Objective: To examine rapidly emerging ventilator technologies during coronavirus disease 2019 and highlight the role of CRISIS, a novel 3D printed solution. Data Sources: Published articles, literature, and government guidelines that describe and review emergency use ventilator technologies. Study Selection: Literature was chosen from peer-reviewed journals and articles were limited to recent publications. Data Extraction: All information regarding ventilator technology was extracted from primary sources. Data Synthesis: Analysis of technology and relevance to coronavirus disease 2019 physiology was collectively synthesized by all authors. Conclusions: The coronavirus disease 2019 pandemic has placed massive stress on global supply chains for ventilators due to the critical damage the virus causes to lung function. There is an urgent need to increase supply, as hospitals become inundated with patients requiring intensive respiratory support. Coalitions across the United States have formed in order to create new devices that can be manufactured quickly, with minimal resources, and provide consistent and safe respiratory support. Due to threats to public health and the vulnerability of the U.S. population, the Food and Drug Administration released Emergency Use Authorizations for new or repurposed devices, shortening the approval timeline from years to weeks. The list of authorized devices varies widely in complexity, from automated bagging techniques to repurposed sleep apnea machines. Three-dimensional printed ventilators, such as “CRISIS,” propose a potential solution to increase the available number of vents for the United States and abroad, one that is dynamic and able to absorb the massive influx of hospitalized patients for the foreseeable future.
Background Following the shooting at Sandy Hook Elementary School, the Hartford Consensus produced the Stop the Bleed program to train bystanders in hemorrhage control. In our region, the police bureau delivers critical incident training to public schools, offering instruction in responding to violent or dangerous situations. Until now, widespread training in hemorrhage control has been lacking. Our group developed, implemented and evaluated a novel program integrating hemorrhage control into critical incident training for school staff in order to blunt the impact of mass casualty events on children. Methods The staff of 25 elementary and middle schools attended a 90-minute course incorporating Stop the Bleed into the critical incident training curriculum, delivered on-site by police officers, nurses and doctors over a three-day period. The joint program was named Protect Our Kids. At the conclusion of the course, hemorrhage control kits and educational materials were provided and a four-question survey to assess the quality of training using a ten-point Likert scale was completed by participants and trainers. Results One thousand eighteen educators underwent training. A majority were teachers (78.2%), followed by para-educators (5.8%), counselors (4.4%) and principals (2%). Widely covered by local and state media, the Protect Our Kids program was rated as excellent and effective by a majority of trainees and all trainers rated the program as excellent. Conclusions Through collaboration between trauma centers, police and school systems, a large-scale training program for hemorrhage control and critical incident response can be effectively delivered to schools.
Background: While patients with Wilms tumor (WT) have an overall survival greater than 90%, tumor rupture is associated with worse outcomes and can increase risk of abdominal recurrence to 20%1. Because our institutional rate of rupture is at least 2.5x higher than that found in literature, we conducted a retrospective chart review to understand the differences between our patient population and the population in literature2. Our aims were to 1) compare our patient demographics and outcomes, 2) describe correlations between preoperative, intraoperative, and pathologic diagnosis of rupture, and 3) compare our outcomes between upfront resection and neoadjuvant chemotherapy. Procedures: We reviewed charts from 2015 to 2019 and assessed: details of presentation, chemotherapy, operative and pathological findings, complications, and outcomes between patients with and without rupture. Results: Of 29 patients with WT, 9 had preoperative rupture by imaging and 8, all females, were confirmed surgically. Our rupture prevalence of 27.6% is higher than that in literature (11-13%.) Despite patients with rupture having more positive margins (50% vs. 19% non-ruptured), they had lower recurrence rates at one year (0 vs 19% non-ruptured) and improved survival mortality (100% vs. 90.5% non-ruptured). Neoadjuvant therapy and flank radiation compared to whole abdominal radiation did not change complication rates or outcomes. Conclusions: The high percentage of ruptured WT at our institution allowed for comprehensive review and revealed variations from literature. Patients with rupture had better outcomes than patients without rupture, with no difference comparing neoadjuvant chemotherapy to upfront resection and flank vs whole abdomen radiation.
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