Viral infections in critical care: a narrative review

Viral infections form a substantial part of the intensive care workload, even before the recent and ongoing COVID-19 pandemic. The growing availability of molecular diagnostics for viral infections has led to increased recognition of these pathogens. This additional information, however, provides new challenges for interpretation and management. As the SARS-CoV-2 pandemic has amply demonstrated, the emergence and global spread of novel viruses are likely to provide continued challenges for critical care physicians into the future. This article will provide an overview of viral infections relevant to the critical care physician, discussing the diagnosis and management of respiratory viral infections, blood borne and enteric viruses. We will also discuss herpesviridae complications, commonly seen due to reactivation of latent infections. Further, we explore some rarer and emerging viruses, including recognition of viral haemorrhagic fevers, and briefly discuss post-viral syndromes which may present to the intensive care unit. Finally, we will discuss infection control and its importance in preventing nosocomial viral transmission.     

Racialized Risk in Clinical Care: Clinician Vigilance and Patient Responsibility

Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care.     

The Dark Side of Addiction Support Forums: Impacts of Poor Quality and Insufficient Emotional Support on Perceived Support Availability and Health Efficacy

Research has identified many benefits of participating in online social support forums; however, the potential negative impacts of these communities have rarely been examined. This study explored the negative impacts of low quality (i.e., low person-centered) and insufficient (i.e., under-benefitted) emotional support on online support seekers. Health stigma and perceived support availability were also examined as mediating and moderating variables, respectively, in the model. An online survey of addiction support forum users (N = 321) was conducted. Results showed that for participants with low health stigma, low person-centered support decreased health self-efficacy through reducing perceived online emotional support availability, but under-benefitted support did not impact them. For those with high health stigma, low person-centered emotional support had positive effects on health self-efficacy through increasing perceived support availability, whereas under-benefitted support reduced health self-efficacy through decreasing perceived support availability. Importantly, a considerable proportion of participants (44.86%) reported under-benefitted emotional support. These findings suggest support forum participation can have negative impacts, but not all participants are adversely impacted equally. Instead, moderating variables, such as health stigma, can play an important role. Implications for future research and health care practitioners are discussed.     

Integration of Genomic and Transcriptional Features in Pancreatic Cancer Reveals Increased Cell Cycle Progression in Metastases

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