Notes

Cause Investigation associated with Adverse Occasions Regarding Opioid Overdoses inside the Experts Well being Supervision.
3% (CI, 2.3% to 4.3%), with a lower HR of mortality in the surgery group (HR, 0.53 [CI, 0.41 to 0.69]). Observed relative effects were similar across sex; however, the observed association in absolute terms was greater in men. Surgery also was associated with lower cardiovascular mortality (HR, 0.53 [CI, 0.34 to 0.84]) and lower cancer mortality (HR, 0.54 [CI, 0.36 to 0.80]).

The observational design limits causal inference.

Bariatric surgery was associated with substantially lower all-cause, cardiovascular, and cancer mortality. The lowered observed mortality of surgery was significant across most subgroups. The largest absolute effects were for men and patients aged 55 years or older.

Ontario Bariatric Network.
Ontario Bariatric Network.
Midterm effects of bariatric surgery on patients with obesity and hypertension remain uncertain.

To determine the 3-year effects of Roux-en-Y gastric bypass (RYGB) on blood pressure (BP) compared with medical therapy (MT) alone.

Randomized clinical trial. (ClinicalTrials.gov NCT01784848).

Investigator-initiated study at Heart Hospital (HCor), São Paulo, Brazil.

Patients with hypertension receiving at least 2 medications at maximum doses or more than 2 medications at moderate doses and with a body mass index (BMI) between 30.0 and 39.9 kg/m
were randomly assigned (11 ratio).

RYGB plus MT or MT alone.

The primary outcome was at least a 30% reduction in total number of antihypertensive medications while maintaining BP less than 140/90 mm Hg. Key secondary outcomes were number of antihypertensive medications, hypertension remission, and BP control according to current guidelines (<130/80 mm Hg).

Among 100 patients (76% female; mean BMI, 36.9 kg/m
[SD, 2.7]), 88% from the RYGB group and 80% ented in Brazil by Johnson & Johnson do Brasil.
Opioids are frequently prescribed for acute musculoskeletal injuries and may result in long-term use and consequent harms.

To explore factors associated with persistent opioid use after its prescription for acute musculoskeletal injury.

Searches of multiple electronic databases, without language restrictions, from inception to 6 January 2020, and reference lists of selected articles.

Observational studies of adults with opioid prescriptions for outpatient acute musculoskeletal injuries, in an adjusted model, that explored risk factors for prolonged use.

6 reviewers, working in pairs, independently extracted data, rated the quality of studies, and evaluated the certainty of evidence.

14 cohorts with 13263393 participants were included. The overall prevalence of prolonged opioid use after musculoskeletal injury for high-risk populations (that is, patients receiving workers' compensation benefits, Veterans Affairs claimants, or patients with high rates of concurrent substance use disorder) was 27% (918104968).
National Safety Council. (PROSPERO CRD42018104968).
Patients and clinicians can choose from several treatment options to address acute pain from non-low back, musculoskeletal injuries.

To assess the comparative effectiveness of outpatient treatments for acute pain from non-low back, musculoskeletal injuries by performing a network meta-analysis of randomized clinical trials (RCTs).

MEDLINE, EMBASE, CINAHL, PEDro (Physiotherapy Evidence Database), and Cochrane Central Register of Controlled Trials to 2 January 2020.

Pairs of reviewers independently identified interventional RCTs that enrolled patients presenting with pain of up to 4 weeks' duration from non-low back, musculoskeletal injuries.

Pairs of reviewers independently extracted data. Certainty of evidence was evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.

The 207 eligible studies included 32959 participants and evaluated 45 therapies. Ninety-nine trials (48%) enrolled populations with diverse musculoskeletal injuries, 59 (29%) includts with acute pain from non-low back, musculoskeletal injuries. No opioid achieved benefit greater than that of NSAIDs, and opioids caused the most harms.

National Safety Council. (PROSPERO CRD42018094412).
National Safety Council. (PROSPERO CRD42018094412).
The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed this guideline to provide clinical recommendations on nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults in the outpatient setting. The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences. This guideline does not address noninvasive treatment of low back pain, which is covered by a separate ACP guideline that has also been endorsed by AAFP.

This guideline is based on a systematic evidence review on the comparative efficacy and safety of nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults in the outpatient setting and a systematic review on the predictors of prolonged opioid use. We evaluated the following clinical outcomes using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system pain (at ≤2 hours and at 1 to 7 days), physical function, symptom relief, treatment satisfaction, and adverse events.

The target audience is all clinicians, and the target patient population is adults with acute pain from non-low back, musculoskeletal injuries.








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