Articles: cations.
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Processed electroencephalography (EEG) is used to monitor the level of anesthesia, and it has shown the potential to predict the occurrence of delirium. While emergence trajectories of relative EEG band power identified post hoc show promising results in predicting a risk for a delirium, they are not easily transferable into an online predictive application. This article describes a low-resource and easily applicable method to differentiate between patients at high risk and low risk for delirium, with patients at low risk expected to show decreasing EEG power during emergence. ⋯ This study developed an easily applicable exploratory method to analyze a single frontal EEG channel and to identify patterns specific for patients at low risk for delirium.
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Aims: Pain is a significant problem for those with a cancer diagnosis. Oncology providers often use opioid therapy to manage cancer-related pain. Accessing opioid therapy has grown increasingly difficult because of the opioid epidemic. The American Society of Clinical Oncology (ASCO) released guidelines to optimize pain management for patients with oncologic diagnoses. The goal of this quality improvement project was to create an educational session and evaluate self-efficacy in providers who manage chronic cancer pain. ⋯ Based on the study's results, the guidelines released by ASCO should be reviewed and used to optimize pain management and self-efficacy in providers who work with oncologic patients. Furthermore, future research is recommended to evaluate the effect of evidence-based guidelines on patient outcomes and morbidity.
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Curr Opin Anaesthesiol · Dec 2023
Office-based anesthesia: a contemporary update on outcomes, incentives, and controversies.
The volume of office-based surgery (OBS) has surged over the last 25-30 years, however patients with increasing comorbidities are being considered for procedures in office locations. This review focuses on office-based surgery outcomes, financial incentives driving this change, and controversies. ⋯ The reported safety supports the proper selection of patients for the proper procedure in the right location. Anesthesiologists need to develop and implement safe and efficient systems to optimize patient outcomes in outpatient office settings. Further research and uniform standardized outcomes tracking are needed in the emerging specialties performing office-based surgery.
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Fibromyalgia has been characterized by augmented cross-network functional communication between the brain's sensorimotor, default mode, and attentional (salience/ventral and dorsal) networks. However, the underlying mechanisms of these aberrant communication patterns are unknown. In this study, we sought to understand large-scale topographic patterns at instantaneous timepoints, known as co-activation patterns (CAPs). ⋯ Using proton magnetic resonance spectroscopy, we found that greater basal excitatory over inhibitory neurotransmitter levels within the anterior insula orchestrated higher cross-network connectivity between the anterior insula and the default mode network through lower occurrence of a CAP encompassing the attentional networks during sustained pain. Moreover, we found that hyperalgesia in fibromyalgia was mediated through increased occurrence of a CAP encompassing the sensorimotor network during sustained pain. In conclusion, this study elucidates the role of momentary large-scale topographic brain patterns in shaping noxious information in patients with fibromyalgia, while laying the groundwork for using precise spatiotemporal dynamics of the brain for the potential development of therapeutics.
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Critical care medicine · Dec 2023
Practice Standards for the Use of Multimodality Neuromonitoring: A Delphi Consensus Process.
To address areas in which there is no consensus for the technologies, effort, and training necessary to integrate and interpret information from multimodality neuromonitoring (MNM). ⋯ We provide expert consensus in the clinical considerations, minimum necessary technologies, implementation, and training/education to provide practice standards for the use of MNM to individualize clinical care.