5 research outputs found

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    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

    Pobreza urbana en América Latina y el Caribe

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    En las ciencias sociales resulta una tarea ardua definir quĂ© es la pobreza urbana. ÂżCuĂĄl es la especificidad que la vida en la ciudad le confiere al ya complejo fenĂłmeno de la pobreza? Las ciudades son territorios histĂłricamente privilegiados para el anĂĄlisis de la pobreza en tanto condensan, incluso visualmente, las marcas de los procesos de acumulaciĂłn econĂłmica, polĂ­tica y de aquellos vinculados a la reproducciĂłn de la vida cotidiana. A travĂ©s de diversos estudios que contemplan una mirada multidimensional, desde diferentes enfoques teĂłricos y metodolĂłgicos, este libro plantea una aproximaciĂłn a los procesos de segregaciĂłn urbana producto de las transformaciones acontecidas en las Ășltimas dĂ©cadas en la regiĂłn. Asimismo, sus anĂĄlisis brindan, desde una mirada crĂ­tica insumos claves que aportan al debate elementos para el diseño de polĂ­ticas tendientes a accionar colectivamente sobre la desigualdad social en nuestro continente.Las huellas de la pobreza en la ciudad / MarĂ­a Mercedes Di Virgilio, MarĂ­a PĂ­a Otero y Paula Boniolo. I. Territorios de pobreza : SegregaciĂłn y fronteras simbĂłlicas en La Carpio, una comunidad centroamericana / Laura Paniagua Arguedas. RegeneraciĂłn urbana y exclusiĂłn social en la ciudad de Guayaquil: el caso de la Playita de El Guasmo / Henrry Patricio AllĂĄn AlegrĂ­a. Pobreza urbana, desempleo y nuevos sentidos del (no)trabajo. Cirujas y Movimientos de Trabajadores Desocupados de la Ciudad de Buenos Aires / Mariano D. Perelman. II. Los rostros de la pobreza urbana: ÂżNuevas formas de exclusiĂłn social en niños? Consumo cultural infantil y procesos de urbanizaciĂłn de la pobreza en la capital cubana / Silvia PadrĂłn DurĂĄn. Trabajo infantil y migraciĂłn: pobreza, marginaciĂłn y exclusiĂłn social de niños y niñas trabajadores/as, migrantes nicaragĂŒenses en Costa Rica. Una lectura desde la pobreza de capacidades y los derechos humanos / Carlos Alvarado Cantero. La construcciĂłn de la identidad juvenil en el contexto de la pobreza y la migraciĂłn del campo a la ciudad / Mirian Isabel Calel MejĂ­a. Da empresa e da casas para rua um estudo sobre as mulheres camelĂŽs em Porto Alegre/RS Brasil / Rosana Soares Campos. ÂżEnvejecer solos o sĂłlo envejecer? La exclusiĂłn social en la tercera edad / Ana Rapoport. Pobres y excluidos en la selva de cemento: los nativos shipibos de Cantagallo en Lima Metropolitana / Adriana Arista Zerga. Justicia condicionada: pobreza y gĂ©nero en espacios de encuentro entre mujeres y justicia / AndreĂ­na Torres. III. La gestiĂłn de la pobreza urbana: CoordinaciĂłn intergubernamental y pobreza urbana en MĂ©xico / Alejandro Navarro Arredondo. Concepciones de ciudadanĂ­a en las polĂ­ticas contra la exclusiĂłn social: el caso de los programas Familia en los conurbanos de BogotĂĄ y de Buenos Aires / AngĂ©lica Gunturiz R

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)
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