ICU Admissions and Outcomes of Childhood Cancer Patients in Single Tertiary Hospital in the Private Sector in India

Ramandeep Singh AroraBackground  Modern-day treatment of childhood cancer is punctuated by the necessary need for intensive care. This study was performed to understand the intensive care unit (ICU) admission rates and factors associated with ICU admission in a cohort of newly diagnosed childhood cancer patients in India. Materials and Methods  All childhood (age <18 years) patients in the hospital-based cancer registry who had registered between March 1, 2013, and May 31, 2018, formed the cohort. ICU admissions were recorded and demographic and clinical factors associated with ICU admission were investigated. ICU admission rates were the primary outcome of interest and secondary outcomes were ICU admission rates for sick/supportive reasons, ICU admission rates for surgical/procedural reasons and mortality during ICU admission. Results  In a cohort of 258 children (66% males, 61% from India, and median age 7 years), 149 (58%) patients needed one or more ICU admission (median one with range of one to five) with total 204 ICU admission episodes. While age group, gender, and nationality were not significantly associated with ICU admission, cancer type was (highest in neuroblastoma (82%) and central nervous system (CNS) tumors (71%)). Sick/supportive care ICU admissions were significantly higher in patients of younger age, Indian origin, and certain cancers (leukemias, lymphomas). Surgical/procedural ICU admissions were significantly higher in international patients and certain cancers (CNS tumors, neuroblastomas, and soft tissue sarcomas). There were 17 ICU deaths (11% of patients admitted to ICU) and all but one were from sick/supportive care ICU admissions. Conclusion  Our study highlights higher than reported ICU admission rates and lower than reported mortality in children with cancer in low- and middle-income countries. We next plan to develop more specific ICU admission criteria, prospectively evaluating severity metrics in these patients, and explore the development of a high dependency unit.

The Importance of Criminal Justice Health Education for Today's Medical Students and Strategies for Integration Into Medical School Curricula

As the United States wrestles with the consequences of the COVID-19 pandemic and concurrently confronts long-standing issues of racial injustice, it is more important than ever that criminal justice health becomes an integrated component of medical school curricula. Nearly all future physicians will someday be caring for justice-involved patients or their family members. A foundational medical school education that includes criminal justice health will better equip these physicians to not only care for their patients, but also help address health care disparities and the public health concerns that affect our communities. These recommended changes to U.S. medical school curricula will occur only with the commitment of academic leaders and their inclusion of medical school faculty with criminal justice health expertise to help guide these efforts. Now is the time for U.S. medical schools to embrace criminal justice health as essential learning.

Improving Patient Outcomes in the Dual Crises of Climate Change and COVID-19: Proceedings of the Third Annual Clinical Climate Change Meeting, January 8, 2021

The tremendous global toll of the COVID-19 pandemic does not fall equally on all populations. Indeed, this crisis has exerted more severe impacts on the most vulnerable communities, spotlighting the continued consequences of longstanding structural, social, and healthcare inequities. This disparity in COVID-19 parallels the unequal health consequences of climate change, whereby underlying inequities perpetuate adverse health outcomes disproportionately among vulnerable populations. As these two crises continue to unfold, there is an urgent need for healthcare practitioners to identify and implement solutions to mitigate adverse health outcomes, especially in the face of global crises. To support this need, the 2021 Clinical Climate Change Conference held a virtual meeting to discuss the implications of the convergence of the climate crisis and COVID-19, particularly for vulnerable patient populations and the clinicians who care for them. Presenters and panelists provided evidence-based solutions to help health professionals improve and adapt their practice to these evolving scenarios. Together, participants explored the community health system and national solutions to reduce the impacts of COVID-19 and the climate crisis, to promote community advocacy, and foster new partnerships between community and healthcare leaders to combat systemic racism and achieve a more just and equitable society.

Barriers to the Development and Sustainability of Bone Banking Programs in Low- and Middle-Income Countries: A Systematic Review

Purpose: The number of bone allograft transplantations required in low- and middle-income countries (LMICs) is growing very quickly. No previous study has investigated the challenges clinical banks face to sustain operations or meet this demand. The purpose of this study was to conduct a systematic review of the barriers to implementation and sustainability of clinical bone tissue banks in LMICs. Barriers identified in clinical bone banking can shed light on strategies for overcoming obstacles in other biobanking programs. Methods: A systematic review protocol was registered with PROSPERO under identification number CRD42019136045. LMIC was defined using World Bank criteria. A search strategy targeting PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the World Health Organization (WHO) Global Health Library was used. Studies from the inception of bone banking until June 4, 2019, that discussed an identifiable barrier to bone banking were included. Study quality was assessed using The Critical Appraisals Skills Programme (CASP) Qualitative Checklist. Results: Of studies identified, 33 studies were included in the final analysis. Based on the full-text review, the primary barriers identified were lack of regulation, low donor rates, and insufficient training and staffing. CASP analysis performed on the 24 qualitative articles showed an average of 3.6 qualitative measurements met. Conclusions: As international organizations such as the International Atomic Energy Agency (IAEA) restructure their participation in global bone banking regulation, these barriers such as lack of regulation, low donor rates, and insufficient training and staffing could pose a challenge to meeting the rising demand for bone transplantation in LMICs. Articles with higher quality evidence are needed to better define barriers and propose evidence-based solutions.