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

Smart logistics diffusion strategies amongst supply chain networks in emerging markets: a case of Nigeria's micro/SMEs 3PLs

This study investigates the mechanism influencing Information and Communication Technology (ICT) diffusion in the Nigerian transport/logistics industry, necessitated by the need to improve logistics performance in the region. The study involved a mixed-method approach, divided into four phases: scoping study; questionnaire survey; multiple case studies; and focus group discussion/in-depth expert interviews. The approach was required to respond to the following specific objectives of the study, including to (i) unpack diverse ranges of both internal and external factors influencing ICT diffusion in the industry. (ii) Empirically capture the causal interrelationships of the relevant factors influencing ICT diffusion in the industry, using evidence from the activities of the local small and medium third-party logistics operators (3PL SMEs). (iii) Compare the influences of firm and structure on the ICT adoption process, and, in turn, logistics performance among the local 3PL SMEs, and (iv) identify policy initiatives required to improve ICT diffusion in the industry. The outcomes of the study suggest as follows: (i) there are varied ranges of context-specific factors influencing ICT diffusion in the Nigerian transport and logistics industry. (ii) Amongst the main barriers include lack of facilitating conditions and limited scope of business, while the main driver was consumer readiness. The three constructs appear interdependent. (iii) The local logistics operators were motivated differently in terms of the extent of ICT adoption. (iv) There are limited policy-driven initiatives, as well as dysfunctional institutional framework stimulating ICT diffusion in the industry. These outcomes lead to making the following recommendations: (i) The logistics practitioners in the region should concentrate on developing their internal resources, particularly technical skills/expertise, as it represents their primary source of sustaining their competitive advantage. (ii) Relevant policy initiatives (e.g., the national IT policy) require revision to enhance their sectorial applications in the industry, and (iii) The study also recommends significant overhaul/reorientation of the local logistics system, particularly the institutional framework. These relate to the dampening effects (barriers) the lack of a functional institutional framework has posed on the efficient coordination of the local logistics system. The outcomes of the study suggest the need for continuous engagement of the relevant stakeholders in addressing some of the critical issues raised in this study, mainly as represented in the developed ICT diffusion framework. This approach is envisaged to help address issues relating to the ever-increasing complex and dynamic nature of the modern smart logistics system. For the practitioners, the contingency management approach is mostly recommended based on the unstable nature of the local economy and logistics market in particular. Overall, the research findings may help lay the foundation for the pragmatic resolution of ICT diffusion challenges in the local transport and logistics industry

Unusual intravesical foreign body following perineo-vesical injury

Reports of foreign body in the bladder are rare. Various objects have been retrieved. Diagnosis is mainly by history of lower urinary tract symptoms and low abdominal pain combined with relevant radiological investigations. Treatment depends on the size, nature, and configuration of the object. The approach may be endoscopic or through open surgery depending on the above highlighted factors.Keywords: Foreign body, heamaturia, intravesical, woo

Unusual Intravesical Foreign Body Following Perineo-vesical Injury

Reports of foreign body in the bladder are rare. Various objects have been retrieved. Diagnosis is mainly by history of lower urinary tract symptoms and low abdominal pain combined with relevant radiological investigations. Treatment depends on the size, nature, and configuration of the object. The approach may be endoscopic or through open surgery depending on the above highlighted factors

Refractory dermatomyositis responsive to anifrolumab

No abstrac