8 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

    Encefalopatías Subagudas Espongiformes Transmisibles (ESET).

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    LA TEORÍA PRIÓN - ENFERMEDADES PRIÓNICAS, REFERENCIA ESPECIAL A LA VIGILANCIA DE LA NUEVA VARIANTE DE LA ENFERMEDAD DE CREUTZFELDT - JAKOB (vCJ).
 
 
 Hasta 1954 la neuropatología sólo utilizaba la denominación encefalopatía espongiforme para el scrapie o prúrigo lumbar de las ovejas y las cabras y para la Enfermedad de Creutzfeldt-Jakob de aparición esporádica (CJE). El scrapie es una enfermedad fatal que afecta selectivamente el sistema nervioso de ovejas y cabras identificada en Escocia desde 1732 y que ya tras doscientos setenta y tres años se ha podido demostrar en prácticamente toda Europa y fuera de ella en África (Etiopía), en el continente australiano en Australia y Nueva Zelandia; en América los países afectados son Canadá, Estados Unidos y Brasil. Su transmisibilidad oveja-oveja se hace evidente a partir de 1936 (1) y Chandler logra transmitirla al ratón en 1961 utilizando inóculo preparado con cerebro de oveja enferma (2,3). No se ha comprobado transmisión de scrapie al ser humano . En relación con la aparición en 2001 de la llamada variedad atípica de scrapie atribuida a la cepa Nor 98 (por su temprana presencia en Noruega) podemos decir que la Agencia de Laboratorios Veterinarios en Weybridge – Inglaterra que es el laboratorio europeo de referencia para Encefalopatías Subagudas Espongiformes Transmisibles (ESET) y responsable también de coordinar la investigación de casos atípicos de prúrigo lumbar, informó a fi nales de 2004 que en los últimos tres años ha podido confirmar 83 casos de esta variedad estudiando 110.000 cerebros de ovejas en el Reino Unido.
 
 Lo tranquilizante es que los expertos que realizaron este estudio concluyeron en su reunión del 30 de marzo de 2004 que este hallazgo no debe considerarse homologable con la presencia de Encefalopatía Espongiforme Bovina (EEB) en ovejas (Promed-mail).
 
 Como está aceptado que el scrapie ha sido el punto de partida en la cadena de transmisión de las más impactantes ESET al comprobarse la transmisión oveja- bovino humano, es comprensible que siga vigente el interés por enriquecer el conocimiento sobre el verdadero origen y patogenia del prúrigo lumbar (4).
 
 La enfermedad de Creutzfeldt-Jakob de presentación esporádica (CJE) descrita por estos autores entre 1920 y 1921 (5,,6) esperó media centuria (hasta 1974) para demostrar su potencial transmisibilidad humanohumano y para, por sus semejanzas con scrapie y con el Kuru, convertirse conjuntamente con estas dos entidades en objeto de un modelo de investigación a partir de la fecha señalada antes (1954); investigación ejemplarizante cuyo itinerario y valiosos hallazgos fueron difundidos en la más voluminosa bibliografía que se haya dedicado a proceso neuropatológico alguno (7-21) y que entre otras cosas demostró por primera vez para las ESET transmisión oral humano-humano propiciada por el canibalismo practicado por las etnias afectadas y ello se comprobó más allá de la duda puesabandonados estos hábitos el kuru ha desaparecido.
 
 La transmisión iatrogénica de la ECJ fue causada primero por un injerto de córnea (16) y después por injerto de duramadre, por extractos de glándula hipó- fisis (21) y por implantación cerebral de electrodos contaminados.
 
 Conceptos expresados por Mc Farlane Burnet desde 1939 hicieron que el veterinario islandés B. Sigurdsson propusiera para las ESET el nombre Enfermedades virales lentas (7), lo cual fue bien aceptado por el grupo que ya iniciaba en la Nueva Guinea sus investigaciones sobre Kuru, cuya etiología consideraban era “un virus no convencional”, propuesta que tras tres décadas (1954-1984) de intensa búsqueda ellos mismos tuvieron que descartar basados en sus propias experiencias, las cuales, a la comprensión del comportamiento clínico y del sustrato neuropatológico agregaban siete características del agente transmisible que hacían poco menos que imposible seguir defendiendo su naturaleza viral.
 
 Como está aceptado que el scrapie ha sido el punto de partida en la cadena de transmisión de lasmás impactantes ESET al comprobarse la transmisión oveja- bovino humano, es comprensible que siga vigente el interés por enriquecer el conocimiento sobre elverdadero origen y patogenia del prúrigo lumbar (4)..

    Zika Virus RNA Replication and Persistence in Brain and Placental Tissue

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    Zika virus is causally linked with congenital microcephaly and may be associated with pregnancy loss. However, the mechanisms of Zika virus intrauterine transmission and replication and its tropism and persistence in tissues are poorly understood. We tested tissues from 52 case-patients: 8 infants with microcephaly who died and 44 women suspected of being infected with Zika virus during pregnancy. By reverse transcription PCR, tissues from 32 (62%) case-patients (brains from 8 infants with microcephaly and placental/fetal tissues from 24 women) were positive for Zika virus. In situ hybridization localized replicative Zika virus RNA in brains of 7 infants and in placentas of 9 women who had pregnancy losses during the first or second trimester. These findings demonstrate that Zika virus replicates and persists in fetal brains and placentas, providing direct evidence of its association with microcephaly. Tissue-based reverse transcription PCR extends the time frame of Zika virus detection in congenital and pregnancy-associated infections

    Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

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    Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

    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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