Pediatric perioperative outcomes: protocol for a systematic literature review and identification of a core outcome set for infants, children, and young people requiring anesthesia and surgery

Clinical outcomes are measurable changes in health, function, or quality of life that are important for evaluating the quality of care and comparing the efficacy of interventions. However, clinical outcomes and related measurement tools need to be well‐defined, relevant and valid. In adults, Core Outcome Measures in Effectiveness Trials (COMET) methodology has been used to develop core outcome sets for perioperative care. Systematic literature reviews identified Standardized Endpoints (StEP) and valid measurement tools, and consensus across a broader range of relevant stakeholders was achieved via a Delphi process to establish Core Outcome Measures in Perioperative and Anaesthetic Care (COMPAC). Core outcome sets for pediatric perioperative care cannot be directly extrapolated from adult data. The type and weighting of endpoints within particular domains can be influenced by age‐dependent differences in the indications for and/or nature of surgery and medical co‐morbidities, and the validity and utility of many measurement tools vary significantly with developmental stage and age. Involvement of parents/carers is essential as they frequently act as surrogate responders for preverbal and developmentally delayed children, parental response may influence child outcome, and parental and/or child ranking of outcomes may differ from those of health professionals. Here we describe formation of the international Pediatric Perioperative Outcomes Group, which aims to identify and create validated, broadly applicable, patient‐centered outcome measures for infants, children and young people. Methodologies parallel that of the StEP and COMPAC projects, and systematic literature searches have been performed within agreed age‐dependent subpopulations to identify reported outcomes and measurement tools. This represents the first steps for developing core outcome sets for pediatric perioperative care

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

<b>Background</b><p></p> Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.<p></p> <b>Methods</b><p></p> We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.<p></p> <b>Results</b><p></p> The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.<p></p> <b>Conclusions</b><p></p> Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge

Estimating the furrow infiltration characteristic from a single advance point

Management and control of surface irrigation, in particular furrow irrigation, is limited by spatio-temporal soil infiltration variability as well as the high cost and time associated with collecting intensive field data for estimation of the infiltration characteristics. Recent work has proposed scaling the commonly used infiltration function by using a model infiltration curve and a single advance point for every other furrow in an irrigation event. Scaling factors were calculated for a series of furrows at two sites and at four points down the length of the field (0.25 L, 0.5 L, 0.75 L and L). Differences in the value of the scaling factor with distance were found to be a function of the shape of the advance curves. It is concluded that use of points early in the advance results in a substantial loss of accuracy and should be avoided. The scaling factor was also strongly correlated with the furrow-wetted perimeter suggesting that the scaling is an appropriate way of both predicting and accommodating the effect of the hydraulic variability

Mechanisms of Optical Regression Following Corneal Laser Refractive Surgery: Epithelial and Stromal Responses

Laser vision correction is a safe and effective method of reducing spectacle dependence. Photorefractive Keratectomy (PRK), Laser In Situ Keratomileusis (LASIK), and Small-Incision Lenticule Extraction (SMILE) can accurately correct myopia, hyperopia, and astigmatism. Although these procedures are nearing optimization in terms of their ability to produce a desired refractive target, the long term cellular responses of the cornea to these procedures can cause patients to regress from the their ideal postoperative refraction. In many cases, refractive regression requires follow up enhancement surgeries, presenting additional risks to patients. Although some risk factors underlying refractive regression have been identified, the exact mechanisms have not been elucidated. It is clear that cellular proliferation events are important mediators of optical regression.  This review focused specifically on cellular changes to the corneal epithelium and stroma, which may influence postoperative visual regression following LASIK, PRK, and SMILE procedures