Prospective comparison of two methods for assessing sarcopenia and interobserver agreement on retrospective CT images.

PURPOSE OF THE STUDY: To compare the relationships between two CT derived sarcopenia assessment methods, and compare their relationship with inter-rater and intrarater validations and colorectal surgical outcomes. STUDY DESIGN: 157 CT scans were identified across Leeds Teaching Hospitals National Health Service Trust for patients undergoing colorectal cancer surgery. 107 had body mass index data available, required to determine sarcopenia status. This work explores the relationship between sarcopenia, as measured by both total cross sectional-area (TCSA) and psoas-area (PA) and surgical outcomes. All images were assessed for inter-rater and intrarater variability for both TCSA and PA methods of sarcopenia identification. The raters included a radiologist, an anatomist and two medical students. RESULTS: Prevalence of sarcopenia was different when measured by PA (12.2%-22.4%) in comparison to TCSA (60.8%-70.1%). Strong correlation exists between muscle areas in both TCSA and PA measures, however, there were significant differences between methods after the application of method-specific cut-offs. There was substantial agreement for both intrarater and inter-rater comparisons for both TCSA and PA sarcopenia measures. Outcome data were available for 99/107 patients. Both TCSA and PA have poor association with adverse outcomes following colorectal surgery. CONCLUSIONS: CT-determined sarcopenia can be identified by junior clinicians, those with anatomical understanding and radiologists. Our study identified sarcopenia to have a poor association with adverse surgical outcomes in a colorectal population. Published methods of identifying sarcopenia are not translatable to all clinical populations. Currently available cut-offs require refinement for potential confounding factors, to provide more valuable clinical information.

Prevalence of frailty and reliability of established frailty instruments in adult elective colorectal surgical patients: a prospective cohort study.

PURPOSE: Large population studies now demonstrate that frailty is prevalent in all adult age groups. Limited data exist on the association between frailty and surgical outcome in younger patients. The aim of the study was to explore the agreement between frailty identification tools and collect pilot data on their predictive value for frailty-associated outcomes in an adult surgical population. STUDY DESIGN: Prospective cohort study. RESULTS: Frailty scores were recorded in 200 patients (91 men), mean (range) age 57 (18-92) years. The prevalence of prefrailty was 52%-67% and that of frailty 2%-32% depending on the instrument used. Agreement between the instruments was poor, kappa 0.08-0.17 in pairwise comparisons. Outcome data were available on 160 patients. Only the frailty phenotype was significantly associated with adverse outcomes, RR 6.1 (1.5-24.5) for postoperative complications. The three frailty scoring instruments studies had good sensitivity (Clinical Frailty Scale (CFS)-90%, Accumulation Deficit (AD)-96%, Frailty Phenotype (FP)-97%) but poor specificity (CFS-12%, AD-13%, FP-18%) for the prediction of postoperative complications. All three instruments were poorly predictive of adverse outcomes with likelihood ratios of CFS-1.02, AD-1.09 and FP-1.17. CONCLUSIONS: This study showed a significant prevalence of prefrailty and frailty in adult colorectal surgical patients of all ages. There was poor agreement between three established frailty scoring instruments. Our data do not support the use of current frailty scoring instruments in all adult colorectal surgical patients. However, the significant prevalence of prefrailty and frailty across all age groups of adult surgical patient justifies further research to refine frailty scoring in surgical patients.

The (future) doctor will see you now: Piloting a longitudinal virtual patient in medical education, simulating general practice.

INTRODUCTION: Virtual patients provide numerous learning opportunities for medical students, yet only support one-off patient interactions. To emulate general practice, allowing multiple encounters with a single patient, a new longitudinal virtual patient (LVP) was developed. METHODS: The LVP was integrated into 2nd year at a graduate-entry medical school, in the 2019/2020 academic year. Students were asked about their prior experience and expectations of LVPs, before they engaged with two consultations and one results session. Data were collected from this survey and from the engagement with the LVP. Feedback was collected and thematically grouped. RESULTS: Survey responses indicated that 1.7% (2/120) had previous experience with virtual patients, and the majority expected the LVP to make a difference to their clinical reasoning. Out of the 142 students engaged with the LVP, 53% completed over 75% of the work. Informal feedback arose around accessibility, professional learning and development, and engagement with the LVP module. DISCUSSION: The data indicate that LVPs are agreeable to medical students, with good engagement and positive reports of clinical learning. CONCLUSION: Future work exploring reasons of engagement or lack of, will support refinement of the LVP to accommodate the learning needs of the medical students.

The use of simulation in medical student education on the topic of breaking bad news: A systematic review.

BACKGROUND: Simulated patients (SPs) are widely used, but the most effective way of utilising them in undergraduate breaking bad news (BBN) medical education is unknown. OBJECTIVES: To conduct a systematic review into SP's use in developing BBN skills in medical students. METHODS: 14 databases searched with the terms "Medical education", "Patient simulation", "Bad news". Data was systematically extracted, and thematic analysis undertaken. RESULTS: Of 2117 articles screened, 29 publications met the inclusion criteria. These demonstrated a variety of SP models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). with delivery at varying times in the curricula. SPs are uniformly reported as having positive impact, but there is a lack of high-quality evidence comparing the use of differing forms of training. There was some evidence that virtual SPs were as useful as in-person SPs. CONCLUSIONS: SPs allow students to practise vital BBN communication skills without risking detriment to patient care. Despite the heterogeneity of ways in which SPs have been used, the benefits of different approaches and when and how these should be delivered remains unclear. PRACTICE IMPLICATIONS: Further educational development and research is needed about the use of SPs to support undergraduate BBN communication skills development.