Postpartum pain, a common symptom after a cesarean birth, is influenced by psychosocial factors. This exploratory qualitative study examined patient perspectives on social support and healthcare communication behaviors in the postpartum setting in relation to the pain experience. In-depth, semi-structured, qualitative interviews about postpartum pain experiences were conducted 2-3 days and 2-6 weeks postpartum with individuals who underwent a cesarean birth (2020-2021). Data were analyzed using the constant comparative method. Among 49 postpartum individuals, themes related to social support and healthcare communication were identified in relation to postpartum pain. Participants discussed the impact of non-healthcare social support (e.g., partners, extended family, other children) on postpartum pain, highlighting emotional and practical assistance. Most commonly mentioned were the positive impacts of emotional and logistical support with household activities and childcare on postpartum pain recovery. The second theme covered individuals' views on how healthcare support and communication affected postpartum pain, with themes of both positive and negative experiences. Some participants discussed positive experiences of shared decision-making and responsiveness of the healthcare team, whereas others recounted negative experiences of lack of counseling and poor outpatient communication. Social support and healthcare communication are integral influences on pain recovery after a cesarean birth. These findings highlight the need for interventions to address psychosocial support and healthcare team communication in the immediate postpartum period.

The Trump administration is restructuring federal health agencies to implement a new policy agenda. Central to this agenda is the Make America Healthy Again movement, which prioritizes individual solutions to broader public health problems, disregards science and scientific institutions, and aligns closely with the “wellness” industry. While it is normal for each administration to establish its own public health priorities, previous administrations did not dismantle existing institutions to do so. In contrast, this administration is consolidating power and actively politicizing the federal health bureaucracy, undermining scientific expertise and agency independence in the process. These changes are likely to have lasting impacts on both federal health agencies and public health that will extend well beyond the current administration.

Healthcare workers face escalating violence despite significant security investments, suggesting current approaches miss fundamental causes. We argue that most healthcare violence stems not from individual pathology but from systemic failures-financial barriers, insurance denials, access delays, and administrative complexity-that create volatile patient-provider interactions. Healthcare workers become targets for anger about institutional dysfunctions they cannot control. Current prevention strategies emphasizing individual risk assessment and physical security fail to address these root causes. We propose a research agenda examining connections between system failures and violence, potentially identifying upstream interventions that complement existing security measures while targeting the healthcare dysfunctions driving this epidemic.

Prophylactic antibiotic use before endoscopic retrograde cholangiopancreatography (ERCP) remains controversial. Current guidelines recommend against routine prophylaxis. This meta-analysis evaluates the role of prophylactic antibiotics in reducing infectious complications in patients with suspected biliary obstruction undergoing ERCP. We included randomized controlled trials (RCTs) published in full and comparing antibiotics with placebo in patients undergoing ERCP for suspected biliary obstruction. Outcomes assessed were rates of cholangitis, bacteremia, and infectious complications. Data sources included CENTRAL, MEDLINE, and EMBASE from inception through January 2025. Studies published as abstract only were excluded. For subgroup analyses, studies were stratified by antibiotic class (cephalosporins vs penicillins), presence of radiologic evidence or clinical suspicion of obstruction, and sample size (n <150 vs n≥ 150). 5 RCTs involving 1,154 patients met inclusion criteria, with 570 individuals receiving antibiotics and 584 serving as controls. Prophylactic antibiotics significantly reduced the risk of cholangitis (RR 0.44, 95% CI 0.22-0.89, p = 0.24; I2 27%), bacteremia (RR 0.28, 95% CI 0.13-0.58, p = 0.57, I2 0%), and infectious complications (RR 0.35, 95% CI 0.17-0.73, p = 0.16, I2 40%). The significant decrease in the rates of cholangitis, bacteremia, and infectious complications remained significant in patients with radiologic evidence of obstruction. Prophylactic antibiotics significantly reduced post-ERCP infections in patients with biliary obstruction. These findings challenge existing guidelines that recommend antibiotics in high-risk scenarios only. Our study highlights the importance of pre-procedural antibiotics, especially in patients with radiologically confirmed biliary obstruction. While further RCTs are needed to refine recommendations, clinicians should consider prophylactic antibiotics to improve patient outcomes.

ABSTRACTIntroduction and ObjectiveTotally tubeless percutaneous nephrolithotomy (PCNL) has been demonstrated to be feasible and safe, particularly for mini-PCNL. Having an objective test to guide patient selection could improve confidence in this practice and facilitate broader adoption. The purpose of this study was to evaluate the utility of an intraoperative methylene blue test to determine candidacy for totally tubeless PCNL.MethodsAdult patients undergoing PCNL at four institutions were included in this study. Patients with prior reconstructive surgery, chronic pain, or requiring ureteral dilation were excluded. After stone clearance, 10 mL methylene blue (MB) dye was injected into the percutaneous access tract. A positive test (“pass”) was defined as visualization of blue dye in the bladder catheter within two minutes of injection. In some standard PCNL cases, totally tubeless management was simulated by placement of a capped nephrostomy tube. Post-operative complications within 7 days were evaluated as the primary outcome.ResultsThe intraoperative MB test was performed in 91 PCNL cases: 60 mini-PCNLs (16 Fr access) and 31 standard PCNLs (24+ Fr access). Mini-PCNL cases were more likely to pass the MB test compared to standard PCNL cases (75% vs 38.7%, p = 0.001). Of the 45 mini-PCNL subjects who passed, 40 were left totally tubeless, resulting in two minor complications (urinary retention, obstructing ureteral stone fragment). In the standard PCNL cohort, 12 passed the MB test. Five were left totally tubeless and 3 simulated totally tubeless management with capped nephrostomy tubes; one subject had a transient postoperative creatinine elevation, and one required uncapping for steinstrasse. There were no other obstructive or infectious complications, and no surgical reintervention was required.ConclusionsAn intraoperative methylene blue test is a simple test with high positive-predictive value to determine candidacy for totally tubeless PCNL in real time for both mini and standard PCNLs.