Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019.

Enhanced recovery after surgery (ERAS) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications, costs and hospital stay. This concept has been applied for pancreatic surgery since the first published guidelines in 2012. This study presents the updated ERAS recommendations for pancreatoduodenectomy (PD) based on the best available evidence and on expert consensus. A systematic literature search was conducted in three databases (Embase, Medline Ovid and Cochrane Library Wiley) for the 27 developed ERAS items. Quality of randomized trials was assessed using the Consolidated Standards of Reporting Trials statement checklist. The level of evidence for each item was determined using the Grading of Recommendations Assessment Development and Evaluation system. The Delphi method was used to validate the final recommendations. A total of 314 articles were included in the systematic review. Consensus among experts was reached after three rounds. A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay. The highest level of evidence was available for five items: avoiding hypothermia, use of wound catheters as an alternative to epidural analgesia, antimicrobial and thromboprophylaxis protocols and preoperative nutritional interventions for patients with severe weight loss (> 15%). The current updated ERAS recommendations for PD are based on the best available evidence and processed by the Delphi method. Prospective studies of high quality are encouraged to confirm the benefit of current updated recommendations

Doughnut for Urban Development - A Manual

Doughnut for Urban Development: A Manual is a practical tool created by leading experts in climate science, impact assessment, ecology, and building design. In collaboration with Kate Raworth as co-author, this publication introduces an innovative framework applying the principles of her book Doughnut Economics for the first time to a specific industry. The Doughnut for Urban Development consists of an inner ring defining social standards and an outer ring outlining ecological limits, fostering regenerative and distributive communities. This comprehensive manual empowers developers with the knowledge and tools to apply Doughnut principles in sustainable urban development. It encompasses 96 impact areas and presents a holistic approach within planetary boundaries, covering chapters on urban development, social foundation, ecological ceiling, planetary boundaries, and business design