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

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

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

Parent involvement in literacy instruction: Perceptions and practices of Hispanic parents of children with learning disabilities

The purpose of this investigation was to interview Hispanic parents to determine their perceptions and practices with respect to home reading and writing activities. Of particular interest was how parents of children with learning disabilities (LD) and of average/high achieving children (AHA) would respond to interview items. Participants included 80 Hispanic parents (40 parents of children with LD and 40 parents of AHA children) who had children in grades 3 through 5. Interview questions addressed four issues: types of activities children do at home; types of activities parents perceive as desirable and feasible to do; facilitators and barriers parents face when implementing activities; and satisfaction of their children\u27s reading and writing programs. All participants were telephone interviewed in Spanish. Nonparametric statistical procedures were used to analyze responses related to Likert-type scale items. The constant comparative method (Glaser & Strauss, 1967) was used to summarize data from open-ended questions.Results after using the Mann-Whitney-Wilcoxon statistic indicated there were no statistically significant differences between parent groups in ratings of frequency and desirability of activities, and only one item in ratings of feasibility and statistically significant difference. Results of the Wilcoxon Signed Rank Test statistic indicated that there were statistically significant differences between desirability and feasibility ratings for 3 activities for the parents of AHA children and for 13 activities for the parents of children with LD. Analyses of the open-ended questions revealed that Hispanic parents of children with LD reported using a wide variety of reading and writing activities on a regular basis, but experience frustration in helping their children at home. Although parents of both groups were satisfied with their children\u27s reading and writing programs at schools, parents wanted professionals to provide more communication and specific suggestions for them to help their children at home. The discussion focuses on implications of findings for development of parent workshops and for future research

Libros en Mano: Phonological Awareness Intervention in Children’s Native Languages

The growing diversity in schools in the United States resulting from the rising number of English learners (ELs) has put more pressure on both children and teachers. Teachers are faced with the challenge of meeting the educational needs of culturally and linguistically diverse (CLD) learners, including the unique needs of CLD children with academic delays or disabilities. As early as preschool, many ELs are performing academically lower than their monolingual peers in literacy, and the gap can be even greater for ELs identified as having a delay or disability. However, providing explicit phonological awareness interventions in the child’s native language may help improve English reading outcomes and mediate the negative effects on reading achievement attributed to limited English proficiency. This intervention study looked at how a phonologically based emergent literacy intervention provided in Spanish to four EL preschoolers affected their emergent literacy and phonological awareness outcomes in English and Spanish. All of the children increased their overall emergent literacy and phonological awareness skills in both English and Spanish. The findings indicated that all four children showed some increase in English phonological awareness skills in both syllable segmentation and letter sound knowledge, while sound isolation and sound segmentation demonstrated mixed results across participants

Leveraging a Spanish Literacy Intervention to Support Outcomes of English Learners

Over 11 million students enter school speaking a language other than English. Due to their emerging English proficiency, many English Learners (ELs) struggle with English literacy, which impacts their overall achievement in school. However, there is evidence that ELs who have solid skills in their native language are able to apply their understanding to their learning in English. Thus, it is critical to understand how Spanish literacy interventions used in schools affect the English literacy outcomes of struggling ELs. The purpose of this study was to determine how a Spanish phonics-based literacy intervention, used during Tier 2 of a multi-tiered system of supports (MTSS), affects ELs’ literacy skills in Spanish and English. Overall, a positive growth trend was noted on all literacy measures in both languages, while statistically significant results were obtained for Spanish and English phonics. Given the positive impact on students’ Spanish and English literacy development, native language instruction and interventions should be provided to struggling ELs. Other implications include the need for teacher preparation in the area of bilingual education as well as the implementation of culturally responsive reading interventions in the students’ native language to assist them in bridging the literacy achievement gap

Reading Comprehension Instruction for Adolescents with Learning Disabilities: A Reality Check

Reading comprehension is a significant concern for adolescents with learning disabilities (LD), particularly in secondary schools in the United States (US) where content is taught primarily through textbooks. Surprisingly little is known about the actual reading instruction for students with LD in secondary classrooms. Thus, the purpose of this study was to examine the reading comprehension instruction in US secondary special education classrooms. Eight special education teachers in urban high schools were observed and interviewed. Findings showed that teachers implemented a number of reading comprehension practices, not all were considered “best practice”. The most frequently observed practices included reading aloud, questioning, seatwork, activating prior knowledge, and using graphic organizers. Explicit instruction in how and when to use reading comprehension strategies, however, was not observed. This study reveals the extent to which evidence-based reading comprehension practices are not making their way into secondary reading classrooms and offers insight into factors that teachers state as influencing their instruction for students with LD

The interpretive strategies utilized by elementary students with and without learning disabilities in comprehending poemsGeorgette G. Lee

Poetry is a genre that supports all aspects of literacy, and it is the first to which most children are exposed through motherly lullabies. Yet, while many studies have been conducted on prose comprehension, there is little empirical research on poetry comprehension, and none published on the specific strategies elementary students with learning disabilities (LD) utilize in understanding poems. The purpose of this study is to examine the interpretive strategies used by students in comprehending poetry. Participants were 16 fifth and sixth grade students with LD and 16 of their typical peers, who individually listened to poems and answered questions about them. Students with LD effectively used as many interpretive operations as their peers, adopted an aesthetic stance to reading, and performed more like experts than novices. Furthermore, the difficulty of the poems did not appear to have affected the students’ enjoyment of them