Rejected

Fast-track or enhanced recovery after surgery (ERAS) pathways are evidence-based perioperative guides that promote stress reduction and earlier return to function following surgery. They emphasize preoperative counseling, nutrition optimization, analgesia standardization, fluid and electrolyte balance, minimally invasive approaches, and early ambulation. Although ERAS pathways were implemented in 2016 on a 43-bed postoperative colorectal medical-surgical unit, inpatient stays remained beyond the projected two-day length of stay (LOS). A quality improvement team was formed and an eight-week pilot project was initiated in 2018. The project included the implementation of a laminated bedside goals-to-discharge checklist in the immediate postoperative period.

To investigate the influence of physical and psychosocial working conditions on the risk of disability pension among eldercare workers.

Electrical neuromodulation by deep brain stimulation (DBS) is a well-established method for treatment of severe essential tremor (ET). The mechanism behind the tremor relieving effect remains largely unknown. Our aim of this study was to evaluate alterations in proteomics pre- and post-DBS in patients diagnosed with severe ET.

There are currently no standardised guidelines on the optimum dressing used for graft donor sites. The aim was to compare the outcomes of human amniotic membrane (HAM) vs routine dressings in split-thickness skin graft (STSG) donor site healing. A systematic review and meta-analysis was performed and a search of electronic information was conducted to identify all randomised controlled trials comparing the outcomes of HAM vs routine dressings in STSG donor sites. Wound healing and infection rate were primary outcome measures. Secondary outcome measures included severity of pain, discharge from donor site, the number of dressing changes, pruritus, and comfort. Fixed effect modelling was used for the analysis. Four studies enrolling 157 patients were identified. There was a significant difference between HAM and routine groups with wound healing time (P < .0001) and proportion of wounds healed by day 12 (P = .01). There was no significant difference between the two groups in infection rates (P = .27). For all secondary outcomes, HAM had improved results. HAM dressings are a superior option when compared with routine dressings used in current clinical practice for STSG donor sites as they improve wound healing and do not increase the infection rate.

Epidermolysis bullosa pruriginosa (EBP; MIM#604129) is a rare clinical subtype of autosomal dominant (or less commonly recessive) dystrophic epidermolysis bullosa (DEB). In addition to usual manifestations of DEB including trauma-induced skin fragility, milia and nail dystrophy, EBP features severe pruritus, prurigo nodularis (PN) and lichen simplex chronicus-like lesions which may resemble other dermatoses and thereby complicate clinical diagnosis. Like other types of DEB, EBP results from heterozygous or bi-allelic mutations in the gene COL7A1 encoding collagen VII which is the main component of the anchoring fibrils.

Myofascial pain syndrome is a chronic syndrome that occurred in a local or focal part of the body. The basis for myofascial pain syndrome is the presence of myofascial trigger point or points, producing pain in clinical examinations.

This study aims to evaluate the effects of physical therapy modalities five days a week versus twice a week with a three-day interval on pain, depression, and functional disability in patients with chronic mechanical low back pain.

Troponin is a crucial biomarker for the diagnosis of an acute coronary syndrome (ACS). It rises in response to myocardial injury from significant acute myocardial ischaemia caused by obstructive coronary artery disease ['classical' myocardial infarction (MI)]. However, raised levels have also been noted in conditions not recognized as classical ACS. This may include MI with non-obstructed coronary arteries such as takotsubo cardiomyopathy and other acute or chronic conditions such as pulmonary embolus or chronic kidney disease. This is commonly labelled as a 'falsely elevated' troponin although there is some myocardial strain to explain the rise, such as an increase in cardiac oxygen demand. True 'falsely elevated' troponin, characterized by a persistent elevation in the absence of cardiac injury does occur and thought to be secondary to an immunoglobulin-troponin complex (macrotroponin).

Intrathecal morphine administration at the time of neuraxial anesthesia performance is the gold standard for post-cesarean delivery (CD) analgesia. When intrathecal morphine administration is inappropriate or contraindicated, the use of systemic analgesic options increase side effects and risks to both the parturient and the breastfeeding neonate. Moreover, systemic analgesia is often inadequate. The increased clinical use of ultrasound has made way for regional analgesia techniques, mostly in the form of local anesthesia injected between muscular planes. The transversus abdominis plane (TAP) block is the most well-known and the most commonly used for Cesarean delivery. It has been shown to be effective in the absence of intrathecal morphine administration. It has however, not been shown to be beneficial when intrathecal morphine has been administered. Other, newer techniques are being increasingly used and investigated. Some may prove to be superior to the TAP block. These techniques include: ilioinguinal/ilio-hypogastric nerve blocks (II-IH), the quadratus lumborum (QL) blocks and the erector spinae plane (ESP) block. In this review, we will discuss and assess these techniques regarding analgesia following CD.