Association between Surgical Technical Skills and Clinical Outcomes: A Systematic Literature Review and Meta-Analysis.

Background: A systematic literature review and meta-analysis was conducted to assess the association between intraoperative surgical skill and clinical outcomes. Methods: Peer-reviewed, original research articles published through August 31, 2021 were identified from PubMed and Embase. From the 1,513 potential articles, seven met eligibility requirements, reporting on 151 surgeons and 17,932 procedures. All included retrospective assessment of operative videos. Associations between surgical skill and outcomes were assessed by pooling odds ratios (OR) using random-effects models with the inverse variance method. Eligible studies included pancreaticoduodenectomy, gastric bypass, laparoscopic gastrectomy, prostatectomy, colorectal, and hemicolectomy procedures. Results: Meta-analytic pooling identified significant associations between the highest vs. lowest quartile of surgical skill and reoperation (OR: 0.44; 95% confidence interval [CI]: 0.23, 0.83), hemorrhage (OR: 0.66; 95% CI, 0.65, 0.68), obstruction (OR: 0.33; 95% CI, 0.30, 0.35), and any medical complication (OR: 0.23, 95% CI, 0.19, 0.27). Nonsignificant inverse associations were noted between skill and readmission, emergency department visit, mortality, leak, infection, venous thromboembolism, and cardiac and pulmonary complications. Conclusions: Overall, surgeon technical skill appears to predict clinical outcomes. However, there are surprisingly few articles that evaluate this association. The authors recommend a thoughtful approach for the development of a comprehensive surgical quality infrastructure that could significantly reduce the challenges identified by this study.

ONS Guidelines™ for Cancer Treatment-Related Lymphedema.

PURPOSE: Lymphedema is a chronic condition that may result from cancer-related surgery. The incidence of lymphedema varies greatly; however, patients remain at risk for life and may experience decreased quality of life and functional capacity. Providing recommendations for an evidence-based guideline for care of cancer treatment-related lymphedema will help to improve outcomes for patients with this chronic condition. METHODOLOGIC APPROACH: A panel of healthcare professionals with patient representation convened to develop a national clinical practice guideline on prospective surveillance, risk reduction, and conservative treatment of lymphedema. Systematic reviews of the literature were conducted and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology approach was used to assess the evidence. FINDINGS: The panel made multiple recommendations for patients who are at risk for or experiencing lymphedema. IMPLICATIONS FOR NURSING: Early diagnosis and treatment of lymphedema may mitigate symptoms. This evidence-based guideline supports patients, clinicians, and other healthcare professionals in clinical decision making. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-lymphedema.

Hawaii's statewide evidence-based practice program.

Hawaii's innovative statewide evidence-based practice program facilitates practice change across multiple health care systems. The innovation eliminated duplicative efforts and provided resources, was compatible with the values of health care organizations, and had experience with a pilot program. Interpersonal and mass media communication promoted and embedded the practice change. Users included nurse champions with multidisciplinary team members. The rate of adoption varied across projects and, although resources seemed to be a major determinant of successful institutionalization, there does not seem to be a predictable pattern of successful project implementation.

Does an individual's fitness level affect baseline concussion symptoms?

CONTEXT: Variables that may influence baseline concussion symptoms should be investigated. OBJECTIVE: To evaluate the effect of physical fitness on self-report of baseline concussion symptoms in collegiate athletes and students. DESIGN: Controlled laboratory study. PATIENTS OR OTHER PARTICIPANTS: A total of 125 undergraduates, including 95 collegiate athletes and 30 recreational athletes (83 males, 42 females). INTERVENTION(S): Participants completed the Standardized Concussion Assessment Tool 2 (SCAT2; symptom report) at baseline, within 10 minutes of completing the Leger test, and within 24 hours of the initial baseline test. The Leger (beep) test is a shuttle-run field test used to predict maximal aerobic power. MAIN OUTCOME MEASURE(S): The total symptom score on the SCAT2 was calculated and analyzed with a repeated-measures analysis of variance. A linear regression analysis was used to determine if 3 variables (sport type, sex, or fitness level) accounted for a significant amount of the variance in the baseline symptom report. RESULTS: Participants reported more symptoms postactivity but fewer symptoms at 24 hours compared with baseline, representing a time effect in our model (F2,234 = 47.738, P < .001). No interactions were seen among the independent variables. We also found an effect for fitness level, with fitter individuals reporting fewer symptoms at all 3 time intervals. The regression analysis revealed that fitness level accounted for a significant amount of the variance in SCAT2 symptoms at baseline (R (2) = 0.22, F3,121 = 11.44, P < .01). CONCLUSIONS: Fitness level affected the baseline concussion symptom report. Exercise seems to induce concussion symptom reporting, and symptom severity may be a function of an athlete's level of conditioning. Sports medicine professionals should consider an athlete's level of fitness when conducting baseline concussion symptom assessments.

Morphological and physiological studies of the silkmoth ovary I. The general histology and some histochemical properties of the ovary of Samia Cynthia (Drury).

Ovaries of the giant silkmoth Samia cynthia Drury have been studied histologically and histochemically during diapause, adult development, and after injury to the diapause animal. In addition to cellular changes involved in follicular growth and vitellogenesis, changes in the intermediate layer cells are very striking, showing a distinct pattern during ovarian development and after injury. Two types of granules, one periodic acid-Schiff (PAS) positive, the other paraldehyde-fuchsin (PF) positive, change in their number and distribution in the intermediate cells during development and after injury. The PAS-positive granules appear during the first one-third of development, increase in number and size until the tenth day, then gradually dwindle in number and size, and disappear in the adult cells. The PF-positive granules, present in moderate numbers in the diapause animal, decrease in number until the tenth day of adult development, then reappear, and are present again in adult intermediate cells. After injury to a diapause pupa, intermediate cells show a greatly increased number of PF-positive granules, but none that are PAS-positive. The PAS-positive granules are a neutral or mildly acidic mucosubstance, and may correspond to lysosomal activity, while the PF-positive granules may be a neurosecretory-like substance or the product of hormone-dependent protein synthesis, since the patterns of granule distribution in the intermediate cells seem to reflect both general metabolic and hormone-related events.