搜索结果：Best practice & research. Clinical anaesthesiology

Intraoperative pain during caesarean delivery (CD) remains a concern, particularly with epidural anaesthesia, with variable incidence depending on the circumstances. While spinal anaesthesia is the standard for scheduled CD, the best approach for unscheduled CD, especially with inadequate conversion of labour epidural analgesia to surgical epidural anaesthesia, remains unclear. We aimed to describe preferred anaesthetic practices among French anaesthesiologists in different clinical scenarios, with a particular focus on intrapartum CD with failed conversion of labour epidural analgesia. A nation-wide, anonymous, online survey was distributed to anaesthesiologists. Participants were asked to indicate their preferred practices in clinical scenarios, including cases without labour epidural analgesia, with adequate labour epidural analgesia, and with inadequate conversion to surgical epidural anaesthesia, for three emergency levels. Between November 2022 and January 2023, 651 anaesthesiologists responded. Most respondents indicated preferring spinal anaesthesia for scheduled (97 %) and unscheduled non-urgent CD without LEA (95 %). In emergency situations, general anaesthesia (GA) was preferred (84 %). With adequate labour epidural analgesia, 99 % favoured epidural conversion. With inadequate labour epidural analgesia, 43 % indicated preferring spinal anaesthesia in non-urgent situations, while 70 % would opt for GA in emergency cases. Only 63 % of respondents were aware of risk factors for epidural conversion failure. Anaesthetic practices were heterogeneous, particularly with inadequate labour epidural analgesia. These findings highlight the need for broader dissemination of updated guidelines and for standardized, evidence-based, clinical decision algorithms to support safe and effective anaesthetic management in complex clinical scenarios.

Trauma-related venous thromboembolism (VTE) represents significant challenges in clinical care for patients with critical illnesses, highlighting the need for evidence-based recommendations. The Saudi Critical Care Society (SCCS), in collaboration with international experts, developed the "VTE Prophylaxis in Trauma Intensive Care Unit Patients" clinical practice guidelines. The guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluation methodology and provide consensus-based, actionable recommendations tailored to diverse clinical contexts. This article highlights key aspects of the guidelines, emphasizing practical implementation strategies for trauma VTE prophylaxis management. The trauma VTE prophylaxis guidelines, endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI), focus on the timing of initiation, agent selection, and mechanical prophylaxis strategies for patients with trauma. The guidelines address unique challenges and knowledge gaps, providing adaptable strategies for clinicians in high-resource and resource-constrained settings. Here, we highlight key aspects of the guidelines, the importance of evidence-based practices, adherence strategies, the need for adaptability in special populations and low-resource settings, and future research priorities in trauma and critical care.

Deprescribing guidelines support safe medication cessation and complement clinical practice guidelines. However, limited evidence exists on the strategies used by organisations and policy bodies to disseminate and implement such guidelines and their impact. The study aimed to identify dissemination and implementation practices of deprescribing guidelines across international organisations. An explanatory mixed-methods design was used, comprising (a) a content-validated 44-item survey comprising components based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and (b) qualitative interviews with survey respondents that provided deeper insights. Of the 75 unique visitors, 47 respondents from 14 countries provided analysable data (24 completed responses); five participated in a follow-up interview. Whereas 12 out of 27 respondents reported organisational tailoring of guidelines for local context, 18 out of 24 reported a lack of planning for implementation, dissemination and/or evaluation. Nineteen out of 24 respondents reported no monitoring of implementation outcomes. Although only three respondents reported provision of ongoing training and support, 25 out of 32 believed that guideline uptake could be improved. Although deprescribing guidelines have gained international attraction, organisations frequently overlook the need for implementation evaluation and the sustainment of implementation. Without attention to these aspects, organisations risk undermining their efforts to implement deprescribing guidelines. This study is the first to apply the RE‐AIM framework to assess how deprescribing guidelines are shared and used across international organisations. Findings reveal a significant gap in organisational planning and evaluation, with most organisations not monitoring guideline uptake or outcomes. There is a clear need for centralised, accessible decision‐support tools and stronger leadership to sustain deprescribing efforts. The study also highlights missed opportunities to engage patients and carers, suggesting that empowering health service users may enhance adoption. These insights offer practical guidance for policymakers and healthcare organisations seeking to integrate deprescribing into routine clinical practice.

Agitation affects 32-70% of adult patients in the intensive care unit (ICU) and is associated with disruption of life-saving treatment, prolonged hospitalisation, and psychological trauma. While nonpharmacological interventions are increasingly encouraged to reduce the reliance on sedatives, existing guidelines predominantly focus on pharmacological management. This contributes to inconsistent practices and underutilisation of effective person-centred nonpharmacological alternatives. The objective of this study was to develop evidence-based recommendations for the nonpharmacological prevention and management of patient agitation in the adult ICU. The clinical practice guideline for non-pharmacological prevention and management of patient agitation in the adult ICU (CALM ICU) was developed following the Australian National Health and Medical Research Council Guidelines for Guidelines and the Danish Health Authority's manual on guideline development. The process included stakeholder consultation with ICU clinicians, researchers, patients, and family members on the initial scope of the guideline, a systematic review and an umbrella review, a three-round modified Delphi study involving 114 participants from Denmark and Australia, and finally, stakeholder and methodological reviews of the draft guideline. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty of the evidence. The guideline offers 14 recommendations, including four conditional recommendations and 10 consensus recommendations. These address early and systematic assessment, identifying and treating underlying causes of agitation, prioritising nonpharmacological interventions, and using multicomponent interventions. The recommendations also include using de-escalation strategies, reorientation, promoting sleep, adjusting stimuli, supporting comfort and relaxation, encouraging mobilisation, and involving family members. The guideline also includes two additional recommendations highlighting the importance of fundamental person-centred care and organisational support for ICU staff. The CALM ICU guideline provides the best available evidence for reducing patient agitation through nonpharmacological strategies. It should be integrated into standard ICU care and serve as a foundation for education and practice. Further research is needed to strengthen the evidence base and explore implementation in diverse ICU settings. This guideline has been endorsed by the Australian College of Critical Care Nurses.

In pediatric intensive care units, pain, sedation, delirium, and iatrogenic withdrawal syndrome (IWS) must be managed as interrelated conditions. Although clinical practice guidelines (CPGs) exist, new evidence needs to be incorporated, gaps in recommendations addressed, and recommendations adapted to the European context. This protocol describes the development of the first patient- and family-informed European guideline for managing pain, sedation, delirium, and IWS by the European Society of Paediatric and Neonatal Intensive Care. This guideline will follow the Grading of Recommendations Assessment, Development, and Evaluation ADOLOPMENT approach across seven phases: (1) setup-establish 3 groups, namely a steering committee, development panel (experts and patient and family partners), and patient and family partner advisory panel, to define guideline scope through voting and consensus; (2) preparation-vote on 30 summary recommendations compiled from existing CPGs of medium quality or above; prioritize new research questions; update the search for CPGs to match new research questions with recommendations using population, intervention, comparator, and outcome elements; prioritize outcomes for effectiveness questions using a 9-point Likert scale; with validation from patient and family partners; (3) evidence identification, analysis, and data extraction-develop individualized search strategies for each research question (2 independent appraisers will select and appraise studies and conduct data extraction); (4) evidence synthesis-expert pairs will summarize findings in evidence profiles and evidence-to-decision (EtD) frameworks (in the absence of evidence, the expert panel will be surveyed to assess current practices); (5) guideline development-expert pairs will draft recommendations, then topic-specific subgroups will reach consensus before full development panel voting (>80% approval needed; subgroups will determine the need for additional supporting content); (6) review-conduct internal, society-level, and external international expert reviews using surveys with Likert scales and open-ended comments; and (7) issue and update-publish the guideline and monitor literature to assess the need for updates before 5 years. In phase 1, a total of 21 clinical experts and 17 patient and family partners were recruited, and the guideline scope was finalized with 80% to 100% agreement. In phase 2, a total of 23 summary recommendations and 17 new research questions (total=40) were selected. The updated CPG search identified 2 low-quality CPGs, which were excluded from recommendation matching. Of the 17 new research questions, 4 matched existing recommendations. Of the 3 effectiveness questions, one had 7 prioritized outcomes, whereas two had 9 outcomes for inclusion in EtD frameworks. The final CPG is expected by spring 2026, with search strategies, EtD frameworks, and recommendations included. This protocol ensures a transparent Grading of Recommendations Assessment, Development, and Evaluation-based development process, leading to a trustworthy and credible guideline tailored to the European context for managing pain, sedation, delirium, and IWS in children who are critically ill. DERR1-10.2196/67930.

Our aim was to update the evidence-based and consensus-based recommendations for prehospital coagulation management and fluid replacement therapy in patients with multiple and/or severe injuries on the basis of current evidence. This guideline topic is part of the 2022 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. MEDLINE and Embase were systematically searched to May 2021. Further literature reports were obtained from clinical experts. Randomised controlled trials, prospective cohort studies, and comparative registry studies were included if they compared interventions for fluid replacement therapy, the transfusion of blood products, the management of coagulation, or intravenous/intraosseous access in patients with multiple and/or severe injuries in the prehospital setting. We considered patient-relevant clinical outcomes such as mortality and bleeding control, or coagulation parameters as surrogate outcomes. Risk of bias was assessed using NICE 2012 checklists. The evidence was synthesised narratively, and expert consensus was used to develop recommendations and determine their strength. Thirty-five new studies were identified. Interventions covered were prehospital fluid replacement therapy (n = 5 studies), infusions (n = 3), transfusions (n = 11), coagulation management (n = 13), and intraosseous access (n = 2). Four recommendations were modified, and six additional recommendations were developed. All achieved strong consensus. The following key recommendations are made. Fluid replacement therapy should be initiated in severely injured patients. In patients with uncontrolled bleeding, fluid replacement therapy should be limited (MAP of 65 mmHg, SBP of 80 mmHg) in order to maintain minimum haemodynamic stability while not increasing blood loss. In hypotensive patients with suspected isolated or concomitant significant traumatic brain injury, the objective of fluid replacement should be to maintain normal blood pressure (MAP of 85 mmHg, SBP of 110 mmHg). Intravenous access is used in trauma patients. If intravenous access cannot be achieved in trauma patients, intraosseous access is used for the delivery of fluids and medications. If there are no signs and symptoms of volume depletion, fluid replacement therapy should not be provided. If the administration of a sufficient volume of fluids fails to achieve adequate blood pressure in a polytrauma patient, the titrated use of vasopressors for circulatory support may be considered. The lethal triad of hypothermia, acidosis, and coagulopathy should be addressed at the prehospital stage. One gram of tranexamic acid should be administered in cases of existing or imminent haemorrhagic shock. The administration of fibrinogen may also be considered in cases of uncontrollable bleeding, as may the administration of erythrocyte and plasma concentrates.

Decision-making regarding treatment limitations such as "Do not attempt resuscitation" (DNAR) orders for older patients has been found deficient. Patients ≥ 80 years with substantial comorbidity have little chance of surviving cardiac arrest, thus require thorough risk classification focusing on comorbidity and frailty. This study aimed to explore the degree of frailty, comorbidity and treatment limitations in patients ≥ 80 years in various forms of care. Additionally, the study examined the extent to which patients and/or relatives participated in these decisions. Descriptive, quantitative cross-sectional design. Medical records of 500 patients ≥ 80 years were reviewed: 100 medical, 100 orthopaedic and 100 surgical in-patients, in addition to 100 patients in Home Health Services (HHS) and 100 patients in Municipal Short-Term Care (MSTC). Comorbidity was classified and categorized using the Age-combined Charlson Comorbidity Index (ACCI). Frailty was assessed using the Clinical Frailty Scale (CFS). DNAR decisions as well as other treatment and care limitations were compiled. Patients' and relatives' participation in discussions and information about treatment limitations was also examined. Of the 500 patients, 48% had a moderate (5-7 points) and 50% a severe burden (≥ 8 points) of ACCI, while 91% were rated as frail (CFS ≥ 5). In total, 176/500 (35%) had valid DNAR-decisions. Both age ≥ 90 years (OR 4.07, 95% CI 2.56-6.37) and CFS ≥ 5 (OR 16.13, 95% CI 4.54-103.40) was significantly associated with a DNAR-decision, while ACCI ≥ 8 was not. Less than a third (29%) of patients with a DNAR-decision had been informed by a physician. For those without a DNAR-decision, there was no documentation of discussions regarding their wish for full cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. Of all 500 patients, 14% had a discussion with a physician about CPR. Fewer treatment limitations than expected were documented for older, frail patients with moderate or severe comorbidity. Considerable deficiencies were found regarding decision-making and actively reviewing and confirming DNAR-decisions, showing a gap between medical-ethical guidelines and their application in practice. Improved adherence to medical-ethical guidelines would strengthen patients' legal rights and their opportunity for shared decision-making.

Clinical guidelines (CGs) standardize care through evidence-based recommendations, while clinical decision support systems (CDSS) can assist in applying these guidelines to individual patients. The scientific basis for the decisions offered by decision support systems is often not explicitly stated or not clearly specified in the literature on CDSS. Therefore, a systematic examination of the literature is needed to map the current state of CDSS, with a particular focus on the integration of CGs. This study aims to systematically collect, describe, and synthesize evidence of randomized controlled studies of interventions using CDSS with a well-defined integration of evidence-based CGs and evaluating direct medical outcomes. This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklists. The eligibility criteria for this review are defined using the patient, intervention, control, outcome, and study design framework, including studies involving patients with any medical condition or disease. Study interventions need to include guideline-based CDSS, encompassing all types of interventions used for treatment. Each intervention must provide a sufficiently accessible technical description, including the types of data and algorithms used for decision-support procedures. The guidelines used within these CDSS interventions must be derived from a clearly defined, evidence-based guideline development process published by a discernible guideline-producing body. Studies must use a randomized controlled study design. Only studies evaluating the effectiveness of the interventions on direct medical outcomes are included. Web of Science, including MEDLINE, and Scopus will be searched with search expressions aligned with the eligibility criteria. On August 11, 2022, the initial search was conducted on Web of Science and Scopus. From a total of 6203 records, 1347 were removed prior to screening as duplicates, 2506 records were excluded during the first screening step, and 2291 were excluded during the second step. Next, 41 papers were excluded based on full-text review, and 18 papers were finally included in the review following this initial search. This review explores whether CDSS based on CGs can improve clinical outcomes, although their effectiveness may vary depending on various factors. Potential limitations, such as high study heterogeneity, have already been identified. An update of the review has been started in April 2025. To our knowledge, this is the first rigorous systematic review on the effectiveness of guideline-based decision support systems in which the technical integration and algorithmic embedding of CGs have been described or can be inferred from secondary literature. With this review, we aim to address this gap by providing a detailed analysis of existing research and identifying best practices, challenges, and areas for future investigation.

This article is the third in a series of articles prepared as part of a comprehensive, international and professional society-approved consensus project to advise on thoracic anesthesia. It represents the views and structured opinions of experts delegated to the Airway Management Task Force of the Thoracic Subcommittee of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC). This review highlights the main concepts and expert opinion of international leaders on the task of lung isolation and separation, as well as the current recommendations on the benefits and disadvantages of different devices in both routine and difficult airway scenarios. The consensus statement addresses the following main clinical topics and questions: (1) What are the overall goals and means of lung isolation and separation? (2) What are the best practices for using double-lumen tubes? (3) What is the role of alternative devices, specifically bronchial blockers? (4) What are the best practices for managing a difficult airway? (5) What are the recommendations for special cases? (6) What are the research priorities for thoracic anesthesia regarding airway management? The authors conclude with a brief reference to how these recommendations relate to the concepts of good clinical practice and enhanced recovery. The document was developed and formally evaluated by senior clinicians representing the core membership of the EACTAIC Thoracic Subcommittee from Europe, the United States, Africa, and the Middle East. Although the high-level evidence base is generally limited and significant controversies remain, all recommendations of the Task Force achieved an agreed (>60%), strong (>80%), or sometimes full (>95%) consensus. This consensus should serve as a consolidation of diverse practices of thoracic anesthesia and a starting point toward obtaining stronger evidence to further enhance our clinical practice in the future.

This study aimed to identify barriers and facilitators affecting implementation of perioperative music interventions in general practice. A qualitative implementation study using semistructured interviews. The updated Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. The domains used were: innovation, outer setting, inner setting and individuals. Primary outcomes were barriers and facilitators for the implementation of perioperative music interventions in general practice. General practices in the Netherlands. Dutch general practitioners. 15 participants were included, among which 11 general practice owners, one salaried general practitioner, two locum general practitioners and one general practitioner in training. In total, 19 key barriers and 34 key facilitators were identified. For the innovation domain, a lack of research conducted in primary care and low awareness of the intervention were considered barriers whereas user-friendliness and low costs were seen as facilitators. For the outer setting domain, no barriers were identified and possibilities for external financing, inclusion in clinical guidelines and patient and media pressure were considered facilitators. For the inner setting, the lack of readily accessible information aimed at primary care was seen as a barrier, whereas a shared belief in minimising perioperative pain and anxiety was seen as a facilitator. For the individuals domain, a pre-existing heavy workload and understaffing were seen as barriers, whereas the autonomous role of general practitioners was seen as a facilitator. Several key barriers and facilitators for implementation of perioperative music interventions in general practice were identified. A lack of research performed in the setting of primary care of the efficacy of the music intervention and low awareness among general practitioners were examples of barriers. Notable facilitators were user-friendliness, low-costs and the autonomous position of the general practitioner. Implementation of music intervention by general practitioners seems feasible, yet there is still room for more research to be performed in the specific context of primary care.

Although clinical trials are fundamental to advancing evidence-based practice, significant heterogeneity in outcome reporting poses a considerable challenge to the validity of systematic reviews. This inconsistency impedes the ability to compare, synthesise and interpret research findings effectively. In the field of paediatric airway management, this issue is particularly relevant because of the low incidence of critical events and the related high morbidity and mortality. The issue of inadequate and variable outcome reporting in clinical trials has been widely acknowledged, necessitating initiatives to enhance the quality of future research. This protocol delineates the methodology used for the development of standardised, consensus-based outcome definitions and reporting items specifically tailored to paediatric airway management trials. The goal is to create guidance that will serve as an extension to the established SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) frameworks, leading to enhanced trial reproducibility and transparency and ultimately improve pediatric airway research, systematic reviews and advance patient care and safety. This project will adhere to the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network's framework for guideline development. The methodology will be structured into four distinct phases: (1) a scoping review to comprehensively identify outcomes and variables currently reported in paediatric airway management trials; (2) a three-round Delphi process involving a multidisciplinary panel of experts to prioritise and refine outcomes and variables; (3) a consensus meeting to achieve agreement on the final set of reporting items, which will then be prepared for publication and (4) dissemination. The finalised outcome reporting guidelines, in the form of SPIRIT and CONSORT extensions for paediatric airway management, will be disseminated through various channels to maximise their reach and impact. These include publication in peer-reviewed journals, presentation at major international conferences and submission to relevant international reporting registries, such as the EQUATOR, SPIRIT and CONSORT registries. Active engagement with key stakeholders, including journal editors, research funders, regulatory bodies and clinician networks and national and international societies, will be a crucial component of the dissemination strategy.

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Due to the continued use of fossil fuels and other chemical pollutants, atmospheric greenhouse gas concentrations and environmental pollution continue to rise. The health sector is both a driver and a victim of these developments, and intensive care medicine (ICM), with its high energy demands, extensive use of disposable products, and large variety of pharmaceuticals, contributes substantially to the climate crisis and environmental degradation. The European Society of Anaesthesiology and Intensive Care (ESAIC) therefore aimed to develop consensus recommendations to reduce the environmental footprint of ICM across Europe. A total of 37 recommendations were initially drafted by four topic groups (1) energy, (2) waste management, (3) medication, and (4) ethics-each composed of three to five experts. To facilitate implementation in both middle- and high-income European countries, the agreement threshold was set at 80%. The recommendations were validated by 37 experts from 20 countries using a two-step Delphi procedure. In the first round, all recommendations reached at least 75% agreement. After amendments to four recommendations based on expert feedback, all achieved over 80% approval in the second round, with 32 receiving more than 90% agreement. The final recommendations address: (1) a complete transition to renewable energy and implementation of energy-saving strategies; (2) optimisation of procurement in clinical processes (10Rs) and waste management solutions for single-use plastics; (3) reduction of greenhouse gas emissions (mainly fluorinated gases) and water toxicity caused by medications, as well as prevention of a further increase in antimicrobial resistance (AMR); and (4) implementation of an environment-related, ethically guided precautionary principle. This ESAIC consensus provides a practical framework for sustainable ICM. Stakeholders at all levels should now introduce these recommendations through institutional policies, procurement criteria, guidelines and quality improvement programmes to align intensive care practice with planetary health goals.

This is the first part of a series of articles prepared for a comprehensive, international, and professional society-approved consensus project to advise on thoracic anesthesia. It represents the views and structured opinions of experts delegated to the General Management: Monitoring Task Force of the Thoracic Subcommittee of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC). This review highlights international leaders' main concepts and expert opinions on how monitoring is the core task of anesthesiologists involved in the care of thoracic patients, providing recommendations for assessing principal organ systems and using different devices in routine and specialized scenarios. The consensus statement addresses the following main clinical topics and questions: (1) What constitutes standard basic and advanced monitoring? (2) What are the overall goals and means of monitoring the respiratory system? (3) How shall we monitor the circulation in thoracic anesthesia? (4) What are the main aspects of monitoring neuromuscular blockade? (5) What are the best practices for monitoring the depth of anesthesia and neurologic function? (6) What are the research priorities for thoracic anesthesia monitoring? (7) The authors briefly discuss how these recommendations relate to the concepts of good clinical practice and enhanced recovery. This document was developed and formally evaluated by senior clinicians representing the core membership of the EACTAIC Thoracic Subspecialty Committee from Europe, the United States, Africa, and the Middle East. Although a high-level evidence base is generally limited and significant controversies remain, all recommendations of the Task Force achieved an agreed (>60%), strong (>80%), or sometimes full (>95%) consensus. This consensus should serve as a consolidation of diverse practices of thoracic anesthesia and a starting point toward obtaining more robust evidence to further enhance our clinical practice in the future.

Peri-operative medicine is a critical component of contemporary healthcare delivery. Despite significant advancements, peri-operative complications remain a relevant concern. Obtaining reliable risk estimates, identifying potential causes, and studying new interventions, revised policies or implementation of best practices to prevent complications, requires data from a large number of participants. Electronic Patient Record systems offer the opportunity to unlock these data, but the limited standardisation of databases and sharing frameworks available across Europe limit the effective use of the available data. We propose creating a European peri-operative shared data registry with continuous data collection, integrating clinical, bedside monitoring and outcome data in a collaborative network. Such network would facilitate outcomes research, could serve as a platform to optimise clinical practices by fostering quality improvement through benchmarking of care delivered by departments or individual physicians, and could be used to evaluate policy changes. This ESAIC initiative aligns well with the development of the European Health Data Space. This article provides examples of contemporary clinical research and practice evaluation questions to illustrate the need for a European collaborative data-sharing network, highlights inspiring examples of existing data-sharing initiatives and describes a road map to establish such network.

The aim of this study was to describe the methodological development of appropriate use criteria for arterial catheter use in adult intensive care units using the RAND Corporation/University of California, Los Angeles (RAND/UCLA) Appropriateness Method. This methods paper reports the prespecified development phase of an appropriateness study. The RAND/UCLA Appropriateness Method was applied in sequential phases, including defining scope and key terms, synthesising evidence through a literature review and national survey, developing clinical indications, and rating indications across two rounds by an interdisciplinary expert panel. Panel members had expertise in arterial catheter insertion and management across intensive care, anaesthesiology, emergency medicine, infectious diseases, critical care nursing, and clinical and tertiary intensive care education. Clinical indications were iteratively developed based on common clinical scenarios, anticipated uses, practice guidelines, and available evidence on efficacy and safety. Each indication was rated on a 9-point scale (1 = harms outweigh benefits; 9 = benefits outweigh harms) and classified as appropriate (median: 7-9 without disagreement), uncertain/neutral (median: 4-6 or any median with disagreement), or inappropriate (median: 1-3 without disagreement). Disagreement was assessed using the Interpercentile Range Adjusted for Symmetry method. The RAND/UCLA Appropriateness Method provides a structured, transparent, and reproducible approach for developing appropriate use criteria for arterial catheters in adult intensive care. The final appropriateness ratings and clinical recommendations derived from this process are reported separately.

To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads, as well as within subgroups, served as an integral part of the guideline development process. New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.

The Central Sensitization Inventory (CSI) assesses central sensitization-related symptoms, but its 25-item length may limit its use in large-scale research or routine clinical practice. Therefore, the aim was to develop a short version of the CSI, using a large international sample of 7862 participants across 23 countries. A multi-step Rasch analysis was applied to the 25-item version of the CSI using a training-validation paradigm to identify the subset of items that best fit a unidimensional model. Then, an expert committee reviewed the face-content validity of each item. A 7-item solution was ultimately developed (Chi-Square Value = 794.728, df = 20; p-value < 0.001; CFI = 0.96; TLI = 0.96; RMSEA = 0.09, 90%CI [0.09-0.10]; SRMR= 0.05). Internal consistency was adequate for both the CSI-25 (&#x3b1; = 0.93; &#x3c9; = 0.93) and CSI-7 (&#x3b1; = 0.85; &#x3c9; = 0.85). Both versions demonstrated strong discriminative validity in identifying subgroups with presumed different levels of central sensitization-related symptoms. As expected, CSI-25 and CSI-7 scores increased progressively from healthy control participants (who scored lowest) to single-site non-spinal chronic pain, chronic spinal pain, multi-site chronic pain, and fibromyalgia (who scored highest). CSI-7 Receiver Operating Characteristic curves showed excellent sensitivity and specificity, particularly in differentiating fibromyalgia from healthy control participants (area under the curve = 0.98; sensitivity of 92% and specificity of 93%). CSI-7 severity levels were empirically derived to aid clinical interpretation. To sum up, the CSI-7 offers an efficient, unidimensional, and internally consistent alternative to the CSI-25 for international use. PERSPECTIVE: The CSI-7 offers a brief, clinically useful screening tool for identifying central sensitization-related symptoms across diverse pain conditions. Derived from international data, it retains the psychometric strength of the full CSI while reducing patient burden, supporting efficient assessment in busy clinical and research settings.

To evaluate the use of ChatGPT and DeepSeek in clinical practice to provide healthcare professionals with accurate information on the prevention, diagnosis, and management of post-dural puncture headache (PDPH), in particular to evaluate ChatGPT-4o, ChatGPT-4o mini, DeepSeek-V3 and DeepSeek with Deep Think(R1)'s responses with consensus practice guidelines for headache after dural puncture. Post-dural puncture headache (PDPH) is a common complication of dural puncture. Currently, there is a lack of evidence-based guidance on the prevention, diagnosis and management of PDPH. The 2023 Consensus guidelines provide comprehensive information. With the development and popularization of AI, more and more people are using ai models, including patients and doctors. However, the quality of the answers provided by ai has not yet been tested. Responses from ChatGPT-4o, ChatGPT-4o mini, DeepSeek-V3, and DeepSeek-R1 were evaluated against PDPH guidelines using four dimensions: Accuracy (guideline adherence), Overconclusiveness (unjustified recommendations), Supplementary information (additional relevant details), and Incompleteness (omission of critical guidelines). A 5-point Likert scale further assessed response accuracy and completeness. All four models show high accuracy and completeness.Of the 10 clinical guidelines evaluated,ChatGPT-4o, ChatGPT-4o mini, DeepSeek-V3 and DeepSeek-R1 all showed 100% accuracy in responses (10/10)(p&#x2009;=&#x2009;1). None of the four models showed overly conclusive results(p&#x2009;=&#x2009;1). In terms of supplementary information, ChatGPT-4o,ChatGPT-4o mini and DeepSeek-R1 are 100% (10/10), DeepSeek-V3 is 90% (9/10)(p&#x2009;=&#x2009;1). In terms of incompleteness, ChatGPT-4o is 80%(8/10), DeepSeek-R1 is 70%(7/10), ChatGPT-4o mini and DeepSeek-V3 are 60% (6/10) (p&#x2009;=&#x2009;0.729). All four AI models demonstrate clinical validity, with ChatGPT-4o and DeepSeek-R1 showing stronger guideline alignment. Though largely accurate, their responses achieve only 60-80% completeness relative to medical guidelines. Healthcare professionals must exercise caution when using AI tools and should critically evaluate outputs before clinical application. While promising, their partial guideline coverage requires careful human oversight. Further validation research is essential before these models can reliably support clinical decision-making for complex conditions like PDPH.