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Abstract Background Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are associated with major morbidity and mortality after surgery. This systematic review and meta-analysis determined whether preoperative cognitive training could reduce POD and POCD in patients undergoing elective surgery. Methods Eligible randomized controlled trials were identified from CENTRAL, MEDLINE, EMBASE, Scopus, Web of Science, and CINAHL databases from inception to April 30, 2024. Two independent reviewers extracted data on trial characteristics and risk of bias for each trial. We rated the quality of reporting of cognitive training interventions using the template for intervention description and replication (TIDieR) and evaluated the overall certainty (quality) of evidence using The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Random-effects models were used to summarize the treatment effect of cognitive training. Post hoc trial sequential analyses (TSA) were performed for POD and POCD to differentiate between “no evidence of effect” and “evidence of no effect.” Results Seven trials (four high risk and three unclear risk of bias) involving 864 participants (mean or median age between 66 and 73 years old) were considered eligible and subject to meta-analysis. The quality of reporting cognitive training interventions was fair to moderate. Most cognitive prehabilitation programs were home-based, unsupervised, computerized interventions requiring 2.3–10 h over 1–4 weeks before surgery. Cognitive prehabilitation did not reduce POD (risk ratio [RR] 0.82, 95% confidence interval [CI] 0.57–1.18; I 2 = 30%; low certainty of evidence in five trials) or early POCD after surgery (RR 0.93, 95% CI 0.58–1.49; I 2 = 67%; very low certainty of evidence in four trials) compared to usual care. Nonetheless, TSA suggested that the sample sizes were insufficient to exclude the effectiveness of preoperative cognitive training in reducing POD or POCD. The participants’ compliance rate was either not reported or mostly below 70%. Conclusions Current evidence is insufficient to determine the beneficial effect of preoperative cognitive training on POD or POCD. Given the well-established benefits of long-term cognitive training on cognition in the elderly, the design of future cognitive prehabilitation trials should be adequately powered and incorporated with strategies to improve patient compliance.

Objectives This study aimed to investigate the impact of COVID-19 on the training of anesthesiologists in Hong Kong. Introduction COVID-19 has caused a substantial impact on anesthesiology training in multiple domains. The challenges faced by both trainees and educators remain a significant concern and adaptations in clinical teaching are warranted. We conducted this study to quantify the impact and identify learning areas in recurring pandemics. Methods Electronic surveys were distributed to anesthesiology trainees and fellows in Hospital Authority in Hong Kong. Data from respondents were collated and analyzed. Reliability analysis and exploratory factor analysis (EFA) were performed. Results A total of 97 responses were collected and analyzed. Majority (59% of trainees and 79% of fellows) agreed that the COVID-19 pandemic negatively impacted anesthesia training overall. Bag-mask ventilation and direct laryngoscopy were the 2 most affected areas in airway training; 47% of fellows observed a technical skill decline among trainees. Most respondents (64% of trainees and 71% of fellows) agreed that simulation sessions could help with residents’ training. Exploratory factor analysis indicated the following subscales: loss of educational opportunities, loss of caseload and formal training, loss of technical skills (regional and procedural), loss of technical skills (airway management), the hampering of ICU rotations, and difficulty teaching residents. Conclusion The COVID-19 pandemic has caused disruptions in caseload, technical skills training, work-based assessment, and continued medical education, hampering both trainees’ and fellows’ education. Measures to counter the effect of the pandemic were discussed. Our findings will help educators better understand the challenges, marshal resources, and plan to enhance trainees’ educational experience.

OBJECTIVES: This study aimed to investigate the impact of COVID-19 on the training of anesthesiologists in Hong Kong. INTRODUCTION: COVID-19 has caused a substantial impact on anesthesiology training in multiple domains. The challenges faced by both trainees and educators remain a significant concern and adaptations in clinical teaching are warranted. We conducted this study to quantify the impact and identify learning areas in recurring pandemics. METHODS: Electronic surveys were distributed to anesthesiology trainees and fellows in Hospital Authority in Hong Kong. Data from respondents were collated and analyzed. Reliability analysis and exploratory factor analysis (EFA) were performed. RESULTS: A total of 97 responses were collected and analyzed. Majority (59% of trainees and 79% of fellows) agreed that the COVID-19 pandemic negatively impacted anesthesia training overall. Bag-mask ventilation and direct laryngoscopy were the 2 most affected areas in airway training; 47% of fellows observed a technical skill decline among trainees. Most respondents (64% of trainees and 71% of fellows) agreed that simulation sessions could help with residents' training. Exploratory factor analysis indicated the following subscales: loss of educational opportunities, loss of caseload and formal training, loss of technical skills (regional and procedural), loss of technical skills (airway management), the hampering of ICU rotations, and difficulty teaching residents. CONCLUSION: The COVID-19 pandemic has caused disruptions in caseload, technical skills training, work-based assessment, and continued medical education, hampering both trainees' and fellows' education. Measures to counter the effect of the pandemic were discussed. Our findings will help educators better understand the challenges, marshal resources, and plan to enhance trainees' educational experience. [ABSTRACT FROM AUTHOR]