Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Considerations in implementation of social risk factor screening and referral in maternal and infant care in Washington, DC: A qualitative study

Background The District of Columbia (DC) has striking disparities in maternal and infant outcomes comparing Black to White women and babies. Social determinants of health (SDoH) are widely recognized as a significant contributor to these disparities in health outcomes. Screening for social risk factors and referral for appropriate services is a critical step in addressing social needs and reducing outcome disparities. Methods We conducted interviews among employees (n = 18) and patients (n = 9) across three diverse, urban clinics within a healthcare system and one community-based organization involved in a five-year initiative to reduce maternal and infant disparities in DC. Interviews were guided by the Consolidated Framework for Implementation Research to understand current processes and organizational factors that contributed to or impeded delivery of social risk factor screening and referral for indicated needs. Results We found that current processes for social risk factor screening and referral differed between and within clinics depending on the patient population. Key facilitators of successful screening included a supportive organizational culture and adaptability of more patient-centered screening processes. Key barriers to delivery included high patient volume and limited electronic health record capabilities to record results and track the status of internal and community referrals. Areas identified for improvement included additional social risk factor assessment training for new providers, patient-centered approaches to screening, improved tracking processes, and facilitation of connections to social services within clinical settings. Conclusion Despite proliferation of social risk factor screeners and recognition of their importance within health care settings, few studies detail implementation processes for social risk factor screening and referrals. Future studies should test implementation strategies for screening and referral services to address identified barriers to implementation

The cross-sectional Relationship between specific and general Impact Factors in psychodynamic and behavioral Psychotherapy Sessions

Biel H, Algner-Herzmann D, Hennig T, Krott NR, Loewe B, Reininger KM. The cross-sectional Relationship between specific and general Impact Factors in psychodynamic and behavioral Psychotherapy Sessions. In: Deutscher Kongress für Psychosomatische Medizin und Psychotherapie vom 16. bis 18. Juni 2021. Zeitschrift für Psychosomatische Medizin und Psychotherapie . Vol 67. Göttingen: Vandenhoeck & Ruprecht; 2021: 158

Affective mentalization as beliefs about the controllability and usefulness of emotions. Validation of a German language version of the Emotion Beliefs Questionnaire

Biel HM, Loewe B, Briken P, et al. Affektive Mentalisierung als wahrgenommene Kontrollierbarkeit und Nützlichkeit von Emotionen. Validierung einer deutschsprachigen Version des Emotion Beliefs Questionnaire. Psychotherapie. 2022.Background: Instruments for the investigation of mentalization should consider and specify the multidimensionality of this construct. Indicative for the pole of affective mentalization is, on the one hand, a perceived controllability of emotions due to the understanding of one's own and others' emotions and on the other hand, a perceived usefulness of emotions due to the attributed meaningfulness of one's own and others' emotions. Perceived controllability and usefulness of positive and negative emotions are assessed with the 16 items of the English language Emotion Beliefs Questionnaire (EBQ; Becerra et al. 2020) in a self-report.Objective: The aim of the present study was to develop a German language version of the EBQ as a survey instrument for affective mentalization ability and to determine its reliability and validity.Material and methods: A total of 104 psychotherapists in training and further education as well as students answered the German language EBQ, which we translated according to the translation guidelines of the European Social Survey, as part of an anonymous online survey. We conducted an exploratory factor analysis and determined internal consistencies and concurrent validities with respect to related constructs.Results: As in the original validation study, the EBQ shows a three-factorial structure and good internal consistency of alpha = 0,87 in the overall scale. Furthermore, associations between the perception of positive and negative emotions as uncontrollable and useless (high EBQ scores) and lower emotion regulation and higher psychopathological symptoms (concurrent validity) are evident.Conclusion: The findings are consistent with the results of the original validation study and suggest that the EBQ is also recommended in the German version. Theoretically justified and empirically tested (see online supplementary), the EBQ appears to be a suitable method for assessing affective mentalization.Hintergrund Instrumente zur Untersuchung von Mentalisierung sollten die Multidimensionalität dieses Konstrukts berücksichtigen und spezifizieren. Indikativ für den Pol der affektiven Mentalisierung sind einerseits aufgrund des Verständnisses für eigene und fremde Emotionen eine wahrgenommene Kontrollierbarkeit von Emotionen, andererseits aufgrund der attribuierten Bedeutsamkeit eigener und fremder Emotionen eine wahrgenommene Nützlichkeit von Emotionen. Die wahrgenommene Kontrollierbarkeit und Nützlichkeit positiver und negativer Emotionen wird mit den 16 Items des englischsprachigen Emotion Beliefs Questionnaire (EBQ; Becerra et al. 2020) im Selbstbericht erfasst. Ziel der Studie Ziele der vorliegenden Studie waren es, eine deutschsprachige Version des EBQ als Erhebungsinstrument für affektive Mentalisierungsfähigkeit zu entwickeln sowie deren Reliabilität und Validität zu ermitteln. Material und Methoden Psychotherapeut:innen in Aus- und Weiterbildung sowie Studierende (n = 104) beantworteten den von uns in Anlehnung an die Translation Guidelines des European Social Survey übersetzten deutschsprachigen EBQ als Teil einer anonymen Online-Befragung. Wir führten eine explorative Faktorenanalyse durch und bestimmten interne Konsistenzen sowie konkurrente Validitäten in Bezug auf verwandte Konstrukte. Ergebnisse Wie in der Originalvalidierungsstudie zeigen sich eine dreifaktorielle Struktur des EBQ sowie eine gute interne Konsistenz von α = 0,87 in der Gesamtskala. Weiterhin zeigen sich Zusammenhänge zwischen der Wahrnehmung von positiven und negativen Emotionen als unkontrollierbar und nutzlos (hohe EBQ-Werte) und einer geringeren Emotionsregulation sowie höheren psychopathologischen Symptomen (konkurrente Validität). Schlussfolgerung Die Befunde decken sich mit den Ergebnissen der originalen Validierungsstudie und legen nahe, dass der EBQ auch in der deutschen Version zu empfehlen ist. Theoretisch begründet und empirisch überprüft (siehe Online-Appendix) erscheint der EBQ als ein geeignetes Verfahren zur Erhebung affektiver Mentalisierung

Comparison of screening and referral across included sites.

Comparison of screening and referral across included sites.</p

Consolidated framework for implementation research constructs used in employee interviews [35].

Consolidated framework for implementation research constructs used in employee interviews [35].</p

Interview participants by department and role.

BackgroundThe District of Columbia (DC) has striking disparities in maternal and infant outcomes comparing Black to White women and babies. Social determinants of health (SDoH) are widely recognized as a significant contributor to these disparities in health outcomes. Screening for social risk factors and referral for appropriate services is a critical step in addressing social needs and reducing outcome disparities.MethodsWe conducted interviews among employees (n = 18) and patients (n = 9) across three diverse, urban clinics within a healthcare system and one community-based organization involved in a five-year initiative to reduce maternal and infant disparities in DC. Interviews were guided by the Consolidated Framework for Implementation Research to understand current processes and organizational factors that contributed to or impeded delivery of social risk factor screening and referral for indicated needs.ResultsWe found that current processes for social risk factor screening and referral differed between and within clinics depending on the patient population. Key facilitators of successful screening included a supportive organizational culture and adaptability of more patient-centered screening processes. Key barriers to delivery included high patient volume and limited electronic health record capabilities to record results and track the status of internal and community referrals. Areas identified for improvement included additional social risk factor assessment training for new providers, patient-centered approaches to screening, improved tracking processes, and facilitation of connections to social services within clinical settings.ConclusionDespite proliferation of social risk factor screeners and recognition of their importance within health care settings, few studies detail implementation processes for social risk factor screening and referrals. Future studies should test implementation strategies for screening and referral services to address identified barriers to implementation.</div