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

Spontaneous Bilateral Lumbar Region Colocutaneous Fistulae: A Case Report

Bilateral spontaneous lumbar colocutaneous fistulae are rare. They are associated with high costs of care, morbidity, and mortality. We present the case of a 50- year-old male patient who presented with a 10-year history of two low-output spontaneous colocutaneous fistulae from both the left and right lower lumbar regions with no identifiable risk factors. He was managed operatively with segmental left colon resection and a temporary loop ileostomy with uneventful recovery after reversal of the ileostomy 2 months later. Whether the etiology of the fistulae is clinically apparent or not, the management should follow commonly known principles. This report highlights a case of bilateral lumbar region spontaneous colocutaneous fistulae of unknown cause that was managed operatively with satisfactory short-term outcomes

Chaff Cutter Hand Injuries from Nakuru,Kenya.

   We conducted a retrospective descriptive study on patients presenting with chaff-cutter hand injuries. The study was done from Nakuru County, in Kenya. We collected data for all patients who presented and were managed from Nakuru Level V Hospital during period starting July 2019 through June 2020. The case notes for the patients were retrieved from patients’ records and from the register of operations in the operating room. The patients’ biodata, type of injury and the surgical procedure performed were obtained. We included all injuries in all volar zones of the hand and used the Hand Injury Severity Score (HISS) to assign a HISS score for every patient. An enquiry was then made through a telephone call to the patients or their caretakers, a year after the month of hospital discharge, collecting data on whether the patient had resumed gainful activity</p

Advancements in the Analysis of Sobolev Spaces and Function Spaces on Manifolds: Theoretical Framework and Applications

This research paper delves into Sobolev spaces and function spaces on smooth manifolds, revealing fundamental theorems such as existence, embeddings, and compactness properties. Noteworthy results include the Poincare inequality elucidating function behavior on compact manifolds and compactness properties of Sobolev spaces on Riemannian manifolds. The study establishes trace theorems for functions on the boundary and interpolation results between Sobolev spaces. Isoperimetric inequalities and stability under weak convergence contribute to a holistic understanding of geometric and analytical aspects of Sobolev spaces. The research concludes by exploring invariance under diffeomorphisms and compactness in dual spaces, providing a unified framework for analyzing function spaces on manifolds

CHARACTERISTICS OF CHRONIC LEG ULCERS AMONG PATIENTS FROM NAKURU, KENYA AND THEIR ASSOCIATED QUALITY OF LIFE.

 We carried out a descriptive cross-sectional study at our facility, Nakuru Level 5 Hospital, Kenya on patients with chronic leg ulcers undergoing care at our facility.  Quality of life data was collected with a self-administered questionnaire developed using the validated Short Form 36 Health Survey (SF-36) tool. . Scores of the SF-36 quality of life (QoL) questions were recorded.</p

Young-IFSO Bariatric/Metabolic Surgery Training and Education Survey

Background This international Young-IFSO survey aims to address variations, trends, and obstacles in bariatric/metabolic surgery (BMS) training globally, since expectations and resources differ among young surgeons.Methods The Young-IFSO scientific team designed an online confidential questionnaire with 50 questions analyzing the individual BMS training. The survey link was sent to all IFSO/ASMBS members and was shared in social media. All Young-IFSO members (age up to 45 years) were invited to participate between 16 December 2022 and 4 February 2023.Results A total of 240 respondents from 61 countries took the survey. Most respondents (70.24%) described their current position as a consultant surgeon with an average of 5.43 years' experience working in BMS, and 55% are working in a bariatric center of excellence. More than 50% of the respondents performed none or less than 10 BMS during residency. Preparation of the stomach and stapling during sleeve gastrectomy (SG) were the first steps performed, and SG was the first BMS completed as a first operating surgeon by most of the respondents (74%). In total, 201 (84.45%) surgeons reported to perform scientific work. Most respondents (90.13%) reported that surgical mentorship had improved their surgical skills.Conclusion This international experts' survey underlines the lack of a standardized global surgical curriculum of BMS during residency. It shows that SG is the single most performed procedure by young surgeons. These data might underline the importance of advancing surgical education in BMS, and accredited fellowship programs should be offered globally to maintain and raise quality of BMS