Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Intermediate-term outcome of placement of Baerveldt glaucoma implant for refractory glaucoma in a Malaysian population

Objective: To report baseline characteristics and surgical outcomes of placement of Baerveldt glaucoma implant (BGI) in Asian eyes with considerably elevated intraocular pressure (IOP) despite maximal medical therapy.&#x0D; Design: Retrospective case series of surgical cases from a single surgeon. Retrospective review of medical records of last clinic visits.&#x0D; Participants: One hundred and ninety-seven eyes of patients underwent placement of 350-mm2 Baerveldt implant.&#x0D; Methods: The medical records of consecutive patients who underwent placement of a Baerveldt 350-mm2 glaucoma drainage device (GDD) at the International Specialist Eye Centre from 2007 to 2014 were reviewed. Patients with a minimum 1-year follow-up were included. Baseline characteristics, pre-operative and post-operative IOP, number of glaucoma medications, visual acuity (VA) and complications were recorded. The pre-operative IOP is compared with the IOP at 1, 2, 3 and 5 years.&#x0D; Measures: The IOP, VA, supplemental medical therapy, complications and success and failures were recorded.&#x0D; Results: One hundred and ninety-seven patients were followed up at 1-year post-operation, 157 patients at 2 years, 120 at 3 years and 37 at 5 years. The mean baseline IOP of 29.2 ± 10.6 mmHg was significantly reduced at all time points post-operatively. Mean number of glaucoma medications was significantly lower at last follow-up than pre-operatively (1.8 vs. 2.7).&#x0D; Conclusions: Placement of GDDs effectively reduces IOP without much long-term complication and may be useful in glaucomatous eyes with considerably elevated pre-operative IOP not well controlled with maximal medical therapy in the Asian population.</jats:p

Cross-Sectional Study Of The Association Between Skin Tags And Vascular Risk Factors In A Bariatric Clinic-Based Cohort Of Irish Adults With Morbid Obesity

Abstract Objective: Skin tags are associated with an insulin resistant phenotype but studies in White Europeans with morbid obesity are lacking. We sought to determine whether the presence of cervical or axillary skin tags was associated with increased cardiovascular risk in Irish adults with morbid obesity. We conducted a cross-sectional study of patients attending our Irish regional bariatric centre with a BMI ≥40 kgm-2(or ≥35 kgm-2 with co-morbidities). We compared anthropometric and metabolic characteristics in those with versus without skin tags. Results: Of 164 patients, 100(31 male, 37 with type 2 diabetes, 36 on lipid lowering therapy, 41 on antihypertensive therapy) participated. Mean age was 53.7±11.3 (range 31.1-80)years. Cervical or axillary tags were present in 85 patients. Those with tags had higher systolic blood pressure 138.0±16.0 versus 125.1±8.3 mmHg, p=0.003) and HbA1c(46.5±13.2 versus 36.8±3.5 mmol/mol, p=0.017). Tags were present in 94.6% of patients with diabetes, compared to 79.4% of those without diabetes(p=0.039). Antihypertensive therapy was used by 45.8% of patients with skin tags compared to 13.3% without tags (p=0.018). In bariatric clinic attenders skin tags were associated with higher SBP and HbA1c and a higher prevalence of diabetes and hypertension, consistent with increased vascular risk, but lipid profiles were similar.</jats:p

Adverse events associated with minimally invasive glaucoma surgeries (MIGS) including bleb-forming microstent surgeries

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To obtain a comprehensive review of harms following MIGS reported in randomised and non-randomised studies, clinical study reports submitted to regulatory organisations for approval or postmarketing surveillance and registries. We will also examine the design characteristics, risk of bias, and reporting adequacy of pivotal MIGS trials submitted to the US and EU regulatory organisations regarding harms reporting and analyses

A Cross-Sectional Study Of The Association Between Skin Tags And Vascular Risk Factors In Patients With Severe And Complicated Obesity

Abstract Objective: We sought to determine whether the presence of cervical or axillary skin tags was associated with an adverse cardiovascular risk profile in Irish adults with severe obesity. Results: We conducted a cross-sectional study of patients attending our regional bariatric centre. Of 167 patients, 100 (31% male, 37% with type 2 diabetes, 36% on lipid lowering therapy, 41% on antihypertensive therapy) agreed to participate. 85 patients had cervical or axillary tags while 15 had none. Those with any skin tags had higher systolic blood pressure (138.0±16.0 versus 125.1±8.3 mmHg, p=0.003) and higher glycated haemoglobin (HbA1c) (46.5±13.2 versus 36.8±3.5 mmol/mol, p=0.017). 94.6% of patients with diabetes, compared to 79.4% of those without diabetes had skin tags (p=0.039). 45.8% of patients with skin tags compared to 13.3% with no tags were on antihypertensive therapy (p=0.018). Skin tags were not associated with any differences in lipid profiles. In Irish adults with severe obesity, skin tags are associated with higher systolic blood pressure and HbA1c and a higher prevalence of diabetes and hypertension, consistent with increased vascular risk, though differences in lipid profiles were not found.</jats:p

Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis

A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). On admission, he was tachycardic, tachypnoeic and drowsy with a Glasgow Coma Scale (GCS) of 10/15. We noted axillary acanthosis nigricans and obesity (BMI 33.2 kg/m(2)). Dipstick urinalysis showed ketonuria and glycosuria. Blood results were consistent with diabetic ketoacidosis (DKA), with hyperosmolar state. We initiated our DKA protocol, with intravenous insulin, fluids and potassium, and we discontinued risperidone. His obesity, family history of T2DM, acanthosis nigricans and hyperosmolar state prompted consideration of T2DM presenting with 'ketosis-prone diabetes' (KPD) rather than T1DM. Antibody markers of beta-cell autoimmunity were subsequently negative. Four weeks later, he had modified his diet and lost weight, and his metabolic parameters had normalised. We reduced his total daily insulin dose from 35 to 18 units and introduced metformin. We stopped insulin completely by week 7. At 6 months, his glucometer readings and glycated haemoglobin (HbA1c) level had normalised

Additional file 1 of Cross-sectional study of the association between skin tags and vascular risk factors in a bariatric clinic-based cohort of Irish adults with morbid obesity

Additional file 1: Table S1. Anthropometric and metabolic characteristics for adults comparing both axillary and cervical skin tags versus none. Table S2. Anthropometric and metabolic characteristics for adults comparing axillary skin tags versus those with no axillary skin tags. Table S3. Anthropometric and metabolic characteristics for adults comparing cervical skin tags versus those with no cervical skin tags