Background Rapid identification of COVID-19 cases, which is crucial to outbreak containment efforts, is challenging due to the lack of pathognomonic symptoms and in settings with limited capacity for specialized nucleic acid–based reverse transcription polymerase chain reaction (PCR) testing. Methods This retrospective case-control study involves subjects (7–98 years) presenting at the designated national outbreak screening center and tertiary care hospital in Singapore for SARS-CoV-2 testing from 26 January to 16 February 2020. COVID-19 status was confirmed by PCR testing of sputum, nasopharyngeal swabs, or throat swabs. Demographic, clinical, laboratory, and exposure-risk variables ascertainable at presentation were analyzed to develop an algorithm for estimating the risk of COVID-19. Model development used Akaike’s information criterion in a stepwise fashion to build logistic regression models, which were then translated into prediction scores. Performance was measured using receiver operating characteristic curves, adjusting for overconfidence using leave-one-out cross-validation. Results The study population included 788 subjects, of whom 54 (6.9%) were SARS-CoV-2 positive and 734 (93.1%) were SARS-CoV-2 negative. The median age was 34 years, and 407 (51.7%) were female. Using leave-one-out cross-validation, all the models incorporating clinical tests (models 1, 2, and 3) performed well with areas under the receiver operating characteristic curve (AUCs) of 0.91, 0.88, and 0.88, respectively. In comparison, model 4 had an AUC of 0.65. Conclusions Rapidly ascertainable clinical and laboratory data could identify individuals at high risk of COVID-19 and enable prioritization of PCR testing and containment efforts. Basic laboratory test results were crucial to prediction models.

BackgroundErgonomics, as defined by the optimization of one's physical environment to enhance work performance, is an important consideration in surgery. While there have been reviews on the ergonomics of laparoscopy, this has not been the case for robotic surgery despite the rising number of publications.MethodsThis study was performed in accordance to the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. A search was performed on main databases to identify relevant articles.ResultsTwenty‐nine articles were included, comprising 3074 participants. Studies employing objective measurement tools showed that robotics conferred superior ergonomic benefits and reduced work load compared to laparoscopy, for both surgeons and trainees. Survey studies also demonstrated that self‐reported discomfort was lower in robotic procedures compared to laparoscopy and open surgery. Compared to other subspecialities, gynecological procedures seem to be associated with greater surgeon‐reported strain.ConclusionRobotic surgery is ergonomically superior to open and laparoscopic surgery. However, rates of physical strain remain significant and should be addressed by formal ergonomic training and adequate console familiarization.

Introduction Enhanced recovery after surgery (ERAS) protocols have been successfully integrated into peri-operative management of different cancer surgeries such as colorectal cancer. Their value for gastric cancer surgery, however, remains uncertain. Methods A search for randomized and observational studies comparing ERAS versus conventional care in gastric cancer surgery was performed according to PRISMA guidelines. Random-effects meta-analyses with inverse variance weighting were conducted, and quality of included studies was assessed using the Cochrane risk-of-bias tool and Newcastle-Ottawa scale (PROSPERO: CRD42017080888). Results Twenty-three studies involving 2686 patients were included. ERAS was associated with reduced length of hospital stay (WMD-2.47 days, 95% CI − 3.06 to − 1.89, P < 0.00001), time to flatus (WMD-0.70 days, 95% CI − 1.02 to − 0.37, P < 0.0001), and hospitalization costs (WMD-USD$ 4400, 95% CI − USD$ 5580 to − USD$ 3210, P < 0.00001), with consistent results across open and laparoscopic surgery. Postoperative morbidity and 30-day mortality were similar, although a higher rate of readmission was observed in the ERAS group (RR = 1.95, 95% CI 1.03-3.67, P = 0.04). Patients in the ERAS arm had significantly attenuated C-reactive protein levels on days 3/4 and 7, interleukin-6 levels on days 1, and 3/4, and tumor necrosis factor-α levels on days 3/4 postoperatively. Conclusion Compared to conventional care, ERAS reduces hospital stay, costs, surgical stress response and time to return of gut function, without increasing post-operative morbidity in gastric cancer surgery. However, precaution is necessary to reduce the increased risk of hospital readmission when adopting ERAS.

The available data on TC TAVI show comparable technical feasibility with other traditional access routes, representing a viable alternative. However, the paucity of data warrants the need for larger randomized controlled trials to establish a firm conclusion.