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ObjectivesCritically ill children frequently receive plasma and platelet transfusions. We sought to determine evidence-based recommendations, and when evidence was insufficient, we developed expert-based consensus statements about decision-making for plasma and platelet transfusions in critically ill pediatric patients.DesignSystematic review and consensus conference series involving multidisciplinary international experts in hemostasis, and plasma/platelet transfusion in critically ill infants and children (Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding [TAXI-CAB]).SettingNot applicable.PatientsChildren admitted to a PICU at risk of bleeding and receipt of plasma and/or platelet transfusions.InterventionsNone.Measurements and main resultsA panel of 29 experts in methodology, transfusion, and implementation science from five countries and nine pediatric subspecialties completed a systematic review and participated in a virtual consensus conference series to develop recommendations. The search included MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020, using a combination of subject heading terms and text words for concepts of plasma and platelet transfusion in critically ill children. Four graded recommendations and 49 consensus expert statements were developed using modified Research and Development/UCLA and Grading of Recommendations, Assessment, Development, and Evaluation methodology. We focused on eight subpopulations of critical illness (1, severe trauma, intracranial hemorrhage, or traumatic brain injury; 2, cardiopulmonary bypass surgery; 3, extracorporeal membrane oxygenation; 4, oncologic diagnosis or hematopoietic stem cell transplantation; 5, acute liver failure or liver transplantation; 6, noncardiac surgery; 7, invasive procedures outside the operating room; 8, sepsis and/or disseminated intravascular coagulation) as well as laboratory assays and selection/processing of plasma and platelet components. In total, we came to consensus on four recommendations, five good practice statements, and 44 consensus-based statements. These results were further developed into consensus-based clinical decision trees for plasma and platelet transfusion in critically ill pediatric patients.ConclusionsThe TAXI-CAB program provides expert-based consensus for pediatric intensivists for the administration of plasma and/or platelet transfusions in critically ill pediatric patients. There is a pressing need for primary research to provide more evidence to guide practitioners.

Despite systematic demonstrations of the effectiveness of the respondent-type procedure in producing relational responding, matching-to-sample continues to be the predominant approach for studying equivalence class formation. The length of exposure to stimulus pairings during respondent-type training, and repeated alternation of blocks of training and testing are factors that seem to undermine the practicality and the perceived effectiveness of the procedure. Further, the presentation of stimulus pairs without the simultaneous presence of nonclass members may be said to lack the complexity of the matching-to-sample stimulus arrangement. The present study evaluates the efficiency of a respondent matching-to-sample arrangement after exposing participants to a reduced number of training trials per baseline relation. Probes were added at the end of each block of training trials to verify the strength of S-S relations while keeping the number of acquisition trials to a minimum. At least half of the participants responded correctly to all probe trials per baseline relation after only one exposure, and all participants performed accurately in tests of derived relations. Procedural components of S-S training such as intermixing probes during training and arranging an environment-elicited orientation response towards the relevant stimuli, are discussed as key elements of efficient respondent equivalence training procedures. Keywords Respondent-type * Equivalence * S-S relations * Derived relations * Stimulus classes, Equivalence research has demonstrated that responding to stimuli as members of a class can be achieved without directly training all possible relations between the class members. Practical applications of these [...]

Multitiered systems of support (MTSS) is an effective model for identifying students at risk for academic failure as well as behavioral concerns (excesses and deficits) that impede classroom success. Over the years, researchers have investigated the positive effects of the MTSS model on behavioral needs of students; however, to date the research has not focused on the need for embedding trauma-informed practices into the MTSS tiers. This article fills a void in the research by providing a framework for a trauma-informed MTSS (TIMTSS) model and a case study implementing this model. Specifically, it describes the scope, sequence, assessments, interventions, and staff roles across each tier as utilized in the pilot study. The success of this TI-MTSS model and lessons learned in this urban setting conclude the article along with suggestions for future research in other settings.

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Introduction: The COVID-19 pandemic, with over 83 million confirmed cases and 1.8 million deaths, has raised concerns about long-term cognitive issues, especially in populations facing disparities. Despite a few years since Peru's first COVID-19 wave, the cognitive effects on adults remain unclear. This study is the first in Peru to explore COVID-19's impact on general cognition and executive function. Methods: A retrospective cross-sectional study compared individuals with COVID-19 history to controls, assessing general cognition, verbal fluency, attention, and executive function. Among 240 assessed, 154 met the study inclusion criteria, with about 60% female and an average age of 38.89 ± 16.001 years. Groups included controls (n = 42), acute phase (AP, n = 74) (1-14 days of symptoms), and hyperinflammatory phase (HP, n = 38) (>14 days of symptoms). Results: Significant cognitive differences were observed. The HP group exhibited lower general cognitive performance (p = 0.02), working memory (p = 0.01), and executive function (planning; p < 0.001; flexibility; p = 0.03) than controls. Those with <14 days of illness (AP vs. HP) had deficits in general cognitive performance (p = 0.02), working memory (p = 0.02), and planning (p < 0.001), mainly during the hyperinflammatory phase, showing differences in working memory (p = 0.003) and planning (p = 0.01). Gender differences emerged, with males in the HP phase having poorer working memory (p = 0.003) and planning (p = 0.01). Discussion: This study underscores COVID-19's negative impact on cognitive function, even in mild cases, with potential heightened effects in men during acute or hyperinflammatory phases. The findings provide Peru's first evidence, highlighting the vulnerability of populations facing socioeconomic disparities. [ABSTRACT FROM AUTHOR]

There is a need for understanding the breadth of interventions for caregivers of individuals receiving hospice care at home, given the important role caregivers play in caring and the negative outcomes (e.g., depression) associated with their caregiving. Previous reviews were limited in scope to certain types of interventions or patient populations. The objective of this scoping review was to broadly examine the interventions targeting caregivers who provide care to terminally ill patients in home, with the purpose of (1) describing the characteristics of these interventions, (2) discussing key outcomes, limitations, and knowledge gaps, (3) highlighting intervention strengths, and (4) proposing future research directions. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Intervention studies that met the inclusion criteria and that were published up until October 2022 were obtained from the following databases: Ovid MEDLINE, Ovid EMBASE, CINAHL (EBSCO), and The Cochrane Library (Wiley). We analyzed 76 studies describing 55 unique interventions that took place in 14 countries. Interventions were largely delivered by nurses (n = 18, 24%), followed by an interdisciplinary team (n = 16, 21%), a health care provider (n = 10, 13%), research staff (n = 10, 13%), social worker (n = 5, 7%), and others (n = 11, 15%). Six interventions (8%) were self-administered. The most measured outcome was caregiver quality of life (n = 20, 26%), followed by anxiety (n = 18, 24%) and burden (n = 15, 20%). Missing data on patient and caregiver characteristics (i.e., age, gender) were common, and less than half of studies (n = 32, 42%) reported race/ethnicity data. Our review highlighted the current state of interventions for caregivers of patients receiving hospice care at home. Many of the interventions were in the early phases of development, raising the need for future studies to look at efficacy, effectiveness, and the ability to implement interventions in real-world settings. [ABSTRACT FROM AUTHOR]

Background: The Weill Cornell Medicine, Samuel J. Wood Library's Systematic Review (SR) service began in 2011, with 2021 marking a decade of service. This paper will describe how the service policies have grown and will break down our service quantitatively over the past 11 years to examine SR timelines and trends. Case Presentation: We evaluated 11 years (2011-2021) of SR request data from our in-house documentation. In the years assessed, there have been 319 SR requests from 20 clinical departments, leading to 101 publications with at least one librarian collaborator listed as co-author. The average review took 642 days to publication, with the longest at 1408 days, and the shortest at 94 days. On average, librarians spent 14.7 hours in total on each review. SR projects were most likely to be abandoned at the title/abstract screening phase. Several policies have been put into place over the years in order to accommodate workflows and demand for our service. Discussion: The SR service has seen several changes since its inception in 2011. Based on the findings and emerging trends discussed here, our service will inevitably evolve further to adapt to these changes, such as machine learning-assisted technology. [ABSTRACT FROM AUTHOR]