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

Use of a high flow nasal cannula in extremely premature infants: Benefits and drawbacks

This research paper provides a comprehensive review of the utilization of high-flow nasal cannula (HFNC) therapy as a means of respiratory support in extremely premature infants. The paper elucidates the underlying mechanisms of HFNC, which encompass the provision of distending pressure, reduction of respiratory effort, facilitation of carbon dioxide elimination, and optimization of gas conditioning. Noteworthy advantages of HFNC in comparison to invasive ventilation include enhanced oxygenation, improved lung compliance, and promotion of bonding, while simultaneously mitigating the occurrence of complications. Nevertheless, it is important to acknowledge potential drawbacks associated with HFNC, such as heightened morbidity, inadequate support necessitating reintubation, and an elevated risk of air leaks. Further investigations are imperative to refine HFNC protocols, conduct comparative analyses with alternative interventions, and enhance overall patient outcomes. In summation, HFNC represents an efficacious noninvasive respiratory treatment modality for premature infants, albeit with certain limitations. The optimization of benefits can be achieved through meticulous monitoring and standardization of practices

Spectrofluorometric quantitative analysis of aripiprazole based on quenching of natural derived carbon quantum dots in spiked human plasma

Abstract Autism spectrum disorder is a significant concern worldwide, particularly in Middle Eastern countries. Aripiprazole, a psychiatric medicine that works as a partial agonist at D2 receptors, is often used for autism-related behavior issues in children. Monitoring the therapy of aripiprazole could enhance the safety and effectiveness of treatment for autistic individuals. The purpose of this study was to develop a highly sensitive and environmentally friendly method for analysis of aripiprazole in plasma matrix. To achieve this, water-soluble N-carbon quantum dots were produced from a natural green precursor, guava fruit, and used in fluorescence quenching spectroscopy to determine the presence of aripiprazole. The synthesized dots were analyzed and characterized using transmission electron microscopy and Fourier transform infrared spectroscopy, and they showed a strong fluorescence emission peak at 475 nm. The proposed method was validated according to ICH M10 guidelines and was shown to be highly sensitive, allowing for nanoscale determination of aripiprazole in plasma matrix. Additionally, the method was compared to a previously reported spectrophotometric method, and it was found to be more sensitive and consistent with the principles of green analytical chemistry

The associations between the credibility of the tobacco control regulatory body and smoking behavior change among Saudi smokers

Introduction Recently, Saudi Arabia has extensively reformed its tobacco control policies and extended its smoking cessation services. A public outrage on social media among smokers was witnessed, especially after the implementation of plain cigarette packaging, which might have discredited the significant efforts of tobacco treatment services and tobacco control policies. However, it is not known how the credibility of the tobacco control regulatory body among Saudi smokers might affect their smoking behavior. Methods Saudi tobacco smokers (n=511) were recruited using a convenience sampling technique. A cross-sectional survey was conducted comprising questions related to the credibility of the tobacco control regulatory body (modified Food and Drug Administration Tobacco Credibility Scale), quit attempts, use of nicotine replacement therapy (NRT), and motivation to change smoking behavior in the future. Logistic and linear regression models were used for the analysis. Results The public interest subscale of the credibility of the tobacco control regulatory body, was positively associated with confidence in changing smoking behavior (β=0.204; 95% CI: 0.078–0.713; t=2.449, p=0.015) and readiness to change smoking behavior (β=0.237; 95% CI: 0.127–0.727; t=2.802, p=0.005). Moreover, the subscale of expertise was positively associated with confidence in changing smoking behavior (β=0.190; 95% CI: 0.006–0.697; t=1.999, p=0.046) and readiness to change smoking behavior (β=0.225; 95% CI: 0.063–0.710; t=2.352, p=0.019). However, public interest in the credibility of the tobacco control regulatory body was negatively associated with NRT use among smokers who tried to quit (adjusted odds ratio, AOR=0.691; 95% CI: 0.526–0.909). The credibility of the tobacco control regulatory body, however, was not associated with the last month’s or ever quit attempts. Conclusions The credibility of the tobacco control regulatory body was positively associated with motivation to change smoking behavior but negatively associated with NRT use. Optimizing communication tools with the public is a potential avenue for improving smoking treatment and prevention in Saudi Arabia

PLGA-Based Nanomedicine: History of Advancement and Development in Clinical Applications of Multiple Diseases

Research on the use of biodegradable polymers for drug delivery has been ongoing since they were first used as bioresorbable surgical devices in the 1980s. For tissue engineering and drug delivery, biodegradable polymer poly-lactic-co-glycolic acid (PLGA) has shown enormous promise among all biomaterials. PLGA are a family of FDA-approved biodegradable polymers that are physically strong and highly biocompatible and have been extensively studied as delivery vehicles of drugs, proteins, and macromolecules such as DNA and RNA. PLGA has a wide range of erosion times and mechanical properties that can be modified. Many innovative platforms have been widely studied and created for the development of methods for the controlled delivery of PLGA. In this paper, the various manufacturing processes and characteristics that impact their breakdown and drug release are explored in depth. Besides different PLGA-based nanoparticles, preclinical and clinical applications for different diseases and the PLGA platform types and their scale-up issues will be discussed

Attitudes, confidence, barriers and current practice of managing depression in patients with COPD in Saudi Arabia: a national cross-sectional survey

Objective To investigate physicians’ perceptions and current practices of identifying and managing depression in patients with chronic obstructive pulmonary disease (COPD).Design A cross-sectional online survey was employed between March and September 2022.Settings Saudi Arabia.Participants 1015 physicians, including general practitioners and family, internal and pulmonary medicine specialists.Primary outcome measures Physicians’ perceptions, confidence, practices and barriers to recognising and managing depression in patients with COPD.Results A total of 1015 physicians completed to the online survey. Only 31% of study participants received adequate training for managing depression. While 60% of physicians reported that depression interferes with self-management and worsens COPD symptoms, less than 50% viewed the importance of regular screening for depression. Only 414 (41%) physicians aim to identify depression. Of whom, 29% use depression screening tools, and 38% feel confident in discussing patients’ feelings. Having adequate training to manage depression (OR: 2.89; 95% CI: 2.02 to 3.81; p<0.001) and more years of experience (OR: 1.25; 95% CI: 1.08 to 1.45; p=0.002) were associated with the intention to detect depression in COPD patients. The most common barriers linked to recognising depression are poor training (54%), absence of standard procedures (54%) and limited knowledge about depression (53%).Conclusion The prevalence of identifying and confidently managing depression in patients with COPD is suboptimal, owing to poor training, the absence of a standardised protocol and inadequate knowledge. Psychiatric training should be supported in addition to adopting a systematic approach to detect depression in clinical practice

Substance Use and Misuse among Adults with Chronic Obstructive Pulmonary Disease in the United States, 2015–2019: Prevalence, Association, and Moderation

Background: Despite the advancements in chronic obstructive pulmonary disease (COPD) treatment, complications related to COPD exacerbation remain challenging. One associated factor is substance use/misuse among adults with COPD. Fewer studies, however, examined the prevalence and association between COPD and substance use and misuse. In addition, limited knowledge existed about the moderation effects of serious psychological distress and gender among adults with COPD and substance use/misuse. We aimed, therefore, to measure such prevalence, association, and moderation from nationally representative samples in the United States. Method: Data were drawn from the 2015–2019 National Survey on Drug Use and Health. Weighted logistic regressions were used to measure the associations of last-month tobacco (cigarettes, cigars, pipe, and smokeless tobacco products), other licit and illicit substance use (alcohol, marijuana, cocaine, crack, heroin, hallucinogens, and inhalants), and substance misuse (pain relievers, tranquilizers, stimulants, and sedatives) among adults with COPD. Serious psychological distress and gender were tested as moderators in the association between COPD and substance use/misuse. Results: The findings revealed that adults with COPD [Weighted N = 53,115,718) revealed greater odds of cigarettes [adjusted odds ratio (aOR) = 2.48 (95%CI = 1.80–3.42)) and smokeless tobacco (aOR = 3.65 (95%CI = 1.75–7.65)). However, they were less likely to use alcohol (aOR = 0.61 (95%CI = 0.45–0.84)). Adults with COPD who had serious psychological distress were more likely to use pipe tobacco and alcohol; however, they were less likely to use hallucinogens and inhalants. Finally, males compared to females with COPD were less likely to use smokeless tobacco. Conclusion: Adults with COPD in the United States were more likely to use tobacco products and less likely to use alcohol. In addition, serious psychological distress and gender were moderators in associations between COPD and substance use but not in substance misuse. Future studies should longitudinally assess the factors that may contribute to the initiation and progression of substance use and misuse among adults with COPD

Burnout, Resilience, Supervisory Support, and Quitting Intention among Healthcare Professionals in Saudi Arabia: A National Cross-Sectional Survey

Although personal resilience and supervisory support are known to reduce the impact of burnout and quitting intention, there is limited data available to explore these relationships among healthcare professionals (HCPs) in Saudi Arabia. This study aimed to assess the prevalence of burnout and explore its association with resilience, supervisory support, and intention to quit among Saudi Arabian HCPs. Methods: A cross-sectional survey was distributed to a convenience sample of HCPs between April and November 2022. Participants responded to socio-demographic questions, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)), the Connor-Davidson resilience scale 10 (CD-RISC 10), and the Perceived of Supervisor Support Scale (PSS). Descriptive, inferential, correlation, and logistic regression tests were performed for data analyses. Results: Of the 1174 HCPs included in the analysis, 77% were presented with high burnout levels: 58% with emotional exhaustion (EE), 72% with depersonalization (DP), and 66% with low personal accomplishment (PA). Females were associated with increased odds of burnout (OR: 1.47; 95% CI: 1.04–2.06) compared to males. Burnout and its subscales were associated with higher intention to leave practice, with 33% of HCPs considering quitting their jobs. Furthermore, HCPs reported a low resilience score overall, and negative correlations were found between EE (r = −0.21; p < 0.001) and DP (r = −0.12; p < 0.01), and positive correlation with low PA (r = 0.38; p < 0.001). In addition, most HCPs perceived supervisory support as low, and it is associated with increased burnout and quitting intention. Conclusion: Burnout is common among HCPs across all clinical settings and is associated with higher intention to quit and low resilience and supervisory support. Workplace management should provide a supportive workplace to reduce burnout symptoms and promote resiliency