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

Missing intrauterine devices, laparoscopic and a_x000D_ conventional management: A single–center experience

Introduction: Intrauterine contraception devices (IUCD) are frequently and safely used in pregnancy control. Migration related complications, such as adhesions and perforations, can be encountered as the most important_x000D_ but rare circumstances. In such cases, the laparoscopic approach is beneficial with the least harm principle._x000D_ Materials and Methods: This study included ten patients who were admitted to our hospital between 2015–_x000D_ 2019 with chronic abdominal pain, induced by migrated intrauterine devices. Patients’ complaints, radiological methods used in diagnosis, IUCD insertion timing, migration of IUCD and time interval to diagnosis, intra–abdominal migration points, and types, as well as surgical interventions, were evaluated retrospectively._x000D_ Results: While all patients were diagnosed with abdominal ultrasonography and gynecological examination, some patients underwent computed tomography 60% and plain radiogram 20% as additional imaging._x000D_ While the intra–abdominal migration site of IUCD was ascertained as the most common localization in the_x000D_ lower right quadrant of the omentum (30%), the placement in the umbilical hernia site was the rarest and the_x000D_ only one in the literature. Three different types of IUCD were detected; Copper–T (80%) was the most common, while IUCDs were laparoscopically removed in all patients except for the patient who underwent open_x000D_ surgery due to acute cholecystitis. All patients who had laparoscopic surgery were discharged the next day._x000D_ Conclusion: In conclusion, the IUCD’s frequency of use is increasing as the current method of contraception,_x000D_ dislocation of the device may be encountered if the required conditions are not taken into consideration_x000D_ during the application. In such a situation, laparoscopic removal of a dislocated IUCD is a safe, feasible, and_x000D_ less invasive method

Pediatricians' COVID-19 experiences and views on the willingness to receive COVID-19 vaccines: A cross-sectional survey in Turkey

Developing an effective and safe vaccine against Covid-19 will facilitate return to normal. Due to hesitation toward the vaccine, it is crucial to explore the acceptability of the COVID-19 vaccine to the public and healthcare workers. In this cross-sectional survey, we invited 2251 pediatricians and 506 (22%) of them responded survey and 424 (84%) gave either nasopharyngeal swap or antibody assay for COVID-19 and 71 (14%) of them got diagnosis of COVID-19. If the effective and safe COVID-19 vaccine was launched on market, 420 (83%) of pediatrician accepted to get vaccine shot, 422 (83%) of them recommended vaccination to their family members, 380 (75%) of them accepted to vaccine their children and 445 (85%) of them offered vaccination to their pediatric patients. Among the participated pediatricians 304 (60%) of them thought COVID-19 vaccine should be mandatory. We found that there are high COVID-19 vaccine willingness rates for pediatricians for themselves, their own children, family members and their pediatric patients. We also found that being a pediatric subspecialist, believing in achieving an effective vaccine, willingness to participate in the phase 1-2 clinical vaccine trial, willingness to get an influenza shot this season, believing a vaccine and vaccine passport should be mandatory were significant factors in accepting the vaccine. It is important to share all information about COVID-19 vaccines, especially effectiveness and safety, with the public in a clear communication and transparency. The opposite will contribute to vaccine hesitancy and anti-vaccine movement

Preferences of inflammatory arthritis patients for biological disease-modifying antirheumatic drugs in the first 100 days of covid-19 pandemic

To evaluate treatment adherence and predictors of drug discontinuation among patients with inflammatory arthritis receiving bDMARDs within the first 100 days after the announcement of COVID-19 pandemic. Method: A total of 1871 patients recorded in TReasure registry for whom advanced therapy was prescribed for rheumatoid arthritis (RA) or spondyloarthritis (SpA) within the 3 months (6-9 months for rituximab) before the declaration of COVID-19 pandemic were evaluated and 1394 (74.5%) responded the survey performed by phone call. Patients? data regarding demographic, clinical characteristics and disease activity before the pandemic were recorded. The patients were inquired for the diagnosis of COVID-19, the rate of continuation on bDMARDs, the reasons for treatment discontinuation, if any, and the current general disease activity (visual analog scale, [VAS]). Results: A total of 1,394 patients (493 RA [47.3% on anti-TNF] patients and 901 SpA [90.0% on anti-TNF] patients) were included. Overall, 2.8% of the patients had symptoms suggesting COVID-19, and 2 (0.15%) patients had polymerase chain reaction (PCR) confirmed COVID-19. Overall, 18.1% of all patients (13.8% of the RA and 20.5% of the SpA; p=0.003) discontinued their bDMARDs. In the SpA group, the patients who discontinued bDMARDs were younger (40 [21-73] vs. 44 years [20-79]; p=0.005) and had higher general disease activity; however, no difference was relevant for RA patients. Conclusion: Although the COVID-19 was quite uncommon in the first 100 days of the pandemic, nearly one-fifth of the patients discontinued bDMARDs within this period. Long-term effects of the pandemic should be monitored.PubMe