Clinical feasibility of quantitative ultrasound texture analysis: A robustness study using fetal lung ultrasound images

OBJECTIVES: To compare the robustness of several methods based on quantitative ultrasound (US) texture analysis to evaluate its feasibility for extracting features from US images to use as a clinical diagnostic tool. METHODS: We compared, ranked, and validated the robustness of 5 texture-based methods for extracting textural features from US images acquired under different conditions. For comparison and ranking purposes, we used 13,171 non-US images from widely known available databases (OUTEX [University of Oulu, Oulu, Finland] and PHOTEX [Texture Lab, Heriot-Watt University, Edinburgh, Scotland]), which were specifically acquired under different controlled parameters (illumination, resolution, and rotation) from 103 textures. The robustness of those methods with better results from the non-US images was validated by using 666 fetal lung US images acquired from singleton pregnancies. In this study, 2 similarity measurements (correlation and Chebyshev distances) were used to evaluate the repeatability of the features extracted from the same tissue images. RESULTS: Three of the 5 methods (gray-level co-occurrence matrix, local binary patterns, and rotation-invariant local phase quantization) had favorably robust performance when using the non-US database. In fact, these methods showed similarity values close to 0 for the acquisition variations and delineations. Results from the US database confirmed robustness for all of the evaluated methods (gray-level co-occurrence matrix, local binary patterns, and rotation-invariant local phase quantization) when comparing the same texture obtained from different regions of the image (proximal/distal lungs and US machine brand stratification). CONCLUSIONS: Our results confirmed that texture analysis can be robust (high similarity for different condition acquisitions) with potential to be included as a clinical tool

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

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

Vaginal cleansing with chlorhexidine gluconate or povidone-iodine prior to cesarean delivery: a randomized comparator-controlled trial

Background: Several randomized controlled trials have demonstrated that preoperative abdominal skin preparation with chlorhexidine gluconate is superior to povidone-iodine for the prevention of surgical site infections. Despite these results, povidone-iodine is still the most commonly used agent for vaginal preparation, even though it may not be ideal

Preterm prelabor rupture of membranes management in Switzerland: a national survey

Objective: To gain an overview of the current management of patients with preterm prelabor rupture of membranes (PPROM) in Swiss maternity hospitals. Study design: We conducted a survey among all maternity hospitals in Switzerland from January to December 2018, irrespective of their annual birth rate and level of complexity. The survey consisted of an 11-item questionnaire, which was developed to retrieve information relevant to different areas of PPROM management

Etude « ARRIVE » : vers une recommandation globale de déclenchement du travail d’accouchement à terme ?

Both cesarean surgery and induction of labor have become common procedures performed in all labor wards in an attempt to reduce adverse obstetrical and neonatal outcomes. Thus, recent evidence, led by the ARRIVE Trial, demonstrated that elective induction at 39 weeks reduced the rates of cesarean deliveries and of hypertensive disorders of pregnancy. However, some concerns must be addressed, as the benefits of universal policies have to be outweighed with the current circumstances of implementation, the economic impact, the number of procedures needed to effectively reduce complications, and, above all, women's perception towards this approach. Therefore, it would be interesting to explore individualization strategies, instead of general recommendations, to offer personalized care

The ARRIVE Trial: Towards a universal recommendation of induction of labour at 39 weeks?

Both caesarean surgery and induction of labour are common practices performed in all labour wards in an attempt to reduce adverse obstetrical and neonatal outcomes. Recent evidence, notably from the ARRIVE Trial, demonstrated that elective induction at 39 weeks reduced the rate of caesarean deliveries and pregnancy-related hypertensive disorders. However, some concerns have to be addressed as the benefits of universal policies have to be weighed against the actual circumstances of their implementation, the economic impact, the number of procedures needed in order to effectively reduce complications and, above all, women's perception towards this approach at the end of pregnancy. Further research is needed to explore individual tailored strategies in order to offer a personalized prognosis to each woman, rather than a blanket application of general recommendations

Prediction of spontaneous onset of labor at term (PREDICT study): Research protocol

Background Recent studies have shown that elective induction of labor versus expectant management after 39 weeks of pregnancy result in lower incidence of perinatal complications, while the proportion of cesarean deliveries remains stable, or even decreases. Still, evidence regarding collateral consequences of the potential increase of induction of labor procedures is still lacking. Also, the results of these studies must be carefully interpreted and thoroughly counter-balanced with women’s thoughts and opinions regarding the active management of the last weeks of pregnancy. Therefore, it may be useful to develop a tool that aids in the decision-making process by differentiating women who will spontaneously go into labor from those who will require induction. Objective To develop a predictive model to calculate the probability of spontaneous onset of labor at term. Methods We designed a prospective national multicentric observational study including women enrolled at 39 weeks of gestation, carrying singleton pregnancies. After signing an informed consent form, several clinical, ultrasonographic, biophysical and biochemical variables will be collected by trained staff. If delivery has not occurred at 40 weeks of pregnancy, a second visit and evaluation will be performed. Prenatal care will be continued according to current hospital guidelines. Once recruitment is completed, the information gathered will be used to develop a logistic regression-based predictive model of spontaneous onset of labor between 39 and 41 weeks of gestation. A secondary exploration of the data collected at 40 weeks, as well as a survival analysis regarding time-to-delivery outcomes will also be performed. A total sample of 429 participants is needed for the expected number of events. Conclusion This study aims to develop a model which may help in the decision-making process during follow-up of the last weeks of pregnancy. Trial registration NCT05109247 (clinicaltrials.gov)