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

The use of black pepper (Piper guineense) as an ecofriendly antimicrobial agent to fight foodborne microorganisms

Consumers demand clean-label food products, necessitating the search for new, natural antimicrobials to meet this demand while ensuring food safety. This review aimed at investigating the antimicrobial properties of black pepper (Piper guineense) against foodborne microorganisms. The existence of foodborne illness, food spoilage, food waste, the resulting negative economic impact of these issues, and consumer interests have all pushed the food industry to find alternative, safe, and natural antimicrobials to be used in foods and beverages. Consumers have also influenced the demand for novel antimicrobials due to the perceived association of current synthetic preservatives with diseases and adverse effects on children. They also have a desire for clean-label products. These combined concerns have prompted researchers at investigating plant extracts as potential sources for antimicrobials. Plants possess many antimicrobial properties; therefore, evaluating these plant extracts as a natural source of antimicrobials can lead to a preventative control method in reducing foodborne illness and food spoilage, inclusively meeting consumer needs. In most regions, P. guineense is commonly utilized due to its potent and effective medicinal properties against foodborne microorganisms

Rectal diclofenac reduces the risk and severity of post-ERCP pancreatitis: a prospective, randomized, double-blind controlled study.

Background: Pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography and its frequency is generally about 1 to 10%. A number of drugs have been used to reduce the frequency of post-ERCP pancreatitis but with conflicting results. We assessed the whether the use of diclofenac administered as rectal suppository would reduce the frequency of post-ERCP pancreatitis. Methods: A total of 925 patients were randomly assigned in a double blind fashion to receive diclofenac given as rectal suppository of100mg (467 patients) or inert placebo (458 patients) 15 min before ERCP. Serum amylase levels and patient and procedure related risk factors for post-ERCP pancreatitis were prospectively evaluated for all patients. Results The overall frequency of post-ERCP pancreatitis was 3.56%, compared to placebo, diclofenac significantly reduced the frequency (5.02% vs 2.1%; p = 0.01) as well as severity of post-ERCP pancreatitis (placebo, 19 mild, 2 moderate, 2 severe; diclofenac, 9 mild, 1 moderate, 0 severe; p = 0.02). Conclusions: Prophylactic administration of rectal diclofenac reduces the frequency and severity of post-ERCP pancreatitis

Prospective, randomized and controlled study of the efficacy of rabeprozole and placebo in the treatment of nonerosive reflux disease.

Background: Nonerosive reflux disease is defined as the presence of typical symptoms of gastroesophageal reflux disease in absence of visible esophageal mucosal injury at endoscopy. 24 hour ph study is needed to define the sub group. Treatment with the acid inhibitory agents is effective, proton pump inhibitors are most effective form of therapy. Clinical results to date suggest that anti-secretory therapy may be less effective in providing symptom relief for the patients nonerosive reflux disease than the patients with erosive disease. Objective: To assess prospectively effectiveness of proton pump inhibitors in nonerosive reflux disease Methods: A total of 200 patients with nonerosive reflux disease were randomized to receive placebo (98) or rabeprozole (102) for 6 months, with consultations at 3 weeks, 6 weeks, and 6 months. The primary end points were change in the severity of heart burn and regurgitation at the above mention periods. Results: Demographics of the randomized in each group were comparable except that placebo group included more males. The baseline characteristics between two groups were similar. After 6 month of treatment, reduction of visual analogue scale (VAS) of heartburn was prominent in treatment group (63% vs. 15%). At 3 weeks and six weeks, treatment group showed greater reduction of VAS for heart burn (p<0.01). Patients of the treatment group had lower frequency of heartburn (p<0.01) and regurgitation (p<0.01) at the end of the 6 month treatment. For the adverse effects, there was no difference in the both groups. Conclusions: Rabeprozole was more effective than placebo of the treatment of symptoms presented by the patients with nonerosive reflux disease, who had positive 24 hour ph study

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society