BACKGROUND: The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA).METHODS: PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995.FINDINGS: We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I 2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis. INTERPRETATION: In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence.FUNDING: Dutch Association for Quality Funds Medical Specialists.
IntroductionThe driving pressure (ΔP) has an independent association with outcome in patients with acute respiratory distress syndrome (ARDS). INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop mode of ventilation that targets the lowest work and force of breathing.AimTo compare transpulmonary and respiratory system ΔP between closed-loop ventilation and conventional pressure controlled ventilation in patients with moderate-to-severe ARDS.MethodsSingle-center randomized cross-over clinical trial in patients in the early phase of ARDS. Patients were randomly assigned to start with a 4-h period of closed-loop ventilation or conventional ventilation, after which the alternate ventilation mode was selected. The primary outcome was the transpulmonary ΔP; secondary outcomes included respiratory system ΔP, and other key parameters of ventilation.ResultsThirteen patients were included, and all had fully analyzable data sets. Compared to conventional ventilation, with closed-loop ventilation the median transpulmonary ΔP with was lower (7.0 [5.0–10.0] vs. 10.0 [8.0–11.0] cmH2O, mean difference − 2.5 [95% CI − 2.6 to − 2.1] cmH2O; P = 0.0001). Inspiratory transpulmonary pressure and the respiratory rate were also lower. Tidal volume, however, was higher with closed-loop ventilation, but stayed below generally accepted safety cutoffs in the majority of patients.ConclusionsIn this small physiological study, when compared to conventional pressure controlled ventilation INTELLiVENT-ASV reduced the transpulmonary ΔP in patients in the early phase of moderate-to-severe ARDS. This closed-loop ventilation mode also led to a lower inspiratory transpulmonary pressure and a lower respiratory rate, thereby reducing the intensity of ventilation.Trial registration Clinicaltrials.gov, NCT03211494, July 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1.
MULTIFILE
The Co-Design Pressure Cooker was set up to gather knowledge on co-design in product development activities of Small-to-Medium Enterprises(SMEs). This booklet gives an impression of ten projects conducted in the Province of Utrecht, the Netherlands. In these ten projects, a total of 22 companies were involved. 5000 booklets have already been printed in Dutch and handed out to SMEs for knowledge dissemination. We have received ample requests from the international community, which leads us to believe that there is an international audience for the cases conducted and knowledge gathered. This is why we decided to publish an English version of this booklet. The booklet will be followed by a scientific publication on the knowledge gathered for the academic community. Feel free to contact us for more information on this project
Due to the existing pressure for a more rational use of the water, many public managers and industries have to re-think/adapt their processes towards a more circular approach. Such pressure is even more critical in the Rio Doce region, Minas Gerais, due to the large environmental accident occurred in 2015. Cenibra (pulp mill) is an example of such industries due to the fact that it is situated in the river basin and that it has a water demanding process. The current proposal is meant as an academic and engineering study to propose possible solutions to decrease the total water consumption of the mill and, thus, decrease the total stress on the Rio Doce basin. The work will be divided in three working packages, namely: (i) evaluation (modelling) of the mill process and water balance (ii) application and operation of a pilot scale wastewater treatment plant (iii) analysis of the impacts caused by the improvement of the process. The second work package will also be conducted (in parallel) with a lab scale setup in The Netherlands to allow fast adjustments and broaden evaluation of the setup/process performance. The actions will focus on reducing the mill total water consumption in 20%.
Due to their diverse funding sources, theatres are under increasing pressure to demonstrate impact on society. The Raad voor Cultuur (2023) for example advised the secretary of state to include societal impact as an additional evaluation measure next to artistic value. Many theaters, such as the Chassé Theater and Parkstad Limburg Theaters, have reformulated their missions to focus on impact of performances on visitors. This is a profound transformation from merely selling tickets and filling seats, and requires new measurement instruments to monitor, manage, and improve impact. Currently available instruments are insufficient, and effective monitoring is crucial to larger future projects that theaters are currently planning to systematically broaden impacts of performances on their communities. The specific goal of this project is to empower theaters to monitor and improve impact by developing a brief experience impact questionnaire, taking existing data from student projects conducted at the Chassé Theater about performing arts experiences on one hand, and experience impact theory innovations on the other, as starting points. We will develop potential items to measure and benchmark against established measures of valued societal outcomes, such as subjective well-being and quality of life. These will be measured in questionnaires developed with project partners Chassé Theater and Parkstad Limburg Theaters and administered before and after performances across a wide range of genres. The resulting data will enable comparison of new questionnaire items with benchmarked measures of valued societal outcomes. The final product of the project will be a brief impact questionnaire, which within several brief self-report instruments and just a few minutes can effectively be used to quantify the impact of a performing arts experience. A workshop and practice-oriented article will make this questionnaire implementable, thereby mobilizing the key enabling methodology of monitoring and impact measurement in the performing arts sector.
Due to their diverse funding sources, theatres are under increasing pressure to demonstrate impact on society. The Raad voor Cultuur (2023) for example advised the secretary of state to include societal impact as an additional evaluation measure next to artistic value. Many theaters, such as the Chassé Theater and Parkstad Limburg Theaters, have reformulated their missions to focus on impact of performances on visitors. This is a profound transformation from merely selling tickets and filling seats, and requires new measurement instruments to monitor, manage, and improve impact. Currently available instruments are insufficient, and effective monitoring is crucial to larger future projects that theaters are currently planning to systematically broaden impacts of performances on their communities.The specific goal of this project is to empower theaters to monitor and improve impact by developing a brief experience impact questionnaire, taking existing data from student projects conducted at the Chassé Theater about performing arts experiences on one hand, and experience impact theory innovations on the other, as starting points. We will develop potential items to measure and benchmark against established measures of valued societal outcomes, such as subjective well-being and quality of life. These will be measured in questionnaires developed with project partners Chassé Theater and Parkstad Limburg Theaters and administered before and after performances across a wide range of genres. The resulting data will enable comparison of new questionnaire items with benchmarked measures of valued societal outcomes. The final product of the project will be a brief impact questionnaire, which within several brief self-report instruments and just a few minutes can effectively be used to quantify the impact of a performing arts experience. A workshop and practice-oriented article will make this questionnaire implementable, thereby mobilizing the key enabling methodology of monitoring and impact measurement in the performing arts sector.Societal issueThe specific goal of this project is to empower theaters to monitor and improve impact by developing a brief experience impact questionnaire, taking existing data about performing arts experiences on one hand, and experience impact theory innovations on the other, as starting points. Benefit to societyWe will develop potential items to measure and benchmark against established measures of valued societal outcomes, such as subjective well-being and quality of life. Collaborative partnersChassé Theater N.V., Parkstad Limburg Theaters N.V.
