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

Multiple domains of functioning in older adults during the pandemic: design and basic characteristics of the Longitudinal Aging Study Amsterdam COVID-19 questionnaire

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing cohort study among older adults in the Netherlands. Respondents are usually interviewed approximately every 3 years. Because of the exceptional situation of the COVID-19 pandemic, it was decided to add an extra assessment in between, consisting of a postal/digital questionnaire with measures assessing the impact of the COVID-19 situation, as well as a selection of measures from regular LASA measurement cycles covering the physical, social and mental domains. In total, 1128 LASA respondents aged 62–102 years provided data, just after the first wave of the pandemic in 2020. This paper describes the methods and design of the LASA COVID-19 questionnaire, as well as the basic characteristics of the sample, including an overview of impactful situations experienced by older adults during the first months of the pandemic. The data of the questionnaire may be used to study the impact of the COVID-19 pandemic on multiple domains of functioning in older adults

Identifying patients with a history of ovarian cancer for referral for genetic counselling: non-randomised comparison of two case-finding strategies in primary care.

Item does not contain fulltextBACKGROUND: Recent guidelines recommend genetic counselling and DNA testing (GCT) for patients with ovarian cancer and survivors of ovarian cancer. Finding survivors of ovarian cancer is challenging. Detecting and referring them for GCT via primary care, to allow proper screening recommendations for patients and their family, may be a solution. AIM: To compare the effectiveness and acceptance of two pilot strategies directed at case finding women with a history of ovarian cancer for referral for GCT by their GP. DESIGN AND SETTING: Non-randomised comparison of the pilot implementation of two case-finding strategies for women with a history of ovarian cancer in Dutch primary care from May 2016 to April 2017. METHOD: Strategy A (unsupported) asked GPs to identify and refer eligible patients with a history of ovarian cancer. Strategy B (ICT-supported) provided GPs with information and communication technology (ICT) support to identify patients with a history of ovarian cancer electronically. The effectiveness of each strategy was assessed as the proportion of patients who were approached, referred for GCT, and seen by the clinical geneticist. Acceptance of each strategy was assessed by the intervention uptake of GP practices and GP and patient questionnaires. RESULTS: Nineteen out of 30 (63%) patients identified with a history of ovarian cancer were deemed eligible for referral for strategy A, and 39 out of 94 (41%) for strategy B. For each strategy, eight patients were referred and five (63%) were seen for GCT. The intervention uptake by GP practices was 31% (11 out of 36) for strategy A and 46% (21 out of 46) for strategy B. GPs considered 'relevance' and 'workability' as facilitators across both strategies whereas, for strategy B, technical barriers hindered implementation. CONCLUSION: The effectiveness and acceptance of both strategies for case finding of survivors of ovarian cancer in primary care for GCT is promising, but larger studies are required before wide-scale implementation is warranted.1 november 201

Nifedipine versus atosiban for threatened preterm birth (APOSTEL III): a multicentre, randomised controlled trial

BACKGROUND: In women with threatened preterm birth, delay of delivery by 48 h allows antenatal corticosteroids to improve neonatal outcomes. For this reason, tocolytics are often administered for 48 h; however, there is no consensus about which drug results in the best maternal and neonatal outcomes. In the APOSTEL III trial we aimed to compare the effectiveness and safety of the calcium-channel blocker nifedipine and the oxytocin inhibitor atosiban in women with threatened preterm birth. METHODS: We did this multicentre, randomised controlled trial in ten tertiary and nine teaching hospitals in the Netherlands and Belgium. Women with threatened preterm birth (gestational age 25-34 weeks) were randomly assigned (1:1) to either oral nifedipine or intravenous atosiban for 48 h. An independent data manager used a web-based computerised programme to randomly assign women in permuted block sizes of four, with groups stratified by centre. Clinicians, outcome assessors, and women were not masked to treatment group. The primary outcome was a composite of adverse perinatal outcomes, which included perinatal mortality, bronchopulmonary dysplasia, sepsis, intraventricular haemorrhage, periventricular leukomalacia, and necrotising enterocolitis. Analysis was done in all women and babies with follow-up data. The study is registered at the Dutch Clinical Trial Registry, number NTR2947. FINDINGS: Between July 6, 2011, and July 7, 2014, we randomly assigned 254 women to nifedipine and 256 to atosiban. Primary outcome data were available for 248 women and 297 babies in the nifedipine group and 255 women and 294 babies in the atosiban group. The primary outcome occurred in 42 babies (14%) in the nifedipine group and in 45 (15%) in the atosiban group (relative risk [RR] 0.91, 95% CI 0.61-1.37). 16 (5%) babies died in the nifedipine group and seven (2%) died in the atosiban group (RR 2.20, 95% CI 0.91-5.33); all deaths were deemed unlikely to be related to the study drug. Maternal adverse events did not differ between groups. INTERPRETATION: In women with threatened preterm birth, 48 h of tocolysis with nifedipine or atosiban results in similar perinatal outcomes. Future clinical research should focus on large placebo-controlled trials, powered for perinatal outcomes. FUNDING: ZonMw (the Netherlands Organisation for Health Research and Development)

Caracterização e descrição da estrutura anatômica do lenho de seis espécies arbóreas com potencial medicinal Characterization and description of wood anatomical structure in six tree species with medicinal potential

A caracterização morfoanatômica e a correta identificação das plantas medicinais são fundamentais para o controle de qualidade dos fitoterápicos. No presente trabalho é caracterizada a anatomia do lenho visando à identificação de seis espécies arbóreas com potencial medicinal. As amostras do lenho foram extraídas por método não destrutivo do tronco das árvores das espécies desenvolvidas em áreas de preservação. Em laboratório as amostras do lenho foram processadas para análises microscópicas do lenho, aplicando as metodologias para estudos de anatomia. Os resultados mostraram que o parênquima axial foi o parâmetro anatômico mais efetivo para a distinção das espécies através da análise do seu lenho. No trabalho discute-se a importância da aplicação da anatomia do lenho como ferramenta na identificação de espécies arbóreas medicinais.<br>The morphoanatomical characterization and the correct identification of medicinal plants are fundamental for the quality control of phytotherapics. In the present work, wood anatomy was characterized in order to identify six tree species with medicinal potential. Wood samples were collected through a non-destructive method from the trunk of trees developed in conservation areas. In the laboratory, wood samples were processed for microscopic analysis by applying the methods for anatomical studies. Axial parenchyma was the most effective anatomical parameter to distinguish species through wood analysis. In this work, the importance of wood anatomy as a tool for the identification of medicinal tree species was discussed