Abdominal Fibromyxoid Sarcoma in Pregnancy: An Unusual Cause of Preterm Labor and Sepsis.

Cancer in pregnancy is rare, with incidence less than 1%, and the most common cancers being melanoma, breast, and cervical cancers. Fibromyxoid sarcoma is a soft tissue tumor involving deep soft tissues of the extremities and trunk, rarely located in the abdomen. A low-grade fibromyxoid sarcoma (LGFMS) falls in the family of fibrosarcoma.

Uncomplicated epidural removal in a patient on a therapeutic heparin infusion: a case report.

Background: Unanticipated postoperative thrombotic complications can occur in complex patients who receive preoperative epidurals. Therefore, it is imperative that we consider the risks and benefits of epidural management in the setting of therapeutic anticoagulation. We present a case of epidural catheter removal on a heparin infusion, due to the extreme risk of holding anticoagulation for any duration.

A retrospective analysis of perioperative medications for opioid-use disorder and tapering additional postsurgical opioids via a transitional pain service.

Aims: To investigate perioperative opioid requirements in patients on methadone or buprenorphine as medication for opioid-use disorder (MOUD) who attended a transitional pain clinic (Personalized Pain Program, PPP).

Methods: This retrospective cohort study assessed adults on MOUD with surgery and attendance at the Johns Hopkins PPP between 2017 and 2022. Daily non-MOUD opioid use over 6 time-points was evaluated with regression models controlling for days since surgery.

Patient Experiences and Clinical Outcomes in a Multidisciplinary Perioperative Transitional Pain Service.

Siloed pain management across the perioperative period increases the risk of chronic opioid use and impedes postoperative recovery. Transitional perioperative pain services (TPSs) are innovative care models that coordinate multidisciplinary perioperative pain management to mitigate risks of chronic postoperative pain and opioid use. The objective of this study was to examine patients' experiences with and quality of recovery after participation in a TPS.

The Built Environment as a Social Determinant of Health.

The built environment encompasses buildings we live in; the distribution systems that provide us with water and electricity; and the roads, bridges, and transportation systems we use to get from place to place. It provides safety, health, and well-being and meaning to its dwellers, as a place to work, live, learn, play, and thrive. Poor-quality housing affects dwellers' health through toxins such as radon and lead, mold, cold indoor temperatures, and overcrowding.

A multidisciplinary transitional pain service to improve pain outcomes following trauma surgery: a preliminary report.

Objectives: Trauma (i.e., musculoskeletal injury from a blunt or penetrating force) can change the trajectory of a person's life.

Patient engagement and prescription opioid use in perioperative pain management.

Objective: To examine (1) patient perceptions regarding their engagement and the engagement of their families in perioperative pain management, (2) demographic and clinical characteristics associated with perceived patient and family engagement, and (3) the association between perceived patient and family engagement and patient outcomes.

Design: A prospective, observational study.

Setting: The Personalized Pain Program (PPP) at the Johns Hopkins Hospital in Baltimore, Maryland.

Experience with an Enhanced Recovery After Spine Surgery protocol at an academic community hospital.

Objective: Enhanced Recovery After Surgery (ERAS) protocols have rapidly gained popularity in multiple surgical specialties and are recognized for their potential to improve patient outcomes and decrease hospitalization costs. However, they have only recently been applied to spinal surgery. The goal in the present work was to describe the development, implementation, and impact of an Enhanced Recovery After Spine Surgery (ERASS) protocol for patients undergoing elective spine procedures at an academic community hospital.

A model for an institutional response to the opioid crisis.

The use of opioid analgesics for pain management has increased dramatically over the past decade, with corresponding increases in negative sequelae including overdose and death. Physicians, policymakers, and researchers are focused on finding ways to decrease opioid use and overdose. This crisis calls for a coordinated response that includes the entire healthcare sector.

Addressing the Opioid Crisis One Surgical Patient at a Time: Outcomes of a Novel Perioperative Pain Program.

Opioid prescriptions in the surgical setting have been implicated as contributors to the opioid epidemic. The authors hypothesized that a multidisciplinary approach to perioperative pain management for patients on chronic opioid therapy could decrease postoperative opioid requirements while reducing postoperative pain scores and improving functional outcomes. Therefore, a Perioperative Pain Program (PPP) for chronic opioid users was implemented.

Opioid-Prescribing Guidelines for Common Surgical Procedures: An Expert Panel Consensus.

Background: One in 16 surgical patients prescribed opioids becomes a long-term user. Overprescribing opioids after surgery is common, and the lack of multidisciplinary procedure-specific guidelines contributes to the wide variation in opioid prescribing practices. We hypothesized that a single-institution, multidisciplinary expert panel can establish consensus on ideal opioid prescribing for select common surgical procedures.

Quality Improvement Initiative to Improve Postoperative Pain with a Clinical Pathway and Nursing Education Program.

Background And Aims: We created a multicomponent intervention to improve pain management in the immediate postoperative period with the goal of improving the quality of patient recovery.

Design: A multicomponent intervention to improve pain management in the immediate postoperative period with the goal of improving the quality of patient recovery.

Settings: Pain management education of postanesthesia recovery room nurses through a practical intervention has the potential to improve patient pain experience, especially in those with a history of opioid tolerance.

An Innovative Perioperative Pain Program for Chronic Opioid Users: An Academic Medical Center's Response to the Opioid Crisis.

Increased utilization of prescription opioids for pain management has led to a nationwide public health crisis with alarming rates of addiction and opioid-related deaths. In the surgical setting, opioid prescriptions have been implicated as a contributing factor to the opioid epidemic. The authors developed an innovative model to address aspects of pain management and opioid utilization during preoperative evaluation, acute surgical hospitalization, and postoperative follow-up for chronic opioid users.

High-frequency epidural stimulation across the respiratory cycle evokes phrenic short-term potentiation after incomplete cervical spinal cord injury.

C2 spinal hemilesion (C2Hx) paralyzes the ipsilateral diaphragm, but recovery is possible through activation of "crossed spinal" synaptic inputs to ipsilateral phrenic motoneurons. We tested the hypothesis that high-frequency epidural stimulation (HF-ES) would potentiate ipsilateral phrenic output after subacute and chronic C2Hx. HF-ES (300 Hz) was applied to the ventrolateral C4 or T2 spinal cord ipsilateral to C2Hx in anesthetized and mechanically ventilated adult rats.

Laparoscopic Total Pancreatectomy With Islet Autotransplantation and Intraoperative Islet Separation as a Treatment for Patients With Chronic Pancreatitis.

Importance: Pain management of patients with chronic pancreatitis (CP) can be challenging. Laparoscopy has been associated with markedly reduced postoperative pain but has not been widely applied to total pancreatectomy with islet autotransplantation (TPIAT).

Objective: To examine the feasibility of using laparoscopic TPIAT (L-TPIAT) in the treatment of CP.

The efficacy and safety of epidural-based analgesia in a case series of patients undergoing lung transplantation.

Objective: Successful pain management after lung transplantation is critical to ensure adequate respiratory effort and graft expansion. The authors investigated whether thoracic epidural analgesia (TEA) provided adequate pain control after lung transplantation without added morbidity.

Design: Retrospective review.

Educational gaps among healthcare providers: an institution needs assessment to improve pain management for postsurgical patients.

Objective: Nurses should be educated in pain management because they are more likely than other healthcare professionals to educate patients about their pain. The authors sought to identify the knowledge gaps in postoperative pain management among postsurgical nursing staff and the existence of institutional policies and educational programs to support them in delivering optimal pain management services.

Setting: Academic hospital.

Improved residents' knowledge after an advanced regional anesthesia education program.

Background: Although residents in anesthesia are confident in performing neuraxial anesthesia, many are not confident in performing peripheral nerve blocks. The purpose of this study was to evaluate the effectiveness of a structured regional anesthesia teaching program in a large academic medical center.

Methods: Residents participated in regional anesthesia didactics that took place in a unique resident education program scheduled during two fully protected teaching days a month.

Curriculum development for an advanced regional anesthesia education program: one institution's experience from apprenticeship to comprehensive teaching.

Results of recent attitude survey studies suggest that most practicing physicians are inadequately treating postoperative pain. Residents in anesthesia are confident in performing lumbar epidural and spinal anesthesia, but many are not confident in performing the blocks with which they have the least exposure. Changes need to be made in the training processes to a comprehensive model that prepares residents to perform a wider array of blocks in postgraduate practice.

Does patient perception of pain control affect patient satisfaction across surgical units in a tertiary teaching hospital?

In this study, the relationship between patients' perceptions of pain control during hospitalization and their overall satisfaction with care was examined. Satisfaction data were collected from the federally mandated Hospital Consumer Assessment of Healthcare Providers and Systems survey for 4349 adult patients admitted to any surgical unit over an 18-month period. Patients' perceptions of pain control and staff's efforts to control pain were associated with their overall satisfaction scores.

Methodological quality of randomized controlled trials of postoperative epidural analgesia: validation of the Epidural Analgesia Trial Checklist as a specific instrument to evaluate methodology.

Background: The overall benefits of epidural analgesia are controversial, in part because of the varying quality of methodology in published randomized controlled trials (RCTs). We performed a systematic review of available RCTs to examine the methodological quality of epidural analgesia trials. Current instruments for evaluating the quality of methodology are generic; thus, we also developed a specific assessment tool named Epidural Analgesia Trial Checklist (EATC).