Paulus Teguh Aditjandra

The following position statement forms part of a response to the current concerns regarding use of mesh to perform rectal prolapse surgery. It highlights the actions being pursued by the Pelvic Floor Society (TPFS) regarding clinical governance in relation to ventral mesh rectopexy (VMR). The following are summary recommendations. Available evidence suggests that mesh morbidity for VMR is far lower than that seen in transvaginal procedures (the main subject of current concern) and lower than that observed following other abdomino‐pelvic procedures for urogenital prolapse, e.g. laparoscopic sacrocolpopexy. VMR should be performed by adequately trained surgeons who work within a multidisciplinary team (MDT) framework. Within this, it is mandatory to discuss all patients considered for surgery at an MDT meeting. Clinical outcomes of surgery and any complications resulting from surgery should be recorded in the TPFS‐hosted national database (registry) available for this purpose; in addition, all patients should be considered for entry into ongoing and planned UK/European randomized studies where this is feasible. A move towards accreditation of UK units performing VMR will improve performance and outcomes in the long term. An enhanced programme of training including staged porcine, cadaveric and preceptorship sessions will ensure the competence of surgeons undertaking VMR. Enhanced consent forms and patient information booklets are being developed, and these will help both surgeons and patients. There is weak observational evidence that technical aspects of the procedure can be optimized to reduce morbidity rates. Suture material choice may contribute towards morbidity. The available evidence is insufficient to support the use of one mesh over another (biologic vs synthetic); however, the use of polyester mesh is associated with increased morbidity.

In the upcoming era of new technologies, a transport system is expected to be ‘more sustainable,’ ‘safer,’ and ‘more efficient.’ However, to what extent is this true? Based on the results of a series of stakeholder engagement workshops, the paper explores the vision of different stakeholders about urban freight of the future. A Participatory Approach was used to allow stakeholders to identify the problem and co-design a set of solutions. Potential impacts of innovative urban deliveries on economy, environment, and society were analysed. Methodology and results were then compared with those of a city stakeholder engagement workshop delivered in Newcastle upon-Tyne in 2014. Stakeholders considered that an “engaging” and “easy to use” process was needed to facilitate the process and it encouraged participants to find solutions for a ‘common good.’ The participatory approach proposed in this process would support transport planners and policy-makers to design and implement a consistent policy framework for future sustainable urban freight systems.

CSID - JID Center for Sustainable Infrastructure Development - Journal of Infrastructure Development

CSID - JID Center for Sustainable Infrastructure Development - Journal of Infrastructure Development

CSID - JID Center for Sustainable Infrastructure Development - Journal of Infrastructure Development

CSID - JID Center for Sustainable Infrastructure Development - Journal of Infrastructure Development

CSID - JID Center for Sustainable Infrastructure Development - Journal of Infrastructure Development