Articles: outcome.
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Retrospective cohort study. ⋯ Receiving ketorolac within two days after ACDF does not appear to be associated with an increased risk of pseudoarthrosis through four years follow-up in adults. Furthermore, there appears to be no meaningful difference in risk of reoperation, severe bleeding, and oral opioid prescriptions, although secondary outcomes should be interpreted with caution. Further corroboration is warranted.
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The aim of this study was to evaluate pre-resection risk factors for neurodevelopmental impairment (NDI) in infants with necrotizing enterocolitis (NEC) that might better inform the timing of intestinal resection. ⋯ Risk for NDI in surgical NEC was associated with the number and trajectory of identification of indicators of metabolic derangement prior to resection. As these indicators progressively appear over hours to days, their assessment might offer an objective means of defining failure of medical management and lead to improvement in neurodevelopmental outcomes in NEC.
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Nocturnists are the principal means by which hospital medicine groups currently ensure continuous overnight coverage of hospitalized patients within academic medical centers and community hospitals. Yet despite their involvement in most aspects of overnight care, a comprehensive review of the impact of nocturnists in the hospital is absent. Here we examine the physiologic effects of overnight work on clinicians, the quality of medical care delivered by nocturnists in floor and intensive care units, the impact of nocturnist presence on trainee supervision and graduated autonomy in academic settings, and prevalent staffing models. ⋯ Compensation is typically greater for nocturnists, but the role's sustainability and impact on overall group retention remain unknown. Nocturnist programs are essential to provide continuous care of hospitalized patients and meet trainee supervision mandates, yet their full impact on patient and educational outcomes requires further investigation. Future research should aim to optimize staffing models to enhance patient care, trainee education, and clinician well-being.