Rejected

Although medicine and nursing are complementary and equally important, paradoxically the relationship can appear adversarial at times. Physicians and nurses work concurrently and conjointly in hospitals where patients are admitted for round-the-clock nursing care to help cure or attenuate diseases. Roles are further obscured for advanced practice nurses and physicians when they perform the same function, such as in the practice of anesthesia. Regarding physician-nurse relationships, the following questions become apparent:Why do these professions compete over the right to take care of patients? Where and when did this conflict originate? Answers are complicated and multifactorial. This commentary briefly reviews the history of the establishment of medicine and nursing, discusses gender roles, and summarizes differences in education and training between the two disciplines.

Acute and chronic pain account for high costs both societally and economically, estimated in the United States to be $635 billion. Untreated or undertreated acute pain is associated with substantial morbidity and may become chronic pain. Surgical patients are at an increased risk of long-term opioid use or addiction. Overdose from drugs of abuse, including opioids, is the leading cause of death due to injury in the United States. Traditional pain management strategies for acute and chronic pain have focused on opioid medications, which are often associated with severe side effects. Cryoneurolysis is a minimally invasive, nonsurgical, nonpharmacologic pain management technique that uses cold temperatures to ablate the sensory nerves that cause pain. Because of its safe and reversible nature, cryoneurolysis should be considered as part of a multimodal pain management plan in patients experiencing pain originating from sensory nerves.

The management of pain in surgical patients has shifted in recent years from a technique grounded in opioid administration, to a multimodal method that uses the analgesic properties of many drugs to minimize required narcotics. Multimodal analgesia has demonstrated a benefit in patient outcomes following a surgical procedure. Also of consideration is the fact that multimodal analgesia allows for less opioid to be administered to achieve acceptable pain scores, in turn reducing a patient's exposure to a potentially addicting substance. Dexamethasone is a corticosteroid that has been widely used in the perioperative setting to prevent postoperative nausea and vomiting. The analgesic properties of dexamethasone have not been as widely acknowledged. A review of literature was conducted. Multiple studies were found that demonstrated dexamethasone's ability to lower postoperative pain scores and reduce the amount of opioids required to achieve adequate pain scores. Single doses of dexamethasone have demonstrated safety with minimal side effects that would be expected from corticosteroid administration. Although an elevation in blood glucose levels is seen, this is likely of little clinical significance. No difference is seen in wound healing or rates of wound infection compared with control groups.

We investigate how distinct residential environments uniquely influence chronic child disease. Aggregating over 200,000 pediatric geocoded medical records to the census tract of residence and linking them to neighborhood-level measures, we use multiple data analysis techniques to assess how heterogeneous exposures of social and environmental neighborhood conditions influence an index of child chronic disease (CCD) prevalence for the neighborhood. We find there is a graded relationship between degree of overall neighborhood disadvantage and children's chronic disease such that the highest neighborhood CCD scores reside in communities with the highest concentrated disadvantage. Finally, results show that higher levels of neighborhood concentrated disadvantage and air pollution exposure associate with higher risks of having at least one chronic condition for children after also considering their individual- and family-level characteristics. Overall, our analysis serves as a comprehensive start for future researchers interested in assessing which neighborhood factors matter most for child chronic health conditions.

Acute inpatient treatment of severe burns. Acute in-hospital care of severely burned patients intricately combines surgery and intensive care. Systemic and supportive care is centered on hemodynamic management of the initial plasmorrhagic shock, airway control, enteral nutrition in order to compensate for hypercatabolism, analgesia and adjuncts. Infection is a major risk, to be prevented and managed topically. Sytemic administration of antibiotics is limited to documented sepsis. Smoke inhalation injury is diagnosed by fiberoptic bronchoscopy and managed with protective ventilation, iterative bronchoscopic cleansing, and nebulized heparin, mucolytics and bronchodilators. Emergent surgery in the burned patient includes initial treatment of associated trauma, escharrotomies, and fasciotomies in selected cases. Acute surgery is centered on early excision and skin autografts to restore cutaneous integrity. Reconstructive surgery is delayed.

Chitosan, the N-deacetylated derivative of chitin, has useful biological properties that promote haemostasis, analgesia, wound healing, and scar reduction; chitosan is bacteriostatic, biocompatible, and biodegradable. This study determined the efficacy of chitosan derivative film as a superficial wound dressing.

Forestier Disease, or Diffuse Idiopathic Skeletal Hyperostosis (DISH), causes a considerable ossification of the anterior longitudinal ligament of the spine. When it involves cervical segments, it can be accompanied by dysphagia, dysphonia and/or dyspnea. This entity usually has a benign course. Surgical treatment is required for progressive cases. We report a 72-year-old male with a history of chronic cervical pain and slight neck stiffness. On the imaging studies, there was an exuberant ossification of the anterior longitudinal ligament, at the cervical spine level, between C2 and C7. He was managed conservatively without clinical deterioration in a six-year follow-up.

Between 30 to 59% of patients with migraine without aura are undiagnosed and improperly treated, because primary care physicians are either too busy or unfamiliar with criteria for diagnosing migraine.

The oral thrombopoietin (TPO) receptor agonist lusutrombopag (Mulpleta®) was developed to improve thrombocytopenia in patients with chronic liver disease prior to elective invasive medical procedures. Mulpleta® was first approved for use in Japan in 2015 and in the USA in 2018. In the present report, we discuss a case in which pain management was performed during left renal artery embolization via continuous epidural anesthesia following oral administration of lusutrombopag. To our knowledge, this is the first report to discuss the use of lusutrombopag prior to epidural anesthesia.

Pre-existing poor respiratory function is a significant challenge for women to successfully continue pregnancy and accomplish delivery.