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

Evaluación del tiempo de espera óptimo para la colocación de implantes dentales tras elevaciones de seno maxilar (ESM) con un injerto compuesto por hueso autólogo y biomaterial

Purpose: To evaluate the ideal implant time insertion in human bone biopsies after maxillary sinus floor elevation (MSFE) with a composite graft consisting of an equal amount of biomaterial and autologous bone, by comparing the bone regeneration obtained 4-5 months after surgery with the obtained after 6-8 months, and having the adjacent native bone as reference. Materials and Methods: A total of 26 biopsies of 11 patients after MSFE were analyzed. Two groups were created depending on the time of implant insertion: t1 group at 4-5 months (n=13) and t2 group at 6-8 months (n=13). The same volume of grafted bone and native bone were analyzed for each biopsy by micro-computed tomography (microCT). Results: Statistically significant differences were found in bone mineral density, bone volume fraction and trabecular separation (Tb. Sp) between native and grafted bone in the t1 and t2 groups, showing grafted bone higher values except for the variable Tb.Sp, which were lower in the grafted bone compared to native bone. The decrease in Tb.Sp in the grafted bone for t1 and t2 groups can be explained by the significant increase in trabecular thickness in t2 group and the trabecular number in t1 group, compared to native bone respectively. Comparing the morphometric parameters and the BMD of the grafted bone between the t1 and t2 groups, no significant differences were found. Conclusions: A composite graft composed of 50% autologous bone and 50% biomaterial shows no differences in 3D microstructure and BMD between 4-5 months and 6-8 months of healing time. Thus, this time can be shortened to 4 months with the security of a grafted area of mature bone.Objetivo: Evaluar el tiempo de espera óptimo para la colocación de implantes dentales tras elevaciones de seno maxilar (ES) con un injerto compuesto con la misma cantidad de hueso autólogo que de biomaterial, a través de biopsias humanas, comparando el hueso regenerado obtenido a los 4-5 meses con el obtenido a los 6-8 meses, teniendo el hueso nativo como referencia. Material y Métodos: Fueron analizadas un total de 26 biopsias de 11 pacientes tras ES. Se crearon dos grupos dependiendo del momento de la colocación del implante: grupo t1 a los 4-5 meses (n=13) y grupo t2 a los 6-8 meses (n=13). Fue analizado por microtomografía computarizada (MicroCT) para cada biopsia el mismo volumen para el hueso injertado que para el nativo. Resultados: Se encontraron diferencias estadísticamente significativas en la densidad mineral ósea (BMD), fracción de volumen óseo y separación trabecular (Tb.Sp) entre el hueso nativo e injertado en los grupos t1 y t2, mostrando valores más altos en el hueso injertado excepto para la variable Tb.Sp. que sucedió a la inversa. El descenso de la Tb.Sp en el hueso injertado de los dos grupos puede explicarse por el aumento sigificativo del grosor trabecular en el grupo t2 y por el aumento del número trabecular en el grupo t1, comparándolos con el hueso nativo respectivamente. No se encontró ninguna diferencia estadísticamente significativa entre los dos grupos de hueso injertado cuando se compararon los parámetros morfométricos y de BMD. Conclusiones: Un injerto compuesto por 50% hueso autólogo y 50% biomaterial muestra que no hay diferencias en la microestructura 3D ni en la BMD entre 4-5 o 6-8 meses de espera de cicatrización ósea. Por ello este tiempo de cicatrización se puede acortar a 4 meses con la seguridad de un área injertada con hueso maduro

International Consensus (ICON): allergic reactions to vaccines

Background Routine immunization, one of the most effective public health interventions, has effectively reduced death and morbidity due to a variety of infectious diseases. However, allergic reactions to vaccines occur very rarely and can be life threatening. Given the large numbers of vaccines administered worldwide, there is a need for an international consensus regarding the evaluation and management of allergic reactions to vaccines.Methods Following a review of the literature, and with the active participation of representatives from the World Allergy Organization (WAO), the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and the American College of Allergy, Asthma, and Immunology (ACAAI), the final committee was formed with the purpose of having members who represented a wide-range of countries, had previously worked on vaccine safety, and included both allergist/immunologists as well as vaccinologists.Results Consensus was reached on a variety of topics, including: definition of immediate allergic reactions, including anaphylaxis, approaches to distinguish association from causality, approaches to patients with a history of an allergic reaction to a previous vaccine, and approaches to patients with a history of an allergic reaction to components of vaccines.Conclusions This document provides comprehensive and internationally accepted guidelines and access to on-line documents to help practitioners around the world identify allergic reactions following immunization. It also provides a framework for the evaluation and further management of patients who present either following an allergic reaction to a vaccine or with a history of allergy to a component of vaccines. Keywords: Allergy, Allergic reactions, Anaphylaxis, Causality, Components, International, Consensus, Vaccin

EAACI Molecular Allergology User's Guide

The availability of allergen molecules (‘components’) from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled ‘component-resolved diagnosis’ (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Lt

EAACI molecular allergology user's guide

The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from primary sensitization. Part B discusses clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, molds, mites, animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food allergy, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients

EAACI Molecular Allergology User's Guide

The availability of allergen molecules (‘components’) from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled ‘component-resolved diagnosis’ (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Lt