LEGĂTURA DINTRE ATROFIA CREIERULUI ȘI REZERVA NEUROCOGNITIVĂ - PRIMUL STUDIU CLINIC ROMÂNESC

BACKGROUND: The cognitive reserve hypothesis explains the ability to tolerate the age-related changes and the disease related pathology in the brain without developing clear clinical symptoms or signs. Persons with a low educational level present earlier clinical symptoms of neuropathology disorders. The brain reserve moderates the relationship between changes at brain level and neuropathology disorders. Cognitive reserve could compensate the deterioration of the brain. OBJECTIVE: This study investigates the relationship between cognitive impairment level, the severity of brain atrophy and the level of education on a sample of 235 individuals with cognitive complains, who required neurocognitive evaluation at Bucharest Memory Center between 2011 to 2016. METHODS: A retrospective study was conducted over six years based on the medical records of those who addressed the Center for Memory for neurocognitive assessment in order to establish the diagnosis. The socio-demographic parameters were recorded along with educational level, the brain atrophy presence, the psychiatric diagnosis and cognitive decline. RESULTS: The cognitive reserve hypothesis was verified, unless the MMSE score was very low (for severe neurocognitive disorder). Thus, the cognitive reserve theory is confirmed by the relationship between the educational level and the Mini Mental Score Evaluation (MMSE) score (the higher the educational level is, the higher the MMSE score is).   Keywords: Brain atrophy, cognitive reverve, educational level, neurocognitive disorderINTRODUCERE:  Ipoteza rezervei cognitive explică capacitatea de a tolera schimbările legate de vârstă și patologia asociată tulburărilor neurocognitive fără a dezvolta simptome sau semne clinice clare. Persoanele cu un nivel scăzut de educație prezintă simptome clinice ale tulburărilor neuropatologice din stadiile precoce. Rezerva cognitivă moderează relația dintre schimbările la nivelul creierului și tulburările neuropatologice și poate compensa deteriorarea la nivel cerebral. OBIECTIV: Acest studiu investighează relația dintre deteriorarea cognitivă, severitatea atrofiei cerebrale și nivelul de educație pe un eșantion de 235 de persoane cu acuze cognitive, care au solicitat o evaluare neurocognitivă la Centrul Memoriei București în perioada 2011-2016. METODA: A fost desfășurat un studiu retrospectiv pe parcursul a șase ani pe baza documentelor medicale ale persoanelor care s-au adresat Centrului Memoriei pentru evaluarea neurocognitivă în vederea stabilirii diagnosticului. Au fost înregistrați parametrii socio-demografici, precum și nivelul de educație, prezența atrofiei cerebrale, diagnosticul psihiatric și declinul cognitiv. REZULTATE: Ipoteza rezervei cognitive a fost verificată, cu excepția cazului în care scorul Mini Mental Score Examination (MMSE) a fost foarte scăzut (pentru tulburarea neurocognitivă severă). Astfel, teoria rezervei cognitive este confirmată de relația dintre nivelul educațional și scorul MMSE (cu cât nivelul de educație este mai înalt, cu atât scorul MMSE este mai mare).   Cuvinte cheie: atrofia creierului, rezerva cognitivă, nivelul educațional, tulburarea neurocognitiv

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)