Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

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The limited generalizability of psychological theories and hypotheses may stem, in part, from a restricted sampling of psychological theorists and investigators and hence from the homogeneity of their background assumptions, biases, and values. A cultural pluralism approach is recommended for the recruitment and training of socioculturally diverse psychologists, capable of conducting research in a wider variety of settings with a wider range of subjects.

Propósito: El Examen Clínico Objetivo Estructurado (ECOE) es una estrategia de evaluación que implica desafíos logísticos y de recursos humanos con ciertos requisitos de preparación y planeación para su implementación. El objetivo de este estudio es describir una colaboración entre tres escuelas de medicina para el diseño de escenarios, procesos y productos académicos. Método: Tres escuelas de medicina mexicanas obtuvieron una subvención del Programa de Premios Latinoamericanos de la National Board of Medical Examiners (NBME). El proyecto implicó el desarrollo de un ECOE formativo para evaluar la competencia clínica en estudiantes de medicina de pregrado al final del internado médico, y obtener evidencia de validez del examen para su uso. Se creó un consorcio formal para desarrollar y compartir estaciones ECOE. Se implementaron talleres de capacitación del profesorado. Resultados: El consorcio de las tres escuelas diseñó un ECOE de nueve estaciones. Se capacitaron a 81 examinadores y a 36 pacientes estandarizados. Se desarrolló una rúbrica y se creó una aplicación de software para capturar los datos. Se aplicó una prueba piloto con 93 estudiantes de medicina. El alfa de Cronbach fue 0.94 y el coeficiente G 0.80. Se crearon varios productos académicos para divulgar los resultados. Conclusiones: La experiencia formativa entre tres instituciones de educación médica permitió el desarrollo conjunto de escenarios para evaluación de la competencia clínica de estudiantes. La implementación conjunta además hizo posible la conceptualización e implementación de nuevas herramientas de evaluación. Esta oportunidad abre la invitación para aprovechar las oportunidades que brindan las organizaciones internacionales para participar en convocatorias que desarrollen a las escuelas de medicina en México. Los aprendizajes se pueden desplegar con otras escuelas de medicina en el país y América Latina.