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 Lived Experiences of Parents and Healthcare Professionals in Treating Children with Chronic Conditions. Distinct Roles and Common Points of View.

Abstract Research problem and background Scientific development for treating life-threatening illnesses combined with an increase of home-based health support contributed in reducing children mortality but it also increases the number of children suffering from pediatric chronic critical illness (PCCI, approximately 49% of hospitalized children have chronic illnesses). Hospitalizations and recurrent readmissions are dramatic experiences for children and they also have a huge impact on their families. The lived experiences of child with PCCI parents and health care workers (HCW) have been poorly analyzed. When the disease is so severe to prompt an admission to a PICU, the impact on the emotional, clinical, ethics, psychological, and relational spheres of the different actors is very complex and often hard to manage. In this research, both parents and health care professionals were the focus of interest. This study aims to explore the lived experience of child with PCCI parents in the Pediatric Intensive Care Unit (PICU) and the experience of health care workers. Methodological framework This study adheres to a phenomenological\u2013hermeneutic approach, suitable for exploring the meaning of lived experiences. Parents and HCW involved in the research ware recruited through the Pediatric Department of the University Hospital in Verona. The data has been collected by recording and transcribing semi-structured interviews. Data analysis was developed through an inductive and recursive process, aimed to identify the overall sense of the described experiences. Results At the end of the data collection, a total of twenty-two parents (fourteen mothers and six fathers) and twelve healthcare workers were interviewed (six nurses were woman, four clinicians were woman, two clinicians were man). The analysis reveals fifty-six emerging dimensions (33 common and 3 protruding elements for parents, 20 common elements for HCW), among which some eight cross-cutting elements between parents and healthcare professionals, as well as some elements that represent the experiences of each group individually. The author identified as crucial the following eight cross- cutting categories: complexity of decision-sharing, close-quarter attitudes, no one like 5 parents, lack of trust, fear of change, smiling and suffering, what\u2019s best for the child and, finally necessity to trust and be trusted. All those categories are strongly interrelated among them and provide an innovative point of view to comprehend the lived experience of child with PCCI parents and HCW. The analyzed literature (Bry et al., 2016; Huang, Kellett, & St John, 2011; Meert et al., 2008) usually report the experiences gathered from parent or HCP interviews on pre-defined topics, such as communication, quality of life, and end of life. The presence of relevant common thoughts and lived experiences that can bring parents and HCP closer with regard to life experience, is one of the innovated outcomes of this research. These findings should be considered in order to improve the quality of pediatric care and other services for children with chronic illness. Setting and Ethical considerations The author worked in the unit where data were collected and, this insider status has allowed her to access directly to the research setting and recruit potential participants. This information was presented to all participants firstly during the introduction of the study and secondly at the informed consent process. The institutional ethic committee approved the study\u2019s before starting the recruiting process approval code 976CESC (Comitato Etico per la Sperimentazione Clinica delle provincie di Verona e Rovigo)

Достижение внешнеэкономического равновесия для малой страны с открытой экономикой

Секция II. Современные тенденции и проблемы в мировой экономике. Внешнеэкономическое сотрудничество Республики Беларус

Zinc Oxide 30% and Tocopherol Compared to 10% Zinc Oxide Ointment in the Treatment of Infant\u2019s Diaper Dermatitis: A Triple Blinded Controlled Randomized Trial

1.1. Aim: Assessing the efficacy of an experimental treatment that lasted 5 days and used the paste of Zinc Oxide 30% and tocopherol / Vitamin E compared to the use of a 10% Zinc Oxide ointment in the treatment of diaper dermatitis (DD) affecting the newborn's skin and the premature infant with gestational age 65 34 weeks. Background. DD is a common inflammatory irritating condition among children and infants. In multiple clinical studies, mycosis has been isolated in up to 80% of children with DD which can be present for even three or more days. Design: Triple blinded controlled randomized trial. 1.2. Methods: 169 infants with DD (aged <24 months) were randomized to receive either 10% zinc oxide ointment (n=64) or Zinc Oxide 30% and tocopherol ointment (n=65). Infants were treated with multiple applications for 5 days. The severity of dermatitis was evaluated at both baseline and the end of trial by using the Severity Classification of Diaper Dermatitis scale (SCDD). Results. Improvement in the severity of DD was observed in both treatment groups (P<0.01). There was not a statistically significant difference between the groups as determined by F (2.164) =0.151, p=0.860. There was not any adverse effect from either of the study products. 1.3. Conclusion: There is not any difference on efficacy of both the treatments. No one mycosis emerged in both groups. Management protocols for DD has relevant role on the improvement of diaper dermatitis in infants and on onset mycosis reduction

Il libro e le sue reti. La circolazione dell'edizione italiana nello spazio della francofonia (sec. XVI-XVII)

Nell\u2019ambito del pi\uf9 vasto progetto EDITEF (\uc9dition italienne dans l\u2019espace francophone \ue0 la premi\ue8re modernit\ue9) che una serie di istituzioni francesi, italiane, svizzere e belghe stanno realizzando, si \ue8 tenuta a a Ravenna nel nel 2013 una giornata di studi sul tema della circolazione del libro italiano nello spazio della francofonia durante il "lungo Rinascimento", organizzata dal Dipartimento Beni Culturali dell\u2019Universit\ue0 di Bologna, Campus di Ravenna, con l\u2019ausilio del Centre d\u2019Etudes Sup\ue9rieures de la Renaissance di Tours, Studiosi di varie universit\ue0 italiane, francesi e belghe hanno indagato i percorsi geografici (vie e mezzi di trasporto), economici (modalit\ue0 delle varie transazioni e ruolo degli attori) e culturali (ruolo del milieu intellettuale francofono e italiano nella diffusione) che hanno portato l\u2019edizione rinascimentale, prodotta in Italia in lingua volgare, ad essere diffusa e letta in Francia e nel Belgio francofono

Parental presence in Italian pediatric intensive care units: a reappraisal of current visiting policies

Parental presence in Italian pediatric intensive care units: a reappraisal of current visiting policie