Articles: treatment.
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Implementation of infant pain practice change (ImPaC) is a multifaceted web-based resource to support pain practice change in neonatal intensive care unit (NICU). We evaluated the (1) intervention effectiveness and (2) implementation effectiveness of ImPaC using a hybrid type 1 effectiveness-implementation study (ie, cluster randomized controlled trial and longitudinal descriptive study). Eligible level 2 and 3 Canadian NICUs were randomized to intervention (INT) or waitlisted to usual care (UC) for 6 months. ⋯ Pain assessment was greater in the INT group (34.7% vs 25.5%, P < 0.001) and pain intensity scores were lower [1.47 (1.25) vs 1.86 (1.97); P = 0.029]. Similarly, in the WL analysis, there were fewer painful procedures/infant/day [3.11 (±3.98) vs 3.85 (±4.13), P = 0.003] and increased pain assessment (30.4% vs 25.5%, P = 0.0001) and treatment (31.2% vs 24.0%, P < 0.001) in the INT group. Feasibility and implementation fidelity were associated with improved clinical outcomes.
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Both heart failure and type 2 diabetes are prevalent conditions and share similar pathogenesis, risk factors, and treatment medications. This review aims to inform clinical practice by summarizing the interaction between heart failure and type 2 diabetes, as well as the medications used to manage them. Novel medications such as Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-likepeptide-1 receptor agonists, and finerenone have been shown to protect patients with type 2 diabetes from hospitalization for heart failure. ⋯ When choosing diabetes treatment medications for patients with heart failure and type 2 diabetes, shared decision-making can be helpful in weighing the benefits and harms based on individual scenarios. The selection of guideline-directed medical therapy aligns with patients without type 2 diabetes. Given the rapid evolution of knowledge in this field, clinicians need to stay updated with the latest evidence to provide optimal medical care.
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The letter responds to a study on the role of erector spinae muscle quality in surgical decision-making for lumbar spondylolisthesis. It highlights the potential of paraspinal muscle fatty infiltration as a predictive factor, suggesting that early rehabilitation targeting these muscles may reduce the need for surgery. The authors propose improvements for future research, such as using advanced MRI techniques for better fat infiltration assessment, controlling patient activity levels, and incorporating multidimensional imaging analyses with machine learning. These advancements could support more personalized treatment strategies for lumbar spondylolisthesis.
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Chronic pancreatitis is a progressive fibroinflammatory disease primarily caused by a complex interplay of environmental and genetic risk factors. It might result in pancreatic exocrine and endocrine insufficiency, chronic pain, reduced quality of life, and increased mortality. ⋯ Management of chronic pancreatitis consists of prevention and treatment of complications, requiring a multidisciplinary approach focusing on lifestyle modifications, exocrine insufficiency, nutritional status, bone health, endocrine insufficiency, pain management, and psychological care. To optimise clinical outcomes, screening for complications and evaluation of treatment efficacy are indicated in all patients with chronic pancreatitis.