Comprehensive geriatric assessment in perioperative care: a protocol for a systematic review and qualitative synthesis

INTRODUCTION: Comprehensive geriatric assessment (CGA) is an intervention that has been deployed in the perioperative setting with the aim to improve outcomes for older patients admitted to hospital. Older patients undergoing surgery are more likely to have postoperative complications, a longer hospital stay and be discharged to a care facility. Despite the increasing application of this intervention within surgical services, the evidence for CGA remains limited in this group. The aim of this systematic review is to describe CGA as in intervention applied to surgical populations in randomised controlled trials (RCTs) as well as the outcomes assessed. METHODS AND ANALYSIS: A systematic search of RCTs of CGA in surgery will be run in Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Cochrane library. Further articles will be identified from reference lists in relevant studies found in the search. A narrative synthesis will be undertaken outlining specialties included, detailed descriptions of the intervention and outcomes. ETHICS AND DISSEMINATION: No ethical approval is required. The results of this review will be published and used as the basis of work to optimise this intervention for future trials in surgical populations. PROSPERO REGISTRATION NUMBER: This review is registered with PROSPERO CRD42020221797

Stress, burnout, depression and work satisfaction among UK anaesthetic trainees:a qualitative analysis of in-depth participant interviews in the Satisfaction and Wellbeing in Anaesthetic Training study

Anaesthetists experience unique stressors. Recent evidence suggests a high prevalence of stress and burnout in trainee anaesthetists. There has been no in-depth qualitative analysis to explore this further. We conducted semi-structured interviews to explore contributory and potentially protective factors in the development of perceived stress, burnout, depression and low work-satisfaction. We sampled purposively among participants in the Satisfaction and Wellbeing in Anaesthetic Training study, reaching data saturation at 12 interviews. Thematic analysis identified three overarching themes: (1) factors enabling work-satisfaction; (2) stressors of being an anaesthetic trainee; (3) suggestions for improving working conditions. Factors enabling work-satisfaction were: patient contact; the privilege of enabling good patient outcomes; and strong support at home and work. Stressors were: demanding non-clinical workloads; exhaustion from multiple commitments; a ‘love/hate’ relationship as trainees value clinical work but find the training burden immense; feeling ‘on edge’, even unsafe at work; and the changing way society sees doctors. Suggested recommendations for improvement include: having contracted hours allowed for non-clinical work; individuals taking responsibility for self-care in and out of work; cultural acceptance that doctors can struggle; and embedding wellbeing support more deeply in organisations and the specialty. Nearly all trainees discussed feeling some levels of burnout, which were high and distressing for some, and high levels of perceived stress. Yet trainees also experienced distinct elements of work-satisfaction and support. Our study provides a foundation for further work to inform organisational and cultural changes to help translate anaesthetic trainees’ passion for their work, into a manageable and satisfactory career

Melatonin for the prevention of postoperative delirium in older adults:a protocol for a systematic review and meta-analysis

INTRODUCTION: Postoperative delirium (POD) is a major cause of morbidity, particularly in elderly patients. Melatonin has been suggested as a low-risk pharmacological intervention to help prevent POD. A previous systematic review found limited high-quality evidence to support the use of melatonin in the prevention of POD. Several further randomised studies have since been published. This systematic review aims to synthesise the evidence from randomised controlled trials (RCTs) examining the effect of melatonin on the prevention of POD in older adults. METHODS AND ANALYSIS: A systematic search of RCTs of melatonin (any dose and formulation) in POD will be run across Embase, Medline, CINAHL and PsychInfo. RCTs published from January 1990 until the end of February 2022 and reporting outcomes for melatonin use to prevent POD in patients will be included. Screening of search results and data extraction from included articles will be performed by two independent reviewers. The primary outcome will be incidence of POD in older adults undergoing surgery. Secondary outcomes are delirium duration and length of hospital stay. The review will also describe the dosage, timing and administration regimes of melatonin therapy and as well as the scales and definitions used to describe POD. A registry review of ongoing trials will be also be performed. For the meta-analysis, data will be pooled using a random effects model to generate a forest plot and obtain an odds ratio (OR) for the incidence of POD. Results will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. ETHICS AND DISSEMINATION: No ethical approval is required. This review will be disseminated via peer-reviewed manuscript and conferences. The results will be used as the basis of work to optimise this intervention for future trials in surgical populations. PROSPERO REGISTRATION NUMBER: This review is registered with PROSPERO (CRD42021285019)