9 research outputs found
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 lowâmiddle-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 âsingle-useâ 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 lowâmiddle-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 highâ and lowâmiddleâincome countries
Humeral shaft non-union in the elderly: Results with cortical graft plus stem cells
Introduction: Humeral shaft is a common site of fracture non-union. Biology and bone quality represent some of the problems that the orthopaedic surgeon has to face up in the elderly. The goals of treatment of humeral shaft non-union are the achievement of mechanical stability and creation of a favourable biologic environment. Bone graft and stem cells are some of the augmentation techniques available to reach these goals. Purpose: Evaluation of the outcomes of humeral shaft non-union in elderly population treated with cortical allograft and stem cells. Material and methods: A cohort of 21 patients with humeral shaft non-union was reviewed. Inclusion criteria were patients aged more than 65 years, with a diagnosis of humeral shaft non-union treated with cortical allograft and stem cells. Primary endpoints were âbone healingâ and âtime-to-unionâ. Secondary endpoints were shoulder and elbow function and patientsâ quality of life with Oxford Shoulder Score (OSS), Constant score and EuroQol-5D (EQ-5D). Results: 6 patients met the inclusion criteria. In 5 of them, the cortical allograft was opposite to a plate, whereas in the other one a âSandwichâ technique was chosen because of large osteolysis. âBone healingâ occurred in all patients after a mean of 3.3 months (range 2â5). In all but two patients, the elbow range of motion was in almost normal range (15â130). The mean OSS was 35.8 (+/â 6.4), whereas the mean Constant was 53.3 (+/â 2.2). The mean EQ-5D index was 0.451 (+/â 0.21). Discussion: Bone healing occurred in all patients, with a time-to-union comparable or even better compared with other series. The use of cortical bone graft provide both stability and biological benefit, whereas stem cells improve the non-union environmental biology. Functional outcomes were lower than other series and patientsâ quality of life was similar to Italian elderly women. Conclusion: The use cortical allograft with stem cells is a viable strategy to treat humeral shaft non-union in the elderly.Introduction: Humeral shaft is a common site of fracture non-union. Biology and bone quality represent some of the problems that the orthopaedic surgeon has to face up in the elderly. The goals of treatment of humeral shaft non-union are the achievement of mechanical stability and creation of a favourable biologic environment. Bone graft and stem cells are some of the augmentation techniques available to reach these goals. Purpose: Evaluation of the outcomes of humeral shaft non-union in elderly population treated with cortical allograft and stem cells. Material and methods: A cohort of 21 patients with humeral shaft non-union was reviewed. Inclusion criteria were patients aged more than 65 years, with a diagnosis of humeral shaft non-union treated with cortical allograft and stem cells. Primary endpoints were âbone healingâ and âtime-to-unionâ. Secondary endpoints were shoulder and elbow function and patientsâ quality of life with Oxford Shoulder Score (OSS), Constant score and EuroQol-5D (EQ-5D). Results: 6 patients met the inclusion criteria. In 5 of them, the cortical allograft was opposite to a plate, whereas in the other one a âSandwichâ technique was chosen because of large osteolysis. âBone healingâ occurred in all patients after a mean of 3.3 months (range 2â5). In all but two patients, the elbow range of motion was in almost normal range (15â130). The mean OSS was 35.8 (+/â 6.4), whereas the mean Constant was 53.3 (+/â 2.2). The mean EQ-5D index was 0.451 (+/â 0.21). Discussion: Bone healing occurred in all patients, with a time-to-union comparable or even better compared with other series. The use of cortical bone graft provide both stability and biological benefit, whereas stem cells improve the non-union environmental biology. Functional outcomes were lower than other series and patientsâ quality of life was similar to Italian elderly women. Conclusion: The use cortical allograft with stem cells is a viable strategy to treat humeral shaft non-union in the elderly
Percutaneous transverse pinning for metacarpal fractures: a clinical trial.
Metacarpal fractures account for 25%-50% of all hand fractures and may negatively impact hand function and ability to work. Percutaneous transverse pinning of non-articular metacarpal fractures allows mobilisation immediately after the procedure. Between March 2017 and February 2022, 56 patients undergoing percutaneous transverse pinning for unstable metacarpal fractures were prospectively recruited. We investigated surgical outcomes in terms of Patient-rated Wrist/Hand Evaluation (PRWHE) and pre-and post-operative radiographic evaluation. The Student t-test was used to compare the means of PRWHE values after surgery. Statistical significance was set at pâ<â0.05. The mean age was 40.21â±â17.9 years (range of 16 to 86 years). The average operating time was 27.96 min. The mean follow-up period was 14.3â±â6.4 months (from 2 to 41 months). The mean PRWHE score was 6.5â±â1.8. None of the patients had clinically observable rotational deformities, and the functional outcomes were satisfactory. Percutaneous transverse pinning for non-articular metacarpal fractures restores excellent function, and imaging results are satisfactory. Further high-quality clinical trials are required to validate these results on a larger scale. II, prospective cohort study. [Abstract copyright: © 2024. The Author(s).
Pulmonary vasoreactivity predicts long-term outcome in patients with Eisenmenger syndrome receiving bosentan therapy.
Vasoreactivity testing is recommended in the management of pulmonary arterial hypertension (PAH), but its clinical relevance in congenital heart disease (CHD)-associated PAH has not been established.Journal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe
Fractures around Trochanteric Nails: The âVergilius Classification Systemâ
Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patientsâ outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. Materials and Methods. A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures