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ing an opportunity for future research and intervention.

In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting.

After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into GroupD - blockade performed with30mL of0.5% levobupivacaine with vasoconstrictor and 6mg (1.5mL) of dexamethasone and Group C - 30mL of 0.5%levobupivacaine with vasoconstrictor and 1.5mL of0.9% saline. The duration of the sensory block was evaluated in 4postoperative moments (0, 4, 12 and 24hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS).

Seventy-four patients were recruited and 71completed the study (GroupC, n=37; GroupD, n=34). Our findings showed a prolongation of the mean time of the sensitive blockade in GroupD (1440±0min vs. 1267±164min, p<0.001). It was observed that GroupC had a higher mean pain score according to VAS (2.08±1.72 vs. 0.02±0.17, p<0.001) and a greater number of patients (68.4%vs.0%, p<0.001) required rescue analgesia in the first24hours. The incidence of postoperative nausea and vomiting was not statistically significant.

Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.

Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.While it is well established that individuals with schizophrenia exhibit a wide range of neurocognitive deficits, there is significant heterogeneity in this regard. Impairments in verbal fluency appear to present consistently across most individuals with the illness. The present study examined the stability of verbal fluency abilities in chronic schizophrenia longitudinally. It was hypothesized that semantic but not phonemic verbal fluency performance would be stable over one year. Data was extracted from a larger study that followed 53 outpatients (70% male; mean age = 39.2 years) diagnosed with schizophrenia or schizoaffective disorder. At each testing interval (baseline, 6, and 12 months), the Brief Assessment of Cognition in Schizophrenia was administered, which included phonemic (i.e., F, S) and semantic (i.e., animals) verbal fluency tasks. No significant differences were found across time points for semantic and phonemic verbal fluency with respect to mean number of words generated, clustering, and switching. The findings provide evidence of stability in semantic and phonemic verbal fluency abilities in chronic schizophrenia. Moving forward, it would be valuable to examine verbal fluency performance longitudinally across multiple stages of illness (i.e., clinically high-risk to chronic schizophrenia).The COVID-19 has sent billions of students worldwide into lockdown. The study aimed to assess the prevalence of anxiety and identify the factors associated with anxiety among French students during lockdown.A cross-sectional study was conducted to collect sociodemographic data, living and learning conditions, anxiety symptoms and social support. Among 3936 students, 15.2%, experienced moderate anxiety and 9.8%, severe anxiety.Female gender (OR=2.2, 95% CI 1.8-2.7) and having relatives or acquaintances from their housing hospitalized for COVID-19 (OR=3.3, 95% CI 1.4-7.9) were the main risk factors for anxiety. Tensions at home (OR=1.8, 95% CI 1.5-2.1), difficulties isolating (OR=1.4, 95% CI 1.1-1.6), noises inside (OR=1.6, 95% CI 1.3-1.9) or outside the housing (OR=1.5, 95% CI 1.3-1.8), no direct outdoor access (OR=1.6, 95% CI 1.3-2.0), delay in final examination (OR=1.6, 95% CI 1.3-2.1), reduced time for learning (OR=1.3, 95% CI 1.1-1.6), increased tobacco consumption (OR=1.9, 95% CI 1.4-2.6), ineffectiveness of using media entertainment (OR=2.2, 95% CI 1.1-4.4) and reading (OR=1.9, 95% CI 1.3-2.7) to calm down, were identified as risk factors. Family (OR=0.85, 95% CI 0.8-0.91) and friend (OR=0.88, 95% CI 0.82-0.94) support were protective factors. This suggests the need to focus on students during epidemics, especially those living with someone hospitalized with COVID-19.Psychotherapy is the cornerstone of treatment for borderline personality disorder (BPD) while pharmacotherapy should be considered only as an adjunctive intervention. In clinical practice, however, most of BPD patients only receive medication. The aim of the study is to first describe pharmacological treatment in BPD patients in Italy and secondly to evaluate if comorbidity or illness severity are associated with the prescription of different class compounds. Data on pharmacological treatment and clinical evaluation of 75 BPD patients were collected in 5 clinical settings. The association between comorbidity and medication was assessed. Moreover, we evaluated the association between pharmacotherapy and severity, defined by a cluster analysis aimed at detecting different groups of patients. Most of the participants (82.7%) were characterized by polypharmacy, with a mean of 2.4 medications per person. Interestingly, the prescription didn't seem to depend on/be based on the severity of the disorder and was only partially determined by the presence of comorbidity. In conclusion, our findings are similar to what described in other clinical studies, supporting the idea that medication management for BPD is only partially coherent with international guidelines. This pilot study confirms the need for more rigorous studies to gain greater understanding of this topic and diminish the gap between guidelines and the real clinical world.Insomnia is a risk factor for hypertension and cardiovascular events, and this association is strongest for sleep-onset insomnia. This study explored morning cardiovascular function in individuals with sleep-onset insomnia by analysing heart rate variability (HRV), blood pressure variability, and baroreflex sensitivity. Sleep quality of fifteen good sleepers and 13 individuals with sleep-onset insomnia was measured by overnight polysomnography, followed by continuous recordings of the participant's blood pressure and heart rate for 10 min immediately after they had woken up the following morning. After morning awakening (averaged time 12.33 ± 10.48 min), a significantly reduced vagal tone assessed by HRV, including lower total power of HRV, lower high frequency of HRV, and elevated slopes of systolic as well as diastolic blood pressure in the morning with a blunted baroreflex sensitivity in the insomnia group were noted, compared to the control group. No differences in sympathetic-related activity were observed. The regulation of cardiovascular activity by the parasympathetic nervous system plays an important role in sleep-onset insomnia. Weak vagal modulation and blunted baroreflex sensitivity were evident in this insomnia subtype, which indicates that difficulty in initiating sleep can independently affect morning cardiovascular function.

We sought to assess the relationship between Leapfrog minimum volume standards, Hospital Safety Grades, and Magnet recognition with outcomes among patients undergoing rectal, lung, esophageal, and pancreatic resection for cancer.

Standard Analytical Files linked with the Leapfrog Hospital Survey and the Leapfrog Safety Scores Denominator Files were used to identify Medicare patients who underwent surgery for cancer from 2016 to 2017. Multivariable logistic regression analysis was used to examine textbook outcomes relative to Leapfrog volume, safety grades, and Magnet recognition.

Among 26,268 Medicare beneficiaries, 7,491 (28.5%) were treated at hospitals meeting the quality trifactor (Leapfrog, safety grade A, and Magnet recognition) vs 18,777 (71.5%) at hospitals not meeting ≥1 designation. Patients at trifactor hospitals had lower odds of complications (odds ratio= 0.83, 95% confidence interval 0.76-0.89), prolonged duration of stay (odds ratio= 0.89, 95% confidence interval 0.82-0.97), and higher odds of experiencing textbook outcome (odds ratio= 1.12, 95% confidence interval 1.06-1.19). Patients undergoing surgery for lung (odds ratio= 1.19, 95% confidence interval 1.10-1.30) and pancreatic cancer (odds ratio= 1.37, 95% confidence interval 1.21-1.55) at trifactor hospitals had higher odds of textbook outcome, whereas this effect was not noted after esophageal (odds ratio= 1.16, 95% confidence interval 0.90-1.48) or rectal cancer (odds ratio= 1.11, 95% confidence interval 0.98-1.27) surgery. Leapfrog minimum volume standards mediated the effect of the quality trifactor on patient outcomes.

Quality trifactor hospitals had better short-term outcomes after lung and pancreatic cancer surgery compared with nontrifactor hospitals.

Quality trifactor hospitals had better short-term outcomes after lung and pancreatic cancer surgery compared with nontrifactor hospitals.

The PowerFlow implantable apheresis intravenous port is a venous access device for therapeutic apheresis procedures. Brincidofovir solubility dmso In this case review article, we identify key similarities and differences between apheresis PowerFlow ports and traditional ports. We also list strategies that emergency departments can implement to aid in correct port identification.

Using a case review format, we describe the clinical presentation of a 33-year-old female with neuromyelitis optica who was evaluated in the emergency department for an acute exacerbation. She had a history of outpatient apheresis procedures that made use of bilateral PowerFlow ports. Mistaken for a conventional port, the right PowerFlow port was accessed with a Huber needle rather than the appropriate catheter-over-needle device. On infusion of intravenous fluids, the patient experienced pain and swelling. Ultimately, the port malfunctioned and was eventually replaced.

A subsequent root cause analysis identified opportunities for education and aids to improve port identification. To this end, strategies were implemented to appropriately identify the PowerFlow port using at least 2 of the following methods (1) look in the patient's chart for record of an implantable apheresis intravenous port; (2) check the port identification card, bracelet, or keychain issued at insertion; (3) palpate the port to look for the rounded top and hollow concave entry point; and (4) use x-ray or fluoroscopy to identify radiopaque port markers.

When a patient with a history of apheresis procedures presents with an implanted port, steps should be taken to ensure correct identification and access.

When a patient with a history of apheresis procedures presents with an implanted port, steps should be taken to ensure correct identification and access.