Articles: function.
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Retraction Of Publication
Retraction Notice to: "Platelet Function in Critically Ill Patients"[Chest. 1994;106(3):899-903].
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Randomized Controlled Trial
Estimating individualized treatment effects using a risk-modeling approach: an application to epidural steroid injections for lumbar spinal stenosis.
Conventional "1-variable-at-a-time" analyses to identify treatment effect modifiers are often underpowered and prone to false-positive results. This study used a "risk-modeling" approach guided by the Predictive Approaches to Treatment effect Heterogeneity (PATH) Statement framework: (1) developing and validating a multivariable model to estimate predicted future back-related functional limitations as measured by the Roland-Morris Disability Questionnaire (RMDQ) and (2) stratifying patients from a randomized controlled trial (RCT) of lumbar epidural steroid injections (LESIs) for the treatment of lumbar spinal stenosis into subgroups with different individualized treatment effects on RMDQ scores at the 3-week follow-up. Model development and validation were conducted in a cohort (n = 3259) randomly split into training and testing sets in a 4:1 ratio. ⋯ R2 values in the training set, testing set, and RCT were 0.38, 0.32, and 0.34, respectively. There was statistically significant modification ( P = 0.03) of the LESI treatment effect according to predicted risk quartile, with clinically relevant LESI treatment effect point estimates in the 2 quartiles with greatest predicted risk (-3.7 and -3.3 RMDQ points) and no effect in the lowest 2 quartiles. A multivariable risk-modeling approach identified subgroups of patients with lumbar spinal stenosis with a clinically relevant treatment effect of LESI on back-related functional limitations.
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Current guidelines for ischaemic stroke treatment recommend a strict, but arbitrary, upper threshold of 185/110 mm Hg for blood pressure before endovascular thrombectomy. Nevertheless, whether admission blood pressure influences the effect of endovascular thrombectomy on outcome remains unknown. Our aim was to study the influence of admission systolic blood pressure (SBP) on functional outcome and on the effect of endovascular thrombectomy. ⋯ Medtronic.
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Minerva anestesiologica · Apr 2023
ReviewPerioperative management and surgical field optimization in functional endoscopic sinus surgery.
A sound anesthesiologist-surgeon collaboration is crucial for the success of functional endoscopic sinus surgery (FESS). The aim of this narrative review was to describe if and how anesthetic choice can decrease bleeding and improve visibility in the surgical field (VSF) and thus contribute to successful FESS. A literature search was conducted on evidence-based practices published from 2011 to 2021 describing perioperative care, intravenous/inhalation anesthetics, and operative approaches for FESS and their effects on blood loss and VSF. ⋯ We recommend that anesthesiologists use the anesthetic technique with which they are most comfortable to facilitate efficiency, recovery, cost, and collaboration with the perioperative team. Future studies should be designed to consider disease severity, the method for measuring blood loss, and a standardized VSF score. Studies should also investigate the long-term effects of TIVA- and IA- induced hypotension.
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Do-not-intubate (DNI) orders are more frequently encountered over time. This widespread diffusion of DNI orders make it essential to develop therapeutic strategies matching patient's and his family willingness. The present review sheds light on the therapeutic approaches employed to support respiratory function of patients with DNI orders. ⋯ In dealing with DNI patients, the individualization of treatments is of pivotal importance to respect patient's preferences and improve quality of life at the same time.