CRP is a useful negative predictive test for the development of anastomotic leakage following colorectal surgery.
Background: Optimized perioperative care within an enhanced recovery after surgery (ERAS) protocol is designed to reduce morbidity after surgery, resulting in a shorter hospital stay. The present study evaluated this approach in the context of sleeve gastrectomy for patients with morbid obesity.Methods: Patients were allocated to perioperative care according to a bariatric ERAS protocol or a control group that received standard care. These groups were also compared with a historical group of patients who underwent laparoscopic sleeve gastrectomy at the same institution between 2006 and 2010, selected using matched propensity scores. The primary outcome was median length of hospital stay. Secondary outcomes included readmission rates, postoperative morbidity, postoperative fatigue and mean cost per patient.Results: Of 116 patients included in the analysis, 78 were allocated to the ERAS (40) or control (38) group and there were 38 in the historical group. There were no differences in baseline characteristics between groups. Median hospital stay was significantly shorter in the ERAS group (1 day) than in the control (2 days; P < 0·001) and historical (3 days; P < 0·001) groups. It was also shorter in the control group than in the historical group (P = 0·010). There was no difference in readmission rates, postoperative complications or postoperative fatigue. The mean cost per patient was significantly higher in the historical group than in the ERAS (P = 0·010) and control (P = 0·018) groups. Conclusion:The ERAS protocol in the setting of bariatric surgery shortened hospital stay and was cost-effective. There was no increase in perioperative morbidity. Registration number: NCT01303809 (http://www.clinicaltrials.gov).
IntroductionInternational interest in peer-teaching and peer-assisted learning (PAL) during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice.ObjectiveTo summarize and critically appraise evidence presented on peer-teaching effectiveness and its impact on objective learning outcomes of medical students.MethodA literature search was conducted in four electronic databases. Titles and abstracts were screened and selection was based on strict eligibility criteria after examining full-texts. Two reviewers used a standard review and analysis framework to independently extract data from each study. Discrepancies in opinions were resolved by discussion in consultation with other reviewers. Adapted models of “Kirkpatrick’s Levels of Learning” were used to grade the impact size of study outcomes.ResultsFrom 127 potential titles, 41 were obtained as full-texts, and 19 selected after close examination and group deliberation. Fifteen studies focused on student-learner outcomes and four on student-teacher learning outcomes. Ten studies utilized randomized allocation and the majority of study participants were self-selected volunteers. Written examinations and observed clinical evaluations were common study outcome assessments. Eleven studies provided student-teachers with formal teacher training. Overall, results suggest that peer-teaching, in highly selective contexts, achieves short-term learner outcomes that are comparable with those produced by faculty-based teaching. Furthermore, peer-teaching has beneficial effects on student-teacher learning outcomes.ConclusionsPeer-teaching in undergraduate medical programs is comparable to conventional teaching when utilized in selected contexts. There is evidence to suggest that participating student-teachers benefit academically and professionally. Long-term effects of peer-teaching during medical school remain poorly understood and future research should aim to address this.
Purpose The Enhanced Recovery After Surgery (ERAS) program aims to combine and coordinate evidence-based perioperative care interventions that support standardizing and optimizing surgical care. In conjunction with its clinical benefits, it has been suggested that ERAS reduces costs through shorter convalescence and reduced morbidity. Nevertheless, few studies have evaluated the cost-effectiveness of ERAS programs. The aim of this systematic review, therefore, is to evaluate the claims that ERAS is cost-effective and to characterize how these costs were reported and evaluated. Source The electronic databases, MEDLINE Ò and EMBASE TM , were searched from inception to April 2014. Principal findings Seventeen studies met the inclusion criteria and were included for review. Enhanced Recovery After Surgery protocols in various abdominal surgeries have been investigated, including colorectal, bariatric, gynecological, gastric, pancreatic, esophageal, and vascular surgery. All studies reported cost savings associated with hastening recovery and reducing morbidity and complications. All studies included in this review focused primarily on in-hospital costs, with some attempting to account for readmission costs and follow-up services. In all but two studies, the breakdown of cost data for the individual studies was poorly detailed. Conclusions In conclusion, ERAS protocols appear to be both clinically efficacious and cost effective across a variety of surgical specialties in the short term. Nevertheless, studies reporting out-of-hospital cost data are lacking. Further research is required to determine how best to evaluate both medium-and long-term costs relating to ERAS pathways while taking quality of life data into account. RésuméObjectif Le programme de Récupération rapide après la chirurgie (RRAC) vise à combiner et coordonner des interventions de soins périopératoires basées sur des données probantes qui soutiennent la standardisation et l'optimisation des soins chirurgicaux. En association avec ses avantages cliniques, il a été suggéré que la RRAC réduisait les coûts grâce à une convalescence raccourcie et une moindre morbidité. Néanmoins, peu d'études ont évalué le rapport efficacité-coût des programmes de RRAC. Le but de cette synthèse systématique est donc d'évaluer l'argument de rentabilité de la RRAC et de préciser dans quelle mesure ces coûts ont été rapportés et évalués. Sources Une recherche a été menée dans les bases de données électroniques MEDLINE Ò et EMBASE TM depuis les origines du concept jusqu'en avril 2014. Constatations principales Dix-sept études répondaient aux critères d'inclusion et ont été analysées. Les protocoles de Récupération rapide après la chirurgie concernant différentes interventions chirurgicales abdominales (colorectales, bariatriques, gynécologiques, gastriques, pancréatiques, oesophagiennes et vasculaires) ont été étudiés. Toutes les études rapportaient des économies associées à l'accélération de la récupération et à la réduction de la morbidité et des complications. Tout...
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