Validating GAN-BioBERT: A Methodology for Assessing Reporting Trends in Clinical Trials.

Background: The aim of this study was to validate a three-class sentiment classification model for clinical trial abstracts combining adversarial learning and the BioBERT language processing model as a tool to assess trends in biomedical literature in a clearly reproducible manner. We then assessed the model's performance for this application and compared it to previous models used for this task. Methods: Using 108 expert-annotated clinical trial abstracts and 2,000 unlabeled abstracts this study develops a three-class sentiment classification algorithm for clinical trial abstracts. The model uses a semi-supervised model based on the Bidirectional Encoder Representation from Transformers (BERT) model, a much more advanced and accurate method compared to previously used models based upon traditional machine learning methods. The prediction performance was compared to those previous studies. Results: The algorithm was found to have a classification accuracy of 91.3%, with a macro F1-Score of 0.92, significantly outperforming previous studies used to classify sentiment in clinical trial literature, while also making the sentiment classification finer grained with greater reproducibility. Conclusion: We demonstrate an easily applied sentiment classification model for clinical trial abstracts that significantly outperforms previous models with greater reproducibility and applicability to large-scale study of reporting trends.

Liposomal Bupivacaine Versus Standard Bupivacaine in the Adductor Canal for Total Knee Arthroplasty: A Randomized, Controlled Trial.

Peripheral nerve blocks are commonly used in total knee arthroplasty (TKA). Liposomal bupivacaine is an extended-release anesthetic medication that maintains efficacy upwards of 72 hours. This study compared single-shot liposomal bupivacaine (LB) with the standard single-shot bupivacaine (SB) in a preoperative adductor canal block in TKA patients. A double-blind randomized, controlled trial at a single institution was performed in patients undergoing TKA. A standard preoperative single-shot adductor canal nerve injection was performed in 31 patients using 266 mg of liposomal bupivacaine (20 mL), whereas 32 patients received a standard formulation of 0.5% bupivacaine hydrogen chloride (20 mL). The primary outcome measure was postoperative gait velocity. Secondary outcomes included knee range of motion, pain scores, patient satisfaction, knee extension strength, opioid consumption, length of stay, and adverse events. There were no differences in baseline measures between groups. Improved pain ratings with activity (P=.009) were noted on postoperative day 1 with LB (mean, 4.4; SD, 2.0) compared with SB (mean, 5.9; SD, 2.6). Fewer opioids were used with LB compared with SB on postoperative day 1 (mean, 51.2 vs 66.1; P=.020) and on postoperative day 2 (mean, 39.5 vs 54.8; P=.016). No statistically significant differences in gait velocity, knee range of motion, knee extension strength, or patient satisfaction occurred. Peripheral nerve blockade with a single-shot adductor canal injection demonstrated improved pain scores with activity and diminished postoperative narcotic use when using LB compared with SB in TKA patients. There may be early postoperative advantages with LB as a single-shot injection in adductor canal blockade for patients undergoing TKA. [Orthopedics. 2021;44(4):249-255.].

Educating Perioperative Nurses About Local Anesthetic Systemic Toxicity Using High-Fidelity Simulation.

BACKGROUND: The rarity of perianesthetic catastrophic events creates a challenge in training support staff in the treatment of emergencies such as local anesthetic systemic toxicity (LAST). Simulation learning offers a unique venue in which to safely encounter rare events. AIMS: This study aimed to evaluate knowledge retention regarding LAST in perianesthetic nursing staff using high-fidelity simulation and a short didactic session. DESIGN: Nurses were recruited from perioperative locations to participate in a simulated scenario of LAST and engage in a short didactic session. SETTINGS: Simulation and education occurred in the high-fidelity simulation center at the University of Wisconsin Hospital. PARTICIPANTS/SUBJECTS: Thirteen nurses from the preoperative, post-anesthesia, and block nursing teams participated in the study. METHODS: Participants completed a pre-test before participating in the simulation, followed by a formal debrief and short lecture. They then completed post-tests and a short survey focused on self-efficacy and review of the simulation experience. RESULTS: Test scores, compared to the pre-test, improved significantly on the immediately-post, 1-month, and 3-month assessments. Participants felt more equipped to handle crisis scenarios. CONCLUSIONS: Experiential learning often results in significant knowledge acquisition and retention. Participants in this study improved their test scores regarding LAST and increased their sense of self-efficacy and ability to handle crisis scenarios after taking part in a high-fidelity simulation.

Preemptive Analgesia in Minimally Invasive Gynecologic Surgery.

Preemptive analgesia is an intervention provided before initiating painful stimuli that may reduce or prevent subsequent pain. This systematic review examines the evidence supporting the practice of preemptive analgesia in minimally invasive gynecologic surgery (MIGS). We searched PubMed, Cochrane Register for Controlled Trials, and Embase from inception through February 26, 2018. The search was limited to human and English language studies. A total of 324 studies were identified. The abstracts were screened for relevance for minimally invasive gynecologic surgery (MIGS) and preemptive analgesia. The final trials reviewed were restricted to randomized controlled trials of preemptive medications given before the completion of MIGS surgery. Preemptive blocks (including paracervical, triple antibiotic paste, and pudendal) appear to have the most consistently beneficial effect on postoperative pain in MIGS with an excellent cost-benefit ratio, with the exception of liposomal bupivacaine, which requires further evaluation to determine if its added cost delivers better outcomes. Preemptive anticonvulsants, ketamine, and dexmedetomidine have a positive effect on postoperative pain and opioid use but are limited by side effects. Preemptive dexamethasone, acetaminophen, and nonsteroidal anti-inflammatory drugs have a modest effect on postoperative pain control. Despite these findings, additional quality work is needed to find more definitive methods of preemptive pain control for MIGS.

Evaluation of antibiotic releasing porous polymethylmethacrylate space maintainers in an infected composite tissue defect model.

This study evaluated the in vitro and in vivo performance of antibiotic-releasing porous polymethylmethacrylate (PMMA)-based space maintainers comprising a gelatin hydrogel porogen and a poly(dl-lactic-co-glycolic acid) (PLGA) particulate carrier for antibiotic delivery. Colistin was released in vitro from either gelatin or PLGA microparticle loaded PMMA constructs, with gelatin-loaded constructs releasing colistin over approximately 7 days and PLGA microparticle-loaded constructs releasing colistin for up to 8 weeks. Three formulations with either burst release or extended release at different doses were tested in a rabbit mandibular defect inoculated with Acinetobacter baumannii (2×10(7) colony forming units ml(-1)). In addition, one material control that released antibiotic but was not inoculated with A. baumannii was tested. A. baumannii was not detectable in any animal after 12 weeks on culture of the defect, saliva, or blood. Defects with high dose extended release implants had greater soft tissue healing compared with defects with burst release implants, with 8 of 10 animals showing healed mucosae compared with 2 of 10 respectively. Extended release of locally delivered colistin via a PLGA microparticle carrier improved soft tissue healing compared with implants with burst release of colistin from a gelatin carrier.