© 2019 The Authors. Published by WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim.The use of opioids in chronic non-cancer pain (CNCP) has been a fast-rising treatment phenomenon in the last two decades. Though opioids are advocated in various chronic pain management guidelines, their use in chronic non-cancer pain still remains controversial as evidence of this approach is still weak. This paper highlights potential adverse effects associated with opioid use in pain management, including an increase in tolerance, dependence, and addiction outcomes. Nonetheless, opioids have an important place in contemporary CNCP management for selected patients. However, pain management must involve regular monitoring and the use of a multimodal pain management strategy. It is essential that the treating physician must be up-to-date with the form of therapy so that they have the requisite confidence to prescribe opioids and effectively manage adverse effects. Moreover, the adverse effects should be treated promptly to enhance patient compliance. Since this approach is beneficial for some patients, opioid treatment should only be applied on a case by case basis. Copyright © 2020, Genova et al.Isolated renal artery dissection (IRAD) is a rare and often unrecognized clinical entity, with a paucity of data on its epidemiology and management. We extracted 129 cases of IRAD from the medical literature between 1972 and 2016. IRAD as a result of an extended dissection from the aorta and splanchnic or mesenteric arteries was excluded. The mean age of presentation was 42.7±12.9 years, with a male predominance (79%). Abdominal pain (75.9%) was the most common presenting symptom. Etiology was more likely to be spontaneous (76%) than traumatic (12%), iatrogenic (9%), or drug-induced (1.5%). The most common risk factors were hypertension (28.7%), fibromuscular dysplasia (8.5%), and Ehlers-Danlos syndrome (5.4%). Unilateral renal artery dissection (right 45.5%, left 40.5%) was more frequent than bilateral (14%). More than half (56.6%) of the cohort were managed medically (blood pressure control and /or anticoagulation). Of those who underwent intervention, endovascular stenting or embolization (35%) was utilized more frequently than nephrectomy or bypass (21%). Computed tomography (CT) and magnetic resonance angiography (MRA) have the highest diagnostic sensitivity (91% and 93%, respectively) as compared to ultrasonography (27%). A high degree of clinical suspicion is required to diagnose IRAD. CT and MRI have a higher diagnostic sensitivity. As compared to invasive management, conservative management has comparable outcomes. Copyright © 2020, Jha et al.The dementia epidemic continues to affect families across Canada.  https://www.selleckchem.com/products/i-bet-762.html  The number of persons living with dementia (PLWD) is projected to reach 1.1 million over the next 20 years, placing further financial and resource constraints on the Canadian healthcare system. Caregiver education is vital in ensuring the quality of life and safety for PLWD and can increase the time they are able to live at home, which is correlated with positive outcomes for both PLWD and their caregivers, and a reduction in system costs. However, current educational support often requires individuals to travel to local, urban service care centers and educational content is often provided in English, which can exacerbate the difficulties faced by marginalized caregivers (e.g., immigrants and those living in rural settings) who are caring for PLWD.  To address this issue, a team of researchers developed a serious game called "SafeHome" that teaches safety strategies by having players identify and rectify potential hazards in the home setting that may negatively impact on PLWD outcomes, such as falls. A usability study was conducted using an adapted, validated questionnaire and semi-structured focus groups to better understand users' experience and obtain suggestions for the SafeHome serious game improvement. Results indicated that 80% of the participants were satisfied with the activities provided through SafeHome. All participants (n = 13) made recommendations for improving the usability, functionality, and comprehensiveness of the educational content. This feedback will inform future iterations of SafeHome and add valuable contributions to the growing literature on innovative e-learning resources that support PLWD and their caregivers. Copyright © 2020, Appel et al.Background and aims The Accreditation Council for Graduate Medical Education (ACGME) mandates that Internal Medicine residents shall place all the orders for their patients. The purpose of this rule is to assure comprehensive knowledge of patient information and direct involvement in decision-making. However, there is a general perception that a large proportion of orders for patients taken care of by the residents are being written by consultants or other providers. The objective of the study was to determine the proportion of routine orders placed by Internal Medicine residents in comparison to consultants/subspecialty providers for patients under the care of the Internal Medicine Residency Service (IMRS).   Material and methods All the orders on patients admitted to the IMRS at AdventHealth Orlando from July 9, 2017, to July 15, 2017, were documented. Of these, Emergency Department (ED) orders, "STAT/ASAP/NOW orders," "discharge by consultant" orders, and "consent for procedure" orders were excluded. The mindings are consistent with the ACGME mandate that residents write all orders for patients under their care except in special circumstances. Copyright © 2020, Parajuli et al.BACKGROUND In obstetrical health care, disparities have been documented in different aspects of maternal care and outcomes. Prior epidemiological studies have shown that labor analgesia is underused in African-American and Hispanic groups, which means there may be inadequate labor pain control in these groups. Differences in usage have been attributed primarily to insurance, educational levels and perceptional influences such as fear of paralysis and chronic low back pain. In cesarean section deliveries, race and ethnicity affect the choice of anesthesia considered. How race and ethnicity affect maternal outcomes in cesarean sections with epidural placements generally has been unexplored. Disparities in health care utilization are shown to contribute to the disparities in health outcomes. METHODS This is a retrospective analysis using data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project (AHRQ-HCUP), the National Inpatient Sample (NIS) database from January 2003 to December 2013, which is a 20% stratified sample of the nonfederal hospitals in the United States.