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

Registri dei farmaci sottoposti a monitoraggio AIFA: la qualità dei dati influenza il costo dei farmaci?

INTRODUZIONE - PREMESSE E SCOPO DELLO STUDIO: I Registri dei Farmaci Sottoposti a Monitoraggio (RFOM) sono uno strumento che garantisce l’appropriatezza prescrittiva ed il controllo della spesa farmaceutica attraverso l’applicazione di accordi di rimborsabilità condizionata (MEAs) per i nuovi farmaci ad alto costo. Poiché i RFOM non permettono l’estrazione di una reportistica, l’obiettivo di questo studio consiste nella creazione di un database che integri le informazioni inserite nei RFOM, i flussi amministrativi sanitari e i rimborsi ottenuti dai MEAs, al fine di risalire al costo dei farmaci al netto degli accordi negoziali. MATERIALI E METODI: Sono stati raccolti i dati registrati nei RFOM da gennaio 2013 ad aprile 2018 presso l’Istituto Oncologico Veneto IRCCS (IOV). Il database generato è stato integrato con i dati dei flussi della Distribuzione Diretta Farmaci e della Somministrazione Interna in Regime Ambulatoriale secondo normativa regionale per quantificare la spesa media sostenuta. Per i farmaci indicati nel carcinoma del colon retto (CRC) e polmonare (NSCLC) è stato elaborato un algoritmo basato sui MEAs e successivamente applicato al database per identificare i trattamenti rimborsabili e calcolare gli sconti ottenuti. In caso di scarsa qualità dei dati inseriti nei RFOM, sono stati organizzati tra novembre 2017 e aprile 2018 audit clinici per condividere misure correttive. RISULTATI: Il database creato include 1534 trattamenti con farmaci sottoposti a MEAs, di cui 802 per CRC e 732 per NSCLC. L’applicazione dell’algoritmo ha identificato come rimborsabili il 50.8% dei trattamenti per il CRC e il 28.3% per il NSCLC. Per la maggior parte dei farmaci la mediana dei cicli rimborsabili è 2 o 3 e gli sconti calcolati variano dal 2% al 40%. La collaborazione derivata dagli audit ha permesso un recupero di circa 600.000 euro. CONCLUSIONI: L’assenza di reportistica sulla piattaforma AIFA rappresenta un limite importante dei RFOM. Lo sviluppo di un modello di gestione permette di garantire la qualità dei dati inseriti e il recupero delle somme dovute per i farmaci oggetto di accordi negoziali. Poiché il costo effettivo dei farmaci deriva da una molteplicità di fattori, la definizione dello sconto ottenuto è utile per previsioni di budget e analisi di Health Technology Assessment

Host-plant preference of Philaenus spumarius nymphs in olive orchards of the Apulia Region of Italy

Field surveys were conducted in 2015-2016 in a total of 50 olive orchards of Apulia region, by recording the incidence of the different plant species and the presence of Philaenus spumarius (Ps) nymphs on at least 100 plants within each genus (Cornara et al. 2017). Percentage of infested plants, number of infested plants over total infested plants within each orchard were determined and hostplant preference was estimated by Chesson’s index (Chesson J. 1978). Nymphs were recorded on plant species of ca. 70 different Genera, with the highest rates of infestation recorded on plants belonging to the Asteraceae and Fabaceae. Sonchus, besides being a very common weed in the olive orchards of the region, was one of the preferred host-plants, representing up to 22% of total infested plants. On the contrary, other common weeds, such as Papaver, Fumaria, Lamium, Oxalis, Mercurialis and Capsella, were not found infested by the nymphs of Ps. Indeed, very rarely spittles were found on plants of Cruciferae and Gramineae. In conclusion, our surveys confirmed that Ps has a very high polyphagy and capacity to adapt to very different plant communities. Nevertheless, densities of this insect showed great variability between orchards characterized by different plant communities, type of soil, environmental conditions and management

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 coprioritized 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