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Objectives: This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods: A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results: The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion: Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy. What is known about the topic? Triage systems can be used to prioritise the order in which patients are treated in a pandemic, but the views of the general public on using chronic comorbidity as intensive care unit (ICU) triage criteria are unknown. What does this paper add? This Australian survey, conducted during the coronavirus disease 2019 pandemic, demonstrated that the majority of respondents perceived ICU triage methods based on comorbidity to be fair, but significant ethical issues exist. What are the implications for practitioners? It may be possible to develop an ICU triage protocol for future pandemics in Australia, but further research is required. [ABSTRACT FROM AUTHOR]

The article introduces the Patient Vigilance System (PVS) to reduce rapid response system (RRS) calls and improve patient care planning, demonstrating that the PVS significantly increased the proportion of patients with clinical plans after RRS calls.

Objective: To compare the demographic and clinical features, management, and outcomes for patients admitted with COVID‐19 to intensive care units (ICUs) during the first, second, and third waves of the pandemic in Australia. Design, setting, and participants: People aged 16 years or more admitted with polymerase chain reaction‐confirmed COVID‐19 to the 78 Australian ICUs participating in the Short Period Incidence Study of Severe Acute Respiratory Infection (SPRINT‐SARI) Australia project during the first (27 February – 30 June 2020), second (1 July 2020 – 25 June 2021), and third COVID‐19 waves (26 June – 1 November 2021). Main outcome measures: Primary outcome: in‐hospital mortality. Secondary outcomes: ICU mortality; ICU and hospital lengths of stay; supportive and disease‐specific therapies. Results: 2493 people (1535 men, 62%) were admitted to 59 ICUs: 214 during the first (9%), 296 during the second (12%), and 1983 during the third wave (80%). The median age was 64 (IQR, 54–72) years during the first wave, 58 (IQR, 49–68) years during the second, and 54 (IQR, 41–65) years during the third. The proportion without co‐existing illnesses was largest during the third wave (41%; first wave, 32%; second wave, 29%). The proportion of ICU beds occupied by patients with COVID‐19 was 2.8% (95% CI, 2.7–2.9%) during the first, 4.6% (95% CI, 4.3–5.1%) during the second, and 19.1% (95% CI, 17.9–20.2%) during the third wave. Non‐invasive (42% v 15%) and prone ventilation strategies (63% v 15%) were used more frequently during the third wave than during the first two waves. Thirty patients (14%) died in hospital during the first wave, 35 (12%) during the second, and 281 (17%) during the third. After adjusting for age, illness severity, and other covariates, the risk of in‐hospital mortality was similar for the first and second waves, but 9.60 (95% CI, 3.52–16.7) percentage points higher during the third than the first wave. Conclusion: The demographic characteristics of patients in intensive care with COVID‐19 and the treatments they received during the third pandemic wave differed from those of the first two waves. Adjusted in‐hospital mortality was highest during the third wave. [ABSTRACT FROM AUTHOR]

Objectives: To describe the characteristics and outcomes of patients with COVID‐19 admitted to intensive care units (ICUs) during the initial months of the pandemic in Australia. Design, setting: Prospective, observational cohort study in 77 ICUs across Australia. Participants: Patients admitted to participating ICUs with laboratory‐confirmed COVID‐19 during 27 February – 30 June 2020. Main outcome measures: ICU mortality and resource use (ICU length of stay, peak bed occupancy). Results: The median age of the 204 patients with COVID‐19 admitted to intensive care was 63.5 years (IQR, 53–72 years); 140 were men (69%). The most frequent comorbid conditions were obesity (40% of patients), diabetes (28%), hypertension treated with angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers (24%), and chronic cardiac disease (20%); 73 patients (36%) reported no comorbidity. The most frequent source of infection was overseas travel (114 patients, 56%). Median peak ICU bed occupancy was 14% (IQR, 9–16%). Invasive ventilation was provided for 119 patients (58%). Median length of ICU stay was greater for invasively ventilated patients than for non‐ventilated patients (16 days; IQR, 9–28 days v 3 days; IQR, 2–5 days), as was ICU mortality (26 deaths, 22%; 95% CI, 15–31% v four deaths, 5%; 95% CI, 1–12%). Higher Acute Physiology and Chronic Health Evaluation II (APACHE‐II) scores on ICU day 1 (adjusted hazard ratio [aHR], 1.15; 95% CI, 1.09–1.21) and chronic cardiac disease (aHR, 3.38; 95% CI, 1.46–7.83) were each associated with higher ICU mortality. Conclusion: Until the end of June 2020, mortality among patients with COVID‐19 who required invasive ventilation in Australian ICUs was lower and their ICU stay longer than reported overseas. Our findings highlight the importance of ensuring adequate local ICU capacity, particularly as the pandemic has not yet ended. [ABSTRACT FROM AUTHOR]

Aim: To describe the first Australian cases of severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV2) disease (COVID‐19) pneumonia treated with the interleukin‐6 receptor antagonist tocilizumab. Methods: Retrospective, open‐label, real‐world, uncontrolled, single‐arm case series conducted in 2 tertiary hospitals in NSW, Australia and 1 tertiary hospital in Victoria, Australia. Five adult male patients aged between 46 and 74 years with type 1 respiratory failure due to COVID‐19 pneumonia requiring intensive care unit (ICU) admission and biochemical evidence of systemic hyperinflammation (C‐reactive protein greater than 100 mg/L; ferritin greater than 700 μg/L) were administered variable‐dose tocilizumab. Results: At between 13 and 26 days follow‐up, all patients are alive and have been discharged from ICU. Two patients have been discharged home. Two patients avoided endotracheal intubation. Oxygen therapy has been ceased in three patients. Four adverse events potentially associated with tocilizumab therapy occurred in three patients: ventilator‐associated pneumonia, bacteremia associated with central venous catheterization, myositis and hepatitis. All patients received broad‐spectrum antibiotics, 4 received corticosteroids and 2 received both lopinavir/ritonavir and hydroxychloroquine. The time from first tocilizumab administration to improvement in ventilation, defined as a 25% reduction in fraction of inspired oxygen required to maintain peripheral oxygen saturation greater than 92%, ranged from 7 hours to 4.6 days. Conclusions: Tocilizumab use was associated with favorable clinical outcome in our patients. We recommend tocilizumab be included in randomized controlled trials of treatment for patients with severe COVID‐19 pneumonia, and be considered for compassionate use in such patients pending the results of these trials. [ABSTRACT FROM AUTHOR]

Background. Human mesenchymal stromal/stem cells (hMSCs) hold great therapeutic potential due to their immunomodulatory and tissue regenerative properties. Enhancement of biological features of hMSCs by transfection has become a focus of investigation for cell- and gene-based therapies. However, many of the current transient transfection methods result in either low transfection efficiency or high cytotoxicity. Methods. In order to find a transfection method that would address the current issues of low transfection efficiency and high cytotoxicity, 6 commercially available cationic lipid and polymer reagents were tested on human bone marrow-derived MSCs (hBM-MSCs) using GFP as a reporter gene. One transfection method using TransIT-2020 was selected and tested with an emphasis on cell quality (viability, identity, and yield), as well as efficacy with a human placental growth factor (PlGF) plasmid. Results. TransIT-2020 yielded the highest fluorescence signal per cell out of the methods that did not decrease cell recovery. Transfecting GFP to 5 hBM-MSC donors using TransIT-2020 yielded 24–36% GFP-expressing cells with a viability of 85–96%. hBM-MSC identity was unaffected as CD90, CD105, and CD73 markers were retained (>95%+) after transfection. When this method was applied to PlGF expression, there was up to a 220-fold increase in secretion. Both growth and secretion of PlGF in overexpressing hBM-MSC were sustained over 7 days, confirming the sustainability and applicability of the TransIT-2020 transfection system. Discussion. We report a simple and efficient method for transient transfection that has not been reported for hBM-MSCs, encompassing high levels of plasmid expression without significant changes to fundamental hBM-MSC characteristics. [ABSTRACT FROM AUTHOR]

The article focuses on a study which analyzed the increase in intensive care unit (ICU) bed availability resulting from the use of the New South Wales and Ontario Health Plan for an Influenza Pandemic (OHPIP) triage protocols. The study included eight Australian, adult, general ICU patients and was conducted between September 2009 and May 2010. Study authors concluded that triage protocols resulted in increased ICU bed availability.

Background: No clinical trial has directly compared nab-paclitaxel/gemcitabine (nab-P/G) with FOLFIRINOX (fluorouracil/leucovorin/oxaliplatin/irinotecan) in metastatic or advanced pancreatic cancer (mPC or aPC). We conducted a systematic review of real-world studies comparing these regimens in the first-line setting. Methods: Embase and MEDLINE databases through 22 January 2019, and Gastrointestinal Cancers Symposium 2019 abstracts were searched for real-world, retrospective studies comparing first-line nab-P/G versus FOLFIRINOX in mPC or aPC that met specific parameters. Studies with radiotherapy were excluded. Study quality was assessed using the Newcastle–Ottawa Scale. Results: Of 818 records initially identified, 35 were duplicates and 749 did not meet the eligibility criteria, mostly because they were either not comparative (n = 356) or not first line (n = 245). The remaining 34 studies (21 mPC; 13 aPC) assessed >6915 patients who received nab-P/G or FOLFIRINOX. In the studies identified, the median overall survival (OS) reached 14.4 and 15.9 months with nab-P/G and FOLFIRINOX, respectively, and median progression-free survival reached 8.5 and 11.7 months, respectively. Safety data were reported in 14 studies (2205 patients), including 8 single-institutional studies. In most single-institutional studies that reported safety data, rates were higher with FOLFIRINOX versus nab-P/G for grade 3/4 neutropenia (five of six studies) and febrile neutropenia (all three studies), while rates of grade 3/4 peripheral neuropathy were higher with nab-P/G in four of seven studies. Conclusions: Although FOLFIRINOX was associated with slightly longer median OS in more studies, the differences, when available, were not statistically significant. Therefore, a randomized, controlled trial is warranted. Toxicity profile differences represent key considerations for treatment decisions. [ABSTRACT FROM AUTHOR]