Digital health interventions have shown promise in improving patient outcomes and experiences in various healthcare settings. However, their effectiveness in the context of cardiac surgery remains uncertain. This systematic review aims to evaluate the existing evidence on the use of digital health interventions for patients undergoing cardiac surgery. A comprehensive search of PubMed MEDLINE, Elsevier EMBASE, Elsevier Scopus databases, and ClinicalTrials.gov was conducted to identify relevant studies published up to the present. Studies that examined the effects of digital health interventions, including mobile applications and web-based interventions, on perioperative care and patient outcomes in cardiac surgery were included. The data were extracted and synthesized to provide a comprehensive overview of the findings. The search yielded 15 studies composed of 4041 patients, analyzing the feasibility and implementation of mobile or internet applications for patients undergoing cardiac surgery. The studies included the use of mobile applications (ManageMySurgery, SeamlessMD, mHeart, Telediaglog, ExSed, Soulage Tavie, Heart Health application, and Mayo Clinic Health Connection) and web-based interventions (Heartnet and Active Heart). The findings indicated that these digital health interventions were associated with improved patient engagement, satisfaction, and reduced healthcare utilization. Patients reported finding the interventions helpful in their recovery process, and there was evidence of enhanced symptom monitoring and timely intervention. The completion rates of modules varied depending on the phase of care, with higher engagement observed during the acute phase. Interest in using digital health applications was expressed by patients, regardless of age, gender, or complexity of the cardiac defect. The results demonstrated that web-based interventions resulted in improvements in mental health, quality of life, and eHealth literacy. This systematic review highlights the potential benefits of digital health interventions in the context of cardiac surgery. Further research, including randomized controlled trials, is needed to establish the effectiveness, feasibility, and generalizability of digital health interventions in cardiac surgery.

BACKGROUND: Patients with inflammatory bowel disease may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. The question of the impact of biologic use on postoperative complications is a topic of active investigation. OBJECTIVE: A systematic literature review was performed to describe the current state of knowledge of the impact of perioperative biologic and tofacitinib use on postoperative complications in patients with inflammatory bowel disease. DATA SOURCES: PubMed and Cochrane databases were searched. STUDY SELECTION: Studies between January 2000 and January 2023, in any language, were searched, followed by a snowball search identifying further studies, in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Articles regarding pediatric or endoscopic management were excluded. INTERVENTIONS: Preoperative or perioperative exposure to biologics in inflammatory bowel disease was included. MAIN OUTCOME MEASURES: Infectious and noninfectious complications, including anastomotic leaks, surgical site infections, urinary tract infections, pneumonia, sepsis, septic shock, postoperative length of stay, readmission, and reoperation, were the main outcomes measured. RESULTS: A total of 28 studies were included for analysis in this review, including 7 meta-analyses or systematic reviews, and 5 randomized studies. Snowball search identified 11 additional studies providing topical information. Overall, tumor necrosis factor inhibitors likely do not increase risk of postoperative adverse outcomes, while data on other biologics and small molecule agents are emerging. LIMITATIONS: This is a qualitative review including all study types. The varied nature of study types precludes quantitative comparison. CONCLUSIONS: Although steroids increase postoperative infectious and noninfectious complications, tumor necrosis factor inhibitors do not appear to increase postoperative infectious and non-infectious complications. There is a need for further perioperative data for other agents. See Video.

Rheumatoid arthritis (RA) is associated with increased cardiometabolic risk due to inflammation and traditional risk factors, both of which can be mitigated by lifestyle modifications. This study examines metabolic pathways influenced by lifestyle changes and related to improved cardiometabolic risk. This is a secondary exploratory analysis of the Supervised Weight loss and Exercise Training (SWET) study, in which twenty older adults with RA and overweight/obesity were randomized to 16 weeks of SWET or a counseling program. Baseline and post-intervention measures included mass spectrometry (MS) and nuclear magnetic resonance (NMR) metabolites and lipoproteins; cardiometabolic risk parameters; and RA clinical outcomes. Principal components analysis (PCA) reduced MS change scores into change factors. Between-group differences were assessed with t-tests and linear regression. Within-group differences were assessed with Wilcoxon-signed rank tests. Spearman’s rank correlated MS change factors and NMR change scores with clinical outcomes. Group differences were minimal. In all participants, improvements in metabolic syndrome score were associated with increases in PCA Factor 1 (short- and medium-chain acylcarnitines) and ketone bodies (ρ=-0.57, unadjusted p = 0.009, adjusted p = 0.04; ρ=-0.45, unadjusted p = 0.049, adjusted p = 1.00) and decreases in large low-density lipoprotein particles (LDLp) and large high-density lipoprotein particles (HDLp) (ρ = 0.48, unadjusted p = 0.03, adjusted p = 1.00; ρ = 0.48, unadjusted p = 0.03, adjusted p = 1.00). Improvements in RA disease activity (DAS-28ESR) were associated with reductions in very large triglyceride-rich lipoprotein particles (TRLp) (ρ = 0.60, unadjusted p = 0.01, adjusted p = 0.48). Improvements in patient-reported physical health were associated with reductions in HDL-c, ApoA1 concentrations, and medium HDLp (ρ=-0.50, unadjusted p = 0.03, adjusted p = 1.00; ρ=-0.47, unadjusted p = 0.04, adjusted p = 1.00; ρ=-0.45, unadjusted p = 0.047, adjusted p = 1.00). Improvements in patient-reported mental health were associated with decreases in high-density lipoprotein 6 (H6) particles (ρ=-0.60, unadjusted p = 0.03, adjusted p = 1.00), medium HDLp (ρ=-0.54, unadjusted p = 0.01, adjusted p = 0.48), and LDL size (ρ=-0.52, unadjusted p = 0.02, adjusted p = 0.96). In older adults with RA and overweight/obesity, both intensive supervised weight loss and exercise and lifestyle-based counseling influenced metabolic pathways, enhancing lipid metabolism (e.g., reductions in large LDLp) and metabolic flexibility (e.g., increases in fasting ketones and short- and medium-chain acylcarnitines). However, reductions in HDL-related measures should be interpreted cautiously as they may not reflect improved cardiometabolic risk. ClinicalTrials.gov, NCT04356183, 04/17/2020.

Experiencing patient loss is emotionally challenging for many medical students. This narrative reflects on the author's encounter with sudden patient loss and the complex emotions it evoked. The commentary underscores the need to prioritize emotional support for medical students dealing with patient loss. The author proposes ways to accomplish this, including equipping students with effective coping mechanisms, creating a supportive environment that encourages students to seek debriefing sessions, and incorporating debriefing sessions into clerkship curricula. By normalizing the emotional complexities of patient loss and fostering a culture of support, medical education can better prepare students to navigate the challenges of patient care with compassion and resilience.