Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
This study aims to psychometrically validate the Chilean version of the Alcohol, Smoking and Substance Involvement Screening Test ASSIST. Specifically, this study is interested in evaluating the reliability, consistency and concurrent and discriminant validity of this instrument. The sample was composed for a total of 400 people from four different settings: treatment centers (residential and ambulatories), primary health care, police stations and companies.The reliability of the ASSIST was high (α = .86 for Alcohol, α = .84 for marijuana and α = .90 for cocaine). The intra class correlation coefficient (ICC) with test-retest comparison was statistically significant for Alcohol (ICC = .66), marijuana (ICC = .74) and cocaine (ICC = .80). There were statistically significant correlations between the ASSIST and the AUDIT score (Pearson's r = .85), the ASSIST and the ASI-Lite score (r between .66 and .83 for tobacco, alcohol, marijuana and cocaine), and the ASSIST and the SDS score (r = .65). The original cutoff point for high risk detection was 27 points, however, in order to have a better balance between sensitivity and specificity the cut was changed to 21 points. The ASSIST presents good psychometric properties and therefore is a reliable and valid instrument to be used as a mechanism to detect risk levels of substance use in the Chilean population. Gonzalo Soto-Brandt*, Rodrigo Portilla Huidobro**, David Huepe Artigas***, Álvaro RiveraRei***, María Josefina Escobar***, Natalia Salas Guzmán****, Andrés Canales-Johnson***. Agustín Ibáñez***, Claudio Martínez Guzmán*****, Álvaro Castillo-Carniglia* *Área de Estudios, Servicio Nacional para la Prevención y Rehabilitación del Consumo de Drogas y Alcohol (SENDA), Chile; **Área de Tratamiento, Servicio Nacional para la Prevención y Rehabilitación del Consumo de Drogas y Alcohol (SENDA), Chile; ***Núcleo UDP-Fundación INECO para las Neurociencias (NUFIN), Universidad Diego Portales, Santiago, Chile; ****Facultad de Educación, Universidad Diego Portales, Santiago, Chile; *****Facultad de Psicología, Universidad Diego Portales, Santiago, Chile.El objetivo del estudio fue analizar la validez de la versión chilena de un instrumento para la identificación de diferentes niveles de riesgo asociado al consumo de alcohol, tabaco, marihuana y cocaína (Alcohol, Smoking and Substance Involvement Screening Test, ASSIST).Se evaluó la fiabilidad y consistencia del instrumento además de la validez concurrente y discriminante. La muestra fue de 400 usuarios de servicios de tratamiento drogas y alcohol ambulatorios y residenciales de la atención primaria de salud, comisarías y empresas.La consistencia interna obtenida fue alta (Alcohol α= .86. marihuana α= .84 y cocaína α= .90). El coeficiente de correlación intraclase (CCI) con la comparación test-retest fue buena para Alcohol (CCI = .66), marihuana (CCI = .74) y cocaína (CCI =.80). Se observó una buena correlación entre los puntajes del ASSIST el puntaje del AUDIT (r de Pearson = .85), ASI-Lite (r entre .66 y .83 para tabaco, alcohol,...
En Chile, los estudiantes con discapacidad intelectual (di) asisten a escuelas especiales o a escuelas regulares con programas de integración escolar (pie). Hasta la fecha se carece de información respecto de las oportunidades de aprendizaje (oda) que se proporcionan a estos estudiantes en ambos contextos. El estudio que se presenta es parte de una investigación mayor, cuyo propósito es explorar las oda de las matemáticas que se generan en centros de educación especial para estudiantes con di. Se realizaron entrevistas semiestructuradas con profesores y directivos de escuelas especiales, con el objetivo de indagar cuáles son sus creencias sobre la enseñanza, sobre los estudiantes con di y las matemáticas. Los resultados indican que la enseñanza a estudiantes con di requiere de mucho tiempo de planificación, de un currículo flexible que se adapte a las necesidades individuales, de uso de material concreto y de una evaluación individualizada. Respecto de los estudiantes, los entrevistados indican que no hay fórmulas generales y que se debe tratar cada caso de manera individual. Finalmente, profesores y directivos estiman que la enseñanza de las matemáticas para estudiantes con di son principalmente el conteo y las operaciones con números, lo cual excluye del currículo ofrecido espacios para el desarrollo de otras habilidades matemáticas.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.