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Background: This review explores the potential benefits of combining totally endoscopic and robotic-assisted cardiac surgery with minimally invasive extracorporeal circulation (MiECC). Robotic techniques herald a new era of surgical precision, leveraging advanced instrumentation and enhanced visualization to navigate cardiac anatomy with unprecedented accuracy. Purpose: Concurrently, MiECC systems provide tailored physiological support during cardiopulmonary bypass, meticulously managing perfusion parameters to safeguard vital organs' function. Results: The convergence of these cutting-edge technologies marks a paradigmatic shift in cardiac surgical practice, with potential mitigation of invasiveness, attenuation of perioperative complications, and expedite postoperative recovery. Conclusions: This review also addresses prevailing challenges and limitations, including technological complexities and procedural intricacies, while elucidating the strategic imperatives for optimizing their collaborative utilization.

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The COVID-19 pandemic has significantly impacted hematopoietic stem cell transplantation (HSCT), necessitating adaptations across pre-transplant, transplantation, and post-transplant phases. HSCT recipients with compromised immune systems face heightened risks of severe COVID-19 outcomes, including increased mortality. The pandemic prompted significant changes in treatment strategies, with many patients experiencing delays or deferrals in autologous stem cell transplantation (ASCT), alongside adjustments to chemotherapy regimens to prevent disease recurrence. Clinical practices have evolved to address pandemic-related challenges, including a decrease in allo-HSCT procedures, a shift towards using domestic donors and peripheral blood stem cells over bone marrow grafts, and integration of telemedicine to reduce patient burden. These adaptations aim to balance COVID-19 exposure risks with the need for lifesaving HSCT. Innovations in response to the pandemic include stringent infection control measures, modified conditioning regimens, and revised post-transplant care protocols to mitigate infection risks. The importance of optimizing antiviral treatments, exploring new immunomodulatory interventions, and researching broadly neutralizing antibodies for HSCT recipients has been underscored. Despite the difficulties, the pandemic has catalyzed significant learning and innovation in HSCT practices, emphasizing the need for ongoing adaptation and research to protect this vulnerable patient population.

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BACKGROUND: Effective medication adherence is vital for managing acute myocardial infarction (AMI) and enhancing patient well-being. This study aimed to evaluate medication adherence levels and associated factors among AMI patients using standardized assessment tools. METHODS: Employing a cross-sectional descriptive design, the study involved 210 patients diagnosed with acute myocardial infarction. Participants completed the General Medication Adherence Scale (GMAS), Hospital Anxiety and Depression Scale (HADS), and provided socio-demographic details. RESULTS: The study revealed partial adherence to medications among AMI patients, with mean scores of 24.89 (± 3.64) out of 33. Notably, good adherence was observed in non-adherence due to patient behavior (mean ± SD = 11.8 ± 2.3 out of 15) and additional disease burden (mean ± SD = 8.65 ± 2.21 out of 12), while partial adherence was noted in non-adherence due to financial constraints (mean ± SD = 4.44 ± 1.34 out of 6). Patients reported mild anxiety (mean ± SD = 8.38 ± 2.81) and no depressive symptoms (mean ± SD = 7.43 ± 2.42). Multiple linear regression analysis indicated that employed status, younger age, shorter duration of MI, lower anxiety, and depression levels were associated with higher medication adherence. However, factors such as monthly income, gender, educational level, and marital status did not predict medication adherence. CONCLUSION: The study highlights the significance of addressing anxiety and depression levels and considering socio-demographic factors when designing interventions to enhance medication adherence among AMI patients. Further research is needed to explore additional determinants of medication adherence and develop tailored interventions to improve patient outcomes post-AMI.

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Background: In healthcare systems prioritizing care of older adults, resource limitations and escalating demand often impede access to outpatient specialized geriatric services. Objectives: This study, theoretically guided by the Consolidated Framework for Implementation Research (CFIR), aimed to explore barriers and facilitators in implementing a centralized "Geri-Hub." The Geri-Hub is a centralized intake system established within 2 hospital systems to coordinate outpatient and community-based services for older adults, aiming to connect them with the most appropriate care in a timely manner. Methods: Qualitative insights were gathered from healthcare professionals at 2 academic institutions in the process of consolidating services. Through open-ended surveys and semi-structured interviews, we solicited feedback on referral management, waiting times, and overall work experiences. Results: Thirteen frequently referring providers and a cohort of 9 geriatricians, along with 4 administrators, contributed to the study. Geriatricians emphasized streamlined referrals, flexible scheduling for urgent cases, and a target wait time of 3 months. Administrators stressed standardized referral procedures, defined roles, and accessible referral information. Discussion: The findings underscored the need for straightforward referral processes, enhanced communication on referral statuses, and reduced wait times. Optimizing these processes could potentially mitigate resource utilization issues and improve patient outcomes in healthcare systems. This research highlights the critical role of timely access to geriatric services during transformative phases in healthcare delivery.

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Spine surgery is essential for restoring alignment, stability, and function in patients with cervical spine injuries, especially when instability, pain, deformity, or progressive nerve damage is present. Effective wound closure is vital in these procedures, aiming to promote rapid healing, reduce infection risks, enable early mobilization, and ensure satisfactory cosmetic results. However, there is limited evidence on the optimal wound closure technique for posterior spine surgery, highlighting the need for innovative approaches. A study by Glener et al. evaluated the effectiveness of STRATAFIX™ Symmetric barbed sutures compared to traditional braided absorbable sutures in spinal surgery. In a randomized trial involving 20 patients, the STRATAFIX™ group demonstrated a shorter mean closure time and significantly fewer sutures used, though without a statistically significant reduction in closure time. No significant differences were observed in postoperative complications between the groups during a six-month follow-up. While the findings suggest potential cost savings and efficiency improvements with STRATAFIX™, the study's small sample size and short follow-up period limit its generalizability. Furthermore, AI-based models, such as the Xception deep learning model, show promise in improving suture training accuracy for medical students, which could enhance surgical outcomes and reduce complications. Despite the promising results, further research with larger sample sizes, extended follow-up periods, and multi-center trials is necessary to validate the effectiveness of barbed sutures like STRATAFIX™ in neurosurgery. The integration of AI in surgical training and continued exploration of innovative techniques are essential to advancing the field and optimizing patient care in spinal surgery.

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Background: Transcatheter atrial septal defect (ASD) closure is the primary approach for treating ASD secundum; however, data on long-term outcomes remain limited. This study aimed to elucidate the prevalence of adverse outcomes following transcatheter ASD closure in a diverse population. Methods: This retrospective cohort study was conducted at the Songklanagarind Hospital and included patients who underwent transcatheter ASD closure between January 2010 and August 2021. Results: The study included 277 patients who completed follow-up for at least 1 year, with varying ages: <25 years (31%), 25-40 years (19%), 40-60 years (34%), and >60 years (16%). The median follow-up duration was 37 months (interquartile range: 20, 61). The overall mortality rate was 1.8%, and no deaths were attributed to device-related complications. Hospitalization due to heart failure occurred in 0.7% of the cases. Most patients improved or stabilized based on the New York Heart Association functional class. Adverse outcomes included new-onset atrial fibrillation (prevalence: 2.7%) and pulmonary hypertension (prevalence: 0.6%). The resolution of pulmonary hypertension varied among age groups, with 100% resolution in patients <25 years. Multivariate analysis identified male sex, overweight, and history of stroke to be significantly associated with adverse outcomes after transcatheter ASD closure. Conclusion: Transcatheter ASD closure was safe and effective, with age not being a limiting factor for success. Male sex, being overweight, and a history of stroke were associated with adverse outcomes. These findings contribute to our understanding of the long-term outcomes following ASD closure.

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PURPOSE OF REVIEW: There is an incomplete understanding regarding the extent of endoscopic sinus surgery (ESS) in managing chronic rhinosinusitis (CRS) and its effect on outcomes. This study aimed to assess and compare limited sinus surgery, full-house, extended and radical ESS for optimizing CRS outcomes. RECENT FINDINGS: An online search in adherence with PRISMA guidelines was performed. Data were pooled for meta-analysis. Forty-six articles met inclusion criteria. Full-house ESS yielded greater improvements in SNOT-22 and endoscopy scores over limited ESS. Radical ESS improved nasal symptoms and reduced disease recurrence more than full house ESS, while extended ESS decreased revision ESS rates when compared to full-house ESS. Total ethmoidectomy reduced SNOT-22 scores more than limited ethmoidectomy. There was no difference in perioperative complications for all extents of ESS. When compared to limited ESS, full-house ESS yielded better patient symptom outcomes. Radical ESS demonstrated even greater reductions in nasal symptoms, while extended ESS additionally decreased revision surgery rates. Thus, in general, greater extent of ESS leads to better outcomes, while all extents of ESS are relatively safe.

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Despite legal protections guaranteeing care for patients with trauma, disparities exist in patient outcomes. We review disparities in patient management and outcomes related to insurance status, race and ethnicity, and gender for patients with trauma in the preadmission, in-hospital, and postdischarge settings. We highlight groups understudied and either underrepresented or unrepresented in national trauma databases-including American Indians/Alaska Natives, non-English preferred patients, and patients with disabilities. We call for more study of these groups and of upstream factors affecting the reviewed demographics to measure and improve outcomes for these vulnerable populations.

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OBJECTIVES: Postgraduate education for primary care dentists offers numerous benefits in terms of advancing clinical skills and career opportunities, culminating in improved treatment and patient outcomes. There is a strong desire amongst primary care dentists to enhance skills and provide contemporaneous evidence-based dentistry, accredited by higher educational qualifications. However, significant barriers hinder their pursuit of further training and career advancement. The aim of this study is to explore the barriers to undertaking formal postgraduate education for dental practitioners working in primary dental care. Exploration of these perceptions should help to identify further areas of study to help alleviate some of these obstacles, enabling more primary care dentists to access postgraduate education and improve patient care. METHOD: A qualitative study was undertaken through individual narrative interviews with primary care dental practitioners (n = 20) with varying levels of experience and located across the UK. All interviews were conducted using a study guide, transcribed and analysed thematically. RESULTS: The participants indicated that there is a strong desire to undertake postgraduate study amongst primary care dental practitioners. Significant barriers were identified, with three major themes emerging: 1.Personal Cost: Time constraints and accessibility, Financial Burden, Family Commitments. 2.Business Viability: Business time constraints, Inability to use Enhanced Skills, Remuneration systems. 3.Business Culture and Team Dynamics: Stage of Career, Current Practice Business Model, Leadership and Vision. These barriers appear to be multifaceted and interconnected, however participants also identified significant opportunities to address them. CONCLUSION: Study participants identified a range of personal and professional barriers to undertaking postgraduate dental education whilst working in primary dental care. Practitioners working within predominately NHS orientated practices perceived more professional barriers than those in private practice. The majority of participants indicated their preference for hybrid models of education which would work around clinical commitments. Further research and engagement with stakeholders should be undertaken to help reduce these barriers.

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PURPOSE: Chordomas are rare malignant neoplasms primarily treated surgically. Disparities related to race and socioeconomic status, may affect patient outcomes. This study aims to identify prognostic factors for access to care and survival in patients with spinal chordomas. METHODS: The NCDB database was queried between the years 2004 and 2017. Kaplan-Meier curves were constructed to compare survival probabilities among different groups, based on race and socioeconomic determinents. RESULTS: 1769 patients were identified, with 87% being White, 5% Hispanic, 4% Black, and Asian each. The mean age was 61.3 years. Most patients received care at academic/research centers and lived in a large metropolitan area, with no difference between races. A significantly higher percentage of Black patients did not undergo surgery (p < 0.001), with no statistically significant difference in survival between races (p = 0.97). A higher survival probability was seen in patients with other government insurances (p < 0.0001), in higher income quartiles (p < 0.0001), in metropolitan areas (p = 0.023), and at an academic/research center (p < 0.0001). A lower survival probability was seen in patients who are uninsured, in rural areas, and at community cancer programs (p < 0.0001). CONCLUSION: This study highlights disparities in access to surgical intervention for patients with spinal chordomas, especially among Black individuals. It emphasizes the significant impact of insurance status and income on access to surgical care and highlights geographical and institutional variations in survival rates. Addressing socioeconomic differences is crucial for fostering equity in neurosurgical outcomes.

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BACKGROUND: Epilepsy requires continuous management and treatment to optimize patient outcomes. The advancement of digital health has led to the development of various mobile health (mHealth) tools designed to enhance treatment adherence among individuals with epilepsy. These solutions offer crucial support through features such as reminders, educational resources, personalized feedback, assistance with managing costs, shared decision-making, and access to supportive communities. To design effective medication adherence mHealth solutions, it is essential to evaluate the effectiveness of existing mHealth tools, understand the unique circumstances of different patients, and identify the roles of health care professionals within the digital care pathway. Existing studies on epilepsy primarily focus on self-management, whereas the effectiveness and usability of medical adherence mHealth solutions often remain overlooked. Furthermore, the involvement of health care professionals in digital care pathways for epilepsy as well as the impact of adherence mHealth solutions on the patient experience have not been adequately explored. OBJECTIVE: This study aims to assess the effectiveness of current mHealth solutions designed to improve medical adherence among patients with epilepsy. Furthermore, the study will examine the experiences of patients using mHealth solutions for maintaining medical adherence in epilepsy care. Finally, this review intends to determine the roles of health care professionals within mHealth systems aimed at supporting adherence to medication among patients with epilepsy. METHODS: A systematic literature review has been selected as the appropriate method to address the research questions, adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion and exclusion criteria have been carefully selected, and both qualitative and quantitative analyses will be used to analyze the results. The expected results will mainly focus on the comparison, classification, and analysis of the effectiveness of current medical adherence mHealth tools. Moreover, the patient experiences using available medical adherence mHealth tools for epilepsy will be assessed. Finally, the role of health care professionals in the epilepsy digital care pathway will be explored, with emphasis on medical adherence. RESULTS: The initial search, full-text screening, and data extraction have been carried out. Thirty-three papers were included in the final stage of the review. The study is expected to be completed by October 2024. CONCLUSIONS: To enhance the digital care pathway for epilepsy, a medical adherence mHealth solution should be personalized, manage medications, include an alarm system, track seizures, support consultations, and offer updated treatment plans. This study aims to understand how findings from the research questions can improve mHealth solutions for individuals with epilepsy. Insights from this research on the effectiveness of current mHealth adherence solutions will provide guidance for developing future mHealth systems, making them more efficient and effective in managing epilepsy. TRIAL REGISTRATION: PROSPERO CRD4202347400; https://tinyurl.com/48mfx22e. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55123.

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INTRODUCTION: Enhanced recovery after surgery (ERAS) protocols are an evidence-based, multidisciplinary, and systematic approach to peri-operative care, which attempt to reduce the anticipated physiological strain on patients after major surgery. This meta-analysis of randomised clinical trials (RCTs) evaluated the impact of ERAS following emergency laparotomy versus standard care. METHODS: A systematic review was performed as per PRISMA guidelines. Meta-analysis was performed using RevMan v5.4. RESULTS: Six RCTs involving 509 patients were included. Patients randomised to ERAS had reduced post-operative nausea and vomiting (PONV) (odds ratio (OR): 0.32, 95 â€‹% confidence interval (CI): 0.20-0.51), time to ambulation (mean difference (MD): 1.67, 95 â€‹% CI: -2.56 to -0.78) and bowel opening (MD: -1.26, 95 â€‹% CI: -2.03 to -0.49), length of stay (LOS) (MD: -2.92 95 â€‹% CI: -3.73 - - 2.10), pulmonary complications (OR: 0.43, 95 â€‹% CI: 0.24-0.75), surgical site (OR: 0.33 95 â€‹% CI: 0.2-0.50) and urinary tract infections (OR: 0.48 95 â€‹% CI: 0.19-1.16). CONCLUSION: ERAS successfully reduced patient recovery, LOS, and complications. ERAS protocols should be deployed, where feasible, for emergency laparotomy.

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Despite a national decline in teenage pregnancy rates, Latinx and Black individuals continue to have higher teenage birth rates compared with White teens. In the United States, Latinx females (ages 15-19) are more than twice as likely to have a teenage birth compared with non-Latinx White teens. With an increasingly diverse nation, a shift toward culturally inclusive approaches to care is critical to achieving equitable patient outcomes. Improving access to preventive care, workforce diversity, and insurance coverage will lead to cost-savings and help restore trust in a system that has failed past generations. In this commentary, targeted recommendations tailored specifically toward Latinx women will be provided, including culturally competent birth control counseling and a focus on reproductive justice. Not speaking English, low socioeconomic status, acculturation, legal status, and being uninsured are all teenage pregnancy risk factors unique to Latinx women. Cultural preferences and attitudes toward contraception must also be considered. Further expansion of Medicaid insurance coverage is also necessary to increase reproductive access among vulnerable populations. A cultural humility framework to reproductive health counseling and services is recommended. Within this framework, family engagement is encouraged, and women are free from reproductive coercion; they have the freedom to access over-the-counter contraception and receive guidance and support from providers and community health workers who are cognizant of culture and heritage. An integrated community-based approach that is culturally sensitive and in tune with Latinx heterogenicity is necessary to lower teenage pregnancy rates and achieve reproductive justice.

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Urban-rural disparities in medical care, including in home healthcare, persist globally. With aging populations and medical advancements, demand for home health services rises, warranting investigation into home healthcare disparities. Our study aimed to (i) investigate the impact of rurality on home healthcare quality, and (ii) assess the temporal disparities and the changes in disparities in home healthcare quality between urban and rural home health agencies (HHAs), incorporating an analysis of geospatial distribution to visualize the underlying patterns. This study analyzed data from HHAs listed on the Centers for Medicare and Medicaid Services website, covering the period from 2010 to 2022. Data were classified into urban and rural categories for each HHA. We employed panel data analysis to examine the impact of rurality on home healthcare quality, specifically focusing on hospital admission and emergency room (ER) visit rates. Disparities between urban and rural HHAs were assessed using the Wilcoxon test, with results visualized through line and dot plots and heat maps to illustrate trends and differences comprehensively. Rurality is demonstrated as the most significant variable in hospital admission and ER visit rates in the panel data analysis. Urban HHAs consistently exhibit significantly lower hospital admission rates and ER visit rates compared to rural HHAs from 2010 to 2022. Longitudinally, the gap in hospital admission rates between urban and rural HHAs is shrinking, while there is an increasing gap in ER visit rates. In 2022, HHAs in Mountain areas, which are characterized by a higher proportion of rural regions, exhibited higher hospital admission and ER visit rates than other areas. This study underscores the persistent urban-rural disparities in home healthcare quality. The analysis emphasizes the ongoing need for targeted interventions to address disparities in home healthcare delivery and ensure equitable access to quality care across urban and rural regions. Our findings have the potential to inform policy and practice, promoting equity and efficiency in the long-term care system, for better health outcomes throughout the USA.

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BACKGROUND: Inflammatory bowel disease (IBD) can have orthopaedic manifestations related to decreased bone mineral density and increased fracture risk. The impact of IBD-spectrum diseases, including Crohn's disease (CD) and ulcerative colitis (UC), on the overall performance of total hip arthroplasty (THA), is not well understood. The present study sought to evaluate whether patients who have IBD were at an increased risk of THA failure compared to those who did not have IBD. METHODS: The Statewide Planning and Research Cooperative System was used to compare postoperative outcomes between patients who have IBD (CD and UC) and patients who do not have IBD from 2010 to 2020. A total of 119,094 patients were included in the study, of whom 1,165 had a diagnosis of IBD. Overall, 501 of those had CD, while 664 had UC. RESULTS: When controlling for comorbidities, patients who had CD had longer hospital length of stay (CD: 3.6 ± 2.5 versus UC: 3.4 ± 2.1 versus control: 3.2 ± 2.3 days, P < 0.001), higher rates of 90-day readmission (CD: 13.6 versus UC: 8.3 versus control: 7.7%, P < 0.001) and 1-year readmission (CD: 20.4 versus UC: 15.1 versus control: 12.8%, P < 0.001), and higher rates of 90-day emergency room visits (CD: 15.4 versus UC: 12 versus control: 11.1%, P = 0.007). There were no differences in all-cause revision or revision for periprosthetic joint infection between CD and UC compared with control patients. CONCLUSIONS: Patients who have UC had more emergency room visits and hospital readmissions following THA; however, survival analysis demonstrated that IBD patients are not at an increased risk of revision or periprosthetic joint infection after THA.

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Most patients diagnosed with oral squamous cell carcinoma (OSCC) present with locally advanced stages, which are typically associated with poor outcomes. Although immunotherapy offers potential improvements in patient survival, its efficacy is hampered by low response rates. The microbiome is widely involved in tumor immunity and may play a role in immunotherapy. This study aimed to investigate the potential association between the oral (salivary) microbiome and immunotherapy response in patients with OSCC. Salivary metagenome sequencing was performed on 47 patients with OSCC undergoing neoadjuvant immunotherapy (NAIT) in a clinical trial (NCT04649476). Patients were divided into responders and nonresponders based on their pathological responses. The results showed that the species richness of the salivary microbiome was lower in the nonresponders before NAIT than in the responders. Differential analysis revealed that nonresponders exhibited a lower relative abundance of 34 bacterial species and a higher relative abundance of 4 bacterial species. Notably, low levels of Eubacterium infirmum, Actinobaculum, and Selenomas (EAS) in the saliva may be associated with the nonresponse of patients with OSCC to NAIT. A nomogram based on EAS was developed and validated to determine the efficacy of NAIT. The area under the curve for the training cohort was 0.81 (95% confidence interval, 0.66 to 0.81). Quantitative polymerase chain reaction confirmed that low levels of salivary EAS effectively identified nonresponders to NAIT. Furthermore, the low abundance of salivary EAS was closely correlated with a low density of intratumoral CD4+, CD14+, CD68+, and FOXP3+ cells. Metabolic functional annotation revealed numerous biosynthetic processes associated with EAS that were more active in responders. In summary, this study provides valuable data resources for the salivary microbiome and reveals that nonresponders have different salivary microbiome profiles than responders do before NAIT. Low salivary EAS levels can serve as potential biomarkers for distinguishing nonresponders from responders.

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Hernia repair surgery is a common procedure to address the protrusion of organs or tissues through weakened muscles or connective tissue. This review compares two prominent surgical techniques for hernia repair: the Rives-Stoppa repair and bilateral inguinal hernioplasty. The Rives-Stoppa repair involves a posterior approach with extensive mesh placement suitable for complex and recurrent hernias. In contrast, bilateral inguinal hernioplasty focuses on simultaneously repairing bilateral hernias, potentially reducing operative time and enhancing recovery. This review examines each approach's technical aspects, including incision methods, mesh placement, and closure techniques. Patient outcomes, such as postoperative pain, recovery time, recurrence rates, and quality of life, are critically analyzed based on current research and clinical data. Economic considerations are also evaluated, encompassing each technique's cost-effectiveness and economic impact. By synthesizing these findings, this review aims to provide valuable insights for surgeons, healthcare providers, and policymakers in optimizing hernia repair strategies. The evolving landscape of surgical techniques and materials underscores the importance of ongoing research to refine practices and improve outcomes for patients undergoing hernia repair surgery.

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BACKGROUND: Chronic systemic anticoagulation use is prevalent for various thromboembolic conditions. Anticoagulation (usually through heparin products) is also recommended for the initial management of non-ST-elevation myocardial infarction (NSTEMI). AIMS: To evaluate the in-hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation. METHODS: Using the National Inpatient Sample (NIS) years 2016-2020, NSTEMI patients and patients with chronic anticoagulation were identified using the appropriate International Classification of Diseases, 10th version (ICD-10) appropriate codes. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included major bleeding, ischemic cerebrovascular accident (CVA), early percutaneous coronary intervention (PCI) (i.e., within 24 h of admission), coronary artery bypass graft (CABG) during hospitalization, length of stay (LOS), and total charges. Multivariate logistic or linear regression analyses were performed after adjusting for patient-level and hospital-level factors. RESULTS: Among 2,251,914 adult patients with NSTEMI, 190,540 (8.5%) were on chronic anticoagulation. Chronic anticoagulation use was associated with a lower incidence of in-hospital mortality (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.65-0.73, p < 0.001). There was no significant difference in major bleeding (aOR: 0.95, 95% CI: 0.88-1.0, p = 0.15) or ischemic CVA (aOR: 0.23, 95% CI: 0.03-1.69, p = 0.15). Chronic anticoagulation use was associated with a lower incidence of early PCI (aOR: 0.78, 95% CI: 0.76-0.80, p < 0.001) and CABG (aOR: 0.43, 95% CI: 0.41-0.45, p < 0.001). Chronic anticoagulation was also associated with decreased LOS and total charges (adjusted mean difference [aMD]: -0.8 days, 95% CI: -0.86 to -0.75, p < 0.001) and (aMD: $-19,340, 95% CI: -20,692 to -17,988, p < 0.001). CONCLUSIONS: Among patients admitted with NSTEMI, chronic anticoagulation use was associated with lower in-hospital mortality, LOS, and total charges, with no difference in the incidence of major bleeding.

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OBJECTIVE: This study aimed to determine the direct and indirect costs of sickle cell disease (SCD) in Saudi Arabia. METHODS: Data were collected from 217 participants aged ≥18 years in the eastern region of Saudi Arabia, using a prevalence-based cost-of-illness approach. The Institute for Medical Technology Assessment Medical Consumption Questionnaire and Institute for Medical Technology Assessment Productivity Cost Questionnaire were used to assess costs. A multistage process was used, encompassing patient data collection over 3 months, cost calculation from clinic visits and drug prices, and extrapolation for annual estimates. RESULTS: The study revealed substantial societal costs of SCD, with an average per-patient cost of SAR181 899 (US$48 506), covering healthcare and productivity losses. Healthcare costs, including hospitalization, informal care, and medication, averaged SAR80 306 (US$21 415). In addition, productivity costs, including unpaid work and presenteeism, averaged SAR101 594 (US$27 092). Obtaining higher levels of education, such as a diploma and BSc degree or higher, has been found to significantly decrease the costs associated with SCD (P = .016, P = .001). Furthermore, when comparing different employment statuses, students (B = -0.301, P = .058) were found to have marginally lower SCD costs, suggesting that their expenses were lower than those of individuals in other employment categories. The predictive model used in this study explained 11.2% of the variation in costs. CONCLUSION: Our study highlights a significant economic burden of SCD in Saudi Arabia and highlights the need for targeted strategies to alleviate financial challenges and improve patient well-being.

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Complex regional pain syndrome (CRPS) is a multifaceted condition characterized by chronic neuropathic pain, allodynia, and hyperalgesia. The incidence of CRPS postoperatively is alarmingly high, particularly following carpal tunnel surgeries, Dupuytren's fasciectomy, and repairs of wrist and hand fractures, with recurrence rates soaring in individuals with a history of CRPS. Despite extensive research, the management of CRPS remains complicated, highlighting the urgent need for effective prevention strategies. This scoping review aimed to consolidate current evidence surrounding the efficacy of perioperative anesthetic techniques in preventing new-onset or recurrent CRPS, focusing on the application of various anesthetic interventions. Through a comprehensive literature search, eight articles were identified, discussing a spectrum of techniques, including wide awake local anesthesia no tourniquet (WALANT) and various regional blockade methods. This review revealed that the WALANT technique, with its simplicity and lower costs, exhibited promising results in preventing CRPS. Conversely, techniques involving intravenous regional and axillary plexus blocks showed variable efficacy, necessitating further investigation. The scarcity of high-quality evidence underscores the critical need for meticulously designed, large-scale randomized controlled trials to validate these findings and explore the potential of stellate ganglion block in the prevention of recurrent CRPS.