Rejected

Pneumonia is the third most common surgical complication after urinary tract infection and wound infections. In addition to increased mortality, patients who develop postoperative pneumonia have a higher risk of prolonged hospital stay, intensive care unit (ICU) admissions, and higher healthcare costs. Obesity and chronic obstructive pulmonary disease (COPD) are both independent risk factors for the development and severity of postoperative pneumonia, although the combined effect of these comorbidities is unknown. Therefore, we evaluated whether the combination of severe obesity and COPD is associated with an increased risk of postoperative pneumonia.

Delirium is defined by the DSM-5 as a fluctuating course of disturbance in attention, cognition, and awareness that develops over a short period without any pre-existing neurocognitive disorder. As people age, there is an increased risk of complications that may occur following a surgical procedure and one such acute complication is delirium. Studies are emerging to reduce the incidence of postoperative delirium, and one such preventive measures implemented in recent years include the administration of dexmedetomidine, a high selectivity α-2 adrenoceptor agonist. This study aims to review the efficacy of Dexmedetomidine in the prevention of postoperative delirium in randomized controlled trials in patients older than 18 years of age. The literature was explored in three online databases, namely, PubMed, Science Direct, and Scopus. Appropriate keywords and MesH terms were employed to scrutinize relevant articles that demonstrated the effects of dexmedetomidine in the prevention of postoperative delirium. The data was restricted to randomized controlled trials and clinical trials published from 2017 to 2021 in human patients older than >18 years of age undergoing non-cardiac-related procedures. The randomized clinical trials were critically assessed with the Cochrane risk of bias tool. We proceeded to screen 428 records with the assessment of the PRISMA chart and filtered out 420 papers to obtain a total of eight studies where we identified data such as sample size, types of surgeries in which the patients were involved, the delirium assessment tool, the plan of the administration of dexmedetomidine and the outcomes evaluated in each study. The Confusion Assessment Method (CAM) was the prevailing assessment tool used with the sole purpose to evaluate the incidence of postoperative delirium as the primary outcome, and assessment of inflammatory cytokines, sleep quality, and pain scales were considered as secondary outcomes. The dosage of dexmedetomidine varied among studies, and it displayed varying impacts on postoperative delirium and the secondary outcomes as well. Limitations include varying ages and ethnicities of the population. It was concluded that dexmedetomidine prevents the development of postoperative delirium in elderly patients undergoing non-cardiac surgical interventions by modulating important predisposing factors such as neuroinflammation, pain, and sleep quality. No funding was made for this study.

Individuals with opioid use disorder (OUD) use the emergency department (ED) at high rates. Medication treatment for OUD (MOUD) is associated with reduced ED utilization. However, individuals receiving MOUD still utilize ED services at higher rates than the general population. The objective of this study is to compare the psychosocial and clinical characteristics of those who do and do not utilize ED services based on the Healthy People 2030 framework regarding social determinants of health (SDoH) among a sample of individuals receiving MOUD.

An estimated 15%-25% of patients with chronic low back pain may in fact suffer from sacroiliac (SI) joint dysfunction. SI joint fusion has become a common treatment option for the management of SI joint dysfunction. However, little is known about opioid use prior to and after surgical treatment in this patient population.

Medical profession is demanding and requires long working hours, lengthy procedures, and constant posturing. Musculoskeletal disorders are common among health care professionals (HCP). The commonest musculoskeletal disorders reported include pain in the neck, back, shoulders, elbows, wrists, repetitive strain disorders, nerve injuries and chronic pain disorders. It can result in reduced performance, poor quality of life and significant disability. Ergonomics is the science of adapting the job, equipment, and the humans to each other for optimal safety and productivity. If workplace of a HCP is ergonomically inadequate it will lead to musculoskeletal disorders. The main ergonomic issues include sustained postures, repetitive tasks, forceful hand exertions, use of equipment and precision requirement. In order to prevent ergonomic related injuries, there is a need to increase awareness among HCPs regarding physical fitness, correct posturing, ergonomic adjustments in equipment and environment, and early recognition of problems specific to field.

One of the most challenging problems facing orthopedic surgeons is persistent pain after surgery and certainly is just as frustrating following hindfoot fusion. The hindfoot joints consist of the subtalar, talonavicular, and calcaneocuboid (CC) joints. These joints are commonly fused for degenerative changes, deformity correction, inflammatory or neuropathic arthropathy, tarsal coalition, or primarily after trauma. Goals of hindfoot fusion are a painless plantigrade foot capable of fitting in shoes without orthotics or a brace. Many believe that deformity correction is achievable without inclusion of the CC joint. Managing patient expectations is important when counseling a patient especially regarding potential complications.

Keloids are a chronic disease and cause pain, pruritus, and limitation of motion. Intralesional corticosteroid injection is the first-line treatment, but its effects can be limited, even with repeated injections.

Procedural sedation is a common procedure performed in the emergency department and is a fundamental skill for emergency clinicians. With a wide variety of procedures and patient populations, procedural sedation can be systematically tailored to individual patients' needs, in order to optimize safety and efficacy. This evidence-based review distinguishes the various levels of sedation, provides insight on which patients are appropriate for procedural sedation, lists adjuncts that should be used, and reviews considerations for special populations. The differences between the most frequently utilized medications are presented, as well as a discussion of documentation requirements and discharge criteria.

The ability to actively control movements of the lumbar spine (LMC) is believed to play an important role in non-specific chronic low back pain (NSCLBP). However, because NSCLBP is a multifactorial problem and LMC a complex ability, different aspects of LMC are still debated including the influence of pain, the question whether LMC is a cause or consequence of NSCLBP or whether differences in LMC are due to population variance. The complexity of LMC is reflected in the large number of described tests, hence it is not possible to evaluate LMC by a single test. LMC ability should be understood as a latent construct. The structure of LMC and how to summarize results of different single LMC tests is unknown. The dataset provided in this article was used to analyse the structural validity of LMC in NSCLBP. 277 participants (age 42.4 years (± 15.8), 61% female) performed 15 different test movements. 21 experienced physiotherapists rated the performance of each test movement on a nominal scale (correct/incorrect including the direction of test movement). A test was rated as "incorrect" if movement in the lumbar spine occurred prematurely and/or excessively based on the visual observation of a trained physiotherapist. In addition to the judgement whether the test performance was correct/incorrect the direction of test movement and the presence of pain was noted. For statistical analysis, raw data was converted to a binary scale (correct/incorrect). Item response theory (IRT) is recommended to analyse the data because the underlying statistical model is reflective, the single LMC tests are binary scaled (correct/incorrect) and the underlying ability (LMC) measured on a continuous scale. First dimensionality and local independence were analysed, followed by selection of the best fitting IRT model. Finally, IRT modelling was used to describe the psychometric properties of each item and each battery of tests. The datasets provided in this article are useful for calibration and for group comparisons. Besides they support a better understanding of LMC. ***Link to publication of original article in "musculoskeletal science and practice"**.