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Record W3004462739 · doi:10.12927/hcq.2020.26045

Accelerating Post-Surgical Best Practices Using Enhanced Recovery After Surgery

2020· article· en· W3004462739 on OpenAlexaffvenueabout
Carla Williams, Claude Laflamme, Brian Penner

Bibliographic record

VenueHealthcare Quarterly · 2020
Typearticle
Languageen
FieldMedicine
TopicEnhanced Recovery After Surgery
Canadian institutionsSunnybrook Health Science CentreCanadian Patient Safety Institute
Fundersnot available
KeywordsBest practiceHealth careMedicineSurgeryPolitical science

Abstract

fetched live from OpenAlex

Patients undergoing surgery today experience longer hospital stays and more complications because evidence-based practices in the areas of nutrition, activity, opioid-sparing analgesia, hydration and overall best practices are not consistently applied or used.There is also emerging evidence that supporting patients and families to become engaged in their perioperative care improves outcomes.Enhanced Recovery After Surgery (ERAS) helps patients be more prepared for surgery and recover more quickly by bringing patients, healthcare providers and health systems together and creating tools and resources that are based on the most up-to-date evidence.The goal of Enhanced Recovery Canada is to support the uptake of these best practices across Canada, improving patient outcomes and experiences.M rs. Lee awaits colon cancer surgery.Her healthcare/surgery team works with her to identify her concerns and to tailor support through evidencebased pathways to help her prepare mentally and physically (e.g., optimizing her diet, activity and medical conditions), which help ease her worry.She uses a customized tablet-based Enhanced Recovery app to track her symptoms and to know when to eat and drink at all times on her surgical journey.After surgery, she knows what to expect and is ready to move and eat the very same day.She has less nausea and pain than she expected.Mrs. Lee is discharged from hospital only 4 days post-surgery.She continues to use her Enhanced Recovery app and has regular follow-ups, which alleviate her anxiety.Six weeks later, she says she feels ready to start chemotherapy.The surgery team tracks her symptoms, uses appropriate pain and symptom control to optimize her recovery and encourages her to move, avoiding the muscle wasting, weakness and frailty that are a consequence of immobilization.This scenario is a far cry from the present state in Canada.In reality, Mrs. Lee suffered terribly from anxiety and a lack of empowerment.Her pre-surgical period was rife with inconsistent patient information and optimization strategies.She stayed 10 days in hospital and waited 4 weeks for results.Her doctor was equally upset by the gaps in care and unnecessary costs that she felt she was unable to change.The health authority recognized the value of adopting evidence-based practices but had difficulty spreading the implementation of best practices and scaling them up without first addressing buy-in among stakeholders. Enhanced Recovery After SurgeryEnsuring the best outcomes for Mrs. Lee and patients like her led to Enhanced Recovery After Surgery (ERAS).ERAS consists of evidence-based care pathways "designed to achieve early recovery after surgical procedures by maintaining Accelerating Post-Surgical Best Practices Using Enhanced Recovery After Surgery

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame machine prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.

metaresearch head score (Codex)0.010
metaresearch head score (Gemma)0.039
Version: metacan-v3-hybrid-931329e0061cValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: none
GenreCandidate signal: Methods · Consensus signal: none
Teacher disagreement score0.012
Threshold uncertainty score0.050

Distilled classifier scores by category (both heads)

CategoryCodexGemma
Metaresearch0.0100.039
Meta-epidemiology (narrow)0.0010.000
Meta-epidemiology (broad)0.0010.002
Bibliometrics0.0020.001
Science and technology studies0.0020.001
Scholarly communication0.0050.004
Open science0.0020.007
Research integrity0.0010.003
Insufficient payload (model declined to judge)0.0120.005

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.095
GPT teacher head0.356
Teacher spread0.261 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreMethods

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations4
Published2020
Admission routes3
Has abstractyes

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