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- Brindle, ME, et al.
(author)
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Consensus Guidelines for Perioperative Care in Neonatal Intestinal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations
- 2020
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In: World journal of surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 44:8, s. 2482-2492
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Journal article (peer-reviewed)abstract
- BackgroundEnhanced Recovery After Surgery (ERAS®) Society guidelines integrate evidence-based practices into multimodal care pathways that have improved outcomes in multiple adult surgical specialties. There are currently no pediatric ERAS®Society guidelines. We created an ERAS®guideline designed to enhance quality of care in neonatal intestinal resection surgery.MethodsA multidisciplinary guideline generation group defined the scope, population, and guideline topics. Systematic reviews were supplemented by targeted searching and expert identification to identify 3514 publications that were screened to develop and support recommendations. Final recommendations were determined through consensus and were assessed for evidence quality and recommendation strength. Parental input was attained throughout the process.ResultsFinal recommendations ranged from communication strategies to antibiotic use. Topics with poor-quality and conflicting evidence were eliminated. Several recommendations were combined. The quality of supporting evidence was variable. Seventeen final recommendations are included in the proposed guideline.DiscussionWe have developed a comprehensive, evidence-based ERAS guideline for neonates undergoing intestinal resection surgery. This guideline, and its creation process, provides a foundation for future ERAS guideline development and can ultimately lead to improved perioperative care across a variety of pediatric surgical specialties.
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- Brindle, M., et al.
(author)
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Recommendations from the ERAS (R) Society for standards for the development of enhanced recovery after surgery guidelines
- 2020
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In: BJS Open. - : John Wiley & Sons. - 2474-9842. ; 4:1, s. 157-163
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Journal article (peer-reviewed)abstract
- Background: ERAS (R) Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS (R) Society guideline and the methodology that should be followed in its development.Methods: The ERAS (R) Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence.Results: Clear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus-based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up-to-date evidence is used consistently to support surgical patients.Conclusion: There is a need for a standardized, evidence-informed approach to both the development of new ERAS (R) Society guidelines, and the adaptation and revision of existing guidelines.
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- Oodit, Ravi, et al.
(author)
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Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's) : Enhanced Recovery After Surgery (ERAS) Society Recommendation
- 2022
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In: World Journal of Surgery. - : Springer. - 0364-2313 .- 1432-2323. ; 46:8, s. 1826-1843
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Research review (peer-reviewed)abstract
- Background: This is the first Enhanced Recovery After Surgery (ERAS (R)) Society guideline for primary and secondary hospitals in low-middle-income countries (LMIC's) for elective abdominal and gynecologic care.Methods: The ERAS LMIC Guidelines group was established by the ERAS (R) Society in collaboration with different representatives of perioperative care from LMIC's. The group consisted of seven members from the ERAS (R) Society and eight members from LMIC's. An updated systematic literature search and evaluation of evidence from previous ERAS (R) guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592-695, Nelson et al in Int J Gynecol Cancer 29(4):651-668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC's and LMIC's were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC's. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC's and determined through discussions and consensus.Results: In addition to previously described ERAS (R) Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline.Conclusions: These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC's.
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- van Zijl, Peter C. M., et al.
(author)
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Hyperpolarized MRI, functional MRI, MR spectroscopy and CEST to provide metabolic information in vivo
- 2021
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In: Current Opinion in Chemical Biology. - : Elsevier BV. - 1367-5931. ; 63, s. 209-218
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Journal article (peer-reviewed)abstract
- Access to metabolic information in vivo using magnetic resonance (MR) technologies has generally been the niche of MR spectroscopy (MRS) and spectroscopic imaging (MRSI). Metabolic fluxes can be studied using the infusion of substrates labeled with magnetic isotopes, with the use of hyperpolarization especially powerful. Unfortunately, these promising methods are not yet accepted clinically, where fast, simple, and reliable measurement and diagnosis are key. Recent advances in functional MRI and chemical exchange saturation transfer (CEST) MRI allow the use of water imaging to study oxygen metabolism and tissue metabolite levels. These, together with the use of novel data analysis approaches such as machine learning for all of these metabolic MR approaches, are increasing the likelihood of their clinical translation.
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