Nevin Manimala

Cytotherapy. 2024 Jun 6:S1465-3249(24)00733-3. doi: 10.1016/j.jcyt.2024.05.025. Online ahead of print.

ABSTRACT

Natural killer (NK) cells make only a small fraction of immune cells in the human body, however, play a pivotal role in the fight against cancer by the immune system. They are capable of eliminating abnormal cells via several direct or indirect cytotoxicity pathways in a self-regulating manner, which makes them a favorable choice as a cellular therapy against cancer. Additionally, allogeneic NK cells, unlike other lymphocytes, do not or only minimally cause graft-versus-host diseases opening the door for an off-the-shelf therapy. However, to date, the production of NK cells faces several difficulties, especially because the critical process parameters (CPPs) influencing the critical quality attributes (CQAs) are difficult to identify or correlate. There are numerous different cultivation platforms available, all with own characteristics, benefits and disadvantages that add further difficulty to define CPPs and relate them to CQAs. Our goal in this contribution was to summarize the current knowledge about NK cell expansion CPPs and CQAs, therefore we analyzed the available literature of both dynamic and static culture format experiments in a systematic manner. We present a list of the identified CQAs and CPPs and discuss the role of each CPP in the regulation of the CQAs. Furthermore, we could identify potential relationships between certain CPPs and CQAs. The findings based on this systematic literature research can be the foundation for meaningful experiments leading to better process understanding and eventually control.

PMID:38944794 | DOI:10.1016/j.jcyt.2024.05.025

J Perianesth Nurs. 2024 Jun 28:S1089-9472(24)00057-1. doi: 10.1016/j.jopan.2024.02.011. Online ahead of print.

ABSTRACT

PURPOSE: This project aimed to implement a continuous capnography protocol in the postanesthesia care unit (PACU) for postoperative adult patients who are at high risk for respiratory failure.

DESIGN: A preintervention and postintervention quality improvement design with retrospective chart reviews evaluated patient demographics (age, weight, body mass index [BMI], perioperative fluid intake and output, use of intraoperative positive-end expiratory pressure), length of surgery, average length of PACU stay, incidence of respiratory events, and adherence to a PACU capnography protocol.

METHODS: Preimplementation data were collected from retrospective chart reviews over a 3-month period. A continuous capnography protocol was implemented for same-day surgery patients with a BMI of 35 kg/m² or greater and who received general anesthesia. Postimplementation data were collected over 3 months in addition to adherence to the capnography protocol. This was presented using descriptive statistics.

FINDINGS: Age, length of surgery, weight, BMI, perioperative fluid intake and output, and use of positive-end expiratory pressure did not impact PACU length of stay. The average PACU length of stay decreased from 76.76 to 71.82 minutes postimplementation but was not statistically significant (P = .470). The incidence of respiratory events was 6% (n = 3). After the implementation of the continuous capnography protocol, adherence to the continuous capnography monitoring was 86% (n = 43).

CONCLUSIONS: Patients who are at high risk for postoperative respiratory failure may benefit from continuous capnography monitoring in the PACU. Capnography monitoring may decrease PACU length of stay and provide earlier detection of pending respiratory depression or failure than pulse oximetry alone.

PMID:38944792 | DOI:10.1016/j.jopan.2024.02.011

J Emerg Nurs. 2024 Jun 28:S0099-1767(24)00134-X. doi: 10.1016/j.jen.2024.05.005. Online ahead of print.

ABSTRACT

It is impossible to fully understand why the United States has consistently failed to protect its citizens from firearm violence until one understands some of the key discrepancies that exist at the center of the firearm policy debate. Differences in language, data categorization, and research related to firearms and their impacts in the United States contribute to confusion and debate between firearm policy advocates and opponents, ultimately stalling progress toward some common goals. As frontline health professionals, emergency nurses must be aware of these nuances in order to be informed advocates for the safety of their patients and their communities. Emergency nurses can use the information from this article to help inform screening and education related to firearm safety and injury prevention. They can also use this information to inform nursing research as well as local and national advocacy efforts related to firearm injuries and deaths.

PMID:38944789 | DOI:10.1016/j.jen.2024.05.005

Adv Gerontol. 2024;37(1-2):122-129.

ABSTRACT

Understanding the recovery process of functional abilities post-COVID-19 in older inpatients with arterial hypertension and ischemic heart disease is important for optimising healthcare delivery and resources. Participants in this study were individuals undergoing hospital-based rehabilitation following COVID-19 (average age 66, n=183). They were categorised into groups with arterial hypertension (n=92), ischemic heart disease (n=18), both conditions (n=38), and a control group without these diseases (n=35). Functional abilities were assessed via the distance walked until signs of exhaustion (meters), handgrip strength (kilograms), and breath-holding time (seconds). Multiple regression analysis revealed that inpatients with arterial hypertension walked shorter distances (β=-19,183; p=0,050) but showed higher handgrip strength (β=3,735; p=0,025) compared to the control group. Post-rehabilitation, inpatients with hypertension demonstrated greater performance (β=40,435, p=0,024) and better improvement rates (β=47,337; p=0,016) in walked distance than those in the control group. Significant interaction effects between groups and pre-/post-rehabilitation changes were observed only for walking distance (β=34,74; p=0,02), with no significant interactions found for other measures. The findings indicate that older inpatients with arterial hypertension may experience comparable or enhanced recovery of functional abilities post-COVID-19. The presence of ischemic heart disease, alone or combined with hypertension, does not significantly impair rehabilitation outcomes compared to those without such conditions.

PMID:38944782

Adv Gerontol. 2024;37(1-2):80-86.

ABSTRACT

One of the most difficult tasks in medical practice is pharmacotherapy in elderly and senile patients. The complexity of pharmacotherapy in elderly patients is due to age-related physiological changes, high frequency of multimorbidity. The age of patients no longer precludes surgical intervention, and surgical procedures are often performed on elderly patients with complex comorbidities. Over the past 15 years, the number of emergency hospitalizations has increased significantly worldwide.

PMID:38944777

Adv Gerontol. 2024;37(1-2):46-49.

ABSTRACT

It is widely known that in economically developed countries there is an increase in the proportion of older people. However, the problem of the influence of territorial features of economic development on the rate of population aging is not sufficiently covered. The goal was to study the impact of economic development indicators (EDI) on the processes of premature aging of the population. The materials were statistical collections of the Ministry of Health of Russia and Russian Statistics Service for 2011-2019. The highest incidence was characteristic of cataracts and glaucoma. A direct correlation has been established between the EDI and the age-specific incidence index (ASII) of cataracts (r=0,31; p=0,00436). A group of regions with a high level of economic development was characterized by a higher value of ASII, which, as a rule, corresponds to the later development of the disease.

PMID:38944772

Adv Gerontol. 2024;37(1-2):33-39.

ABSTRACT

In recent years, complications of drug therapy are an important medical problem. Data on adverse drug reactions (ADR) in patients of older age groups were analyzed. The object of the study was notification cards for unwanted reactions received from medical organizations of the Irkutsk region for period 2009-2020 years. The Narangio scale was used to assess the causality between ADR and medicines. Of the 1021 ADR notifications in patients over 65 years of age, 2/3 (668) are presented with ADR notifications in women, 353 (34,6%) in men. The presence of background diseases was registered in 915 notifications (89,6%). There were no gender differences except for a higher incidence of chronic obstructive pulmonary disease in men (7,2 and 3,5% respectively, p<0,05) and diabetes mellitus in women (14 and 3,5% respectively, p<0,05). ADRs for antibacterial agents amounted to 31,8%, drugs for the treatment of cardiovascular diseases – 10,5%, cases of therapeutic inefficiency – 5,1%. The ADR data statement was in line with the recommended form of 76%. The most common filling defect was incomplete patient information. The validity of the Narango causation was high. The deadlines for reporting data were observed in 89,1%. For effective interaction in the pharmacovigilance system, it is necessary in each medical organization to constantly inform about the procedure for pharmacovigilance, types of ADRs, the rules for their detection and the timing of data reporting. The work should be supervised by a trained specialist.

PMID:38944770

JAMA Health Forum. 2024 Jun 30;5(6.9):e241932. doi: 10.1001/jamahealthforum.2024.1932.

ABSTRACT

IMPORTANCE: Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households.

OBJECTIVE: To estimate the distribution of household health care payments across income under health care reform policies.

DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study with microsimulation used nationally representative data of the US population in 2030. Civilian, noninstitutionalized population from the 2022 Current Population Survey linked to expenditures from the 2018 and 2019 Medical Expenditure Panel Survey and 2022 National Health Expenditure Accounts were included.

EXPOSURE: Rate regulation of hospital, physician, and other health care professional payments equal to the all-payer mean in the status quo, spending growth target at 4% annual per capita growth, and single-payer health care financed through taxes.

MAIN OUTCOMES AND MEASURES: Household health care payments (out-of-pocket expenses, premiums, and taxes) as a share of compensation.

RESULTS: The synthetic population contained 154 456 records representing 339.5 million individuals, with 51% female, 7% Asian, 14% Black, 18% Hispanic White, 56% non-Hispanic White, and 5% other races and ethnicities (American Indian or Alaskan Native only; Native Hawaiian or other Pacific Islander only; and 2 or more races). In the status quo, mean household health care payments as a share of compensation was 24% to 27% (standard error [SE], 0.2%-1.2%) across income groups (median [IQR] 22% [4%-52%] below 139% of the federal poverty level [FPL]; 21% [4%-34%] for households above 1000% FPL [11% of the population]). Under rate setting, mean (SE) payments by households above 1000% FPL increased to 29% (0.6%) (median [IQR], 22% [6%-35%]) and decreased to 23% to 25% for other income groups. Under the spending growth target, mean (SE) payments decreased from 23% to 26% (SE, 0.2%-1.2%) across income groups. Under the single-payer system, mean (SE) payments declined to 15% (0.7%) (median [IQR], 4% [0%-30%]) for those below 139% FPL and increased to 31% (0.6%) (median [IQR], 23% [3%-39%]) for those above 1000% FPL. Uninsurance fell from 9% to 6% under rate setting due to improved Medicaid access, and to zero under the single-payer system.

CONCLUSIONS AND RELEVANCE: Single-payer financing based on the current federal income tax schedule and a payroll tax could substantially increase progressivity of household payments by income. Rate setting led to slight increases in payments by higher-income households, who financed higher payment rates in Medicare and Medicaid. Spending growth targets reduced payments slightly for all households.

PMID:38944764 | DOI:10.1001/jamahealthforum.2024.1932

JAMA Health Forum. 2024 Jun 30;5(6.9):e241939. doi: 10.1001/jamahealthforum.2024.1939.

ABSTRACT

IMPORTANCE: In the US, the COVID-19 pandemic led to a significant rise in unemployment and economic loss that disproportionately impacted low-income individuals. It is unknown how health care and prescription medication affordability changed among low-income adults during the COVID-19 pandemic overall and compared with their higher-income counterparts.

OBJECTIVE: To evaluate changes in health care affordability and prescription medication affordability during the COVID-19 pandemic (2021 and 2022) compared with pre-COVID-19 pandemic levels (2019) and whether income-based inequities changed.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study included adults 18 years and older participating in the National Health Interview Survey (NHIS) in 2019, 2021, and 2022. Low-income adults were defined as having a household income of 200% or less of the federal poverty level (FPL); middle-income adults, 201% to 400% of the FPL; and high-income adults, more than 400% of the FPL. Data were analyzed from June to November 2023.

MAIN OUTCOMES AND MEASURES: Measures of health care affordability and prescription medication affordability.

RESULTS: The study population included 89 130 US adults. Among the weighted population, 51.6% (95% CI, 51.2-52.0) were female, and the mean (SD) age was 48.0 (0.12) years. Compared with prepandemic levels, during the COVID-19 pandemic, low-income adults were less likely to delay medical care (2022: 11.2%; 95% CI, 10.3-12.1; 2019: 15.4%; 95% CI, 14.3-16.4; adjusted relative risk [aRR], 0.73; 95% CI, 0.66-0.81) or avoid care (2022: 10.7%; 95% CI, 9.7-11.6; 2019: 14.9%; 95% CI, 13.8-15.9; aRR, 0.72; 95% CI, 0.64-0.80) due to cost, while high-income adults experienced no change, resulting in a significant improvement in income-based disparities. Low-income and high-income adults were less likely to experience problems paying medical bills but experienced no change in worrying about medical bills during the COVID-19 pandemic compared with prepandemic levels. Across measures of prescription medication affordability, low-income adults were less likely to delay medications (2022: 9.4%; 95% CI, 8.4-10.4; 2019: 12.7%; 95% CI, 11.6-13.9; aRR, 0.74; 95% CI, 0.65-0.84), not fill medications (2022: 8.9%; 95% CI, 8.1-9.8; 2019: 12.0%; 95% CI, 11.1-12.9; aRR, 0.75; 95% CI, 0.66-0.83), skip medications (2022: 6.7%; 95% CI, 5.9-7.6; 2019: 10.1%; 95% CI, 9.1-11.1; aRR, 0.67; 95% CI, 0.57-0.77), or take less medications (2022: 7.3%; 95% CI, 6.4-8.1; 2019: 11.2%; 95% CI, 10.%-12.2; aRR, 0.65; 95% CI, 0.56-0.74) due to costs, and these patterns were largely similar among high-income adults. Improvements in measures of health care and prescription medication affordability persisted even after accounting for changes in health insurance coverage and health care use. These patterns were similar when comparing measures of affordability in 2021 with 2019.

CONCLUSIONS AND RELEVANCE: Health care affordability improved for low-income adults during the COVID-19 pandemic, resulting in a narrowing of income-based disparities, while prescription medication affordability improved for all income groups. These findings suggest that the recent unwinding of COVID-19 pandemic-related safety-net policies may worsen health care affordability and widen existing income-based inequities.

PMID:38944763 | DOI:10.1001/jamahealthforum.2024.1939

JAMA Health Forum. 2024 Jun 30;5(6.9):e242055. doi: 10.1001/jamahealthforum.2024.2055.

ABSTRACT

IMPORTANCE: The Centers for Medicare & Medicaid Services’ mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.

OBJECTIVE: To assess the ETC’s association with use of home dialysis and kidney transplant during the model’s first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model’s implementation.

EXPOSURE: Receiving dialysis treatment in a region randomly assigned to the ETC model.

MAIN OUTCOMES AND MEASURES: Primary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions.

RESULTS: The study population included 724 406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female). The proportion of patients receiving home dialysis increased from 12.1% to 14.3% in ETC regions and from 12.9% to 15.1% in control regions, yielding an adjusted DiD estimate of -0.2 percentage points (pp; 95% CI, -0.7 to 0.3 pp). Similar analysis for transplant yielded an adjusted DiD estimate of 0.02 pp (95% CI, -0.01 to 0.04 pp). When further stratified by sociodemographic measures, including age, sex, race and ethnicity, dual Medicare and Medicaid enrollment, and poverty quartile, there was not a statistically significant difference in home dialysis use across joint strata of characteristics and ETC participation.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the first 2 years of the ETC model were not associated with increased use of home dialysis or kidney transplant, nor changes in racial, ethnic, and socioeconomic disparities in these outcomes.

PMID:38944762 | DOI:10.1001/jamahealthforum.2024.2055