Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd

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

Preparación y caracterización de microesferas de Eudragit y etilcelulosa cargadas con 5-fluorouracilo

In the present investigation, 5-fluorouracil loaded microspheres of Eudragit (RS 100, RL 100 and RSPO) and ethylcellulose were prepared. “O/O solvent evaporation” technique was used for preparation of microspheres using (methanol + acetone)/liquid paraffin system. Magnesium stearate was used as the droplet stabilizer and n-hexane was added to harden the microspheres. The prepared microspheres were characterized for their micromeretic properties and entrapment efficiency; as well by Fourier transform infrared spectroscopy (FTIR) and thin layer chromatography (TLC). Photomicrographs were taken to study the shape of microspheres. The best fit release kinetics was achieved with Higuchi plot. Mean particle size, entrapment efficiency and production yields were highly influenced by the type of polymer and polymer concentration. It is concluded from the present investigation that various Eudragit and Ethylcellulose are promising controlled release carriers for 5-FU.En la presente investigación, se han preparado microesferas de Eudragit (RS 100, RL 100 y RSPO) y etilcelulosa cargadas con 5-fluorouracilo. Se ha utilizado la técnica de “evaporación del disolvente o/o” para preparar las microesferas utilizando el sistema de (metanol + acetona)/ parafina líquida. Se ha utilizado estearato de magnesio como estabilizador de gotículas y se ha añadido n-hexano para endurecer las microesferas. Las microesferas preparadas se caracterizan por sus propiedades micromeríticas y su eficaz compresión, así como a través de la espectroscopia infrarroja transformada de Fourier (FTIR, por sus siglas en inglés) y la cromatografía en capa fina. Se han tomado microfotografías para estudiar la forma de las microesferas. La mejor cinética de liberación se ha alcanzado con el modelo de Higuchi. El tamaño de la partícula principal, la eficacia de compresión y los rendimientos de producción han sido fuertemente influenciados por el tipo de polímero y su concentración. Tras la presente investigación, se ha determinado que el Eudragit y la Etilcelulosa tienen carreras muy prometedoras en la liberación controlada para el 5-FU

Surgical outcome of cortical dysplasias presenting with chronic intractable epilepsy: A 10-year experience

Background: There has been sparse description of cortical dysplasias (CDs) causing intractable epilepsy from India. Aim: Clinical retrospective study of CDs causing intractable epilepsy that underwent surgery. Materials and Methods: Fifty-seven cases of CDs reviewed (1995 till July 2006) are presented. All patients had intractable epilepsy, and underwent a complete epilepsy surgery workup (inter ictal electroencephalography (EEG), video EEG, MRI as per epilepsy protocol, SPECT {interictal, ictal with subtraction and co-registration when required}, and PET when necessary). Surgical treatment included a wide exposure of the pathology with a detailed electrocorticography under optimal anesthetic conditions. Mapping of the sensori-motor area was performed where indicated. Procedures included resection either alone or combined with multiple subpial transactions when extending into the eloquent areas. Results: Our study had 28 (49.12%) cases of isolated focal CDs, and 29 (50.67%) with dual pathology. Average age at the time of onset of seizures in our series was 7.04 years (three months to 24 years), and average age at the time of surgery was 10.97 years (eight months to 45 years). Among coexistent pathologies, one had associated MTS, 16 had coexistent gangliogliomas and 12 (dysembryonic neuroepithelial tumor) DNTs. At an average follow-up of 3.035 years (range 5-10 years), three patients were lost to follow-up. Fifty-one per cent (29/57) patients had a good outcome (Engel Grade I) and 26%(15/57) had a Grade II outcome. Conclusion: Cortical dysplasias have a good outcome if evaluated and managed with concordant electrical and imaging modalities