Joint models inform the longitudinal assessment of patient-reported outcomes in clinical trials: a simulation study and secondary analysis of the restrictive Vs. liberal fluid therapy for major abdominal surgery (RELIEF) randomized controlled trial.

Objectives: Evaluate the utility of a joint model when analysing a patient-reported endpoint as part of a randomized controlled trial (RCT) in which censoring occurs when patients die during follow-up.

Study Design And Setting: The present study comprises two parts as follows: first we reanalyzed data from a previously published RCT comparing two fluid regimens in the first 24 hours of major abdomino-pelvic surgery ('Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery [RELIEF]' trial). In this trial, patient-reported disability was measured at multiple timepoints before and after surgery.

Routine Protamine Administration for Bleeding in Transcatheter Aortic Valve Implantation: The ACE-PROTAVI Randomized Clinical Trial.

Importance: Vascular complications after transfemoral transcatheter aortic valve implantation (TAVI) remain an important cause of procedure-related morbidity. Routine reversal of anticoagulation with protamine at the conclusion of transfemoral TAVI could reduce complications, but data remain scarce.

Objective: To evaluate the efficacy and safety of routine protamine administration after transfemoral TAVI.

The psychometric properties and minimal clinically important difference for disability assessment using WHODAS 2.0 in critically ill patients.

The 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) provides a standardised method for measuring health and disability.

Predicting Death or Disability after Surgery in the Older Adult.

Background: Older patients are vulnerable to developing new or worsening disability after surgery. Despite this, patient or surgical characteristics predisposing to postoperative disability are poorly defined. The aim of the study was to develop and validate a model, subsequently transformed to point-score form, to predict 6-month death or disability in older patients after surgery.

Perioperative outcomes in intermediate and high-risk patients after major surgery following introduction of a dedicated perioperative medicine team: A single centre cohort study.

Intermediate and high-risk patients undergoing surgery are often managed on a surgical ward in the absence of haemodynamic or ventilatory support requirements necessitating intensive care unit or high dependency unit admission. We describe a model of care for the multidisciplinary management of selected postoperative patients and the epidemiology of patients managed using this model at a tertiary Australian hospital.Of 25,139 patients undergoing inpatient surgery at our institution over a two-year period, 506 (2%) were referred to the Perioperative Medicine team.

Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery.

Background: Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort.

Postoperative anaemia and patient-centred outcomes after major abdominal surgery: a retrospective cohort study.

Background: Compared with anaemia before surgery, the underlying pathogenesis and implications of postoperative anaemia are largely unknown.

Methods: This retrospective cohort study analysed prospective data obtained from 2983 adult patients across 47 centres enrolled in a clinical trial evaluating restrictive and liberal intravenous fluids. The primary endpoint was persistent disability or death up to 90 days after surgery.

Comparison of 6-month outcomes of sepsis versus non-sepsis critically ill patients receiving mechanical ventilation.

Background: Data on long-term outcomes after sepsis-associated critical illness have mostly come from small cohort studies, with no information about the incidence of new disability. We investigated whether sepsis-associated critical illness was independently associated with new disability at 6 months after ICU admission compared with other types of critical illness.

Methods: We conducted a secondary analysis of a multicenter, prospective cohort study in six metropolitan intensive care units in Australia.

Pressure-induced high-spin/low-spin disproportionated state in the Mott insulator FeBO.

The pressure-induced Mott insulator-to-metal transitions are often accompanied by a collapse of magnetic interactions associated with delocalization of 3d electrons and high-spin to low-spin (HS-LS) state transition. Here, we address a long-standing controversy regarding the high-pressure behavior of an archetypal Mott insulator FeBO and show the insufficiency of a standard theoretical approach assuming a conventional HS-LS transition for the description of the electronic properties of the Mott insulators at high pressures. Using high-resolution x-ray diffraction measurements supplemented by Mössbauer spectroscopy up to pressures ~ 150 GPa, we document an unusual electronic state characterized by a "mixed" HS/LS state with a stable abundance ratio realized in the [Formula: see text] crystal structure with a single Fe site within a wide pressure range of ~ 50-106 GPa.

Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis.

Background: There are very few patient-centred global outcome measures of recovery in the days or weeks after surgery. This meta-analysis evaluated the psychometric properties and clinical acceptability of the 15-item quality of recovery (QoR-15) scale.

Methods: We searched bibliographic databases for studies undertaking psychometric evaluation of the QoR-15 or using the QoR-15 as an outcome measure after surgery.

Predicting recovery and disability after surgery in patients with severe obesity: The role of the six-minute walk test.

The most appropriate method to predict postoperative outcomes in patients with severe obesity undergoing elective non-bariatric surgery is not known. We conducted a single-centre prospective cohort study in patients with a body mass index of at least 35 kg/m undergoing non-bariatric, non-cardiac surgery. Patients completed the six-minute walk test prior to surgery.

Cardiopulmonary Exercise Testing and Other Tests of Functional Capacity.

Purpose Of Review: Assessment of functional capacity is a cornerstone of preoperative risk assessment. While subjective clinician assessment of functional capacity is poorly predictive of postoperative outcomes, other objective functional assessment measures may provide more useful information.

Recent Findings: Cardiopulmonary exercise testing (CPET) is generally accepted as the gold standard for functional capacity assessment.

Postdischarge Functional Capacity, Health-Related Quality of Life, Depression, Anxiety, and Post-traumatic Stress Disorder in Patients Receiving a Long-term Left Ventricular Assist Device.

Background: There is a paucity of data on depression, anxiety and post-traumatic stress disorder after left ventricular assist device (LVAD) implantation. We designed an observational study to integrate these with functional capacity and health-related quality of life (HR-QOL) in surviving LVAD patients.

Methods And Results: Consenting patients between 1 month and 9 years after LVAD implantation (n = 121) were screened for functional capacity (World Health Organization Disability Assessment Schedule 2.

Association of six-minute walk test distance with postoperative complications in non-cardiac surgery: a secondary analysis of a multicentre prospective cohort study.

Purpose: The six-minute walk test (6MWT) is a simple and valid test for assessing cardiopulmonary fitness. Nevertheless, the relationship between preoperative 6MWT distance and postoperative complications is uncertain. We conducted a secondary analysis of the 6MWT nested cohort substudy of the Measurement of Exercise Tolerance before Surgery study to determine if 6MWT distance predicts postoperative complications or death.

Towards a national perioperative clinical quality registry: The diagnostic accuracy of administrative data in identifying major postoperative complications.

Accurately measuring the incidence of major postoperative complications is essential for funding and reimbursement of healthcare providers, for internal and external benchmarking of hospital performance and for valid and reliable public reporting of outcomes. Actual or surrogate outcomes data are typically obtained by one of three methods: clinical quality registries, clinical audit, or administrative data. In 2017 a perioperative registry was developed at the Alfred Hospital and mapped to administrative and clinical data.

Defining the Minimal Clinically Important Difference and Patient-acceptable Symptom State Score for Disability Assessment in Surgical Patients.

Background: The World Health Organization Disability Assessment Schedule 2.0 has been used to measure postoperative disability in several clinical trials and cohort studies. It is uncertain what the minimal clinically important difference or patient-acceptable symptom state scores are for this scale in patients recovering from surgery.

Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.

Background: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications.

Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study.

Background: Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery.

Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia.

Objective: To evaluate 'days at home up to 30 days after surgery' (DAH) as a patient-centred outcome measure.

Design: Prospective cohort study.

Data Source: Using clinical trial data (seven trials, 2109 patients) we calculated DAH from length of stay, readmission, discharge destination and death up to 30 days after surgery.

Measuring perioperative outcome.

Purpose Of Review: Measuring clinically relevant and patient-centered perioperative outcomes provides the knowledge that enables clinicians to optimize their practice and guide shared decision-making, researchers to set a future agenda and policymakers to prioritize healthcare spending.

Recent Findings: A large international collaboration is currently working to define a set of core outcomes for use in perioperative medicine research. Standardizing which outcomes are measured and how they are defined will help ensure that perioperative research output is meaningful and practice changing.

Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery.

Introduction: Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors' subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia.

Measurement of disability-free survival after surgery.

Background: Survival and freedom from disability are arguably the most important patient-centered outcomes after surgery, but it is unclear how postoperative disability should be measured. The authors thus evaluated the World Health Organization Disability Assessment Schedule 2.0 in a surgical population.

Surgical treatment of an amniotic fluid embolism with cardiopulmonary collapse.

Amniotic fluid embolism is a rare but devastating condition associated with a very high rate of morbidity and mortality. The treatment has traditionally been aggressive supportive care. We report a case of a term pregnant woman with complete cardiovascular collapse secondary to a paradoxical amniotic fluid embolism.

Amniotic fluid embolism complicated by paradoxical embolism and disseminated intravascular coagulation.

Amniotic fluid embolism is a rare syndrome with potentially lethal outcomes. Complications include cardiorespiratory failure, disseminated intra-vascular coagulation, seizures, neurological deficits, and death. A 34-year-old woman had amniotic fluid embolism complicated by paradoxical embolism and disseminated intravascular coagulation.