Study protocol for the Anesthesiology Control Tower—Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: A pilot randomized controlled trial in intraoperative telemedicine [version 1; referees: 2 approved]

Background: Each year, over 300 million people undergo surgical procedures worldwide. Despite efforts to improve outcomes, postoperative morbidity and mortality are common. Many patients experience complications as a result of either medical error or failure to adhere to established clinical practice guidelines. This protocol describes a clinical trial comparing a telemedicine-based decision support system, the Anesthesiology Control Tower (ACT), with enhanced standard intraoperative care. Methods: This study is a pragmatic, comparative effectiveness trial that will randomize approximately 12,000 adult surgical patients on an operating room (OR) level to a control or to an intervention group. All OR clinicians will have access to decision support software within the OR as a part of enhanced standard intraoperative care. The ACT will monitor patients in both groups and will provide additional support to the clinicians assigned to intervention ORs. Primary outcomes include blood glucose management and temperature management. Secondary outcomes will include surrogate, clinical, and economic outcomes, such as incidence of intraoperative hypotension, postoperative respiratory compromise, acute kidney injury, delirium, and volatile anesthetic utilization. Ethics and dissemination: The ACTFAST-3 study has been approved by the Human Resource Protection Office (HRPO) at Washington University in St. Louis and is registered at clinicaltrials.gov (NCT02830126). Recruitment for this protocol began in April 2017 and will end in December 2018. Dissemination of the findings of this study will occur via presentations at academic conferences, journal publications, and educational materials

ART EDUCATION IN MEDICAL EDUCATION: BENEFITS AND CHALLENGES

Humanity is synergistic with art and medicine. Likewise, art education can be impactful throughout medical education. Art as a tool to develop the next generation of healthcare differs from the clinical goals of creative art therapies. Over the prior decade, many medical schools now provide curricular offerings in the arts and humanities. Less is known about the application in postgraduate medical settings. The focus of this thesis is to review the pairing of artist-educators with postgraduate medical training programs. One such program is ArtsCAFE (Arts Connect Around Food and Enrichment), an intercollegiate project fusing experienced arts educators with medical educators to improve trainee experiences across disciplinary boundaries. The ArtsCAFE pilot study provided monthly visual art-making workshops to surgical residents and their guests at a single university-affiliated institution. Resident participants self-reported on their overall sense of support and communication effectiveness. Response to the pilot showed encouraging results—limitations, including the COVID-19 pandemic, paired with the pilot performance to stimulate further exploration. In review, art activities have the potential for replication in postgraduate medical training programs. This thesis provides a roadmap by which art educators and medical education programs may further develop enrichment efforts for trainees or faculty

Perspective: a conceptual framework for adaptive personalized nutrition advice systems (APNASs)

Nearly all approaches to personalized nutrition (PN) use information such as the gene variants of individuals to deliver advice that is more beneficial than a generic one-size-fits-all recommendation. Despite great enthusiasm and the increased availability of commercial services, thus far, scientific studies have only revealed small to negligible effects on the efficacy and effectiveness of personalized dietary recommendations, even when using genetic or other individual information. In addition, from a public health perspective, scholars are critical of PN because it primarily targets socially privileged groups rather than the general population, thereby potentially widening health inequality. Therefore, in this perspective, we propose to extend current PN approaches by creating adaptive personalized nutrition advice systems (APNASs) that are tailored to the type and timing of personalized advice for individual needs, capacities, and receptivity in real-life food environments. These systems encompass a broadening of current PN goals (i.e., what should be achieved) to incorporate individual goal preferences beyond currently advocated biomedical targets (e.g., making sustainable food choices). Moreover, they cover the personalization processes of behavior change by providing in situ, just-in-time information in real-life environments (how and when to change), which accounts for individual capacities and constraints (e.g., economic resources). Finally, they are concerned with a participatory dialogue between individuals and experts (e.g., actual or virtual dieticians, nutritionists, and advisors), when setting goals and deriving measures of adaption. Within this framework, emerging digital nutrition ecosystems enable continuous, real-time monitoring, advice, and support in food environments from exposure to consumption. We present this vision of a novel PN framework along with scenarios and arguments that describe its potential to efficiently address individual and population needs and target groups that would benefit most from its implementation

OECD reviews of higher education in regional and city development, State of Victoria, Australia

With more than 5.3 million inhabitants Victoria is the second most populous state in Australia. Once a manufacturing economy, Victoria is now transforming itself into a service and innovation-based economy. Currently, the largest sectors are education services and tourism. In terms of social structure, Victoria is characterised by a large migrant population, 24% of population were born overseas and 44% were either born overseas or have a parent who was born overseas. About 70% of the population resides in Melbourne. Victoria faces a number of challenges, ranging from an ageing population and skills shortages to drought and climate change and increased risk of natural disasters. Rapid population growth, 2% annually, has implications for service delivery and uneven development as well as regional disparities. There are barriers to connectivity in terms of transport and infrastructure, and a high degree of inter-institutional competition in tertiary education sector. The business structure in Victoria includes some highly innovative activities such as in biotechnology, but other sectors, especially those with high number of small and medium-sized enterprises, are lagging behind. Most of the larger manufacturing enterprises are externally controlled and there is uncertainty over the long term investments they will make in the state, as well as the place of Victoria in the global production networks

Timely and reliable evaluation of the effects of interventions: a framework for adaptive meta-analysis (FAME)

Most systematic reviews are retrospective and use aggregate data AD) from publications, meaning they can be unreliable, lag behind therapeutic developments and fail to influence ongoing or new trials. Commonly, the potential influence of unpublished or ongoing trials is overlooked when interpreting results, or determining the value of updating the meta-analysis or need to collect individual participant data (IPD). Therefore, we developed a Framework for Adaptive Metaanalysis (FAME) to determine prospectively the earliest opportunity for reliable AD meta-analysis. We illustrate FAME using two systematic reviews in men with metastatic (M1) and non-metastatic (M0)hormone-sensitive prostate cancer (HSPC)

Contemporary Topics in Graduate Medical Education

Graduate medical education (GME) is a continually evolving, highly dynamic area within the complex fabric of the modern health-care environment. Given the rapidly changing regulatory, financial, scientific and technical aspects of GME, many institutions and programs face daily challenges of "keeping up" with the most recent developments within this ever-more-sophisticated operational environment. Organizational excellence is a requirement for the seamless functioning of GME programs, especially when one consider the multiple disciplines and stakeholders involved. The goal of the current book cycle, titled Contemporary Topics in Graduate Medical Education, beginning with this inaugural tome, is to provide GME professionals with a practical and readily applicable set of reference materials. More than 20 distinguished authors from some of the top teaching institutions in the US, touch upon some of the most relevant, contemporary, and at times controversial topics, including provider burnout, gender equality issues, trainee wellness, scholarly activities and requirements, and many other theoretical and practical considerations. We hope that the reader will find this book to be a valuable and high quality resource of a broad range of GME-related topics. It is the Editors' goal to create a multi-tome platform that will become the definitive go-to reference for professionals navigating the complex landscape of modern graduate medical education