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

Morphometric analysis of odontoid process among Arab population: a retrospective cone beam CT study

Objective This study aims to evaluate the feasibility of using cone beam computed tomography (CBCT) scans to assess the odontoid process diameter in the Arab population and to determine whether one or two cortical screws can be used for treating odontoid fractures. Methods The odontoid process of 142 individuals aged 12–75 years, including 72 males (mean age: 35.5) and 70 females (mean age: 36.2), were analyzed using CBCT scans. The sagittal and coronal CBCT views were used to evaluate the antero-posterior (AP) and transverse diameters of the odontoid process. Results Males had substantially bigger transverse and AP diameters of the odontoid process than females (p < 0.05 & P < 0.01 respectively). Among the sample, 97 individuals (67.4%) had external transverse diameter (METD) of less than 9 mm which is slightly bigger than that of Indians and 48 individuals (31.83%) had enough room for two 3.5 mm or two 2.7 mm screws as their METD was more than 9 mm like that of Greek and Turkish. Age had no significant impact on the morphometric measurements of the odontoid process. Conclusion More than sixty percent of the sample had METDs of less than 9 millimeters, indicating that a single 4.5-mm Herbert screw may be suggested for fixing fractured odontoid processes in the Arab population

Collaborative use of virtual patients after a lecture enhances learning with minimal investment of cognitive load

<p><b>Background:</b> The use of virtual patients (VPs), due to their high complexity and/or inappropriate sequencing with other instructional methods, might cause a high cognitive load, which hampers learning.</p> <p><b>Aim:</b> To investigate the efficiency of instructional methods that involved three different applications of VPs combined with lectures.</p> <p><b>Method:</b> From two consecutive batches, 171 out of 183 students have participated in lecture and VPs sessions. One group received a lecture session followed by a collaborative VPs learning activity (collaborative deductive). The other two groups received a lecture session and an independent VP learning activity, which either followed the lecture session (independent deductive) or preceded it (independent inductive). All groups were administrated written knowledge acquisition and retention tests as well as transfer tests using two new VPs. All participants completed a cognitive load questionnaire, which measured intrinsic, extraneous and germane load. Mixed effect analysis of cognitive load and efficiency using the R statistical program was performed.</p> <p><b>Results:</b> The highest intrinsic and extraneous load was found in the independent inductive group, while the lowest intrinsic and extraneous load was seen in the collaborative deductive group. Furthermore, comparisons showed a significantly higher efficiency, that is, higher performance in combination with lower cognitive load, for the collaborative deductive group than for the other two groups.</p> <p><b>Conclusion:</b> Collaborative use of VPs after a lecture is the most efficient instructional method, of those tested, as it leads to better learning and transfer combined with lower cognitive load, when compared with independent use of VPs, either before or after the lecture.</p

Assessment of dental students′ psychomotor skills using oral surgery simulation models

Aim: The aim of this study was to determine the validity of using oral surgery simulation models as a tool to assess the psychomotor skills of dental students. Materials and Methods: All students in the 4 th year of a 6 years dental program were enrolled in the study. 23 dental students were asked to display their competency in the injection of local anesthesia and dental extraction in two summative testing environments namely; in the simulation and in the outpatient clinic. A panel of four experts assessed the students′ performance during the injection of local anesthesia and tooth extraction on patients and simulation using a pre-validated checklist. Students′ scores were compared in both settings. Results: The results showed no significant correlation between the scores on patients and simulation in the two settings (P = 0.759). Conclusion: The study revealed that the real patient remains the gold standard in summative assessment of dental students′ psychomotor skills

Alpinia zerumbet (Pers.) : Food and Medicinal Plant with Potential In Vitro and In Vivo Anti-Cancer Activities

Background/Aim: Plants play an important role in anti-cancer drug discovery, therefore, the current study aimed to evaluate the biological activity of Alpinia zerumbet (A. zerumbet) flowers. Methods: The phytochemical and biological criteria of A. zerumbet were in vitro investigated as well as in mouse xenograft model. Results: A. zerumbet extracts, specially CH2Cl2 and MeOH extracts, exhibited the highest potent anti-tumor activity against Ehrlich ascites carcinoma (EAC) cells. The most active CH2Cl2 extract was subjected to bioassay-guided fractionation leading to isolatation of the naturally occurring 5,6-dehydrokawain (DK) which was characterized by IR, MS, H-1-NMR and C-13-NMR. A. zerumbet extracts, specially MeOH and CH2Cl2 extracts, exhibited significant inhibitory activity towards tumor volume (TV). Furthermore, A. zerumbet extracts declined the high level of malonaldehyde (MDA) as well as elevated the levels of superoxide dismutase (SOD) and catalase (CAT) in liver tissue homogenate. Moreover, DK showed anti-proliferative action on different human cancer cell lines. The recorded IC50 values against breast carcinoma (MCF-7), liver carcinoma (Hep-G2) and larynx carcinoma cells (HEP-2) were 3.08, 6.8, and 8.7 mu g/mL, respectively. Conclusion: Taken together, these findings open the door for further investigations in order to explore the potential medicinal properties of A. zerumbet