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.
Context: Limited evidence has been found on the effectiveness of Stimulan ® antibiotic beads for the treatment of diabetic foot ulcer. Aims: The aim of the study was to evaluate the safety and efficacy of Stimulan ® antibiotic beads in treating diabetic foot infection and review the healing rate, infection recurrence rate, and the length of postoperative hospital stay. Settings and Design: It was a retrospective review of patients implanted with Stimulan ® antibiotic beads at a district general hospital in England from 2017 to 2019. Subjects and Methods: Nineteen patients with Wagner Grade 3 and 4 ulcers were included, with a mean age of 62.3 years. Stimulan ® , an antibiotic loaded absorbable calcium sulfate biocomposite, was used to treat persistent diabetic foot infection with chronic osteomyelitis. Staphylococcus aureus was the most common bacteria isolated. Exclusion criteria consisted of those with Wagner Grade 1 or 2 ulcers and infections that had clinically responded to long courses of systemic antibiotics treatment. Results: All patients underwent local wound debridement with the application of Stimulan ® beads and received intravenous antibiotics for 48 h postoperatively. The average postoperative hospital stay was 2 days. After 1 month of follow-up, 16 wounds (84%) fully healed, two wounds (11%) had partially healed, and one wound (5%) showed no sign of healing. Two patients (11%) had shown recurrence of diabetic foot infection in a different foot after 24 months. Amputation rate was 0% over 24 months. Conclusions: This study recorded the clinical efficacy of Stimulan ® antibiotic beads by demonstrating 0% amputation rate after two years and shortened hospital stay. With a low recurrence rate (16%), Stimulan ® beads could be considered as one of the alternative treatments in managing diabetic foot infection.
The limping child and painful hip are common presentations in many paediatric emergency units. Typically caused by mild self-limiting events, less commonly, they may be implicated in one of a group of inflammatory myopathies, or myositis. Diagnosis of this condition can be extremely difficult, and is aided by thorough clinical assessment, radiological imaging, and extensive blood serum testing. Myositis with associated osteomyelitis and a pathological fracture is an incredibly rare finding, described in this case report in a seven-year-old child.
physical functionality scores was 27.6 in the vertebroplasty group and 36.1 in the other group which was statistically significant (P = 0.005). The mean amount of cement injected was 4 ml in vertebroplasty group and 5.1 in the other group. The mean change in anterior vertebral height was 0.63 mm in the vertebroplasty group and 2.47 mm in the other group which was significantly higher (P < 0.001). There was cement leak seen in 20% patients in the vertebroplasty group which was minor and mainly involved the paravertebral and intradiscal regions. In the other group, no intradiscal leak was seen. Conclusion: Balloon vesselplasty is superior to vertebroplasty in terms of disability scores, increase in anterior vertebral body height, and volume of cement injected with low complication rate.
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