Risultati per: Short Acting Opioid

Introduction
The rise of opioid-free anaesthesia (OFA) aims to reduce postoperative pain while reducing opioid-related side effects during surgery. However, the various adjuvant agents used in OFA complicate the evaluation of their effectiveness and risks. Recent reviews question the clinical benefits of OFA, highlighting the need for thorough evaluation. This protocol describes a network meta-analysis to compare the effectiveness of OFA with opioid-based anaesthesia and will identify key components for optimal postoperative outcomes.

Methods and analysis
We will perform a systematic search of literature published in English without time restriction in Embase, The Cochrane Library, MEDLINE (via PubMed) and CINAHL, along with Google Scholar for grey literature. The final search will be performed on 1 October 2024. We will include randomised controlled trials with adult patients undergoing surgery with general anaesthesia, excluding preclinical, observational, regional anaesthesia-only and prolonged anaesthesia outside the operating room studies. The primary outcome is postsurgical pain scores, with secondary outcomes including quality of recovery, opioid consumption, adverse effects and long-term events. We will assess bias using the Cochrane risk of bias 2 tool and conduct Bayesian network meta-analyses for pooled estimates. We will report effect estimates as ORs and standardised mean differences with 95% credible intervals and assess certainty using GRADE methodology.

Ethics and dissemination
Ethics approval is not required for this systematic review. Results will be published in a peer-reviewed journal and presented at national and international anaesthesia and pain management conferences.

PROSPERO registration number
CRD42024505853.

Introduction
Increased globalisation and technological advancements have led to the emergence of distributed teams in various sectors, including healthcare. However, our understanding of how leadership, communication and collaboration influence distributed healthcare teams remains limited.

Objectives
This study aimed to map knowledge on leadership, communication and collaboration in short-term distributed teams across various fields to gain insights that could benefit healthcare.

Design
Scoping review.

Data source
A database search of PubMed, CINAHL, Scopus and PsycINFO was conducted in May 2021 and updated in February 2023 and May 2024.

Eligibility criteria
Articles were eligible if they involved leadership, communication or collaboration in distributed short-term teams supported by synchronised audio-visual communication technology. Two researchers independently screened titles, abstracts and full texts for inclusion.

Data extraction and synthesis
Extracted data on leadership, communication and collaboration were synthesised narratively and reported in terms of patterns, advances, gaps, evidence for practice and research recommendations.

Results
Among 6591 articles, 55 met the eligibility criteria, spanning military, engineering, business, industrial and healthcare contexts. The research focus has shifted over time from adverse effects to solutions for overcoming challenges in distributed teams. Inclusive leadership is vital for engaging all team members. ‘Team opacity’, the absence of non-verbal cues and reduced awareness of team members’ actions, can occur in distributed teams relying on technology. Clear communication is crucial for avoiding misunderstandings and fostering collaboration and adaptability. Developing shared mental models and trust is more challenging, leading to uncertainty and reduced information sharing. There is a lack of studies examining how to apply this knowledge to health professionals’ education.

Conclusion
Our findings highlight the importance of implementing strategies in healthcare to enhance inclusive leadership and improve communication in distributed healthcare settings. More empirical research is needed to understand the intricacy of distributed healthcare settings and identify effective ways to train distributed healthcare teams.

Objectives
This study aimed to develop a model for the dissemination of information on emerging infectious diseases (EIDs) by identifying the specific features of mpox (monkeypox)-related short video content that encourages public sharing.

Design
This was an exploratory analysis of the dissemination of information on short video platform.

Main outcome measures
Focusing on Douyin (TikTok in mainland China), this study collected data from the top 500 most popular short videos using ‘monkeypox’ as the keyword from 1 May 2022 to 31 October 2022. Under the guidance of the health belief model, the videos were coded using two sets of conditional variables: information type variables and information content variables. The information type variables distinguish between fact-checking information and disinformation. Regarding information content variables, this study integrated the features of audiovisual media with the needs of the Chinese public, introducing efficacy information. The study then used fuzzy-set qualitative comparative analysis to analyse the correlation and consistency between the video contents and the level of public sharing, which was the outcome variable. Subsequently, a Poisson regression model was estimated to verify their significance on video-sharing volume.

Results
The results showed that there were three configurations of short video content related to mpox which could trigger a high level of sharing among the general public. It was found that the number of fact-checked cases in the most widely disseminated short videos of mpox was 21.8:1 compared with the number of disinformation cases. Therefore, it can be concluded that fact-checked information was more likely to spread than disinformation in the case of an outbreak of EIDs on China’s short video platforms. Based on the analysis of the three configurations, we also found that they separately formed three paths of the short video communication model, and each path had a more significant variable playing a central role. We named each pathway after the core variable: authoritative source path, personal efficacy path and disinformation path.

Conclusions
This study developed a model for information dissemination of EIDs and found that fact-checked content was more likely to spread on Chinese short video platforms instead of disinformation. It also explored public demand for guidance on EIDs precautions.

This cross-sectional study analyzes characteristics of prehospital encounters for youth opioid overdoses and trends before and during the COVID-19 pandemic.

A phase 3 clinical trial evaluating the safety and efficacy of a messenger RNA (mRNA) combination vaccine for COVID-19 and influenza had mixed results, the vaccine’s manufacturers announced. The vaccine was a collaboration between BioNTech and Pfizer and was tested among more than 8000 healthy adults aged 18 to 64 years.

We read with interest the recent study by Liu et al, which investigated associations between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and increased gastro-oesophageal reflux disease (GERD) in patients with type 2 diabetes.1 This large retrospective analysis of real-world data raises important clinical considerations, but also has limitations that warrant thoughtful interpretation. The extensive dataset of more than 127 million patients enables the detection of subtle signals, and propensity-score matching probably adapts well for measured confounders. Therefore, the main findings, increased risks of incident GERD and complications related to GERD with short-acting but not long-acting GLP-1 RAs, deserve attention. However, several factors should be considered before applying these conclusions widely. Most significantly, the differences between short-acting and long-acting GLP-1 users may not reflect only pharmacological properties.2 The lack of head-to-head comparisons leaves open alternative explanations, as clinical and demographic characteristics can vary substantially between these…

Objectives
We aimed to investigate the association between the albumin-corrected anion gap (ACAG) and the prognosis of cardiogenic shock (CS).

Design
A multicentre retrospective cohort study.

Setting
Data were collected from the Medical Information Mart for Intensive Care (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD) datasets.

Participants
808 and 700 individuals from the MIMIC-IV and eICU-CRD, respectively, who were diagnosed with CS.

Primary and secondary outcomes
The primary endpoint was short-term all-cause mortality, including intensive care unit (ICU), in-hospital and 28-day mortality. The secondary endpoints were the 28-day free from the ICU duration and the length of ICU stay.

Results
CS patients were divided into two groups according to the admission ACAG value: the normal ACAG group (≤20 mmol/L) and the high ACAG group ( > 20 mmol/L). CS patients with higher ACAG values exhibited increased short-term all-cause mortality rates, including ICU mortality (MIMIC-IV cohort: adjusted HR: 1.43, 95% CI=1.05–1.93, p=0.022; eICU-CRD cohort: adjusted HR: 1.38, 95% CI=1.02–1.86, p=0.036), in-hospital mortality (MIMIC-IV cohort: adjusted HR: 1.31, 95% CI=1.01–1.71, p=0.03; eICU-CRD cohort: adjusted HR: 1.47, 95% CI=1.12–1.94, p=0.006) and 28-day mortality (adjusted HR: 1.42, 95% CI: 1.11 to 1.83, p=0.007). A positive linear correlation was observed between the ACAG value and short-term mortality rates via restricted cubic splines. Compared with the AG, the ACAG presented a larger area under the curve for short-term mortality prediction. In addition, the duration of intensive care was longer, whereas the 28-day free from the ICU duration was shorter in patients with a higher ACAG value in both cohorts.

Conclusion
The ACAG value was independently and strongly associated with the prognosis of patients with CS, indicating that the ACAG value is superior to the conventional AG value.

This Clinical Insights describes the process for initiating buprenorphine treatment for patients with opioid use disorder.

These findings suggest that caesarean delivery of singletons is associated with a higher risk of cardiovascular morbidity in patients without pre-existing CVD. This risk was highest in the first month but remained elevated for one year after delivery. These findings add to the accumulating evidence that undergoing caesarean delivery may have long-standing health implications and support the extension of the post-partum surveillance period. Limitations of this study include the lack of adjustment for body mass index, race, and parity.

Circulation, Ahead of Print. BACKGROUND:Short-coupled ventricular fibrillation (SCVF) is increasingly being recognized as a distinct primary electrical disorder and cause of otherwise unexplained cardiac arrest. However, the pathophysiology of SCVF remains largely elusive. Despite extensive genetic screening, there is no convincing evidence of a robust monogenic disease gene, thus raising the speculations for alternative pathogeneses. The role of autoimmune mechanisms in SCVF has not been investigated so far. The objective of this study was to screen for circulating autoantibodies in patients with SCVF and assess their role in arrhythmogenesis.METHODS:This is a prospective, single-center, case-control study enrolling cardiac arrest survivors diagnosed with SCVF or idiopathic ventricular fibrillation (IVF) between 2019 and 2023 at the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval Inherited Arrhythmia Clinic in Canada. Plasma samples were screened for autoantibodies targeting cardiac ion channels using peptide microarray technology. Identified target autoantibodies were then purified from pooled plasma samples for subsequent cellular electrophysiological studies.RESULTS:Fourteen patients with SCVF (n=4 [29%] female patients; median age, 45 years [36, 58]; n=14 [100%] non-Hispanic White) and 19 patients with idiopathic ventricular fibrillation (n=8 [42%] female patients; median age, 49 years [38, 57]; n=19 [100%] non-Hispanic White) were enrolled in the study and compared with 38 (n=20 [53%] female subjects; median age, 45 years [29, 66]; n=36 [95%] non-Hispanic White) sex-, age- and ethnicity-matched healthy controls. During the study period, 11 (79%) SCVF probands experienced ventricular fibrillation recurrence after a median of 4.3 months (interquartile range, 0.3–20.7). Autoantibodies targeting cardiac TREK-1 (TWIK [tandem of pore-domains in a weakly inward rectifying potassium channel]–related potassium channel 1 were identified in 7 (50%) patients with SCVF (P=0.049). Patch clamp experiments demonstrated channel-activating properties of anti–TREK-1 autoantibodies that are antagonized by quinidine in both HEK293 cells and human induced pluripotent stem cell–derived cardiomyocytes.CONCLUSIONS:Patients with SCVF harbor circulating autoantibodies against the cardiac TREK-1 channel. Anti–TREK-1 autoantibodies not only present the first reported biomarker for SCVF, but our functional studies also suggest a direct implication in the arrhythmogenesis of SCVF.

Adding radiation to NACT increased the R0 resection rate, prolonged the PFS, and potentially improved OS in selected patients with initially unresectable LACC. The trial findings indicate that this approach is safe, feasible, and may confer a survival benefit.

This Viewpoint examines a recent report that used data from the 2022 National Survey on Drug Use and Health to estimate the opioid cascade of care, a framework to characterize the adult US populations who needed and received opioid use disorder (OUD) treatment, as well as discusses ways in which clinicians can close gaps in care.

This randomized clinical trial examines the effectiveness of interprofessional hospital addiction consultation services in increasing medication for opioid use disorder treatment initiation and engagement.

Increasingly, health systems are recognizing hospitals as a critical touchpoint in the opioid use disorder (OUD) care continuum. Rapidly emerging evidence from observational studies show that interprofessional hospital-based addiction consultation services (ACS) can mitigate stigma toward people who use drugs, increase patients’ trust in hospital clinicians, increase in-hospital use of methadone and buprenorphine, reduce patient-directed discharges, educate a hospital workforce, transform health systems, and reduce mortality after hospital discharge. Hospitalized people with OUD experience disproportionately high morbidity and mortality. Methadone and buprenorphine are lifesaving and the most effective treatment for OUD, yet most hospitalized patients who need them do not access them.

To the Editor We read with great interest the article by Kang et al regarding opioid use and acute health care utilization in the population with sickle cell disease (SCD) in the US after the release of the 2016 Centers of Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain. The authors state that reduction in home opioid prescriptions in response to CDC guideline was associated with an increase in hospitalizations for individuals with SCD. This important conclusion may have a lasting impact on opioid prescribing practices for individuals with SCD. Prolonged prescribing of opioids may lead to opioid-induced hyperalgesia, chronic pain, reduced quality of life, and higher health care utilization. Therefore, it is important that the data be rigorously analyzed.

This Viewpoint explores the current barriers to implementing contingency management treatment for individuals experiencing both opioid use and stimulant use disorders in the context of high numbers of US overdoses.