Veno-venous extracorporeal membrane oxygenation (ECMO) support surged during the COVID-19 pandemic. Our program changed the model of care pursuing to protect the multidisciplinary team from the risk of infection and to serve as many patients as possible. Patient–healthcare interactions were restricted, and the ECMO bed capacity was increased by reducing the ECMO specialist–patient ratio to 1:4 with non-ECMO trained nurses support. The outcomes worsened and we paused while we evaluated and modified our model of care. The ECMO bed capacity was reduced to allow a nurse ECMO–specialist nurse ratio 2:1 with an ECMO trained nurse assistant’s support. Intensivists, general practitioners, nurse assistants, and physical and respiratory therapists were trained on ECMO. Tracheostomy, bronchoscopy, and microbiological molecular diagnosis were done earlier, and family visits and rehabilitation were allowed in the first 48 hours of ECMO cannulation. There were 35 patients in the preintervention cohort and 66 in the postintervention cohort. Ninety days mortality was significantly lower after the intervention (62.9% vs. 31.8%, p = 0.003). Factors associated with increased risk of death were the need for cannulation or conversion to veno arterial or veno arterio venous ECMO, hemorrhagic stroke, and renal replacement therapy during ECMO. The interventions associated with a decrease in the risk of death were the following: early fiberoptic bronchoscopy and microbiological molecular diagnostic tests. Increasing the ECMO multidisciplinary team in relation to the number of patients and the earlier performance of diagnostic and therapeutic interventions, such as tracheostomy, fiberoptic bronchoscopy, molecular microbiological diagnosis of pneumonia, rehabilitation, and family support significantly decreased mortality of patients on ECMO due to COVID-19.

Background: Adolescent mothers have lower rates of initiation, continuation, and exclusivity of breastfeeding, and even more so in the first pregnancy. Current interventions target adult women, and little evidence is available for breastfeeding promotion among adolescents. Methods: This is a pilot study protocol with a parallel, single-blind, randomized, and controlled trial design, to evaluate the feasibility of the intervention “Lactation Counseling” in first-time adolescent mothers to maintain exclusive breastfeeding in the first 6 months of life. The control group will receive routine education in prenatal care and prenatal and childbirth classes, the experimental group will receive additionally the intervention “Lactation Counseling”, for 4 weeks, both conducted by trained nurses. Feasibility outcome includes recruitment and dropout rates, and, pilot outcomes will be the exclusive breastfeeding rate and the breastfeeding knowledge. Measurements will be taken at baseline, post-intervention, and 2, 4, and 6 months after childbirth. Discussion: Exclusive breastfeeding rates could be increased in adolescent mothers through nursing counseling interventions that are previously structured and evaluated from their feasibility. This study will allow the evaluation of the feasibility of an intervention in low-income, Latin American population adolescents. Trial registration: ClinicalTrials.gov NCT04655846, Registered 7 December 2020.

Introduction: Geographic Information Systems (GIS) are key tools for managing spatial data and understanding the determinants of occupational cancer. Objective: To evaluate the applications, advantages, and limitations of GIS in the surveillance of occupational cancer. Materials and Methods: A systematic scoping review was conducted using PubMed, Embase, Scopus, and Bireme databases, following the Population, Context, and Concept (PCC) framework outlined in the Joanna Briggs Institute (JBI) methodological guidelines and the PRISMA ScR. A semi-automated process supported by Rayyan® software was employed for study selection. The variables identified were transferred to a spreadsheet for qualitative analysis and synthesis. Results: A total of 55 articles were included, addressing various cancer types and exposure to industrial emissions and potentially carcinogenic pollutants. The most commonly used GIS, spatial analysis methodologies, and the main advantages and limitations of their use were identified in monitoring morbidity and mortality, equity, timeliness, coverage, and access to health services, as well as in modeling environmental agents. Discussion: GIS advance cancer research by integrating and analyzing diverse datasets, mapping cases, and identifying risk factors. Challenges include data accuracy, incomplete records, and omission of socioeconomic variables. Despite limitations, GIS support cancer surveillance, occupational health policies, and prevention plans. Conclusion: GIS are valuable tools for cancer surveillance, as they improve understanding of the geographic patterns of exposure and associated variables, providing critical insights for public policy formulation, healthcare planning, and preventive strategies.

Background: Road traffic injuries are a major public health and economic burden, particularly in low- and middle-income countries, where increasing motorization and limited trauma system capacity contribute to healthcare expenditures. Evidence on factors associated with hospital costs in Latin America remains limited. Objective: To evaluate sociodemographic, accident-related, and clinical complexity factors associated with hospital costs among patients with traffic-related injuries treated at a Colombian referral hospital. Methods: A retrospective cohort study included patients treated for road traffic injuries between 2016 and 2025 at a high-complexity referral center in Colombia. Hospital costs were expressed in Colombian pesos (COP). Multivariable linear regression using logarithmically transformed costs was performed. Results: A total of 13,899 patients were included. Median age was 32 years (IQR 25–43), and 64.0% were male. Motorcycles were involved in 87.1% of accidents. Median hospital cost was COP 431,300 (IQR 190,071–1,524,400). Surgical intervention was associated with the greatest increase in costs (1,502.6%), followed by ICU admission (1,063.2%) and each additional hospital day (6.8%). Early-morning accidents were associated with 46.8% higher costs, while nighttime crashes showed a 19.3% increase. Male sex and selected occupational categories were also associated with higher costs. After adjustment for clinical complexity markers, most geographic differences were attenuated. Conclusion: Hospital costs following road traffic injuries were mainly associated with clinical complexity markers, particularly surgery, ICU admission, and hospital length of stay. Early-morning crashes and selected sociodemographic factors were also associated with increased costs.

Invasive fungal infections are frequent complications in patients with hematologic malignancies due to immunosuppression and intensive treatments. In Colombia, limited diagnostic availability, heterogeneous prescribing practices, and emerging antifungal resistance highlight the need for optimized use. We evaluated an interdisciplinary antifungal stewardship intervention in the hematology unit of a tertiary-care hospital. A quasi-experimental before-and-after study included 353 hospitalized patients receiving systemic antifungals between 1 January 2023 and 31 December 2024 (1154 prescriptions). Following the intervention, antifungal prescribing shifted toward increased prophylaxis and reduced therapeutic use, with substantial reduction in prophylactic Amphotericin B dosing, stable treatment dosing, and selective changes in agent choice, including decreased voriconazole and discontinuation of some broad-spectrum drugs. Microbiological sampling decreased, reflecting a more targeted diagnostic approach rather than improved documentation. Antifungal consumption patterns showed redistribution among agents rather than uniform reduction. Prophylaxis-related costs increased, while treatment-related costs decreased without statistical significance. ICU admissions and in-hospital mortality remained unchanged. These results demonstrate that structured antifungal stewardship programs are feasible and safe in hematology units in middle-income settings, supporting more rational antifungal use without compromising patient outcomes.