Standardized Outcome Measures Research Articles

Performance assessment of the Surpass Evolve flow diverter for the treatment of intracranial aneurysms: A systematic review and meta-analysis.

The Surpass Evolve (SE) has emerged as a promising alternative treatment from the flow diverter series. The utilization of the SE has gradually increased, however, there is a scarcity of comprehensive data on the solidity of this technology in the endovascular treatment of intracranial aneurysms (IAs). This meta-analysis aimed to evaluate the safety and effectiveness of the SE flow diverter. A systematic literature search from inception to April 2024 was conducted across five databases for studies involving IAs treated with the SE. The primary effectiveness outcome was the proportion of complete aneurysm occlusion at the final follow-up, and the primary safety outcome comprised a composite of early and delayed complications. Subgroup analyses based on aneurysm size, anatomical location, and rupture status were also conducted. Our analysis included nine studies with 645 patients and 722 IAs. Effectiveness outcomes revealed an overall complete aneurysm occlusion rate of 69% (95% confidence interval (CI) = 58%-78%; I2 = 72%) and a favorable aneurysm occlusion rate of 91% (95% CI = 82%-96%; I2 = 49%). Safety outcomes demonstrated an overall complications rate of 6% (95% CI = 3%-12%; I2 = 66%), with an early complications rate of 6% (95% CI = 4%-11%; I2 = 0%), and a delayed complications rate of 0% (95% CI = 0%-7%; I2 = 0%). Our findings suggest a favorable outcome with a high rate of complete aneurysm occlusion at the last follow-up, with acceptable rates of neurological complications. Future research efforts should focus on larger, prospective studies with standardized outcome measures to further elucidate the clinical utility of the SE flow diverter in the management of IAs.

Clinician- vs non-clinician-supported eTherapy for anxiety and depression

Purpose The efficacy of supported computerised therapy (eTherapy) for anxiety and depression is established; however, questions remain regarding supporter type. This paper aims to examine differences in client outcomes between clinician- (Psychological Wellbeing Practitioner) and non-clinician-supported, low intensity eTherapy. Standardised outcome measures were collected and analysed pre- and post-intervention in two eTherapy services as part of National Health Service (NHS) commissioned, Improving Access to Psychological Therapy provision – now known as NHS Talking Therapies for anxiety and depression (TT). Design/methodology/approach This study is a routine service evaluation comparing two eTherapy services. In total, 494 clients (including 455 clients meeting caseness) accessed the service over a year as part of routine care for anxiety and depression. The Patient Health Questionnaire and Generalised Anxiety Disorder Questionnaire scales were administered pre- and post-treatment as part of the TT data set (NHS England, 2024). Findings Following adjustment for demographics, baseline assessment scores and clinical variables, the authors found no evidence to support differences in the likelihood of recovery between clients in the non-clinician-supported site and clients referred to the clinician-supported site: OR = 1.24 [95%CI: 0.71 to 2.17] for TT recovery, OR = 0.83 [95%CI: 0.47 to 1.49] for TT reliable improvement and OR = 1.11 [95%CI: 0.65 to 1.92] for TT reliable recovery. Originality/value Non-clinician-supported eTherapy is as effective as clinician-supported eTherapy. This finding supports the case for expansion of non-clinician-supported eTherapy services in TT services.

Old but gold: Is the Judet procedure still a viable option for posttraumatic knee stiffness in 2024? A comprehensive systematic review and meta-analysis.

Posttraumatic extension contracture of the knee (PECK) is common after knee injury. Initial management is conservative to improve the range of motion; if it fails, surgery may be necessary. This systematic review analyses existing literature on Judet quadricepsplasty for PECK. We will assess clinical outcomes, complications, patient satisfaction and factors that may influence its success. A search was conducted on 25 November 2023, adhering to preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed, Embase and Google Scholar were used. Search strings were ([Judet] OR [quadricepsplasty]) AND (knee) AND (stiffness) and ([Judet] OR [quadricepsplasty]) AND (knee). Inclusion criteria: English articles focused on PECK, published between 2003 and 2023, and a minimum follow-up of 24 months. Exclusion criteria: case reports, alternative techniques, knee stiffness cases not only due to trauma, a sample size of <10 patients and articles not reporting functional outcomes. Among selected studies, 239 patients were considered. The average time between injury and Judet was 27 months. The population was predominantly male; the mean follow-up was 33 months. An average intraoperative knee range of motion improvement of 79.1 degrees (confidence interval 76.9; 81.3) compared to the average preoperative starting value of 30.7 degrees was observed. This improvement decreased by 13.5 degrees at the first postoperative check and by an additional 2.4 degrees at the follow-up, while maintaining an average value of bending above 90 degrees. Judet quadricepsplasty appears an effective technique for the management of PECK. The heterogeneity of included studies and the absence of standardized outcome measures limit the ability to draw definitive conclusions. Level III.

Teiripe sa Bhaile: ICPOP Early Supported Discharge for Frailty

Abstract Background Older adults and particularly older adults with frailty are high users of acute hospital care which results in overall higher hospital costs and reduced functional independence. Early supported discharge (ESD) was found to have a statistically significant impact in reducing length of stay in older adults admitted for medical reasons. This poster outlines the rehabilitation pathway developed by an ICPOP team to provide early supported discharge for frail older inpatients with SMART rehab goals. Methods Suitable patients are identified and assessed prior to discharge from the acute ward. Each patient receives a comprehensive geriatric assessment in their own home. All patients receive at least 2 hours of therapy per week until they have reached their goals. Standardised outcome measures including Functional Assessment Measure (FIM/FAM) and EQ5D5L are captured for each patient. Clients are discharged once they have reached their goals or are at their new functional baseline. Results 52 patients have been seen on this pathway since 2023. Hip fracture was the most common reason for referral, followed by Falls. Average length of stay on service was 40 days. Average wait time to first assessment was 1.7 days, highlighting the responsiveness of the service. 4 patients seen in 2024 live alone, indicating this service is also appropriate for patients who don’t have supports readily available in the home. FIM/FAM scores increased from 148 to 160 on average- Indicating more functional independence. Conclusion This ICPOP Rehabilitation pathway offers a safe, person-centred alternative to traditional inpatient rehabilitation. Readmission rates post discharge were low indicating the programme's safety. Given the large number of hospital bed saved without compromising functional outcomes for the patients, the ICPOP team is working on expanding this pathway.

Prediction of adverse maternal and perinatal outcomes associated with pre-eclampsia and hypertensive disorders of pregnancy: a systematic review and meta-analysis

Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. If women at high risk for developing complications could be identified early, level of care could be triaged, limited resources could be correctly allocated and targeted interventions to prevent complications could be implemented. We updated a systematic review and meta-analysis and added single outcomes. Women with hypertensive disorders of pregnancy were included. Exposures were tests predicting adverse maternal and/or perinatal outcomes. We searched Medline, Embase, CINAHL, and Cochrane library from January 2016-February 2024. We included studies identified from the previous review. We calculated effect measures. For similar predictive tests and outcomes, area under the receiver-operating-characteristic curve (AUROC) were pooled. This study was registered by PROSPERO: CRD42022336368. Of the 2898 studies identified, 80 were included. Thirty were added from the previous review resulting in 110 included studies with 506,178 women. Despite more than 1500 tests being performed, most outcomes could not be pooled due to heterogeneity in populations, tests, and outcome definitions. For maternal outcomes, only studies reporting on the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS) model could be pooled. For the composite outcome within 48-h the AUROC was 0.78 (95% CI 0.71-0.86, N=8). There was significant heterogeneity (I 2 =95.7%). For perinatal outcomes, data were pooled for pulsatility index in the umbilical artery and soluble FMS-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio. Biomarkers like the sFlt-1/PlGF ratio showed promising predictive performance for some outcomes but were not externally validated. Despite including over 100 studies with more than 1500 predictors, we were unable to pool any single maternal outcomes and only a few individual perinatal outcomes. The fullPIERS model was externally validated, showing moderate accuracy which varied across studies and should be validated in each new population. Angiogenic biomarkers showed promise but need validation. Future studies should use standardized outcome measures and validate promising tests. VB is supported by the Swedish Research Council, Grant number 2020-01481. University of Gothenburg.

Bundling implementation strategies supports outcome measure adoption in stroke rehabilitation: preliminary findings

BackgroundOver 80% of people who experience a stroke present with residual impairment of the upper extremity, such as the shoulder, elbow, wrist, and hand. However, rarely do stroke rehabilitation practitioners (e.g., occupational therapists) use standardized outcome measures to objectively evaluate upper extremity function. Accordingly, the purpose of this project was to develop a bundle of implementation strategies that supports practitioners’ adoption of the Fugl-Meyer Assessment of the Upper Extremity in stroke rehabilitation practice.MethodsWe used tenets of Implementation Mapping to guide the development of our implementation strategy bundle. We partnered with one, large academic health system serving over 200 stroke patients annually through intensive rehabilitation care. Strategies were selected and developed through a multi-method process that included a review of the literature, qualitative input from our health system’s practitioners and managers, and expert consultation. We also specified the hypothesized implementation “mechanisms” our strategies intended to change. Practitioners’ adoption (yes/no) of the Fugl-Meyer Assessment was calculated by analyzing electronic health record documentation of the 6-month time frame before strategies were deployed compared to the 6-month time frame after deployment.ResultsPractitioners were exposed to the following implementation strategies to support Fugl-Meyer adoption: conduct educational meetings, prepare outcome measure champions, provide equipment, develop training materials, and adapt documentation systems. In the 6-months before deployment of our implementation strategies, practitioners implemented the Fugl-Meyer with 14.8% of stroke patients. In the six months after deployment, adoption of the Fugl-Meyer increased to 73.8% (p < .001).ConclusionsWhen systematically developed in collaboration with health system partners, a bundle of implementation strategies may support outcome measure adoption in stroke rehabilitation. Improving the use of standardized outcome measures is of paramount importance in stroke rehabilitation to objectively monitor patients’ progress or decline, to demonstrate the value of rehabilitation services for enhancing patients’ recovery, and to advocate for continued reimbursement for rehabilitation care. Future opportunities lie in further specifying the mechanisms through which implementation strategies are intended to work and how those mechanisms contribute to strategy effectiveness.Trial registrationNCT registration: NCT04888416; May 06, 2021.

The Indirect Effect of an Internet-Based Intervention on Third-Party Disability for Significant Others of Individuals with Tinnitus.

This study aimed to investigate whether Internet-based cognitive behavioural therapy intervention (ICBT) for individuals with tinnitus had an indirect effect on the third-party disability noticed by significant others (SOs). Significant Others Questionnaire (CTSOQ). Individuals with tinnitus completed standardized self-reported outcome measures for tinnitus severity, anxiety, depression, insomnia, hearing-related quality of life, tinnitus cognitions, hearing disability, and hyperacusis. In total, 194 pairs of individuals with tinnitus and their SOs participated. The impact of third-party disability experienced by SOs was significantly reduced after individuals with tinnitus undertook the ICBT intervention (d = 0.41). This reduced SOs with severe difficulties from 52% to 35%. The remaining impact was mild for 30% and moderate for 35%. SOs with higher baseline difficulties and SOs who were partners (e.g., spouses) were less likely to notice indirect benefits from intervention undertaken by their family members. There was a moderate positive correlation between the post-intervention CTSOQs and the clinical variables of tinnitus severity and depression. Third-party disability may be reduced as an indirect effect of individuals with tinnitus undertaking ICBT. Including SOs of individuals with tinnitus within the rehabilitation process may add additional benefits, and such involvement should be encouraged.

Artificial intelligence for optimizing recruitment and retention in clinical trials: a scoping review.

The objective of our research is to conduct a comprehensive review that aims to systematically map, describe, and summarize the current utilization of artificial intelligence (AI) in the recruitment and retention of participants in clinical trials. A comprehensive electronic search was conducted using the search strategy developed by the authors. The search encompassed research published in English, without any time limitations, which utilizes AI in the recruitment process of clinical trials. Data extraction was performed using a data charting table, which included publication details, study design, and specific outcomes/results. The search yielded 5731 articles, of which 51 were included. All the studies were designed specifically for optimizing recruitment in clinical trials and were published between 2004 and 2023. Oncology was the most covered clinical area. Applying AI to recruitment in clinical trials has demonstrated several positive outcomes, such as increasing efficiency, cost savings, improving recruitment, accuracy, patient satisfaction, and creating user-friendly interfaces. It also raises various technical and ethical issues, such as limited quantity and quality of sample size, privacy, data security, transparency, discrimination, and selection bias. While AI holds promise for optimizing recruitment in clinical trials, its effectiveness requires further validation. Future research should focus on using valid and standardized outcome measures, methodologically improving the rigor of the research carried out.

Clinical Characteristics of Charcot-Marie-Tooth Disease Type 4J.

Charcot-Marie-Tooth disease type 4J (CMT4J) is caused by autosomal recessive variants in the Factor-Induced Gene 4 (FIG4) gene. Recent preclinical work has demonstrated the feasibility of adeno-associated virus serotype 9-FIG4 gene therapy. This study aimed to further characterize the CMT4J phenotype and evaluate feasibility of validated CMT-related outcome measures for future clinical trials. This cross-sectional study enrolled children and adults with genetically confirmed CMT4J, with 2 documented disease-causing variants in the FIG4 gene. Patients were recruited through the Inherited Neuropathy Consortium network. Disease severity was assessed using standardized CMT-specific outcome measures and exploratory biomarkers including muscle MRI fat fraction, electrophysiology, and neurofilament light chain levels. Descriptive statistics and correlation analyses were conducted to explore relationships between variables. We recruited a total of 19 patients, including 14 pediatric patients (mean age 10.9 ± 3.9 years) and 5 adults (mean age 40.0 ± 13.9 years). The most frequent symptoms were gross motor delay and distal more than proximal muscle weakness, which were observed in 14 of 19 patients. The most common non-neuromuscular symptoms were cognitive and respiratory deficits, each seen in 8 of 19 patients. We denoted asymmetric weakness in 2 patients and nonuniform slowing of conduction velocities in 6 patients. Charcot-Marie-Tooth Disease Pediatric Scale (CMTPedS), Pediatric Quality of Life Inventory, and Vineland Adaptive Behavior Scale scores were affected in most patients. We observed a significant positive correlation between neurofilament light chain levels and CMTPedS, but the study was underpowered to observe a correlation between CMTPedS and MRI fat fraction. We obtained baseline clinical and biomarker data in a broad cohort with CMT4J in pediatric and adult patients. Motor delay, muscle weakness, and respiratory and cognitive difficulties were the most common clinical manifestations of CMT4J. Many patients had nerve conduction studies with nonuniform slowing, and 2 had an asymmetric pattern of muscle weakness. We observed that the neurofilament light chain levels correlated with the CMTPedS in the pediatric population. This study showed feasibility of clinical outcomes including CMTPedS in assessment of disease severity in the pediatric patient population and provided baseline characteristics of exploratory biomarkers, neurofilament light chain levels, and muscle MRI fat fraction. The coronavirus disease 2019 pandemic affected some of the visits, resulting in a reduced number of some of the assessments.

Barriers and Facilitators of Using Standardized Outcome Measures in Stroke Rehabilitation in Saudi Arabia: A Cross-Sectional Study of Practice Among Neurophysiotherapists.

Clinical guidelines emphasize the use of standardized outcome measures (SOMs) in post-stroke rehabilitation. However, the extent of SOM utilization among physiotherapists in this context in Saudi Arabia remains unclear. 1) assess the current use of SOMs by physiotherapists involved in stroke rehabilitation in Saudi Arabia and 2) identify facilitators and barriers influencing the use of SOMs. An online survey was administered using a three-section questionnaire designed for this study. The first section collected demographic data, the second evaluated the use of SOMs recommended by the American Physical Therapy Association, and the third explored factors facilitating or hindering SOM use in clinical practice. Only highly recommended outcome measures capturing the three levels of the International Classification of Functioning, and Disability (ICF) model were considered: body structure and function, activities, and participation. Poisson regression analysis was used to investigate the association between SOMs utilization and educational level, work experience, type of work facility, and the number of patients treated per week. A total of 138 physiotherapists responded. Most participants (98.5%) used at least one outcome measure in clinical practice. Regression analysis showed that number of strokes treated per week and facility type were associated with the likelihood of using higher number of SOMs. Physiotherapists managing more than 10 stroke patients per week and working in private sector had significantly higher odds of using a greater number of SOMs. The most pronounced barriers were time restrictions and limited resources. Physiotherapists working with stroke patients in Saudi Arabia demonstrate a high awareness and positive attitude toward SOM utilization. Addressing barriers such as time management and resource allocation is crucial to enhancing SOM integration in clinical practice. Organizational support in terms of adequate time and resources is needed to enhance the use of SOMs among physiotherapists.

Comparing 3D imaging devices for the measurement of cutaneous neurofibromas in patients with Neurofibromatosis Type 1.

Cutaneous neurofibromas (cNFs) are a major cause of disfigurement in patients with Neurofibromatosis Type 1 (NF1). However, clinical trials investigating cNF treatments lack standardised outcome measures to objectively evaluate changes in cNF size and appearance. 3D imaging has been proposed as an objective standardised outcome measure however various systems exist with different features that affect useability in clinical settings. The aim of this study was to compare the accuracy, precision, feasibility, reliability and accessibility of three imaging systems. We compared the Vectra-H1, LifeViz-Micro and Cherry-Imaging systems. A total of 58 cNFs from 13 participants with NF1 were selected for imaging and analysis. The primary endpoint was accuracy as measured by comparison of measurements between imaging systems. Secondary endpoints included reliability between two operators, precision as measured with the average coefficient of variation, feasibility as determined by time to capture and analyse an image and accessibility as determined by cost. There was no significant difference in accuracy between the three devices for length or surface area measurements (p>0.05), and reliability and precision were similar. Volume measurements demonstrated the most variability compared to other measurements; LifeViz-Micro demonstrated the least measurement variability for surface area and image capture and analysis were fastest with LifeViz-Micro. LifeViz-Micro was better for imaging smaller number of cNFs (1-3), Vectra-H1 better for larger areas and Cherry for uneven surfaces. All systems demonstrated excellent reliability but possess distinct advantages and limitations. Surface area is the most consistent and reliable parameter for measuring cNF size in clinical trials.

53162 Dermatologic disparities by high-risk zip codes revealed by Standard Dermatology Outcome Measures (SDOM)

53162 Dermatologic disparities by high-risk zip codes revealed by Standard Dermatology Outcome Measures (SDOM)

Feasibility of Using Standardized Outcome Measures in the Remote Assessment of Patients with Chronic Stroke: A Case Series

Introduction: With the increase of telerehabilitation utilization worldwide after the COVID-19 pandemic, a review of the current literature shows a concurrent increase in telerehabilitation studies focusing on interventions and delivery models. There is a gap in research on valid and reliable tests and measures that can be used in the physical therapy examination of people with stroke via telerehabilitation. Current reports on psychometric properties of most standardized outcome measures are only applicable in an in-person setting and may not be directly applicable in a remote setting where various challenges contribute to the reliability of results. This report describes the feasibility of administering selected standardized outcome measures in the remote assessment of three patients with chronic stroke with different contexts. Methods: Three patients with chronic stroke underwent physical therapy examination and intervention sessions via telerehabilitation with varying contexts. Results: Various factors affected the results of the assessment including patient and caregiver’s (if present) ability to follow instructions, availability of material and spatial resources, and stability of internet connection. Strategies to improve reliability of assessment results can also be employed such as performing repeat trials, reviewing recordings for accuracy and confirmation, using highly visible markers, and confirming measurement accuracy on video. Discussion: Physical therapy outcome measures that can feasibly be administered remotely are the Timed Up and Go Test, the 10-Meter Walk Test, the 6-Minute Walk Test, the 5-Times Sit to Stand Test, and the Stroke Impact Scale. The Mini Balance Evaluation Systems Test could not be administered remotely as close to standard protocol as possible due to the difficulty of administering the reactive postural component with patient anxiety and safety considerations and materials required.

Different Uses of Conscious Sedation for Managing Dental Anxiety During Third-Molar Extraction: Clinical Evidence and State of the Art.

Dental anxiety, linked to avoiding dental treatment and heightened medical and surgical risks, prompted this systematic review. The objective is to synthesize existing evidence on conscious sedation techniques employed for managing dental anxiety in patients scheduled for third molar extraction surgery, aiming to identify optimal approaches and address knowledge gaps. This systematic review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" checklist and the population, investigation, comparation, outcome framework. The protocol still needs to be registered. A thorough search was conducted, incorporating MEDLINE/PubMed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews until February 2024. Only randomized controlled trials were considered, following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The risk of bias was evaluated following the Cochrane Handbook for Systematic Reviews of Interventions. Eighteen randomized controlled trials involving 2081 patients were included. Certain factors limited the feasibility of a meaningful meta-analysis, leading to a narrative synthesis. Conscious sedation with virtual reality showed an association with improved dental anxiety in 4 studies. One study reported reduced cortisol levels with midazolam compared with a placebo, whereas another noted significant variations in perioperative renin levels with remifentanil versus placebo. This review reveals inconclusive and conflicting findings regarding the role of conscious sedation in managing dental anxiety during third molar extraction surgery. Persistent uncertainties arise due to a need for consistent, standardized outcome measures. Addressing these limitations in study design is crucial for future research.

Impact of oncology pharmacy services on the management of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To evaluate the effect of oncology services rendered by clinical pharmacists on reducing chemotherapy-induced nausea and vomiting (CINV) and improving overall treatment experiences. A systematic review and meta-analysis were conducted using studies retrieved from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Information Sharing Service (RISS). The incidence and severity of CINV were evaluated as primary outcomes. Secondary outcomes were patient adherence, patient satisfaction, quality of life (QoL), emergency department (ED) visits, hospitalizations, and costs. A total of 12 studies were selected for systematic review, with 8 studies eligible for meta-analysis. We found that clinical pharmacy services contributed to preventing and alleviating CINV as well as improving patient's medication adherence, treatment satisfaction, and QoL, reducing hospital visits, and achieving cost savings. In the meta-analysis, pharmacists' interventions were notably effective in reducing the incidence of nausea (odds ratio [OR], 1.917; 95% CI, 1.243-2.955; P = 0.003) and vomiting (OR, 2.491; 95% CI, 1.199-5.177; P = 0.014) during overall treatments periods relative to results in control groups. In addition, the impact of clinical pharmacy services on CINV control was greater during the delayed phase compared to the acute phase. This study demonstrated the important role of clinical pharmacy services in controlling CINV and enhancing the overall treatment experience for patients with cancer. Further studies with standardized pharmacists' services and outcome measures are needed to validate our findings.

Cleft lip re-repair: How does it affect the nasolabial appearance?

Cleft lip re-repair is a procedure frequently endorsed to enhance a compromised nasolabial appearance. However, the actual effect of such revision surgery on the nasolabial appearance has scarcely been studied. Therefore, the aim of this study was to critically review surgical outcomes of patients that underwent surgical re-do of their cleft lip, using well-validated objective and subjective methods and standardised outcome measures.20 patients with at least 6 months follow-up after cleft lip re-repair were assessed. Standardised pre- and postoperative photographs were analysed. The objective assessment was carried out using the SymNose-software. Furthermore, a subjective evaluation of the nasolabial area was conducted by ten examiners who rated seven parameters using a Likert-scale ranging from 1to5. The objective evaluation showed substantial improvement regarding symmetry values. Significant postoperative decrease in labial asymmetry from 26.42% (±8.13) to 18.77% (±6.28) (p < 0.001) and upper lip asymmetry in relation to the facial midline (26.91% (±8.03) vs. 18.27% (±5.17) (p < 0.001)) was observed. Similar results were corroborated in the subjective analysis. Differences regarding the ratings were detected considering the examiners’ professional background and level of expertise. Cleft re-repair was found to significantly improve upper lip symmetry and lead to a more harmonious nasolabial appearance.

Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice.

Surgical care in the operating room (OR) contributes one-third of the greenhouse gas (GHG) emissions in healthcare. The European Association of Endoscopic Surgery (EAES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) initiated a joint Task Force to promote sustainability within minimally invasive gastrointestinal surgery. A scoping review was conducted by searching MEDLINE via Ovid, Embase via Elsevier, Cochrane Central Register of Controlled Trials, and Scopus on August 25th, 2023 to identify articles reporting on the impact of gastrointestinal surgical care on the environment. The objectives were to establish the terminology, outcome measures, and scope associated with sustainable surgical practice. Quantitative data were summarized using descriptive statistics. We screened 22,439 articles to identify 85 articles relevant to anesthesia, general surgical practice, and gastrointestinal surgery. There were 58/85 (68.2%) cohort studies and 12/85 (14.1%) Life Cycle Assessment (LCA) studies. The most commonly measured outcomes were kilograms of carbon dioxide equivalents (kg CO2eq), cost of resource consumption in US dollars or euros, surgical waste in kg, water consumption in liters, and energy consumption in kilowatt-hours. Surgical waste production and the use of anesthetic gases were among the largest contributors to the climate impact of surgical practice. Educational initiatives to educate surgical staff on the climate impact of surgery, recycling programs, and strategies to restrict the use of noxious anesthetic gases had the highest impact in reducing the carbon footprint of surgical care. Establishing green teams with multidisciplinary champions is an effective strategy to initiate a sustainability program in gastrointestinal surgery. This review establishes standard terminology and outcome measures used to define the environmental footprint of surgical practices. Impactful initiatives to achieve sustainability in surgical practice will require education and multidisciplinary collaborations among key stakeholders including surgeons, researchers, operating room staff, hospital managers, industry partners, and policymakers.

Emerging Indications for Hyperbaric Oxygen Treatment: Registry Cohort Study.

Hyperbaric oxygen (HBO2) treatment is used across a range of medical specialties for a variety of applications, particularly where hypoxia and inflammation are important contributors. Because of its hypoxia-relieving and anti-inflammatory effects HBO2 may be useful for new indications not currently approved by the Undersea and Hyperbaric Medical Society. Identifying these new applications for HBO2 is difficult because individual centers may only treat a few cases and not track the outcomes consistently. The web-based International Multicenter Registry for Hyperbaric Oxygen Therapy captures prospective outcome data for patients treated with HBO2 therapy. These data can then be used to identify new potential applications for HBO2, which has relevance for a range of medical specialties. Although hyperbaric medicine has established indications, new ones continue to emerge. One objective of this registry study was to identify cases where HBO2 has been used for conditions falling outside of current Undersea and Hyperbaric Medical Society-approved indications and present outcome data for them. This descriptive study used data from a web-based, multicenter, international registry of patients treated with HBO2. Participating centers agree to collect data on all patients treated using standard outcome measures, and individual centers send deidentified data to the central registry. HBO2 treatment programs in the United States, the United Kingdom, and Australia participate. Demographic, outcome, complication, and treatment data, including pre- and posttreatment quality of life questionnaires (EQ-5D-5L) were collected for individuals referred for HBO2 treatment. Out of 9726 patient entries, 378 (3.89%) individuals were treated for 45 emerging indications. Post-COVID-19 condition (PCC; also known as postacute sequelae of COVID-19; 149/378, 39.4%), ulcerative colitis (47/378, 12.4%), and Crohn disease (40/378, 10.6%) accounted for 62.4% (n=236) of the total cases. Calciphylaxis (20/378, 5.3%), frostbite (18/378, 4.8%), and peripheral vascular disease-related wounds (12/378, 3.2%) accounted for a further 13.2% (n=50). Patients with PCC reported significant improvement on the Neurobehavioral Symptom Inventory (NSI score: pretreatment=30.6; posttreatment=14.4; P<.001). Patients with Crohn disease reported significantly improved quality of life (EQ-5D score: pretreatment=53.8; posttreatment=68.8), and 5 (13%) reported closing a fistula. Patients with ulcerative colitis and complete pre- and post-HBO2 data reported improved quality of life and lower scores on a bowel questionnaire examining frequency, blood, pain, and urgency. A subset of patients with calciphylaxis and arterial ulcers also reported improvement. HBO2 is being used for a wide range of possible applications across various medical specialties for its hypoxia-relieving and anti-inflammatory effects. Results show statistically significant improvements in patient-reported outcomes for inflammatory bowel disease and PCC. HBO2 is also being used for frostbite, pyoderma gangrenosum, pterygium, hypospadias repair, and facial filler procedures. Other indications show evidence for improvement, and the case series for all indications is growing in the registry. RR2-10.2196/18857.

Racial and Ethnic Disparities in Primary Total Knee Arthroplasty Outcomes: A Systematic Review and Meta-Analysis of Two Decades of Research.

Racial disparities in outcomes following total knee arthroplasty (TKA) remain persistent. This systematic review and meta-analysis aims to comprehensively synthesize data between 2000-2020. An electronic search of studies was performed on PubMed, SCOPUS, and the Cochrane Library databases from January 1, 2000, and December 31, 2020. Random effects models were used to report unadjusted and adjusted estimates for a comprehensive list of care outcomes in TKA. 63 studies met PRISMA criteria. Black patients report greater odds of in-hospital mortality (odds ratio [OR]: 1.37, 95% CI: 1.00-1.59 (p = 0.049); adjusted OR [aOR]: 1.34, 95% CI: 1.09-1.64), in-hospital complications (OR: 1.31, 95% CI: 1.27-1.35), 30-day complications (aOR: 1.19, 95% CI: 1.07-1.33), infection (OR: 1.11, 95% CI: 1.07-1.16; aOR: 1.30, 95% CI: 1.16-1.46), bleeding (OR: 1.33, 95% CI: 1.03-1.71; aOR: 1.47, 95% CI: 1.23-1.75), peripheral vascular events (PVE) (aOR: 1.46, 95% CI: 1.11-1.92), length of stay (LOS) (OR: 1.20, 95% CI: 1.08-1.34), extended-LOS (aOR: 1.89, 95% CI: 1.53-2.33), discharge disposition (OR: 1.59, 95% CI: 1.29-1.96; aOR: 1.96, 95% CI: 1.70-2.25), 30-day (OR: 1.20, 95% CI: 1.13-1.27; aOR: 1.17 95% CI: 1.09-1.26) and 90-day (OR: 1.46, 95% CI: 1.17-1.82) readmission compared to White patients. Disparities in bleeding, extended-LOS, discharge disposition, PVE, and 30-day readmission were observed in Asian patients. Hispanic patients experienced disparities in extended LOS and discharge disposition, while Native-American patients had disparities in bleeding outcomes. Persistent racial disparities in TKA outcomes highlight a need for standardized outcome measures and comprehensive data collection across multiple racial groups to ensure greater healthy equity.

Using Diet to Treat Inflammatory Bowel Disease: A Systematic Review.

To review the efficacy of various dietary interventions for induction of clinical remission in inflammatory bowel disease (IBD) and provide healthcare providers with a practical reference for recommending suitable diets for managing patients with IBD. PubMed, Medline(R), and Cochrane were searched from inception up to February 17, 2023 to identify all studies reporting information on using diet to treat IBD. Studies investigating the role of dietary interventions on adult patients with a confirmed diagnosis of active IBD for improvement or remission of IBD symptoms were rigorously considered. Sample meal plans, with a list of included and excluded foods, were also generated in order to provide clinicians with practical tools for advising patients on dietary intake. Eleven included studies provided data on 10 distinct diets: autoimmune protocol diet, high fiber diet, 4-SURE diet, highly restricted diet, McMaster elimination diet for Crohn's disease, specific carbohydrate diet, Mediterranean diet, Crohn's disease exclusion diet, individualized elimination diet, and the food-specific IgG4-guided exclusion diet. A total of 9 studies provided data on clinical remission. Many of these diets share common elements, such as an initial elimination phase with subsequent reintroduction of dietary components, inclusion of whole foods, and exclusion of highly or ultra-processed foods. Currently, there is limited evidence to support the use of specific diets to treat adult patients with mildly to moderately active IBD. Larger, randomized studies with standardized methodologies and outcome measures, rigorous adherence assessment, and an emphasis on endoscopic assessment outcome measures are required to validate most diets that have been studied for IBD. The included sample diet plans and dietary recommendations may prove helpful in the interim as part of a holistic strategy to manage patients with IBD.