The Comprehensive Antibiotic Resistance Database (CARD; http://arpcard.mcmaster.ca) is a manually curated resource containing high quality reference data on the molecular basis of antimicrobial resistance (AMR), with an emphasis on the genes, proteins and mutations involved in AMR. CARD is ontologically structured, model centric, and spans the breadth of AMR drug classes and resistance mechanisms, including intrinsic, mutation-driven and acquired resistance. It is built upon the Antibiotic Resistance Ontology (ARO), a custom built, interconnected and hierarchical controlled vocabulary allowing advanced data sharing and organization. Its design allows the development of novel genome analysis tools, such as the Resistance Gene Identifier (RGI) for resistome prediction from raw genome sequence. Recent improvements include extensive curation of additional reference sequences and mutations, development of a unique Model Ontology and accompanying AMR detection models to power sequence analysis, new visualization tools, and expansion of the RGI for detection of emergent AMR threats. CARD curation is updated monthly based on an interplay of manual literature curation, computational text mining, and genome analysis.

BackgroundThe use of in situ simulation has previously been shown to increase confidence, teamwork and practical skills of trained professionals. However, a direct benefit to patient outcomes has not been sufficiently explored. This review focuses on the effect of in situ simulation training in a hospital setting on morbidity or mortality.MethodsA combined search was conducted in PUBMED, OVID, WEB OF SCIENCE, CINAHL, SCOPUS and EMBASE. 478 studies were screened with nine articles published between 2011 and 2017 meeting the inclusion criteria for analysis.ResultsThis review selected eight prospective studies and one prospective-retrospective study. Three studies isolated in situ simulation as an experimental variable while the remaining studies implemented in situ programmes as a component of larger quality improvement initiatives. Seven studies demonstrated a significant improvement in morbidity and/or mortality outcomes following integrated in situ simulation training.ConclusionExisting literature, albeit limited, demonstrates that in situ training improves patient outcomes either in isolation or within a larger quality improvement programme. However, existing evidence contains difficulties such as isolating the impact of in situ training from various potential confounding factors and potential for publication bias.

Objective: To determine if Black race is associated with worse short-term postoperative morbidity and mortality when compared to White race in a contemporary, cross-specialty-matched cohort. Background: Growing evidence suggests poorer outcomes for Black patients undergoing surgery. Methods: A retrospective analysis was conducted comprising of all patients undergoing surgery in the National Surgical Quality Improvement Program dataset between 2012 and 2018. One-to-one coarsened exact matching was conducted between Black and White patients. Primary outcome was rate of 30-day morbidity and mortality. Results: After 1:1 matching, 615,118 patients were identified. Black race was associated with increased rate of all-cause morbidity (odds ratio [OR] = 1.10, 95% confidence interval [CI] 1.08–1.13, P < 0.001) and mortality (OR = 1.15, 95% CI 1.01–1.31, P = 0.039). Black race was associated with increased risk of re-intubation (OR = 1.33, 95% CI 1.21–1.48, P < 0.001), pulmonary embolism (OR = 1.55, 95% CI 1.40–1.71, P < 0.001), failure to wean from ventilator for >48 hours (OR = 1.14, 95% CI 1.02–1.29, P < 0.001), progressive renal insufficiency (OR = 1.63, 95% CI 1.43–1.86, P < 0.001), acute renal failure (OR = 1.39, 95% CI 1.16–1.66, P < 0.001), cardiac arrest (OR = 1.47, 95% CI 1.24–1.76 P < 0.001), bleeding requiring transfusion (OR = 1.39, 95% CI 1.34–1.43, P < 0.001), DVT/thrombophlebitis (OR = 1.24, 95% CI 1.14–1.35, P < 0.001), and sepsis/septic shock (OR = 1.09, 95% CI 1.03–1.15, P < 0.001). Black patients were also more likely to have a readmission (OR = 1.12, 95% CI 1.10–1.16, P < 0.001), discharge to a rehabilitation center (OR = 1.73, 95% CI 1.66–1.80, P < 0.001) or facility other than home (OR = 1.20, 95% CI 1.16–1.23, P < 0.001). Conclusion and Relevance: This contemporary matched analysis demonstrates an association with increased morbidity, mortality, and readmissions for Black patients across surgical procedures and specialties.

Background Despite persistently poor oncological outcomes, approaches to the management of T4 colonic cancer remain variable, with the role of neoadjuvant therapy unclear. The aim of this review was to compare oncological outcomes between direct-to-surgery and neoadjuvant therapy approaches to T4 colon cancer. Methods A librarian-led systematic search of MEDLINE, Embase, the Cochrane Library, Web of Science, and CINAHL up to 11 February 2020 was performed. Inclusion criteria were primary research articles comparing oncological outcomes between neoadjuvant therapies or direct to surgery for primary T4 colonic cancer. Based on PRISMA guidelines, screening and data abstraction were undertaken in duplicate. Quality assessment was carried out using Cochrane risk-of-bias tools. Random-effects models were used to pool effect estimates. This study compared pathological resection margins, postoperative morbidity, and oncological outcomes of cancer recurrence and overall survival. Results Four studies with a total of 43 063 patients met the inclusion criteria. Compared with direct to surgery, neoadjuvant therapy was associated with increased rates of margin-negative resection (odds ratio (OR) 2.60, 95 per cent c.i. 1.12 to 6.02; n = 15 487) and 5-year overall survival (pooled hazard ratio 1.42, 1.10 to 1.82, I2 = 0 per cent; n = 15 338). No difference was observed in rates of cancer recurrence (OR 0.42, 0.15 to 1.22; n = 131), 30-day minor (OR 1.12, 0.68 to 1.84; n = 15 488) or major (OR 0.62, 0.27 to 1.44; n = 15 488) morbidity, or rates of treatment-related adverse effects. Conclusion Compared with direct to surgery, neoadjuvant therapy improves margin-negative resection rates and overall survival.

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