Articles: cations.
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Immigrants in the US face unique challenges in accessing healthcare. There have been several studies highlighting some of the barriers that this population faces; however, there is still a lack of robust research on this patient population in the context of surgical access and outcomes. ⋯ This makes it incredibly difficult to identify this population in the first place, resulting in a decreased ability to study this group retrospectively and, therefore, restricting the quantity and quality of research into these vulnerable patients. This article aims to provide a call to action for medical professionals to develop ways to accurately document immigration status in medical records while assuaging the concerns related to this documentation and its implications on patient care and confidentiality.
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Chronic pain is a pervasive and debilitating condition with increasing implications for public health, affecting millions of individuals worldwide. Despite its high prevalence, the underlying neural mechanisms and pathophysiology remain only partly understood. Since its introduction 35 years ago, brain diffusion magnetic resonance imaging (MRI) has emerged as a powerful tool to investigate changes in white matter microstructure and connectivity associated with chronic pain. ⋯ We conclude by highlighting emerging approaches and prospective avenues in the field that may provide new insights into the pathophysiology of chronic pain and potential new therapeutic targets. Because of the limited current body of research and unidentified targeted therapeutic strategies, we are forced to conclude that further research is required. However, we believe that brain diffusion MRI presents a promising opportunity for enhancing our understanding of chronic pain and improving clinical outcomes.
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Multicenter Study
Graduated Autonomy of Laparoscopic Liver Resection Based on Liver Resection Complexity: A Western and Eastern Bi-Institution Study for Learning Curve.
Laparoscopic liver resection (LLR) requires a high degree of expertise in both hepatobiliary and minimally invasive surgery. Our group previously reportwed a 3-level LLR complexity classification based on intrapostoperative outcomes: grade I (low), grade II (intermediate), and grade III (high). We evaluated the learning curve effect in each complexity grade to assess the experience needed for a surgeon to safely progress through the grades. ⋯ A gradual progression in LLR per complexity grade as follow: 40 cases of low grade I procedures before starting intermediate complexity grade II procedures, and 30 cases of intermediate complexity grade II procedures before starting high complexity grade III procedures may ensure a safe implementation of high complexity LLR procedures.
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Postextubation respiratory support treatment approaches, indications, and subgroups of patients with different responses to those therapies are rapidly changing. Planning optimal therapy in terms of choosing devices, timing of application and selecting settings with the goal of minimizing extubation failure is becoming a challenge. This review aims to analyze all the available evidence from a clinical point of view, trying to facilitate decision making at the bedside. ⋯ Planning postextubatin respiratory support must consider the risk for failing and the presence of some clinical conditions favoring noninvasive ventilation.Extubation can be safely accelerated by modifying screening criteria and spontaneous breathing trial settings, but there is room to increase the role of postextubation noninvasive respiratory support for this indication, always keeping in mind the dangers of delaying a needed intubation.
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Anesthesia and analgesia · Feb 2025
ReviewProposed Quality Metrics for Congenital Cardiac Anesthesia: A Scoping Review.
Congenital cardiac anesthesiologists practice in a unique environment with high risk for morbidity and mortality. Quality metrics can be used to focus clinical initiatives on evidence-based care and provide a target for local quality improvement measures. However, there has been no comprehensive review on appropriate quality metrics for congenital cardiac anesthesia to date. ⋯ Of these, 5 candidate metrics were unanimously proposed for local collection and national benchmarking efforts: use of a structured handover in the intensive care unit, use of an infection prevention bundle, use of blood conservation strategies, early extubation of cardiopulmonary bypass cases, and cardiac arrest under the care of a cardiac anesthesiologist. Many metrics were excluded due to a lack of primary data and perceived complexity beyond the scope of cardiac anesthesia practice. There is a need to develop more primary data including linking process measures with outcomes, developing risk-stratification for our patients, and collecting national data for benchmarking purposes.