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Bariatric procedures are associated with nutrient deficiencies. Studies show an association between gastric bypass (Roux-en-Y gastric bypass [RYGB]) and hypovitaminosis D as well as hyperparathyroidism, yet few compare RYGB to sleeve gastrectomy (SG), and large long-term analyses are scarce. Evaluate trends of vitamin D and parathyroid hormone (PTH) levels in RYGB and SG. National quality register. The Scandinavian Obesity Surgery Registry records all bariatric surgeries in Sweden. Data from 2008 to 2021 on primary RYGB or SG with reported 25-hydroxy vitamin D (25-OH-D) and/or PTH levels were included. Individuals with an estimated glomerular filtration rate of <60 mL/min/1.73 m2 were excluded, leaving a study population of 25,385 RYGB and 5073 SG patients. A decrease in 25-OH-D, mirrored by an increase in PTH, was observed after the first year for both procedures, but more pronounced in RYGB. At 5 years, 25-OH-D levels were still higher than at baseline. Regular supplementation resulted in better 25-OH-D and PTH levels. Linear regression found that procedure type (RYGB versus SG), 25-OH-D levels, and time since surgery were significant factors in predicting PTH levels. The risk of pathologic PTH levels (>7 pmol/L) at 2 and 5 years postoperatively was roughly three times higher in RYGB (odds ratios = 3.41 and 2.84, respectively). Previous studies alongside these results suggest that RYGB, more so than SG, may cause hypovitaminosis D and thereby hyperparathyroidism, which could lead to osteopenia. The threshold for 25-OH-D should be >75 nmol/L, and despite higher levels, current vitamin D supplementation may not be sufficient. Follow-up should include screening for hyperparathyroidism and hypovitaminosis D. • In both RYGBP and sleeve, 25-OH D decreased, mirrored by increased PTH. • At five years, 25-OH D levels were still higher than at baseline. • Regular supplementation resulted in better 25-OH D and PTH levels. • The risk of pathological PTH levels (>7 pmol/L) was roughly tripled in RYGBP. [ABSTRACT FROM AUTHOR]

Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia. A single-center randomized controlled trial. This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period. The final cohort had 83 children (MID, n =27; CLO, n =26; DEX, n =30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P <0.001 and P =0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r =-0.570, P <0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P =0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P <0.001). The HR was lower immediately after induction (P =0.009) and intraoperatively (P =0.025) in the CLO and DEX groups than in the MID group. When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period. [ABSTRACT FROM AUTHOR]

Language differences and diverse cultural norms influence the transmission and receipt of information. The online environment provides yet another potential source of miscommunication. Although distance learning has the potential to reach students in cultural groups that have been disenfranchised from traditional higher education settings in the past, intercultural miscommunication is also much more likely to occur through it. There is limited research examining intercultural miscommunication within distance education environments. This article presents the results of a qualitative study that explored the communication experiences of Canadian faculty and Aboriginal students while participating in an online baccalaureate nursing degree program that used various delivery modalities. The microlevel data analysis revealed participants'' beliefs and interactions that fostered intercultural miscommunication as well as their recommendations for ensuring respectful and ethically supportive discourses in online courses. The unique and collective influences of intercultural miscommunication on the experiences of faculty and students within the courses are also identified. Instances of ethnocentrism and othering are illustrated, noting the effects that occurred from holding dualistic perspectives of us and them. Lastly, strategies for preventing intercultural miscommunication in online courses are described. [Copyright &y& Elsevier]

The article discusses the investigation of antibiotic prescription behavior and the influence of national recommendations among clinicians performing bone augmentation procedures prior or in conjunction to dental implant surgery.