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

Morphometric forms, biovolume and cellular carbon content of dinoflagellates from polluted waters on the Karachi coast, Pakistan

19-25Present   study reports new information on the biovolume and carbon biomass estimates for dinoflagellates from Manora Channel, Karachi coast, Pakistan. Biovolume per cell was calculated using the geometric shape of dinoflagellates at species level. Both thecate and athecate species were examined under light and scanning electron microscope.  A total of 45 species were measured and their cell size was ranged between 20-450<span style="font-size:9.0pt;font-family: " times="" new="" roman";mso-fareast-font-family:"times="" roman";mso-bidi-font-family:="" "times="" roman";mso-ansi-language:en-us;mso-fareast-language:en-us;="" mso-bidi-language:ar-sa"="" lang="EN-US">µm.  Geometric forms of the species were seven classed into as ellipsoidal, spherical, double cone shape, prolate sphere, cone and half sphere, “cone+3 cylinder” shape, “ellipsoidal + 2 cone+ cylinder” shape, “cylinder+ cone” shaped. Total biovolume ranged from 3.743 <span style="font-size:9.0pt;font-family:Arial;mso-fareast-font-family: " times="" new="" roman";mso-bidi-font-family:arial;mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"="" lang="EN-US">×103 to 2.2 <span style="font-size:9.0pt;font-family:Arial; mso-fareast-font-family:" times="" new="" roman";mso-bidi-font-family:arial;="" mso-ansi-language:en-us;mso-fareast-language:en-us;mso-bidi-language:ar-sa"="" lang="EN-US">×105 µm3 cell-1 and estimated cellular carbon content per cell ranged from 397 × 102 to 26.5 x 104 pg C cell-1.  Carbon and biovolume relationship was significant for thecate species which can thus be used for carbon flux studies.  </span

Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and Middle-Income Countries: A Systematic Review

Background: Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs.Methods: A systematic review was conducted with PubMed, Scopus, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively.Results: A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to prehospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%), and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house computed tomography scanners (35%), malfunctioning computed tomography scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%), and financial constraints (14%) were identified.Conclusions: Several factors, both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs

Factors delaying the continuum of care for the management of traumatic brain injury in low- and-middle income countries: A systematic review

Background: Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low-and-middle income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs.Methods: A systematic review was conducted with PubMed, Scopus, Google Scholar and CINAHL (Cumulative Index to Nursing and Allied Health Literature). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively.Results: A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to pre-hospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%) and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house CT scanners (35%), malfunctioning CT scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%) and financial constraints (14%) were identified.Conclusions: Several factors both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs

Temporal delays in the management of traumatic brain injury: A comparative meta-analysis of global literature

Objective: A meta-analysis was conducted to compare: 1) time from traumatic brain injury (TBI) to the hospital, and 2) time within the hospital to intervention or surgery, by country-level income, World Health Organization region, and healthcare payment system.Methods: A comprehensive literature search was conducted and followed by a meta-analysis comparing duration of delays (prehospital and intrahospital) in TBI management. Means and standard deviations were pooled using a random effects model and subgroup analysis was performed using R software.Results: Our analysis comprised 95,554 TBI patients from 45 countries.By country-level income: From 23 low- and middle-income countries, a longer mean time from injury to surgery (862.53 minutes, confidence interval [CI]: 107.42-1617.63), prehospital (217.46 minutes, CI: -27.34-462.25), and intrahospital (166.36 minutes, 95% CI: 96.12-236.60) durations were found compared to 22 high-income countries.By who region: African Region had the greatest total (1062.3 minutes, CI: -1072.23-3196.62), prehospital (256.57 minutes [CI: -202.36-715.51]), and intrahospital durations (593.22 minutes, CI: -3546.45-4732.89).By healthcare payment system: Multiple-Payer Health Systems had a greater prehospital duration (132.62 minutes, CI: 54.55-210.68) but greater intrahospital delays were found in Single-Payer Health Systems (309.37 minutes, CI: -21.95-640.69).Conclusion: Our study concludes that TBI patients in low- and middle-income countries within African Region countries face prolonged delays in both prehospital and intrahospital management compared to high-income countries. Additionally, patients within Single-Payer Health System experienced prolonged intrahospital delays. An urgent need to address global disparities in neurotrauma care has been highlighted

Abstract P337: Social Network Size is Associated With Healthy Lifestyle Factors: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Background: Social ties within social networks have been shown to influence healthy lifestyles. However, little is known about the association among size of familial social networks, social network dynamics (such as frequency of contact and perceived connectedness), and healthy lifestyle factors in Hispanic/Latino adults. We examined cross-sectional associations of central family social network size, as well as frequency of contact with central family members (children, parents, in-laws) and perceived connectedness to extended family members (uncles, aunts, and other relatives), with individual healthy lifestyle factors. Methods: Data were analyzed from 15,511 self-identified Hispanic/Latino adults ages 18-74 years from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Size of central family, frequency of contact with central family members in past 2 weeks, and perceived connectedness to extended family, were categorized into approximate tertiles based on the distribution of the data. Healthy lifestyle factors included alcohol use (men <30g/day; women <15g/day), not currently smoking, body mass index [BMI] 18.5 to <25.0 kg/m 2 , physical activity in the highest sex-specific 40%, and healthy diet in the highest sex-specific 40%. Survey logistic regression was used to compute odds ratios [OR] and 95% confidence intervals [CI], with models adjusted for age, sex, education, income, Hispanic/Latino background, employment status, religion, church attendance, marital status, acculturation, and language preference. Results: Compared to participants with a central family social network of 0-3 individuals, those with a family social network of 4-5 members were significantly less likely to have a healthy diet (OR: 0.86; 95% CI: 0.74, 0.99) or a healthy BMI (OR: 0.74; 95% CI: 0.65, 0.85). Also, those with 6-11 members were also significantly less likely to have a healthy BMI (OR: 0.58; 95% CI: 0.49, 0.69). Individuals reporting frequent contact with 3-4 and 5-11 family members were less likely to have a healthy BMI (OR: 0.76; 95% CI: 0.66, 0.87; OR: 0.60; 95% CI: 0.51, 0.72; respectively) versus those reporting frequent contact with only 0-2 family members. However, individuals who reported feeling connected to 3-5 extended family members were more likely to have a healthy diet (OR: 1.16; 95% CI: 1.00, 1.36) and healthy BMI (OR: 1.15; 95% CI: 1.00, 1.33), and those who felt connected to 6-7 extended family members were more likely to be non-smokers and to have a healthy BMI (OR: 1.16; 95% CI: 1.00, 1.34; OR: 1.20, 95% CI: 1.20; 95% CI: 1.04, 1.38; respectively) versus those who reported feeling connected to 0-2 extended family members. Conclusions: These findings suggest that social network size and dynamics may play an important role in influencing healthy lifestyle factors among Hispanic/Latino adults. Further, specific influences may differ based on the type of relationship

The Association Between Family Social Network Size and Healthy Lifestyle Factors: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

We examined associations of central family (i.e., children, parents, in-laws) social network size with healthy lifestyle factors (i.e., favorable body mass index, physical activity, diet, alcohol use, smoking). Using data on 15,511 Hispanics/Latinos 18-74 years old from the Hispanic Community Health Study/Study of Latinos, multivariable adjusted survey logistic regression was used to compute associations of social network size with healthy lifestyle factors. A one-unit higher total of central family size was associated with lower odds of healthy body mass index (OR 0.90; 95% CI 0.86-0.93) and having all five healthy lifestyle factors (OR 0.90; 95% CI 0.85-0.96). Findings suggest familial structural social support may contribute to healthy lifestyle factors and differ based on the type of relationship among Hispanics/Latinos

Adolopment of clinical practice guidelines and creation of referral pathways for psychiatric conditions in Pakistan

Psychiatric disorders are highly prevalent in Pakistan and burdens the scarce number of psychiatrists present in the country. The establishment of evidence-based clinical practice guidelines (EBCPGs) and primary-care referral pathways within the local context is imperative to make the process efficient. In this Health Policy, we aimed to develop EBCPGs and primary-care referral pathways that are specific to Pakistan\u27s primary-care setting, with the aim of facilitating the management of psychiatric conditions. Ten EBCPGs were created through the GRADE-ADOLOPMENT process; two recommendations were adopted with minor changes, 43 were excluded, and all others were adopted without any changes. Ten primary-care referral pathways for managing ten psychiatric disorders were created and 23 recommendations were added which will help to bridge the gap in care provision. These psychiatric referral pathways and EBCPGs will bring Pakistan\u27s healthcare system a step closer to achieving optimal health outcomes for patients