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

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

Use and ease of self-administered International Prostate Symptoms Score (IPSS) and Visual Prostate Symptoms Score (VPSS) questionnaires for the assessment of lower urinary tract symptoms in Nigerian men

Objectives: To evaluate the use of the Visual Prostate Symptoms Score (VPSS) and International Prostate Symptoms Score (IPSS) questionnaires for the assessment of lower urinary tract symptoms (LUTS) in Nigerian men, with special emphasis on the ease of administration and the time needed to complete the questionnaires. Patients and methods: This cross-sectional survey of men with LUTS was carried out at a tertiary-care hospital in Nigeria between July and December, 2014. The symptoms were assessed using the IPSS and VPSS questionnaires. A structured questionnaire was created to collect data on socio-demographics, literacy, visual impairment and the time needed to complete the IPSS and VPSS questionnaires. The data were collated, and Pearson's chi-square test was performed using a contingency table. Spearman's rank correlation test was done for IPSS and VPSS, while the paired t-test was used for the average time spent in completing both questionnaires. A p-value <0.05 was considered as significant. Results: Ninety patients aged between 56 and 80 years were enrolled in the study. Thirty-one (34.4%) were literate in English, while 59 (65.6%) were illiterate. The literate patients with at least secondary education completed the IPSS questionnaire without assistance. The VPSS questionnaire was completed without assistance by 43 (72.9%) illiterate patients, while all the patients with visual impairment needed assistance to complete it. There was a statistically significant correlation between the IPSS and VPSS. Completion of the VPSS questionnaire required half of the time needed to complete the IPSS questionnaire. Conclusion: To complete the IPSS questionnaire, Nigerian men require a literacy status of at least secondary education. VPSS correlated significantly with IPSS. Both questionnaires can be used to assess LUTS in uneducated patients and those with a low educational level, but visual impairment may preclude their use. It takes less time to complete the VPSS compared to the IPSS questionnaire

A randomized, double-blind study of six combined oral contraceptives

Contraception253231-241CCPT