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

Rural risk: Geographic disparities in trauma mortality

Background: Barriers to trauma care for rural populations are well documented, but little is known about the magnitude of urban-rural disparities in injury mortality. This study sought to quantify differences in injury mortality comparing rural and nonrural residents with traumatic injuries.Methods: Using data from the 2009-2010 Nationwide Emergency Department Sample, multiple logistic regression analyses were conducted to estimate odds of death after traumatic injury for rural residents compared with nonrural residents, while controlling for age, sex, injury type and severity, comorbidities, trauma designation, and Census region.Results: Rural residents were 14% more likely to die after traumatic injury compared with nonrural residents (P \u3c .001). Increased odds of death for rural residents were observed at level I (odds ratio = 1.20, P \u3c .001), level II (odds ratio = 1.34, P \u3c .001), and level IV/nontrauma centers (odds ratio = 1.23, P \u3c .001). The disparity was greatest for injuries occurring in the South and Midwest (odds ratio = 1.54, P \u3c .001 and odds ratio = 2.06, P \u3c .001, respectively) and for cases with an injury severity score \u3c9 or unknown severity (odds ratio = 2.09, P \u3c .001 and odds ratio = 1.31, P \u3c .001, respectively).Conclusion: Rural residents are significantly more likely than nonrural residents to die after traumatic injury. This disparity varies by trauma center designation, injury severity, and US Census region. Distance and time to treatment likely play a role in rural injury outcomes, along with regional differences in prehospital care and trauma system organization

The Hopkins Rehabilitation Engagement Rating Scale: Development and Psychometric Properties

Kortte KB, Falk LD, Castillo RC, Johnson-Greene D, Wegener ST. The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties. To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services. We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure’s internal consistency, interrater reliability, construct validity, and criterion validity. Acute inpatient rehabilitation in 3 metropolitan hospitals. A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement. Not applicable. The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine’s Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument. The HRERS has good internal consistency (α=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression ( r=−.24, P<.01), higher ratings of denial of illness ( r=−.30, P<.001), and self-rated negative affect ( r=−.23, P<.01), and correlated positively with self-rated positive affect ( r=.36, P<.001) and level of functioning 3 months postdischarge ( r=.22, P<.01). The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes

The use of the NEO-five factor inventory to assess personality in trauma patients: A two-year prospective study

Objective: To assess the usefulness and validity of a brief personality assessment for orthopaedic trauma patients. Methods: The NEO-Five Factor Inventory was evaluated within the context of the Lower Extremity Assessment Project, a prospective study of patients with severe lower extremity trauma admitted to eight level I trauma centers. Patients/participants: The NEO-FFI was administered to 557 adults and 416 of their significant others. At 2 years postinjury, the NEO-FFI was readministered to 396 patients. Main outcome measures: Main outcome measures were as follows: (a) agreement between patient and significant other scores; (b) stability of personality traits over two years; and (c) the relationship of the measured NEO-FFI traits with patient characteristics and health habits. Results: There was fair to moderate agreement between assessments of personality provided by the patients themselves and their significant others, with intraclass correlation coefficients ranging from 0.44 to 0.54 for the different domains of personality. Patient assessments on the NEO-FFI were found to be robust with no significant changes in four of the five personality domains at 2 years postinjury. We also found that personality traits of patients are related to patient characteristics and behaviors in the directions that were expected. Conclusions: The NEO-FFI is a brief, valid, and stable measure of underlying personality traits that is practical for use in a trauma setting. Its use in both outcomes research and patient evaluation should be encouraged. In cases in which patients cannot complete the test, evaluations by significant others may be usefu

Increase in plasma IL-10 levels and rapid loss of CD4+ T cells among HIV-infected individuals in south India.

Increased levels of immune activation among HIV patients from developing countries are believed to accelerate and/or enhance the shift to a Th2 cytokine environment, which in turn may result in a more rapid progression to AIDS. In support of this hypothesis, we present data from a cohort of 35 HIV+ individuals in southern India. Among asymptomatic individuals in this cohort, a dramatic increase in plasma interleukin (IL)-10 coincided with rapid decrease in CD4 counts and progression to AIDS. Serum IL-10 levels were significantly higher after 6 months of follow up (P = 0.01), while CD4 counts declined at a rate of 280 cells/ul per year, roughly 3 times the rate of decline reported for HIV+ asymptomatic subjects in developed countries. Changes in serum IL-10 levels and CD4 counts fell short of statistically significant correlation (P = 0.1). Among AIDS patients in this cohort, the mean period from diagnosis of AIDS to death was &lt; 5 months and is in agreement with an earlier report of rapid progression in India

Determinants of Patient Satisfaction After Severe Lower-Extremity Injuries

Background: In health care, increased emphasis has been placed on patient-centered care, but to our knowledge little work has been conducted to understand the influences on patient satisfaction after surgery for the treatment of severe lower-extremity injury. Our purpose was to analyze how the patient's satisfaction with the outcome correlates with other measures of outcome (clinical, functional, physical impairment, psychological impairment, and pain) and with the sociodemographic characteristics of the patient, the nature of the injury, and the treatment decisions