Strategies to Promote ResiliencY (SPRY): a randomised embedded multifactorial adaptative platform (REMAP) clinical trial protocol to study interventions to improve recovery after surgery in high-risk patients.

Introduction: As the population ages, there is interest in strategies to promote resiliency, especially for frail patients at risk of its complications. The physiological stress of surgery in high-risk individuals has been proposed both as an important cause of accelerated age-related decline in health and as a model testing the effectiveness of strategies to improve resiliency to age-related health decline. We describe a randomised, embedded, multifactorial, adaptative platform (REMAP) trial to investigate multiple perioperative interventions, the first of which is metformin and selected for its anti-inflammatory and anti-ageing properties beyond its traditional blood glucose control features.

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited.

Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19.

Design, Setting, And Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin.

Association Between Preoperative Metformin Exposure and Postoperative Outcomes in Adults With Type 2 Diabetes.

Importance: Adults with comorbidity have less physiological reserve and an increased rate of postoperative mortality and readmission after the stress of a major surgical intervention.

Objective: To assess postoperative mortality and readmission among individuals with diabetes with or without preoperative prescriptions for metformin.

Design, Setting, And Participants: This cohort study obtained data from the electronic health record of a multicenter, single health care system in Pennsylvania.

Reduction of snoring with a plasma-mediated radiofrequency-based ablation (Coblation) device.

We evaluated the effectiveness of using a plasma-mediated radiofrequency-based ablation (Coblation) device to perform volumetric tissue reduction of the soft palate as a means of controlling snoring in 23 patients with loud snoring and mild or no sleep apnea. Tissue reduction was achieved by performing a channeling procedure designed to shrink the tissue surrounding the treatment zone. The soft palate was treated at three separate sites, and each channel was completed in approximately 11 seconds.

Protecting medical record information: start your research registries today.

Objective: The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted with the long-term goal of improving the efficiency and effectiveness of health care. It has created sweeping changes for clinical medicine and research. Generally, the standards for privacy of individual, identifiable health information (the privacy rule) require patient consent before their protected health information (PHI) can be employed in clinical research.