PURPOSE OF REVIEW:This article aimed to examine the value of education and training within perioperative neuroscience and its development for supporting the delivery of high-quality, safe patient care. RECENT FINDINGS:Perioperative neuroscience is a rapidly evolving field in anesthesiology, with current research demonstrating the potential for neurological injury in patients undergoing nonneurological and neurological surgery. Expertise is essential to mitigate risk. Current evidence in perioperative neuroscience suggests a patient benefit with subspecialty training. Advanced training programs have continued to evolve with the development of global accreditation programs for fellowship training. SUMMARY:Advanced training within perioperative neuroscience is necessary to improve healthcare outcomes. Accreditation of training programs offers standardization and quality assurance.
PURPOSE OF REVIEW:Chronic pain management increasingly requires a patient-centered, adaptive approach. This review examines how shared decision-making (SDM) and individualized strategies develop and function in chronic pain care, emphasizing their relevance in practice. RECENT FINDINGS:Recent literature highlights that SDM improves patient satisfaction, engagement, and psychological outcomes across various chronic pain conditions. However, SDM is most effective when viewed as an ongoing, iterative process rather than a one-time decision. Studies show that alignment between patient and clinician expectations, effective communication, and recognition of patient preferences are key determinants of success. In opioid management, SDM may unintentionally sustain prescribing patterns, underscoring the need for balanced communication and clinician training. Decision aids and structured tools can support SDM by improving patient knowledge and involvement, although barriers such as health literacy and access to technology remain. Persistent discrepancies between patient and clinician perspectives, as well as contextual and socioeconomic factors, can challenge implementation. SUMMARY:SDM is an essential component of chronic pain management but is insufficient as a standalone strategy. Effective care requires continuous support, education, and adaptation within a strong therapeutic relationship. Future approaches should focus on flexible, context-sensitive interventions that integrate biopsychosocial principles and address individual patient needs.
PURPOSE OF REVIEW:The growing incidence of acute neurological disorders, has underscored the increasing global need for dedicated neurocritical care (NCC) services. The organization and delivery of NCC services in low- and middle-income countries (LMICs) continue to evolve from a fragmented care system toward a comprehensive care model. This article reviews the available literature on the delivery of NCC services in LMICs and examines key domains, including infrastructure requirements, education and training frameworks, and research capacity, to support organizational models of care. RECENT FINDINGS:Earlier publications from LMICs highlight the state of NCC services and the persistent rural versus urban disparities in access to specialized care. Authors have also discussed the organization of existing NCC units and have proposed minimum standards for establishing NCC units. In an effort toward standardized care for NCC patients, researchers have focused on strategies to increase education, training, and research capacity. They discuss pragmatic strategies and future directions aimed at strengthening and expanding NCC services across LMICs. SUMMARY:There is an urgent need to strengthen NCC facilities across LMICs to mitigate the ongoing variability in clinical practice and service delivery. Addressing NCC infrastructure together with disparities experienced by critically ill patients requires targeted, context-sensitive interventions.
PURPOSE OF REVIEW:To review and summarize the current clinical evidence supporting sympathetic neural blockade for recurrent and refractory ventricular arrhythmias and electrical storm. These conditions continue to be associated with substantial morbidity and mortality, despite advances in antiarrhythmic therapy, catheter ablation, and mechanical circulatory support. Sympathetic overactivity is a key driver of ventricular arrhythmogenesis, and cardiac autonomic neuromodulation should be recognized as an important tool in the therapeutic algorithms. RECENT FINDINGS:Clinical evidence and acceptance of percutaneous and neuraxial sympathetic blockade for ventricular tachyarrhythmias and electrical storm are rapidly accumulating. A dramatic increase in the amount of peer-reviewed publications indicates a transition from emergence and recognition to mainstream adoption and consolidation phases.Currently, most reports and strongest evidence support percutaneous stellate ganglion block (SGB), associated with rapid reductions in ventricular arrhythmia episodes and implantable cardioverter defibrillator shocks across systematic reviews and multicenter observational studies. Continuous block techniques may prolong benefit beyond a single-injection. Thoracic epidural anesthesia has also demonstrated clinically meaningful arrhythmia suppression, while evidence for thoracic paravertebral and proximal intercostal blocks is accumulating. SUMMARY:Sympathetic neural blockade is a clinically effective adjunct therapy for refractory ventricular arrhythmias, with SGB currently supported by the strongest clinical evidence.
PURPOSE OF REVIEW:Universal healthcare coverage (UHC) is a controversial political and financial topic in any healthcare system. Unfortunately, the best value-based care for patients is not always achievable in many healthcare systems and the impact of the presence or absence of UHC has significant ramifications for healthcare institutions, clinicians, and patients. This review provides an overview of the different universal healthcare funding models to equip clinicians with the tools needed to navigate and advocate for better general and perioperative care for patients. RECENT FINDINGS:The United Nations included UHC in the United Nations Sustainable Development Goals in 2015, with the goal of UHC by 2030. The race to achieve this goal has meant policy and system changes that translate to a system in which clinicians working to deliver care is constantly evolving and challenged by epidemics, multiple world economic crises, geopolitical unrest, change in philanthropic investment, and a change in legal frameworks in healthcare delivery. SUMMARY:The way clinicians navigate value-based care in a UHC system will always be ethically and professionally challenging. Perioperative neuroscience clinical teams are, however, uniquely positioned to produce better patient outcomes and to advocate at every level of care and society for UHC.
