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

Seismic upgrade of RC buildings using CFRP sheets

Protupotresno poboljšanje postojećih građevina s armiranobetonskom okvirnom konstrukcijom obično zahtijeva iseljenje stanara, a često su i kratki vremenski rokovi za izvođenje građevinskih radova. Ovakvi problemi uglavnom dovode do kašnjenja i dodatnih troškova u projektima protupotresne obnove. Jedan od načina poboljšanja seizmičke otpornosti konstrukcije je uporaba CFRP (ugljičnim vlaknima ojačanog polimera) traka i čeličnih spona. U radu je na temelju provedenih analiza dokazana ekonomičnost i praktičnost ovog tehničkog rješenja.The seismic upgrade of existing reinforced-concrete frame buildings usually calls for evacuation of occupants, and the time available for construction works is often quite limited. These problems usually cause time delays and additional costs on seismic rehabilitation projects. One of the ways of improving seismic resistance of structures is to use CFRP (carbon fibre-reinforced polymer) sheets and steel fuse elements. The cost-effectiveness and practical value of this technical solution is proven in the paper through appropriate analyses

Evaluation of immunomodulatory drugs in multiple myeloma: single center experience

WOS: 000378351100006PubMed ID: 27069758Objective: Multiple myeloma (MM) comprises 1% of all cancers and 10% of hematologic malignancies and known as an incurable disease. The introduction of immunomodulatory drugs (IMiDs) has brought a major shift in therapeutic paradigm in the treatment of newly diagnosed and relapsed/refractory MM patients. The aim of this study was to evaluate the relationship between response status and hematological parameters in patients with MM treated with thalidomide or lenalidomide. Methods: Sixty-eight patients who were treated with IMiDs in Ege University, School of Medicine, Department of Hematology, between 2005 and 2012, were evaluated, retrospectively. Results and Conclusion: We could not find any difference between the hematological parameters before and after the treatment neither with thalidomide nor lenalidomide. However, the heterogenity of our groups, the difference in treatment strategies and potential side effects would have an impact on this result. It is needed to perform prospective clinical trials to prove that whether correction of hematological parameters would reflect the response status in patients with myeloma that treated with IMiDs

Do Different Types of Adhesive Agents Effect Enamel Demineralization for Orthodontic Bonding? An In Vitro Study

(1) Objective: The aim of this study was to compare the demineralization around brackets bonded with different types of adhesive agents in a cariogenic suspension environment. (2) Methods: In the study, 60 extracted upper first premolar teeth were divided into three groups with 20 teeth in each group. In Group 1, Transbond XT Primer + Transbond XT Light Cure Adhesive (3M Unitek, Monrovia, CA, USA), in Group 2, GC Ortho Connect Light Cure Adhesive (GC Crop, Tokyo, Japan) and in Group 3, Transbond™ Plus Self Etching Primer + Transbond XT Light Cure Adhesive (3M Unitek, Monrovia, CA, USA) adhesive agents were used. In Group 1 and 2, buccal enamel surfaces were etched for 30 s, washed for 15 s and dried for 15 s. All groups were bonded with Gemini metal (3M Unitek, Monrovia, CA, USA) brackets. Gingival, occlusal and proximal enamel surfaces of the brackets were measured with a DIAGNOdent pen (KaVo, Biberach, Germany), and demineralization values were recorded. Measurements were performed after bracketing (T0) and after 28 days in a cariogenic environment (T1), which was renewed every 48 h. The Kolmogorov–Smirnov test was used to determine whether or not the data were homogeneously distributed, the Wilcoxon test was used for comparisons within groups, and the Mann–Whitney U and Kruskal–Wallis tests were used for comparisons between groups. (3) Results: In all groups, demineralization values on all enamel surfaces of the brackets were found to be statistically significantly higher in the T1 period than in the T0 period (p p p p > 0.05). (4) Conclusion: Significantly less occlusal enamel surface demineralization was observed in teeth in which the Transbond™ Plus Self Etching Primer adhesive agent was not applied with acid etching

Factors Associated with Insufficient Nutrition and Effects of Timely Adequate Nutrition Support on Patient Outcomes in Intubated Adult Intensive Care Unit Patients

Objective: Our primary aim was to evaluate the relationship between adequate nutrition support and infectious complications, length of stay in the intensive care unit (ICU) and hospital, and rate of mortality in critically ill patients. Our secondary aim was to evaluate the causes of insufficient nutrition in patients

The Changed Route of Anterior Tibial Artery due to Healed Fracture

We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia)

Perception of and satisfaction from Intensive Care in Patients' Relatives

Objective: Evaluation of needs and satisfaction of families of patients admitted to intensive care unit (ICU) is an important concern. The aim of this study was to determine relatives' perception and satisfaction about ICU in our hospital

Demographic Characteristics of the School-age Children With Voiding Dysfunction, and Diagnostic Role of Ultrasound per se

Background: To determine the demographic characteristics of school-age children with voiding dysfunction and to determine the diagnostic role of urinary ultrasonography alone. Methods: A questionnaire form was distributed to 5,000 students. Survey questions were prepared in 3 sections. In the first section, general information about the child was questioned. Demographic characteristics of the parents were included in the second section. In the last section, the child's urinary problems, accompanying constipation and familial predisposition were questioned. Results: A total of 4850 (97%) questionnaires were obtained. In 497 (10.2%) of the 4850 students’ data related to voiding dysfunction were detected. A total of 137 (31.7%) children could hold their urine (delayed their urination). Hundred and eighty (41.5%) children had daytime wetting by drops, while 99 (22.8%) of them could not hold their urine entirely during the daytime. Thirty-five percent (n=152) of the children felt urgent need to urinate. Seventy-one (16.4%) children were holding their urine by crossing their legs. Ninety-one (20.9%) children were having painful urination. Twenty-four (5.5%) children were urinating intermittently. Fifty-two (12.0%) children were involuntarily losing urine when they were coughing and laughing. Sixty-five (15%) children had the feeling that they could not empty their bladders. A total of 371 (85.5%) children were wet at night. Conclusion: Nearly half of the children with voiding dysfunction were observed to have similar problems in the family. The urinary system ultrasonography after from detailed history and physical examination will help us to make a diagnosis without the need for further evaluations

CAN NEUTROPHIL-LYMPHOCYTE RATIO PREDICT DISEASE SEVERITY AND MORTALITY IN SEPSIS AND SEPTIC SHOCK PATIENTS?

Introduction: Sepsis and septic shock are the most serious clinical conditions in intensive care units with increased mortality rates. Efforts on improving treatment modalities and survival is still the most hot topic worldwide. One of the key points is finding out a reliable and cost-effective marker that can predict prognosis. The neutrophil-lymphocyte ratio (NLR) has been shown to be associated with prognosis in various clinical situations. The aim of this study was to investigate the relationship of NLR at admission and disease severity and 28-day mortality in sepsis and septic shock patients