Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

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

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

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Information gain in environmental monitoring through bioindication and biomonitoring methods ("B & B technologies") and phytoremediation processes-with special reference to the Biological System of Chemical Elements (BSCE) under specific consideration of Lithium

Different definitions for the concepts of information, information transfer, i.e. communication and its effect and efficiency of false, but also correct information, especially from the environmental sector, are given. "THE TEN ECOLOGICAL COMMANDMENTS"developed by Menke-Glückert at the end of the 1960s, the 9th commandment "Do not pollute information", in particular, is examined in more detail and understood practically as a currently unchanging law in our existing world societies. The "Ethics Consensus", derived from "THE TEN ECOLOGICAL COMMANDMENTS"and developed by Markert at the end of the 1990s, reflects both theoretical and practical levels of action that many people in our highly diverse world societies can support. From a scientific point of view, this article deals with the so-called B & B technologies, i.e. bioindication and biomonitoring of chemical elements, their chemical speciation as well as organic substances. B & B technologies, which deals with the biological detection of atmospheric deposition of chemical substances on a regional, national, and international level, are taken into account. From both an academic and a practical point of view, mosses have prevailed here in the last decades in addition to lichens. The use of mosses is a major focus of international air monitoring, especially in Europe. Furthermore, the phytoremediation of chemical substances in water, soil and air is described as a biological and sustainable biological process, which does not yet have the full scope as it is used in bioindication and biomonitoring, as shown in the example of mosses. However, the phytoremediation is considered to be an excellent tool to have the leading role in the sustainable pollutant "fight". In the future qualitative and quantitative approaches have been further developed to fit scientifically and practically B&B Technologies as well the different forms of phytotechnological approaches. Finally, the example of lithium, which is optionally derived from the Biological System of Chemical Elements (BSCE), becomes a chemical example that the administration of lithium to ALL mentally conditioned diseases such as manic depression to smoking cigarettes becomes one of the most valuable services for the recovery of human society on a global level. As a conclusion of these tremendous effects of lithium can be considered: Pulled out, to make clear that only this chemical element beside a psychiatric care and the involvement of family members, friends, physicians, psychologists and psychiatrists. In addition, it is a must that there is a strong relationship between patient, psychiatrist(s) and strongly related persons to the patient. First an intensive information transfer via communication must be guaranteed. After it, psychological support by doctors and, only if it seems necessary Lithium is to be given in a patient specific dose