http://hdl.handle.net/10256/8809 2025-06-27T13:01:33Z http://hdl.handle.net/10256/26877 A comparative analysis of the carbon footprint in minimally invasive colorectal surgery: laparoscopic versus robotic Dingelyte Duarte Ribeiro, Jéssica Background: Given the growing concern regarding climate change - and the healthcare sector, particularly the operating theatres, being one of the largest contributors to this issue - it is relevant to conduct research in this area. Operating theatres (OT) alone are estimated to produce up to one third of a hospital’s total waste; the increased adoption of minimally invasive surgical (MIS) techniques, considered the gold standard, has further contributed to this high environmental cost. Although previous studies have assessed the carbon footprint in a variety of surgeries, a carbon footprint comparison of the waste streams generated in colorectal MIS remains unaddressed. Aim: This study aims to compare the carbon footprint of the waste generated in both robotic and laparoscopic colorectal surgeries, addressing the current gap in understanding the environmental impact of the minimally invasive techniques in this speciality. Methods: A uni-centered, cross-sectional pilot study was conducted at the Department of Coloproctology at the Hospital Universitari Doctor Josep Trueta (Girona). It was initiated in June 2024 and is expected to continue until February 2025. This investigation includes a total of 30 subjects requiring elective colorectal oncological surgery. Waste was categorized into four streams: paper and plastic, both pertaining to group I waste; group II, consisting of non-specific sanitary waste; and group III encompassing biohazardous medical waste. The weight of each waste stream was recorded, and conversion factors were applied to translate the weight into carbon emissions (carbon footprint). Main outcome: The primary outcome is the carbon footprint generated by the waste produced in each surgical intervention (laparoscopic or robotic surgery). Results: As of now, a total of 16 surgeries have been included in the study, therefore the results presented here reflect the findings up to this point in the investigation. Robotic surgery was the technique with the highest carbon footprint, with a median value of 50.85 kg CO2 compared to the laparoscopic, with 40.5 kg CO2 (p=0.044). A total of 261.25 kg of waste was produced during the study, equivalent to 783.75 kg CO2 attributed only to solid waste disposal. Conclusion: Despite robotic surgery being the major contributor, both techniques revealed as highly polluting. The results underline the importance of considering the adoption of sustainable measures inside the OT. Additionally, establishing new recycling and waste treatment protocols may allow for a reduction of the overall OT’s impact on the environment without compromising patient care 2024-11-01T00:00:00Z http://hdl.handle.net/10256/26876 Thumb reconstruction after traumatic amputation: algorithm based treatment vs usual care: a multicentre randomized trial Barriuso López, Lucía Background: Traumatic thumb amputation implies a big restriction of normal life activities owing to the main role of the thumb in hand basic movements as grasp or pinch. Appropriate thumb reconstruction is essential for a good quality of life and to minimize economic impact on patients. Several techniques have been developed and proven to be effective and safe but no criteria for the selection of the technique are stablished yet. Aim: The aim of this study is to assess whether the use of the algorithm-based treatment (Panu et al.) provides better overall hand function and post operative outcomes than usual care. Design: Multicentre, randomized, single-blind, parallel-group controlled trial. Patients, outcome assessors and statistician will be blind to group assignment and independent of treatment delivery. Setting: 5 hospitals of Girona province will be involved in an estimated duration of 4 years. Participants: Patients aged ≥ 18 years with acute traumatized non-replantable thumb. Patients will be excluded if they have other affected areas, previous congenital hand malformation or amputation of the injured hand, are not registered in the Catalan Health Service or cannot communicate in Spanish or Catalan. Intervention: 64 patients will be enrolled following a sampling method and randomly assigned in 1:1 ratio to the intervention group (algorithm-based treatment) or control group (usual care). Main outcome measures: The primary outcome is the hand function which will be measured through the overall hand function subscale of the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include post operative and recovery outcomes. Outcome assessment will be at 3 and 12 months post intervention. Analysis will be performed in an intention-to-treat basis 2024-11-01T00:00:00Z http://hdl.handle.net/10256/26861 Creation and evaluation of a student-based programme on the knowledge of mental health services and the prevention of depression, anxiety and burnout syndrome in medical students: The Sentinel Student Programme Study Marí Gorreto, Jesús Worldwide, in Spain and in Catalonia, mental health conditions are one of the most prevalent health burdens that society is struggling with. University students and especially medical students are no different from the rest, presenting even higher proportions of emotional discomfort. In addition, measures to solve this predicament from a public mental health perspective have been scarce and evidence on their effectiveness has been very heterogeneous and of poor quality, with students not knowing how to access or use this resources or services. Therefore, it is the aim of this investigation to create and evaluate a student-based mentoring programme (Sentinel Student Programme) developed to assist students in the access to already existing mental health services, as well as to evaluate the impact on their mental health, particularly in depression, anxiety and burnout symptoms, and their selfawareness abilities hypothesising that it will not worsen the situation and will give them more insight capacity together with better knowledge of the mental health services available fostering students autonomy. To do this, a pilot test will be set up with a prepost quasi-experimental design that will take place at Girona’s School of Medicine aiming to cover all medical students between fifth and first year. Results have proven that changes in pre-post programme favour the utility, feasibility and preliminary security of the Sentinel Student Programme with no significant changes in the pre-post prevalence of depression, anxiety and burnout symptoms and no major differences between those students who participated as sentinels and those who didn’t together with a considerable increase in mental health services’ knowledge. For these reasons, considering limitations linked to the study design and sample size, it can be concluded that future implementation of the Sentinel Student Programme is possible and future research is needed to prove its efficacy in the prevention of mental health disorders and the promotion of mental wellbeing 2025-01-01T00:00:00Z http://hdl.handle.net/10256/26822 Implementation of an early detection program for Long QT Syndrome in Pakistan to reduce Sudden Cardiac Death in children Tariq Bibi, Sehar BACKGROUND: Long QT Syndrome is a rare inherited genetic condition characterized by a prolonged QT interval on a baseline ECG. Due to the immaturity of the cardiac conduction system, infants are particularly vulnerable to malignant arrhythmias, which can result in fatal outcomes such as SCD. Studies have demonstrated that ECG screening protocol in newborns is an effective approach to identify infants at risk. In Pakistan, where infant mortality rates remain high, there are currently no diagnostic tools or programs targeting this condition. Implementing a screening program using simple ECG tests offers a feasible and cost-effective strategy for early detection, with the potential to save lives and reduce preventable mortality. OBJECTIVE: The primary objective of this study is to evaluate the effectiveness of an early detection screening program for Long QT Syndrome, adapted to the available resources in Pakistan, in reducing the mortality rate due to unidentified conditions in which sudden cardiac death is included. DESIGN AND METHODS: Structured as a prospective single-centre quasi experimental study. The study will be performed in Jinnah Postgraduate Medical Centre, Karachi. All newborns in our study group will undergo an ECG at 48 hours of birth, alongside an assessment of family history for SCD. To determine whether this will reduce mortality, they will be compared to a pre-implementation group of children born five years ago, for whom mortality data and causes will be collected. We aim to evaluate the mortality rate and causes of death before and after implementation of program. To achieve this, newborns data will be obtained from the hospital and mortality data from the competent authority in Pakistan. STUDY PARTICIPANTS: 18.054 newborns will be recruited over an estimated period of one year and two months using a consecutive, non-probabilistic sampling 2025-02-01T00:00:00Z