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

Comparing the Use of Modern and Traditional Building Design Systems in Construction Projects

Any construction project through several stages, starting from the feasibilitystudy stage to the project delivery stage, as the most critical stage that must be focused on is the design stage. It was essential to adopt modern and advanced programs at the design stage to avoid problems and claims between the employer and the contractor due to changes and errors that occur in the project—design process. BIM is one of the modern technologies with many benefits that can be used to solve these errors and obstacles. This research aims to clarify the effectiveness of introducing the BIM system in the design stage of the construction building by comparing it with traditional CAD systems. In this research, ten different actual projects were studied in the architectural design stage to be used in the comparison process between BIM and CAD systems. The researcher reached a set of results, including that introducing the (BIM) in the architectural and structural design stage can reduce the time required to produce design documents by up to (67.6%). This study is helpful for all governmental and private design companies and encourages decision-makers to use the BIM system

Combined microbiological and clinical outcomes of short-term inhaled colistin adjunctive therapy in ventilator-associated pneumonia

Purpose Aerosolized antibiotics have potential lower risks of toxicity. Colistin has an excellent bactericidal activity against most gram-negative bacilli. We aimed to define both microbiological and clinical target outcomes after a 5-day treatment period in the treatment of patients with gram-negative ventilator-associated pneumonia (VAP). Patients and methods We recruited all patients with gram-negative bacteria culture and sensitivity taken from endotracheal tube aspirates after greater than or equal to 48 h of mechanical ventilation and clinical pulmonary infection score (CPIS) greater than or equal to 6. Patients were randomized to enter either the study group of inhaled colistin (3 million IU/day, for 5 days) as an adjunctive therapy to intravenous antibiotic treatment of VAP or enter the control group of intravenous antibiotics only. In both arms, intravenous antibiotics were started from the day of clinical suspicion according to American Thoracic Society/Infectious Disease Society of America guidelines. Interpretations on day 6 included microbiological outcome (endotracheal tube aspirate culture and sensitivity) and CPIS. Favorable outcome was defined if there was a microbiological clearance and CPIS less than 6. Patients were monitored for bronchospasm, daily serum creatinine, days of mechanical ventilation, and 30-day mortality. Results A total of 102 patients were recruited. Colistin group included 52 patients and the control group included 50 patients. Favorable outcome was higher [41 (78.8%) vs. 27 (54%), P=0.02] in colistin versus control group, respectively. Prolonged mechanical ventilation for more than 15 days was lower [23 (44.2%) vs. 44 (88%), P=0.01] and a 30-day hospital mortality was lower [21/52 (40.3%) vs. 35/50 (70%), P=0.008] in colistin versus control group, respectively. Conclusion Five days of adjunctive inhaled colistin in patients with gram-negative VAP showed a higher combined clearance and clinical improvement, including multidrug resistant groups, decreased duration of mechanical ventilation, and ICU mortality when compared with conventional intravenous therapy alone