Surgical outcomes and quality of life following exercise-based prehabilitation for hepato-pancreatico-biliary surgery:A systematic review and meta-analysis

Background:Hepato-pancreatico-biliary(HPB)patients experience significant risk of preoperative frailty.Studies assessing preventative prehabilitation in HPB populations are limited.This systematic review and meta-analysis evaluates outcomes for HPB patients treated with exercise prehabilitation.Data sources:A comprehensive search of MEDLINE(via Ovid),Embase(Ovid),Scopus,Web of Science Core Collection,Cochrane Library(Wiley),Pro Quest Dissertations,Theses Global,and Google Scholar was conducted with review and extraction following PRISMA guidelines.Included studies evaluated more than 5 adult HPB patients undergoing≥7-day exercise prehabilitation.The primary outcome was postoperative length of stay(LOS);secondary outcomes included complications,mortality,physical performance,and quality of life.Results:We evaluated 1778 titles and abstracts and selected 6(randomized controlled trial,n=3;prospective cohort,n=1;retrospective cohort,n=2)that included 957 patients.Of those,536 patients(56.0%)underwent exercise prehabilitation and 421(44.0%)received standard care.Patients in both groups were similar with regards to important demographic factors.Prehabilitation was associated with a 5.20-day LOS reduction(P=0.03);when outliers were removed,LOS reduction decreased to 1.85 days and was non-statistically significant(P=0.34).Postoperative complications(OR=0.70;95%CI:0.39 to 1.26;P=0.23),major complications(OR=0.83;95%CI:0.60 to 1.14;P=0.24),and mortality(OR=0.67;95%CI:0.17 to 2.70;P=0.57)were similar.Prehabilitation was associated with improved strength,cardiopulmonary function,quality of life,and alleviated sarcopenia.Conclusions:Exercise prehabilitation may reduce LOS and morbidity following HPB surgery.Studies with well-defined exercise regimens are needed to optimize exercise prehabilitation outcomes.

Cardiovascular rehabilitation in patients aged 70-year-old or older:benefits on functional capacity,physical activity and metabolic profile in younger vs.older patients

Background The benefits of exercise-based cardiac rehabilitation(EBCR)programs in post-acute myocardial infarction(AMI)patients have been demonstrated.Our aim was to assess the impact of EBCR in³70-years-old vs.younger post-AMI patients.Methods We retrospectively evaluated patients who underwent a supervised EBCR protocol,twice a week during 6-12 weeks.We evaluated changes in several outcomes based on pre-and post-CRP assessments.Results Of a total of 1607 patients,333(21%)were³70-years-old.After the EBCR,an overall improvement on functional capacity,daily physical activity,lipid profile,body mass index,glycated hemoglobin(HbA1c),N-terminal pro-brain natriuretic peptide(NT-pro-BNP)and C-reactive protein was observed in both younger and older patients(P<0.05).Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement,but a larger reduction in NT-pro-BNP.In the multivariate analysis,only improvements on daily physical activity and HbA1c were dependent on age.Conclusion As their younger counterparts,older patients,significantly improved functional capacity,metabolic parameters and level of daily physical activity after EBCR.

How Should Oral Skills be Taught in the English Language Classroom

There is general agreement today that the communicative approach to the teaching and learning of English is the correct one and that we learn English for the purpose of communicating with other English-speakers. However, this is a comparatively recent development. This paper begins with an historical overview outlining the origins of the communicative approach in Europe and the United States and noting that they arrived at a consensus for entirely different historical reasons. In China English replaced Russian as the most important foreign language a generation ago but even then the emphasis was on receptive skills. The thorny question of authenticity is then discussed. While everyone agrees that in theory authenticity is a key consideration there is considerably less agreement on how to convert theory into practice. Finally the paper goes on to note how recent practice has abandoned the teacher-centered approach in favor of the learner-centered approach and the exercise-based approach in favor of the task-based approach, The task-based approach emphasizes integrated as opposed to individual skills acquisition. Examples of integrated tasks are given in the Appendix.