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

Η επίδραση της θεραπείας με Anakinra στην ποιότητα ζωής των ασθενών με COVID-19 πνευμονία

Η νόσος COVID-19, που προκαλείται από τον ιό SARS-CoV-2, ένα μέλος του γένους των betacoronaviruses, συνιστά τα τελευταία χρόνια ένα σημαντικό παράγοντα νοσηρότητας και θνητότητας σε παγκόσμιο επίπεδο, τόσο λόγω του αυξημένου δυναμικού μετάδοσής του, όσο και λόγω του παθογενετικού του προφίλ. Με την προσβολή μεγάλου μέρους του παγκόσμιου πληθυσμού και τη επακόλουθη ανάρρωσή του, προκύπτουν συνεχώς δεδομένα που αναδεικνύουν την παρουσία εμμένουσας συμπτωματολογίας, σωματικής και ψυχικής, μετά την πάροδο της οξείας νόσησης, για άλλοτε άλλο χρονικό διάστημα που μπορεί να εκτείνεται ακόμη και εως 1 έτος από την έναρξη της συμπτωματολογίας. Η βαρύτητας της αρχικής νόσου δεν είναι ξεκάθαρο αν και κατά πόσο διαδραματίζει ρόλο, καθώς ακόμη και ασυμπτωματικοί ασθενείς μπορεί να εμφανίζουν σύνδρομο long-COVID. To Anakinra αποτελεί μία από τις θεραπευτικές επιλογές αντιμετώπισης της νόσου, καθώς είναι αποτελεσματικό στην πρόληψη της εμφάνισης συνδρόμου αναπνευστικής δυσχέρειας και συνεπακόλουθης ανάγκης για διασωλήνωση και στην ελάττωση της θνητότητας από τη νόσο COVID-19. Στην παρούσα εργασία αναδεικνύεται η ευεργετική επίδραση της θεραπείας με Anakinra στην ποιότητα ζωής ασθενών με COVID-19 πνευμονία που χρειάστηκαν νοσηλεία, όπως αυτή καθορίζεται από την παρουσία συμπτωματολογίας και δυνατότητας αυτοεξυπηρέτησης τις πρώτες 28 ημέρες από την έναρξη της αγωγής.COVID-19 disease that is caused by SARS-CoV-2, a member of the betacoronavirus genus, is an important health threat in the past few years due to the morbidity and mortality that it causes globally. Its virulence and its high rate of transmission play an important part in its global burden. A large number of people around the world are recovering from the disease and thus, a wide range of data suggest the presence of symptoms, either physical or phycoogical, for a certain period of time following acute illness, that could last for up to 12 months after disease onset. The relationship between the severity of acute illness and long-COVID syndrome still remains unclear, since it can be presented even in asymptomatic patients. Anakinra is an important therapeutic option for acute COVID-19 disease, since it reduces the risk for acute respiratory distress and following need for mechanical ventilation, and also reduces hosptial stay and overal 28 day mortality. This study suggests the possible effectiveness of Anakinra in quality of life of patients with COVID-19 pneumonia in need of hospitalisation, with regards to the presence of symptoms and the need of assistance in everyday life at the first 28 days after therapy

Early treatment of COVID-19 with anakinra guided by soluble urokinase plasminogen receptor plasma levels: a double-blind, randomized controlled phase 3 trial

Early increase of soluble urokinase plasminogen activator receptor (suPAR) serum levels is indicative of increased risk of progression of coronavirus disease 2019 (COVID-19) to respiratory failure. The SAVE-MORE double-blind, randomized controlled trial evaluated the efficacy and safety of anakinra, an IL-1 alpha/beta inhibitor, in 594 patients with COVID-19 at risk of progressing to respiratory failure as identified by plasma suPAR >= 6 ng ml(-1), 85.9% (n = 510) of whom were receiving dexamethasone. At day 28, the adjusted proportional odds of having a worse clinical status (assessed by the 11-point World Health Organization Clinical Progression Scale (WHO-CPS)) with anakinra, as compared to placebo, was 0.36 (95% confidence interval 0.26-0.50). The median WHO-CPS decrease on day 28 from baseline in the placebo and anakinra groups was 3 and 4 points, respectively (odds ratio (OR) = 0.40, P < 0.0001); the respective median decrease of Sequential Organ Failure Assessment (SOFA) score on day 7 from baseline was 0 and 1 points (OR = 0.63, P = 0.004). Twenty-eight-day mortality decreased (hazard ratio = 0.45, P = 0.045), and hospital stay was shorter.The SAVE-MORE phase 3 study demonstrates the efficacy of anakinra, an IL-1 alpha/beta inhibitor, in patients with COVID-19 and high serum levels of soluble plasminogen activator receptor

Early treatment of COVID-19 with anakinra guided by soluble urokinase plasminogen receptor plasma levels: a double-blind, randomized controlled phase 3 trial

Early increase of soluble urokinase plasminogen activator receptor (suPAR) serum levels is indicative of increased risk of progression of coronavirus disease 2019 (COVID-19) to respiratory failure. The SAVE-MORE double-blind, randomized controlled trial evaluated the efficacy and safety of anakinra, an IL-1 alpha/beta inhibitor, in 594 patients with COVID-19 at risk of progressing to respiratory failure as identified by plasma suPAR >= 6 ng ml(-1), 85.9% (n = 510) of whom were receiving dexamethasone. At day 28, the adjusted proportional odds of having a worse clinical status (assessed by the 11-point World Health Organization Clinical Progression Scale (WHO-CPS)) with anakinra, as compared to placebo, was 0.36 (95% confidence interval 0.26-0.50). The median WHO-CPS decrease on day 28 from baseline in the placebo and anakinra groups was 3 and 4 points, respectively (odds ratio (OR) = 0.40, P < 0.0001); the respective median decrease of Sequential Organ Failure Assessment (SOFA) score on day 7 from baseline was 0 and 1 points (OR = 0.63, P = 0.004). Twenty-eight-day mortality decreased (hazard ratio = 0.45, P = 0.045), and hospital stay was shorter. The SAVE-MORE phase 3 study demonstrates the efficacy of anakinra, an IL-1 alpha/beta inhibitor, in patients with COVID-19 and high serum levels of soluble plasminogen activator receptor

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally