BackgroundFrailty is an important prognostic factor for adverse outcomes and increased resource use in the growing population of older surgical patients. We identified and appraised studies that tested interventions in populations of frail surgical patients to improve perioperative outcomes.MethodsWe systematically searched Cochrane, CINAHL, EMBASE and Medline to identify studies that tested interventions in populations of frail patients having surgery. All phases of study selection, data extraction, and risk of bias assessment were done in duplicate. Results were synthesized qualitatively per a prespecified protocol (CRD42016039909).ResultsWe identified 2 593 titles; 11 were included for final analysis, representing 1 668 participants in orthopedic, general, cardiac, and mixed surgical populations. Only one study was multicenter and risk of bias was moderate to high in all studies. Interventions were applied pre- and postoperatively, and included exercise therapy (n = 4), multicomponent geriatric care protocols (n = 5), and blood transfusion triggers (n = 1); no specific surgical techniques were compared. Exercise therapy, applied pre-, or post-operatively, was associated with significant improvements in functional outcomes and improved quality of life. Multicomponent protocols suffered from poor compliance and difficulties in implementation. Transfusion triggers had no significant impact on mortality or other outcomes.ConclusionsDespite a growing literature that demonstrates strong independent associations between frailty and adverse outcomes, few interventions have been tested to improve the outcomes of frail surgical patients, and most available studies are at substantial risk of bias. Multicenter, low risk of bias, studies of perioperative exercise are needed, while substantial efforts are required to develop and test other interventions to improve the outcomes of frail people having surgery.
Background: Educational videos have become valuable resources and can address some of the pitfalls of traditional learning. To ensure clerkship students have adequate exposure to curriculum objectives, a series of objective-aligned self-directed learning video podcasts covering core surgical concepts were developed by medical students and surgical residents. The objective of the study was to evaluate the efficacy of the video podcasts in the surgery clerkship rotation. Methods: Nineteen video podcasts were created, housed at www.surgicaleducationportal.com, and distributed to third-year medical students completing their surgical clerkship. A 10-question multiple-choice quiz was administered before and after students viewed each video, and they were also asked to complete a satisfaction survey. Results: A total of 302 paired pretests and posttests were completed. There was a mean increase of 2.7 points in posttest scores compared with pretest scores (p < 0.001). On a Likert scale from 1 to 5, with 5 being excellent, students rated the usefulness of the videos as 4.3, the quality of the content as 4.3 and the quality of the video as 4.2. Ninety-eight percent of students would recommend these videos to their classmates. Conclusion: Video podcasts are an effective modality for engaging medical students and may improve standardization of learning during their surgical clerkship.
typical condensed chromatin. The remained cytoplasm contains several viral particles (ranging in diameter from 90 to 110 nm). The inset corresponds to a higher magnification of the boxed area containing two virions, showing the SARS-CoV-2 characteristics: viral envelope (white arrowhead), nucleocapsids (black arrowhead), and spike-like projections (white arrow).CONCLUSIONS: Although SARS-CoV-2 is not found in the infected men's semen, it was intracellularly present in the spermatozoa. The potential implications for assisted conception should be addressed.
Introduction: Most cohort studies are limited by sampling and accrual bias. The capability to detect specific lesions identified in radiological text reports could eliminate these biases and benefit patient care, clinical research, and trial recruitment. This study derived and internally validated text search algorithms to identify four common urological lesions (solid renal masses, complex renal cysts, adrenal masses, and simple renal cysts) using radiology text reports. Methods: A simple random sample of 10 000 abdominal ultrasound (US) and computed tomography (CT) reports was drawn from our hospital’s data warehouse. Reports were manually reviewed to determine the true status of the four lesions. Using commonly available software, we created logistic regression models having as predictors the status of a priori selected text terms in the report. We used bootstrap sampling with 95th percentile thresholds to select variables for the final models, which were modified into point systems. A second independent, random sample of 2855 reports, stratified by the number of points for each abnormality, was reviewed in a blinded fashion to measure the accuracy of each lesion’s point system. Results: The prevalence of solid renal mass, complex renal cyst, adrenal mass and simple renal cyst, was 2.0%, 1.7%, 3.2%, and 20.0%, respectively. Each model contained between one and five text terms with c-statistics ranging between 0.66 and 0.90. In the independent validation, the scoring systems accurately predicted the probability that a text report cited the four lesions. Conclusions: Textual radiology reports can be analyzed using common statistical software to accurately determine the probability that important abnormalities of the kidneys or adrenal glands exist. These methods can be used for case identification or epidemiological studies.
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