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Surgical frailty assessment: a missed opportunity.

ABSTRACT: Preoperative frailty predicts adverse postoperative outcomes. Despite the advantages of incorporating frailty assessment into surgical settings, there is limited research on surgical healthcare professionals' use of frailty assessment for perioperative care.Healthcare professionals caring for patients enrolled at a Canadian teaching hospital were surveyed to assess their perceptions of frailty, as well as attitudes towards and practices for frail patients. The survey contained open-ended and 5-point Likert scale questions. Responses were compared across professions using independent sample t-tests and correlations between survey items were analyzed.Nurses and allied health professionals were more likely than surgeons to think frailty should play a role in planning a patient's care (nurses vs. surgeons p?=?0.008, allied health vs. surgeons p?=?0.014). Very few respondents (17.5%) reported that they 'always used' a frailty assessment tool. Results from qualitative data analysis identified four main barriers to frailty assessment: institutional, healthcare system, professional knowledge, and patient/family barriers.Across all disciplines, the lack of knowledge about frailty issues was a prominent barrier to the use of frailty assessments in practice, despite clinicians' understanding that frailty affects their patients' outcomes. Confidence in frailty assessment tool use through education and addressing barriers to implementation may increase use and improve patient care. Healthcare professionals agree that frailty assessments should play a role in perioperative care. However, few perform them in practice. Lack of knowledge about frailty is a key barrier in the use of frailty assessments and the majority of respondents agreed that they would benefit from further training.

SUBMITTER: Eamer G

PROVIDER: S-EPMC5525360 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Surgical frailty assessment: a missed opportunity.

Eamer Gilgamesh G Gibson Jennifer A JA Gillis Chelsia C Hsu Amy T AT Krawczyk Marian M MacDonald Emily E Whitlock Reid R Khadaroo Rachel G RG

BMC anesthesiology 20170724 1

<h4>Background</h4>Preoperative frailty predicts adverse postoperative outcomes. Despite the advantages of incorporating frailty assessment into surgical settings, there is limited research on surgical healthcare professionals' use of frailty assessment for perioperative care.<h4>Methods</h4>Healthcare professionals caring for patients enrolled at a Canadian teaching hospital were surveyed to assess their perceptions of frailty, as well as attitudes towards and practices for frail patients. The ...[more]

PMID: 28738809

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Project description:RationaleBiological studies are conducted at ever-increasing rates by relying on proteomic workflows. Although data acquisition by mass spectrometry is highly automated and rapid, sample preparation continues to be the bottleneck of developing high-throughput workflows. Enzymatic protein processing, in particular, involves time-consuming protocols that can extend from one day to another. To address this gap, we developed and evaluated simple, in-solution tryptic enzymatic reactions that unfold within a few minutes, and demonstrate the utility of the methodology for the rapid analysis of proteins originating from cancer cell extracts.MethodsTryptic enzymatic reactions were conducted for 7-60 min, and the results were compared with that of a routine approach conducted for 18 h. No other reaction conditions were changed relative to the 18 h procedure. The reaction products were analyzed by nanospray high-performance liquid chromatography/tandem mass spectrometry (nano-HPLC/MS/MS), and the quality of the products was assessed in terms of peptide/protein identifications, sequence coverage, peptide length, missed-cleavage sites, quality of generated ions, and peptide hydrophilic/hydrophobic properties.ResultsThe results demonstrate that brief, and therefore incomplete, enzymatic processes lead to a large number of peptide fragments that improve protein sequence and proteome coverage, that the tandem mass spectra produced from these peptides are of high quality for reliable protein identifications, and that the physical properties of peptides are prone to supporting the development of alternative multi-dimensional separations and middle-down proteomics analysis strategies. The reproducibility of generating the same peptides within a few minutes of enzymatic digestion was remarkably close to that obtained from 18 h long reactions, and the combined results of short and long reactions increased proteome coverage by ~40%.ConclusionsWe demonstrate that partial enzymatic reactions conducted on short time-scales represent a valuable asset to proteomic studies, and propose their implementation either as simple, cost-effective, stand-alone protocols for substantially streamlining the analysis of biological samples, or as complementary protocols, for improving protein sequence and proteome coverage.

Dataset Information

Surgical frailty assessment: a missed opportunity.

Publications

Surgical frailty assessment: a missed opportunity.

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