Turbulence in the system: Higher rates of left-without-being-seen emergency department visits and associations with increased risks of adverse patient outcomes since 2020.

Objective: To examine risks of severe adverse patient outcomes shortly after a left-without-being-seen emergency department (LWBS ED) visit since 2020.

Methods: In this retrospective study using linked administrative data, we examined temporal trends in monthly rates of ED and LWBS visits for adults in Ontario, Canada, 2014‒2023. In patient-level analyses restricted to the first eligible LWBS ED visit, we used modified Poisson regression to compare the composite outcome of 7-day all-cause mortality or hospitalization following a LWBS ED visit for April 1, 2022‒March 31, 2023 (recent period) to April 1, 2014‒March 31, 2020 (baseline period), adjusted for age, sex, and Charlson comorbidity index.

The Essential Components of Adult Critical Care Neuroscience Nursing Orientation: A Delphi Study.

BACKGROUND: Critical care neuroscience nursing is a specialized field requiring a complex knowledge base and unique clinical orientation. A comprehensive orientation for nurses new to this specialty can improve retention, performance, and satisfaction. Critical care neuroscience orientations are often hospital based and regionally specific, and lack a systematic approach.

Ulcerative Jejunitis in Celiac Disease: A Thirty-Year U.S. Experience.

Introduction: Ulcerative jejunitis (UJ) or ulcerative enteritis (UE) is a rare complication of celiac disease (CeD). Guidelines regarding diagnosis and management are missing and these cases have seldom been reported in the United States.

Design: Single center case-series of CeD in which UE developed at a large academic center in the USA.

Comparison of efficacy and safety of three different concentrations of ropivacaine for labor pain management using patient-controlled epidural analgesia (PCEA): A double-blind, randomized controlled trial.

Background And Aims: Labor pain is consistently ranked high on the various pain rating scales, when compared to other painful life experiences, and the experience of labor during the process of childbirth is both complex and subjective. Though patient-controlled epidural analgesia (PCEA) using dilute concentrations of local anesthetics (LAs) has been a popular method to control labor pain, yet the optimal dose and regimen for PCEA remain ambiguous. So, the present study was undertaken to evaluate the safety and efficacy of three different concentrations of ropivacaine for labor analgesia using PCEA.

Is there a prodrome to NMOSD? An investigation of neurologic symptoms preceding the first NMOSD attack.

Background: It is unknown whether people with aquaporin-4 antibody positive (AQP4-IgG+) neuromyelitis optica spectrum disorder (NMOSD) experience a prodrome, although a few cases report AQP4 + serology up to 16 years before the first attack.

Objectives: To evaluate whether individuals with AQP4-IgG + NMOSD have prodromal neurologic symptoms preceding the first attack.

Methods: We reviewed medical records of participants meeting the 2015 diagnostic criteria for AQP4-IgG + NMOSD from four demyelinating disease centres in the Canadian NMOSD cohort study CANOPTICS.

Role of Phytocompounds for Effective Management of Migraine: Current and Future Prospectives.

Migraine is one of the most painful and debilitating conditions, which is characterized by a pulsating headache. Many therapeutic strategies are being used to prevent and treat the symptoms and underlying pathology. A relatively high number of different medications are currently being used for migraine prevention in clinical practice.

Metagenome Analysis of Cholesteatoma-associated Bacteria: A Pilot Study.

Introduction: Cholesteatoma usually harbors a poly-microbial infection. As the diversity of bacterial pathogens in the Indian COM is unknown, we set out to identify the bacteria associated with cholesteatoma disease in different patients of North India using targeted metagenomic analysis of the 16 S rRNA gene.

Methods: We recruited 15 patients of cholesteatomatous chronic otitis media (COM), who underwent surgical disease clearance.

Dental Caries: Unveiling the State-of-the-art Insights and Crafting Hypotheses for Oral Health.

The pathophysiological understanding of dental caries explains that the primary factor responsible is linked to an imbalance in microbial composition within the oral cavity, stemming from both artificial and natural sources. () is the most accountable and prevalent pathogen for caries development among the diverse pool. , an acidogenic bacterium, lowers oral pH through the metabolic conversion of dietary sugar into organic acids, leading to enamel demineralization and dental caries.

Caregiver-reported symptom burden and preferences for therapeutic goals in pediatric primary sclerosing cholangitis.

This study analyzed qualitative and quantitative survey responses from 51 pediatric primary sclerosing cholangitis (PSC) patients and caregivers using the PSC Partners Patient Registry-Our Voices survey. The most common symptoms reported by children/caregivers include: fatigue (71%), abdominal pain (69%), anxiety (59%), appetite loss (51%), insomnia (49%), and pruritus (45%). When experiencing symptoms at their worst, over half of patients/caregivers reported limitations in physically demanding activities (67%), work/school duties (63%), social life activities (55%), and activities for fun or exercise (53%).

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada.

Background And Objectives: Secondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada.

Methods: We conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada.

Patient-focused drug development in primary sclerosing cholangitis: Insights on patient priorities and involvement in clinical trials.

Background: According to the new AASLD Practice Guidance, all patients with primary sclerosing cholangitis (PSC) should be considered for participation in clinical trials. However, PSC's rarity has posed challenges to characterizing patient interest in trial participation and identifying predictors of patient willingness to participate in drug trials.

Methods: PSC Partners Seeking a Cure developed the "Our Voices" survey to inform the development of the Externally-Led Patient-Focused Drug Development Forum, an FDA initiative to capture patient experiences and perspectives on drug development.

Acute and Long-Term Effects of App-Delivered Heartfulness Meditation on Psychological Outcomes and the Endocannabinoid Signaling System in Cyclic Vomiting Syndrome.

Introduction: Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction often triggered by stress. Interventions such as meditation may improve psychological outcomes and health-related quality of life (HRQoL), but their efficacy and the underlying mechanism are unknown.

Methods: We conducted a 6-week single-arm pilot study to assess the effects of heartfulness meditation (HFM) in CVS using a custom-designed meditation app.

Association between migraine and exclusive breastfeeding: A cross-sectional study.

Background: Medical conditions may preclude a mother from exclusively breastfeeding her infant; however, the association between migraine and the duration of exclusive breastfeeding is not well known.

Objective: To evaluate the association between migraine and the duration of exclusive breastfeeding in a representative sample of Canadian females.

Methods: We used the Canadian Community Health Survey, a cross-sectional survey, to identify females aged 20-49 years who delivered a baby in the previous 5 years.

COVID anomaly in the correlation analysis of S&P 500 market states.

Analyzing market states of the S&P 500 components on a time horizon January 3, 2006 to August 10, 2023, we found the appearance of a new market state not previously seen and we shall discuss its possible implications as an isolated state or as a beginning of a new general market condition. We study this in terms of the Pearson correlation matrix and relative correlation with respect to the S&P 500 index. In both cases the anomaly shows strongly.

Long-term neuropsychiatric complications of aneurysmal subarachnoid hemorrhage: a narrative review.

This review focuses on the often-neglected long-term neuropsychiatric consequences of aneurysmal subarachnoid hemorrhage (aSAH), beyond traditional randomized trial outcomes of mortality and retreatment. While current guidelines recommend screening for these sequalae, it may not be routinely practiced. This review will underscore the prevalence and management of common neuropsychiatric sequalae, including anxiety, depression, cognitive dysfunction, headaches, seizures, and sexual dysfunction, all of which can significantly impact the quality of life of survivors of aSAH.

Population Trends of New Prescriptions for Antihyperglycemics and Antihypertensives Between 2014 and 2022.

Background: In the wake of pandemic-related health decline and health care disruptions, there are concerns that previous gains for cardiovascular risk factors may have stalled or reversed. Population-level excess burden of drug-treated diabetes and hypertension during the pandemic compared with baseline is not well characterized. We evaluated the change in incident prescription claims for antihyperglycemics and antihypertensives before versus during the pandemic.

Essential Components of a Neuroscience Nursing Orientation: A Delphi Study.

BACKGROUND: The essential components of an effective neuroscience nurse orientation program for those caring for the adult general care population have not been well defined or standardized. METHODS : Using a 2-round, modified Delphi methodology, electronic surveys were distributed to 53 experts in neuroscience nursing orientation to gain consensus on the essential components of orientation for the neuroscience nurse. Survey data included demographics of the expert, literature-based components of neuroscience nurse orientation, and an opportunity to agree/disagree or write in additional components.