Understanding social value creation in public construction projects using systems thinking

Interest in social issues increased in EU member states and the UK where this interest was shown via public policy documents and governmental initiatives to create social value as part of the procurement activities of construction projects. This encouraged construction client organisations to use their buying power to create value for their local communities. However, after reviewing literature and reports about using procurement in creating social value and the factors affecting social value creation in construction projects, and stakeholders’ perceptions of social value this research concluded that satisfaction with social value creation was disputed and contested. This was due to the soft, non-quantifiable nature of social value outcomes, the multiple perception about it in every stage of construction project, the gap between the social value strategies and the operational tools available and the varying impacts of factors influencing the performance of construction projects. Accordingly, the researcher adopted an abductive approach and utilised Soft System Methodology (SSM) and the Generic Design and Construction Process Protocol (GDCPP) to understand how current processes in public construction projects are used to create social value. SSM was used because of its ability to investigate ill-defined issues and problem situations through using system’s concepts in the investigation of these problem situations. Human Activity Systems which consist of activities to provide multiple perceptions to think about the problem situation. The GDCPP was used in association with the HAS models to produce the Social Value Activity Zone which is a set of, task driven, activities distributed across different construction project phases and performed by a cross-functional team to achieve social value objectives. The research’s propositions and the SVAZ were developed through a pilot study that used expert panels to investigate current social value delivery processes and test the SSM and GDCPP approach. Then the research tested and validated the propositions and the SVAZ in four construction projects case studies which were selected according to the factors thought to influence social value in each project. The cases implied that client organisations who lead how Social Value was perceived achieved their objectives and were satisfied with it, despite the notion of social value varied from one stakeholder to the other because including social value in the core construction objectives and early involvement clarified how social value was viewed to other stakeholders

Overactive bladder – 18 years – part I

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk