Effect of Alvimopan on Postoperative Ileus and Length of Hospital Stay in Patients Undergoing Bowel Resection: A Systematic Review and Meta-Analysis.

AIMS: The aim is to investigate the effect of alvimopan on postoperative ileus and length of hospital stay in patients undergoing bowel resection. METHODS: The PRISMA statement standards were followed to conduct a systematic review and meta-analysis. The available literature was searched to identify all studies comparing alvimopan with no alvimopan in patients undergoing bowel resection. Postoperative ileus and length of hospital stay were the primary outcomes, and time to first bowel motion was the secondary outcome. Random-effects modeling was applied for analyses. RESULTS: Analysis of 94 833 patients from 26 studies showed that alvimopan was associated with lower risk of postoperative ileus (OR: .57, 95% CI .48 to .67, P <.00001; high GRADE certainty), shorter length of hospital stay (MD: -1.08 day, 95% CI -1.36 to -.81, P < .00001; moderate GRADE certainty), and shorter time to first bowel motion (MD: -.43 day, 95% CI -.58 to -.28, P < .00001; moderate GRADE certainty). Separate analyses of randomized controlled trials and observational studies showed similar findings. Subgroup analyses suggested consistent findings in patients undergoing elective bowel resection, emergency bowel resection, and open surgery; however, alvimopan did not improve the outcomes in patients undergoing minimally invasive surgery. CONCLUSION: Robust evidence supports the routine use of alvimopan in patients undergoing open bowel resection as indicated by lower risk of postoperative ileus and shorter length of hospital stay. We support incorporation of alvimopan into enhanced recovery after surgery programs for the procedures involving open bowel resection. The role of alvimopan in minimally invasive bowel resection needs more research.

Remote consultations in community mental health: A qualitative study of clinical teams.

WHAT IS KNOWN ON THE SUBJECT?: Mental health care can be delivered remotely through video and telephone consultations. Remote consultations may be cheaper and more efficient than in person consultations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Accessing community mental health care through remote consultations is perceived as not possible or beneficial for all service users. Delivering remote consultations may not be practical or appropriate for all clinicians or community mental health teams. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Remote consultation cannot be a 'one-size-fits-all' model of community mental health care. A flexible approach is needed to offering remote consultation that considers its suitability for the service-user, service and clinician. ABSTRACT: INTRODUCTION: Responding to COVID-19, community mental health teams in the UK NHS abruptly adopted remote consultations. Whilst they have demonstrable effectiveness, efficiency, and economic benefits, questions remain around the acceptability, feasibility and medicolegal implications of delivering community mental health care remotely. AIM: To explore perceived advantages, challenges, and practice adaptations of delivering community mental health care remotely. METHODS: Ten community mental health teams in an NHS trust participated in a service evaluation about remote consultation. Fifty team discussions about remote consultation were recorded April-December 2020. Data analysis used a framework approach with themes being coded within a matrix. RESULTS: Three major horizontal themes of operations and team functioning, clinical pathways, and impact on staff were generated, with vertical themes of advantages, challenges, equity and adaptations. DISCUSSION: Remote consultation is an attractive model of community mental healthcare. Clinical staff note benefits at individual (staff and service-user), team, and service levels. However, it is not perceived as a universally beneficial or practical approach, and there are concerns relating to access equality. IMPLICATIONS FOR PRACTICE: The suitability of remote consultation needs to be considered for each service-user, clinical population and clinical role. This requires a flexible and hybrid approach, attuned to safeguarding equality.

Global competency impact of sustained remote international engagement for students.

BACKGROUND: To provide just equity in academic exchange, as well as to reduce prohibitive travel cost and address environmental concerns, the past paradigm of international student exchange has fundamentally shifted from one directional travel to mutually beneficial bidirectional remote communication between students all over the globe. Current analysis aims to quantify cultural competency and evaluate academic outcomes. METHODS: Sixty students half from the US and half from Rwanda grouped in teams of 4 engaged in a nine-month project-focused relationship. Cultural competency was evaluated prior to project initiation and six months after completion of the project. Student perspective of project development was analyzed weekly and final academic outcome was evaluated. RESULTS: Change in cultural competency was not significant; however, students did identify satisfaction in team interaction and academic outcomes were achieved. CONCLUSION: A single remote exchange between students in two countries may not be transformative but it can provide cultural enrichment and successful academic project outcome and may serve to enhance cultural curiosity.

Assessing knowledge of and attitudes towards plagiarism and ability to recognize plagiaristic writing among university students in Rwanda.

Plagiarism is a serious type of scholastic misconduct. In Rwanda, no research has been conducted to assess university students' attitudes and knowledge of plagiarism and if they have the skills to avoid plagiarizing. This study was conducted to assess knowledge of and attitudes towards plagiarism, as well as ability to recognize plagiaristic writing, among university students in Rwanda. An online questionnaire containing 10 knowledge questions, 10 attitude statements, and 5 writing cases with excerpts to test identification of plagiarism was administered between February and April 2021. Out of the 330 university students from 40 universities who completed the survey, 75.8% had a high knowledge level (score ≥ 80%), but only 11.6% had a high score in recognizing plagiaristic writing (score ≥ 80%). There was no statistically significant association between knowledge level and ability to recognize plagiaristic writing (P = 0.109). Lower odds were found in both diploma/certificate and bachelor students of having high knowledge as well as of having high ability to recognize plagiaristic writing than in master's students. Although respondents generally disapproved of plagiarism, approximately half of the respondents indicated that sometimes plagiarism is unavoidable, and self-plagiarism should not be punished in the same way as plagiarism of others' work. Inter-collegial collaboration on effective plagiarism policies and training programs is needed.