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

Correlation between PET-CT and ct in the staging after the treatment of head and neck squamous cell carcinoma

Objective: The aim of this study is to find out if a single imaging test is enough to follow-up on an oncological post-treatment patient. In such a case, we would know which was more valuable after comparing the two, by CT or PET-CT. Methods: Between January 2012 and July 2018, we collected data from all patients with previous medical history who were treated with a head and neck squamous cell carcinoma in our hospital, through surgery or by using an organ preservation protocol which we had done. Patients were required to have a CT and a PET-CT performed in a maximum period of 30 days between techniques. We compared the post post-treatment stage given to each case by using only the physical examination (only the CT and the PET-CT), with the ones given by the Tumor Board. After treatment, we analysed the similarity through Cramer''s V statistic test. Results: We performed a comparative analysis, obtaining a correlation of 0.426 between the stages given by the Tumor Board and the one assigned based on physical examination, without imaging techniques. By only using the computed tomography as an imaging method the correlation was 0.565, whereas with only the use of positron emission computed technology, it was estimated at 0.858. When we compared the statistical association between stages using exclusively one of the two imaging techniques, the correlation was 0.451. Conclusion: Independent of the modality, we have demonstrated that in patients who have received previous treatment, there was a higher correlation in the stages with respect to the diagnostic method conducted by the Tumor Board using PET-CT as the sole image. Level of evidence: Level 1. © 2021 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facia

Correlation between positron emission tomography/computed tomography and computed tomography in the staging prior to the treatment of head and neck squamous cell carcinoma

Introduction: Head and neck squamous cell carcinoma is the seventh most common malignant tumor. The advances in treatment have improved the global survival rates in the past years, although the prognosis is still grave. Objective: The aim of the present study is to evaluate the correlation between positron emission computed tomography and computed tomography at the time of staging a previously untreated head and neck squamous cell carcinoma, and to determine which of the two imaging techniques gives us more information at the time of initial diagnosis. Methods: Data from all patients diagnosed in our hospital of head and neck squamous cell carcinoma by a biopsy of any location or unknown primary tumor was collected, between January 2012 and July 2017. In all cases, a computed tomography and a positron emission computed tomography scan were performed with a maximum of 30 days difference between them and patients had not received any prior treatment to staging. The stage given to each case was compared based solely on the physical examination, only on the computed tomography and only on the positron emission computed tomography, with respect to the stage given by the Tumor Board, observing the concordance obtained through Cramer''s V statistical test. Results: We performed a comparative analysis obtaining a correlation of 0.729 between the stage given by the Tumor Board and the one assigned based on the physical examination without imaging techniques. When only using computed tomography as an imaging method, the correlation was 0.848, whereas with only the use of positron emission computed tomography it was estimated at 0.957. When comparing the statistical association between staging using exclusively one of the two imaging techniques, correlation was 0.855. Conclusion: Positron emission computed tomography is useful for the diagnosis of head and neck squamous cell carcinoma, improving the patient''s staging especially when detecting cervical and distant metastases. Therefore, we consider that the use of positron emission computed tomography for the staging of patients with head and neck squamous cell carcinoma is a diagnostic test to be considered

Tinnitus suppression after cochlear implantation in patients with single-sided deafness

Abstract Background Tinnitus associated with single-sided deafness (SSD) is frequent and often incapacitating, and is difficult to treat. Numerous studies have reported the suppression of tinnitus by electrical stimulation of the acoustic pathway through a cochlear implant (CI), with a low risk of worsening of tinnitus after implantation. Objective The main aim of this study was to demonstrate the effectiveness of CI as a treatment option in patients with SSD and incapacitating tinnitus. Patients and methods We studied the tinnitus-suppression effect of CI in a series of 13 patients with unilateral profound sensorineural hearing loss (SSD), associated with incapacitating tinnitus with normal hearing in the contralateral ear. Tinnitus impact was measured with the Tinnitus Handicap Inventory (THI), and tinnitus severity was measured with the Tinnitus Rating Scale (TRS) before and after CI. Results Thirteen patients were enrolled in this study, eight men and five women, ranging in age from 24 to 60 years with a mean±SD of 40±10 years. Mean scores for THI and TRS were obtained preoperatively and at 1 and 3 months postoperatively after activation of the CI. Mean scores for the THI total scores ranged from 79.6±7 preoperatively to 12±13.5 at 3 months postoperatively. Mean scores for the TRS ranged from 4.53±0.5 preoperatively to 1.46±0.5 at 3 months postoperatively. The postoperative THI and TRS improved significantly as compared with the baseline preoperative scores (P<0.005). Conclusion The outcome of the current study supports the belief that CI is not only a treatment option for hearing loss in SSD but also a treatment option to suppress tinnitus