological distress, access to psychological support, psychological support needs, and willingness to use digital psychological interventions. Following the first four steps of Intervention Mapping, from needs assessment to program development, Acceptance and Commitment Therapy and Mindfulness-Based Stress Reduction were integrated in light of the needs of organ donor families, relevant literature, and expert input. Six experts participated in a panel review (collective authority coefficient=0.867) and refined an 8-week WeChat mini-program-based intervention delivered once weekly for 30 minutes per session. The digital psychological intervention program for organ donor families developed through Intervention Mapping provides a structured, theory- and evidence-informed framework for subsequent psychological support. It may offer a basis for future pilot testing, refinement, and the development of digital mental health support strategies for organ donor families.

To assess the incidence of postoperative delirium and its outcomes in older non-cardiac surgical patients. A systematic review and meta-analysis with multiple databases searched from inception to February 22, 2022. Postoperative assessments. Non-cardiac and non-neurological surgical patients aged ≥60 years with and without postoperative delirium. Included studies must report ≥1 postoperative outcome. Studies with a small sample size (N < 100 subjects) were excluded. Outcomes comprised the pooled incidence of postoperative delirium and its postoperative outcomes, including mortality, complications, unplanned intensive care unit admissions, length of stay, and non-home discharge. For dichotomous and continuous outcomes, OR and difference in means were computed, respectively, with a 95% CI. Fifty-four studies (20,988 patients, 31 elective studies, 23 emergency studies) were included. The pooled incidence of postoperative delirium was 19% (95% CI: 16%, 23%) after elective surgery and 32% (95% CI: 25%, 39%) after emergency surgery. In elective surgery, postoperative delirium was associated with increased mortality at 1-month (OR: 6.60; 95% CI: 1.58, 27.66), 6-month (OR: 5.69; 95% CI: 2.33, 13.88), and 1-year (OR: 2.87; 95% CI: 1.63, 5.06). The odds of postoperative complications, unplanned intensive care unit admissions, prolonged length of hospital stay, and non-home discharge were also higher in delirium cases. In emergency surgery, patients with postoperative delirium had greater odds of mortality at 1-month (OR: 3.56; 95% CI: 1.77, 7.15), 6-month (OR: 2.60; 95% CI: 1.88, 3.61), and 1-year (OR: 2.30; 95% CI: 1.77, 3.00). Postoperative delirium was associated with higher odds of mortality, postoperative complications, unplanned intensive care unit admissions, length of hospital stay, and non-home discharge. Prevention and perioperative management of delirium may optimize surgical outcomes. •Pooled incidence of delirium was 19% after elective surgery in older patients.•Pooled incidence of delirium was 32% after emergency surgery in older patients.•Delirium was associated with increased mortality at 1-month, 6-month, and 1-year.•Delirium was associated with increased odds of many adverse postoperative outcomes.

What are the change in and duration of hyperglycemia after intra-articular steroid injections in patients with diabetes mellitus?