Restricted access to the NHS during the COVID-19 pandemic : is it time to move away from the rationed clinical response?

Recently a Lancet Commission examined the future prospects of the NHS in the wake of COVID-19. The report cites poor healthcare capacity and chronic staff shortages as key contributing factors to the UK’s inadequate pandemic response. Notable strengths included universal access, the goodwill of staff, and the ability to generate innovative solutions - qualities that are likely to have averted an even deeper national crisis [1]. The prosperity of the NHS is intrinsically connected to the prosperity of the nation. Access to healthcare influences morbidity, mortality, economic activity, and whether or not social restrictions are necessary [2,3]. Public health measures such as timely implementation of social distancing are also important to limit mortality, but going forward it is the capacity to respond in a clinically effective and decisive manner that is vital to diminish the threat associated with the virus [4]. The importance of examining the national clinical response to SARS-CoV-2 cannot be overstated. Arguably the greatest mistake of this pandemic would be failing to prepare for the next. There are also the looming unknowns of SARS-CoV-2 variants [5], the higher rates of Long COVID following more severe disease [6], and the increased healthcare demands associated with delayed presentation of COVID-19 pneumonia [7-11]. Improving the tolerance of society to background levels of SARS-CoV-2 will require an improved clinical response. With this in mind, we examine one aspect of the UK’s clinical response that remains in place today: restricted access to healthcare

Integrating Literature, Biodiversity Databases, and Citizen-Science to Reconstruct the Checklist of Chondrichthyans in Cyprus (Eastern Mediterranean Sea)

Chondrichthyans are apex predators influencing the trophic web through a top-down process thus their depletion will affect the remaining biota. Notwithstanding that, research on chondrichthyans is sparse or data-limited in several biogeographic areas worldwide, including the Levantine Sea. We revise and update the knowledge of chondrichthyans in Cyprus based on a bibliographic review that gains information retrieved from peer-reviewed and grey literature, Global Biodiversity Information Facility (135 records of at least 18 species) and the Ocean Biodiversity Information System (65 records of at least14 species), and the citizen science project Mediterranean Elasmobranchs Citizen Observations (117 records per 23 species). Our updated checklist reports 60 species that account for about 70% of the Mediterranean chondrichthyan biota. The list includes 15 more species than the previous checklist and our study reports three new species for Cyprus waters, namely the blackmouth catshark Dalatias licha, the round fantail stingray Taeniurops grabatus, and the sawback angelshark Squatina aculeata. Our research highlights the need for conservation measures and more studies regarding the highly threatened blackchin guitarfish Glaucostegus cemiculus and the devil ray Mobula mobular, and stresses the importance for training a new generation of observers to strengthen the knowledge and conservation of elasmobranchs in the region.</jats:p

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

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SIGLEBibliothek Weltwirtschaft Kiel C 154758 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman