Exercise Training for Heart Failure Patients with and without Systolic Dysfunction: An Evidence-Based Analysis of How Patients Benefit

Significant benefits can be derived by heart failure patients from exercise training. This paper provides an evidence-based assessment of expected clinical benefits of exercise training for heart failure patients. Meta-analyses and randomized, controlled trials of exercise training in heart failure patients were reviewed from a search of PubMed, Cochrane Controlled Trial Registry (CCTR), CINAHL, and EMBASE. Exercise training improves functional capacity, quality of life, hospitalization, and systolic and diastolic function in heart failure patients. Heart failure patients with preserved systolic function (HFnEF) participating in exercise training studies are more likely to be women and are 5–7 years older than their systolic heart failure (CHF) counterparts. All patients exhibit low functional capacities, although in HFnEF patients this may be age related, therefore subtle differences in exercise prescriptions are required. Published works report that exercise training is beneficial for heart failure patients with and without systolic dysfunction

Coronavirus pandemic and colorectal surgery: practical advice based on the Italian experience

Aim: The current COVID-19 pandemic is challenging healthcare systems at a global level. We provide a practical strategy to reorganize pathways of emergency and elective colorectal surgery during the COVID-19 pandemic. Method: The authors, all from areas affected by the COVID-19 emergency, brainstormed remotely to define the key-points to be discussed. Tasks were assigned, concerning specific aspects of colorectal surgery during the pandemic, including the administrative management of the crisis in Italy. The recommendations (based on experience and on the limited evidence available) were collated and summarized. Results: Little is known about the transmission of COVID-19, but it has shown a rapid spread. It is prudent to stop non-cancer procedures and prioritize urgent cancer treatment. Endoscopy and proctological procedures should be performed highly selectively. When dealing with colorectal emergencies, a conservative approach is advised. Specific procedures should be followed when operating on COVID-19-patients, using dedicated personal protective equipment and adhering to specific rules. Some policies are described, including minimally-invasive surgery. These policies outline the strict regulation of entry/ exit into theatres and operating building as well as advice on performing procedures safely to reduce risk of spreading the virus. It is likely that a reorganization of health system is required, both at central and local levels. A description of the strategy adopted in Italy is provided. Conclusion: Evidence on the management of patients needing surgery for colorectal conditions during the COVID-19 pandemic is currently lacking. Lessons learnt from healthcare professionals that have managed high volumes of surgical patients during the pandemic could be useful to mitigate some risks and reduce exposure to other patients, public and healthcare staff.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.published version, accepted version (12 month embargo), submitted versio

Perspectives on Surgery in the Time of COVID-19: Safety First

This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.published version, accepted version (12 month embargo), submitted versio

How to report educational videos in robotic surgery: an international multidisciplinary consensus statement

The swift endorsement of the robotic surgical platform indicates that it might prevail as the preferred technique for many complex abdominal and pelvic operations. Nonetheless, use of the surgical robotic system introduces further layers of complexity into the operating theatre necessitating new training models. Instructive videos with relevant exposition could be optimal for early training in robotic surgery and the aim of this study was to develop consensus guidelines on how to report a robotic surgery video for educational purposes to achieve high quality educational video outputs that could enhance surgical training. A steering group prepared a Delphi survey of 46 statements, which was distributed and voted on utilising an electronic survey tool. The selection of committee members was designed to include representative surgical trainers worldwide across different specialties, including lower and upper gastrointestinal surgery, general surgery, gynaecology and urology. 36 consensus statements were approved and classified in seven categories: author's information and video introduction, case presentation, demonstration of the surgical procedure, outcomes of the procedure, associated educational content, review of surgical videos quality and use of surgical videos in educational curricula. Consensus guidelines on how to report robotic surgery videos for educational purposes have been elaborated utilising Delphi methodology. We recommend that adherence to the guidelines presented could support advancing the educational quality of video outputs when designed for training.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.published version, accepted version (12 month embargo

Development and validation of a recommended checklist for assessment of surgical videos quality: the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool

Introduction: There has been a constant increase in the number of published surgical videos with preference for open-access sources, but the proportion of videos undergoing peer-review prior to publication has markedly decreased, raising questions over quality of the educational content presented. The aim of this study was the development and validation of a standard framework for the appraisal of surgical videos submitted for presentation and publication, the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool. Methods: An international committee identified items for inclusion in the LAP-VEGaS video assessment tool and finalised the marking score utilising Delphi methodology. The tool was finally validated by anonymous evaluation of selected videos by a group of validators not involved in the tool development. Results: 9 items were included in the LAP-VEGaS video assessment tool, with every item scoring from 0 (item not presented in the video) to 2 (item extensively presented in the video), with a total marking score ranging from 0 to 18. The LAP-VEGaS video assessment tool resulted highly accurate in identifying and selecting videos for acceptance for conference presentation and publication, with high level of internal consistency and generalisability. Conclusions: We propose that peer review in adherence to the LAP-VEGaS video assessment tool could enhance the overall quality of published video outputs.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.published version, accepted version (12 month embargo

How Should the Law Think About Robots?

The robots are coming. We don’t mean this in a scary, apocalyptic way, like in The Terminator or Battlestar Galactica, or in a tongue-in-cheek way, like in the Flight of the Conchords song “The Humans are Dead.” What we mean is this: Robots and robotic technologies are now mature enough to leave the research lab and come to the consumer market in large numbers. These early technologies are just the start, and we might soon be witnessing a personal robotics revolution. These systems have the potential to revolutionize our daily lives and to transform our world in ways even more profound than broad access to the Internet and mobile phones have done over the past two decades. We need to be ready for them and, in particular, we need to think about them in the right way so that the lawmakers can craft better rules for them, and engineers can design them in ways that protect the values our society holds dear. But how should we do this? This essay is an attempt to think through some of the conceptual issues surrounding law, robots and robotics, to sketch out some of their implications. It draws on our experience as a cyberlaw scholar and a roboticist to attempt an interdisciplinary first cut at some of the legal and technological issues we will face. In the essay, we advance four claims about the ways we, as scholars and as a society, should approach this problem. First, we offer a definition of robots as non-biological autonomous agents that we think captures the essence of the regulatory and technological challenges that robots present, and which could usefully be the basis of regulation. Second, we briefly explore the sometimes surprisingly advanced capabilities of robots today, and project what robots might be able to do over the next decade or so. Third, we argue that the nascent project of law and robotics should look to the experience of cyber-law, which has struggled instructively of the problems of new digital technologies for almost two decades. This experience has revealed one particularly important lesson: when thinking about new technologies in legal terms, the metaphors we use to understand them are crucially important. Lawyers are used to understanding legal subjects metaphorically, especially in developing areas of the law like new technologies. If we get the metaphors wrong for robots, the lessons of cyber-law reveal that it could have potentially disastrous consequences. Finally, we argue that one particularly seductive metaphor for robots should be rejected at all costs, the idea that robots are “just like people” and that there is a meaningful difference between humanoid and non-humanoid robots. We call this idea “the Android Fallacy.

Open versus Closed Kinetic Chain Exercises following an Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Background. There is no consensus on whether closed kinetic chain (CKC) or open kinetic chain (OKC) exercises should be the intervention of choice following an anterior cruciate ligament (ACL) injury or reconstruction. Methods. A systematic search identified randomized controlled trials of OKC versus CKC exercise training in people who had undergone ACL reconstructive surgery. All published studies in this systematic review were comparisons between OKC and CKC groups. Results. Seven studies were included. Lysholm knee scoring scale was not significantly different between OKC and CKC exercise patients: MD: −1.03%; CI: −13.02, 10.95; p value = 0.87 (Chi2  =  0.18, df = 1, and p value  =  0.67). Hughston clinic questionnaire scores were not significantly different between OKC and CKC exercise patients: MD: −1.29% (−12.02, 9.43); p value = 0.81 (Chi2  =  0.01, df = 1, and p value = 0.93). Conclusions. While OKC and CKC may be beneficial during ACL surgical rehabilitation, there is insufficient evidence to suggest that either one is superior to the other

Bioabsorbable mesh use in midline abdominal wall prophylaxis and repair achieving fascial closure: a cross-sectional review of stage of innovation

Background: Achieving stable closure of complex or contaminated abdominal wall incisions remains challenging. This study aimed to characterise the stage of innovation for bioabsorbable mesh devices used during both midline closure prophylaxis and complex abdominal wall reconstruction and to evaluate the quality of current evidence. Methods: A systematic review of published and ongoing studies was performed until 31st December 2019. Inclusion criteria were studies where bioabsorbable mesh was used to support fascial closure either prophylactically after midline laparotomy or for repair of incisional hernia with midline incision. Exclusion criteria were: (1) study design was a systematic review, meta-analysis, letter, review, comment, or conference abstract; (2) included less than p patients; (3) only evaluated biological, synthetic or composite meshes. The primary outcome measure was the IDEAL framework stage of innovation. The key secondary outcome measure was the risk of bias in non-randomised studies of interventions (ROBINS-I) criteria for study quality. Results: Twelve studies including 1287 patients were included. Three studies considered mesh prophylaxis and nine studies considered hernia repair. There were only two published studies of IDEAL 2B. The remainder was IDEAL 2A studies. The quality of the evidence was categorised as having a risk of bias of a moderate, serious or critical level in nine of the twelve included studies using the ROBINS-I tool. Conclusion: The evidence base for bioabsorbable mesh is limited. Better reporting and quality control of surgical techniques are needed. Although new trial results over the next decade will improve the evidence base, more trials in emergency and contaminated settings are required to establish the limits of indication.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.published version, accepted version (12 month embargo

Short- and Midterm Outcomes of Off- and On-Pump Coronary Artery Bypass in Patients with a Mean Age of 65 or More: Systematic Review and Meta-Analysis

Background. Advancing age is a nonmodifiable risk factor for the development of coronary artery disease. Furthermore, patients \u3e65 years old are considered at high risk for coronary artery bypass grafting (CABG). The aim of this study was to investigate whether there were any differences in clinical outcomes for patients with a mean age ≥65 undergoing CABG on or off pump. Methods. Systematic searches were conducted in EMBASE, PubMed, Web of Science, and Cochrane Central Registry of Controlled Trials (CENTRAL). The key search terms used were cardiopulmonary bypass OR On pump AND off pump OR beating heart AND coronary artery bypass grafting OR CABG AND age. This was followed by a meta-analysis assessing the primary outcomes mortality, myocardial infarction, renal failure, and stroke in the short - (30 days) and midterm (12-44 months) and repeat revascularisation at midterm follow up. Secondary outcomes investigated included postoperative atrial fibrillation, number of units of blood transfused, ventilation time, length of intensive care unit stay, and length of hospital stay. Results. 14 studies involving 10,260 participants, 5,141 of whom had on-pump CABG and 5,119 of whom had off-pump CABG were identified. There was a significantly greater need for repeat revascularisation in the off-pump group (risk ratio 1.47, 95% confidence interval 1.07 to 2.01, I2 = 0%, p=0.02) at midterm follow up. The off-pump group also had a shorter hospital stay. All other comparisons were insignificant. Conclusion. A number of different factors contribute to whether the increased need for repeat revascularisation for off-pump patients is truly clinically significant. This requires further investigation in meta-analysis based on longer-term trials in patients with a mean age ≥65. Otherwise, the similarity in clinical outcomes for patients in this age group suggests the choice to carry out CABG on or off pump should continue to be at the surgeon\u27s discretion