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

AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY

As a rare form of ectopic pregnancy, interstitial pregnancy threatens the future fertility of the patient. Methods of management include observation only, medical treatment with methotrexate either systemically or locally, or surgery either with laparotomy or laparoscopy. We present the case of a woman with recurrent interstitial pregnancy. Treatment with methotrexate was successful in her first interstitial pregnancy, however the second necessitated laparotomy. Selection of patients for treatment with methotrexate and the importance of subsequent tubal investigation are emphasized

sepsis

The systemic inflammatory response of the body to invading microorganisms, called sepsis, leads to profound activation of the complement (C3 and C4) system. The present study was conducted to compare the use of serum C3 and C4 levels with C-reactive protein (CRP) and thrombocyte and leukocyte counts in differentiating patients with systemic inflammatory response syndrome (SIRS) from those with sepsis. Over a 6-mo period, all patients with SIRS or sepsis who stayed in the intensive care unit for > 24 h were enrolled in the study. At admission, each patient's clinical status was recorded, and blood was taken for laboratory analysis (complete blood count, CRP, C3, and C4). A total of 58 patients with SIRS and 41 patients with sepsis were admitted to the study. The mean +/- SD thrombocyte count was found to be significantly lower in septic patients (179,975 +/- 95,615) than in those with SIRS (243,165 +/- 123,706) (P=.005); no difference in plasma concentrations of CRP and levels of C3 and C4 was noted between groups. The thrombocyte count was determined to be the most reliable parameter for differentiating between SIRS and sepsis (highest area under the curve=0.656).C1 Pamukkale Univ, Sch Med, Dept Anesthesiol & Reanimat, Denizli, Turkey

Public Health Rep

19315270PMCnul

patients

OBJECTIVE: Different methods have been used to assess nutritional status in hospitalized patients, and there is no agreement as to which index best reflects nutritional status. The aim of this study was to determine the prevalence of malnutrition and compare the Subjective Global Assessment, Nutrition Risk Index, and non-nutritional factors in hospitalized patients

Nutrition Assessment in Critically Ill Patients

Background: The aim of this study was to assess whether subjective global assessment (SGA) is useful in identifying malnutrition and outcomes in the intensive care unit (ICU). Methods: After obtaining institutional approval, 124 consenting patients were enrolled in this study. Patients were evaluated at admission using clinical data, SGA, height, weight, triceps skinfold thickness (TSF), mid-arm circumference (MAC), Acute Physiology and Chronic Health Evaluation (APACHE II), and Simplified Acute Physiologic Score (SAPS). Patients were classified as well nourished, moderately malnourished, or severely malnourished with SGA. Results: According to SGA, 62% (n = 77) of the patients were classified as well nourished, 26% (n = 33) as moderately malnourished, and 11% (n = 14) as severely malnourished. Body weight, body mass index (BMI), MAC, TSF, and mid-arm muscle circumference (MAMC) were lower, whereas APACHE II and SAPS II scores and mortality were higher in the malnourished groups compared with the well-nourished group. The SGA rating correlated significantly with age, body weight, percentage of weight loss, serum albumin level, APACHE II and SAPS II scores, and mortality. Anthropometrics data were correlated with SGA. Mortality rate was correlated with high APACHE II score, SAPS II score, days in the ICU and low BMI, MAMC, and serum albumin level. Conclusions: The results support that SGA is simple and may predict the patient's outcomes in the ICU. (Nutr Clin Pract. 2008; 23: 635-641

Nutrition assessment in critically ill patients.

BACKGROUND: The aim of this study was to assess whether subjective global assessment (SGA) is useful in identifying malnutrition and outcomes in the intensive care unit (ICU). METHODS: After obtaining institutional approval, 124 consenting patients were enrolled in this study. Patients were evaluated at admission using clinical data, SGA, height, weight, triceps skinfold thickness (TSF), mid-arm circumference (MAC), Acute Physiology and Chronic Health Evaluation (APACHE II), and Simplified Acute Physiologic Score (SAPS). Patients were classified as well nourished, moderately malnourished, or severely malnourished with SGA. RESULTS: According to SGA, 62% (n = 77) of the patients were classified as well nourished, 26% (n = 33) as moderately malnourished, and 11% (n = 14) as severely malnourished. Body weight, body mass index (BMI), MAC, TSF, and mid-arm muscle circumference (MAMC) were lower, whereas APACHE II and SAPS II scores and mortality were higher in the malnourished groups compared with the well-nourished group. The SGA rating correlated significantly with age, body weight, percentage of weight loss, serum albumin level, APACHE II and SAPS II scores, and mortality. Anthropometrics data were correlated with SGA. Mortality rate was correlated with high APACHE II score, SAPS II score, days in the ICU and low BMI, MAMC, and serum albumin level. CONCLUSIONS: The results support that SGA is simple and may predict the patient's outcomes in the ICU

Comparison of two nutrition assessment techniques in hospitalized patients.

OBJECTIVE: Different methods have been used to assess nutritional status in hospitalized patients, and there is no agreement as to which index best reflects nutritional status. The aim of this study was to determine the prevalence of malnutrition and compare the Subjective Global Assessment, Nutrition Risk Index, and non-nutritional factors in hospitalized patients. METHODS: This prospective study was done in the teaching hospital of Pamukkale University Medical School, Denizli, Turkey. Two hundred fifty-one consecutive patients hospitalized in medical and surgical wards were studied. On admission, the Subjective Global Assessment, Nutrition Risk Index, anthropometric measurements, and laboratory data were assessed. Differences between independent groups were assessed with Student's t test and one-way analysis of variance. Spearman's rank correlation coefficients were calculated for associations between scores and variables. Agreement between two assessment methods was analyzed by the K statistic. RESULTS: On admission, 30% of patients were malnourished according to the Subjective Global Assessment and 36% according to the Nutrition Risk Index. Body weight, albumin, lymphocyte, total cholesterol, and anthropometric data were lower in the malnourished patients according to both assessments (P < 0.01). Body weight loss and length of stay were higher in the malnourished patients according to both assessments (P < 0.01). Body weight, anthropometric data, albumin, and total cholesterol correlated inversely with nutritional status according to both techniques. Concordance was observed in 203 of the 251 (81%) patients with both assessments (K = 0.57, P = 0.000). CONCLUSIONS: Both tests correlated with each other with respect to age, length of stay, and anthropometric and laboratory data in hospitalized patients. Therefore, these two techniques can be used for nutritional assessment in hospitalized patients