International journal of clinical and experimental medicine
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The purpose of this systematic review was to evaluate the predictive validity of the Identification of Seniors at Risk (ISAR) Tool in identifying elderly patients at risk of adverse outcomes after a visit to the emergency department (ED). Since older adults are frequently sent to the ED, screening for risk of adverse outcomes in elderly patients is increasingly important in the ED. Also it is a way to ensure that interventions based on a comprehensive geriatric assessment (CGA) are provided to patients identified at risk to reduce the risk of adverse outcomes. ⋯ With a cutoff score at least 2, the ISAR was proved to have poor validity related to revisiting the ED (AUC: 0.59-0.60) and hospital readmission (AUC: 0.59-0.60). The predictive validity of the ISAR related to mortality and composite outcomes was graded as poor to fair. It is not suitable to use the ISAR alone for identifying seniors at risk for adverse outcomes in the ED.
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Review
Local anaesthetic wound infiltration used for caesarean section pain relief: a meta-analysis.
Local anaesthetic wound infiltration techniques were reported to reduce opiate requirements and pain scores in women undergoing caesarean section (CS). However, the results were conflicting. The primary aim of this meta-analysis was to assess whether local analgesia could reduce pain intensity when injected via wound catheters. ⋯ Local anaesthetic wound infiltration can reduce morphine requirements and the rate of patients suffer nausea but not pain scores after caesarean section. Further procedure-specific RCTs were encouraged to confirm the efficacy of local anaesthetic wound infiltration techniques.
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Postoperative nausea and vomiting (PONV) is a common complication after gynecological surgeries. This meta-analysis was conducted to evaluate the efficacy of dexmedetomidine on PONV after gynecological surgeries. ⋯ The current meta-analysis exhibits that dexmedetomidine is superiority to placebo in attenuating the incidence of PONV, postoperative shivering, pruritus, as well as the pain scores in patients undergoing gynecological surgeries. Still, the potential cardiovascular complications should be taken seriously.
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Atrial fibrillation (AF) is a quite common complication during the postoperative period after cardiac surgery. Increasing studies have reported that landiolol may be effective in prevention of AF after cardiac surgery. Its efficacy and safety are seldom explored; hence we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of landiolol in prevention of AF after cardiac surgery. ⋯ Compared with the control group, landiolol was associated with a significant reduction of AF after cardiac surgery (RR=0.41; 95% CI 0.32-0.52; P<0.001), and the administration of landiolol seems more effective in patients who underwent coronary artery bypass grafting (CABG) (RR=0.36; 95% CI 0.25-0.52; P<0.001). Compared with placebo, no difference was detected in the incidence of major complications (RR=0.77; 95% CI 0.34-1.72; P=0.52). Landiolol is effective in prevention of AF after cardiac surgery and without increasing the risk of major complications.
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Dexmedetomidine, as a sole or combinable sedative, has served in pediatric sedation undergoing MRI. However, clinical effects of dexmedetomidine are still controversial. This meta-analysis was to assess the effects between dexmedetomidine and propofol in children undergoing MRI, especially outcomes and adverse events of patients. ⋯ There were statistically significant increased in the pediatric anesthesia emergence Delirium scores of 5-min after awakening (WMD: 2.40; 95% CI: 1.00 to 3.81; P = 0.0008) and 10-min after awakening (WMD: 3.06; 95% CI: 1.81 to 4.31; P < 0.00001) in patients who were treated with dexmedetomidine than propofol. Improved the prognosis of patients, nonetheless, dexmedetomidine must have an indispensable role to undergoing pediatric MRI scanning. Compared with propofol, however, dexmedetomidine did not induce the duration of sedation and might lead to a longer recovery time.