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Decision aids (DA) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. MethodsWe searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial's risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA and discuss plans for development of a new DA. ResultsWe identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM and increased accuracy of patients' perceived fracture risk compared with controls.Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients' own needs and risk. ConclusionsExisting DAs for informing patient decisions about osteoporosis treatment fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development.

con la administración intradiscal de plasma rico en plaquetas para dolor crónico discogénico cervical y lumbar / Treatment with intradiscal administration of platelet-rich plasma for chronic cervical and lumbar discogenic pain. MPJ 2021.

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Spinal anesthesia is practical and safe in infants and toddlers and prevents perioperative complications including cardiorespiratory instability and apnea. Other perioperative advantages include reduced time from surgery completion to operating room exit and first feed. This article presents the case of an ex-premature infant who underwent laparoscopic inguinal hernia repair under spinal anesthesia. The infant remained calm and stable throughout the uneventful procedure and postoperative period. Spinal anesthesia may be feasible for laparoscopic herniotomy when pneumoperitoneum pressure and operative time are restricted to 8 mm Hg and 60 minutes, respectively, with sensory level at T10 or higher.