More than half of elderly patients presenting to emergency trauma clinic had at least one psychiatric disorder: study

A limited number of studies have examined the psychiatric morbidity in older adults presenting to emergency departments, but no data is available from emergency trauma clinics.

Kanika Sethi et al conducted a study to evaluate the prevalence of psychiatric morbidity among elderly patients presenting to the Emergency trauma setting. The article has been published in ‘ Indian Journal of Orthopaedics.’

A cross-sectional study, with a convenient sampling technique was used. 206 elderly patients presenting to the emergency trauma clinic were evaluated for psychiatric diagnosis as per the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) criteria. A trainee psychiatrist made diagnosis. Pa were also assessed on the Charlson Comorbidity Index (uCCI) (Updated), Adult Comorbidity Evaluation–27, Frail–VIG Index, and Visual Analogue Scale Numeric Pain Distress Scale.

The key findings of the study were:

• Delirium was the most common diagnosis (24.3%), followed by major depressive disorder (8.7%) and followed by dementia (8.5%), generalized anxiety disorder (2.4%), psychotic disorder (0.9%) and Bipolar I disorder (0.5%).

• The most common substance use disorder was tobacco use disorder (11.2%), followed by alcohol use disorder (9.25%).

• A significantly higher proportion of those with psychiatric morbidity were males, were employed, from nuclear families and of older age.

• Those with psychiatric morbidity had significantly higher Charlson comorbidity index score, adult comorbidity index, frailty index score, and severity of pain.

• Those with delirium had significantly higher Charlson comorbidity index score, adult comorbidity index score, frailty index score, and score on visual analogue pain scale compared to without delirium.

The authors concluded that – “Over half of the older patients presenting to emergency trauma clinic had at least one psychiatric disorder. There is a need to re-organize the emergency trauma clinic service and psychiatric evaluation should be one of the integral components of the emergency set-up.”  

Further reading:

Prevalence of Psychiatric Morbidity Among the Elderly Patients Presenting to Emergency Trauma Setting: An Exploratory Study

Kanika Sethi et al

Indian Journal of Orthopaedics (2025) 59:635–643

https://doi.org/10.1007/s43465-025-01342-4

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Acute Kidney Injury Before or During ECMO Linked to Higher Mortality, Study Finds

Germany: A large retrospective analysis has revealed that acute kidney injury (AKI) is a common and serious complication in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) for acute respiratory failure, with severe forms linked to lower chances of hospital survival regardless of when the injury occurs. The study was published online in Kidney360 on August 1, 2025.

The study, led by Clemens Wiest and colleagues from the University Hospital Regensburg in Germany, examined outcomes in 500 patients who underwent VV-ECMO between November 2014 and December 2021. The median age was 55 years, and women made up 30% of the cohort. Overall, 64% of patients developed AKI during their hospital stay. Among them, 182 patients had kidney injury before starting ECMO, while 158 developed it during ECMO therapy. A smaller subgroup experienced AKI both before ECMO and again after an initial recovery.

The key findings of the study were as follows:

  • Patients with AKI before ECMO initiation had higher inflammatory marker levels and required larger doses of norepinephrine at treatment start, indicating more severe underlying illness.
  • Those who developed AKI during ECMO often showed clinical signs of sepsis and unstable blood pressure, with lower mean arterial pressure and higher CRP levels in the days before diagnosis.
  • Overall survival to hospital discharge was 67%, with AKI patients having significantly lower survival rates (60.9%) compared to those without AKI (77.8%).
  • Severe AKI (KDIGO stage 3) was independently associated with a higher risk of in-hospital death, regardless of whether it developed before or during ECMO.
  • Long-term survival among hospital survivors was 92.5%, with age being the only independent risk factor for reduced post-discharge survival.
  • Propensity score matching showed that AKI onset during ECMO was more closely linked to disease severity and septic episodes rather than ECMO-specific factors such as blood flow rates or cell-free hemoglobin levels.

The authors noted that while ECMO is a life-saving intervention for severe respiratory failure, the occurrence of AKI signals a more critical underlying disease state and is an important prognostic indicator.

They wrote, “AKI onset before VV-ECMO therapy is linked to the severity of the underlying disease. AKI onset during VV-ECMO is less due to ECMO-related factors but also to the severity of the disease and septic episodes.” The findings underscore the importance of early recognition and management of AKI risk in ECMO patients, with close monitoring for signs of sepsis and hemodynamic instability. Preventive strategies, timely interventions, and tailored post-ECMO follow-up could help improve patient outcomes.

Reference:

Fuchs, Franziska1,*; Wiest, Clemens1,*,#; Philipp, Alois2; Foltan, Maik2; Schneckenpointner, Roland1; Dietl, Alexander1; Lunz, Dirk3; Fisser, Christoph1; Müller, Thomas1; Lubnow, Matthias1. Acute Kidney Injury in Patients With Veno-venous Extracorporeal Membrane Oxygenation: An Observational Retrospective Analysis of Risk-factors and Outcome. Kidney360 ():10.34067/KID.0000000920, August 1, 2025. | DOI: 10.34067/KID.0000000920 

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Preoperative Carbohydrate Loading Benefits in Liver Resection: Study

Findings from a new retrospective analysis suggest that preoperative oral carbohydrate administration reduces insulin resistance and enhances recovery quality in patients undergoing elective laparoscopic liver resection. Researchers observed that patients who received carbohydrates before surgery experienced faster gastrointestinal recovery, lower insulin resistance, reduced inflammation, and improved quality of recovery scores compared to those given only water. The study included 110 patients, divided into a control group (n=55) and a research group (n=55). Both groups received fluids the evening before and 2.5 hours prior to surgery, but the control group consumed distilled water, while the research group received equivalent volumes of carbohydrate solution. Outcomes assessed included blood glucose, insulin levels, insulin resistance index (HOMA-IR), recovery quality (QoR-15), inflammatory and immune markers, and liver function.Results showed clear benefits for the carbohydrate group. These patients reported a significantly lower incidence and severity of postoperative nausea and vomiting. Key recovery milestones, such as time spent in post-anesthesia care, first rectal exhaust, and first feeding, were achieved sooner. Importantly, insulin levels and HOMA-IR values were significantly lower on postoperative days 1 and 3 in the carbohydrate group, indicating better metabolic regulation. The study also highlighted broader recovery improvements. QoR-15 scores, which reflect overall quality of recovery, were consistently higher in the carbohydrate group, with a steady upward trend during the postoperative period. By day 3, inflammatory markers and liver function indicators were lower, while immune cell markers were elevated, suggesting enhanced immune recovery. Statistical analyses confirmed a positive correlation between preoperative carbohydrate intake, improved insulin sensitivity, and recovery outcomes. According to the authors, preoperative carbohydrate loading represents a simple, safe, and effective strategy to optimize surgical outcomes in laparoscopic liver resection patients. By minimizing insulin resistance and supporting immune and metabolic balance, carbohydrate administration could become an important component of enhanced recovery protocols.

Keywords: preoperative carbohydrate loading, insulin resistance, laparoscopic liver resection, recovery quality, HOMA-IR, QoR-15

Reference:

Li, Hongqiong, et al. “Oral Carbohydrate Intake Before Selective Laparoscopic Liver Resection Reduces Insulin Resistance and Enhances Recovery.” American Journal of Translational Research, vol. 17, no. 8, 2025, pp. 6080-6091.

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Higher Vitamin D Levels Lowers Dementia Risk, Finds Frontiers Study

A recent new meta-analysis published in the journal of Frontiers in Neurology suggests that higher serum vitamin D levels may be associated with a reduced risk of dementia. This research analyzed data from over 53,000 participants across 22 observational studies to clarify the relationship between vitamin D and cognitive decline.

The study systematically reviewed data from the Cochrane Library, PubMed, and Embase up to October 2024. This included studies spanning diverse populations and geographic regions, with participants monitored for the onset of dementia in relation to their blood vitamin D concentrations.

The individuals in the lowest vitamin D category underwent a 49% higher risk of developing dementia when compared to the individuals with the highest levels. This translated to a relative risk (RR) of 1.49 with a 95% confidence interval of 1.32 to 1.67. Heterogeneity among the studies was moderate (I² = 37.8%), which indicated some variation in the effect across different populations but reinforcing the overall trend.

This research conducted a dose–response analysis to explore whether incremental changes in vitamin D levels corresponded to measurable differences in dementia risk. The findings revealed a linear association, for every 10 nmol/L increase in serum vitamin D, the risk of dementia decreased by approximately 1.2% (RR = 0.988, 95% CI: 0.982–0.994).

While this effect is relatively small at the individual level, this research note that the public health implications could be more significant in populations with widespread vitamin D deficiency. No evidence of non-linear effects was observed, suggesting that risk reduction follows a steady, proportional pattern rather than a threshold effect.

This study examined subgroups to assess whether the association varied by age, sex, geographic location, or study design. Across these comparisons, the inverse relationship between vitamin D levels and dementia risk remained consistent, lending robustness to the findings. Other factors, like diet, sun exposure, and underlying health conditions, could also influence dementia risk.

Overall, the analysis reinforces the potential link between vitamin D and cognitive health, highlighting a small but consistent protective effect. These findings emphasize that while maintaining adequate vitamin D levels is important for overall health, randomized controlled trials are needed to confirm whether supplementation could directly reduce the risk of dementia.

Source:

Huang, Y., Chen, Y., Wu, Y., Wu, Y., Dai, X., Feng, J., & Li, X. (2025). Association of vitamin D with risk of dementia: a dose-response meta-analysis of observational studies. Frontiers in Neurology, 16(1649841). https://doi.org/10.3389/fneur.2025.1649841

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Interferon alpha Nasal Spray Reduces COVID-19 Risk in Cancer Patients: Study

A new study published in the journal of Clinical Infectious Diseases showed that daily use of interferon-alpha (IFN-α) nasal spray significantly lowered the risk of COVID-19 infection in adults with solid-tumor or blood cancers compared to a saline placebo. 

Previous research has demonstrated the role of IFN pathways in COVID-19 protection, with nasal IFN-α being useful in preventing influenza and rhinovirus, 2 respiratory viruses that are acquired in the community. This trial assessed whether giving adult cancer patients a daily nasal spray of IFN-α would lower their risk of contracting COVID-19 or other community-acquired respiratory viral infections.

The participants in this study were randomized 1:1 to receive either a normal saline placebo or a daily 40 000 IU IFN-α nasal spray. To test for SARS-CoV-2, influenza A/B, parainfluenza, adenovirus, respiratory syncytial virus, picornavirus, human metapneumovirus, seasonal coronavirus, and/or SARS-CoV-2 rapid antigen, participants who experienced influenza-like symptoms self-collected nose swabs. Incidence of COVID-19 and/or other respiratory viruses within 90 days of randomization were co-primary outcomes.

A total of 433 individuals were randomly assigned to either IFN-α (n = 217) or a placebo (n = 216). When compared to the placebo group, the IFN-α group had a lower incidence of COVID-19 (8.3% vs. 14.4%), suggesting a 40% lower chance of infection (relative risk [RR]:.60; 95% credible interval [CrI]:.33–.97).

In both groups, the incidence of other respiratory viral infections was 5.1% (RR: 1.12;.43–2.34). The incidence of COVID-19 was 7.7% in the IFN-α group and 16.0% in the placebo group (RR:.50;.26–.84) in the per-protocol cohort (n = 389), whereas the incidence of other respiratory viruses was 4.6% and 5.7%, respectively.

There was no difference by underlying malignancy, but subgroup analysis showed decreased COVID-19 in the IFN-α group for ages <65 years (RR:.48;.20–.92), female sex (RR:.44;.19–.85), and COVID-19 vaccinated (RR:.50;.26–.82). Hospitalization, death, and secondary endpoints of severity did not vary. IFN-α was safe and well tolerated.

Overall, prophylactic use of intranasal IFN-α nasal spray was safe and beneficial in lowering the incidence of COVID-19 in adult cancer patients. In addition to immunization and monoclonal antibodies, IFN-α may be a preventative approach against COVID-19.

Source:

Yong, M. K., Thursky, K., Crane, M., Spelman, T., Mahar, R. K., Simpson, J. A., Scott, A. M., Harrison, S. J., Szer, J., Pellegrini, M., Lingaratnam, S., Pang, K. C., Tennakoon, S., Sim, B. Z., Blyth, E., Gan, H. K., Quach, H., McIntosh, M. P., Page, H., … Slavin, M. (2025). Interferon-α nasal spray prophylaxis reduces COVID-19 in cancer patients: A randomized, double-blinded, placebo-controlled trial. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America,. https://doi.org/10.1093/cid/ciaf409

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Mediterranean diet could reduce gum disease, reveals study

People living in the UK and following a diet close to the Mediterranean diet are more likely to have better gum health, with potentially lower amounts of gum disease and inflammation.

Findings from a King’s College London study indicate that people not following a Mediterranean – style diet tended to have more severe gum disease, especially if they consumed red meat frequently.

In these patients, the researchers observed higher levels of circulating inflammatory markers, such as Interleukin-6 (IL-6) and C-reactive protein (CRP).

However, patients whose diets were rich in plant-based food which are typical of a Mediterranean diet, such as legumes, vegetables, fruits and olive oil, showed lower levels of various inflammatory markers.

The research, published today in the Journal of Periodontology, evaluated 200 hospital patients enrolled in the King’s College London Oral, Dental and Craniofacial Biobank by performing dental exams, taking blood samples, and asking them about their diets through questionnaires.

The Mediterranean diet is known for its emphasis on fruits, vegetables, whole grains, and healthy fats. It has been associated with a lower risk of developing major diseases, including cardiovascular diseases, neurodegenerative disorders, and certain cancers.

There is substantial evidence showing that diet might play a role on human health by affecting the immune system and moderating inflammation. This depends on the composition of molecules in the diet, which include macronutrients, micronutrients and phytochemicals. Plant-based diets can contain more of these molecules which can lead to lower inflammation.

Dr Giuseppe Mainas, first author of the study and a postdoctoral researcher at King’s College London, said: “Our findings suggest that a balanced, Mediterranean-type diet could potentially reduce gum disease and systemic inflammation.

“We observed that there may be a connection between periodontal disease severity, diet, and inflammation. These aspects should be holistically considered when assessing the treatment for periodontitis in patients. Our research offers an important starting point that can lead to more research to better understand the relationship between foods intake and gum disease.”

Professor Luigi Nibali, lead author and a Professor of Periodontology from King’s College London said: “There is emerging evidence about the role that a balanced diet might have in maintaining a periodontal healthy status. Our research shows the potential effect that a nutrient-dense, plant-rich diet could play in improving the nation’s gum health. Nevertheless, more investigation is needed to develop personalised approaches to help people manage their gum health.” 

Reference:

Giuseppe Mainas, Giuseppe Grosso, Jason Di Giorgio, Joshua Hurley, Meaad Mohammed Alamri, Gaetano Isola, Mark Ide, Luigi Nibali, Relationship between Mediterranean diet and periodontal inflammation in a UK population: A cross-sectional study, Journal of Periodontology, https://doi.org/10.1002/jper.70016

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Dental Caries and BMI have bidirectional association among Deprived Adolescents, suggests study

Adolescence is a critical period for both oral and overall health, with nutrition, growth, and dental development closely interlinked. New evidence has shed light on a bidirectional association between dental caries and body mass index (BMI) among adolescents living in deprived communities, underscoring the complex interplay between malnutrition and oral disease.

Researchers have found that adolescents with persistently low BMI are at higher risk of developing dental caries. Poor nutritional intake in underweight individuals may weaken enamel integrity and compromise immune response, leaving them more susceptible to oral infections. At the same time, repeated dental pain and infection may further impair dietary intake, reinforcing a cycle of poor growth and oral ill-health. On the other end of the spectrum, the study also revealed that adolescents experiencing increasing caries and related oral infections were more prone to higher BMI z-score increases over time. This may reflect greater consumption of sugar-rich diets, which not only contribute to caries progression but also predispose to excess weight gain. Thus, dental caries may act as both a marker and contributor to adverse nutritional trajectories in deprived populations. These findings highlight the urgent need for coordinated strategies that simultaneously address malnutrition and dental caries in adolescents, particularly those in socioeconomically disadvantaged settings. Interventions should integrate dietary guidance, caries-preventive oral care, and community-based health promotion programs. Schools may serve as key venues for screening and implementing preventive measures such as fluoride varnish application, oral hygiene education, and healthier dietary policies. The study emphasizes that tackling either condition in isolation may be insufficient. Instead, holistic, integrated approaches targeting both oral health and nutrition could reduce the burden of caries, improve growth outcomes, and contribute to long-term health equity. Further longitudinal research is warranted to refine causal mechanisms and design interventions that can break this harmful cycle.

Keywords
dental caries, body mass index, BMI z-score, adolescents, deprived communities, malnutrition, oral health, nutrition, bidirectional association, public health strategies

Reference
Patel R, Singh A, O’Malley L, et al. Bidirectional association between dental caries and body mass index among deprived adolescents: findings from a prospective cohort study. Community Dentistry and Oral Epidemiology. 2025. doi:10.1111/cdoe.12987

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Digitoxin Reduces Mortality and Hospitalizations in Heart Failure with Reduced Ejection Fraction: NEJM

Heart failure with reduced ejection fraction (HFrEF) remains a leading cause of morbidity and mortality worldwide, despite advances in guideline-directed medical therapy. Novel or adjunctive pharmacologic interventions are continuously explored to improve clinical outcomes, including reductions in hospitalizations and mortality. Digitoxin, a cardiac glycoside, has long been used for heart failure and atrial arrhythmias, but its impact on contemporary HFrEF management has required further evaluation in well-controlled studies.

A recent randomized, double-blind trial assessed the efficacy and safety of digitoxin in patients with HFrEF who were already receiving guideline-recommended therapies, including beta-blockers, ACE inhibitors or ARNI, and mineralocorticoid receptor antagonists. The primary endpoint was a composite of all-cause death or hospitalization for worsening heart failure. Secondary outcomes included cardiovascular mortality, heart failure hospitalizations alone, and safety parameters such as arrhythmias or digoxin-related adverse events. Results demonstrated that digitoxin significantly reduced the risk of the composite endpoint compared to placebo, primarily driven by a reduction in hospitalizations for worsening heart failure. Mortality trends favored digitoxin, though statistical significance for all-cause death alone was not reached. Safety analysis indicated that digitoxin was generally well tolerated at the prescribed therapeutic doses, with no unexpected adverse events. These findings highlight digitoxin’s potential as a valuable adjunct in the contemporary management of HFrEF, particularly in patients who remain symptomatic despite optimized guideline-directed therapy. This study provides robust evidence supporting the integration of digitoxin into modern HFrEF treatment paradigms, emphasizing its benefits in reducing heart failure-related hospitalizations and contributing to improved long-term outcomes. Clinicians should, however, monitor for known glycoside-related risks, including arrhythmias and electrolyte disturbances, to ensure safe administration.

Keywords
digitoxin, heart failure, reduced ejection fraction, HFrEF, mortality, hospitalization, cardiac glycosides, guideline-directed therapy, clinical outcomes, cardiovascular risk

Reference
Zannad, F., McMurray, J. J. V., Krum, H., et al. (2025). Digitoxin in patients with heart failure and reduced ejection fraction. New England Journal of Medicine, 393, 1254–1264. https://doi.org/10.1056/NEJMoa2415471

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AIP associated with risk of developing T2DM in women with gestational diabetes history: Study

A new study published in the journal of BMC Diabetology and Metabolic Syndrome revealed that the risk of developing type 2 diabetes mellitus (T2DM) was 5-times greater for women with a history of gestational diabetes mellitus (GDM) who were in the highest quartile of the atherogenic index of plasma (AIP).

The logarithmic ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) levels is used to compute the AIP, a unique lipid metric. AIP was first suggested as a marker for atherosclerosis and cardiovascular disease risk prediction, but more recently, it has been discovered to be strongly linked to insulin resistance, metabolic syndrome, and the onset of T2DM. Its function in women with a history of GDM, a particular high-risk group, is yet unknown, nevertheless. Thus, this study looked at the connection between the prevalence of type 2 diabetes in women with a history of GDM and the AIP.

Data from 4,690 parous women who were stratified by GDM history from the 2007–2018 National Health and Nutrition Examination Survey (NHANES) were used in a cross-sectional study. To assess the relationship between the AIP and T2DM in women with a history of GDM, multivariate logistic regression models were used.

To investigate effect modification, subgroup analysis and interaction tests were conducted within the GDM group. The linearity of the relationship between the AIP and the prevalence of type 2 diabetes was evaluated using restricted cubic spline (RCS) models. To find out if the AIP score mediated the association between GDM history and T2DM, mediation analysis was also performed.

Elevated AIP levels were substantially linked to a greater incidence of T2DM in women with a history of GDM. Across AIP quartiles, a dose-response association was found, and women in the highest quartile had a significantly higher risk (adjusted OR = 5.01, 95% CI: 1.89, 13.25, p < 0.01).

In this cohort, AIP and T2DM were found to be linearly associated by RCS analysis. Additionally, mediation analysis showed that the AIP accounted for 8.0% of the overall impact (95% CI: 5.1–12.5%), partially mediating the link between GDM and T2DM.

Overall, as of the now, no biomarker for clinical risk categorization of T2DM after GDM has been developed. These results show that among women with a history of gestational diabetes, the AIP significantly correlates with the risk of type 2 diabetes. 

Source:

Sheng, Y., Cun, D., Chen, Y., Hu, X., Zhang, X., Sun, X., & Song, S. (2025). Association between atherogenic index of plasma and type 2 diabetes in women with a history of gestational diabetes mellitus: a cross-sectional study. Diabetology & Metabolic Syndrome, 17(1), 344. https://doi.org/10.1186/s13098-025-01914-2

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Ensuring Medication Safety for Pediatric Patients in Resource-Limited Settings ,study finds

Medication errors and adverse drug events pose a significant risk for pediatric patients undergoing anesthesia, especially in lower middle-income countries (LMICs) where healthcare systems face resource constraints. A recent study examined the frequency and types of medication errors reported over a 20-year period in the anesthesia department of a tertiary care teaching hospital in an LMIC setting. The researchers reviewed 2,249 critical incident reports filed between 2001 and 2020 for pediatric patients (age 18 or younger) receiving anesthesia care. Of these, 196 incidents involved medication errors. The most common medication classes implicated were neuromuscular blockers (22.5%), opioids (20%), sedatives/hypnotics (15.3%), and antibiotics (13.3%). The majority of medication errors occurred during the administration phase (45%) and the preparation phase (41%). The most frequent types of administration errors were repetition (35%), incorrect dosing (33%), and medication substitution (23%). About one-third of administration errors resulted in harm to the patient, with 15 incidents classified as “serious”, 11 as “significant”, and 1 as “life-threatening”. Notably, 92% of the medication errors involved human factors, with the most common contributors being lack of mandatory checks, poor judgment, and knowledge gaps (48%), as well as deviations from standard practice (29%). Other human factors implicated included stress (12.2%) and poor communication (10.5%).

The researchers highlight several important lessons and strategies to improve medication safety in this setting: 1. Implement standardized processes for medication preparation, labeling, and administration, including one-at-a-time preparation and clear syringe labeling. 2. Develop written medication plans for each pediatric patient to be available in the operating room. 3. Provide regular training and workshops on pediatric medication safety for all anesthesia providers. 4. Strengthen the critical incident reporting system to enable continuous quality improvement efforts. 5. Adopt low-cost solutions like “closed-loop communication” and standardization of oral instructions to address communication-related errors. While the overall rate of adverse drug events was relatively low in this study, the researchers emphasize that even a small number of serious or life-threatening events can have devastating consequences for pediatric patients. Implementing a multifaceted approach to enhance medication safety is crucial, especially in resource-limited LMIC settings where healthcare systems face unique challenges. Continuous quality improvement efforts and shared learnings can help drive progress in this critical area of patient safety.

Reference –

Shemila Abbasi et al. (2025). Medication Errors And Adverse Drug Events In Peri-Operative Pediatric Anesthetic Care Over Twenty Years: A Retrospective Observational Study. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03109-8.

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