Despite the relatively high prevalence of PIs/NFPAs, the evidence on the natural history of these entities is scarce and of low quality. PIs/NFPAs seem to have fairly rare complications that may be more common when lesions are large (>10 mm) and solid.

Observational evidence supports the association between a combined approach of transsphenoidal surgery with radiotherapy and improvements in visual field defects and reduction in tumour recurrence.

A growing number of studies on coronavirus disease 2019 (COVID-19) are becoming available, but a synthesis of available data focusing on the critically ill population has not been conducted. We performed a scoping review to synthesize clinical characteristics, treatment, and clinical outcomes among critically ill patients with COVID-19. Between 1/1/2020 and 5/15/2020, we identified high-quality clinical studies describing critically ill patients with a sample size >20 patients by performing daily searches of the World Health Organization and LitCovid databases on COVID-19. Two reviewers independently reviewed all abstracts (2785 unique articles), full-text (218 articles), and abstracted data (92 studies). 92 studies were included, including 61 from Asia, 16 from Europe, 10 from North and South America, as well as 5 multinational studies. Notable similarities among critically ill populations across all regions included a higher proportion of older males infected and with severe illness, high frequency of co-morbidities (hypertension, diabetes, and cardiovascular disease), abnormal chest imaging findings, and death secondary to respiratory failure. Differences in regions included newly identified complications (e.g., pulmonary embolism) and epidemiologic risk factors (e.g., obesity), less chest computed tomography imaging performed, and increased use of invasive mechanical ventilation (70-100% vs. 15-47% of ICU patients) in Europe and the US compared to Asia. Future research directions should include proof-of-mechanism studies to better understand organ injuries and large-scale collaborative clinical studies to evaluate the efficacy and safety of antivirals, antibiotics, IL-6 receptor blockers, and interferon. The current established predictive models require further verification in other regions outside China.

Delays in rapid response team activation occur frequently and are independently associated with worse patient mortality and morbidity outcomes.

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ObjectiveTo determine the feasibility and effectiveness of a video-enabled remote simulation training program to teach a systematic, standardized approach to the evaluation and management of the critically ill patients as part of an international quality improvement intervention.Patients and MethodsIn this pilot “train-the-trainer” prospective cohort study, we provided a remote simulation-based educational program for practicing clinicians from intensive care units involved in an international quality improvement project (www.icertain.org). Between February 21, 2014, and August 6, 2015, participants completed a self-guided online curriculum and participated in structured simulation training using web conference software with recording capabilities. The performance was assessed using a matched pair analysis at baseline and using standardized scenarios and a validated assessment tool postintervention. Participants rated their satisfaction with the training experience and confidence in implementing these skills in clinical practice.ResultsEighteen local champions from 8 hospitals in 7 countries in Asia, Europe, and South and Central America completed the educational program. Learners exhibited significant improvements in cumulative critical task performance during simulated critical care scenarios with training (60.3%-81.8%; P=.002). Most clinicians (94%) reported that they felt well prepared to manage the common critical care scenarios after training. These local champions have subsequently delivered this educational program to more than 800 international clinicians over a 4-year period.ConclusionInsufficient training is a major barrier to the delivery of cost-effective critical care in many areas of the world. Video-enabled remote simulation training is a low-cost, feasible, and effective method to disseminate clinical skills to critical care practitioners in diverse international settings.

There are important differences in end-of-life care and decision making for patients with LEP.

Background: Socioeconomic status (SES) is an important determinant of disparities in health care and may play a role in end-of-life care and decision-making. The SES is difficult to retrospectively abstract from current electronic medical records and data sets. Objective: Using a validated SES measuring tool derived from home address, the HOUsing-based SocioEconomic Status index, termed HOUSES we wanted to determine whether SES is associated with differences in end-of-life care and decision-making. Design/Setting/Participants: This cross-sectional study utilized a cohort of Olmsted County adult residents admitted to 7 intensive care units (ICUs) at Mayo Rochester between June 1, 2011, and May 31, 2014. Measurements: Multiple variables that reflect decision-making and care at end of life and during critical illness were evaluated, including presence of advance directives and discharge disposition. The SES was measured by individual housing-based SES index (HOUSES index; a composite index derived from real property as a standardized z-score) at the date of admission to the ICU which was then divided into 4 quartiles. The greater HOUSES, the higher SES, outcomes were adjusted for age, 24-hour Acute Physiology and Chronic Health Evaluation III score, sex, race/ethnicity, and insurance. Results: Among the eligible 4134 participants, the addresses of 3393 (82%) were successfully geocoded and formulated into HOUSES. The adjusted odds ratios comparing HOUSES 1 versus 2, 3, and 4 demonstrated lower likelihood of advance directives −0.77(95% CI: 0.63-0.93) and lower likelihood of discharge to home −0.60(95% CI: 1.0.5-0.72). Conclusion: Lower SES, derived from a composite index of housing attributes, was associated with lower rates of advance directives and lower likelihood of discharge to home.