Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group.

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Background: Extracorporeal membrane oxygenation (ECMO) is a rescue procedure used for cardiac and pulmonary dysfunction. Patients on ECMO often require blood transfusions to maintain oxygen delivery and recover from bleeding complications. Goals of the current study were to determine transfusion requirements while on ECMO, and incidence and transfusion requirements for bleeding complications. Methods: Packed red blood cell (PRBC) transfusions and bleeding complications were identified by retrospective chart review of patients on ECMO from 2010 to 2018 at our institution. Patients were categorized into those who did not bleed (group A) and those who bled (group B). Incidence, sites of bleed, and transfusion requirement for each bleeding were analyzed. Results: Among 217 patients including veno-arterial (VA) ( n = 148) and veno-venous (VV) ( n = 69) ECMO, we identified 62 patients without bleeding complications (group A) and 155 patients with bleeding complications (group B). In group A, transfusion requirement was 0.6 PRBC/day for VA-ECMO ( n = 42) and 0.2 PRBC/day for VV-ECMO ( n = 20) (p = 0.0015). In group B, number of PRBC given per event per day for bleeding complications during ECMO was mediastinal/thoracic bleed (83 events, 4.7 PRBC/event/day), gastrointestinal bleed (59 events, 4.8 PRBC/event/day), cannulation site bleed (88 events, 3.6 PRBC/event/day), and nasopharyngeal bleed (103 events, 2.8 PRBC/event/day). Thirty-day hospital mortality rate was co-related to transfusion requirement (area under ROC curve: 0.70). Conclusion: Patients without clinical bleeding still required transfusion, with higher rates observed with VA- than VV-ECMO. Transfusion requirements dramatically increased when patients developed various bleeding complications and had a significant impact on 30-day mortality rate.

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Purpose: Patients with paraesophageal hernias (PEHs) typically present in the sixth and seventh decades of life. Frequently, elderly patients are not offered elective repair due to historical data on high operative risk. Given the broad adoption of minimally-invasive (MIS) techniques, we hypothesized that risk would be more acceptable in elderly patients. Methods: A retrospective study of the National Inpatient Sample (NIS) from 2016 to 2018 was performed. Patients were divided by age (50–79 and ≥80 years) and compared using Pearson’s Chi-squared and Student’s t-tests. Propensity score-match using age, race, gastroesophageal reflux disease, frailty, and 11 comorbidities was performed. Results: 10 456 patients were included, 90.4% 50–79 (9,454) and 9.6% ≥ 80 (1002). The cohort was predominantly female (76.3%). Younger patients had fewer overall comorbidities and lower likelihood of frailty (2.5% vs. 9.3%, P < .01). Younger patients had shorter lengths of stay (2 days vs. 3 days, P < .01), fewer overall complications (26% vs. 36.8%, P < .01), and major complications (20.8% vs. 29.2%, P < .01). In-hospital mortality was higher for those over 80 (0.3% vs. 2.3%, P < .01). Propensity matching selected 942 pairs. Age remained associated with more frequent minor complications (23% vs. 28.7%, P < .01), major complications (12.1% vs. 16.1%, P < 0.01), and in-hospital mortality (0.5% vs. 2.3%, P < .01). Conclusions: There remains a significant association between age and risk of minor complication, major complication, and in-hospital mortality for elective repair of PEH despite the broad adoption of MIS techniques. This data may support the elective repair of PEHs at a younger age.

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The current system of blood banks in India is such that rural patients are deprived of timely access to an adequate volume of life-saving blood, adding to preventable mortality. On the basis of an academic framework for a blood transfusion system, we describe an alternative approach in which rural practitioners utilise unbanked blood transfusions from a voluntary pool of pre-screened donors. This system would provide safe blood - as evidenced by international experience and limited projected increase in transfusion-transmissible infection in India - at a fraction of the financial cost imposed by the current system. Given the failing status quo and the undue burden placed on rural clinicians and patients to procure blood, it is imperative that policy-makers further explore the use of unbanked, direct blood transfusion for patients facing emergent, life-threatening haemorrhage.

There is a significant burden of surgically correctable cardiovascular disease in Africa. The goal of this research was to review the last 20 years of literature on this topic. A systematic search was performed using PubMed, Embase and African Index Medicus for the period 1996–2016. Publications came from 29 countries, all of different income brackets. Research output increased by 15-fold over the 20-year time period, with the majority of publications authored by local teams (71.4%) compared to visiting (4.9%) and mixed teams (23.7%). Although increasing, clinical reporting on cardiac surgery is still limited. Increased publication of results should be encouraged to better benchmark capacity and improve research capacity.