Screening instruments for cognitive impairment in older patients in the Emergency Department:A systematic review and meta-analysis

Background: Cognitive impairment is highly prevalent among older patients attending the Emergency Department (ED) and is associated with adverse outcomes. Methods: we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of cognitive screening instruments to rule out cognitive impairment in older patients in the ED. A comprehensive literature search was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. A risk of bias assessment using QUADAS-2 was performed. Results: 23 articles, examining 18 different index tests were included. Only seven index tests could be included in the meta-analysis. For ruling out cognitive impairment irrespective of aetiology, Ottawa 3 Day Year (O3DY) (pooled sensitivity 0.90; (95% CI) 0.71-0.97) had the highest sensitivity. Fourteen articles focused on screening for cognitive impairment specifically caused by delirium. For ruling out delirium, the 4 A's Test (4AT) showed highest sensitivity (pooled sensitivity 0.87, 95% confidence interval (95% CI) 0.74-0.94). Conclusions: High clinical and methodological heterogeneity was found between included studies. Therefore, it is a challenge to recommend one diagnostic test for use as a screening instrument for cognitive impairment in the ED. The 4AT and O3DY seem most promising for ruling out cognitive impairment in older patients attending the ED. The review protocol was registered in PROSPERO (CRD42018082509)

ASO Visual Abstract:Improved Postoperative Outcomes After Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

This study (https://doi.org/10.1245/s10434-022-12623-9) aimed to assess the effect of a multimodal prehabilitation program on perioperative outcomes in colorectal cancer patients using an emulated target trial design. The study identified potential benefits of prehabilitation in daily clinical practice

ASO Visual Abstract:Improved Postoperative Outcomes After Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

This study (https://doi.org/10.1245/s10434-022-12623-9) aimed to assess the effect of a multimodal prehabilitation program on perioperative outcomes in colorectal cancer patients using an emulated target trial design. The study identified potential benefits of prehabilitation in daily clinical practice

Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals

BACKGROUND: Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors. METHODS: Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians’ judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores. RESULTS: Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001). CONCLUSION: This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care

ASO Visual Abstract:Improved Postoperative Outcomes After Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

This study (https://doi.org/10.1245/s10434-022-12623-9) aimed to assess the effect of a multimodal prehabilitation program on perioperative outcomes in colorectal cancer patients using an emulated target trial design. The study identified potential benefits of prehabilitation in daily clinical practice

ASO Visual Abstract:Improved Postoperative Outcomes After Prehabilitation for Colorectal Cancer Surgery in Older Patients: An Emulated Target Trial

This study (https://doi.org/10.1245/s10434-022-12623-9) aimed to assess the effect of a multimodal prehabilitation program on perioperative outcomes in colorectal cancer patients using an emulated target trial design. The study identified potential benefits of prehabilitation in daily clinical practice