A systematic review of the risk factors for clinical response to opioids for all-age patients with cancer-related pain and presentation of the paediatric STOP pain study

Inter-patient variability in response to opioids is well known but a comprehensive definition of its pathophysiological mechanism is still lacking and, more importantly, no studies have focused on children. The STOP Pain project aimed to evaluate the risk factors that contribute to clinical response and adverse drug reactions to opioids by means of a systematic review and a clinical investigation on paediatric oncological patients

SARS-CoV-2 vaccination modelling for safe surgery to save lives : data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.Peer reviewe

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

Ovariectomia Laparoscopica e Ovariectomia Laparotomica nella cagna: confronto tra le tempistiche e le complicanze post operatorie.

La finalità di questo studio è di confrontare la tecnica chirurgica laparoscopica con la tecnica chirurgica laparotomica(open) nell’intervento di ovariectomia nella cagna . Il nostro lavoro è stato effettuato con lo scopo di andare a confrontare in particolare le tempistiche e le complicanze post-operatorie tra i due interventi . In questo studio sono stati inclusi 67 soggetti di età compresa tra 7 mesi e 9 anni che sono stati sottoposti all’intervento di ovariectomia (sia laparoscopica che laparotomica) ai fini della castrazione . I risultati del nostro lavoro hanno messo in evidenza che tra i due interventi non ci sono significative differenze per quanto riguarda le complicanze post-operatorie mentre per quanto riguarda le tempistiche di svolgimento dell’intervento si è rivelata piu rapida la tecnica laparoscopica rispetto alla laparotomica . Viceversa per quanto riguarda il “dolore” post-operatorio è risultato al quanto maggiore nella laparotomia rispetto alla laparoscopia . Abstract : The purpose of this study is to compare laparoscopic surgical technique with laparotomic(open) surgical technique in ovariectomy surgery in the bitch . Our work was carried out with the purpose of going to compare in particular the timing and postoperative complications between the two surgeries . This study included 67 subjects aged 7 months to 9 years who underwent ovariectomy surgery (both laparoscopic and laparotomic) for the purpose of castration . The results of our work showed that there were no significant differences between the two surgeries with regard to postoperative complications while with regard to the timing of the procedure, the laparoscopic technique proved to be faster than the laparotomic technique . Viceversa regarding postoperative "pain" was at how much greater in laparotomy than laparoscopy