BACKGROUND:Intraoperative hypotension is a common occurrence in patients undergoing anaesthesia, although there is no standardised definition of hypotension. International consensus statements provide some guidelines for the management of intraoperative hypotension, but general clinical practice is unknown. We aimed to survey anaesthesiologists' values and preferences regarding intraoperative blood pressure management, including whether they would support future research on this topic. METHODS:We conducted an international, online survey of routine practice and opinion. The target population was anaesthesiologists who regularly anaesthetise adult patients. Results are reported descriptively and in accordance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist. RESULTS:A total of 1640 anaesthesiologists from 11 European countries participated in the survey. The majority of respondents were specialists (1322 of 1640, 80.6%, 95% CI 78.7-82.6). Almost all respondents worked in public hospitals (1613 of 1640, 98.4%). The overall response rate was 22.7%. Most respondents reported using absolute mean arterial pressure as their main unit of measurement to quantify hypotension (1098 of 1640, 67.0%, 95% CI 64.6-69.2). Respondents were most likely to initiate vasoactive treatment at a mean arterial pressure below 60 or 65 mmHg. Chronic arterial hypertension, traumatic brain injury and surgical procedures involving head-up positioning of the patient were the three most common scenarios where respondents would raise their threshold for treatment. Most respondents considered the establishment of safe intraoperative blood pressure thresholds a critical research question, and almost all respondents (1509 of 1640, 92.0%) indicated a willingness to randomise patients to specific blood pressure targets. For 72.9% (1196 of 1640), the lowest acceptable mean arterial pressure for randomisation was 60 mmHg. Respondents were also interested in the comparison of efficacy and safety of vasoactive agents, and the most sought-after comparison was phenylephrine versus noradrenaline (1252 of 1640, 76.3%). The willingness of respondents to administer these agents in peripheral venous access differed according to geography. CONCLUSION:In this international survey, mean arterial pressures of 60 or 65 mmHg were the most commonly reported blood pressure thresholds leading to initiation of treatment with vasoactive agents. Almost all respondents indicated patient groups for whom they would alter their treatment threshold, namely those suffering from chronic arterial hypertension, those undergoing surgery in a head-up position, and patients with traumatic brain injury. The majority of respondents supported future trials establishing optimal mean arterial pressure threshold and choice of vasoactive agent. We noticed a geographical variation in willingness to administer vasoactive agents in peripheral venous access. EDITORIAL COMMENT:This survey of anaesthesiologists from European countries queried practitioner perceptions of blood pressure management in adults during anaesthesia with focus on hypotension. Queries and responses also concerned circumstances and blood pressure levels which clinicians report being willing to treat actively, and how they might do this practically.
Patients admitted with viral respiratory tract infections are at risk ofbacterial co-infections that may exacerbate disease severity. Detection of atypical bacteria requires specific laboratory diagnostic modality and specific antibiotics. In this retrospective regionwide cohort study we included all patients admitted to a hospital in the Central Denmark Region with COVID-19, influenza A, influenza B, or Respiratory Syncytial Virus (RSV) from February 2019 to February 2024. Firstly, we investigated the number of patients testing positive for atypical bacterial co-infection. Secondly, we evaluated associations with diagnostic testing for these atypical bacteria, and the use and associations with administration of empirical treatment with clarithromycin. During the study period a total of 19,651 patients were admitted with one of the viral respiratory tract infections. Only 21 patients tested positive for atypical bacterial co-infection, corresponding to 0.1
BACKGROUND:Pain affects up to 85% of people living with common neurodegenerative diseases, yet evidence on the analgesic effects of exercise remains limited. This systematic review and meta-analysis examined whether exercise reduces pain in people with multiple sclerosis (MS), stroke, Parkinson's disease (PD), and Alzheimer's disease (AD). METHODS:A systematic search was conducted across six databases (PubMed, Embase, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) from November 2024 up to November 2025 to identify randomized controlled trials examining the effects of exercise (across different modalities) on pain (across different outcomes) in MS, stroke, PD, or AD. Qualitative and quantitative analyses were performed. Quality was assessed using TESTEX. RESULTS:A total of 39 studies were identified, of which 36 were included in the meta-analyses. The overall meta-analysis showed that exercise substantially reduced pain in people with neurodegenerative diseases compared with control conditions (- 0.83 [- 1.10; - 0.57], standardized mean difference [95% CI]). Large comparable effects were observed in MS (22 studies; - 0.63 [- 0.89; - 0.38]) and stroke (12 studies; - 1.07 [- 1.63; - 0.52]). Only one eligible study was found for PD and AD, respectively, highlighting a critical gap in the literature. CONCLUSIONS:This review provides strong evidence that exercise alleviates pain in people with MS and stroke and emphasizes its potential as a non-pharmacological analgesic strategy for managing pain in neurodegenerative diseases. More high-quality studies are needed, particularly in PD and AD. TRIAL REGISTRY:PROSPERO (CRD42024583498).
Introduction Midwives and obstetricians often overuse Cardiotocography (CTG) when monitoring low-risk births, despite evidence and guidelines recommending intermittent auscultation (IA). This study aims to examine whether and how a participatory intervention can provide initiatives that enhance midwives' use of evidence-based CTG monitoring in low-risk births. Methods Midwives and obstetricians from Viborg Regional Hospital participated in workshops at the hospital. Participatory design was applied using the “User Innovation Management” framework to guide two workshops with midwives and obstetricians. In Workshop 1, the participants explored needs, motives, and visions related to fetal monitoring. In Workshop 2, they developed specific initiatives for evidence-based practice. Data from the workshops was collected through audio recordings and written notes and analysed using manifest content analysis. Results Through collaborative workshops, participants co-developed three overarching initiatives aimed at the midwives: (1) Creating a culture of psychological safety and knowledge sharing, (2) Fostering recognition and mentoring, (3) Implementing practical changes. These initiatives were supported by 14 proposed actions, including training days for educational staff, improved communication materials, and structural adjustments to daily routines. These initiatives reflect a strong desire among clinicians to create a psychologically safe working environment, enhance professional recognition, and implement practical changes aligned with clinical guidelines and evidence-based practice. Conclusion Engaging clinicians through participatory methodologies facilitated the co-development of initiatives that are both actionable and contextually appropriate. This collaborative approach may enhance midwives' information to couples, thereby aligning the use of CTG monitoring in low-risk births with current evidence-based guidelines.
A 50-year-old woman developed delayed post-hypoxic leukoencephalopathy with severe cognitive and behavioural symptoms a month after hypoxic injury, with subsequent slow recovery and radiological improvement. DPHL is a rare neurological syndrome that develops days to weeks after cerebral hypoxia. Patients often show neuropsychiatric symptoms. MRI usually shows white matter changes. There is no specific treatment, but most improve gradually with neurorehabilitation. This case report highlights the challenge of diagnosing DPHL in patients with new neuropsychiatric symptoms following hypoxic events.
