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

An Update From the Pediatric Proton Consortium Registry

Background/objectives The Pediatric Proton Consortium Registry (PPCR) was established to expedite proton outcomes research in the pediatric population requiring radiotherapy. Here, we introduce the PPCR as a resource to the oncology community and provide an overview of the data available for further study and collaboration. Design/methods A multi-institutional registry of integrated clinical, dosimetric, radiographic, and patient-reported data for patients undergoing proton radiation therapy was conceived in May 2010. Massachusetts General Hospital began enrollment in July of 2012. Subsequently, 12 other institutions joined the PPCR and activated patient accrual, with the latest joining in 2017. An optional patient-reported quality of life (QoL) survey is currently implemented at six institutions. Baseline health status, symptoms, medications, neurocognitive status, audiogram findings, and neuroendocrine testing are collected. Treatment details of surgery, chemotherapy, and radiation therapy are documented and radiation plans are archived. Follow-up is collected annually. Data were analyzed 25 September, 2017. Results: A total of 1,854 patients have consented and enrolled in the PPCR from October 2012 until September 2017. The cohort is 55% male, 70% Caucasian, and comprised of 79% United States residents. Central nervous system (CNS) tumors comprise 61% of the cohort. The most common CNS histologies are as follows: medulloblastoma (n = 276), ependymoma (n = 214), glioma/astrocytoma (n = 195), craniopharyngioma (n = 153), and germ cell tumors (n = 108). The most common non-CNS tumors diagnoses are as follows: rhabdomyosarcoma (n = 191), Ewing sarcoma (n = 105), Hodgkin lymphoma (n = 66), and neuroblastoma (n = 55). The median follow-up is 1.5 years with a range of 0.14 to 4.6 years. Conclusion: A large prospective population of children irradiated with proton therapy has reached a critical milestone to facilitate long-awaited clinical outcomes research in the modern era. This is an important resource for investigators both in the consortium and for those who wish to access the data for academic research pursuits

Evolution of Proton Radiotherapy Brainstem Constraints on the Pediatric Proton/Photon Consortium Registry.

INTRODUCTION Increasing concern that brainstem toxicity incidence after proton radiotherapy (PRT) might be higher than with photons led to a 2014 XXXX (XX) landmark paper identifying its risk factors and proposing more conservative dose constraints. We evaluated how practice patterns changed among the XXXX (XXXX). METHODS This prospective multicenter cohort study gathered data from patients under age 22 enrolled on the XXXX, treated between 2002-2019 for primary posterior fossa brain tumors. After standardizing brainstem contours, we garnered dosimetry data and correlated those meeting the 2014 proton-specific brainstem constraint guidelines by treatment era, histology, and extent of surgical resection. RESULTS A total of 467 patients with evaluable PRT plans were reviewed. Median age was 7.1 years (range: <1-21.9), 63.0% (n=296) were male, 76.0% (n=357) were white, and predominant histologies were medulloblastoma (55.0%, n=256) followed by ependymoma (27.0%, n=125). Extent of resection was mainly gross total resection (GTR) (67.0%, n=312), followed by subtotal resection (STR) or biopsy (20.0%, n=92). The XX brainstem constraint metrics most often exceeded were the goal D50% of 52.4 GyRBE (43.3%, n=202) and maximal D50% of 54 GyRBE (12.6%, n=59). The compliance rate increased after the new guidelines (2002-2014: 64.0% vs. 2015-2019: 74.6%, p=0.02), except for ependymoma (46.3% pre vs. 50.0% post guidelines, p=0.86), presenting lower compliance (48.8%) in comparison to medulloblastoma/PNET/pineoblastoma (77.7%), glioma (89.1%), and ATRT (90.9%) (p<0.001). Degree of surgical resection did not affect compliance rates (GTR/NTR 71.0% vs. STR/biopsy 72.8%, p=0.45), even within the ependymoma subset (GTR/NTR 50.5% vs. STR/biopsy 38.1%, p=0.82). CONCLUSION Since the publication of the XX guidelines, the pediatric proton community has implemented more conservative brainstem constraints in all patients except those with ependymoma, irrespective of residual disease after surgery. Future work will evaluate if this change in practice is associated with decreased rates of brainstem toxicity

MetaP: Revisiting Privacy-Preserving Data Publishing using Secure Devices

International audienceThe goal of Privacy-Preserving Data Publishing (PPDP) is to gen- erate a sanitized (i.e. harmless) view of sensitive personal data (e.g. a health survey), to be released to some agencies or simply the public. However, traditional PPDP practices all make the assumption that the process is run on a trusted central server. In this article, we argue that the trust assumption on the central server is far too strong. We propose MetAP, a generic fully distributed protocol, to execute various forms of PPDP algorithms on an asymmetric architecture composed of low power secure devices and a powerful but untrusted infrastructure. We show that this protocol is both correct and secure against honest-but-curious or malicious adversaries. Finally, we provide an experimental validation showing that this protocol can support PPDP processes scaling up to nation-wide survey