Introduction
Enhanced recovery after surgery (ERAS) programs have been developed to improve patient outcomes, accelerate recovery after surgery, and reduce healthcare costs. ERAS programs are a ...multimodal approach, with interventions during all stages of care. This meta-analysis examines the impact of ERAS programs on patient outcomes and recovery.
Methods
A comprehensive search of all published randomized control trials (RCTs) assessing the use of ERAS programs in surgical patients was conducted. Outcomes analyzed were length of stay (LOS), overall mortality, 30-day readmission rates, total costs, total complications, time to first flatus, and time to first bowel movement.
Results
Forty-two RCTs involving 5241 patients were analyzed. ERAS programs significantly reduced LOS, total complications, and total costs across all types of surgeries (
p
< 0.001). Return of gastrointestinal (GI) function was also significantly improved, as measured by earlier time to first flatus and time to first bowel movement,
p
< 0.001. There was no overall difference in mortality or 30-day readmission rates; however, 30-day readmission rates after upper GI surgeries nearly doubled with the use of ERAS programs (RR = 1.922;
p
= 0.019).
Conclusions
ERAS programs are associated with a significant reduction in LOS, total complications, total costs, as well as earlier return of GI function. Overall mortality and readmission rates remained similar, but there was a significant increase in 30-day readmission rates after upper GI surgeries. ERAS programs are effective and a valuable part in improving patient outcomes and accelerating recovery after surgery.
Introduction
Colorectal surgeries (CRS) have one of the highest rates of surgical site infections (SSIs) with rates 15 to >30%. Prevention “bundles” or sets of evidence-based interventions are ...structured ways to improve patient outcomes. The aim sof this study is to evaluate CRS SSI prevention bundles, bundle components, and implementation and compliance strategies.
Methods
A meta-analysis of studies with pre- and post-implementation data was conducted to assess the impact of bundles on SSI rates (superficial, deep, and organ/space). Subgroup analysis of bundle components identified optimal bundle designs.
Results
Thirty-five studies (51,413 patients) were identified and 23 (17,557 patients) were included in the meta-analysis. A SSI risk reduction of 40% (
p
< 0.001) was noted with 44% for superficial SSI (
p
< 0.001) and 34% for organ/space (
p
= 0.048). Bundles with sterile closure trays (58.6 vs 33.1%), MBP with oral antibiotics (55.4 vs 31.8%), and pre-closure glove changes (56.9 vs 28.5%) had significantly greater SSI risk reduction.
Conclusion
Bundles can effectively reduce the risk of SSIs after CRS, by fostering a cohesive environment, standardization, and reduction in operative variance. If implemented successfully and complied with, bundles can become vital to improving patients’ surgical quality of care.
Real-time ultrasound (US) guidance for central venous catheter (CVC) insertion has been shown to increase cannulation success rates and reduce complications in adults. Literature regarding US-guided ...CVC placement in children remains limited and conflicting. This meta-analysis examines the efficacy and safety of US-guided CVC placement among pediatric patients.
A comprehensive literature search of all published randomized control trials (RCTs) comparing the use of real-time US-guided CVC insertion with anatomic landmark (LM)-guided CVC insertion in pediatric patients <18 y of age was conducted. Outcomes analyzed were cannulation success rate, number of attempts required, incidence of accidental arterial puncture, and time to cannulation.
Eight RCTs involving 760 patients were analyzed. US-guided CVC insertion significantly increased success rates by 31.8% and decreased the mean number of attempts required. A trend toward a decrease in the risk of accidental arterial puncture with the use of US-guided CVC insertion was also observed. US-guided CVC insertion was not associated with a significant difference in time required for CVC placement.
US-guided CVC placement is associated with significantly higher success rates and decreased mean number of attempts required for cannulation. US-guided CVC insertion improves success rates, and should be utilized in pediatric patients.
Background
The health benefits of probiotics and synbiotics are well established in healthy adults, but their role in preventing postoperative sepsis remains controversial. This meta-analysis ...assesses the impact of probiotics and synbiotics on the incidence of postoperative sepsis in gastrointestinal (GI) surgical patients.
Methods
A comprehensive literature search of all published randomized control trials (RCTs) was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966–2015). Inclusion criteria included RCTs comparing the use of any strain or dose of a specified probiotic/synbiotic with placebo or a “no treatment” control group. The incidence of postoperative sepsis (within 1 month of surgery) and postoperative mortality were analyzed.
Results
Fifteen RCTs involving 1201 patients (192 receiving probiotics, 413 receiving synbiotics, and 596 receiving placebo) were analyzed. Overall, probiotic and synbiotic uses significantly reduced the risk of developing postoperative sepsis by 38 % (relative risk (RR) = 0.62, 95 % confidence interval (CI) 0.52–0.74,
p
< 0.001).
Conclusions
The use of probiotic/synbiotic supplementation is associated with a significant reduction in the risk of developing postoperative sepsis in patients undergoing elective GI surgery. Probiotic/synbiotic supplementation is a valuable adjunct in the care of patients undergoing GI surgery. Additional studies are required to determine the optimal dose and strain of probiotic/synbiotic.
Abstract Purpose Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants, affecting ~ 6–7% of very-low-birth-weight (VLBW) infants. Early intervention and ...aggressive treatment has improved clinical outcomes, but considerable morbidity continues to accrue to NEC survivors. This meta-analysis examines the impact of probiotics on the incidence of NEC and complications among VLBW infants. Methods A comprehensive literature search for all published randomized control trials (RCTs) assessing the use of probiotics to prevent NEC in VLBW infants was conducted using PubMed, Cochrane Central Registry of Controlled Trials, and Google Scholar (1966–2014). The incidences of NEC, sepsis, overall mortality, and time to reach full enteral feeds were analyzed. Results 20 RCTs involving 5982 preterm VLBW infants were analyzed. Risk of NEC was reduced by 49.1% (RR = 0.509; 95% CI, 0.385–0.672; p < 0.001), and overall mortality by 26.9% among infants receiving probiotics (RR = 0.731; 95% CI, 0.577–0.926; p = 0.009). An 8.1% reduction in sepsis was also observed in infants receiving probiotics (RR = 0.919; 95% CI, 0.823–1.027; p = 0.137). Time to reach full enteral feeds was reduced by 1.2 days among infants receiving probiotics (MD: − 1.217; 95% CI, − 2.151 to − 0.283; p = 0.011). Conclusion The use of probiotic supplementation in preterm VLBW infants is associated with a significant reduction in the risk of NEC and overall mortality. Additional studies are required to determine the optimal genus, species, and dose of probiotic.
COVID-19 Exposure Among First Responders in Arizona Shukla, Vershalee; Lau, Christine S M; Towns, Mikayla ...
Journal of occupational and environmental medicine,
12/2020, Letnik:
62, Številka:
12
Journal Article
Recenzirano
Odprti dostop
The number of COVID-19 cases in Arizona is rapidly increasing, leading the country in the rate of new daily cases. Exposure among first responders remains unknown.
Rates of SARS-CoV-2 IgG among first ...responders in Arizona were determined, and attitudes/views about the impact of COVID-19 on their work life was analyzed.
Of 3326 first responders, 50 (1.50%) tested positive for SARS-CoV-2 IgG. Most first responders thought antibody testing would help ease their anxieties (62.5%) and be beneficial to their work-life (60.6%).
The rate of COVID-19 exposure among first responders in Arizona is low-1.50%. COVID-19 is a concern among many of the first responders, and antibody testing was beneficial in easing their anxieties about going to work and performing work-related duties.
Introduction
Prehabilitation programs or interventions are employed prior to surgery with the aim to optimize the patient before surgery and to improve their physiologic ability to recover from ...surgery. Components of these programs often include exercise, nutritional supplementation, and psychological interventions. This meta-analysis examines the impact of prehabilitation programs on both surgical and patient outcomes among gastrointestinal (GI) cancer patients undergoing surgery.
Methods
A comprehensive literature search was conducted to identify all published randomized control trials (RCT) evaluating the use of prehabilitation programs (with one or more interventions) in GI cancer surgery patients. Outcomes assessed were 6-min walk distance (6MWD), postoperative complications, major complications (as defined as Clavien Dindo grade ≥ 3), surgical site infections (SSI), pneumonia, length of stay (LOS), 30-day readmission, and mortality.
Results
Eleven RCTs including 929 patients (475 prehabilitation program and 454 controls) were analyzed. Prehabilitation programs were associated with statistically significant improvements in 6MWD between baseline and immediately prior to surgery (MD = 32.542 m; 95% CI, 10.774–54.310;
p
= 0.003) and 4–8 weeks after surgery (MD = 48.220 m; 95% CI, 1.532–94.908;
p
= 0.043) compared with patients who did not receive prehabilitation programs. Similar rates of postoperative complications, major complications, SSI, pneumonia, 30-day readmission, and mortality, as well as LOS, were observed (
p
> 0.05).
Conclusions
Prehabilitation programs improve exercise capacity both before and after surgery, with no significant difference in LOS, or rates of postoperative complications, 30-day readmission, and mortality. Future studies assessing the different components of prehabilitation programs to identify the most beneficial interventions are required.
Over 3 years since the onset of the coronavirus (COVID-19), the COVID-19 pandemic remains a global health challenge. At the same time, review of the response to the current pandemic is required for ...planning for future pandemics and global health crises. Approximately 2.5 million cases of COVID-19 have been reported in Arizona, a state with a 7.2 million population. Analyzing trends in COVID-19 case and positivity rates is crucial in planning to ensure public health safety for both this and future pandemics. This current observational study analyzes the trends in COVID-19 testing and positivity rates in the Phoenix metropolitan area, from data collected from a mobile testing program between December 2020 and April 2022. A total of 72,827 COVID-19 tests were performed, with a total of 8666 positive cases, yielding an overall positivity rate of 11.9%. Case counts and positivity rates increased during the fall and winter months, peaking in January (January 2021: 13.96% and January 2022: 24.84%). These cyclical trends cyclical can help with planning and mitigation. Continued public health awareness, including vaccinations and testing, is required in controlling COVID-19 transmission.
► Cued recall of word pairs tests not just association-memory but also item-memory. ► With a model-based analysis, we isolated item- and association effects on emotional memory. ► Negative words ...decreased cued recall by lowering association-memory. ► Taboo words increased cued recall, but only by enhancing item-memory. ► Emotional enhancement of verbal memory relies on item- but not association-memory.
Emotionally arousing information is remembered better than neutral information. This enhancement effect has been shown for memory for items. In contrast, studies of association-memory have found both impairments and enhancements of association-memory by arousal. We aimed to resolve these conflicting results by using a cued-recall paradigm combined with a model-based data analysis method (Madan, Glaholt, & Caplan, 2010) that simultaneously obtains separate estimates of arousal effects on memory for associations and memory for items. Participants studied sequentially presented words in pairs that were pure (NEGATIVE–NEGATIVE or NEUTRAL–NEUTRAL) or mixed (NEGATIVE–NEUTRAL or NEUTRAL–NEGATIVE). Cued recall tests had NEUTRAL or NEGATIVE probes and NEUTRAL or NEGATIVE targets. We found impaired memory for associations involving negative words despite enhanced item-memory (more retrievable targets). A category-list control condition explained away the item-memory enhancement but could not explain the impairment of association-memory due to arousal. A second experiment with identical structure but using higher arousing taboo words revealed increased cued recall of taboo than neutral words. However, this was exclusively mediated by item-memory effects with neither enhancement nor impairment of association-memory. Thus, although cued recall was lower for pure negative pairs and higher for pure taboo pairs, our modeling approach determined a different locus of action for these memory impairing or increasing effects: Although item memory was increased by arousal, association-memory was impaired by moderately arousing, negative words and unaffected by taboo words. Our results suggest that previous results reporting an enhancement of association-memory due to arousal may have instead been solely driven by enhanced item-memory.
Introduction. Gallbladder carcinoma (GBC) is the most common malignancy of the biliary tract and the third most common gastrointestinal tract malignancy. This study examines a large cohort of GBC ...patients in the United States in an effort to define demographics, clinical, and pathologic features impacting clinical outcomes. Methods. Demographic and clinical data on 22,343 GBC patients was abstracted from the SEER database (1973–2013). Results. GBC was presented most often among Caucasian (63.9%) females (70.7%) as poorly or moderately differentiated (42.5% and 38.2%) tumors, with lymph node involvement (88.2%). Surgery alone was the most common treatment modality for GBC patients (55.0%). Combination surgery and radiation (10.6%) achieved significantly longer survival rates compared to surgery alone (4.0±0.2 versus 3.7±0.1 years, p=0.004). Overall mortality was 87.0% and cancer-specific mortality was 75.4%. Conclusions. GBC is an uncommon malignancy that presents most often among females in their 8th decade of life, with over a third of cases presenting with distant metastasis. The incidence of GBC has doubled in the last decade concurrent with increases in cholecystectomy rates attributable in part to improved histopathological detection, as well as laparoscopic advances and enhanced endoscopic techniques. Surgical resection confers significant survival benefit in GBC patients.
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