Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

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

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

New national and regional bryophyte records, 66

a The Natural History Museum, Cromwell Road, London, SW7 5BD, UK; b Department of Plant and Animal Production, Munzur University, Vocational School of Tunceli, Tunceli, Turkey; c International School of Advanced Studies, University of Camerino, Camerino (MC), Italy; d Grupo de Investigación Biología para la Conservación, Universidad Pedagógica y Tecnológica de Colombia, Colombia; e Botanical Survey of India, Central National Herbarium, Howrah, India; f Botanical Garden-Institute, Russian Academy of Science, Vladivostok, Russia; g Viale Rovereto, Trento, Italy; h Department of Botany, Kherson State University, Kherson, Ukraine; i Kherson Branch of Admiral Makarov University, Kherson, Ukraine; j Institute of Industrial Ecology Problems of the North of the Kola Science Center of RAS, Apatity, Murmansk Province, Russia; k University of Insubria, Varese, Italy; l Departamento de Biología Vegetal (Botánica), Facultad de Biología, Universidad de Murcia, E-30100, Murcia, Spain; mTeam of Ecological Survey Research, National Institute of Ecology, Seocheon, Korea; n Departamento de Biología (Botánica), Facultad de Ciencias, Universidad Autónoma de Madrid, Madrid, Spain; o Centro de Investigación en Biodiversidad y Cambio Global, Madrid, Spain; p Institute of Biology Komi Science Centre UB RAS, Kommunisticheskaja St., 28, Syktyvkar, 167982, Komi Republic, Russia; q Botanical Museum, P.O. Box 7, FI-00014 University of Helsinki, Helsinki, Finland; r Department of Landscape Architecture, Faculty of Architecture, Niğde Ömer Halisdemir University, Niğde, Turkey; s Geobotany Department, Lomonosov Moscow State University, Moscow, Russia; t Botanical Garden-Institute, Far East Branch of Russian Academy of Sciences, Vladivostok, Russia; u Departamento de Biodiversidad, Ecología y Evolución, Facultad de Biología, Universidad Complutense de Madrid, 28040 Madrid, Spain; v Departamento de Botánica y Geología, Facultad de Farmacia, Universidad de Valencia, Avda, Vicente Andrés Estellés s/n, E-46100 Burjassot, Spain; wDepartment of Systematics, Biodiversity and Evolution of Plants, Albrecht von Haller Institute, University of Göttingen, 37073 Göttingen, Germany; x Donceel, Belgium; y Conservatoire Botanique National du Massif Central, Chavaniac, Laffayette, France; z Plant Resources Division, National Institute of Biological Resources, Incheon, Korea; aaAdnan Menderes Üniversitesi, Fen Edebiyat Fakültesi, Biyoloji Bölümü, TR-09010 Kepez-Aydin, Turkey; abPolar-Alpine Botanical Garden, Kola Science Centre, Russian Acadamy of Science, Kirovsk-6, Murmansk Province 184256, Russia; acInstitute of Botany, University of Natural Resources and Life Sciences Vienna, Vienna, Austria; adDepartment of Botany, University of South Bohemia, České Budějovice, Czech Republic; aeFreie Universität Berlin, Institut für Biologie, Systematische Botanik und Pflanzengeographie, Altensteinstr, 6, D-14195 Berlin, Germany; afKomarov Botanical Institute of the Russian Academy of Sciences, St. Petersburg, Russia; agDepartment of Botany, University of Calcutta, Kolkata, India; ahTetbury, Gloucestershire, UK; aiDepartment of Botany, University of British Columbia, Vancouver, British Columbia, Canada; ajValkenswaard, The Netherlands; akLicenciatura en Biología, Universidad Distrital Francisco José de Caldas, Torre de Laboratorios, Bogotá, Colombia; alMTA Centre for Ecological Research, Institute of Ecology and Botany, Vácrátót, Hungary; am51 Wood Street, Wallingford, Oxfordshire, OX10 0AX, UK; anDepartamento de Botânica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil; aoDepartment of Environmental and Life Science, University of Cagliari, Sardinia, Italy; apCera dos Pomares, Aljezur, Portugal; aqKomarov Botanical Institute of the Russian Academy of Sciences, St. Petersburg, Russia; arDepartment of Biological, Geological and Environmental Biology, University of Catania, Catania, Italy; asCSIR-National Botanical Research Institute, Rana Pratap Marg, Lucknow, India; atThe Ministry of Forests, Lands, Natural Resource Operations and Rural Development, B. C. Government, Victoria, British Columbia, Canada; auDepartment of Botany, Bijoy Krishna Girls’ College, Howrah, West Bengal, India; avCenter for Biodiversity Research and Extension in Mindanao (CEBREM), Central Mindanao University, Musuan, Bukidnon Province, 8710 Mindanao Island, Philippines; awDepartamento de Botánica y Geología, Facultad de Ciencias Biológicas, Universitat de València, Avda. Dr. Moliner 50, E-46100, Burjassot, Valencia, Spain; axVia Selvotta, Muzzana del Turgnano, Udine, Italy; ayInstitute of Environmental Sciences, Kazan Federal University, Kazan, Tatarstan Republic, Russia; azCalifornia Academy of Sciences (CAS), 55 Music Concourse Drive, Golden Gate Park, San Francisco, CA 94118, USA; baInstitute of Biology Bucharest of Romanian Academy, 296 Splaiul Independentei, 060031 Bucharest, P.O. Box 56-53, Romania; bbDepartment of Biology, Faculty of Science and Letters, Aksaray University, Aksaray, Turkey; bcDepartment of Forest Engineering, Faculty of Forestry, Çankırı Karatekin University, Çankırı, Turkey; bdInstitute of Botany and Biodiversity Research, University of Vienna, Vienna, Austria; beMissouri Botanical Garden, 4344 Shaw Boulavard, St. Louis, Missouri, 63110, US

New national and regional bryophyte records, 67

Bulgaria. Samokov Region, Rila Mountains, Rila National Park, N slopes of peak Deno, on granite slabs and scree, collected with occasional sporophytes, 42.19709°N, 23.60322°E, 2780 m a.s.l, 17 September 2019, leg./det. R. Natcheva s.n. (SOM 9811-B). This arctic-alpine species has a north Holarctic circumpolar distribution and this is the first report of Andreaea blyttii for SE Europe. It is its southernmost locality and extends its range further south in Europe. The Rila Mountains are the highest in the Balkan peninsula and A. blyttii was found near the highest summit (Mussala, 2925 m a.s.l.). In Bulgaria the genus Andreaea is also represented by A. alpestris (Thed.) Schimp. and A. rupestris Hedw., both of which occur in the Rila Mountains

New national and regional bryophyte records, 67

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