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

Propuesta de metodología para el aprendizaje mediante el uso de blogs educativos en la carrera de ingeniería informática de la UPIICSA

TESIS IF2.5

Itálica : tiempo y paisaje

253 páginas.Dos argumentos tan poderosos y sugestivos como el tiempo y el paisaje han impulsado la realización del Seminario Internacional sobre Itálica, entre el 26 de septiembre y el 1 de octubre de 2010. Para arquitectos y arqueólogos ha sido una extraordinaria oportunidad de profundizar en las relaciones entre las disciplinas más directamente involucradas en la conservación, la protección, la restauración y la gestión de los sitios arqueológicos: la Arqueología y la Arquitectura. Dos argumentos las vinculan inevitablemente: el tiempo, entendido como memoria, como rica acumulación de huellas y de saberes de la historia, y el paisaje, que es forma y expresión de una cultura en el territorio. Paisaje que entendemos como una realidad compleja en la que podemos rastrear el espesor de la acción humana a lo largo de los siglos. La obra consta de dos partes: I. Seminario científico sobre Arquitectura y Arquelogía, que incluye diversas ponencias que son desglosadas en esta descripción. II. Taller Internacional de Proyectos. A. Esther Mayoral y Gabriel Bascones. B. Marco D'Annutis y Libero Carlo Palazzolo. C. Antonio Tejedor y Mauro Marzo. D. José Enrigue López-Cani y Félix de la Iglesia. E. Mercedes Linares y Francisco Pinto. F. Andrés López y María García de Casasola. G. Gianluigi Mondalini y Rita Simone. H. Mar Loren y José Pérez de Lama. I. Gernot Schulz y Luis Ridao. J. Francisco Reina y Claudia Zavalet

Influence of the length of hospitalisation in post-discharge outcomes in patients with acute heart failure: Results of the LOHRCA study.

To investigate the relationship between length of hospitalisation (LOH) and post-discharge outcomes in acute heart failure (AHF) patients and to ascertain whether there are different patterns according to department of initial hospitalisation. Consecutive AHF patients hospitalised in 41 Spanish centres were grouped based on the LOH (15 days). Outcomes were defined as 90-day post-discharge all-cause mortality, AHF readmissions, and the combination of both. Hazard ratios (HRs), adjusted by chronic conditions and severity of decompensation, were calculated for groups with LOH >6 days vs. LOH 6 days vs. LOH We included 8563 patients (mean age: 80 (SD = 10) years, 55.5% women), with a median LOH of 7 days (IQR 4-11): 2934 (34.3%) had a LOH 15 days. The 90-day post-discharge mortality was 11.4%, readmission 32.2%, and combined endpoint 37.4%. Mortality was increased by 36.5% (95%CI = 13.0-64.9) when LOH was 11-15 days, and by 72.0% (95%CI = 42.6-107.5) when >15 days. Conversely, no differences were found in readmission risk, and the combined endpoint only increased 21.6% (95%CI = 8.4-36.4) for LOH >15 days. Stratified analysis by hospitalisation departments rendered similar post-discharge outcomes, with all exhibiting increased mortality for LOH >15 days and no significant increments in readmission risk. Short hospitalisations are not associated with worse outcomes. While post-discharge readmissions are not affected by LOH, mortality risk increases as the LOH lengthens. These findings were similar across hospitalisation departments