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

Field application of Trichoderma spp. combined with thiophanate-methyl for controlling Fusarium solani and Fusarium oxysporum in dry bean

Abstract Background Damping-off and root rot/wilt diseases caused by the soil-borne fungi Fusarium solani and F. oxysporum are a serious problem of dry bean productions in Egypt. This study examines the potential of controlling these diseases biologically by using three Trichoderma isolates, compatible with the fungicide thiophanatemethyl, i.e., T. harzianum, T. viride, and T. virens. Soil application with inoculants containing these isolates employed either alone or in combination with seed coating with thiophanate-methyl was applied. Results Under greenhouse and field conditions, all treatments significantly reduced the incidence of damping-off and root rot/wilt diseases and increased the percentage of survival plants. These treatments increased vegetative growth parameters and yield components of the survival dry bean plants compared with untreated control. Soil application with Trichoderma isolates combined with thiophanate-methyl seed treatments was more effective than using both of them individually. Meanwhile, T. virens + thiophanate-methyl was the most effective treatment. The tested treatments stimulated systemic defense responses in dry bean plants by activating defense enzymes including peroxidase, polyphenoloxidase, and chitinase. Conclusions Based on the obtained results, compatible isolates of Trichoderma spp. as soil treatment combined with thiophanate-methyl as seed treatment may have potential to develop a new biofungicide for integrated management of damping-off and root rot/wilt diseases in dry bean

Effect of inoculum density of Stromatinia cepivora on the amount of white rot reduced by Trichoderma species in garlic

Abstract Background White rot, a garlic disease caused by the soil-borne fungus Stromatinia cepivora (Berk.) Whetzel, is a serious problem of garlic productions in Egypt. This study examines the potential of controlling the disease biologically by using three Trichoderma species, i.e., Trichoderma harzianum, Trichoderma koningii, and Trichoderma virens employed either alone or in combination. Results In in vitro assays, three Trichoderma species, i.e., Trichoderma harzianum, Trichoderma koningii, and Trichoderma virens and tebuconazole, were compared for their ability to suppress S. cepivora isolate (Sc8). In greenhouse experiments, the chemical treatment was the most effective, with the lowest incidence of garlic white rot compared with the control. The antagonistic fungi tested either individually or in combination significantly reduced the incidence of white rot on garlic. In general, dual and triple combinations of the fungal isolates were more effective than these isolates used individually. The combination of the three Trichoderma species was the most effective treatment, decreasing disease incidence by 50.0% in 2016/2017 season and 40.0% in 2017/2018 season, respectively. The three Trichoderma species employed alone or in combinations and tebuconazole were evaluated under low and high disease pressures in field trials to determine which situation (s) provided the best control of garlic white rot. Under low (40 sclerotia/kg of soil) and high (600 sclerotia/kg of soil) inoculum density, the standard fungicide programme (dipping of garlic cloves in tebuconazole (1 ml of Folicur 25% l−1 of water) plus spraying garlic stem bases with the same concentration of tebuconazole) gave statistically significant disease control, decreasing disease incidence by 67.7 and 29.4% in 2016/2017 season and 72.6 and 31.1% in 2017/2018 season, respectively. Under low disease pressure, significant control, equal to the fungicide treatment, was achieved with the trip combination of three Trichoderma species. However, Trichoderma species employed alone gave insignificant control of garlic white rot under high disease pressure. The triple combination of three Trichoderma species decreasing disease incidence by 65.6 and 15.5% in 2016/2017 season and 74.2 and 18.6% during 2017/2018 season, under low and high inoculum density, respectively. The activities of defense enzymes, i.e., peroxidase, polyphenoloxidase, and chitinase due to application of Trichoderma species, were enhanced in garlic plants either grown under low or high disease pressures. Reduction of white rot disease incidence was accompanied by increased growth parameters and bulbs yield of garlic plants grown under field conditions. Conclusions These results indicated that the performance of three Trichoderma species may be influenced as much by the absolute disease pressure. It was concluded that, at the low disease pressure site, the low level of inoculum and disease incidence enabled three Trichoderma species to bring about disease control

Comparing the usefulness of VividTrac and classic Macintosh laryngoscope in intubation in pediatric patients with cleft palate

Abstract Background Surgical repair for pediatric patients with cleft palate is performed under general anesthesia requiring endotracheal intubation. However, intubating these cases is usually difficult because of the cleft itself and associated airway abnormalities. VividTrac, a video laryngoscopy that could provide a real-time picture of the glottic area, could be helpful in these cases. Methods We conducted the current prospective investigation to compare VividTrac and conventional Macintosh laryngoscope in intubating pediatric patients with cleft palate. Results All patient demographics did not express significant differences between the two groups. The number of trials and the first trial success rate were in favor of group L. The former had mean values of 1.28 and 1.05, while the latter occurred in 81.4% and 97.7% of patients in groups L and V, respectively. Group V showed a significant increase in the time interval passing between mouth opening and connecting the tube with the ventilator. Nonetheless, the difficulty of intubation was increased in group L. The need for cricoid pressure and tube introducer was increased in group L. Conclusions VividTrac laryngoscope could be a valid and more suitable option for intubation in pediatric patients with cleft palate. Compared to the conventional laryngoscope, it has a higher success rate, lower attempt number, and lower need for assisting maneuvers

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks

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 coprioritized 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