Systematic review of randomized trials demonstrates topical lidocaine significantly reduces acute pain and gag reflex discomfort during nasogastric tube insertion

Ventilator weaning in the intensive care unit is often complicated by severe patient distress, agitation, and escalating sedative requirements that paradoxically lengthen mechanical ventilation. In a parallel-group randomized controlled trial conducted in a general adult ICU, 100 critically ill patients ventilated for at least 48 hours were randomized to standard weaning care alone or standard care with daily individualized music therapy. The intervention consisted of daily sessions averaging 25 minutes delivered by a music therapist, incorporating music-assisted relaxation, guided listening, and clinical improvisation tailored to patient preferences. The primary outcome—ventilator weaning duration—did not differ significantly between groups (p = 0.97). However, patients receiving music therapy exhibited significant reductions in agitation and sedation instability on the Richmond Agitation-Sedation Scale (RASS) on days 1 and 3 (p = 0.048, 0.005, and 0.024). Significantly fewer music therapy patients required propofol infusions during weaning (p = 0.028), and tracheostomy placement was significantly reduced (14% rate reduction, p = 0.025). Perceived pain and vital signs showed no significant differences.

Nurse staffing ratios remain central to inpatient quality and nurse retention, yet prior meta-analyses relied largely on coarse categorical groupings rather than quantifying marginal mortality shifts per extra patient. In this systematic review and per-unit linear random-effects meta-analysis (PROSPERO CRD420261368891), researchers searched PubMed, Embase, CINAHL, and Web of Science through July 10, 2026, for observational studies of acute care adults reporting fully adjusted per-unit effect estimates. Thirteen low-risk-of-bias studies spanning 3,831,327 patients across 1,593 hospitals were synthesized using restricted maximum likelihood and Bayesian hierarchical modeling. Each additional patient per nurse was associated with higher odds of 30-day all-cause mortality (pooled odds ratio [OR] 1.057, 95% CI: 1.041–1.074; I² = 43.3%; 95% prediction interval: 1.018–1.098). Bayesian modeling yielded a 1.000 posterior probability of a positive association. Although small-study effects were detected (Egger test t = 4.33, p < 0.001), trim-and-fill adjustment maintained significance. Because all included data were observational, evidence certainty was rated very low under GRADE, indicating estimates serve as policy reference parameters rather than definitive causal proof.

Severe emergency department overcrowding and prolonged length of stay threaten clinical safety and hospital throughput. The pragmatic, open-label RESHAP-ED randomized controlled trial evaluated an advanced physiotherapist-led model of care across five emergency departments in New South Wales, Australia. Adults presenting with uncomplicated musculoskeletal conditions—including soft-tissue injuries, neck and back pain, and closed fractures or dislocations not requiring surgical admission—were randomized 1:1 to physiotherapist-led care (n=737) or usual physician- or nurse practitioner-led care (n=738). The primary outcome, emergency department length of stay from arrival to departure, was analyzed via an intention-to-treat linear mixed-effects model. Mean length of stay was 2.4 hours in the physiotherapist group versus 3.4 hours in usual care, representing a statistically significant reduction of 1.0 hour (95% CI: -1.2 to -0.8 hours). Adverse events occurred in 6.6% (39/591) of physiotherapy patients versus 5.9% (33/555) of controls (p = 0.72). The intervention delivered mean direct savings of -$35.1 (95% CI: -69.0 to -1.7) per patient with a 98.1% probability of cost-effectiveness.