Inverse association between serum albumin and future risk of venous thromboembolism:interrelationship with high sensitivity C-reactive protein

Purpose: We aimed to assess the prospective association of serum albumin with venous thromboembolism (VTE) risk and evaluate if the association is independent of or modified by inflammation, as measured by high sensitivity C-reactive protein (hsCRP). Design: We analysed data of 2176 men aged 42–61 years free from VTE in the Kuopio Ischemic Heart Disease study, with serum albumin concentrations measured at baseline using Coulter’s bromocresol purple colorimetric assays. Hazard ratios (HRs) (95% confidence intervals [CI]) were calculated for VTE. Results: There were 109 validated cases of VTE recorded during a median follow-up of 24.9 years. The risk of VTE increased linearly below a serum albumin concentration of ∼48 g/l. In Cox regression analysis adjusted for established risk factors and other potential confounders, the HR (95% CI) for VTE per 1 standard deviation lower serum albumin was 1.23 (1.02–1.47). The association remained persistent on further adjustment for hsCRP 1.22 (1.01–1.46). Furthermore, the association was not modified by hsCRP and persisted on exclusion of men with elevated hsCRP levels. Conclusions: In middle-aged Caucasian men, low serum albumin is associated with an increased risk of VTE, consistent with a linear dose-response relationship. The association is independent of and not modified by inflammation.Key messages •Serum albumin may be associated with future risk of venous thromboembolism (VTE); however, the shape, nature, magnitude and consistency of the association is uncertain. •In a population-based prospective cohort study, low serum albumin was associated with an increased risk of VTE in a linear dose-response manner and this association was independent of and not modified by inflammation. •Serum albumin concentrations may play a role in the development of VTE.</p

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

Close and incomplete excision margins in non-melanoma skin cancer: A tertiary plastic surgery center experience

Dear Sir, Non-melanoma  skin cancers (NMSC) are the commonest skin cancers, treated by  specialists. Previous national audit data have reported incomplete  excision rates of around 2.3–3%.1  Nolan et al. published NMSC incomplete excision rates by operating  specialty (dermatology, plastic surgery and general practitioners (GP));  the lowest incomplete excision rates were by dermatologists with 6.2%  for basal cell carcinoma (BCC) and 4.7% for squamous cell carcinoma (SCC).1  In contrast, the highest incomplete excision rates were by GPs (20.4%  for BCCs, 19.9% for SCCs). For plastic surgery, results were  intermediate with rates of 9.4% for BCCs and 8.2% for SCCs. Our  experience of treating NMSCs in our plastic surgery tertiary referral  center during the recent pandemic is presented...</p

Close and incomplete excision margins in non-melanoma skin cancer: A tertiary plastic surgery center experience

Dear Sir, Non-melanoma  skin cancers (NMSC) are the commonest skin cancers, treated by  specialists. Previous national audit data have reported incomplete  excision rates of around 2.3–3%.1  Nolan et al. published NMSC incomplete excision rates by operating  specialty (dermatology, plastic surgery and general practitioners (GP));  the lowest incomplete excision rates were by dermatologists with 6.2%  for basal cell carcinoma (BCC) and 4.7% for squamous cell carcinoma (SCC).1  In contrast, the highest incomplete excision rates were by GPs (20.4%  for BCCs, 19.9% for SCCs). For plastic surgery, results were  intermediate with rates of 9.4% for BCCs and 8.2% for SCCs. Our  experience of treating NMSCs in our plastic surgery tertiary referral  center during the recent pandemic is presented...</p