Search Results for: Short Acting Opioid

I risultati dello studio di fase IIIb VOLITION appena resi noti dimostrano che l’89% (n=129/145) delle persone con HIV naïve ed eleggibili al trattamento hanno scelto di passare al regime long acting cabotegravir + rilpivirina (CAB/RPV LA), dopo aver ottenuto una rapida soppressione virologica con il regime orale quotidiano dolutegravir/lamivudina (DTG/3TC).

Stroke, Ahead of Print. BACKGROUND:The PASSIoN study (Perinatal Arterial Stroke Treated With Stromal Cells Intranasally) demonstrated the feasibility and short-term safety of single-dose allogeneic mesenchymal stromal cells (MSCs) administered intranasally to neonates with perinatal arterial ischemic stroke between February 2020 and April 2021. In this study, we assessed long-term safety and neurodevelopmental outcomes and explored outcome differences with a non–MSC-treated cohort.METHODS:In this post hoc analysis, we evaluated the safety of MSC administration by assessing brain tissue loss, adverse events, and neurodevelopmental outcomes of PASSIoN participants (n=10). The tissue loss ratio was calculated using semi-automatic segmentation based on neonatal and 3-month magnetic resonance imaging. At the age of 2 years, we assessed the occurrence of cerebral palsy, motor and cognitive delays (Zscore

The significant variability in opioid-related hospital utilization trends among U.S. adults underscores the need for careful consideration in the design of future policies, especially during crises. Management strategies should be tailored to specific subpopulations, opioid categories, and OUD-related clinical events to maximize success rates.

Introduction
Cognitive behavioural therapy (CBT) serves as a first-line treatment for internalising disorders (ID), encompassing depressive, anxiety or obsessive-compulsive disorders. Nonetheless, a substantial proportion of patients do not experience sufficient symptom relief. Recent advances in wearable technology and smartphone integration enable new, ecologically valid approaches to capture dynamic processes in real time. By combining ecological momentary assessment (EMA) with passive sensing of behavioural and physiological information, this project seeks to track daily fluctuations in symptom-associated constructs like affect, emotion regulation (ER) and physical activity. Our central goal is to determine whether dynamic, multimodal markers derived from EMA and passive sensing can predict treatment non-response and illuminate key factors that drive or hinder therapeutic change.

Methods and analysis
PREACT-digital is a subproject of the Research Unit FOR 5187 (PREACT), a large multicentre observational study in four outpatient clinics. PREACT channels state-of-the-art machine learning techniques identify predictors of non-response to CBT in ID. The study is currently running and will end in June 2026. Patients seeking CBT at one of four participating outpatient clinics are invited to join PREACT-digital. They can take part in (1) a short version with a 14-day EMA and passive sensing phase prior to therapy, or (2) a long version in which the short version’s assessments are extended throughout the therapy. It is estimated that 468 patients take part in PREACT-digital, of which 350 opt for the long version of the study. Participants are provided with a smartwatch and a customised study app. We collect passive data on heart rate, physical activity, sleep and location patterns. EMA assessments cover affect, ER strategies, context and therapeutic agency. Primary outcomes on (non)-response are assessed after 20 therapy sessions and therapy end. We employ predictive and exploratory analyses. Predictive analyses focus on classification of non-response using basic algorithms (ie, logistic regression and gradient boosting) for straightforward interpretability and advanced methods (LSTM, DSEM) to capture complex temporal and hierarchical patterns. Exploratory analyses investigate mechanistic links, examine the interplay of variables over time and analyse change trajectories. Study findings will inform more personalised and ecologically valid approaches to CBT for ID.

Ethics and dissemination
The study has received ethical approval from the Institutional Ethics Committee of the Department of Psychology at Humboldt Universität zu Berlin (Approval No. 2021–01) and the Ethics Committee of Charité-Universitätsmedizin Berlin (Approval No. EA1/186/22). Written informed consent will be obtained from all participants prior to enrolment. Results will be disseminated through peer-reviewed journals and presentations at national and international conferences.

Trial registration number
DRKS00030915; OSF PREACT: http://osf.io/bcgax; OSF PREACT-digital: https://osf.io/253nb.

In EMPA-KIDNEY, 2 years treatment with empagliflozin improved QALYs, and reduced use and cost of other healthcare, resulting in high likelihood of cost-effectiveness across a broad range of patients with CKD. The study’s key limitation is its relatively short active treatment period and follow-up duration, which may lead to underestimation of the cost-effectiveness of long-term SGLT2i treatment in CKD.

In children with SBS, longer residual small bowel, better nutritional status and absence of liver disease were associated with response to teduglutide. Complete PN weaning was predicted by lower calories needs and higher citrulline at baseline. An increase of haemoglobin and citrulline in the first 6 months of treatment were further predictors of complete PN weaning. Even if limited by the real-life design of the study, these findings may guide a tailored indication for the use of teduglutide in children with short bowel syndrome.

For many years, robotic surgery for rectal cancer gained widespread adoption based on better short-term outcomes and noninferior long-term outcomes compared with laparoscopic surgery, as well as an ergonomically superior surgical environment, minimizing surgeon fatigue and enhancing precision. However, what remained unknown was whether an advance in minimally invasive techniques (such as a robotic-assisted approach) for rectal cancer would not only accelerate recovery, but also play a key role in improving oncological safety and outcomes.

Acute severe ulcerative colitis (ASUC) remains one of the challenging presentations in inflammatory bowel disease (IBD) where progress on therapeutic approaches has been limited since 1955 when corticosteroids revolutionised care 1 to reduce the mortality associated with ASUC. Despite the advent of rescue therapy options, short- and long-term colectomy rates remain stubbornly high2 . While newer strategies to reduce the need for in-hospital colectomy during an index admission are being considered with variable success, there is limited data guiding the management of steroid-responsive patients with ASUC. In GUT, Amiot et al 3 aimed to address this gap in knowledge by randomising ASUC patients responding to intravenous steroids (IV) to infliximab with azathioprine (IFX+AZA) or azathioprine (AZA) alone. The results indicate a 28% reduction in treatment failure at week 52, defined as the composite of the absence of steroid-free clinical remission and endoscopic response…

Circulation, Volume 152, Issue 1, Page 58-73, July 8, 2025. The increasing demand for donor hearts presents both a critical challenge and a significant opportunity for innovation in cardiac transplantation. Advancements in immunosuppressive regimens and genetic engineering have reignited recent interest in xenotransplantation. Notably, 2 human patients have received genetically modified pig hearts under expanded-access authorization. They survived for 40 and 60 days, with xenograft failure preceding death in both cases. Concurrently, decedent studies have focused on monitoring the short-term physiological function of genetically modified cardiac xenografts in legally brain-dead recipients, representing a novel experimental paradigm for preclinical testing to help bridge the gap between nonhuman primate studies and clinical trials. These contemporary achievements build on a large body of exploratory efforts in cardiac xenotransplantation in nonhuman primates. Despite significant progress in overcoming hyperacute rejection, adaptive cellular and humoral immunological barriers remain. This review aims to critically evaluate the current advancements in xenotransplantation, to explore ongoing challenges, and to discuss the future potential of this innovative approach in addressing the growing demand for donor organs in cardiac transplantation.

Objectives
To study the prevalence of and interplay between common neuropsychiatric sequelae 3–4 years after onset of first-ever stroke—specifically post-stroke fatigue (PSF), post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI).

Design
Population-based cohort study.

Setting
Catchment area of a Swedish University Hospital.

Participants
We recruited individuals with first-ever ischaemic stroke or intracerebral haemorrhage in the initial cohort; 151 of these died prior to follow-up and 47 (12%) were lost to detailed follow-up. We followed up 202 individuals with median age: 72 (IQR 65–79), 40% female, either in clinic, via home visits or via telephone.

Primary and secondary outcome measures
Primary outcome measures included PSF (Fatigue Assessment Scale), PSD (Patient Health Questionnaire-9) and PSCI (Montreal Cognitive Assessment). Secondary outcome measures included dependency in activities of daily living (ADL; Barthel Index), health-related quality of life (HRQoL; Short-Form Questionnaire-36, EuroQoL-5D and Stroke Impact Scale) and stroke severity (National Institutes of Health Stroke Scale (NIHSS)).

Results
Significant PSF was present in 46/195 (24%), PSD in 21/191 (11%), and PSCI in 93/173 (54%) respondents. Among 169 participants with available data for all three domains, 100 (59%) had impairment in at least one domain. Participants with PSCI were older than those without (median: 75 vs 67 years; p

Introduction
Emergence delirium (ED) stands out as a prevalent postoperative complication among paediatric patients, correlating with extended hospitalisation periods, escalated healthcare expenses and increased incidence of postoperative maladaptive behaviours (POMBs). Well-established pharmacological or non-pharmacological interventions demonstrating efficacy in reducing the occurrence of ED are notably absent. Therefore, this study aimed to assess the potential of family-centred perioperative care for anaesthesia (FPCA) in mitigating the incidence of ED in children compared with routine anaesthesia.

Method and analysis
This multicentre, prospective, open-label, randomised controlled clinical trial will enrol a total of 444 children aged 2–6 years undergoing elective short surgery (estimated duration ≤2 h). According to the stratification factors of surgical types (ophthalmology, ear, nose and throat (Oph&ENT) and non-Oph&ENT surgeries), patients will be randomly allocated into two groups in a 1:1 ratio. For the FPCA group (group F), both children and parents will receive FPCA (including video education, mask practice, electronic pamphlet, distraction strategies and parental presence), without sedatives before surgery. For the routine anaesthesia group (group R), both children and parents will receive routine preoperative education and anaesthesia, and preoperative sedatives (such as oral midazolam or intranasal dexmedetomidine) will be recommended. The primary outcome is the incidence of ED. Secondary outcomes include the severity of ED, incidence of POMBs, cognitive function, quality of sleep and life, preoperative anxiety, compliance with anaesthesia induction and postoperative pain score. Logistic regression will be applied to compare differences in primary and secondary outcomes between groups, and patients’ age, sex, and body mass index will be considered as covariates in baseline measurements.

Ethics and dissemination
This study protocol was approved by the Ethics Committee of The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University. Results will be disseminated via peer-reviewed journals, academic conferences and mass media. Recruitment began in October 2023.

Trial registration number
NCT06092671.

Objectives
COVID-19 in children is generally of short duration, but some may take longer to recover. This study investigated the time to symptom resolution following SARS-CoV-2 infection among children in a community setting on the outskirts of an urban centre in Brazil.

Design
Prospective cohort study.

Setting
This is a community-based cohort of children living in Manguinhos, a favela in Rio de Janeiro. The cohort was followed through home visits and telephone monitoring of symptoms. The analysis focused on symptomatic children from this cohort with confirmed SARS-CoV-2 infection. Recovery time was defined as the interval between the first date with symptoms and the first date without symptoms following a positive SARS-CoV-2 test.

Participants
A total of 1276 children (boys and girls aged 2–

Objectives
To review the available evidence of screening for atherosclerosis in adults in a primary prevention setting with coronary artery calcium scoring (CACS) on the impact on cardiovascular (CV) risk factor control, health behaviour and clinical events.

Design
Systematic review, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources
We searched MEDLINE, Embase and Cochrane Central Register of Controlled Trials through 22 January 2025.

Eligibility criteria
We included randomised controlled trials (RCTs) and prospective cohorts, without language restrictions, comparing adults without cardiovascular diseases undergoing CACS to a control group that either did not undergo CACS or where the participants and physicians were blinded to its result. Outcomes included changes in CV risk factor control, CV therapy, changes in health behaviour at follow-up and clinical events (all-cause and CV mortality and non-fatal CV events).

Data extraction and synthesis
Two independent reviewers extracted data and assessed the risk of bias. Due to substantial heterogeneity among the included studies, a quantitative analysis was not possible.

Results
We identified seven RCTs and one observational study, with participants ranging from 56 to 43 447 with a total of 51 554. Populations were heterogeneous with a mean age range of 42–64 years, % women ranging from 21% to 100% and mean baseline CACS from 1.37 to >100 Agatston units. Interventions following CACS were also heterogeneous, ranging from simply communicating results to participants to initiating statin therapy for detectable CACS. One RCT demonstrated improvement regarding blood pressure (BP) (n=2137; change in systolic BP: CACS: –5 mm Hg; control: –7 mm Hg; p=0.02), several an improvement in blood lipids between groups (five studies, n=3693; eg, low-density lipoprotein (LDL) cholesterol: range –6.0 to –4.9 mg/dL). Results regarding CV medication (seven studies, n=51 104) were more discrepant, with some studies showing a decrease and others an increase in indication for or usage of CV medication. Three trials (n=3338) investigated adherence to CV medication, with only one showing increased adherence to statins (CACS: 63.3%; control: 45.6%; p=0.03). Five trials (n=3692) investigated behavioural changes, with one showing an increased motivation to change lifestyle (CACS: 94%; control: 62.8%; p=0.002) and another a higher adherence in self-reported physical activity (CACS: 96%; control: 59%; p

Background
Childbirth can have psychological, social and emotional effects on women and their families. Psychological birth trauma (PBT) is defined as the emotional distress and mental health challenges resulting from negative or distressing experiences during the childbirth process. Labour management plays an important role in the health of women and children. Consequently, the study aims to assess the status of PBT among Iranian women, identify factors influencing it and suggest effective preventive strategies.

Methods and analysis
This study is a mixed-method research with an explanatory sequential approach. The first phase is quantitative and cross-sectional, involving 300 postpartum women visiting health centres in Tabriz-Iran. In this phase, cluster sampling will be used, and data will be collected using the following questionnaires: Sociodemographic and Obstetric Characteristics, Birth Trauma Scale, PTSD Symptom Scale 1, Perceived Quality of Care Scale, Childbirth Experience Questionnaire version 2.0, Edinburgh Postpartum Depression Scale, Postpartum Specific Anxiety Scale Research Short-Form and the questionnaire on the desire for subsequent pregnancy. The second phase is qualitative, and participants will be selected based on the results of the quantitative phase and extreme cases, using purposive sampling. Data analysis will be performed using qualitative content analysis with a conventional approach. Qualitative data will be collected through in-depth and semi-structured individual interviews with open-ended questions. In the third phase, strategies to prevent childbirth psychological trauma will be designed by integrating the results of the quantitative and qualitative studies, reviewing the literature and gathering expert opinions using a modified Delphi study. Examining PBT and its influencing factors can provide culturally relevant, evidence-based strategies. These strategies can be effective in improving the quality of care for women during childbirth.

Ethics and dissemination
This study has received approval from the Ethics Committee of Tabriz University of Medical Sciences in Tabriz, Iran (code number: IR.TBZMED.REC.1402.945). All participants will provide written informed consent before taking part in the study. The outcomes will be shared through articles published in journals, presentations at medical conferences, the validation of a reliable scale for assessing the level of PBT in postpartum women, and the provision of strategies to prevent childbirth psychological trauma. These resources will be valuable for policymakers and healthcare providers.

Objective
This study investigates the effects of dexmedetomidine on short-term and long-term survival rates in intensive care unit (ICU) patients with ischaemic stroke.

Design
This is a retrospective study.

Setting
Data were sourced from the Medical Information Mart for Intensive Care IV database.

Participants
This study analysed 2816 patients with ischaemic stroke from the US Intensive Care database.

Interventions
Dexmedetomidine administration during the ICU stay was defined as the exposure.

Methods
Patients were categorised into the dexmedetomidine group and the control group. Cox regression analysis was used to identify factors that may influence the 28-day mortality rate of patients with ischaemic stroke. High-risk factors were incorporated as covariates, and a 1:1 propensity score matching using the logit model was constructed to compare the prognosis between the two groups.

Primary and secondary outcome measures
The primary outcome was 28-day mortality. The secondary outcomes included in-hospital mortality, ICU length of stay, hospital length of stay, mechanical ventilation duration and 180-day mortality in discharged patients.

Results
A total of 2816 patients were included. Cox regression analysis revealed that dexmedetomidine use was associated with a reduced risk of 28-day mortality. Following propensity score matching, each group comprised 407 patients. Dexmedetomidine was found to improve 28-day mortality (27.8% vs 36.6%, p=0.007). However, it was also associated with the prolonged length of hospital and ICU stay (p=0.002). Among discharged patients, dexmedetomidine use was also associated with an improved 180-day mortality rate (p=0.0019).

Conclusion
The use of dexmedetomidine is associated with improved short-term and long-term prognosis in patients with ischaemic stroke and could potentially confer benefits in those receiving mechanical ventilation.

Objective
This study aimed to evaluate the utility of optical sensor-based technology in mitigating the frequency and severity of peripheral intravenous infiltration and/or extravasation (PIVIE) in neonates.

Design
Single-centre, retrospective, observational cohort study.

Setting
Tertiary-level neonatal intensive care unit (NICU) (112 cots) at the Women’s Wellness and Research Centre (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar, January 2019–December 2022.

Participants
All neonates admitted to the NICU requiring intravenous therapy via a neonatal short peripheral intravenous catheter (n-SPC) were included. Participants were excluded if the insertion was unsuccessful, if they had incomplete data, or if they received intravenous therapy exclusively through alternative vascular access devices.

Interventions
The study analysed two cohorts representing different clinical practices over two distinct periods. In the conventional cohort (Phase 1, 2019–2020), PIVIE detection relied solely on periodic ‘Touch Look Compare (TLC)’ assessments. In the ivWatch cohort (Phase 2, 2021–2022), continuous optical sensor-based monitoring using the ivWatch system was implemented alongside TLC assessments. This sequential design allowed for a comparison of outcomes between the two phases.

Outcome measurements
The primary outcomes were the occurrence and severity of PIVIE. Secondary outcomes included the influence of patient demographics, vascular access characteristics, and management details on PIVIE incidence and severity.

Results
Over the 4-year data collection period, 32 713 peripheral intravenous catheters were analysed across two cohorts. PIVIE was the most common reason for unplanned device removal. In the conventional cohort (Phase 1, 2019–2020), 4941 infiltration events were reported (29.9%), compared with 4872 events (30.1%) in the ivWatch cohort (Phase 2, 2021–2022). However, severity measures using the Intravenous Extravasation Grading Scale (IEGS) revealed a marked reduction in severe PIVIE cases, with severe events decreasing from 243 (4.9%) in the conventional cohort to 54 (1.1%) in the ivWatch cohort (p