Physician Personal Well-Being and Resilience: An Action Plan and Sustainable Approach.

This comprehensive review addresses the critical issue of burnout among obstetricians and gynecologists (OB/GYNs), exploring strategies to enhance personal well-being and resilience. The study examines the personal and professional consequences of burnout, including its impact on patient care and health care systems. It outlines institutional responsibilities and provides practical strategies for creating supportive work environments.

Understanding Mental Health as a Public Health Issue.

Mental health disorders impose a significant burden on individuals and society, with far-reaching implications that extend beyond personal suffering to substantial economic costs. Public health initiatives have traditionally focused on conditions like obesity and infectious diseases, but public mental health has only recently received comparable attention. This review explores the critical role of public mental health.

Improving lung protective mechanical ventilation: the individualised intraoperative open-lung approach.

Despite the maturity and sophistication of anaesthesia workstations, improvements in our understanding of intraoperative mechanical ventilation, and use of less invasive surgical techniques, postoperative pulmonary complications (PPCs) are still a common problem in surgical patients of all ages. PPCs are associated with a higher incidence of perioperative morbidity and mortality, longer hospital stays, and higher healthcare costs. PPCs are strongly associated with anaesthesia-induced atelectasis, which predisposes to lung damage when partially collapsed lungs are subjected to mechanical ventilation.

Fast is fine, but accuracy is everything: making intraoperative transfusion decisions using point-of-care testing.

Accurate and timely diagnostic information is a vital adjunct to clinical assessment to inform therapeutic decision-making, including decisions to transfuse, or not transfuse, blood components. A prospective cohort study of diagnostic point-of-care (POC) haemoglobin measurements on arterial or central venous samples from adults undergoing major noncardiac surgery compared three widely used devices, HemoCue®, i-STAT™, and the Rad-67™ pulse CO-Oxymeter® finger sensor device, against standard laboratory haemoglobin measurements, but importantly not against a blood gas analyser. The study focused on haemoglobin results below 100 g L to establish the utility of these devices to guide red cell transfusion decisions.

Haemodynamic profiling: when AI tells us what we already know.

Machine learning (ML) algorithms hold significant potential for extracting valuable clinical information from big data, surpassing the processing capabilities of the human brain. However, it would be naïve to believe that ML algorithms can consistently transform data into actionable insights. Clinical studies suggest that in some instances, they tell clinicians what they already know or can plainly see.

Development and validation of a novel risk-predicted model for early sepsis-associated acute kidney injury in critically ill patients: a retrospective cohort study.

Objectives: This study aimed to develop a prediction model for the detection of early sepsis-associated acute kidney injury (SA-AKI), which is defined as AKI diagnosed within 48 hours of a sepsis diagnosis.

Design: A retrospective study design was employed. It is not linked to a clinical trial.

Facilitators and barriers to parental involvement in neonatal pain management in the NICU: a scoping review.

Objectives: Neonatal pain prevention is not only a humanistic but also an ethical imperative. Fitting with the principles of family-centred care, parental involvement in neonatal pain management plays an active role in infant development and parental well-being. However, the process of parental involvement faces constant challenges.

Clinical effectiveness and implementation outcomes of pMDI-to-DPI switch in children between 5 and 12 years of age: a scoping review protocol.

Introduction: Inhalers are critical in asthma treatment, and inappropriate inhaler use leads to poor asthma outcomes. In adults and adolescents, dry powder inhalers (DPIs) are safe and effective alternatives to mainstay pressurised metered dose inhalers and could bridge the asthma care gap while also reducing the environmental burden of asthma care. Despite being licensed for use in ages 5 years old and older, the evidence for clinical effectiveness is less clear for patients between ages 5 and 12 years.

Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition).

Hemorrhagic complications associated with regional anesthesia are extremely rare. The fifth edition of the American Society of Regional Anesthesia and Pain Medicine's Evidence-Based Guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy reviews the published evidence since 2018 and provides guidance to help avoid this potentially catastrophic complication.The fifth edition of the American Society of Regional Anesthesia and Pain Medicine's Evidence-Based Guidelines on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy uses similar methodology as previous editions but is reorganized and significantly condensed.

Detection of Breath Nitric Oxide at Ppb Level Based on Multiperiodic Spectral Reconstruction Neural Network.

As breath nitric oxide (NO) is a biomarker of respiratory inflammation, reliable techniques for the online detection of ppb-level NO in exhaled breath are essential for the noninvasive diagnosis of respiratory inflammation. Here, we report a breath NO sensor based on the multiperiodic spectral reconstruction neural network. First, a spectral reconstruction method that transforms a spectrum from the wavelength domain to the intensity domain is proposed to remove noise and interference signals from the spectrum.

Unveiling Hidden Dangers: Quantitative Analysis of Ischemic Risks in High-Risk Patients with ASCVD and Dyslipidemia.

Cardiovascular disease is one of the foremost causes of morbidity and mortality worldwide, with low-density lipoprotein cholesterol (LDL-C) identified as a significant risk factor for subsequent ischemic events. Elevated LDL-C contributes to vascular injury and fibrosis by upregulating the expression of connective tissue growth factor and collagen IV, which leads to endothelial cell dysfunction that initiates the process of atherosclerotic diseases. Currently, there is an absence of clear, risk-defined criteria to identify patients who are in greater needs for intensive LDL-C reduction, particularly with PCSK9 inhibitors.

The effect of first intervention on cardiac parameters in patients with acromegaly: a systematic review.

Objective: Cardiovascular disease in acromegaly patients remains a major cause of morbidity and all-cause mortality. This systematic review investigates the effect of the first growth hormone lowering intervention on cardiac parameters.

Design: Systematic review.

Anaphylaxis definition, overview, and clinical support tool: 2024 consensus report.

Background: The 2006 National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN) anaphylaxis criteria are widely used in clinical care and research. In 2020, the World Allergy Organization (WAO) published modified criteria that have not been uniformly adopted. Different criteria contribute to inconsistent care and research outcomes.

Prolonged mechanical ventilation in critically ill patients: six-month mortality, care pathways, and quality of life.

Background: There is limited knowledge about long-term mortality, care pathways and health-related quality of life (HrQoL) among intensive care unit (ICU) patients receiving prolonged mechanical ventilation (PMV).

Research Question: What are the long-term mortality, care pathways, and HrQoL of patients receiving invasive PMV, stratified by weaning success?

Study Design: and methods: We conducted a secondary analysis of patients from the cluster-randomised controlled Enhanced Recovery after Intensive Care trial who were treated in two ICU clusters and received invasive PMV (≥21 days via endotracheal tube/tracheostomy or ≥four days via tracheostomy). Data on weaning success, mortality, care place transitions, readmissions, and HrQoL were collected for six months after ICU discharge.

Alpha-1-Antitrypsin Deficiency Targeted Testing and Augmentation Therapy: A Canadian Thoracic Society Meta-analysis and Clinical Practice Guideline.

Alpha-1-Antitrypsin (A1AT) deficiency is a common hereditary disorder associated with increased risk of developing chronic obstructive pulmonary disease (COPD). Many individuals with severe A1AT deficiency go undiagnosed, or are diagnosed late, and fail to benefit from disease-specific counseling and modifying care. Since the 2012 Canadian Thoracic Society (CTS) A1AT deficiency clinical practice guideline, new approaches to optimal diagnosis using modern genetic testing and studies of A1AT augmentation therapy have been published.

Ability of the modified NUTRIC score to predict all-cause mortality among ICU patients with acute pancreatitis: A retrospective analysis using the MIMIC-IV database.

Background: Acute pancreatitis (AP) is a common acute abdominal condition that can lead to severe complications. Malnutrition significantly impacts the prognosis of patients with AP, so effective tools are needed to identify those at high nutritional risk. This study validated the ability of the modified NUTRIC score to predict all-cause mortality and identify nutritional risk in patients with acute pancreatitis in the ICU.

National Survey of Lung Cancer Screening Eligibility in United States Veterans.

Introduction: Lung cancer screening is underutilized, especially in rural areas where lung cancer mortality is high. Approximately 11.2% of the United States (US) population over age 50 meet the United States Preventive Services Task Force (USPSTF) 2021 lung cancer screening eligibility criteria; the proportion of eligible Veterans is unknown.

Significance of TYMS Polymorphism rs3819102 as a Prognostic Marker for Nonsmoking Lung Cancer Patients of the Han Ethnicity in China.

Introduction: With high incidence and mortality rates, lung cancer is now one of the most common cancers in the world. The 5-year survival rate of lung cancer patients is very low, and predicting the prognosis of lung cancer patients and using it to develop treatment strategies and interventions is important for prolonging the survival time of patients. Folate metabolism involves various aspects such as methylation of DNA, RNA, proteins, lipids, etc.

Nutrition therapy for critically ill patients - Five key problems.

Background & Aims: A pragmatic trial and its secondary analyses have demonstrated that nutritional care not only reduces complications but also significantly improves survival in medical patients at risk of malnutrition. In contrast, for critically ill patients comparable evidence is scarce. Consequently, many propositions for refining the research agenda and study design in the field of critical care nutrition have already been made.

NOD-like receptor protein 3 inhibition by MCC950 improves the cognitive function of rats with sepsis-associated encephalopathy.

This study aimed to investigate the effects of MCC950 in a rat model of sepsis-associated encephalopathy (SAE). Adult male rats were randomly assigned to 12 groups according to the surgery or treatment received and evaluation times. The SAE model was established using the cecal ligation and puncture (CLP) method.

Synthesis of expert opinions on fluid management in severe sepsis: A contextual review of human albumin and crystalloids.

Background: Sepsis is a critical condition associated with high mortality rates that necessitates effective fluid resuscitation. Crystalloids are widely utilized; however, human albumin solutions have been attributed potential oncotic and anti-inflammatory benefits. Given the ongoing debate and the absence of definitive empirical evidence, expert opinions provide valuable insights into the contextual and practical aspects of fluid management.

Pulmonary rehabilitation under supervision of health-professional at institute versus conventional exercise-based pulmonary rehabilitation at home in COPD patients: A longitudinal cohort study.

Objectives: To evaluate the efficacy and safety of pulmonary rehabilitation under the supervision of health professionals at the institute versus conventional exercise-based pulmonary rehabilitation at home in Chronic Obstructive Pulmonary Disease (COPD) patients.

Methods: Patients of COPD received pulmonary rehabilitation under the supervision of a professional at the institute (PI cohort, n = 115) or self-driven traditional Chinese methods-based pulmonary rehabilitation at home (CE cohort, n = 127) or did not receive any type of pulmonary rehabilitation (ME cohort, n = 155). All patients received inhaled pharmacological treatment for COPD.

Impact of continuous positive airway pressure therapy on restless legs syndrome in patients with coexistent obstructive sleep apnea: A qualitative systematic review.

Introduction: Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial upper airway collapse during sleep. Restless legs syndrome (RLS) is a sleep-related movement disorder characterized by an uncomfortable urge to move the legs, especially during inactivity and evenings. Both OSA and RLS are common with significant overlap: RLS is present in up to 36% of those with OSA.

Intensive care clinician attitudes and perceptions towards whānau participation in adult intensive care bedside ward rounds in Aotearoa New Zealand: An online survey.

Background: Clinical practice guidelines endorse family involvement in ward rounds to improve communication and engagement between patients, whānau (family), and healthcare teams, yet the practice has not been universally implemented. Whānau inclusion in adult bedside rounds is often met with hesitation by intensive care unit (ICU) healthcare clinicians, and reasons for this have not been explored in Aotearoa, New Zealand.

Objectives: The aim of this study was to assess attitudes and perceptions of ICU clinicians towards whānau-family inclusion in adult ICU ward rounds in Aotearoa New Zealand.

Traditional Chinese medicine Chaiqinchengqi decoction for patients with acute pancreatitis: A randomized clinical trial.

Background: Chaiqinchengqi decoction, a traditional Chinese medicine, has shown promising effects in in vitro, animal and preliminary small human studies for acute pancreatitis, but evidence of clinical practice is limited.

Purpose: To investigate whether Chaiqinchengqi decoction could improve clinical outcomes in patients with acute pancreatitis.

Study Design: Prospective, pragmatic, randomized controlled trial.