Search Results for: Short Acting Opioid

Apixaban demonstrates slightly superior efficacy and safety over rivaroxaban and warfarin.

Stroke, Volume 56, Issue 6, Page 1650-1654, June 1, 2025. Evidence-based rehabilitation and secondary prevention interventions improve poststroke functional recovery and reduce secondary complications. However, stroke rehabilitation expertise, processes of care, and educational resources vary among sites where postacute care (PAC) is delivered. The American Heart Association developed quality standards based on the American Heart Association 2016 Guidelines for Adult Stroke Rehabilitation and Recovery to address these gaps. An interdisciplinary PAC standards writing committee identified key areas for PAC: quality improvement, medical management, care coordination, patient/caregiver and personnel education, and program management. Subgroups developed draft standards, combining results from a national landscape survey of PAC sites with clinical practice guidelines. The committee then refined the draft standards using a consensus-based process. American Heart Association staff and PAC sites in Montana convened a learning collaborative to gather feedback and provide gap analyses of the standards relative to current practices. Qualitative input from beta testing in Montana and quantitative results from the nationwide survey and Montana sites were analyzed and used to refine the standards further. The national landscape survey demonstrated that most sites do not meet the proposed standards: stroke program oversight structure (78% fall short), stroke rehabilitation leadership (70%), stroke-specific order sets/protocols (61%), and policies requiring staff stroke education (66%). Regarding Montana findings, 41% of the PAC sites have no mechanisms to identify areas of quality improvement specific to their stroke rehabilitation programs, and 59% do not use standardized tools to ensure that performance improvement initiatives are followed. However, with adequate support and resources, most Montana sites stated that they would be able to meet the proposed standards. We conclude that the Stroke PAC Quality Standards are applicable in PAC settings and provide a pathway to improving access to high-quality care for stroke survivors. Outcome studies are needed to confirm anticipated improvements in medical and functional outcomes.

Objectives
The effect of esketamine on perioperative neurocognitive dysfunction (PND) remains controversial. This systematic review and meta-analysis aimed to evaluate the impact of perioperative esketamine administration on PND.

Design
Systematic review and meta-analysis.

Data sources
PubMed, EMBASE, Web of Science and Cochrane Library were searched from their inception to 25 April 2024.

Eligibility criteria for selecting studies
We included the randomised controlled trials (RCTs) that compared single or continuous intravenous infusion of esketamine to saline among adult surgical patients without pre-existing neurocognitive disorders.

Data extraction and synthesis
Two reviewers independently extracted pertinent information from the included studies. Risk of bias was assessed using Cochrane’s risk of bias criteria. Risk ratios (RRs) and their corresponding 95% CIs were synthesised using a random-effects model. The overall evidence quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework.

Results
10 RCTs were included in our meta-analysis, involving 854 surgical patients. Perioperative esketamine was associated with a reduced risk of postoperative delirium (POD) (relative risk (RR): 0.46, 95% CI: 0.30 to 0.71, p

Introduction
Postoperative pain management is a major concern for patients undergoing distal radius open reduction internal fixation (ORIF). Inadequate pain control negatively impacts patient’s satisfaction and may increase opioid use. Topical tranexamic acid (TXA) has been demonstrated as an effective intervention that reduced acute postoperative pain in total knee arthroplasty. There is no study evaluating the effects of TXA on acute postoperative pain for distal radius ORIF. This study aims to evaluate the effect of topical TXA administration during isolated distal radius ORIF on early postoperative pain.

Methods and analysis
The effect of topical TRanexamic Acid versus placebo on acute postoperative pain following Distal Radius fracture fixation (TRADR) study is a randomised controlled double-blinded trial that will enrol 90 patients, 18 years of age or older, undergoing volar open reduction internal fixation. Patients will be randomly assigned to topical TXA versus topical saline (placebo) in a 1:1 ratio. The surgeon at the time of surgical closure after standard distal radius fixation will apply either 1 g of topical TXA (100 mg/mL; treatment group) or 10 mL of saline (control group) to the wound and let it sit for 5 min. Surgeons, patients, and outcome assessors will be blinded to the treatment group. The primary outcome is acute postsurgical pain as measured by the visual analogue scale (VAS). Pain outcomes will be between postoperative days 0 to 7, and at 2 and 6 weeks postsurgery. The secondary outcomes include opioid usage, unscheduled emergency visits, wrist swelling and adverse events.

Ethics and dissemination
This study was approved by the University Health Network Research Ethics Board (REB 23–5708). The results of this trial will be disseminated through peer-reviewed journals and presented at related conferences. The principal investigator will communicate the results with patients who have indicated an interest in knowing the results.

Trial registration number
Clinicaltrials.gov NCT06384456, April 26, 2024; Pre-enrolment.

Protocol version
Version 2.0: August 26, 2024.

This multicenter study uses reinforcement learning to examine the treatment implications of a vasopressin initiation rule developed to improve short-term and hospital outcomes in critically ill adults with septic shock receiving norepinephrine.

Objective
To explore the perceived acceptability, barriers and enablers in implementing mobile phone messaging-based message-framing interventions to improve maternal and newborn care in Jimma Zone, Ethiopia.

Design
A qualitative study employing thematic analysis of data collected through in-depth interviews (IDIs) and key informant interviews (KIIs).

Setting
The study was conducted in Dedo, Shabe Sombo and Manna districts of Jimma Zone.

Participants
We conducted 12 IDIs and 14 KIIs with pregnant women, male partners, health extension workers, healthcare providers and Ethio-Telecom experts across the three districts. Thematic analysis was used to identify patterns and themes in the data.

Intervention
Mobile phone messaging-based interventions using gain-framed and loss-framed messages were explored for their potential to promote maternal and newborn health practices.

Key areas of exploration
The study explored participants’ awareness, perceived relevance, acceptability, and barriers and enablers, as well as participants’ engagement with mobile health messaging interventions.

Results
Participants were generally aware of the potential benefits of mobile phone messaging for maternal and newborn health. Mobile phone-based messaging was perceived as highly relevant and useful by most participants. However, many had limited prior experience using mobile messaging for health information. Despite this, participants expressed a strong willingness and readiness to receive and actively engage with the maternal and newborn mobile messaging intervention. The study also identified various barriers and enablers affecting the implementation of message-framing interventions through mobile phone messaging.

Conclusions
Participants in this study generally recognised and accepted the benefits of mobile phone messaging for improving maternal and newborn health. Although rural women faced challenges in reading and understanding short messages, they demonstrated a strong willingness to engage with mobile health messaging interventions. The identified barriers were categorised as technological, social, cultural, behavioural and contextual. To maximise the impact of mobile health messaging and ensure broad and effective reach, it is crucial to address these barriers while leveraging existing enablers.

Trial registration number
This study was conducted as part of a larger cluster randomised controlled trial at Clinical trials PACTR202201753436676, 4 January 2022.

Objectives
Receiving a false positive in colorectal cancer screening is associated with psychosocial consequences, yet the reasons why some people are more affected than others remain unclear. This study examines the association between sociodemographic factors and psychosocial consequences among screening participants with false positives in colorectal cancer screening.

Design
Prospective cohort study.

Participants
1432 screening participants with positive faecal immunochemical test (FIT) screening with a follow-up colonoscopy with either no abnormalities or benign polyps (low or medium-high risk).

Outcome measures
We measured psychosocial consequences with the Consequences Of Screening – ColoRectal Cancer (COS-CRC) questionnaire, after the positive FIT but before the follow-up colonoscopy and again 1 year later. Sociodemographic factors were obtained from national registers and included sex, age, urbanicity, educational level, occupational status, income, assets, cohabitation status and Charlson Comorbidity Index. Psychosocial consequences were measured before colonoscopy (baseline) and 1 year after, and sociodemographic factors were assessed at baseline.

Results
We tested 19x2x3=114 associations between the sociodemographic factors and psychosocial consequences within the three groups of false positives and five associations were significant. We found that for participants with medium- and high-risk polyps, experiencing short-term psychosocial consequences was significantly associated with having a university degree compared with secondary school (OR=5.04 (1.38; 18.37), p=0.0142) and being unemployed compared with being employed (OR=5.61 (1.42; 22.14), p=0.0139). For participants with low-risk polyps, long-term consequences were significantly associated with the mid-income quartile (OR=2.32 (1.13; 4.76), p=0.0224) and the highest income quartile (OR=5.47 (1.13; 26.48), p=0.0349) compared with the lowest quartile. For participants with no abnormalities, there was an association between short-term psychosocial consequences and having comorbidities compared with none (OR=2.95 (1.13; 7.71), p=0.0277).

Conclusion
This study found few significant associations between psychosocial consequences and sociodemographic factors and with no apparent pattern in these. This suggests no strong evidence that specific sociodemographic groups should be especially vulnerable to experiencing psychosocial consequences after a false-positive result from colorectal cancer screening. Thus, there is currently weak evidence for identifying screening participants at higher risk for psychosocial consequences and developing targeted interventions to reduce psychosocial consequences.

Objectives
To explore interprofessional team members’ experiences of teamwork at an intensive care unit.

Design
Qualitative content analysis of focus group interviews with members from the intensive care teams.

Setting
University hospital in Sweden.

Participants
In total, 31 participants were interviewed. Enrolled nurses (n=7), critical care registered nurses (n=16), and intensive care physicians (n=8) employed at an intensive care unit were divided into nine focus groups organised according to the profession.

Results
The overall theme, Balancing behaviour and knowledge in teamwork, emerged from the two categories of creating a safe atmosphere when working in an unknown environment and counteracting and mitigating destructive team dynamics. The theme captures how well-functioning teamwork must take into account members not acting as team players while also building a secure environment when working in new surroundings outside the intensive care unit. The categories describe how mutual respect, effective teamwork and a safe atmosphere were fostered through support without taking over tasks and countering power structures.

Conclusions
Navigating teamwork during critical situations is inherently complex, making it essential to understand team interactions and factors influencing individual behaviour. To ensure patient safety, the interprofessional team must recognise, understand and manage diverse behaviours and knowledge in dynamic settings. This research contributes to existing knowledge on teamwork in the intensive care context by providing insights into how knowledge and behaviour in teamwork can be optimised to enhance patient safety.

Objectives
To investigate levels of recreational physical activity, screen time, sleep quality and mood in undergraduate medicine and nursing students.

Design
Observational, cross-sectional study using an online survey administered during the academic term in 2024.

Setting
International Health Professions University in Bahrain.

Participants
279 undergraduate students from the school of medicine and school of nursing.

Primary and secondary outcome measures
Physical activity levels (International Physical Activity Questionnaire-Short Form), recreational screen time (Sedentary Behaviour Questionnaire), sleep quality (Pittsburgh Sleep Quality Index) and mood (Brief Mood Introspection Scale) were measured and compared across groups, and associations between measures were assessed.

Results
Participants reported high rates of not meeting physical activity recommendations (46.6%), high levels of recreational screen time (median=32 hours per week) and poor-quality sleep (63.1%). Males reported higher levels of physical activity, screen time and sleep quality. Higher sleep quality was observed for the school of medicine, the preclinical stage of study and participants living alone. Overweight and obese participants had significantly higher recreational screen time and more unpleasant and tired moods. Higher levels of screen time and lower sleep quality were associated with tired, unpleasant and negative moods, while not meeting physical activity recommendations was associated with poor sleep in addition to unpleasant, tired and negative moods.

Conclusions
Physical activity levels are positively associated with mood and sleep quality in young adult healthcare students. Recreational screen time is negatively associated with mood but has no relationship with sleep quality. Intervention programmes to increase physical activity are warranted for young adults in healthcare training.

Data availability statement
Study data is available on reasonable request from the corresponding author.

Introduction
Delirium is a common complication in elderly patients after major surgeries and can lead to poor outcomes such as neurocognitive decline. Acetaminophen is one of the most widely used adjuvants for perioperative multimodal analgesia. Previous studies showed that it can effectively alleviate postoperative pain, promote opioid sparing and exert anti-neuroinflammatory response, showing strong potential for preventing postoperative delirium. We, thus, propose to test the primary hypothesis that postoperative intravenous acetaminophen would reduce delirium over 5 postoperative days in older patients following major non-cardiac surgery.

Methods and analysis
We propose a multicentre, randomised, placebo-controlled, parallel-group trial in patients aged >65 years old scheduled for non-cardiac major surgery with general anaesthesia expected to last at least 2 hours. A total of 1930 elderly patients will be enrolled and randomised at 1:1 ratio to acetaminophen or saline placebo groups, stratified by age, education level and trial site with randomsised blocking. Acetaminophen or saline will be given when the surgical suture begins at the end of surgery and, thereafter, a total of seven doses within 48 hours after surgery. Our primary outcome will be the incidence of delirium, assessed two times per day, through the fifth postoperative day. Secondary and exploratory outcomes will include pain scores with movement, total opioid consumption, severity of delirium, intensive care unit and hospital lengths of stay.

Ethics and dissemination
This study has been approved by the Ethics Committee of Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine (LY2023-239-C) and approved by each participating centre. This report follows the Consolidated Standards of Reporting Trials reporting guideline for randomised studies. The findings will be shared in academic meetings and peer-reviewed academic journals.

Trial registration number
NCT06653465.

Introduction
Opioids play a pivotal role in being capable of effectively blocking the pain and stress responses triggered by procedures such as surgery and intubation. However, it should not be overlooked that opioids have numerous side effects, such as respiratory depression, postoperative nausea and vomiting. These effects can raise intracranial pressure, posing a life-threatening risk in neurosurgical patients. Opioid-free anaesthesia can prevent or significantly reduce opioid usage. The aim of this study is to investigate the effect of opioid-free anaesthesia on the quality of recovery in patients undergoing supratentorial tumour resection in neurosurgery.

Methods and analysis
This is a single-centre, randomised controlled clinical trial. A total of 170 patients receiving general anaesthesia will be randomised in a 1:1 ratio into two groups, one receiving opioid-free anaesthesia and the other receiving opioid-based anaesthesia. The primary outcome measure is the Quality of Recovery-15 Score on the second day after surgery. The secondary outcomes include the Quality of Recovery Score on the fifth day, the incidence of nausea and vomiting within 48 hours, the NRS Pain Score on the second and fifth days, the sleep quality on the second and fifth days after surgery, and the incidence of chronic pain at 3 months and 6 months after surgery.

Ethics and dissemination
This study received official approval from the Ethics Committee of Beijing Tiantan Hospital, Capital Medical University, on 9 September 2024 (KY2024-219-02). The findings of this study are intended to be disseminated through publications in international peer-reviewed journals, presentations at national and international academic conferences, and broad distribution via online platforms.

Trial registration number
ClincalTrials.gov, NCT06607029 (15 September 2024)

Objectives
The influence of short-term variations in blood pressure (BP) in acute stroke on clinical outcomes remains uncertain. Our study explores the relationship between BP variability (BPV) from stroke admission up to 72 hours and in-hospital and 1-year mortality.

Design
Retrospective observational cohort study.

Setting
Hamad General Hospital (HGH) a tertiary care stroke centre in Qatar.

Participants
2820 participants were initially included. After the exclusion of ineligible subjects, 2554 patients (82.5% male, median age 53±9 years) were included. 893 (34.96%) were from the Middle East and North Africa, 1302 (50.98%) were from South Asia, 258 (10.10%) from Southeast Asia, 9 (0.35%) were from East Asia and 92 (3.60%) were from other regions. Eligible participants were adult patients above 18 years of age who presented with acute ischaemic or haemorrhagic stroke. Excluded individuals were those younger than 18 years, had incomplete data, had transient ischaemic attack (TIA), had severe hypoglycaemia on admission (

Objectives
Identifying the underlying cause of acute coma is crucial for improving outcomes in this time-sensitive medical emergency. This study aimed to explore the clinical characteristics, incidence, causes and outcomes of acute coma.

Design
A nationwide population-based retrospective cohort study.

Participants
Among 99 217 322 emergency department (ED) visits between 2000 and 2017, 419 480 acute coma events were identified. After excluding visits with only acute coma diagnosis codes lacking detailed information, individuals without socio-demographic data or those with prior nursing home residence or disability, a total of 205 747 first-ever acute coma cases constituted the final research cohort.

Primary and secondary outcome measures
The primary outcomes included the acute coma event rate, incidence rates stratified by age and underlying causes categorised into 23 clinical groups by the Agency for Healthcare Research and Quality Clinical Classification Software (CCS). Secondary outcomes assessed were reversible coma, hospitalisation rates, 30-day mortality, 1-year medical utilisation and long-term functional outcomes. Cox regression models identified factors influencing long-term mortality.

Results
The overall event rate for acute coma was 4.23 per 1000 ED visits, and the incidence rate was 0.93 per 1000 person-years. The median age of cases was 58.27 years (SD 23.04), with a male predominance (58.90%). Infection and central nervous system (CNS)-related causes were most prevalent. Of these cases, 45.49% experienced reversible coma, 41.66% required hospitalisation and the 30-day mortality group accounted for 12.85%. CNS and drug-related causes contributed to increased 30-day mortality, while psychiatric, alcohol, women’s health and perinatal care, and seizure are causes linked to reversible coma. Patients frequently required intensive care (26.54%), life-sustaining treatments (41.09%) or experienced disability (6.57%) within one year. Generalised estimating equations revealed significantly lower odds of reversible coma for CNS (adjusted OR (aOR), 0.68; 95% CI: 0.62 to 0.74; p

Objectives
To investigate the outcomes of patients with ST-elevation myocardial infarction (STEMI) who were treated with coronary artery bypass grafting (CABG) surgery.

Design
Retrospective nationwide cohort study.

Setting
Patients with STEMI in Finland who were treated with CABG between January 2004 and December 2018.

Participants
1069 patients (mean age: 66.4, 21.4% women).

Primary outcome measure
All-cause mortality (median follow-up 6.4 years) and usage of evidence-based secondary preventive medication early after CABG.

Results
In-hospital mortality among the total cohort was 10.0%, with a significant decrease (p90% of patients and ACE inhibitors/angiotensin II receptor blockers by 70% of patients after discharge from the hospital. The proportion of high-dose statin users increased from 33.1% in 2004–2008 to 63.1% in 2014–2018. ADP inhibitors were used by 29.0% of patients, but the proportion increased during the study.

Conclusions
Contemporary in-hospital and long-term outcomes of CABG-treated patients with STEMI are acceptable. In-hospital mortality has decreased, and the usage of secondary prevention medications after CABG procedures has increased in recent years.

Stroke, Ahead of Print. BACKGROUND:Poststroke cognitive impairment is associated with disability and decreased quality of life. We assessed whether individual or collective magnetic resonance imaging (MRI) biomarkers can aid in predicting cognitive impairment after lacunar infarction (LACI).METHODS:We conducted a retrospective analysis of data from the American Stroke Association Bugher Small Vessel Study, which included 134 patients within 2 years of an acute LACI, enrolled between 2007 and 2012 at 4 North Carolina hospitals. MRI brain measures at the time of the stroke included as follows: 1, total number of LACIs (index LACI and nonindex radiographic lacunes); 2, size of the largest lacune; 3, ventricular size; 4, cerebral atrophy; 5, radiographic locations (supratentorial, infratentorial, or both); and 6, white matter disease (WMD) extent. WMD extent, cerebral atrophy, and ventricular size were graded using the CHS (Cardiovascular Health Study) scores. The primary outcomes were as follows: 1, total score on Short-Form Montreal Cognitive Assessment to assess global cognition; and 2, time to complete TRAIL Making Test Part B (TMT-B) to evaluate executive function. Regression analyses were used to assess the association between the 6 MRI measures and cognitive function adjusting for demographic and clinical variables.RESULTS:One hundred thirty-four participants completed Short-Form Montreal Cognitive Assessment testing and 100 completed TMT-B at a mean of 76.5 (SD, 172.7) days from the index LACI. There were no associations between MRI characteristics and Short-Form Montreal Cognitive Assessment. On univariable analyses, cerebral atrophy (β=35 [95% CI, 14.17–55.83];P=0.0010), ventricular size (β=40.1 [95% CI, 22.24–57.96];P

Objective
To determine whether an enhanced community rehabilitation intervention (the Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR) intervention) was more effective than usual National Health Service care, following surgical repair of hip fracture, in terms of the recovery of activities of daily living (ADLs).

Design
Definitive, pragmatic, multisite, parallel-group, two-armed, superiority randomised controlled trial with 1:1 allocation ratio.

Setting
Participant recruitment in 13 hospitals across England and Wales, with the FEMuR intervention delivered in the community.

Participants
Patients aged over 60 years, with mental capacity, recovering from surgical treatment for hip fracture and living in their own home prior to fracture.

Interventions
Usual rehabilitation care (control) was compared with usual rehabilitation care plus the FEMuR intervention, which comprised a patient-held workbook and goal-setting diary to improve self-efficacy, and six additional therapy sessions delivered in-person in the community, or remotely during COVID-19 restrictions (intervention), to increase the practice of exercise and ADL.

Primary and secondary outcome measures
Primary outcome was the Nottingham Extended Activities of Daily Living (NEADL) scale at 12 months. Secondary outcomes included: Hospital Anxiety and Depression Scale, Falls Self-Efficacy-International scale, hip pain intensity, fear of falling, grip strength and Short Physical Performance Battery. Outcomes were collected by research assistants in participants’ homes, whenever possible, but had to be collected remotely during COVID-19 restrictions.

Results
In total, 205 participants were randomised (n=104 experimental; n=101 control). Trial processes were adversely affected by the COVID-19 pandemic. There were 20 deaths, 34 withdrawals and three lost to follow-up. At 52 weeks, there was no significant difference in NEADL score between the FEMuR intervention and control groups. Joint modelling analysis testing for difference in longitudinal outcome adjusted for missing values also found no significant difference with a mean difference of 0.1 (95% CI –1.1, 1.3). There were no significant between-group differences in secondary outcomes. Sensitivity analyses, examining the impact of COVID-19 restrictions, produced similar results. A median of 4.5 extra rehabilitation sessions were delivered to the FEMuR intervention group, with a median of two sessions delivered in-person. Instrumental variable regression did not find any effect of the amount of rehabilitation on the main outcome. There were 53 unrelated serious adverse events (SAEs) including 11 deaths in the control group: 41 SAEs including nine deaths in the FEMuR intervention group.

Conclusions
The FEMuR intervention was not more effective than usual rehabilitation care. The trial was severely impacted by COVID-19. Possible reasons for lack of effect included limited intervention fidelity (fewer sessions than planned and remote delivery), lack of usual levels of support from health professionals and families, and change in recovery beliefs and behaviours during the pandemic.

Trial registration number
ISRCTN28376407.