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The US Food and Drug Administration's Sentinel System was established in 2009 to use routinely collected electronic health data for improving the national capability to assess post-market medical product safety. Over more than a decade, Sentinel has become an integral part of FDA's surveillance capabilities and has been used to conduct analyses that have contributed to regulatory decisions. FDA's role in the COVID-19 pandemic response has necessitated an expansion and enhancement of Sentinel. Here we describe how the Sentinel System has supported FDA's response to the COVID-19 pandemic. We highlight new capabilities developed, key data generated to date, and lessons learned, particularly with respect to working with inpatient electronic health record data. Early in the pandemic, Sentinel developed a multi-pronged approach to support FDA's anticipated data and analytic needs. It incorporated new data sources, created a rapidly refreshed database, developed protocols to assess the natural history of COVID-19, validated a diagnosis-code based algorithm for identifying patients with COVID-19 in administrative claims data, and coordinated with other national and international initiatives. Sentinel is poised to answer important questions about the natural history of COVID-19 and is positioned to use this information to study the use, safety, and potentially the effectiveness of medical products used for COVID-19 prevention and treatment.This study tests the effects of supplementation of high-dosing Aspergillus oryzae phytase into the corn-wheat-soybean meal (SBM)-based basal diet on growth performance, nutrient digestibility, faecal gas emission, carcass traits and meat quality in growing-finishing pigs (29.73-110.86 kg live weight; 70-day-old to 166-day-old). A total of 56 crossbred pigs [(Landrace × Yorkshire) × Duroc] were divided into two dietary groups for a 96-day experiment (growing period, days 0-42; finishing period, days 43-96) with a completely randomized block design. There were seven replicate pens in each dietary group, and each pen has four pigs (two barrows and two gilts). The dietary treatments consisted of a corn-wheat-SBM-based nutrient sufficient basal diet or the basal diet supplemented with 1500 FTU/kg A. oryzae phytase. One phytase unit (FTU) was defined as the amount of enzyme that catalyses the release of one micromole phosphate from phytate/min at 37°C and pH 5.5. Higher average daily gain and lower feed conversion ratio were observed in growing-finishing pigs consuming a high-dosing A. oryzae phytase supplementing diet during days 0-42 and 0-96. Supplementing high-dosing A. oryzae phytase to the diet of growing-finishing pigs increased apparent total tract digestibility of phosphorus on days 42 and 96. Moreover, growing-finishing pigs fed the diet supplemented with high-dosing A. oryzae phytase had higher carcass back-fat thickness than those fed the control diet. However, the faecal gas emission and meat quality were not affected by high-dosing A. oryzae phytase supplementation. In conclusion, dietary supplementation of high-dosing A. oryzae phytase (1500 FTU/kg) had beneficial effects on the growth performance, apparent phosphorus digestibility and carcass back-fat thickness in growing-finishing pigs.

We aim to audit our institution's opioid prescribing practices after common cervical procedures.

Retrospective cohort study from one medical center. Reviewed records from 2016-2019 for 472 patients who underwent one of several common cervical procedures. Data collected on demographics, perioperative details, in-hospital pain medication use, and opioids prescribed at discharge. Multivariable logistic regression was run.

In hospital, median daily milligram morphine equivalents (MME) was 4 (IQR 0-15). Median MME prescribed at discharge was 112.5 MME (IQR 75-150). 3/472 patients received NSAIDs. Predictors of decreased discharge MME were age 70 and older (OR 0.33, p = 0.037) and more recent year (compared to 2016, OR 0.23 [p = 0.031] for 2017, OR 0.13 [p = 0.001] for 2018, and OR 0.070 [p < 0.001] for 2019).

MME prescribed at discharge was 28 times the daily in-hospital MME. Only 3/472 patients received postoperative NSAIDs. Self-auditing of opioid prescribing practices identifies actionable items for change.

MME prescribed at discharge was 28 times the daily in-hospital MME. Only 3/472 patients received postoperative NSAIDs. Self-auditing of opioid prescribing practices identifies actionable items for change.

To investigate the association between work-family conflicts and career development with resilience among nurses.

Nurses tend to have high levels of work-family conflict. Resilience may affect their individual career development, the stability of the nursing team and the quality of nursing care.

A cross-sectional survey using correlational design was conducted in mainland China. Data were collected using demographic and career development questionnaire, work-family conflict and resilience scale.

A total of 70,932 nurses were included. The total score for work-family conflict was relatively high (38.37±12.82). Work-family conflict of nurses had a significant negative correlation with career development (r=-0.35, p<.001) and with resilience (r=-0.23, p < .001), while resilience had a significant positive correlation with career development (r=0.62, p<.001). Resilience plays a mediating role between work-family conflict and career development.

The work-family conflict had a significant negative correlation with career development among nurses. Resilience has a mediating role between work-family conflict and career development. Nursing managers could reduce the level of work-family conflict by enhancing nurses' resilience.

Nursing managers should prioritize the improvement of resilience through training and education, enhancing nurses' ability to address work-family conflicts.

Nursing managers should prioritize the improvement of resilience through training and education, enhancing nurses' ability to address work-family conflicts.Sutureless aortic bioprostheses were introduced more than ten years ago, with the aim of decreasing cross-clamp time and thus becoming the first choice in older patients for many surgeons. However, published data are limited to a 5-year follow-up, and some cases of deterioration have already been described. High-risk patients who once have benefitted from a fast sutureless aortic replacement and now are experiencing a prosthesis dysfunction, could take advantage of a percutaneous Valve-in-Sutureless technique. Furthermore, thanks to technological improvement, new transcatheter prostheses have been designed, allowing a more precise positioning. read more In this report, we described the first Myval-in-Perceval case, which resulted in a safe and effective procedure.