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tween 3 and 6 months, suggesting participation may improve over time.

Limited smartphone ownership, missing data, and time-consuming data extraction limit current implementation of mass extraction of location data from patients' smartphones to aid prognostication or measure outcomes. The number of journeys taken and the linear distance travelled increased between 3 and 6 months, suggesting participation may improve over time.

Clinically significant post-traumatic stress symptoms (PTSS) have been reported in up to a quarter of paediatric intensive care unit (PICU) survivors. Ongoing PTSS negatively impacts children's psychological development and physical recovery. However, few data regarding associations between potentially modifiable PICU treatment factors, such as analgosedatives and invasive procedures, and children's PTSS have been reported.

We sought to investigate the medical treatment factors associated with children's PTSS after PICU discharge.

A prospective longitudinal cohort study was conducted in two Australian tertiary referral PICUs. Children aged 2-16 y admitted to the PICU between June 2008 and January 2011 for >8h and <28 dwere eligible for participation. Biometric and clinical data were obtained from medical records. Parents reported their child's PTSS using the Trauma Symptom Checklist for Young Children at 1, 3, 6, and 12 months after discharge. Logistic regression was used to assess potential assocn children who had received midazolam therapy.

Elevated PTSS were evident in one quarter (24%) of children during the 12 months after PICU discharge. One month after discharge, elevated PTSS were most likely to occur in children who had received midazolam therapy.

Perinatal substance use programs employ multidisciplinary teams to support women who use drugs through pregnancies and parenting, with some programs expanding to include peer support workers with lived experience of parenting and substance use. Research has shown peer support to enhance care in substance use treatment; however, little research exists that examines this model of support within perinatal substance use programs. We explore the current and potential role of peer support workers within perinatal substance use programs, from the perspectives of mothers accessing these programs.

We conducted focus groups with 20 mothers enrolled in three perinatal substance use programs serving the greater Vancouver area, including two community-based programs that employed peer workers and an acute care maternity ward that did not. We recorded focus groups, had them professionally transcribed, and analyzed them thematically.

Participants characterized peer support workers as extending and complementing inform perinatal substance use programs, while also indicating the need for organizational processes to ensure that peer staff are integrated equitably and supported adequately.

This study evidences benefits of employing peer support workers within perinatal substance use programs, while also indicating the need for organizational processes to ensure that peer staff are integrated equitably and supported adequately.

Relaxation of federal regulations for methadone take-out dosing during the COVID-19 pandemic is unprecedented. The impact of this change on drug use is unknown. This study explores the impact of the federal take-out variance on drug use in one urban opioid treatment program as measured by drug testing.

This study collected drug test results from 613 patients receiving methadone from July 2020, following COVID-19-related take-out dose adjustments, and July 2019 for comparison. Using a generalized linear mixed model, we computed the average estimated probability of a positive drug test for each year for each take-out phase. To isolate the effect of changing take-out, we removed the main effect of year, while retaining the main effect of take-out phase and the interaction between year and phase.

The percent of drug tests positive for opiates, benzodiazepines, and methamphetamine was greater in July 2020 than in July 2019 (p<0.001 for each), while the percent of tests negative for methadone increased (p&alterations in the take-out schedule.

Minimally invasive robot-assisted laparoscopic radical prostatectomy (RALP) has replaced open prostatectomy. However, RALP does not reduce postoperative pain compared to the open approach. We explored whether bundled intraoperative intravenous infusion of dexmedetomidine and ketorolac reduced opioid requirements during the 24h after RALP.

Eighty patients (two parallel groups) were enrolled in this prospective non-randomized study from September 2020 to November 2020. All received preoperative rectus sheath blocks for analgesia after RALP. A multimodal analgesic bundle (dexmedetomidine and ketorolac) was administered intraoperatively in the study group (n=39) but not in the control group (n=40). The total postoperative opioid requirements (expressed in milligrams of intravenous morphine) and pain scores (derived using a visual analog scale) were compared between the two groups up to 24h after surgery.

The two groups were demographically similar. During surgery, patients in the study group received less remifentanil and more ephedrine than controls. Microbiology activator The study group required significantly less opioids during the 24h after surgery (28.3 vs. 40.0mg, p=0.006). The between-group pain scores differed significantly at 1 and 6h after surgery. All other postoperative characteristics were comparable between the two groups.

The intraoperative multimodal analgesic bundle (intravenous dexmedetomidine and ketorolac) improved postoperative analgesia after RALP in patients with rectus sheath blocks, as evidenced by the opioid-sparing effect after surgery.

The intraoperative multimodal analgesic bundle (intravenous dexmedetomidine and ketorolac) improved postoperative analgesia after RALP in patients with rectus sheath blocks, as evidenced by the opioid-sparing effect after surgery.

Conflicting data have been published regarding the oncologic appropriateness of minimally invasive surgery (MIS) in the treatment of cervical cancer. The purpose of the present study was to investigate whether our experience in the treatment of early cervical cancer using a robotic surgical approach was safe and oncologically effective.

The data of 557 patients with cervical cancer treated by robotic surgery were retrospectively collected, including the perioperative and survival outcomes. Tumor stage was based on the International Federation of Gynecology and Obstetrics (FIGO 2009). The disease-free survival (DFS) and overall survival (OS) were calculated by the Kaplan-Meier method.

Of the 557 patients, 196 (35.2%) patients were stage IA1 to IB1, and 304 (54.6%) patients were stage IB2 to I1A2. Also included were 57 (10.2%) patients with either recurrent or persistent disease following concurrent chemoradiotherapy. Two patients (0.4%) experienced severe intraoperative complications and 11 patients (2.0study results demonstrated that the robotic surgical approach could achieve satisfying therapeutic outcomes in patients with early-stage cervical cancer, with a low complication rate. For advanced cervical cancer patients with recurrent or persistent disease following concurrent chemoradiotherapy, robotic surgery undertaken as supplementary therapy may improve prognosis. However, there remains a need for additional prospective data reporting long-term survival of cervical cancer patients treated with a robotic surgical approach.

Component separation techniques have recently gained popularity for the repair of complex ventral hernias. Anterior and posterior component separation techniques offer similar myofascial medialization, with a differing complication profile. The aim of this study is to compare the efficacy, patient morbidity and post-operative complications between anterior component separation (ACST) and transversus abdominis release (TAR) for large ventral hernias.

Between December 2017 and September 2019, data was collected and analysed for patients undergoing ACST and TAR, in terms of demographics, peri-operative events, adverse events and hernia recurrence.

25 patients each underwent ACST and TAR during our study period. Mean age was 53.5 and 52.8 years and mean BMI was 31.4 and 29.5 respectively. The mean defect area was 120.8cm

and 131.9cm

, and average mesh size was 741.8cm

and 1429.04cm

respectively in the ACST and TAR groups. Four patients undergoing TAR had intra-operative complications with none in the ACST group. In the ACST group, 8 patients had an SSI, of which 5 patients needed operative intervention, while 3 patients in the TAR group had an SSI, all of whom were managed with bedside procedures. One patient in the ACST group had a recurrence. None of the patients in the TAR group had a recurrence.

Component separation techniques are gaining popularity in treatment of large ventral hernias. While they have comparable outcomes with respect to recurrence, wound morbidity is more frequent and severe in the ACST group.

Component separation techniques are gaining popularity in treatment of large ventral hernias. While they have comparable outcomes with respect to recurrence, wound morbidity is more frequent and severe in the ACST group.

Indocyanine green (ICG) fluorescence imaging has been used for blood flow assessment in anastomoses in the field of colorectal cancer surgery. However, whether ICG fluorescence is related to the presence of cancer cells in the lymph nodes is unclear. We explored the utilization of ICG fluorescence in colorectal cancer surgery.

ICG was injected into the submucosa around the tumor before radical resection in colorectal cancer patients. Intraoperatively, near-infrared (NIR) fluorescence was used for lymphatic flow visualization. After specimen removal, harvested lymph nodes were classified as positive or negative based on the detection of fluorescence, followed by pathological examination. ICG distribution on a section of each lymph node was examined by fluorescence microscopy.

Overall, 155 patients underwent real-time NIR fluorescence imaging-guided surgery. Altogether, 1,017 lymph nodes were retrieved from these patients. Metastatic lymph nodes were present in 36 (5.8%) of 622 fluorescence-negative lymph nodes, which was significantly higher than 11 (2.8%) of 395 fluorescence-positive lymph nodes (odds ratio 2.15, P=0.03). Fluorescence microscopy of metastatic lymph nodes showed that ICG fluorescence was present in the normal structural region but not in the cancerous region of the lymph nodes. Furthermore, ICG fluorescence was observed in all metastatic lymph nodes, except those with cancer cells occupying >90% of the total area.

ICG fluorescence detected only the normal parts of the lymph node draining from the peritumoral area and not the cancer tissues. This finding is important for developing appropriate strategies for navigation surgery using NIR fluorescence.

ICG fluorescence detected only the normal parts of the lymph node draining from the peritumoral area and not the cancer tissues. This finding is important for developing appropriate strategies for navigation surgery using NIR fluorescence.