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

Subjective well-being and feeding patterns in Chilean adults: A qualitative study / Bienestar subjetivo y patrones de alimentación en adultos chilenos: Un estudio cualitativo

AbstractThis article reviews the relationship between the experience of subjective well-being and the processes of selection, purchase, preparation and consumption of food in adults in the southern part of Chile. Based on qualitative methodology and conceived as an exploratory design this research aims how feeding impacts on the vital satisfaction of people as well as in their dissatisfaction and discontent experiences. A group of 60 men and women between 18-76 years participated in focus group sessions and in-depth interviews; their speech was studied by content analysis. The results redefine feeding practices in terms of socio-affective and socio-cultural influence in the experience of subjective well-being regarding food purchasing behavior and feeding patterns. We conclude that feeding practices are not only associated to sensory pleasures but also to family and social life as well as to health care. Thus, this study establishes an analytical interface in the dialogue regarding the experience of subjective well-being from the positive psychology and those related to feeding behavior from the psychology of consumption. ResumenEl presente estudio aborda la relación entre las vivencias de bienestar subjetivo y los procesos de selección, compra, preparación y consumo de alimentos en adultos residentes en el sur de Chile. Con base a una aproximación cualitativa y un diseño exploratorio, se indaga sobre cómo la alimentación incide en la satisfacción vital de las personas, así como en sus vivencias de descontento o insatisfacción. Se realizaron grupos focales y entrevistas en profundidad con 60 participantes, hombres y mujeres,  de 18 a 76 años de edad, cuyo discurso fue sometido a análisis de contenido. Los resultados redefinen las prácticas alimentarias en términos de su influencia socioafectiva y sociocultural en el bienestar subjetivo, en el comportamiento de compra de alimentos y en sus patrones de alimentación. Se concluye que las prácticas alimentarias no sólo están asociadas al deleite sensorial, sino que también son centrales tanto para la convivencia familiar y social, como para el cuidado de la salud. Este estudio establece una interfase analítica entre los debates sobre bienestar subjetivo de la psicología positiva, y los relativos al comportamiento alimentario presentes en la psicología del consumo

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)