March 5, 2019 e1 WRITING GROUP MEMBERS Emelia J. Benjamin, MD, ScM, FAHA, Chair Paul Muntner, PhD, MHS, FAHA, Vice Chair Alvaro Alonso, MD, PhD, FAHA Marcio S. Bittencourt, MD, PhD, MPH Clifton W. Callaway, MD, FAHA April P. Carson, PhD, MSPH, FAHA Alanna M. Chamberlain, PhD Alexander R. Chang, MD, MS Susan Cheng, MD, MMSc, MPH, FAHA Sandeep R. Das, MD, MPH, MBA, FAHA Francesca N. Delling, MD, MPH Luc Djousse, MD, ScD, MPH Mitchell S.V. Elkind, MD, MS, FAHA Jane F. Ferguson, PhD, FAHA Myriam Fornage, PhD, FAHA Lori Chaffin Jordan, MD, PhD, FAHA Sadiya S. Khan, MD, MSc Brett M. Kissela, MD, MS Kristen L. Knutson, PhD Tak W. Kwan, MD, FAHA Daniel T. Lackland, DrPH, FAHA Tené T. Lewis, PhD Judith H. Lichtman, PhD, MPH, FAHA Chris T. Longenecker, MD Matthew Shane Loop, PhD Pamela L. Lutsey, PhD, MPH, FAHA Seth S. Martin, MD, MHS, FAHA Kunihiro Matsushita, MD, PhD, FAHA Andrew E. Moran, MD, MPH, FAHA Michael E. Mussolino, PhD, FAHA Martin O’Flaherty, MD, MSc, PhD Ambarish Pandey, MD, MSCS Amanda M. Perak, MD, MS Wayne D. Rosamond, PhD, MS, FAHA Gregory A. Roth, MD, MPH, FAHA Uchechukwu K.A. Sampson, MD, MBA, MPH, FAHA Gary M. Satou, MD, FAHA Emily B. Schroeder, MD, PhD, FAHA Svati H. Shah, MD, MHS, FAHA Nicole L. Spartano, PhD Andrew Stokes, PhD David L. Tirschwell, MD, MS, MSc, FAHA Connie W. Tsao, MD, MPH, Vice Chair Elect Mintu P. Turakhia, MD, MAS, FAHA Lisa B. VanWagner, MD, MSc, FAST John T. Wilkins, MD, MS, FAHA Sally S. Wong, PhD, RD, CDN, FAHA Salim S. Virani, MD, PhD, FAHA, Chair Elect On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee

Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovas...

Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association

Pedagosko i psiholosko testiranje i procjenjivanje spadaju među najvažnije doprinose znanosti o ponasanju nasem drustvu i pružaju temeljna i znacajna poboljsanja u odnosu na ranije postupke. Iako se ne može ustvrditi da su svi testovi dovoljno usavrseni niti da su sva testiranja razborita i korisna, postoji velika kolicina informacija koje ukazuju na ucinkovitost kvalitetnih instrumenata u onim situacijama u kojima je njihovo koristenje potkrijepljeno validacijskim podacima. Pravilna upotreba testova može dovesti do boljih odluka o pojedincima i programima nego sto bi to bio slucaj bez njihovog koristenja, a također i ukazati na put za siri i pravedniji pristup obrazovanju i zaposljavanju. Međutim, losa upotreba testova može dovesti do zamjetne stete nanesene ispitanicima i drugim sudionicima u procesu donosenja odluka na temelju testovnih podataka. Cilj Standarda je promoviranje kvalitetne i eticne upotrebe testova te uspostavljanje osnovice za ocjenu kvalitete postupaka testiranja. Svrha objavljivanja Standarda je uspostavljanje kriterija za evaluaciju testova, provedbe testiranja i posljedica upotrebe testova. Iako bi evaluacija prikladnosti testa ili njegove primjene trebala ovisiti prvenstveno o strucnim misljenjima, Standardi pružaju okvir koji osigurava obuhvacanje svih relevantnih pitanja. Bilo bi poželjno da svi autori, sponzori, nakladnici i korisnici profesionalnih testova usvoje Standarde te da poticu druge da ih također prihvate.

Standards for educational and psychological testing

Background: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascul...

Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association.

Simulation-based care pathway approach (CPA) training is a novel approach in surgical education. The objective of the present study was to determine whether CPA was feasible for training surgical residents and could improve efficiency in patients’ management. A common disease was chosen: acute appendicitis. All five junior residents of our department were trained in CPA: preoperative CPA consisted in virtual patients (VPs) presenting with acute right iliac fossa pain; intraoperative CPA involved a virtual competency-based curriculum for laparoscopic appendectomy (LAPP); finally, post-operative VP were reviewed after LAPP. Thirty-eight patients undergoing appendectomy were prospectively included before (n = 21) and after (n = 17) the training. All demographic and perioperative data were prospectively collected from their medical records, and time taken from admission to management was measured. All residents had performed less than 10 LAPP as primary operator. Pre- and intraoperative data were comparable between pretraining and post-training patients. Times to liquid and solid diet were significantly reduced after training [7 h (2–20) vs. 4 (4–6); P = 0.004, and 17 h (4–48) vs. 6 (4–24); P = 0.005] without changing post-operative morbidity [4 (19%) vs. 0 (0); P = 0.11] and length of stay [48 h (30–264) vs. 44 (21–145); P = 0.22]. CPA training is feasible in abdominal surgery. In the current study, it improved patients’ management in terms of earlier oral intake.

Implementation of a Surgical Simulation Care Pathway Approach to Training in Emergency Abdominal Surgery.

Virtual reality simulator- answer to training needs of european urology residents

While the largemajority of total joint arthroplasties (TJA) successfully provide long-term functional improvement and pain relief, 1–2% of patients develop periprosthetic joint infection (PJI) [1]. PJI is a devastating complication, often causing severe pain, functional deficits, and poor quality of life. PJI requires considerable effort and resources to treat, putting the patient at increased risk of further complications, including amputation, and even mortality [1]. Among the numerous identified risk factors for PJI, obesity has been recognized as a significant factor in numerous studies [2]. The impact of obesity appears to differ between hip and knee surgery, with a BMI of 30 or greater demonstrating an odds ratio (OR) of 2.04 for total hip arthroplasty and 1.39 for total knee arthroplasty in a recent meta-analysis [2]. Risk of PJI has been demonstrated to increase by 10% with each 2-point increase in body mass index (BMI) and patients with class III obesity (BMI ≥ 40 kg/m) are at a greater than 3-fold risk of PJI within 90 days than patients of normal weight [3]. Although an ideal BMI threshold for patients undergoing TJA has not been determined, it is believed that weight reduction prior to TJA may reduce the incidence of subsequent complications [3]. However, there is a paucity of data to demonstrate that such a strategy is effective [4]. Lifestyle modification, through diet and exercise, is generally the first step in weight reduction programs. Weight loss interventions led by a licensed dietician have been shown to be both safe and more effective than simply advising patients to lose weight prior to undergoing TJA [4]. In a randomized controlled trial, patients who followed a dietician-led weight management program were significantly more likely to lose weight than patients instructed to lose weight on their own accord. However, the mean weight loss of the intervention group was 3.38 kg (7.45 lb) with less than half achieving an overall weight loss of ≥5% of body weight at 12 months [5]. While effective in aiding patients to lose weight, the modest reduction in body weight with lifestyle modification alone may not be enough to significantly reduce the risk of PJI in the obese patients. For many patients, pharmacological or surgical intervention may be required to achieve and maintain significant weight loss. Currently, there are five FDA-approved medications for weight reduction: orlistat, lorcaserin, naltrexone-bupropion, phenterminetopiramate, and liraglutide [6]. All five of these medications have demonstrated superiority to placebo in aiding patients to achieve significant weight loss, with phentermine-topiramate potentially being superior to the other four agents [6]. However, each carries a risk of adverse events, which vary based upon their mechanism of action, with liraglutide demonstrating the greatest risk of discontinuation due to adverse outcomes having an OR of 2.82 compared to placebo [6]. In a meta-analysis, additional weight loss following 1 year of treatment ranged from 2.6 kg (5.7 lb) with orlistat to 8.8 kg (19.4 lb) with phentermine-topiramate compared to placebo [6]. No studies have been performed to determine their efficacy to significantly reduce weight prior to TJA or impact on outcomes, but as with lifestyle modification alone, weight reduction appears only modest and may not have a significant effect on the risk of PJI. If considering pharmacological weight loss therapy prior to TJA, physiciansmust weigh the potential for adverse effects against the potential for improved outcomes and reduced risk of PJI which has yet to be substantiated in the literature. For some patients, especially those with a BMI of 40 or greater, bariatric surgery may be the only feasible option to achieve and sustain substantial weight loss. In recent years, there have been three commonly performed procedures, including laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy, and laparoscopic gastric banding [7]. While still performed, laparoscopic gastric banding has fallen out of favor as a surgical option due to inferior outcomes and complications secondary to band slippage, erosions, and viscous penetrations, necessitating removal [8]. RYGB is considered the gold-standard procedure, having demonstrated superior results through several studies with long-term follow-up [9]. However, sleeve gastrectomy has recently become the preferred procedure for many bariatric surgeons due to its relative technical ease and lower risk of complications [7,8]. Evidence regarding the long-term outcomes of sleeve gastrectomy is limited, but two recent RCTs comparing sleeve gastrectomy to RYGB found no clinically significant differences between the procedures at a 5-year follow-up [7,10]. Unlike lifestyle modification or weight loss medications, bariatric surgery can result in rapid weight loss, which may be substantial enough to impact the risk of PJI.

https://www.tandfonline.com/doi/pdf/10.1080/17434440.2020.1720509

Rajesh Aggarwal

Papers

Implementation of a Surgical Simulation Care Pathway Approach to Training in Emergency Abdominal Surgery.

Virtual reality simulator- answer to training needs of european urology residents

How viable is pre-surgery weight reduction for the reduction of periprosthetic joint infection risk after total joint arthroplasty?

Simulation and assessment

SIMweek: an intensive and immersive simulation week ‘boot camp' improves clinical outcomes and confidence of surgical interns