Latest Articles
-
Advocacy, one of the five domains of global neurosurgery, represents a powerful avenue to influence public policy to expand access to safe, timely, and affordable neurosurgical care. In this manuscript, we characterize advocacy in global neurosurgery, describe specific neurosurgeon-led initiatives, and delineate how neurosurgeons can become involved in global neurosurgery advocacy efforts. Advocacy in global neurosurgery involves working together in organized neurosurgery with organizations focused on clinical provisions, training, and policy initiatives. ⋯ Neurosurgery-led initiatives transforming public policy have occurred on regional and global scales and accelerated since 2019. Folate fortification of staple foods to prevent neural tube defects represents a recent and notably successful area of advocacy and remains in progress. Neurosurgeons who aspire to become involved in advocacy efforts must obtain competencies and skills distinct from, yet complementary to, the traditional neurosurgical training curriculum.
-
Randomized Controlled Trial
Positive end-expiratory pressure and emergence preoxygenation after bariatric surgery: A randomised controlled trial on postoperative oxygenation.
Positive end-expiratory pressure (PEEP) is important to increase lung volume and counteract airway closure during anaesthesia, especially in obese patients. However, maintaining PEEP during emergence preoxygenation might increase postoperative atelectasis by allowing susceptible lung areas to be filled with highly absorbable oxygen that gets entrapped when small airways collapse due to the sudden loss of PEEP at extubation. ⋯ www.clinicaltrials.gov , NCT04150276.
-
Eur. J. Clin. Invest. · Jan 2025
ReviewCatheter-related deep vein thrombosis: Where are we at and where are we going? Updates and ongoing unmet clinical needs.
Catheter-related thrombosis (CRT) is one of the major complications affecting patients with indwelling venous catheters, usually involving the upper extremity deep venous system. This condition can lead to potentially life-threatening complications such as pulmonary embolism and sepsis. The risk of developing CRT varies depending on type of catheters and patient characteristics. Despite advances in materials and technologies, the actual incidence of CRT is still considerable. Available evidence on CRT management remains controversial, and clinical guidelines base their recommendations on data from non-catheter related upper extremity or lower extremity deep venous thromboses. ⋯ The management of CRT is still challenging with constant need for updated evidence to support tailored approaches.
-
Palliative medicine · Jan 2025
Randomized Controlled TrialMixed methods process evaluation of an advance care planning intervention among nursing home staff.
We developed the ACP+ intervention to support nursing home staff with implementation of advance care planning. While ACP+ was found to improve staff's self-efficacy, it did not change their knowledge about advance care planning. ⋯ There was limited staff engagement. Management ownership, clear roles, and collaborative practices may enhance nursing home advance care planning. Accessible and ongoing training for all staff, and ample practical learning opportunities are needed.
-
An increased understanding of the predisposing genetics and complex pathogenic mechanisms of Alzheimer's disease have facilitated delineation of the long preclinical course and re-invigorated the search for disease-modifying treatments. Establishment of accurate blood-based biomarkers has enabled preclinical identification of early disease and permits trials of preventative treatment and quantitative monitoring of therapeutic effects. The broad range of therapeutic possibilities encompasses gene editing, enzyme activators and inhibitors, antisense oligonucleotides, and antagonists of receptors for inflammatory mediators.