Expert consensus on the clinical application of robotic-assisted bronchoscopy

Background: Rehabilitation Nursing assumes a fundamental role in contemporary society in the response to the installation of new paradigms of chronic illness and dependence, induced by demographic aging and the advent of a large number of associated comorbidities. Health indicators sensitive to Rehabilitation Nursing care reflect how these nurses contribute to the health of the population in order to achieve health gains. It is necessary to define and contribute to the ontology of aging, which will allow, using machine learning processes, to provide foundations for knowledge acquisition and support for professional decision-making. Objective: To determine the indicators to be included in the ontology of aging, in relation to nursing care of rehabilitation of dependent elderly people in self-care with various comorbidities. Methods: A systematic review of the literature was carried out. Articles published between 2012 and 2017 were selected by searching the MEDLINE, CINAHL and MedicLatina database, using PI [C] OS methodology, resulting in the selection of 11 articles. Results: We identified 30 sensitive indicators of Rehabilitation Nursing care in relation to the dependent person in self-care with comorbidity. As a proposal for inclusion in the ontology of aging. From the qualitative synthesis of the indicators, improvements were observed in the variables: Readaptation and Functional Reeducation; Wellness and Self Care; Symptom Control; Prevention of Complications; Psychological Support; Customer Satisfaction; Use of Health Services; Quality of Life; Promotion of Social Inclusion; Self-management of Disease and Health Promotion. Conclusions: This systematic review of the literature, which is part of the development of an ontology of aging and its integration into the discipline of Rehabilitation Nursing, aims to provide valid contributions to the corpus of knowledge on which its practice is based. The recognition of indicators sensitive to rehabilitation nursing care is an opportunity for reflection on praxis and a means of conducting to excellence in care and the development of the ontology of aging in international terms.

Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis.

The purpose of this article was to review current literature on peri-operative pain management in hip arthroscopy. A systematic review of the literature on pain control in hip arthroscopy published January 2008 to December 2018 was performed. Inclusion criteria consisted of English language or articles with English translations, subjects undergoing hip arthroscopy with documented peri-operative pain control protocols in studies reporting Level I to IV evidence. Exclusion criteria were non-English articles, animal studies, prior systematic review or meta-analyses, studies not reporting peri-operative pain control protocols, studies documenting only pediatric (<18 years of age) patients, studies with Level V evidence and studies including less than five subjects. Statistical analysis was performed to assess pain protocols on narcotic consumption in PACU, VAS score on discharge, time to discharge from PACU and incidence of complications. Seventeen studies were included, comprising 1674 patients. Nerve blocks were administered in 50% of patients (n = 838 of 1674), of which 88% (n = 740 of 838) received a pre-operative block while 12% (n = 98 of 838) post-operative block. Sixty-eight complications were recorded: falls (54%, n = 37), peripheral neuritis (41%, n = 28), seizure (1.5%, n = 1), oxygen desaturation and nausea (1.5%, n = 1) and epidural spread resulting in urinary retention (1.5%, n = 1). No significant differences in narcotic consumption, VAS score at discharge, time until discharge or incidence of complication was found based on pain control modality utilized. No statistically significant difference in PACU narcotic utilization, VAS pain scores at discharge, time to discharge or incidence of complications was found between peri-operative pain regimens in hip arthroscopy.

Retained reservoirs can be a complex problem for clinicians who manage patients with inflatable penile prostheses (IPPs). Although the general safety of retained reservoirs is well documented, data on the long-term outcomes of these foreign bodies is scarce. In recent years, complications associated with retained reservoirs and the subsequent management of these cases have become more recognized. To review, analyze, and summarize the concept of retained reservoirs and their associated complications with retained reservoirs and to provide a guide for management of complicated retained reservoir patients. We performed a systematic review of the PubMed database on retained reservoir-related complications and perioperative management. We reviewed all publications that detailed complications associated specifically with retained penile prosthesis reservoirs and analyzed perioperative strategies used by providers. Any publication outlining IPP reservoir-related complication(s) stemming from a reservoir that was part of a functioning IPP was excluded. Although the risk is low, serious complications can and do arise from retained reservoirs. To properly manage these patients, clinicians must have knowledge of the prosthetic history and maintain a low threshold for obtaining cross-sectional imaging. By using methodical perioperative planning, the need for reintervention in patients with complications can be reduced, and improved surgical outcomes can be achieved. The management of retained reservoirs and their complications can be a clinical challenge for prosthetics providers. As such, more data regarding long-term outcomes and management strategies of retained reservoirs are required to better serve this subset of patients with prostheses. Reddy AG, Tsambarlis PN, Akula KP, etal. Retained Reservoirs of Inflatable Penile Prosthesis: A Systematic Review of Literature. Sex Med Rev 2020;8:355-363.

The Multimodal Imaging in Uveitis (MUV) project is a comprehensive initiative aimed at developing guidelines for the use of multimodal imaging (MMI) in diagnosing and managing noninfectious posterior uveitis (NIPU). This project seeks to develop standardized guidelines and a minimal imaging set leading to evidence and consensus-based imaging guidelines that are applicable across diverse clinical settings. This manuscript describes the overall goals and methodology of the project. Descriptive study. The MUV project was structured into 7 phases: (1) a global survey to assess current practices and the need for standardized MMI criteria, (2) study design planning to define research questions and establish expert committees, (3) systematic review of the literature, (4) evidence and consensus-building on imaging guidelines through the Nominal Group Technique (NGT), (5) agreement with proposed guidelines by task force and development of consensus statements for use of MMI in the diagnosis and monitoring of NIPU, (6) standardizing the endpoints of inflammation on imaging in NIPU and (7) prospective validation of MMI criteria, using formal consensus techniques, to achieve supermajority agreement. The initial survey revealed that nearly 90% of uveitis and retina specialists already incorporate MMI into their diagnostic process for NIPU, with strong support for standardized practices. The NGT phase formulated and achieved statements on imaging guidelines of MMI, findings that were further substantiated by the systematic review. The final guidelines, proposed by the NGT and approved by the task force, offer a standardized framework for utilizing MMI in NIPU. This was a key aspect of this patient-focused update. The MUV project introduces a formalized set of guidelines for MMI use in NIPU, enhancing and extending the Standardization of Uveitis Nomenclature (SUN) classification framework. The comprehensive guidelines developed through this initiative will standardize the use of MMI in clinical practice, which should lead to optimal use of imaging for more accurate diagnoses, better monitoring of disease activity, and improved management of complications.

Residents’ journal review

Evaluation of surgeon and patient radiation exposure by imaging technology in patients undergoing thoracolumbar fusion: systematic review of the literature

BackgroundRaynaud’s phenomenon (RP) and digital ulcer (DU) are prominent features of SSc. According to the 2017 EULAR recommendations, intravenous (IV) iloprost (ILO) may be used for RP and DU after...

Background Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions. Methods An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items. Results Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic. Conclusions Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the “ideal” medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.

Spanish consensus statement on the diagnosis and treatment of sialorrhoea in children with cerebral palsy.

BackgroundPrimary Atopic Disorders (PAD) represent a recently recognized subset of inborn errors of immunity (IEI), characterized by severe atopy driven by genetic mutations leading to dysregulated type 2 immune responses, excessive mast cell activation, and hyper production of IgE. In PAD patients, severe atopic manifestations, including eczema, asthma, food allergies, and eosinophilic gastrointestinal disorders, are often associated with other signs of immune dysfunction.MethodsRecognizing the need for standardized diagnostic and management guidelines for PAD, a Delphi‐based expert consensus was developed within the Immunology Committee of the Italian Society of Pediatric Allergy and Immunology (SIAIP). After a systematic review of the literature and the development of the clinical statements, 45 specialists from multiple pediatric subspecialties reached an agreement on key aspects of PAD classification, diagnosis, and treatment.ResultsThe consensus focuses on some red flags that could aid clinicians in suspecting PAD. The document also proposes a diagnostic work‐up to differentiate monogenic PAD from polygenic allergic conditions. It also emphasizes the importance of molecular pathway analysis to direct precision treatments, including biological drugs. Given the complexity of the field and the potential overlap between PAD and other IEI, the consensus recommends a multidisciplinary approach to diagnosis and treatment. The document establishes a framework for early recognition of PAD, integrating emerging genetic insights into clinical practice and promoting personalized therapeutic strategies.ConclusionsThe present work is the first structured consensus to standardize PAD diagnosis and management among pediatric subspecialists, aiming to improve patient outcomes through early intervention and tailored therapies.

Suicide signs have been identified by expert consensus and are relied on by service providers, community helpers’ and family members to identify suicidal men. Whether signs that are reported in suicide literature accurately describe male presentations of suicidality is unclear. A systematic review of the literature was conducted to identify male-specific signs of current suicidality and identify gaps in the literature for future research. Searches through Medline, CINAHL, PsychInfo and the Behavioral Sciences Collection, guided by the PRISMA-P statement, identified 12 studies that met the study eligibility criteria. Although the results generally reflected suicide signs identified by expert consensus, there is little research that has examined male-specific signs of the current suicidal state. This review highlights the need for scientific research to clarify male presentation of suicidality. Implications for future research to improve the prompt identification of suicidal men are discussed.

Actinic keratoses (AK) arise on sun-exposed regions of the skin. If left untreated, AK may progress to invasive squamous cell carcinoma (SCC), although the rate of progression is low. A practical treatment algorithm for the treatment of AK in standard situations has been published by the AKTeam™ expert panel. However, management of particular situations of AK with increasing/higher carcinoma risk or AK progressing into carcinomas with increased aggressiveness due to their anatomical location (risky areas), or in patients with an increased risk of SCC requires further discussion. These include AK on the dorsal hands, forearms, legs, periorbital region, eyelids, ears, or lips, and organ transplant recipients, patients undergoing treatment with carcinogenic agents and patients with chronic lymphocytic leukaemia. The main objective was to propose therapeutic strategies for the treatment of AK located in risky areas and in patients with more invasive/aggressive lesions and a higher risk of progression to SCC. A systematic review of the literature was initially performed, and results were discussed by the experts to propose best management practices in specific situations. Finally, adapted management strategies for AK occurring in risky areas and in high-risk patients are presented, taking into account the experts' own clinical experience and current guidelines. In most of these 'at-risk' situations, patients can be treated according to the AKTeam™ treatment algorithm. Difficult-to-treat lesions should be treated more aggressively due to their higher risk of transformation. For patients with skin that is highly susceptible to actinic damage, monitoring and sun protection strategies are mandatory, and patients should undergo more regular follow-up. Further assessment of newer therapies in clinical trials is necessary to determine optimal treatment conditions. This expert consensus provides guidance for the management of AK in risky body sites and in patients with an increasing/higher risk for SCCs.

Image-guided navigation has existed for nearly 3 decades, but its adoption to craniofacial surgery has been slow. A systematic review of the literature was performed to assess the current status of navigation in craniofacial surgery. A Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) systematic review of the Medline and Web of Science databases was performed using a series of search terms related to Image-Guided Navigation and Craniofacial Surgery. Titles were then filtered for relevance and abstracts were reviewed for content. Single case reports were excluded as were animal, cadaver, and virtual data. Studies were categorized based on the type of study performed and graded using the Jadad scale and the Newcastle-Ottawa scales, when appropriate. A total of 2030 titles were returned by our search criteria. Of these, 518 abstracts were reviewed, 208 full papers were evaluated, and 104 manuscripts were ultimately included in the study. A single randomized controlled trial was identified (Jadad score 3), and 12 studies were identified as being case control or case cohort studies (Average Newcastle-Ottawa score 6.8) The most common application of intraoperative surgical navigation cited was orbital surgery (n = 36), followed by maxillary surgery (n = 19). Higher quality studies more commonly pertained to the orbit (6/13), and consistently show improved results. Image guided surgical navigation improves outcomes in orbital reconstruction. Although image guided navigation has promise in many aspects of craniofacial surgery, current literature is lacking and future studies addressing this paucity of data are needed before universal adoption can be recommended.

Background: Pheochromocytoma, a rare endocrine tumor, produces substantial quantities of catecholamines, leading to severe cardiovascular complications. Perioperative management for its surgical resection entails significant risks. This case report, detailing the anesthetic and perioperative management of a giant pheochromocytoma excision, underscores the complexity inherent in managing these tumors and emphasizes the critical importance of employing multiple monitoring modalities for dynamic assessment to guide timely therapeutic interventions. Case Report: We report a case of a 31-year-old female patient who presented with abdominal pain and was found to have a large mass in the left retroperitoneal adrenal region. The diagnosis of pheochromocytoma was confirmed by plasma catecholamine assays and high-resolution computed tomography (HRCT). Following preoperative pharmacologic preparation with alpha-adrenergic blockade, surgical resection of the tumor was performed. Intraoperatively, the patient developed significant hemodynamic instability, notably persistent hypotension after tumor removal that was refractory to empirical management. Combined transesophageal echocardiography (TEE) and pulse index continuous cardiac output (PiCCO) monitoring were employed for comprehensive assessment of cardiac function and volume status. Real-time guidance from this multimodal monitoring facilitated dynamic adjustments to the therapeutic strategy, enabling goal-directed hemodynamic support. Ultimately, the patient experienced an uncomplicated postoperative course. Conclusion: This article integrates the features of the presented case with a systematic review of the literature on pheochromocytoma, comprehensively summarizing key diagnostic considerations, therapeutic strategies, and perioperative management protocols to serve as a clinical reference.