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

Evaluation of cyclosporin effects on renal function of diabetic rsts induced by streptozotocin

1. Parametros de hemodinamica glomerular nao foram significantemente alterados em D, provavelmente pelo curto periodo de hiperglicemia a que foram submetidos os animais. Quando animais diabeticos foram submetidos a acidose metabolica (AD) estes parametros apresentaram queda significante. Em relacao aos parametros de hemodinamica renal estudados, a Cya causou um prejuizo significante. Quando os animais tratados com Cya foram submetidos a acidose metabolica (ACY), a queda no RFG foi ainda maior, comparado a AC, provavelmente pela soma dos efeitos nefrotoxicos das duas situacoes. 2. Animais DCY nao apresentaram alteracoes significantes nos parametros de hemodinamica glomerular estudados, quando comparados a D. Uma hipotese para explicar este achado seria que, no diabetes, algumas drogas nefrotoxicas se acumulam menos no parenquima renal. Entretanto, animais ADCY nao apresentaram protecao da funcao renal. Neste caso houve predominio das alteracoes funcionais causadas pela acidose. 3. Em animais diabeticos (D) houve um aumento significante na excrecao renal de acidos, comparados a C. Animais tratados com Cya (CY) apresentaram queda significante na excrecao renal de acidos, quando comparados a animais controles (C), isto ocorreu as custas de queda na acidez titulavel e carga excretada de amonia e aumento na carga excretada de bicarbonato. Animais diabeticos tratados com Cya (DCY) mantiveram a capacidade renal de excretar acidos, por provavel predominancia do efeito estimulador do diabetes na atividade do trocador Na+/H+, contra o efeito inibidor da Cya. Isto ocorreu tanto em condicoes normais de equilibrio acido-basico, quanto na acidose metabolica (ADCY). Em relacao ao manejo tubular de ions, animais CY diminuiram a capacidade tubular de reabsorver sodio. Uma explicacao para este dado seria a inibicao da Na+/K+/APTase, causada pela droga. Animais D tenderam a diminuir a excrecao renal de sodio. Entretanto, animais DCY apresentaram uma menor excrecao renal deste ion, quando comparados aos animais CY. Uma explicacao para este resultado seria o predominio da estimulacao do diabetes sobre a atividade da Na+/K+/APTase contra a inibicao causada pela Cya, sobre esta enzima. 5. Animais CY apresentaram aumento na concentracao plasmatica de potassio, quando comparado ao C, isto ocorreu as custas de diminuicao na sua carga excretada, tanto em condicoes normais, quanto na acidose. A diminuicao na carga excretada...(au)BV UNIFESP: Teses e dissertaçõe

Influência do diabetes mellitus sobre a nefrotoxicidade da gentamicina em condições normais de equilíbrio ácido-básico e na acidose metabólica

BV UNIFESP: Teses e dissertaçõe

Relationship between mental health and spiritual wellbeing among hemodialysis patients: a correlation study

CONTEXT AND OBJECTIVE: The stress of living with a terminal disease has a negative impact on the mental health of hemodialysis (HD) patients. Spirituality is a potential coping mechanism for stressful experiences. Studies on the relationship between spirituality and mental health among HD patients are scarce. The purpose of this study was to evaluate the relationship between mental health and spiritual well-being among HD patients. DESIGN AND SETTING: Cross-sectional observational study on hemodialysis patients at a single center in Brazil, between January and December 2011. METHODS : Mental health was assessed using the General Health Questionnaire and spiritual wellbeing was assessed using the Spiritual Wellbeing Scale; 150 HD patients participated in the study. RESULTS : A significant correlation was found between mental health and spiritual wellbeing (P = 0.001). Spiritual wellbeing was the strongest predictor of mental health, psychological distress, sleep disturbance and psychosomatic complaints. CONCLUSION: Poor mental health was associated with lower spiritual wellbeing. This has important implications for delivery of palliative care to HD patients