Impact of Preoperative Nutritional Support on Surgical Outcomes in Gastrointestinal Surgeries: A Systematic Review.

Malnutrition presents a significant risk to patients undergoing gastrointestinal surgery, with direct consequences on postoperative complication rates, recovery times, and mortality. Our systematic review, guided by PRISMA protocols, examined the impact of preoperative nutritional support on these surgical outcomes. We scrutinized publications from PubMed, Medline, Embase, and the Cochrane Library up to April 2023, including randomized controlled trials, cohort studies, and systematic reviews. The stringent selection process narrowed to 10 studies demonstrating the efficacy of preoperative nutritional support, from oral supplements to enteral and parenteral nutrition, in reducing postoperative complications and length of hospital stays while enhancing recovery rates. The benefits varied, indicating a pressing need for customized nutritional regimens based on patient demographics and surgical specifics. Our findings advocate incorporating individualized nutritional strategies into preoperative care, enhancing patient outcomes. Future research should aim to refine these strategies, focusing on the optimal timing, duration, and type of nutritional support.

Mental Health Nurses' and Allied Health Professionals' Individual Research Capacity and Organizational Research Culture: A Comparative Study.

Introduction: Healthcare professionals have development needs related to their consumption, use, and practice of clinical research. Little is known about these issues in mental health services specifically. Objectives: A survey of healthcare staff working in an NHS Mental Health and Disability Trust in England was conducted to describe research capacity and culture compared with previously reported samples, and to examine subgroup differences. Methods: An online questionnaire was utilized. The main measure was the Research Capacity and Culture tool comprising measures of individual's perceived research skills and of team and organizational research culture. Previous studies using the same measure were systematically identified, and pooled results, weighted by sample size, were calculated. Analyses were descriptive (current sample versus previous results) and inferential (comparisons between demographic and professional groups within the current sample). Results: N = 293 people completed the survey. The median item scores were poorer than those of pooled samples from studies reporting median item scores on 39/51 (76.5%) occasions and poorer than those pooled samples of studies reporting mean item scores on 51/51 (100.0%) occasions. Individual capability for research was in the 'less than adequate' range more than in previous samples (71.4% vs. 42.9%). For team culture items, the proportions were 84.2% vs. 78.9%, while most responses about organizational culture were in the 'adequate' range (55.6% vs. 66.7%). Staff >20 years employment had poorer perceptions of team and organizational culture. Conclusion: Perceptions of individual research capacity and team and organizational culture were poor compared with previous studies, most of which were conducted in non-mental health settings. There is need for development of research capacity and culture in mental health services including opportunities to develop basic research skills through to strategic developments to promote clinical academic careers. There is considerable room for improvement in the way organizations support research and signpost opportunities.

From Sugar Spikes to Pressure Peaks: Navigating the World of Diabetes, Hypertension, Obesity, and Kidney Health.

Diabetes, hypertension, obesity, and chronic kidney disease (CKD) are major public health challenges globally, contributing significantly to morbidity and mortality. The co-occurrence and interplay among these conditions exacerbate health outcomes, highlighting the need for an integrated understanding and approach to management. This narrative review aims to explore the complex relationships between diabetes, hypertension, obesity, and CKD, elucidating their collective impact on health. It discusses the epidemiological trends, underlying pathophysiological mechanisms, genetic predispositions, current treatment strategies, and the future direction of research and therapy. An extensive review of current literature was conducted, focusing on the epidemiology, pathophysiology, risk factors, diagnosis, and treatment of diabetes, hypertension, obesity, and CKD. Additionally, the review delves into the genetic and molecular biology underlying these conditions, the potential for personalized medicine, and the importance of a multidisciplinary approach to care. The review identifies key areas where these conditions intersect, enhancing disease progression and complicating management. It highlights the role of genetic and environmental factors in disease etiology, the critical need for personalized treatment strategies, and the gaps in current management approaches. Innovations in pharmacotherapy, monitoring technologies, and the potential of pharmacogenomics are discussed as avenues for advancing patient care. Diabetes, hypertension, obesity, and CKD are intricately linked, necessitating an integrated, patient-centered approach to care that goes beyond traditional treatment modalities. Future research should focus on collaborative models and interdisciplinary strategies to address the multifaceted challenges posed by these conditions. Emphasizing personalized medicine and leveraging technological advancements offer promising pathways to improve outcomes and reduce the global health burden of these metabolic disorders.

From Nanobots to Neural Networks: Multifaceted Revolution of Artificial Intelligence in Surgical Medicine and Therapeutics.

This comprehensive exploration unveils the transformative potential of Artificial Intelligence (AI) within medicine and surgery. Through a meticulous journey, we examine AI's current applications in healthcare, including medical diagnostics, surgical procedures, and advanced therapeutics. Delving into the theoretical foundations of AI, encompassing machine learning, deep learning, and Natural Language Processing (NLP), we illuminate the critical underpinnings supporting AI's integration into healthcare. Highlighting the symbiotic relationship between humans and machines, we emphasize how AI augments clinical capabilities without supplanting the irreplaceable human touch in healthcare delivery. Also, we'd like to briefly mention critical findings and takeaways they can expect to encounter in the article. A thoughtful analysis of the economic, societal, and ethical implications of AI's integration into healthcare underscores our commitment to addressing critical issues, such as data privacy, algorithmic transparency, and equitable access to AI-driven healthcare services. As we contemplate the future landscape, we project an exciting vista where more sophisticated AI algorithms and real-time surgical visualizations redefine the boundaries of medical achievement. While acknowledging the limitations of the present research, we shed light on AI's pivotal role in enhancing patient engagement, education, and data security within the burgeoning realm of AI-driven healthcare.

Mastering the Art of Dermatosurgery: Aesthetic Alchemy in Medical Excellence.

Dermatosurgery, a specialized branch within dermatology, has traversed an extraordinary journey through time, shaped by ancient practices, technological leaps, and shifting societal perceptions. This review explores the evolution of dermatosurgery, highlighting its profound transformation from addressing solely medical concerns to seamlessly integrating aesthetics. From its roots in ancient civilizations, where cultural traditions laid the foundation for modern techniques, to the twentieth-century technological renaissance, marked by innovative tools and enhanced understanding of skin anatomy, dermatosurgery has emerged as a dynamic field. Societal notions of beauty and health have significantly influenced dermatosurgery, blurring the lines between medical necessity and elective aesthetic procedures. The delicate balance between satisfying aesthetic desires and upholding medical ethics is a central challenge that dermatosurgeons face today. Open dialogue between practitioners and patients as well as psychological support plays a pivotal role in navigating this terrain. The training and ethics associated with dermatosurgery have evolved to meet the increasing demand for specialized procedures. Maintaining a focus on patient safety and satisfaction remains paramount as commercial pressures and disparities in access to care loom. Upholding best practices and standards in the field is essential for ensuring consistent, high-quality care for all patients. Looking ahead, dermatosurgery stands on the brink of a transformative era, marked by non-invasive techniques, artificial intelligence (AI) integration, and personalized medicine. The field's ability to harmonize medical science with aesthetic artistry is evident in various case studies, showcasing the intricate balance dermatosurgeons strike between addressing medical concerns and fulfilling aesthetic desires. As dermatosurgery continues to evolve, it promises to provide patients with even more precise, tailored treatments that enhance both their physical well-being and aesthetic satisfaction.

Successful psychotherapy for psychogenic seizures in men.

This qualitative study examined factors contributing to the development and successful treatment of psychogenic non-epileptic seizures (PNES), in civilian men. In-depth interviews were conducted with therapist-client dyads comprising two male clients who had been successfully treated for PNES and their therapists. A theory-building case study approach provided evidence that those factors known to contribute to PNES and other somatoform symptoms in females and in males engaged in war also contributed to these symptoms in these two civilian males. In addition, PNES in these civilian males occurred in contexts where masculine identity was developmentally curtailed and socially constrained. Successful treatments occurred in long-term therapeutic relationships that sanctioned verbal expression of strong emotion and provided the attunement necessary for development of a robust masculine identity. These findings have implications for the funding of therapy, and training of therapists.

Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio.

INTRODUCTION: Opioid-involved overdose deaths continue to surge in many communities, despite numerous evidence-based practices (EBPs) that exist to prevent them. The HEALing Communities Study (HCS) was launched to develop and test an intervention (ie, Communities That HEAL (CTH)) that supports communities in expanding uptake of EBPs to reduce opioid-involved overdose deaths. This paper describes a protocol for a process foundational to the CTH intervention through which community coalitions select strategies to implement EBPs locally. METHODS AND ANALYSIS: The CTH is being implemented in 67 communities (randomised to receive the intervention) in four states in partnership with coalitions (one per community). Coalitions must select at least five strategies, including one to implement each of the following EBPs: (a) overdose education and naloxone distribution; expanded (b) access to medications for opioid use disorder (MOUD), (c) linkage to MOUD, (d) retention in MOUD and (e) safer opioid prescribing/dispensing. Facilitated by decision aid tools, the community action planning process includes (1) data-driven goal setting, (2) discussion and prioritisation of EBP strategies, (3) selection of EBP strategies and (4) identification of next steps. Following review of epidemiologic data and information on existing local services, coalitions set goals and discuss, score and/or rank EBP strategies based on feasibility, appropriateness within the community context and potential impact on reducing opioid-involved overdose deaths with a focus on three key sectors (healthcare, behavioural health and criminal justice) and high-risk/vulnerable populations. Coalitions then select EBP strategies through consensus or majority vote and, subsequently, suggest or choose agencies with which to partner for implementation. ETHICS AND DISSEMINATION: The HCS protocol was approved by a central Institutional Review Board (Advarra). Results of the action planning process will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. TRIAL REGISTRATION NUMBER: NCT04111939.

Permission to speak: therapists' understandings of psychogenic nonepileptic seizures and their treatment.

Psychogenic nonepileptic seizures (PNES), somatoform symptoms that diminish quality of life, can be difficult to treat. A previously proposed conceptualization of PNES is further developed using grounded theory methodology to explore the understandings of therapists who successfully treated clients with PNES. Participants conceptualized PNES as nonverbal communication behaviors that usually evolved in traumatic, interpersonal systems in which verbal expression of affect was proscribed and nonverbal communication of affect was prescribed. Clients without significant trauma and psychiatric comorbidity were successfully treated by means of sensitive delivery of the diagnosis and brief cognitive interventions. Traumatized clients with compromised orientation to the present required a process of cultural transformation in a safe therapeutic relationship. Implications for clinical practice, research methodology, professional training, and service funding are discussed.

Taller de radio: una experiencia a viva voz

El presente trabajo tiene como objetivo realizar un análisis y dar cuenta de las distintas actividades e intervenciones desplegadas en el taller de radio perteneciente al dispositivo de hospital de día. Para tal fin se utilizan fragmentos de la obra de Freud y Lacan, así como aportes de autores contemporáneos para llevar adelante una articulación teórico-clínica. La elección del taller como eje del trabajo se debe a la idea de repensar la práctica cotidiana y la posición de los profesionales dentro del dispositivo. (AU)

Conceptualization and treatment of psychogenic non-epileptic seizures.

Psychogenic non-epileptic seizures (PNES) frequently present co-morbidly with a range of somatic and psychiatric conditions. This review discusses the relationship between PNES, a number of co-morbid psychiatric symptoms, early attachment trauma, and disruption of neurological development. We suggest that it may be clinically useful to understand PNES with reference to three patterns of co-morbidity and trauma history. In the first group, PNES are one symptom of a response to severe, chronic trauma and invalidation in attachment relationships, or a response to a recent event that overwhelms an emotion regulation system shaped by attachment trauma. For a second group, PNES occur in the context of ongoing interruptions to self and memory with or without a history of attachment trauma. For a third group, PNES occur in the absence of extensive co-morbidity and apparent trauma, primarily as a panic reaction, in a population with under-developed emotion regulation skills. Treatment approaches consistent with these conceptualizations are suggested.