Managing Selected Chronic Conditions in Hospitalized Patients.

The management of chronic illnesses should continue during hospitalization. Some chronic conditions require immediate intervention, whereas intensification of therapy for other conditions may be delayed until after discharge. Factors such as pain, anxiety, poor sleep hygiene, and concurrent illness can result in a transient elevation of blood pressure. Acute lowering of blood pressure in hospitalized patients who do not have target-organ damage is not recommended and may lead to harm. If treatment is needed, intravenous antihypertensive agents should be avoided. Patients with diabetes mellitus require continued management of their blood glucose while hospitalized. Noninsulin agents are typically discontinued. Blood glucose levels should be managed using basal, prandial, and/or correction insulin. During hospitalization, conservative blood glucose targets (140 to 180 mg per dL) are preferred vs. lower targets to reduce length of stay, mortality, and the risk of hypoglycemic events in critically ill patients. Alcohol use disorder is common and hospitalization for other conditions necessitates identification and management of alcohol withdrawal syndrome. The mainstay of therapy for alcohol withdrawal syndrome is benzodiazepines; however, phenobarbital is an alternative treatment option. The risk of venous thromboembolic disease is significantly increased for hospitalized patients. Venous thromboprophylaxis is recommended for all but low-risk patients. Pharmacologic prophylaxis with subcutaneous low-molecular-weight heparin is preferred; mechanical prophylaxis is an alternative for patients who are at high risk of bleeding or have contraindications to anticoagulation.

CROS or hearing aid? Selecting the ideal solution for unilateral CI patients with limited aidable hearing in the contralateral ear.

A hearing aid or a contralateral routing of signal device are options for unilateral cochlear implant listeners with limited hearing in the unimplanted ear; however, it is uncertain which device provides greater benefit beyond unilateral listening alone. Eighteen unilateral cochlear implant listeners participated in this prospective, within-participants, repeated measures study. Participants were tested with the cochlear implant alone, cochlear implant + hearing aid, and cochlear implant + contralateral routing of signal device configurations with a one-month take-home period between each in-person visit. Audiograms, speech perception in noise, and lateralization were evaluated. Subjective feedback was obtained via questionnaires. Marked improvement in speech in noise and non-implanted ear lateralization accuracy were observed with the addition of a contralateral hearing aid. There were no significant differences in speech recognition between listening configurations. However, the chronic device use questionnaires and the final device selection showed a clear preference for the hearing aid in spatial awareness and communication domains. Individuals with limited hearing in their unimplanted ears demonstrate significant improvement with the addition of a contralateral device. Subjective questionnaires somewhat contrast with clinic-based outcome measures, highlighting the delicate decision-making process involved in clinically advising one device or another to maximize communication benefits.

Distress in the care of people with chronic low back pain: insights from an ethnographic study.

Introduction: Distress is part of the experiences and care for people with chronic low back pain. However, distress is often pathologised and individualised; it is seen as a problem within the individual in pain and something to be downplayed, avoided, or fixed. To that end, we situate distress as a normal everyday relational experience circulating, affecting, moving in, through, and across bodies. Challenging practices that may amplify distress, we draw on the theorisation of affect as a relational assemblage to analyse physiotherapy clinical encounters in the care of people with chronic low back pain. Methods: Adopting a critical reflexive ethnographic approach, we analyse data from a qualitative project involving 15 ethnographic observations of patient-physiotherapist interactions and 6 collaborative dialogues between researchers and physiotherapists. We foreground conceptualisations of distress- and what they make (im)possible-to trace embodied assemblage formations and relationality when caring for people with chronic low back pain. Results: Our findings indicate that conceptualisation matters to the clinical entanglement, particularly how distress is recognised and navigated. Our study highlights how distress is both a lived experience and an affective relation-that both the physiotherapist and people with chronic low back pain experience distress and can be affected by and affect each other within clinical encounters. Discussion: Situated at the intersection of health sociology, sociology of emotions, and physiotherapy, our study offers a worked example of applying an affective assemblage theoretical framework to understanding emotionally imbued clinical interactions. Viewing physiotherapy care through an affective assemblage lens allows for recognising that life, pain, and distress are emerging, always in flux. Such an approach recognises that clinicians and patients experience distress; they are affected by and affect each other. It demands a more humanistic approach to care and helps move towards reconnecting the inseparable in clinical practice-emotion and reason, body and mind, carer and cared for.

Bilateral Erector Spinae Plane Blocks versus Bilateral Transversus Abdominis Plane Blocks in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis.

Postoperative pain associated with abdominal surgeries impairs physical function, delays recovery, and decreases quality of life. Regional anesthetic techniques such as transversus abdominis plane (TAP) block and erector spinae plane (ESP) block are used to improve patients' postoperative pain experiences. PubMed, CINAHL, Google Scholar, Cochrane Library, and gray literature were searched. Mean difference (MD) and risk ratio were used to estimate continuous and dichotomous variables. Quality of evidence was analyzed using Risk of Bias and GRADE. Sixteen studies involving 934 patients were analyzed. Compared with TAP block, ESP reduced resting (MD, -0.83; 95% confidence interval [CI], -1.02 to -0.64; P < .00001) and dynamic pain intensity (MD, -0.71; 95% CI, -0.93 to -0.50; P < .00001) in the first 24 hours lowered postoperative opioid consumption (MD, -4.52; 95% CI, -5.99 to -3.04; P < .00001) and prolonged the time to first rescue analgesic (MD, 3.18; 95% CI, 2.43 to 3.93; P < .00001). However, ESP was similar to TAP block for intraoperative opioid consumption, and the incidence of nausea or vomiting. Although the ESP block provided statistical superiority over the TAP block for acute pain management, the clinical relevance of the differences was small.

Prediction of the Response of a Photoionization Detector to a Complex Gaseous Mixture of Volatile Organic Compounds Produced by α-Pinene Oxidation.

Photoionization detectors (PIDs) are lightweight and respond in real time to the concentrations of volatile organic compounds (VOCs), making them suitable for environmental measurements on many platforms. However, the nonselective sensing mechanism of PIDs challenges data interpretation, particularly when exposed to the complex VOC mixtures prevalent in the Earth's atmosphere. Herein, two approaches to this challenge are investigated. In the first, quantum-chemistry calculations are used to estimate photoionization cross sections and ionization potentials of individual species. In the second, machine learning models are trained on these calculated values, as well as empirical PID response factors, and then used for prediction. For both approaches, the resulting information for individual species is used to model the overall PID response to a complex VOC mixture. In complement, laboratory experiments in the Harvard Environmental Chamber are carried out to measure the PID response to the complex molecular mixture produced by α-pinene oxidation under various conditions. The observations show that the measured PID response is 15% to 30% smaller than the PID response modeled by quantum-chemistry calculations of the photoionization cross section for the photo-oxidation experiments and 15% to 20% for the ozonolysis experiments. By comparison, the measured PID response is captured within a 95% confidence interval by the use of machine learning to model the PID response based on the empirical response factor in all experiments. Taken together, the results of this study demonstrate the application of machine learning to augment the performance of a nonselective chemical sensor. The approach can be generalized to other reactive species, oxidants, and reaction mechanisms, thus enhancing the utility and interpretability of PID measurements for studying atmospheric VOCs.

Asbestos and Iron.

Theories of disease pathogenesis following asbestos exposure have focused on the participation of iron. After exposure, an open network of negatively charged functional groups on the fiber surface complexes host metals with a preference for iron. Competition for iron between the host and the asbestos results in a functional metal deficiency. The homeostasis of iron in the host is modified by the cell response, including increased import to correct the loss of the metal to the fiber surface. The biological effects of asbestos develop in response to and are associated with the disruption of iron homeostasis. Cell iron deficiency in the host following fiber exposure activates kinases and transcription factors, which are associated with the release of mediators coordinating both inflammatory and fibrotic responses. Relative to serpentine chrysotile, the clearance of amphiboles is incomplete, resulting in translocation to the mesothelial surface of the pleura. Since the biological effect of asbestos is dependent on retention of the fiber, the sequestration of iron by the surface, and functional iron deficiency in the cell, the greater clearance (i.e., decreased persistence) of chrysotile results in its diminished impact. An inability to clear asbestos from the lower respiratory tract initiates a host process of iron biomineralization (i.e., asbestos body formation). Host cells attempt to mobilize the metal sequestered by the fiber surface by producing superoxide at the phagosome membrane. The subsequent ferrous cation is oxidized and undergoes hydrolysis, creating poorly crystalline iron oxyhydroxide (i.e., ferrihydrite) included in the coat of the asbestos body.

Park Area and Physical Activity Among Children and Adolescents: Findings From the Healthy Communities Study.

BACKGROUND: There is currently a nationwide effort to bring parks and green spaces within a 10-minute walk of the home. We examined the association between park area within 1 km of a child's residence and self-reported park-specific physical activity (PA) along with accelerometer-derived moderate to vigorous physical activity (MVPA). METHODS: A subsample of K through eighth-grade youth (n = 493) from the Healthy Communities Study reported whether they engaged in park-specific PA during the last 24 hours and wore an accelerometer for up to 7 days. Park area was defined as the percentage of park land in a 1 km Euclidean buffer around the participant's residence, categorized into quintiles. Analysis consisted of logistic and linear regression modeling with interaction effects that controlled for clustering within communities. RESULTS: Regression models estimated greater park-specific PA for participants in the fourth and fifth quintiles of park land. Age, sex, race ethnicity, and family income were unrelated to park-specific PA. Accelerometer analysis indicated that total MVPA was unrelated to park area. Older children (ß = -8.73, P < .001) and girls (ß = -13.44, P < .001) engaged in less MVPA. Seasonality significantly predicted both park-specific PA and total MVPA. CONCLUSION: Increasing park area is likely to improve youth PA patterns, lending support for the 10-minute walk initiative.

Machine Learning for Ionization Potentials and Photoionization Cross Sections of Volatile Organic Compounds.

Molecular ionization potentials (IP) and photoionization cross sections (σ) can affect the sensitivity of photoionization detectors (PIDs) and other sensors for gaseous species. This study employs several methods of machine learning (ML) to predict IP and σ values at 10.6 eV (117 nm) for a dataset of 1251 gaseous organic species. The explicitness of the treatment of the species electronic structure progressively increases among the methods. The study compares the ML predictions of the IP and σ values to those obtained by quantum chemical calculations. The ML predictions are comparable in performance to those of the quantum calculations when evaluated against measurements. Pretraining further reduces the mean absolute errors (ε) compared to the measurements. The graph-based attentive fingerprint model was most accurate, for which εIP = 0.23 ± 0.01 eV and εσ = 2.8 ± 0.2 Mb compared to measurements and computed cross sections, respectively. The ML predictions for IP correlate well with both the measured IPs (R 2 = 0.88) and with IPs computed at the level of M06-2X/aug-cc-pVTZ (R 2 = 0.82). The ML predictions for σ correlated reasonably well with computed cross sections (R 2 = 0.66). The developed ML methods for IP and σ values, representing the properties of a generalizable set of volatile organic compounds (VOCs) relevant to industrial applications and atmospheric chemistry, can be used to quantitatively describe the species-dependent sensitivity of chemical sensors that use ionizing radiation as part of the sensing mechanism, such as photoionization detectors.

Basal and inducible Osterix expression reflect equine mesenchymal progenitor cell osteogenic capacity.

Introduction: Mesenchymal stem cells are characterized by their capacities for extensive proliferation through multiple passages and, classically, tri-lineage differentiation along osteogenic, chondrogenic and adipogenic lineages. This study was carried out to compare osteogenesis in equine bone marrow-, synovium- and adipose-derived cells, and to determine whether osteogenic capacity is reflected in the basal expression of the critical osteogenic transcription factors Runx2 and Osterix. Methods: Bone marrow, synovium and adipose tissue was collected from six healthy 2-year-old horses. Cells were isolated from these sources and expanded through two passages. Basal expression of Runx2 and Osterix was assessed in undifferentiated third passage cells, along with their response to osteogenic culture conditions. Results: Bone marrow-derived cells had significantly higher basal expression of Osterix, but not Runx2. In osteogenic medium, bone-marrow cells rapidly developed dense, multicellular aggregates that stained strongly for mineral and alkaline phosphatase activity. Synovial and adipose cell cultures showed far less matrix mineralization. Bone marrow cells significantly up-regulated alkaline phosphatase mRNA expression and enzymatic activity at 7 and 14 days. Alkaline phosphatase expression and activity were increased in adipose cultures after 14 days, although these values were less than in bone marrow cultures. There was no change in alkaline phosphatase in synovial cultures. In osteogenic medium, bone marrow cultures increased both Runx2 and Osterix mRNA expression significantly at 7 and 14 days. Expression of both transcription factors did not change in synovial or adipose cultures. Discussion: These results demonstrate that basal Osterix expression differs significantly in progenitor cells derived from different tissue sources and reflects the osteogenic potential of the cell populations.

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology.

OBJECTIVE: This study sought to validate alternative pain management strategies that can reduce reliance on opioids for postoperative pain management in otology. STUDY DESIGN: Prospective cohort study. SETTING: Single tertiary-care facility. METHODS: Adult patients who underwent outpatient otologic surgery from September 2021 to July 2022 were randomized into treatment cohorts. The opioid monotherapy cohort received a standard opioid prescription. The multimodal analgesia cohort received the same opioid prescription, prescriptions for acetaminophen and naproxen, and additional pain management education with a flyer on discharge. All patients completed a questionnaire 1 week after surgery to evaluate opioid usage and pain scores. RESULTS: Eighty-six patients completed the study. The opioid monotherapy cohort (n = 42) and multimodal analgesia cohort (n = 44) were prescribed an average of 42.1 ± 20.4 morphine milligram equivalents (MME) and 38.4 ± 5.7 MME, respectively (p = 0.373). Four patients (9.52%) in the opioid monotherapy cohort required opioid refills compared to 1 patient (2.27%) in the multimodal analgesia cohort (p = 0.156). Multivariate analysis demonstrated that the multimodal analgesia cohort consumed significantly fewer opioids on average than the opioid monotherapy cohort (11.9 ± 15.9 MME vs 22.8 ± 28.0 MME, respectively). There were no significant differences in postoperative rehospitalizations (p = 0.317) or Emergency Department visits (p = 0.150). Pain scores on the day of surgery, postoperative day (POD) 1, POD3, and POD7 were not significantly different between cohorts (p = 0.395, 0.896, 0.844, 0.765, respectively). CONCLUSION: The addition of patient education, acetaminophen, and naproxen to postoperative opioid prescriptions significantly reduced opioid consumption without affecting pain scores, refill rates, or complication rates after otologic surgery.

Total Intravenous Anesthesia Versus Inhaled Sevoflurane in Obstructive Sleep Apnea Surgery: A Randomized Controlled Trial.

OBJECTIVE: Specific guidelines regarding an optimal general anesthesia (GA) approach to obstructive sleep apnea (OSA) patients remain undefined. Literature comparing the efficacy of total intravenous anesthesia (TIVA) and inhalational anesthesia in this population is sparse. We hypothesize that OSA patients receiving TIVA will experience reduced recovery times and other improved post-surgical outcomes. STUDY DESIGN: Randomized controlled trial. METHODS: Adult OSA patients undergoing upper airway surgery (hypoglossal nerve stimulation [HNS], nasal, or palate surgery) from February 2020-December 2020 were included. A post-anesthesia care unit (PACU) nursing survey documented patients' alertness, pain, oxygen supplementation, and postoperative nausea and vomiting from PACU arrival to 2 hours. Perioperative timepoints from the electronic medical record (EMR) and a nurse-estimated Phase I recovery time were collected. RESULTS: One hundred eleven patients were included (46 TIVA and 65 inhalational anesthesia). Per EMR-recorded timepoints, TIVA patients undergoing HNS and palate surgery experienced Phase I Time reductions of 12.5 min (p = 0.042) and 27.5 min (p = 0.016), respectively. Per the PACU survey, TIVA patients undergoing any surgery, HNS, or palate surgery experienced nurse-estimated Phase I Time reductions of 16.5 min (p = 0.004), 12.5 min (p = 0.031), and 38.5 min (p = 0.024), respectively. Overall, TIVA patients experienced higher alertness and pain ratings, and lower oxygen supplementation requirements from PACU arrival to 30 min (p < 0.05). CONCLUSION: Patients with OSA receiving TIVA for GA maintenance during upper airway procedures experienced reduced recovery times and oxygen supplementation requirements, and a more rapid return to alertness. Future work toward developing optimized anesthetic guidelines for OSA patients is merited. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:984-992, 2023.

Bringing Radiology Education to a New Reality: A Pilot Study of Using Virtual Reality as a Remote Educational Tool.

Purpose: We investigated virtual reality (VR) during a 2-week, undergraduate, radiology elective to determine if it improved learning outcomes and user satisfaction. Methods: Eighteen students enrolled between August 2021 and February 2022. Each student had a collaborative Zoom teaching session with a preceptor using a Picture Archive and Communications System (PACS)-like viewing system Online DICOM Image Navigator (ODIN), followed by a teaching session using a VR, Digital Imaging and Communications in Medicine (DICOM) viewer (SieVRt). After each teaching session, the students independently reviewed 8 imaging cases and completed case related questions. The students completed a survey, rating their subjective experiences using ODIN and SieVRt. Results: There was no difference in total test scores between the two learning strategies. However, students did perform statistically better on two of five questions designed to test the detection/measurement capabilities of SieVRt vs ODIN. Students stated that they preferred using SieVRt over ODIN and agreed that they were able to view subtle imaging findings and abnormalities better using SieVRt. However, students found that some of the functions of SieVRt (measuring angles/lengths, and multitasking) were difficult. There were technical challenges with VR and minor undesirable physical effects (dizziness, nausea, etc.). Conclusions: Virtual reality has the potential to enhance radiology education by providing an immersive and engaging experience. Objectively, students were able to perform two tasks better with SieVRt. Subjectively, the VR platform received favourable reviews from students for a variety of features. There were reported technical and physical challenges related to using VR. Future developments in VR systems should focus on improving the user experience.

Assessing Postoperative Recovery With Volatile Gas Versus Total Intravenous Anesthesia in Patients With and Without Obstructive Sleep Apnea.

INTRODUCTION: To determine if there is a recovery time difference between patients with and without obstructive sleep apnea (OSA) when using total intravenous anesthesia (TIVA) compared to volatile gas inhalational anesthesia. PATIENTS AND METHODS: OSA and Non-OSA patients were identified at a tertiary institution between January 2019 and November 2020. Non-OSA patients were defined as those who have not been formerly diagnosed with OSA. A modified STOP-BANG score (MSBS) was performed to screen Non-OSA patients for OSA. Recovery was measured by Phase I recovery time, or time it took a patient to reach ≥9/10 on the Aldrete scoring system. RESULTS: A total of 334 patients were included with 142 in the OSA cohort (59 TIVA, 83 inhalational anesthesia) and 192 in the Non-OSA cohort (119 TIVA, 73 inhalational anesthesia). In OSA patients, there was a 41.29-minute recovery time reduction when using TIVA versus sevoflurane (P < .0001). Non-OSA patients recovered faster than OSA patients when undergoing inhalational anesthesia by 46.76 minutes and TIVA by 18.58 minutes (P < .0001 and P = .0907, respectively). Non-OSA patients with a MSBS < 3 and ≥3 had a shorter recovery time compared to OSA patients when both underwent sevoflurane anesthesia (57.27 minutes, P < .0001 and 56.23 minutes, P = .040, respectively). Non-OSA patients with a MSBS of <3 had a decrease in recovery time of 26.68 minutes when compared to OSA patients who underwent TIVA (P = .0004). CONCLUSIONS: When utilizing TIVA over inhalational anesthesia, patients with OSA have significantly increased benefit in terms of reduced Phase I recovery times as compared to Non-OSA patients.

Preparedness of Residents and Medical Students for the Transition to Competence by Design in Diagnostic Radiology Post-Graduate Medical Education.

Introduction: This needs assessment evaluated residents' and medical students' knowledge of Competence by Design (CBD), perceived benefits of and challenges or barriers to the transition to CBD for residents, and perceived overall preparedness for the transition to CBD in diagnostic radiology. Materials and Methods: All diagnostic radiology residents and medical students in Canada were eligible to participate in this national cross-sectional, questionnaire-based needs assessment. Knowledge of CBD was evaluated through participants' self-reported rating of their knowledge of CBD on a 5-point Likert scale. Perceived benefits of and challenges or barriers to the transition to CBD for residents were rank ordered. Participants' overall self-reported preparedness for the transition to CBD was assessed on a 5-point Likert scale. Data were summarized by descriptive statistics and bivariate analyses were conducted as appropriate. Results: Ninety-four residents (n = 77) and medical students (n = 17) participated in this needs assessment. Participants' mean ± standard deviation self-reported rating of their overall knowledge of CBD was 2.86 ± .94. Provision of meaningful feedback to learners and learners' ability to identify their own educational needs were among the highest ranked perceived benefits of the transition to CBD, while demands on time and increased frequency of evaluation were among the highest ranked perceived challenges or barriers to the transition to CBD. Few participants reported being either "prepared" (4.7%) or "somewhat prepared" (14.0%) for the transition to CBD. Conclusion: Preparedness for the transition to CBD in diagnostic radiology may be improved. Targeted interventions to augment the preparedness of residents and medical students should be considered.

River Winds and Transport of Forest Volatiles in the Amazonian Riparian Ecoregion.

Volatile organic compounds (VOCs) emitted from forests are important chemical components that affect ecosystem functioning, atmospheric chemistry, and regional climate. Temperature differences between a forest and an adjacent river can induce winds that influence VOC fate and transport. Quantitative observations and scientific understanding, however, remain lacking. Herein, daytime VOC datasets were collected from the surface up to 500 m over the "Rio Negro" river in Amazonia. During time periods of river winds, isoprene, α-pinene, and ß-pinene concentrations increased by 50, 60, and 80% over the river, respectively. The concentrations at 500 m were up to 80% greater compared to those at 100 m because of the transport path of river winds. By comparison, the concentration of methacrolein, a VOC oxidation product, did not depend on river winds or height. The differing observations for primary emissions and oxidation products can be explained by the coupling of timescales among emission, reaction, and transport. This behavior was captured in large-eddy simulations with a coupled chemistry model. The observed and simulated roles of river winds in VOC fate and transport highlight the need for improved representation of these processes in regional models of air quality and chemistry-climate coupling.

Kinetic Analysis in Horses With Deep Digital Flexor Tendinopathy Within the Digit Diagnosed by Magnetic Resonance Imaging.

Objectives: To determine the stance duration and ground reaction forces (GRF) of horses with deep digital flexor (DDF) tendinopathy at the level of the foot and compare the stance duration and GRF to those of clinically sound horses. Design: Prospective clinical study. Animals: Sixteen horses (seven horses with bilateral forelimb lameness, four horses with unilateral forelimb lameness, and five horses with no lameness). Procedures: Analyses of kinetic variables were performed on both forelimbs from sound horses and horses diagnosed with chronic DDF tendinopathy. Stance duration and longitudinal and vertical components of the GRF were determined for the limbs of clinically sound horses and limbs of horses with DDF tendinopathy. Separate Spearman correlation analyses were used to assess potential association within groups (combined left and right forelimbs of clinically sound horses, lamest limbs of horses with DDF tendinopathy, and contralateral limbs of horses with DDF tendinopathy) and with the set of kinetic variables. Analysis of variance on mean ranks of tied values was used to determine differences in kinetic variables between groups (PROC GLIMMIX) using the kinetic values of the clinically sound horses as the reference group. Results: There were a total of 11 lame horses. Seven horses had bilateral forelimb lameness and four had unilateral lameness. Of the 11 horses, there were 15 DDF tendinopathies. There were eight dorsal border DDF tendinopathies, five core DDF tendinopathies, and two sagittal/parasagittal splits DDF tendinopathies. The most lame limbs of horses with DDF tendinopathy had significantly smaller values for peak vertical force and time of peak braking force than did forelimbs of clinically sound horses. Also, the most lame limbs of horses with DDF tendinopathy had significantly larger values for the time of peak vertical force than did forelimbs of clinically sound horses. Conclusions and Clinical Relevance: Horses with chronic DDF tendinopathies develop certain alterations of GRF parameters. This information can be used in future studies to determine if particular kinetic variable changes in horses with DDF tendinopathies differ from those of horses with other pathologies within the foot and therefore could be diagnostic.

Performance of predictive models of survival in horses undergoing emergency exploratory laparotomy for colic.

OBJECTIVE: To evaluate previously published predictive survival models in a population of horses undergoing colic surgery in the midwestern United States. STUDY DESIGN: Retrospective cohort study; single referral hospital. ANIMALS: A total of 260 horses met the inclusion criteria. METHODS: Medical records of horses undergoing surgical treatment for colic were reviewed. Previously published models were applied to cohort data to predict outcome. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for prediction of short-term survival were calculated. RESULTS: Single-variable and multivariable models performed similarly for prediction of survival, with a mean 79% sensitivity (range: 44%-94%), 48% specificity (range: 22%-83%), 63% PPV (range: 56%-72%), 73% NPV (range: 60%-83%), and 64% accuracy (range: 59%-72%). Blood lactate ≤6 mmol/l and the colic severity score (CSS) were highly sensitive for prediction of survival; however, both had poor specificity. CONCLUSION: Single-variable and multivariable predictive models did not perform as well for prediction of survival in the study cohort compared to original reports, suggesting that population-specific factors contribute to patient survival. CLINICAL SIGNIFICANCE: Predictive models of survival developed in one population may be less reliable when used to predict outcome in horses undergoing colic surgery from an independent population. Additional model testing and refinement using data from multiple surgical centers could be considered to improve prediction of outcome for horses undergoing laparotomy for treatment of colic.

Patient experiences of sialendoscopy with monitored anesthesia care versus general anesthesia.

OBJECTIVE: To compare the experiences of patients who received sialendoscopy under general anesthesia (GA) with those who received monitored anesthesia care (MAC). METHODS: Patients who underwent sialendoscopy for sialadenitis or sialolithiasis from July 1, 2020, to July 31, 2021, were offered inclusion to this prospective observational study. A survey was sent to consenting patients on post-operative day 1 to record aspects of their pre-, intra-, and post-operative experience. The primary outcome was overall satisfaction. Secondary outcomes included pain tolerability and preference for similar anesthetic modality in the future. RESULTS: Seventy-five patients completed the post-operative survey (86% response rate), of which 39 patients received GA and 36 received MAC. Patient overall satisfaction was similar between groups (GA: "Poor/Average/Good" = 23%, "Excellent" = 77%; MAC: "Poor/Average/Good" = 25%, "Excellent" = 75%, p = 1.00). Tolerability of immediate post-operative pain was likewise similar between the GA (82%) and MAC (97%) groups (p = 0.058). Patients who received MAC reported intra-operative pain as "none/tolerable" 72% of the time and "uncomfortable" 28% of the time. Patients who received GA would prefer the same anesthetic in the future more often than in the MAC group (85% versus 61%, respectively, OR 3.50, 95% CI 1.17-10.50, p = 0.035). CONCLUSION: In regard to patient satisfaction, both MAC and GA are acceptable anesthetic choices in sialendoscopy for appropriate cases. Patients report similar overall satisfaction and post-operative pain tolerance under either anesthetic modality. Patients who undergo GA report higher rates of preference for similar anesthetic modality in the future. Further study is needed to determine the most appropriate criteria for anesthesia modality selection.