Personal rights over public Health: Anti-vaccine rhetoric in the Texas Legislature.

During the COVID-19 pandemic, there was an observed increase in anti-vaccine sentiment linked with requirements for the vaccines. But how did these ideas impact the politics of vaccines? In this paper, the authors analyze witness statements from the 2021 Texas Legislative Session during vaccine-related hearings. Specifically, the research focused on five hearings for bills that related to vaccine requirements or vaccine transparency laws filed during the 2021Texas Legislative Session and witnesses who opposed these measures. From the 128 witnesses cataloged and analyzed, we found 84 witnesses opposed to vaccines. Medical freedom and the right to opt-out of a medical procedure as well as concerns about vaccine safety and effectiveness were most frequently used by witnesses to justify their stance against vaccine requirements or vaccines. While some witnesses were opposed to all vaccines, most focused their objections on the COVID-19 vaccine specifically.

Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA.

Since the first case of COVID-19 was identified in the USA in January, 2020, over 46 million people in the country have tested positive for SARS-CoV-2 infection. Several COVID-19 vaccines have received emergency use authorisations from the US Food and Drug Administration, with the Pfizer-BioNTech vaccine receiving full approval on Aug 23, 2021. When paired with masking, physical distancing, and ventilation, COVID-19 vaccines are the best intervention to sustainably control the pandemic. However, surveys have consistently found that a sizeable minority of US residents do not plan to get a COVID-19 vaccine. The most severe consequence of an inadequate uptake of COVID-19 vaccines has been sustained community transmission (including of the delta [B.1.617.2] variant, a surge of which began in July, 2021). Exacerbating the direct impact of the virus, a low uptake of COVID-19 vaccines will prolong the social and economic repercussions of the pandemic on families and communities, especially low-income and minority ethnic groups, into 2022, or even longer. The scale and challenges of the COVID-19 vaccination campaign are unprecedented. Therefore, through a series of recommendations, we present a coordinated, evidence-based education, communication, and behavioural intervention strategy that is likely to improve the success of COVID-19 vaccine programmes across the USA.

Transfusion of red blood cells is associated with improved central venous oxygen saturation but not mortality in septic shock patients.

BACKGROUND: Although the optimum hemoglobin (H) concentration for patients with septic shock (SS) has not been specifically investigated, current guidelines suggest that H of 7 - 9 g/dL, compared with 10 - 12 g/dL, was not associated with increased mortality in critically ill adults. This contrasts with early goal-directed resuscitation protocols that use a target hematocrit of 30% in patients with low central venous oxygen saturation (ScvO2) during the first 6 hours of resuscitation of SS. METHODS: Data elements were prospectively collected on all patients with SS patients (lactic acid (LA) > 4 mmol/L, or hypotension). Out of a total of 396 SS patients, 46 patients received red blood cell (RBC) transfusion for ScvO2 < 70% (RBC group). We then matched 71 SS patients that did not receive RBC transfusion (NRBC group) on the following goals (G): LA obtained within 6 hours (G1), antibiotics given within 3 hours (G2), 20 mL/kg fluid bolus followed by vasopressors (VP) if needed to keep mean arterial pressure > 65 mm Hg (G3), central venous pressure > 8 mm Hg within 6 hours (G4) and ScvO2 > 70% within 6 hours (G5). RESULTS: In the RBC group, after one unit of RBC transfusion, ScvO2 improved from average of 63% (± 12%) to 68% (± 10%) (P = 0.02). Sixteen patients required another unit of RBC, and this resulted in increase of ScvO2 to 78% (± 11%) (P < 0.01). The RBC and NRBC groups were matched on sequential organ failure assessment (SOFA) scores and all five goals. There was no difference in mortality between the two groups: 41% vs. 39.4% (OR: 0.8, 95% CI: 0.4 - 1.7, P = 0.6). CONCLUSIONS: In our study, transfusion of RBC was not associated with decreased mortality in SS patients.

Placement of intracranial pressure monitors by neurointensivists: case series and a systematic review.

PRIMARY OBJECTIVE: Placement of an intracranial pressure (ICP) monitor to guide the management of patients with severe traumatic brain injury (TBI) has been historically performed by neurosurgeons. It is hypothesized that ICP monitors can be placed by non-surgeon neurointensivists, with placement success and complication rates comparable to neurosurgeons. RESEARCH DESIGN: Retrospective review and systematic review of the literature. METHODS AND PROCEDURES: This study reviewed the medical records of patients with TBI who required insertion of parenchymal ICP monitors performed by four neurointensivists in a large level I trauma centre. Patient data recorded were age, gender, CT findings, ICP monitor placement, location and length of placement, complications related to the ICP monitor and patient outcomes. MAIN OUTCOMES AND RESULTS: Thirty-eight (38) monitors (Camino) were placed. Patients' average age was 43.0 years (SD = 21.6); 76% were males. The location of monitor was right frontal in 89% and left frontal in 11%. Mean ICP was 24 (SD = 15), duration of ICP monitor was 4.9 days (SD = 3.6). All monitors were placed successfully. There were no major technical complications, no episodes of major catheter-induced intracranial haemorrhage and no infectious complications. These findings were comparable to published outcomes from neurosurgeon placements. CONCLUSIONS: It is believed that insertion of ICP monitors by neurointensivists is safe and may aid in providing prompt monitoring of patients with severe TBI.

The FOUR score predicts outcome in patients after traumatic brain injury.

BACKGROUND: The most widely used and most studied coma score to date is the Glasgow Coma Scale (GCS), which is used worldwide to assess level of consciousness and predict outcome after traumatic brain injury (TBI). Our aim was to determine whether the Full Outline of UnResponsiveness (FOUR) score is an accurate predictor of outcome in TBI patients and to compare its performance to GCS. METHODS: We prospectively identified TBI patients admitted to our Neuro-ICU between July 2010 and February 2011. We enrolled 51 patients. The FOUR score and GCS were determined by one of the investigators. Outcomes were in-hospital mortality, and poor neurologic outcome (Glasgow Outcome Scale (GOS) 1-3 and Modified Rankin Scale (mRS) score 3-6) at 3-6 months. RESULTS: There was a high degree of internal consistency for both the FOUR score (Cronbach's alpha = 0.89) and GCS (Cronbach's alpha = 0.85). In terms of predictive power for in-hospital mortality, the area under the receiver operating characteristic (ROC) curve was 0.93 for FOUR score and 0.89 for GCS. In terms of predictive power of poor neurologic outcome at 3-6 months, the area under the ROC curve was 0.85 for FOUR score and 0.83 for GCS as evidenced by GOS 1-3, and 0.80 for FOUR score and 0.78 for GCS as evidenced by mRS 3-6. The odds ratio (OR) for in-hospital mortality was 0.64 (0.46-0.88) from FOUR score and 0.63 (0.45-0.89) from GCS, for poor neurologic outcome was 0.67 (0.53-0.85) from FOUR score and 0.65 (0.51-0.83) from GCS for GOS, and was 0.71 (0.57-0.87) from FOUR score and 0.71 (0.57-0.87) from GCS for mRS. CONCLUSION: The FOUR score is an accurate predictor of outcome in TBI patients. It has some advantages over GCS, such as all components of FOUR score but not GCS can be rated in intubated patients.

Percutaneous tracheostomy tube obstruction: warning.

STUDY OBJECTIVES: To determine the patency of standard and modified Portex tracheostomy tubes inserted by the percutaneous dilatational technique. DESIGN: Prospective observational study. SETTING: Medical-surgical ICUs in a tertiary care community hospital. PATIENTS: Medical-surgical ICU patients requiring tracheostomy. INTERVENTIONS: Consecutive medical-surgical ICU patients requiring tracheostomy were eligible for the study. Percutaneous tracheostomy tubes were inserted using the percutaneous dilatational technique with bronchoscopic guidance. The study population consisted of the following two groups: group 1 (receiving the standard Portex Per-fit percutaneous tracheostomy tube); and group 2 (receiving the modified Portex Per-fit percutaneous tracheostomy tube). Patients underwent daily fiberoptic evaluation to assess tracheostomy tube patency following the first 72 h after the tracheostomy tube placement. Demographic data and clinical signs or symptoms of airway obstruction were recorded. MEASUREMENTS AND RESULTS: Thirty-seven patients received the standard percutaneous tracheostomy tube (group 1), and 17 patients received the modified percutaneous tracheostomy tube (group 2). Partial tracheostomy tube occlusion (> 25%) was observed in 21 of 37 group 1 patients (57%) and in 1 of 17 group 2 patients (6%; p < 0.005). Fifteen of 37 group 1 patients (41%) and none of the group 2 patients sustained a > or = 40% occlusion of the distal tracheostomy tube opening (p < 0.005). One patient from group 1 had clinical manifestations of tracheostomy tube obstruction. None of the patients in group 2 experienced signs or symptoms of airway obstruction. CONCLUSIONS: The standard Portex Per-fit percutaneous tracheostomy tubes used in this study were associated with partial airway obstruction. Modifications of the standard Portex percutaneous tracheostomy tube markedly decreased the airway obstruction. Due to the findings in this study, the authors recommend abandoning the continued use of the Portex Per-fit percutaneous tracheostomy tube in its current configuration and replacing it with the modified tracheostomy tube described in this study.