A systematic review and meta-analysis of high-quality randomized controlled trials on the role of prehabilitation programs in colorectal surgery.

BACKGROUND Prehabilitation is gaining popularity in colorectal surgery but lacks high-quality postoperative outcomes data. This meta-analysis explored whether prehabilitation impacts postoperative outcomes. METHODS In this meta-analysis, compliant with Preferred Reporting Items for Systematic reviews and Meta-Analyses, we searched PubMed and Scopus through November 2022. High-quality randomized control trials involving adults who underwent colorectal surgery with/without exercise-based prehabilitation were included. The main outcomes were short-term postoperative morbidity, readmissions, and length of stay. Random-effect meta-analyses were performed, and statistical heterogeneity was assessed using the I2 statistic. RESULTS Seven high-quality randomized control trials comprising 1,225 patients were included. The median prehabilitation duration was 4 (2-4) weeks. Four studies compared prehabilitation and standard of care, and 3 compared prehabilitation and rehabilitation. Exercise-based prehabilitation did not reduce the odds of short-term complications (odds ratio 0.62, 95% confidence interval 0.27-1.40, P = .25, I2 = 68%) or readmission (odds ratio 1, 95% confidence interval 0.73-1.46, P = .85, I2 = 0%). The prehabilitation group had shorter length of hospital stay (weighted mean difference -0.2, 95% confidence interval -0.25 to -0.14, P < .0001, I2 = 43.3%). Prehabilitation and rehabilitation had similar odds of short-term complications (odds ratio 1.03, 95% confidence interval 0.56-1.89, P = .91, I2 = 33%), length of stay (weighted mean difference -0.16, 95% confidence interval -0.47 to 0.16, P = .33, I2 = 59%), and readmission (odds ratio 1.25, 95% confidence interval 0.28-5.56, P = .77, I2 = 52%). The only benefit of prehabilitation over rehabilitation was better 6-minute walking distance test results at time of surgery (weighted mean difference: -9.4 m; 95% confidence interval -18.04 to 0.79, P = .03, I2 = 42%). CONCLUSION Prehabilitation provided decreased postoperative length of hospital stay and improved preoperative functional outcomes, but not reduced odds of complications and/or readmissions. Prehabilitation and rehabilitation had similar clinical outcomes

Trans‑anal minimally invasive surgery (TAMIS) versus rigid platforms for local excision of early rectal cancer: a systematic review and meta-analysis of the literature.

BACKGROUND Available platforms for local excision (LE) of early rectal cancer are rigid or flexible [trans‑anal minimally invasive surgery (TAMIS)]. We systematically searched the literature to compare outcomes between platforms. METHODS PRISMA-compliant search of PubMed and Scopus databases until September 2022 was undertaken in this random-effect meta-analysis. Statistical heterogeneity was assessed using I2 statistic. Studies comparing TAMIS versus rigid platforms for LE for early rectal cancer were included. Main outcome measures were intraoperative and short-term postoperative outcomes and specimen quality. RESULTS 7 studies were published between 2015 and 2022, including 931 patients (423 females); 402 underwent TAMIS and 529 underwent LE with rigid platforms. Techniques were similar for operative time (WMD 11.1, 95%CI - 2.6 to 25, p = 0.11), percentage of defect closure (OR 0.7, 95%CI 0.06-8.22, p = 0.78), and peritoneal violation (OR 0.41, 95%CI 0.12-1.43, p = 0.16). Rigid platforms had higher rates of short-term complications (19.1% vs 14.2, OR 1.6, 95%CI 1.07-2.4, p = 0.02), although no significant differences were seen for major complications (OR 1.41, 95%CI 0.61-3.23, p = 0.41). Patients in the rigid platforms group were 3-times more likely to be re-admitted within 30 days compared to the TAMIS group (OR 3.1, 95%CI 1.07-9.4, p = 0.03). Rates of positive resection margins (rigid platforms: 7.6% vs TAMIS: 9.34%, OR 0.81, 95%CI 0.42-1.55, p = 0.53) and specimen fragmentation (rigid platforms: 3.3% vs TAMIS: 4.4%, OR 0.74, 95%CI 0.33-1.64, p = 0.46) were similar between the groups. Salvage surgery was required in 5.5% of rigid platform patients and 6.2% of TAMIS patients (OR 0.8, 95%CI 0.4-1.8, p = 0.7). CONCLUSION TAMIS or rigid platforms for LE seem to have similar operative outcomes and specimen quality. The TAMIS group demonstrated lower readmission and overall complication rates but did not significantly differ for major complications. The choice of platform should be based on availability, cost, and surgeon's preference

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Hybrid approaches to allied health services for children and young people: a scoping review

Abstract Background Hybrid models that integrate both in-person and remote health services are increasingly recognized as a promising approach. Nevertheless, research that defines and characterizes these models in children and young people is scarce and essential for establishing guidelines for implementation of hybrid allied health services. This scoping review evaluates four key aspects of hybrid allied health services in children and young people: 1. definitions, 2. service characteristics, 3. outcome measures, and 4. results of hybrid allied health services. Methods Six databases were searched: Medline (Ovid), Embase, CINHAL, Psycinfo, Cochrane CENTRAL, and Web of Science. Of the 9,868 studies potentially meeting the inclusion criteria, 49 studies focused on children and young people. Following full-text review, n = 21 studies were included. Results Terminology used for hybrid allied health services varied across studies which targeted diverse clinical populations and varied in study design, type and frequency of remote and in-person treatments. Over 75% of cases used custom-written software, limiting scalability. All interventions started in-person, possibly to establish a therapeutic alliance and solve technological issues. Most hybrid allied health services (67%) were in mental health, while only a minority involved physical, occupational or speech therapy. The most common outcomes were feasibility and satisfaction, but tools used to measure them were inconsistent. Although 57% of studies demonstrated effectiveness of hybrid allied health services, none measured cost-effectiveness. Discussion Despite the potential of hybrid allied health services for children and young people, the literature remains at a preliminary stage. Standardization of definitions and outcome measures, and clearer reporting of service characteristics and results would likely promote consolidation of hybrid allied health services in children and young people into clinical practice

Hybrid Tele-Health Approaches to Allied Health Services: A Scoping Review

Background and aim: During the past 2 years (during COVID-19), tele-health services by allied health professions (health professions other than doctors and nurses) have become widespread; uptake was almost immediate due to restrictions of social distancing and limitations on in-person services. In the aftermath of the pandemic, as limitations were receded, tele-health services substantially subsided, despite their many advantages. Hybrid tele-health is a service modality that combines in-person and remote services, thus reaping the demonstrated benefits of both. Still, research that defines the terminology of the service, existing models, outcomes, “best practices” and evaluation of service effectiveness is sparse. The aim of this review is to formulate a multidimensional, conceptual framework of hybrid tele-health services for adults and children requiring allied health interventions. The guiding research question is: What are the existing definitions, models, and outcome measures of hybrid allied health interventions for people across the lifespan? Methods: A scoping review will systematically map evidence and identify existing models for hybrid administration of allied health services. According to the framework of Arksey and O’Malley (2005), two independent researchers will systematically and iteratively search databases (PubMed, Cochrane Library, Embase, CINAHL, ERIC, Scopus, PsycInfo, Science Direct, Web of Science, Google Scholar) for peer-reviewed manuscripts and conference proceedings that examined or described hybrid interventions. Based on the results, we will develop a multidimensional conceptual framework of hybrid tele-health services for adults and children requiring allied health interventions Expected results: This scoping review will provide a comprehensive synthesis of existing models, uses, definitions, and outcomes for hybrid telehealth services. The resulting framework will recommend uniform terminology and assist in identifying gaps in the literature regarding potential uses of and need for research of hybrid models. Importance to Medicine: Understanding hybrid telehealth services is expected to guide the development of future services in Israel and beyond, capitalizing on knowledge established during COVID-19, and will inform ongoing research and policies, thus improving accessibility to professional allied health care

Xenopus Meis3 protein lies at a nexus downstream to Zic1 and Pax3 proteins, regulating multiple cell-fates during early nervous system development

In Xenopus embryos, XMeis3 protein activity is required for normal hindbrain formation. Our results show that XMeis3 protein knock down also causes a loss of primary neuron and neural crest cell lineages, without altering expression of Zic, Sox or Pax3 genes. Knock down or inhibition of the Pax3, Zic1 or Zic5 protein activities extinguishes embryonic expression of the XMeis3 gene, as well as triggering the loss of hindbrain, neural crest and primary neuron cell fates. Ectopic XMeis3 expression can rescue the Zic knock down phenotype. HoxD1 is an XMeis3 direct-target gene, and ectopic HoxD1 expression rescues cell fate losses in either XMeis3 or Zic protein knock down embryos. FGF3 and FGF8 are direct target genes of XMeis3 protein and their expression is lost in XMeis3 morphant embryos. In the genetic cascade controlling embryonic neural cell specification, XMeis3 lies below general-neuralizing, but upstream of FGF and regional-specific genes. Thus, XMeis3 protein is positioned at a key regulatory point, simultaneously regulating multiple neural cell fates during early vertebrate nervous system development

Phenotypically concordant distribution of pick bodies in aphasic versus behavioral dementias

Abstract Pick’s disease (PiD) is a subtype of the tauopathy form of frontotemporal lobar degeneration (FTLD-tau) characterized by intraneuronal 3R-tau inclusions. PiD can underly various dementia syndromes, including primary progressive aphasia (PPA), characterized by an isolated and progressive impairment of language and left-predominant atrophy, and behavioral variant frontotemporal dementia (bvFTD), characterized by progressive dysfunction in personality and bilateral frontotemporal atrophy. In this study, we investigated the neocortical and hippocampal distributions of Pick bodies in bvFTD and PPA to establish clinicopathologic concordance between PiD and the salience of the aphasic versus behavioral phenotype. Eighteen right-handed cases with PiD as the primary pathologic diagnosis were identified from the Northwestern University Alzheimer’s Disease Research Center brain bank (bvFTD, N = 9; PPA, N = 9). Paraffin-embedded sections were stained immunohistochemically with AT8 to visualize Pick bodies, and unbiased stereological analysis was performed in up to six regions bilaterally [middle frontal gyrus (MFG), superior temporal gyrus (STG), inferior parietal lobule (IPL), anterior temporal lobe (ATL), dentate gyrus (DG) and CA1 of the hippocampus], and unilateral occipital cortex (OCC). In bvFTD, peak neocortical densities of Pick bodies were in the MFG, while the ATL was the most affected in PPA. Both the IPL and STG had greater leftward pathology in PPA, with the latter reaching significance (p < 0.01). In bvFTD, Pick body densities were significantly right-asymmetric in the STG (p < 0.05). Hippocampal burden was not clinicopathologically concordant, as both bvFTD and PPA cases demonstrated significant hippocampal pathology compared to neocortical densities (p < 0.0001). Inclusion-to-neuron analyses in a subset of PPA cases confirmed that neurons in the DG are disproportionately burdened with inclusions compared to neocortical areas. Overall, stereological quantitation suggests that the distribution of neocortical Pick body pathology is concordant with salient clinical features unique to PPA vs. bvFTD while raising intriguing questions about the selective vulnerability of the hippocampus to 3R-tauopathies