Upon entering medical school, many students encounter a steep learning curve when handling the vast and intricate vocabulary that healthcare workers use daily. Since the basis of medical terminology ...has developed from the roots of classical languages, it would theoretically be helpful to provide medical students with a foundational knowledge of Latin and Greek. My experience with learning classical languages before entering medical school has allowed me to have a formulaic approach when tackling unfamiliar medical terminology. By breaking up medical terms like transsphenoidal hypophysectomy into their respective roots, I can create a quick definition for myself before being given any formal teaching on the matter. The primary advantage of this learning style is that it reduces the burden of memorization on the student. The lectures from medical school help refine the preliminary definitions, which makes memorization much easier since students already have a basic framework for each new term encountered. However, certain considerations need to be kept in mind when utilizing the classical approach to understanding medical terminology. For example, the Latin and Greek roots cannot define eponyms like Wilson’s disease, named after the person who discovered the disease, or provide information on medications as their names have non-classical origins. Overall from my experience, the benefits of the formulaic approach make it a valuable tool during the initial years of medical school when the content is taught in a classroom setting and it can provide the foundation for an easier transition into the clinical environment.
Purpose
Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in ...colorectal surgery has never been synthesized.
Methods
MEDLINE, Embase, and CENTRAL were searched until May 2021. Randomized controlled trials (RCTs) comparing patients undergoing colorectal surgery with and without preoperative carbohydrate loading were included. Primary outcomes were changes in blood insulin and glucose levels. A pairwise meta-analysis was performed using inverse variance random effects.
Results
The search yielded 3656 citations, from which 12 RCTs were included. In total, 387 patients given preoperative carbohydrate loading (47.2% female, age: 62.0 years) and 371 patients in control groups (49.4% female, age: 61.1 years) were included. There was no statistical difference for blood glucose and insulin levels between both patient groups. Patients receiving preoperative carbohydrate loading experienced a shorter time to first flatus (SMD: − 0.48 days, 95% CI: − 0.84 to − 0.12,
p
= 0.008) and stool (SMD: − 0.50 days, 95% CI: − 0.86 to − 0.14,
p
= 0.007). Additionally, length of stay was shorter in the preoperative carbohydrate loading group (SMD: − 0.51 days, 95% CI: − 0.88 to − 0.14,
p
= 0.007). There was no difference in postoperative morbidity and patient well-being between both groups.
Conclusions
Preoperative carbohydrate loading does not significantly impact postoperative glycemic control in patients undergoing colorectal surgery; however, it may be associated with a shorter length of stay and faster return of bowel function. It merits consideration for inclusion within colorectal enhanced recovery after surgery protocols.
•Recurrence rates for full-thickness rectal prolapse following proctosigmoidectomy with levatorplasty occur at an average of 13.8%.•Addition of levatorplasty does not significantly reduce recurrence ...rates.•Levatorplasty may provide improvement in functional outcomes such as obstructive defecation and fecal incontinence.
Full-thickness rectal prolapse remains a challenging pathology to correct surgically with significant recurrence rates. Among perineal approaches, the proctosigmoidectomy with levatorplasty, commonly referred to as the Altemeier procedure is frequently performed. The addition of levatorplasty has been postulated to improve recurrence rates, however, its efficacy varies across studies. The aim of this study was to systematically review recurrence rates following proctosigmoidectomy with levatorplasty, and to meta-analyze pooled data comparing recurrence rates between proctosigmoidectomy with and without a levatorplasty.
A search of EMBASE, OVID Medline, and CENTRAL was performed from database inception to October 2021 aimed at identifying studies investigating recurrences of rectal prolapse following proctosigmoidectomy with levatorplasty. Primary endpoint was recurrence of rectal prolapse. Articles that did not report this endpoint or did not evaluate proctosigmoidectomy with levatorplasty were excluded. A pairwise meta-analysis was performed using Mantel-Haenszel random effects.
From 200 citations, 14 primary studies met inclusion criteria. A total of 620 patients (88.9% female, mean age: 71 years) underwent proctosigmoidectomy with levatorplasty, and 117 without levatorplasty. Of the patients undergoing levatorplasty, 86 (13.8%) experienced a recurrence. Mean follow up was 46 months. Meta-analysis comparing recurrence rates between proctosigmoidectomy with and without levatorplasty demonstrated no significant difference (RR 0.80, 0.92, 95% CI 0.32–2.59, P = 0.87, I2 = 77%). Narrative review of postoperative quality of life metrics demonstrated decreased incontinence with levatorplasty as measured by Wexner and ICIQ-SIF scores.
The addition of a levatorplasty does not significantly reduce the risk of recurrent rectal prolapse after proctosigmoidectomy, however it may improve postoperative continence.
Intraoperative administration of dexmedetomidine has shown promise in improving postoperative gastrointestinal function. In the context of colorectal surgery, the results remain inconsistent. This ...review aims to provide a synthesis of studies assessing the effect of dexmedetomidine on postoperative gastrointestinal function in colorectal surgery patients.BACKGROUNDIntraoperative administration of dexmedetomidine has shown promise in improving postoperative gastrointestinal function. In the context of colorectal surgery, the results remain inconsistent. This review aims to provide a synthesis of studies assessing the effect of dexmedetomidine on postoperative gastrointestinal function in colorectal surgery patients.CENTRAL, Emcare, Embase, and MEDLINE were searched up to September 2023. Randomized controlled trials involving adult patients (≥ 18 years) undergoing elective colorectal surgery, comparing dexmedetomidine administration to a control group, and reporting on postoperative gastrointestinal function were included. Non-comparative and emergent procedures were excluded. Primary outcome was time to first flatus or bowel movement, and secondary outcomes included length of stay and time to solid oral intake. Risk of bias was assessed using the Cochrane risk of bias tool for randomized studies.METHODSCENTRAL, Emcare, Embase, and MEDLINE were searched up to September 2023. Randomized controlled trials involving adult patients (≥ 18 years) undergoing elective colorectal surgery, comparing dexmedetomidine administration to a control group, and reporting on postoperative gastrointestinal function were included. Non-comparative and emergent procedures were excluded. Primary outcome was time to first flatus or bowel movement, and secondary outcomes included length of stay and time to solid oral intake. Risk of bias was assessed using the Cochrane risk of bias tool for randomized studies.After screening 1194 citations, eight studies were included. Studies comprised of 570 patients in the dexmedetomidine group (mean age: 65.8 years, 43% female, mean BMI: 22.7 kg/m2) and 556 patients in control group (mean age 70.6 years, 40% female, mean BMI 22.5 kg/m2). Dexmedetomidine administration resulted in a shorter time to flatus (MD -4.55 h, 95% CI: 20.14-8.95, p < 0.005, very low certainty of evidence), a shorter time to first bowel movement (MD -11.9 h, 95% CI: 18.74-5.05, p < 0.005, very low certainty of evidence), a shorter time to solid oral intake (MD -4.34 h, 95% CI: 17.43-11.24, p < 0.005, moderate certainty of evidence), and a shorter length of stay (MD -.06 days, 95% CI: 1.99-0.12, p < 0.05, very low certainty of evidence).RESULTSAfter screening 1194 citations, eight studies were included. Studies comprised of 570 patients in the dexmedetomidine group (mean age: 65.8 years, 43% female, mean BMI: 22.7 kg/m2) and 556 patients in control group (mean age 70.6 years, 40% female, mean BMI 22.5 kg/m2). Dexmedetomidine administration resulted in a shorter time to flatus (MD -4.55 h, 95% CI: 20.14-8.95, p < 0.005, very low certainty of evidence), a shorter time to first bowel movement (MD -11.9 h, 95% CI: 18.74-5.05, p < 0.005, very low certainty of evidence), a shorter time to solid oral intake (MD -4.34 h, 95% CI: 17.43-11.24, p < 0.005, moderate certainty of evidence), and a shorter length of stay (MD -.06 days, 95% CI: 1.99-0.12, p < 0.05, very low certainty of evidence).In adult patients undergoing elective colorectal surgery, intraoperative use of dexmedetomidine results in clinically meaningful improvements in postoperative gastrointestinal function and consequently, shorter length of stay. Therefore, dexmedetomidine may serve as a valuable adjunct in enhancing postoperative recovery of patients following elective colorectal surgery, thereby reducing healthcare utilization, and improving patient outcomes.CONCLUSIONIn adult patients undergoing elective colorectal surgery, intraoperative use of dexmedetomidine results in clinically meaningful improvements in postoperative gastrointestinal function and consequently, shorter length of stay. Therefore, dexmedetomidine may serve as a valuable adjunct in enhancing postoperative recovery of patients following elective colorectal surgery, thereby reducing healthcare utilization, and improving patient outcomes.
•All-cause and cardiovascular-related mortality is decreased in vaccinated patients.•Current evidence is low or very low certainty, and all observational studies.•Future studies must focus on ...vascular risk post-vaccination using randomized trials.
The association between influenza and adverse vascular events in patients with heart failure is well documented. The effect of the influenza vaccine on preventing such adverse events is uncertain. This systematic review and meta-analysis addressed whether vaccination against influenza reduces adverse vascular events and mortality in heart failure patients.
MEDLINE and EMBASE databases were comprehensively searched, study screening and quality assessment were completed, and data was synthesized. Eligible studies investigated heart failure patients who received the influenza vaccine, and reported outcomes within 12 months, compared to heart failure patients who did not receive the influenza vaccine. The following 6 outcomes were assessed: all-cause mortality, cardiovascular-related mortality, all-cause hospitalization, cardiovascular-related hospitalization, non-fatal myocardial infarction, and non-fatal stroke. Risk of bias was assessed using the Newcastle-Ottawa Scale and a GRADE assessment was completed. A random-effects meta-analysis was performed to estimate the pooled risk ratio (RR), 95% confidence intervals (CIs), and heterogeneity using I2 statistics.
After synthesizing data from 7 non-randomized studies (247,842 patients), the results demonstrate the risk of all-cause mortality is significantly reduced within 12 months of a heart failure patient receiving the influenza vaccine (RR = 0.75, 95% CI 0.71–0.79; P<0.0001); very low certainty of evidence. The risk of cardiovascular-related mortality was significantly reduced (RR = 0.77, 95% CI 0.73–0.81; P<0.0001); low certainty of evidence. The pooled risk of all-cause hospitalization was higher among vaccinated heart failure patients (RR = 1.24, 95% CI 1.13–1.35; P<0.0001), based on two studies; very low certainty of evidence and considerable heterogeneity (I2 = 90%). No eligible studies assessed cardiovascular-related hospitalization, non-fatal myocardial infarction, or non-fatal stroke.
Influenza vaccination appears to reduce adverse cardiovascular events, although the certainty of the evidence is low or very low. Rigorous randomized controlled trial evidence is needed to further examine the protective effect of the influenza vaccine in heart failure patients.
Background
Prolonged postoperative ileus (PPOI) contributes to morbidity and prolonged hospitalization. Prucalopride, a selective 5-hydroxytryptamine receptor agonist, may enhance bowel motility. ...This review assesses whether the perioperative use of prucalopride compared to placebo is associated with accelerated return of bowel function post gastrointestinal (GI) surgery.
Methods
OVID, CENTRAL, and EMBASE were searched as of January 2024 to identify randomized controlled trials (RCTs) comparing prucalopride and placebo for prevention of PPOI in adult patients undergoing GI surgery. The primary outcomes were time to stool, time to flatus, and time to oral tolerance. The secondary outcomes were incidence of PPOI, length of stay (LOS), postoperative complications, adverse events, and overall costs. The Cochrane risk of bias tool for randomized trials and the Grading of Recommendations, Assessment, Development, and Evaluations framework were used. An inverse variance random effects model was used.
Results
From 174 citations, 3 RCTs with 139 patients in each treatment group were included. Patients underwent a variety of GI surgeries. Patients treated with prucalopride had a decreased time to stool (mean difference 36.82 hours, 95% CI 59.4 to 14.24 hours lower, I2 = 62%, low certainty evidence). Other outcomes were not statistically significantly different (very low certainty evidence). Postoperative complications and adverse events could not be meta-analyzed due to heterogeneity; yet individual studies suggested no significant differences (very low certainty evidence).
Discussion
Current RCT evidence suggests that prucalopride may enhance postoperative return of bowel function. Larger RCTs assessing patient important outcomes and associated costs are needed before routine use of this agent.
Background: Full-thickness rectal prolapse is associated with significant morbidity and remains a challenging pathology to correct surgically with significant recurrence rates. Among perineal ...surgical approaches, the perineal rectosigmoidectomy, commonly referred to as the Altemeier procedure, is the most frequently performed. The addition of levatorplasty has been postulated to improve recurrence rates; however, its efficacy varies across prospective studies. The aim of this study was to systematically review recurrence rates following Altemeier with levatorplasty, and to meta-analyze pooled data comparing recurrence rates between Altemeier with and without a levatorplasty. Methods: A search of Embase, Ovid MEDLINE, and CENTRAL was performed from database inception to October 2021 aimed at identifying all studies investigating recurrence rate of rectal prolapse following Alteimer with levatorplasty. The primary end point was recurrence of rectal prolapse. Articles that did not report the primary end point or did not evaluate Altemeir procedure with levatorplasty were excluded. A pairwise meta-analysis was performed using Mantel-Haenszel random effects. Results: From 200 citations, a total of 14 primary studies met inclusion criteria. A total of 620 patients (88.9% female, mean age 71 yr) underwent Altemeier with levatorplasty. Of the patients undergoing levatorplasty, 86 (13.8%) experienced a recurrence. Mean follow-up was 46 months. Meta-analysis of recurrence rates between Altemeier with and without levatorplasty demonstrated no significant difference (relative risk 0.92, 95% confidence interval 0.32-2.59, p = 0.87, I2 = 77%). Conclusion: Narrative review of postoperative quality of life metrics demonstrated an improvement in incontinence following Altemeier with levatorplasty as measured by the Wexner and ICIQ-SIF scores. The addition of a levatorplasty does not significantly reduce the risk of recurrent rectal prolapse after an Altemeier; however, it may improve incontinence. Additional randomized controlled trials with standardized surgical techniques are needed to confirm the findings of this review.
Background
Maintenance of normothermia is a crucial part of enhanced recovery after colorectal surgery. Dry‐cold carbon dioxide (CO2) traditionally used for insufflation in laparoscopic surgery and ...negative pressure operating theatres has been associated with intraoperative hypothermia. Studies suggest that use of warmed‐humidified CO2 may promote normothermia. However, due to a scarcity of high‐quality studies demonstrating a proven benefit on intraoperative core body temperature, its use in colorectal surgery remains limited. Therefore, the aim of this review was to evaluate the effects of warmed‐humidified CO2 compared to traditional dry‐cold CO2, or ambient air in operating theatres, during colorectal surgery.
Methods
A search of Medline, EMBASE, and CENTRAL was performed. Randomised controlled trials (RCTs) that compared patients receiving warmed‐humidified CO2 with either dry‐cold CO2 insufflation in laparoscopic procedures or no insufflation during open surgery were included. The primary outcome was change in intraoperative core body temperature. Secondary outcomes included length of stay, operating time, return of gastrointestinal function, wound infection, and postoperative pain. A pairwise meta‐analysis was performed using inverse variance random effects.
Results
Among the six RCTs included, 208 patients received warmed‐humidified CO2 (42.3% female, mean age: 65.8 years) and 210 patients received either dry‐cold CO2 in laparoscopic procedures or no gas insufflation during open procedures (46.2% female, mean age: 66.1 years). No significant difference was found for change in intraoperative core body temperature (MD = 0.01, 95% CI: −0.1, 0.11, p = 0.90, very low certainty). Patients in the warmed‐humidified CO2 group had significantly higher pain scores on postoperative day 1 (MD = 1.61, 95% CI: 0.91, 2.31, p < 0.05, very low certainty). No significant differences were found in any of the other secondary outcomes studied.
Conclusion
Patients undergoing colorectal surgery receiving warmed‐humidified CO2 do not experience any clinically meaningful difference in core body temperature change compared to their counterparts receiving dry‐cold CO2 insufflation or no insufflation. However, patients may report greater pain scores on postoperative day 1 with warmed‐humidified CO2. There is likely no clinically important difference between warmed‐humidified CO2 and dry‐cold CO2 for patients undergoing colorectal surgery. Patient, clinician, and institution factors should be considered when deciding between these two insufflation modalities.
Background
Though gastrojejunostomy (GJ) has been a standard palliative procedure for gastric outlet obstruction (GOO), endoscopic stenting (ES) has shown to provide benefits due to its non-invasive ...approach. The aim of this review is to perform a comprehensive evaluation of ES versus GJ for the palliation of malignant GOO.
Methods
MEDLINE, Embase, and CENTRAL databases were searched and comparative studies of adult GOO patients undergoing ES or GJ were eligible for inclusion. The primary outcomes were survival time and mortality. Secondary outcomes included technical success, clinical success, reinterventions, days until oral food tolerance, postoperative adjuvant palliative chemotherapy, postoperative morbidities, length of stay (LOS), and costs. Pairwise meta-analyses using inverse-variance random effects were performed.
Results
After identifying 2222 citations, 39 full-text articles fit the inclusion criteria. In total, 3128 ES patients (41.4% female, age: 68.0 years) and 2116 GJ patients (40.4% female, age: 66.8 years) were included. ES patients experienced a shorter survival time (mean difference -24.77 days, 95% Cl − 45.11 to − 4.43,
p
= 0.02) and were less likely to undergo adjuvant palliative chemotherapy (risk ratio 0.81, 95% Cl 0.70 to 0.93,
p
= 0.004). The ES group had a shorter LOS, shorter time to oral intake of liquids and solids, and less surgical site infections (risk ratio 0.30, 95% Cl 0.12 to 0.75,
p
= 0.01). The patients in the ES group were at greater risk of requiring reintervention (risk ratio 2.60, 95% Cl 1.87 to 3.63,
p
< 0.001).
Conclusion
ES results in less postoperative morbidity and shorter LOS when compared to GJ, however, this may be at the cost of decreased initiation of adjuvant palliative chemotherapy and overall survival, as well as increased risk of reintervention. Both techniques are likely appropriate in select clinical scenarios.
Graphical abstract
Background
When surgery is indicated for fulminant
Clostridioides difficile
infection (CDI), total abdominal colectomy (TAC) is the most common approach. Diverting loop ileostomy (DLI) with antegrade ...colonic lavage has been introduced as a colon-sparing surgical approach. Prior analyses of National Inpatient Sample (NIS) data suggested equivalent postoperative outcomes between groups but did not evaluate healthcare resource utilization. As such, we aimed to analyze a more recent NIS cohort to compare these two approaches in terms of both postoperative outcomes and healthcare resource utilization.
Methods
A retrospective analysis of the NIS from 2016 to 2019 was conducted. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, system-specific postoperative complications, total admission cost, and length of stay (LOS). Univariable and multivariable regressions were utilized to compare the two operative approaches.
Results
In total, 886 patients underwent TAC and 409 patients underwent DLI with antegrade colonic lavage. Adjusted analyses demonstrated no difference between groups in postoperative in-hospital morbidity (aOR 0.96, 95%CI 0.64–1.44,
p
= 0.851) or in-hospital mortality (aOR 1.15, 95%CI 0.81–1.64,
p
= 0.436). Patients undergoing TAC experienced significantly decreased total admission cost (MD $79,715.34, 95%CI 133,841–25,588,
p
= 0.004) and shorter postoperative LOS (MD 4.06 days, 95%CI 6.96–1.15,
p
= 0.006).
Conclusions
There are minimal differences between TAC and DLI with antegrade colonic lavage for fulminant CDI in terms of postoperative morbidity and mortality. Healthcare resource utilization, however, is significantly improved when patients undergo TAC as evidenced by clinically important decreases in total admission cost and postoperative LOS.
