Nudging strategies to influence prescribers' behavior toward reducing opioid prescriptions: a systematic scoping review.

Objective: This systematic scoping review aimed to map the literature on the use of various nudging strategies to influence prescriber behavior toward reducing opioid prescriptions across diverse healthcare settings.

Methods: A systematic database search was conducted using seven electronic databases. Only articles published in English were included.

Postoperative Recovery in the Youngest: Beyond Technology.

Background: Measuring and interpreting vital signs in pediatric patients recovering from anaesthesia, particularly those up to 36 months old, is challenging. Nurses' decision-making regarding the level of monitoring must balance patient safety with individualized care. This study aimed to explore the perceptions of critical care nurses and registered nurse anesthetists regarding their experiences and actions when making decisions about vital sign monitoring for children in post-anesthesia care units (PACUs).

Performance of the neutrophil-lymphocyte ratio as a predictor of severity and mortality in children and adolescents with traumatic brain injury.

Purpose: An inflammatory cascade associated with the systemic neutrophil response can be triggered after traumatic brain injury (TBI), causing neuronal dysfunction, which is considered to be related to the prognosis of the victims. The scope of this research is to identify the performance of the neutrophil-lymphocyte ratio (NLR) as a predictor of prognosis considering TBI severity and death as outcomes in a group of pediatric patients.

Methods: We retrospectively evaluated NLR through a consecutive review of the medical records (cross-sectional study) of children and adolescents aged < 17 years victims of TBI.

How to Achieve Highly Professional Care in the Postoperative Ward: The Care of Infants and Toddlers.

Purpose: The purpose of this study was to describe the experiences of critical care nurses (CCNs) and registered nurse anesthetists (RNAs) when monitoring and observing infants and toddlers recovering from anesthesia.

Design: A qualitative design with a critical incident approach.

Methods: Semistructured individual interviews were conducted with a purposeful sample of CCNs and RNAs (n = 17) from postanesthesia care units at two hospitals.

Red-Haired People's Altered Responsiveness to Pain, Analgesics, and Hypnotics: Myth or Fact?-A Narrative Review.

Red hair has been linked to altered sensitivity to pain, analgesics, and hypnotics. This alteration may be impacted by variants in the melanocortin-1 receptor () gene, which are mainly found in redheads. The aim of this narrative review was to explore and present the current state of knowledge on red hair and its plausible associations with altered responsiveness to pain, analgesics, and hypnotics.

Accuracy of acute hyperglycemia as a biomarker of severe brain damage in children with traumatic brain injury.

Purpose: Biomarkers are substances measured at the systemic level to evaluate organic responses in certain situations, establishing diagnoses, disease staging, and prognosis. Blood glucose is a biomarker recognized as a predictor of prognosis in children victims of traumatic brain injury (TBI). The scope of this study was to identify the accuracy of blood glucose as a biomarker of severe brain injury.

Patients' perioperative experiences of an opioid-free versus opioid-based care pathway for laparoscopic bariatric surgery: A qualitative study.

Background: Despite recent evidence supporting the adoption of opioid-free anaesthetic and analgesic alternatives in the perioperative context, opioid-based regimens remain standard of care. There is limited knowledge about the patients' perioperative experiences of bariatric surgery, with no study yet investigating their experiences within an opioid-free care pathway.

Objective: We aimed to describe similarities and differences in patients' perioperative experiences of undergoing bariatric surgery with either an opioid-free or opioid-based care pathway.

Pituitary function before and after surgery for nonfunctioning pituitary adenomas-data from the Swedish Pituitary Register.

Objective: Data on pre- and postoperative pituitary function in nonfunctioning pituitary adenomas (NFPA) are not consistent. We aimed to investigate pituitary function before and up to 5 years after transsphenoidal surgery with emphasis on the hypothalamic-pituitary-adrenal axis (HPA).

Design And Methods: Data from the Swedish Pituitary Register was used to analyze anterior pituitary function in 838 patients with NFPA diagnosed between 1991 and 2014.

Consensus Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations Part 2-Emergency Laparotomy: Intra- and Postoperative Care.

Background: This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care.

Methods: Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS Society.

Clinical practice selectively follows acute appendicitis guidelines.

Introduction: Acute appendicitis is a common surgical emergency, and the standard approach to diagnosis and management has been codified in several practice guidelines. Adherence to these guidelines provides insight into independent surgical practice patterns and institutional resource constraints as impediments to best practice. We explored data from the recent ESTES SnapAppy observational cohort study to determine guideline compliance in contemporary practice to identify opportunities to close evidence-to-practice gaps.

Registered Nurse Anesthetists' Perceptions of Providing Care Within a Global Health Framework: A Qualitative Study.

Purpose: The purpose of this study was to investigate how Registered Nurse Anesthetists (RNAs) who have been working for nongovernmental organizations in low- and middle-income countries perceive their role in global health.

Design: A qualitative design was used in this study.

Methods: Data were collected by means of semistructured interviews with 11 participants who met the inclusion criteria, and qualitative analysis of the interview content was performed.

Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study.

Introduction: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications.

Material And Methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.

Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective.

Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy.

Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study.

Introduction: Surgical skill, a summation of acquired wisdom, deliberate practice and experience, has been linked to improved patient outcomes. Graded mentored exposure to pathologies and operative techniques is a cornerstone of surgical training. Appendectomy is one of the first procedures surgical trainees perform independently.

Prophylactic cholecystectomy offers best outcomes following ERCP clearance of common bile duct stones: a meta-analysis.

Background: Symptomatic calculus biliary disease is common with associated morbidity and occasional mortality, further confounded when there is concomitant common bile duct (CBD) stones. Choledocholithiasis and clearance of the duct reduces recurrent cholangitis, but the question is whether after clearance of the CBD if there is a need to perform a cholecystectomy. This meta-analysis evaluated outcomes in patients undergoing ERCP with or without sphincterotomy to determine if cholecystectomy post-ERCP clearance offers optimal outcomes over a wait-and-see approach.

Spectral edge frequency during general anaesthesia: A narrative literature review.

Previous studies have attempted to determine the depth of anaesthesia with different anaesthetic agents using electroencephalogram (EEG) measurements with variable success. Measuring depth of anaesthesia is confounded by the complexity of the EEG and the fact that different agents create different pattens. A narrative review was undertaken to examine the available research evidence on the effect and reliability of spectral edge frequency (SEF) for assessing the depth of anaesthesia in adult patients under general anaesthesia.

What trauma patients need: the European dilemma.

There is a need for implementation and maturation of an inclusive trauma system in every country in Europe, with patient centered care by dedicated surgeons. This process should be initiated by physicians and medical societies, based on the best available evidence, and supported and subsequently funded by the government and healthcare authorities. A systematic approach to organizing all aspects of trauma will result in health gain in terms of quality of care provided, higher survival rates, better functional outcomes and quality of life.

Evaluation of cardiovascular risk in patients with psoriatic disease in a multiracial population: a cross-sectional study.

Background: Psoriatic disease (PD) is a chronic inflammatory disorder often associated with cardiovascular risk (CVR) factors such as obesity, hypertension, diabetes, dyslipidaemia and smoking. It is estimated that 2%-4% of the population worldwide has PD. Cutaneous lesions of psoriasis (PsO) may be associated with psoriatic arthritis (PsA) in up to 40% of patients.

Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: A systematic review and meta-analysis.

Background: Opioid-based treatment is used to manage stress responses during surgery and postoperative pain. However, opioids have both acute and long-term side effects, calling for opioid-free anaesthetic strategies. This meta-analysis compares adverse events, postoperative recovery, discharge time from post-anaesthesia care unit, and postoperative pain, nausea, vomiting, and opioid consumption between strict opioid-free and opioid-based general anaesthesia.

Association of HLA Alleles and HLA Haplotypes with Psoriasis, Psoriatic Arthritis and Disease Severity in a Miscegenated Population.

Background: The study of HLA classes I and II in Brazilian psoriasis patients may contribute to a better understanding of their association with the disease.

Objective: To describe HLA classes I and II of Brazilian patients with psoriasis, with or without arthritis, compare them to controls and correlate HLA markers with epidemiological and evolutional aspects of psoriasis.

Methods: A total of 55 patients with more than 5 years of psoriasis, with or without arthritis, answered a questionnaire on ethnic background and disease severity.

Does ATLS Training Work? 10-Year Follow-Up of ATLS India Program.

Background: Studies evaluating the efficacy of ATLS in low- and middle-income countries are limited. We followed up ATLS providers certified by the ATLS India program over a decade (2009 to 2019), aiming to measure the benefits in knowledge, skills, attitude and their attrition over time.

Methods: The survey instrument was developed taking a cue from published literature on ATLS and improvised using the Delphi method.

Comparing continuous subcutaneous insulin infusion and multiple daily injections in children with Type 1 diabetes in Sweden from 2011 to 2016-A longitudinal study from the Swedish National Quality Register (SWEDIABKIDS).

Objective: This study aimed to compare metabolic control measured as hemoglobin A1c (HbA1c), the risk of severe hypoglycemia, and body composition measured as body mass index standard deviation scores (BMI-SDS) in a nationwide sample of children and adolescents with Type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), respectively.

Research Design And Methods: Longitudinal data from 2011 to 2016 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with both cross-sectional (6 years) and longitudinal (4 years) comparisons. Main end points were changes in HbA1c, BMI-SDS, and incidence of severe hypoglycemia.

Cerebral autoregulation in infants during sevoflurane anesthesia for craniofacial surgery.

Background: Data on cerebral pressure-flow autoregulation in the youngest children are scarce. We studied the correlation between mean arterial pressure and cerebral tissue oxygen saturation (rSO ) by near-infrared spectroscopy (NIRS) in patients undergoing nose, lip, and palate surgery.

Aim: We tested the hypothesis that cerebral pressure-flow autoregulation is impaired in children less than 1 year undergoing surgery and general anesthesia with sevoflurane under controlled mechanical ventilation.

Lepromatous Reaction Type II: Clinical and Laboratory Aspects.

In Type II lepromatous reaction, there is exacerbation of humoral immunity, classified as Gell & Coombs Type III hypersensitivity reaction. It is more common in lepromatous borderline (LB) and lepromatous lepromatous (LL) patients. Our objective was to study the clinical and laboratorial expressions of lepromatous Type II reactions, establishing concordances between them, and for this the medical records of leprosy patients observed at the Clementino Fraga Filho University Hospital of the Federal University of Rio de Janeiro (HUCFF/UFRJ) were reviewed.

Practical guide for identifying unmet clinical needs for biomarkers.

The development and evaluation of novel biomarkers and testing strategies requires a close examination of existing clinical pathways, including mapping of current pathways and identifying areas of unmet need. This approach enables early recognition of analytical and clinical performance criteria to guide evaluation studies, in a cyclical and iterative manner, all the time keeping the clinical pathway and patient health outcomes as the key drivers in the process. The Test Evaluation Working Group of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM TE-WG) https://www.