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

Impact of the climatic change on animal diseases spread: the example of bluetongue in Spain

Climate change is affecting the ecosystem and many of the factors associated with human and animal diseases. In particular, significant changes in insect-borne diseases have been shown. The clearest example is found in Europe regarding the bluetongue virus (BTV), a disease of ruminants transmitted by insects (Culicoides spp.). Traditionally this disease was distributed below the 40th parallel, but since 2006 spread to northern Europe where the situation is now endemic. This spread of BTV has been produced by several factors. First, there is a direct relationship between the increased of temperature and the presence of Culicoides. It is also important to highlight the role of the wind in the movement of insects, and could be a significant mode of transmission of vector-borne diseases (such as bluetongue) from endemic areas to free areas. In Spain, the introduction of Culicoides by the wind has not formally been proved, but many experts and epidemiological data has hypothesized it, especially in the first outbreaks occurred in 2004 in the Iberian Peninsula. The objective of the model described here has been, first, to predict the number of Culicoides introduced by the wind and its potential survival in Spain and, secondly, to assess the impact that a potential increase in temperature could have on the distribution and survival Culicoides in Spain. This model will help to identify locations and time periods at highest risk for mosquitoes introduction and survival, and will help to optimize efforts and better prevent and control future outbreaks of bluetongue in the country

Impacto del cambio clinmático en la difusión de enfermedades animales: el ejemplo de lengua azul en España

Climate change is affecting the ecosystem and many of the factors associated with human and animal diseases. In particular, significant changes in insect-borne diseases have been shown. The clearest example is found in Europe regarding the bluetongue virus (BTV), a disease of ruminants transmitted by insects (Culicoides spp.). Traditionally this disease was distributed below the 40th parallel, but since 2006 spread to northern Europe where the situation is now endemic. This spread of BTV has been produced by several factors. First, there is a direct relationship between the increased of temperature and the presence of Culicoides. It is also important to highlight the role of the wind in the movement of insects, and could be a significant mode of transmission of vector-borne diseases (such as bluetongue) from endemic areas to free areas. In Spain, the introduction of Culicoides by the wind has not formally been proved, but many experts and epidemiological data has hypothesized it, especially in the first outbreaks occurred in 2004 in the Iberian Peninsula. The objective of the model described here has been, first, to predict the number of Culicoides introduced by the wind and its potential survival in Spain and, secondly, to assess the impact that a potential increase in temperature could have on the distribution and survival Culicoides in Spain. This model will help to identify locations and time periods at highest risk for mosquitoes introduction and survival, and will help to optimize efforts and better prevent and control future outbreaks of bluetongue in the country.El cambio climático está afectando al ecosistema y con ello a muchos de los factores asociados con enfermedades humanas y animales. En particular, se ha demostrado cambios importantes en las enfermedades transmitidas por insectos. El ejemplo más claro se encuentra en Europa referente al virus de la lengua azul, enfermedad de los rumiantes transmitida por insectos (Culicoides spp.). Tradicionalmente esta enfermedad se distribuía por debajo del paralelo 40, pero desde 2006 se ha difundido hacia el norte de Europa y desde entonces la situación es endémica. Esta difusión se ha podido producir por varios factores. En primer lugar, existe una relación directa entre el aumento de temperatura y la presencia de Culicoides. Además, es importante destacar el papel del viento en el movimiento de los insectos, y podría ser un modo de transmisión importante de enfermedades como la lengua azul desde zonas endémicas a las zonas libres. 121 Cianci, C et al. Revista Complutense. En España, la introducción de Culicoides por el viento no está formalmente demostrada, pero hay muchos expertos y datos epidemiológicos que lo sugieren, sobre todo en los primeros brotes que se produjeron en 2004 en la Península Ibérica. El objetivo del modelo aquí descrito ha sido, en primer lugar, predecir el número de Culicoides introducidos por el viento y su potencial supervivencia en España y, en segundo lugar, evaluar el impacto que un potencial incremento de temperatura podría tener en la distribución y supervivencia de Culicoides en España. Este modelo permitirá la identificación de lugares y períodos de tiempo con mayor riesgo de introducción de los mosquitos y de su supervivencia, y ayudará a optimizar los esfuerzos de prevención y control de futuras epidemias de lengua azul en el país.Depto. de Análisis Matemático y Matemática AplicadaFac. de Ciencias MatemáticasTRUEMinisterio de Educación y Ciencia (España)Banco de SantanderUniversidad ComplutenseComunidad de Madrid”pu

Hyperoxemia in postsurgical sepsis/septic shock patients is associated with reduced mortality.

Despite growing interest in treatment strategies that limit oxygen exposure in ICU patients, no studies have compared conservative oxygen with standard oxygen in postsurgical patients with sepsis/septic shock, although there are indications that it may improve outcomes. It has been proven that high partial pressure of oxygen in arterial blood (PaO <sub>2</sub> ) reduces the rate of surgical-wound infections and mortality in patients under major surgery. The aim of this study is to examine whether PaO <sub>2</sub> is associated with risk of death in adult patients with sepsis/septic shock after major surgery. We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups whether they had hyperoxemia, defined as PaO <sub>2</sub> > 100 mmHg (n = 216), or PaO <sub>2</sub> ≤ 100 mmHg (n = 238) at the day of sepsis/septic shock onset according to SEPSIS-3 criteria maintained during 48 h. Primary end-point was 90-day mortality after diagnosis of sepsis. Secondary endpoints were ICU length of stay and time to extubation. In patients with PaO <sub>2</sub> ≤ 100 mmHg, we found prolonged mechanical ventilation (2 [8] vs. 1 [4] days, p < 0.001), higher ICU stay (8 [13] vs. 5 [9] days, p < 0.001), higher organ dysfunction as assessed by SOFA score (9 [3] vs. 7 [5], p < 0.001), higher prevalence of septic shock (200/238, 84.0% vs 145/216) 67.1%, p < 0.001), and higher 90-day mortality (37.0% [88] vs. 25.5% [55], p = 0.008). Hyperoxemia was associated with higher probability of 90-day survival in a multivariate analysis (OR 0.61, 95%CI: 0.39-0.95, p = 0.029), independent of age, chronic renal failure, procalcitonin levels, and APACHE II score > 19. These findings were confirmed when patients with severe hypoxemia at the time of study inclusion were excluded. Oxygenation with a PaO <sub>2</sub> above 100 mmHg was independently associated with lower 90-day mortality, shorter ICU stay and intubation time in critically ill postsurgical sepsis/septic shock patients. Our findings open a new venue for designing clinical trials to evaluate the boundaries of PaO <sub>2</sub> in postsurgical patients with severe infections

Recomendaciones específicas para mejorar la atención médica en el diagnóstico prenatal

Congenital defects are morphological, structural, functional or molecular anomalies of the fetus that are responsible for 10% of infantile deaths in Mexico. They can be diagnosed appropriately with the prenatal diagnosis. The prenatal diagnosis includes clinical, biochemical and imaging tools applied during the embryonic-fetal life to know the health state of the fetus and to discover a congenital defects. Authors were analyzed the dissents related with Diagnostic Prenatal received at CONAMED (National Medical Arbitration Commission). The most frequent deviation was an incomplete explanation of the diagnosis, prognosis and handling plan. Two thirds of the claims were solved through an explanation to the patient in simple language or with the physician�s commitment to provide the specialized medical care. A group integrated by prestigious specialist in Ob-Gyn, Clinical Genetics, Fetal Maternal Medicine, Clinical Pathology and Psychology, revised the dissents and they emitted the following Recommendations: 1) Offer a high-quality professional attention, 2) Value integrally each case and establish the best plan of prenatal diagnosis, 3) Provide appropriate information, 4) Limit the inherent risks as much as possible, 5) Offer the best attention during the pregnancy before the prenatal diagnosis and 6) Document the whole attention process and obtain the Validly Informed Consent.Los defectos congénitos son anomalías morfológicas, estructurales, funcionales o moleculares del feto, que son responsables del 10% de muertes infantiles en México. Pueden diagnosticarse oportunamente mediante el diagnóstico prenatal. El diagnóstico prenatal incluye detecciones clínicas, bioquímicas o de imagen que se aplican durante la vida embrionaria-fetal para conocer el estado de salud del producto, descubrir un defecto congénito y poder dirigir mejor el manejo en los casos de enfermedad o alteración fetal. Se analizaron las inconformidades relacionadas con Diagnóstico Prenatal recibidas ante CONAMED. La desviación más frecuente fue una explicación incompleta del diagnóstico, pronóstico y plan de manejo. Dos tercios de los asuntos se resolvieron a través de una explicación al paciente en un lenguaje sencillo o con el compromiso del médico a proporcionar la atención médica especializada. Un grupo integrado por reconocidos médicos especialistas en Gineco-obstetricia, Genética Clínica, Medicina Materno Fetal, Patología Clínica y Psicología, revisaron las inconformidades y emitieron las siguientes Recomendaciones: 1) Ofrecer una atención profesional de alta calidad, 2) Valorar integralmente cada caso y establecer el mejor plan de diagnóstico prenatal, 3) Proporcionar información adecuada, 4) Limitar en lo posible los riesgos inherentes, 5) Procurar la mejor atención durante el embarazo ante el diagnóstico prenatal y 6) Documentar todo el proceso de atención y obtener el Consentimiento Válidamente Informado