A Systematic Review and Meta-analysis Examining the Impact of Age on Perioperative Inflammatory Biomarkers.

BACKGROUND: Dysregulation of immune responses to surgical stress in older patients and those with frailty may manifest as differences in inflammatory biomarkers. We conducted a systematic review and meta-analysis to examine differences in perioperative inflammatory biomarkers between older and younger patients, and between patients with and without frailty. METHODS: MEDLINE, Embase, Cochrane, and CINAHL databases were searched (Inception to June 23, 2020). Observational or experimental studies reporting the perioperative level or activity of biomarkers in surgical patients stratified by age or frailty status were included. The primary outcome was inflammatory biomarkers (grouped by window of ascertainment: pre-op; post-op: <12 hours, 12-24 hours, 1-3 days, 3 days to 1 week, and >1 week). Quality assessment was conducted using the Newcastle-Ottawa Scale. Inverse-variance, random-effects meta-analysis was conducted. RESULTS: Forty-five studies (4263 patients) were included in the review, of which 36 were pooled for meta-analysis (28 noncardiac and 8 cardiac studies). Two studies investigated frailty as the exposure, while the remaining investigated age. In noncardiac studies, older patients had higher preoperative levels of interleukin (IL)-6 and C-reactive protein (CRP), lower preoperative levels of lymphocytes, and higher postoperative levels of IL-6 (<12 hours) and CRP (12-24 hours) than younger patients. In cardiac studies, older patients had higher preoperative levels of IL-6 and CRP and higher postoperative levels of IL-6 (<12 hours and >1 week). CONCLUSIONS: Our findings demonstrate a paucity of frailty-specific studies; however, the presence of age-associated differences in the perioperative inflammatory response is consistent with age-associated states of chronic systemic inflammation and immunosenescence. Additional studies assessing frailty-specific changes in the systemic biologic response to surgery may inform the development of targeted interventions.

Designing a touchless physical examination for a virtual Objective Structured Clinical Examination.

Purpose: Given the COVID-19 pandemic, many Objective Structured Clinical Examinations (OSCEs) have been adapted to virtual formats without addressing whether physical examination maneuvers can or should be assessed virtually. In response, we developed a novel touchless physical examination station for a virtual OSCE and gathered validity evidence for its use. Methods: We used a touchless physical examination OSCE station pilot-tested in a virtual OSCE in which Internal Medicine residents had to verbalize their approach to the physical examination, interpret images and videos of findings provided upon request, and make a diagnosis. We explored differences in performance by training year using ANOVA. In addition, we analyzed data using elements of Bloom's taxonomy of learning, i.e. knowledge, understanding, and synthesis. Results: Sixty-seven residents (PGY1-3) participated in the OSCE. Scores on the pilot station were significantly different between training levels (F=3.936, p = 0.024, ηp2 = 0.11). The pilot station-total correlation (STC) was r = 0.558, and the item-station correlations ranged from r = 0.115-0.571, with the most discriminating items being those that assessed application of knowledge (interpretation and synthesis) rather than recall. Conclusion: This touchless physical examination station was feasible, had acceptable psychometric characteristics, and discriminated between residents at different levels of training.

Objet: Compte tenu de la pandémie de COVID-19, de nombreux examens cliniques objectifs structurés (ECOS) ont été adaptés vers un format virtuel sans que l'on se questionne à savoir si les manœuvres d'examen physique peuvent ou doivent être évaluées virtuellement. Conséquemment, nous avons développé une nouvelle station d'examen physique sans contact pour un ECOS virtuel et recueilli des preuves de validité concernant son utilisation. Méthodes: Nous avons utilisé une station d'examen physique sans contact testée dans le cadre d'un ECOS virtuel pendant lequel les résidents en médecine interne devaient verbaliser leur approche concernant l'examen physique, interpréter des images et des vidéos d'examens fournis sur demande, et poser un diagnostic. Nous avons étudié les différences de rendement en fonction de l'année de formation à l'aide de l'ANOVA. En outre, nous avons analysé les données en utilisant les éléments de la taxonomie de l'apprentissage de Bloom, c'est-à-dire la connaissance, la compréhension et la synthèse. Résultats: Soixante-sept résidents (PGY1-3) ont participé à l'ECOS. Les scores de la station pilote étaient significativement différents entre les niveaux de formation (F=3.936, p=0.024, ηp2=0.11). La corrélation totale de la station pilote (STC) était de r=0,558, et les corrélations question-station variaient de r=0,115-0,571, les questions les plus discriminantes étant celles qui évaluaient l'application (interprétation et synthèse) plutôt que le rappel de connaissances. Conclusion: Cette station d'examen physique sans contact était réalisable, a présenté des caractéristiques psychométriques acceptables et a permis d'établir une discrimination entre les résidents de différents niveaux de formation.