Latest news with #tertiaryCare
Medscape
07-07-2025
- Health
- Medscape
Surgery Resolves Limb Movements in Pediatric Sleep Apnea
TOPLINE: Periodic limb movements in sleep (PLMS) were found to be common in children with obstructive sleep apnea (OSA), with age and severity of OSA influencing its prevalence. In most cases, adenotonsillectomy effectively resolved PLMS. METHODOLOGY: Researchers conducted a retrospective study to evaluate the prevalence of PLMS in children with OSA and assess the effect of adenotonsillectomy on these movements. They enrolled 1159 children (median age, 5 years; 58.3% boys) with OSA who underwent adenotonsillectomy between January 2022 and July 2023 at a tertiary care children's hospital. The severity of OSA was categorized using the obstructive apnea-hypopnea index as mild (1-4 events per hour), moderate (5-9 events per hour), or severe (10 or more events per hour). Elevated periodic limb movement index (PLMI) was measured as PLMS per hour before and after adenotonsillectomy, with an elevated PLMI defined as more than 5 events per hour. TAKEAWAY: Children older than 5 years had a higher prevalence of an elevated PLMI than those younger than 5 years (odds ratio, 0.3; P < .001). The odds of elevated PLMI were 2.3 times higher in children with moderate OSA (P = .007) and 1.9 times higher in those with severe OSA (P = .01) than in those with mild OSA. The PLMI significantly reduced after adenotonsillectomy (11.9 vs 2.9; P ≤ .001). Among 54 children with an elevated PLMI who underwent follow-up polysomnography, 85% showed resolution after adenotonsillectomy. Children with residual OSA had a higher PLMI than those without residual OSA (P = .04). IN PRACTICE: 'The potential clinical implications of our findings are the consideration of AT [adenotonsillectomy] for the initial management of children with OSA and elevated PLMI and counseling caregivers regarding the treatment of elevated PLMI,' the authors of the study wrote. SOURCE: This study was led by Amor Niksic, University of Texas Southwestern Medical Center, Dallas. It was published online on June 07, 2025, in The Laryngoscope. LIMITATIONS: The retrospective study design limited data collection on sleep characteristics, patient symptoms, the impact of adenotonsillectomy on symptoms, and serum ferritin levels. Additionally, the small number of children who underwent polysomnography before and after adenotonsillectomy may have affected the detection of differences in subgroup analyses. DISCLOSURES: The authors reported receiving no specific funding for this work and reported having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
27-06-2025
- Health
- Medscape
Local Anesthesia Pain: A Predictor of Post-Cesarean Pain?
TOPLINE: A higher intensity of pain during infiltration of local anesthesia during cesarean delivery was associated with increased pain at 24 hours postpartum and lower global health ratings, although the quality of recovery scores remained unaffected. METHODOLOGY: Researchers conducted a prospective observational study at a university-affiliated tertiary care center between August 2019 and September 2023 to evaluate local anesthesia pain as a predictor of severity of post-cesarean pain and recovery quality. A total of 114 women (median age, 32 years; 52.6% White) undergoing cesarean delivery with neuraxial anesthesia were included in the final analysis. Pain during infiltration of local anesthesia was assessed prior to the neuraxial procedure using a numerical rating scale of 0-100 after lidocaine injection, and participants were categorized into mild (n = 83), moderate (n = 24), and severe (n = 7) pain groups on the basis of their scores. The primary outcome was postoperative pain assessed at 24 hours postpartum, using six pain scores (average and peak pain at rest, with movement, and with uterine cramping). Secondary outcomes were recovery, assessed using the 11-item Obstetric Quality of Recovery questionnaire (ObsQoR-11), and a global health rating, evaluated with numerical rating scale scores of 0-100, with the numbers indicating worst and best imaginable health states, respectively. TAKEAWAY: Significant differences were found among the three pain groups for all primary outcomes. Average and peak pain at rest (P = .0002 and P = .003, respectively), as well as peak pain during movement (P = .002), were significantly associated with pain during infiltration of local anesthesia. Global health ratings were significantly different among the pain groups, but ObsQoR-11 scores were not. Only the global health rating showed a significant association with local anesthesia pain (P = .008). The study found low sensitivity but high specificity in using pain scores during infiltration of local anesthesia for predicting severe post-cesarean pain and poor recovery at 24 hours post-cesarean delivery. IN PRACTICE: 'Our findings underscore the potential of ILA [infiltration of local anesthesia] as only one component of a multifactorial approach to predicting postoperative pain,' the researchers reported. SOURCE: The study was led by Christine McKenzie, MD, of the University of North Carolina at Chapel Hill. It was published online on June 20, 2025, in the International Journal of Obstetric Anesthesia. LIMITATIONS: The single-center design and focus on scheduled cesarean deliveries may limit the generalizability of the findings. The low number of patients reporting severe pain during local anesthesia infiltration may have affected the study's power. The study did not account for anxiety or other mental health conditions, which may affect the internal validity of the findings. DISCLOSURES: The authors reported having no conflicts of interest or funding sources for this study. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
09-05-2025
- Health
- Medscape
Cancer Pain Most Common Symptom Before Acute Care Visits
Pain, nausea, and vomiting were the most frequently documented symptoms preceding unplanned acute care visits in patients with cancer, new research showed. Women, individuals from racial minority groups, and those with Medicaid insurance were more likely to have a high symptom burden, although men and White patients accounted for most of the visits. METHODOLOGY: Many patients with cancer require unplanned acute care, including emergency department (ED) visits and hospitalizations, due to complications from their disease or treatment. These encounters affect outcomes, quality of life, and healthcare costs. However, little is known about symptom patterns preceding such visits. A cohort study conducted at a single tertiary-care institution analyzed outcomes from 28,708 adult patients with cancer who had symptoms documented in the 30 days before an acute care visit. Researchers used natural language processing to scan clinical notes for symptoms recorded in the 30 days before an ED visit or hospital stay. High symptom burden was defined as more than 10 different symptoms noted during that time. The primary outcomes were symptom burden and characterization of symptoms preceding acute care visits. Secondary outcomes included associations between symptom burden and sociodemographic characteristics (sex, race and ethnicity, age, and insurance type). TAKEAWAY: Overall, 70,606 acute care encounters were observed, and 854,830 symptoms were documented before an acute care visit. Men had 53.6% of the acute care encounters, and White patients had about 56.6%. The top 10 most common documented symptoms were pain (7.54%), nausea (6.74%), vomiting (5.79%), fatigue (5.26%), constipation (3.93%), fever (3.39%), generalized muscle weakness (3.32%), extremity edema (3.28%), dyspnea (3.12%), and headache (2.92%). Women (adjusted odds ratio [aOR], 1.14); patients of Asian (aOR, 1.22), Black (aOR, 1.17), and American Indian or Alaska Native (aOR, 1.21) races; and Medicaid-insured patients (aOR, 1.10) were significantly more likely to have a documented high symptom burden. Patients aged 65 years or older (aOR, 0.96) and those without insurance (aOR, 0.58) were significantly less likely to have a documented high symptom burden preceding an acute care visit. IN PRACTICE: 'This analysis highlights differences in cancer symptom documentation across racial, sex, and socioeconomic subgroups, suggesting potential areas of disparities. This raises attention to the potential need to develop targeted interventions to ensure equitable access to health care for improved symptom management,' the authors wrote. SOURCE: This study, led by Chichi Chang, MEng, Bakar Computational Health Sciences Institute, University of California San Francisco, was published online in JAMA Network Open . LIMITATIONS: The limitations included retrospective design, single-center study, potentially incomplete data, and a predominantly White and insured population. Natural language processing methods could have limitations in accurately capturing complex clinical documentation. Repeated visits by the same patients might have biased symptom data. DISCLOSURES: This study received support from a National Cancer Institute of the National Institutes of Health grant, a Conquer Cancer Career Development Award, and a University of California San Francisco Computational Cancer Award. One author reported providing paid services to Epi-Vant Consulting, outside the submitted work. Another author reported receiving grants from Roche, outside the submitted work.
