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

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

Challenges of the Nigerian agricultural extension of the 21st century

Meaningful agricultural development in any society largely hinges on the Extension System in place. The developed economics such as the United States of America have evolved, over time, highly workable extension systems. In spite of this, extension is seen as a dynamic process which requires regular modifications in order to make it relevant in a constantly changing technological world. In Nigeria, much of our extension activities are borrowed from alien technologies, and there are lots of deficiencies. There is need to get Extension going in order to attempt to catch up in the next century

Factors Constraining Farmers Use of Improved Cowpea Technologies in Bauchi and Gombe States of Nigeria

This paper investigated major factors constraining the use of improved cowpea technologies among farmers in Bauchi and Gombe states of Nigeria. A structured interview schedule was used to collect data from a randomly selected sample of 130 farmers. Data were factor analyzed using the principal factor model with iteration and varimax rotation. The results show that land and labour problems, marketing problems, poor technical information, cultural incompatibility, high cost of farm inputs and unavailability of necessary inputs were the major factors constraining the use of improved cowpea technologies in the area. These findings suggest that there is an urgent need for researchers, policy makers and administrators of extension service to consider these factors seriously, if increased cowpea production is to be achieved by farmers in the area. Keywords: Cowpea, technologies, Bauchi, Gomb

Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trial

Objective: The objective of this study was to compare short-and midterm clinical and echocardiographic outcomes according to the use of pledgeted sutures during aortic valve replacement.Methods: Patients with aortic stenosis or regurgitation requiring aortic valve replacement were enrolled in a prospective cohort study to evaluate the safety of a new stented bioprosthesis. Outcomes were analyzed according to the use of pledgets (pledgeted group) or no pledgets (nonpledgeted group). The primary outcome was a composite of thromboembolism, endocarditis, and major paravalvular leak at 5 years of follow-up. Secondary outcomes included multiple clinical end-points and hemodynamic outcomes. Propensity score matching was performed to adjust for prognostic factors, and subanalyses with small valve sizes (< 23 mm) and suturing techniques were performed.Results: The pledgeted group comprised 640 patients (59%), and the nonpledgeted group 442 (41%), with baseline discrepancies in demographic characteristics, comorbidities, and stenosis severity. There were no differences between groups in any outcome. After propensity score matching, the primary outcome occurred in 41 (11.7%) patients in the pledgeted and 36 (9.8%) in the nonpledgeted group (P = .51). The effective orifice area was smaller in the pledgeted group (P = .045), whereas no difference was observed for the mean or peak pressure gradient. Separate subanalyses with small valve sizes and suturing techniques did not show relevant differences.Conclusions: In this large propensity score-matched cohort, comprehensive clinical outcomes were comparable between patients who underwent aortic valve replacement with pledgeted and nonpledgeted sutures up to 5 years of follow-up, but pledgets might lead to a slightly smaller effective orifice area in the long run

Pledgeted versus nonpledgeted sutures in aortic valve replacement: Insights from a prospective multicenter trial

Objective: The objective of this study was to compare short-and midterm clinical and echocardiographic outcomes according to the use of pledgeted sutures during aortic valve replacement.Methods: Patients with aortic stenosis or regurgitation requiring aortic valve replacement were enrolled in a prospective cohort study to evaluate the safety of a new stented bioprosthesis. Outcomes were analyzed according to the use of pledgets (pledgeted group) or no pledgets (nonpledgeted group). The primary outcome was a composite of thromboembolism, endocarditis, and major paravalvular leak at 5 years of follow-up. Secondary outcomes included multiple clinical end-points and hemodynamic outcomes. Propensity score matching was performed to adjust for prognostic factors, and subanalyses with small valve sizes (< 23 mm) and suturing techniques were performed.Results: The pledgeted group comprised 640 patients (59%), and the nonpledgeted group 442 (41%), with baseline discrepancies in demographic characteristics, comorbidities, and stenosis severity. There were no differences between groups in any outcome. After propensity score matching, the primary outcome occurred in 41 (11.7%) patients in the pledgeted and 36 (9.8%) in the nonpledgeted group (P = .51). The effective orifice area was smaller in the pledgeted group (P = .045), whereas no difference was observed for the mean or peak pressure gradient. Separate subanalyses with small valve sizes and suturing techniques did not show relevant differences.Conclusions: In this large propensity score-matched cohort, comprehensive clinical outcomes were comparable between patients who underwent aortic valve replacement with pledgeted and nonpledgeted sutures up to 5 years of follow-up, but pledgets might lead to a slightly smaller effective orifice area in the long run.Thoracic Surger