Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

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

Normas internacionales de auditoría

El Instituto Mexicano de Contadores Públicos, el cual es miembro de la International Federation of Accountants (IFAC), adquirió el compromiso de adoptar las Normas Internacionales de Auditoría para las auditorías de estados financieros, cuyos ejercicios contables inicien a partir del 1 de enero de 2012, con motivo de estas nuevas reformas a la ley, desaparecerá lo que anteriormente se reconocía como Normas de Auditoría Generalmente Aceptadas

Las Izquierdas Latinoamericanas

Este libro recoge lo más sobresaliente del Seminario Internacional Las izquierdas latinoamericanas: sus trayectorias nacionales y relaciones internacionales durante el siglo XX, actividad convocada por la Cátedra Antonio Gramsci del Instituto Cubano de Investigación Cultural Juan Marinello (La Habana, 14 al 16 de noviembre de 2016), concurriendo a la cita participantes del Instituto de Historia de Cuba, la Universidad de Santiago de Chile, la Universidad Nacional Autónoma de México, del Instituto de Ciencias Sociales de la Universidad Federal de Uberlandia (Brasil), y de la Red Iberoamericana de Historiadores del siglo XX. En las cuatro partes de esta entrega, se pasa revista a los elementos principales de la exposición y los debates acaecidos, reflejándose en todo momento la necesidad de replanteamientos y de nuevos desarrollos que, a la luz de su pasado reciente, desafían hoy a nuestras Izquierdas en toda la regiónA mi compañero Elías, Vencido por la muerte, en los mismos momentos en que mis colegas debatían sobre las izquierdas Por su ayuda y apoyo de siempre a todos mis proyectos Por su recuerdo en mi corazón y en el de nuestros hijos