Articles: amines.
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J Neurosurg Anesthesiol · Jan 2025
Epidemiology of Post-craniotomy Hypertension and Its Association With Adverse Outcome(s): A Systematic Review and Meta-analysis.
After intracranial surgery, sympathetic overdrive and increased blood catecholamine levels can contribute to postoperative hypertension, a significant clinical problem. The objective of this review was to summarize, quantify, and assess the epidemiological perspective of post-craniotomy hypertension and its association with adverse outcomes. This PROSPERO-registered systematic review was conducted following PRISMA guidelines. ⋯ There were insufficient data to investigate the quantitative association of post-craniotomy hypertension with 30-day adverse events. In summary, 1 out of 3 patients exhibited hypertension post-craniotomy, and this was associated with a significantly higher risk of having intracranial hemorrhage within 72 hours post-procedure. A generally accepted and clinically relevant criteria for post-craniotomy hypertension should be defined.
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Critical care medicine · Jan 2025
Significant Disparities in Adolescents With Severe Traumatic Brain Injury Across Trauma Center Types: Wide Variation of Tracheostomy and Gastrostomy.
To explore practice variations in the rate and timing of tracheostomy and gastrostomy for adolescent with severe traumatic brain injury (TBI) across trauma center types. ⋯ Our results offer insights into the existing current practice variations between ATC, MTC, and PTC in tracheostomy and gastrostomy placement for adolescent with severe TBI. Further research is warranted to examine the impact of these observed disparities on short- and long-term outcomes and to standardize the care process for adolescent patients.
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Neuroprognostication after acute brain injury (ABI) is complex. In this review, we examine the threats to accurate neuroprognostication, discuss strategies to mitigate the self-fulfilling prophecy, and how to approach the indeterminate prognosis. ⋯ The approach to neuroprognostication after ABI should be systematic, use highly reliable multimodal data, and involve experts to minimize the risk of erroneous prediction and perpetuating the self-fulfilling prophecy. Even when such standards are rigorously upheld, the prognosis may be indeterminate. In such cases, clinicians should engage in shared decision-making with surrogates and consider the use of a time-limited trial.
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Chronic pain (CP) significantly impacts emotional and physical well-being and overall quality of life across diverse populations in the United States (U.S.). Notably, underrepresented minoritized (URM) groups, such as Hispanic/Latinx youth, may experience disproportionate effects due to health disparities and lack of access to quality healthcare. However, this remains understudied. This study aims to examine the association between CP and its related psychosocial factors- depressive and anxiety symptoms, and pain catastrophizing- in Hispanic/Latinx youth, as compared to Non-Hispanic White (NHW) youth. ⋯ Our results suggested that for NHW youth with CP, greater tendencies toward catastrophizing and experiences of anxiety may more strongly contribute to depressive symptoms, when compared to their Hispanic/Latinx youth counterparts. Further investigation of pain-coping mechanisms among Hispanic/Latinx youth and other youth from historically marginalized populations (e.g., racial/ethnic minoritized groups) will help advance clinical understanding of sociocultural variability in links between pain-related psychosocial outcomes in the CP experience.
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Historically in medicine and beyond, the understanding of and treatment of pain is based on finding tissue injury. The fact that for chronic pain, there often is no (longer) any traceable tissue injury, in combination with the fact that pain essentially is a private experience, poses a challenge for clinical communication. This paper therefore examines how pain is linguistically and interactionally constructed as invisible. ⋯ The discussion explores how on these three levels, notions of the abnormal or deviant body come into play, in which patients and health professionals complexly construct pain both as not normal (i.e. not a neutral or desirable state of being), while, at the same time, the lack of traceable tissue injury is constructed as medically normal for chronic pain. This also shows how patients and healthcare providers often orient to the stigma around chronic pain.