Hospital-Level Variation in Transcatheter versus Surgical Aortic Valve Replacement Among Patients Younger than 65 Years

The Annals of Thoracic Surgery · 2026-04-01

Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Part 3: Trauma Ethics and Systems Aspects

World Journal of Surgery · 2025-07-22 · 6 citations

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality. These consensus guidelines examine optimal pre-hospital, resuscitation-room, intra- and post-operative treatment, systems of ethical management, and overall care for trauma patients in the post-resuscitation phase of care. The guideline is presented in three parts, this being part 3. METHODS: Experts in aspects of management of trauma surgical patients and intensive care were invited to contribute by the International ERAS Society and IATSIC. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements using the patient intervention comparator outcome (PICO) consensus questions created by the expert group. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies; reviewed; and summarized recommendations were graded using the grading of recommendations, assessment, development and evaluation (GRADE) system. These recommendations based on current best evidence, with extrapolation from elective patient studies where appropriate, were followed by a modified two-round Delphi method to validate final recommendations. Several ERAS components are already standard of care within national and society guidelines and are endorsed. The bulk of the text focuses on key areas pertaining specifically to trauma care of major trauma and polytrauma in the ICU-requiring group. RESULTS: Overall 37 aspects of trauma care were considered with multiple PICO questions and sub-points. Consensus was reached after two rounds of a modified Delphi process involving all authors, with minor adjustments to some phrasing required but with 87% overall agreement on all statements (100% agreement on 31 of the main statement sets, prior to minor edits to address the points of difference for the rest with 100% total agreement thereafter). None were rejected outright. The recommendations and level of evidence for each aspect of trauma care that may impact on improved recovery and reduced length of hospital stay are presented with grade of recommendation. CONCLUSIONS: Four main areas of relevance to ethics and systems are presented as part 3. The guidelines are based on current best evidence for an ERAS approach to patients who have had major injuries and polytrauma. These guidelines are not exhaustive but collate the best available evidence on important components of care for this patient population. As some of the evidence is extrapolated from elective surgery and non-trauma emergency surgery, some of the components need further evaluation in future studies.

Effect of prehabilitation on cardiopulmonary fitness and insulin sensitivity before pancreatic surgery

Clinical Nutrition ESPEN · 2025-05-16 · 1 citations

Modelling the effect of commingling events on bovine coronavirus shedding in beef-on-dairy calves

Animal - science proceedings · 2025-06-01

Person-Centered approach to improve wellbeing and outcomes from medicines: iSIMPATHY (Stimulating Innovation in management of Polypharmacy, Adherence Through the Years)

International Journal of Integrated Care · 2025-04-09

Introduction: Inappropriate polypharmacy and adherence impact adversely on both population health and quality of life and health system burden and costs. The EU-funded SIMPATHY project identified recommendations to manage polypharmacy in Europe, building on the implementation of a Scottish programme addressing inappropriate prescribing and prevent medication-related harm. iSIMPATHY ( implementing Stimulating innovation in the Management of Polypharmacy and Adherence Through the Years) sought to implement these SIMPATHY findings in Scotland, Northern Ireland and Ireland. The approach centred around patient partnership, “what matters to me” and shared decision making in medicines reviews. The project increased workforce capacity capability through training healthcare professionals. Aims, Objectives, Theory or Methods. The project aimed to: Determine the feasibility of embedding a standardised approach to medicines review in Northern Ireland and Ireland and scaling up the Scottish work. Apply change management methodology and shared decision making as part of a person centred approach to pharmacist-led medicines use review delivery in multiple healthcare settings, with multidisciplinary team (MDT) collaboration. Ensure the most sustainable use of medicines by training healthcare professionals in polypharmacy, change management and delivering person-centred medicines reviews. Utilise and develop digital tools to facilitate service delivery and data management. Facilitate sustainability and spread through developing workforce capability and evidence base. Highlights or Results or Key Findings: The project was highly effective, welcomed by patients and MDT colleagues and demonstrated economic dominance across care settings and three jurisdictions. 6,481 patients engaged in reviews in primary care, secondary care, outpatient clinics and care homes. An average of 11 interventions were made per patient, with 82% classified as clinically significant and 4% potentially preventing major organ failure or similar. 94% of interventions were accepted. The average number of medications reduced from 12 to 11 and 92% of reviews resulted in more appropriate medication use. Patient reported outcome measures (PROMs) indicated improved understanding, adherence and reduced adverse effects. Economic evaluation identified a positive return on investment as well as a reduction in carbon footprint of both admissions and wastage of medicines. Training was delivered to over 180 healthcare professionals. Online recruitment, training, meetings, learning events, data entry and remote service delivery including video and phone reviews were effective and acceptable Conclusions: The iSIMPATHY person-centred comprehensive medicines review model has been demonstrated to be acceptable and effective in a range of healthcare settings and systems. iSIMPATHY is transforming the approach to medicines optimisation in the three project jurisdictions. The approach is being incorporated into guidance and mainstream use, with project findings informing policy and business cases, where investment is required. Implications for applicability/transferability, sustainability, and limitations: The approach recommended in SIMPATHY is transferable . The evidence produced supports robust policy development . Barriers such as competing priorities and workforce capacity must be addressed. Patient awareness and empowerment to be active participants in the review is crucial An implementation pack and accredited online training pack is available.

Understanding the hydrological and landscape connectivity of lakes

Landscape Ecology · 2025-07-03 · 6 citations

Context: Connectivity is a key property of water, enabling the flow of energy, material and individuals within and between sites. Climate and land use changes can profoundly modify connectivity, yet few studies have quantified the patterns in connectivity among lakes at national scales. Objectives: Our objectives were: i) to examine relationships between a broad range of lake connectivity metrics, ii) to evaluate how lake connectivity varies nationally, regionally and in relation to land cover. Methods: We calculated hundreds of metrics of freshwater connectivity for all lakes in Great Britain > 1 ha (n = 10,095), quantifying connectedness in their catchments and surrounding landscape. Patterns of metrics, as well as their correlations and inter-connectedness, were examined at multiple scales. Results: Strong correlations existed within groups of metrics for lake, pond and river connectivity. However, both pond and river metrics varied independently of lake metrics. The most and least urban river basin districts showed noticeable differences in metric correlation. Lake area, pond count and river length in catchments were selected as a core set of connectivity metrics, which explain most of the variation across national and regional scales. Conclusions: in the zone nearest the lake. When interpreting ecological responses, the connectivity metric within each core group can be selected based on suitability and data availability. The minimum set of three metrics is recommended to support comparative, global studies.

Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) Society and International Association of Trauma Surgery and Intensive Care (IATSIC) Recommendations: Paper 1: Initial Care—Pre and Intraoperative Care Until ICU, Including Non‐Operative Management

World Journal of Surgery · 2025-07-22 · 6 citations

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality. These consensus guidelines examine optimal pre-hospital, resuscitation-room, intra-, and post-operative treatment, systems of ethical management, and overall care for trauma patients in the post-resuscitation phase of care. The guideline is presented in three parts, this being part 1. METHODS: Experts in aspects of management of trauma surgical patients and intensive care were invited to contribute by the International ERAS Society and IATSIC. PubMed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements using the patient intervention comparator outcome (PICO) consensus questions created by the expert group. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies, reviewed, and summarized recommendations were graded using the grading of recommendations, assessment, development and evaluation (GRADE) system. These recommendations based on current best evidence, with extrapolation from elective patient studies, where appropriate, were followed by a modified two-round Delphi method to validate final recommendations. Several ERAS components are already standard of care within national and society guidelines and are endorsed. The bulk of the text focuses on key areas pertaining specifically to trauma care of major trauma and polytrauma in the ICU-requiring group. RESULTS: Overall 37 aspects of trauma care were considered with multiple PICO questions and sub-points. Consensus was reached after two rounds of a modified Delphi process involving all authors, with minor adjustments to some phrasing required, but with 87% overall agreement on all statements (100% agreement on 31 of the main statement sets, prior to minor edits to address the points of difference for the rest with 100% total agreement thereafter). None were rejected outright. The recommendations and level of evidence for each aspect of trauma care that may impact on improved recovery and reduced length of hospital stay are presented with grade of recommendation. CONCLUSIONS: The guidelines relating to initial care and decision-making are presented in part 1 of the Guidelines. These guidelines are based on current best evidence for an ERAS approach to patients who have had major injuries and polytrauma. The guidelines are not exhaustive but collate the best available evidence on important components of care for this patient population. As some of the evidence is extrapolated from elective surgery and non-trauma emergency surgery, some of the components need further evaluation in future studies.

Guidelines for Enhanced Recovery After Trauma and Intensive Care (ERATIC): Enhanced Recovery After Surgery (ERAS) and International Association for Trauma Surgery and Intensive Care (IATSIC) Society Recommendations: Paper 2: Postoperative and Intensive Care Recommendations

World Journal of Surgery · 2025-07-22 · 6 citations

BACKGROUND: Enhanced recovery after surgery (ERAS) protocols reduce length of stay, complications, and costs for elective surgical procedures. It remains challenging to implement ERAS concepts in the acute trauma patient due to deranged physiological reserve from the penetrating or blunt trauma producing altered physiology. However, systems of care improve access to early intervention and potentially reduce mortality. These consensus guidelines examine optimal prehospital, resuscitation-room, intraoperative and postoperative treatment, systems of ethical management, and overall care for trauma patients in the postresuscitation phase of care. The guideline is presented in three parts, this being Part 2. METHODS: Experts in aspects of management of trauma surgical patients and intensive care were invited to contribute by the International ERAS Society and IATSIC. PubMed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements using the patient, intervention, comparator outcome (PICO) consensus questions created by the expert group. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies; reviewed and summarized recommendations were graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. These recommendations based on current best evidence, with extrapolation from elective patient studies, where appropriate, were followed by a modified two-round Delphi method to validate final recommendations. Several ERAS components are already standard of care within national and society guidelines and are endorsed. The bulk of the text focuses on key areas pertaining specifically to trauma care of major trauma and polytrauma in the ICU-requiring group. RESULTS: Overall, 37 aspects of trauma care were considered, with multiple PICO questions and subpoints. Consensus was reached after two rounds of a modified Delphi process involving all authors, with minor adjustments to some phrasing required, but with 87% overall agreement on all statements (100% agreement on 31 of the main statement sets, prior to minor edits to address the points of difference for the rest, with 100% total agreement thereafter). None were rejected outright. The recommendations and level of evidence for each aspect of trauma care that may impact on improved recovery and reduced length of hospital stay are presented with grade of recommendation. CONCLUSIONS: This paper presents the results of the postoperative care and ICU aspects. The guidelines are based on current best evidence for an ERAS approach to patients who have had major injuries and polytrauma. These guidelines are not exhaustive but collate the best available evidence on important components of care for this patient population. As some of the evidence is extrapolated from elective surgery and nontrauma emergency surgery, some of the components need further evaluation in future studies.

(242) THE IMPACT OF ENVIRONMENTAL FACTORS AND CHRONIC MEDICAL CONDITIONS ON SEMEN PARAMETERS: A TEN-YEAR LONGITUDINAL ANALYSIS

The Journal of Sexual Medicine · 2024-08-12

Abstract Introduction The environmental and chronic medical conditions including metabolic risk factors appear to continue to negatively impact the semen qualities in men worldwide including United States. Poor semen parameters is often used as marker for underlying men’s health and can be associated with increased morbidities and overall mortality. Objective In this large longitudinal analysis, we aim to evaluate the correlations between variable risk factors and medical conditions and semen analysis in adult men at a large reproductive urology center. Methods In this ten-year retrospective chart review, male patients ≥18 of age with documented semen analyses were included. Data collected included the patients’ demographics, comorbid medical conditions recreational alcohol, tobacco or marijuana use. Semen analysis as per WHO 10th reference included sperm concentration, count and motility. Data analyzed using multivariate and univariate linear regression and logistic regression. Results A total of 2,322 patients were included in the study. White and black non-Hispanic men had higher rates of oligospermia and/or azoospermia compared with Asian men (p < 0.001) and had higher body mass index (BMI) (p = 0.019). Among the comorbidities, type 2 diabetes (p = 0.046), hypertension (p = 0.014), anemia (p = 0.001), chronic kidney disease (p = 0.013), and heart failure (p = 0.001) were associated with higher rates of oligospermia and/or azoospermia. Among recreational use, tobacco and marijuana use were associated with oligospermia. (p = 0.043) (Table 1). Conclusions In our study, environmental and metabolic risk factors and conditions appear to be significantly associated with reduced semen qualities particularly sperm concentration, count and motility. This analysis underpins this critical association between men’s health marker ie, semen analysis and underlying environmental and chronic medical conditions in men at-risk. Future studies are warranted to further exploit these association and provide appropriate medical counseling and treatment. Disclosure No.

Search for Periodic Time Variations of the Solar <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline"><mml:mrow><mml:mmultiscripts><mml:mrow><mml:mi mathvariant="normal">B</mml:mi></mml:mrow><mml:mprescripts/><mml:none/><mml:mrow><mml:mn>8</mml:mn></mml:mrow></mml:mmultiscripts></mml:mrow></mml:math> Neutrino Flux between 1996 and 2018 in Super-Kamiokande

Physical Review Letters · 2024-06-14 · 3 citations

We report a search for time variations of the solar ^{8}B neutrino flux using 5804 live days of Super-Kamiokande data collected between May 31, 1996, and May 30, 2018. Super-Kamiokande measured the precise time of each solar neutrino interaction over 22 calendar years to search for solar neutrino flux modulations with unprecedented precision. Periodic modulations are searched for in a dataset comprising five-day interval solar neutrino flux measurements with a maximum likelihood method. We also applied the Lomb-Scargle method to this dataset to compare it with previous reports. The only significant modulation found is due to the elliptic orbit of the Earth around the Sun. The observed modulation is consistent with astronomical data: we measured an eccentricity of (1.53±0.35)%, and a perihelion shift of (-1.5±13.5) days.