ARTICLES| VOLUME 5, ISSUE 1, E36-E46, JANUARY 01, 2023 Four SARS-CoV-2 vaccine doses or hybrid immunity in patients on immunosuppressive therapies: a Norwegian cohort study Kristin H Bjørlykke, Hilde S Ørbo, Anne T Tveter, et al. Lancet Rheumatol 2023; 5: E36-E46 Published:November 16, 2022 DOI:https://doi.org/10.1016/S2665-9913(22)00330-7 Summary Background Data on response and safety of repeated vaccinations and hybrid immunity in pat...

ORIGINAL ARTICLE Methylprednisolone for Heart Surgery in Infants — A Randomized, Controlled Trial Kevin D. Hill, Prince J. Kannankeril, Jeffrey P. Jacobs, et al N Engl J Med 2022; 387:2138-2149DOI: 10.1056/NEJMoa2212667 Abstract BACKGROUND Although perioperative prophylactic glucocorticoids have been used for decades, whether they improve outcomes in infants after heart surgery with cardiopulmonary bypass is unknown. METHODS We conducted a multicen...

CORRESPONDENCE| VOLUME 22, ISSUE 12, P1666-1668, DECEMBER 01, 2022 Resistance of SARS-CoV-2 omicron subvariant BA.4.6 to antibody neutralisation Qian Wang, Zhiteng Li, Jerren Ho, et al Lancet Infect Dis 2022; 22: 1666-1668 SARS-CoV-2, the causative agent of the COVID-19 pandemic, continues to evolve. A subvariant of SARS-CoV-2 omicron (B.1.1.529), known as BA.4.6, emerged in March, 2022, and it appears to be expanding its coverage even in the pr...

Prehospital Bundle of Care Associated With Mortality Decrease in Septic Shock Over 50 million people worldwide suffer from sepsis every year. Sepsis causes nearly 11 million deaths and is responsible for one-third to half of all in-hospital deaths. The mortality rate for sepsis ranges from 10 to 20%. For septic shock, the most serious form of sepsis, the mortality rate can range from 50 to 60%.  Guidelines recommend early recognition, severity assessment an...

Article Published: 15 September 2022 Anti-CD19 CAR T cell therapy for refractory systemic lupus erythematosus Andreas Mackensen, Fabian Müller, Dimitrios Mougiakakos, et al Nature Medicine volume 28, pages 2124–2132 (2022) Abstract Systemic lupus erythematosus (SLE) is a life-threatening autoimmune disease characterized by adaptive immune system activation, formation of double-stranded DNA autoantibodies and organ inflammation. Five patients with ...

EDITORIAL Constancy of Purpose for Improving Patient Safety — Missing in Action Donald M. Berwick N Engl J Med 2023; 388:181-182DOI: 10.1056/NEJMe2213567 The 20th-century statistician and quality scholar W. Edwards Deming proposed the “14 Points for Top Leaders” — a checklist of management principles for executives who wish to nurture improvement in complex systems. First on his list was “constancy of purpose for improvement.”1 In Deming’s view, when leaders s...

Obesity and Critical Care Nutrition A panel discussion with an international group of experts in the care of obese patients in the critical care setting evaluated best practices in malnutrition screening and assessment, estimation of energy needs for obese patients, the risks and management of sarcopenic obesity, the importance of tailored nutrition, and the role of immunonutrition.  Patients in the ICU are often overweight and/or obese, with obesity r...

SPECIAL ARTICLE The Safety of Inpatient Health Care David W. Bates, David M. Levine, Hojjat Salmasian, et al N Engl J Med 2023; 388:142-153DOI: 10.1056/NEJMsa2206117 Abstract BACKGROUND Adverse events during hospitalization are a major cause of patient harm, as documented in the 1991 Harvard Medical Practice Study. Patient safety has changed substantially in the decades since that study was conducted, and a more current assessment of harm during hospital...

ORIGINAL ARTICLE Hypothermia or Machine Perfusion in Kidney Donors Darren Malinoski, Christina Saunders, Sharon Swain, et al N Engl J Med 2023; 388:418-426DOI: 10.1056/NEJMoa2118265 Abstract BACKGROUND Therapeutic hypothermia in brain-dead organ donors has been shown to reduce delayed graft function in kidney recipients after transplantation. Data are needed on the effect of hypothermia as compared with machine perfusion on outcomes after kidney transpla...

Effect of Daily Written Updates for Families of ICU Patients ICU patients are often too ill to make decisions for themselves and need family members or surrogates to make medical decisions on their behalf. Surrogates may have to use substituted judgment when the critically ill patient has left no advanced directives. In such a situation, the surrogate may have to make decisions by considering what the patient would have done in a similar situation. This can cause u...