Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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

Análisis fitoquímico cualitativo de los extractos acuosos de Thalassia testudinum Banks ex Köning et Sims de la localidad de Champotón, Campeche, México, durante el ciclo anual 2016-2017

ABSTRACT: Thalassia testudinum Banks ex Köning et Sims is a marine phanerogam, monocotyledonous, dioica that is distributed from Florida and Gulf of Mexico, up to the coasts of Colombia and Venezuela. Recent researches have shown that T. testudinum has anti-inflammatory, antinociceptive, antioxidant, antiviral, dermo-regenerative, hypoglycemic, hypolipidemic and neuroprotective activity. The purpose of this investigation was to analyze the seasonal variability in the content of metabolites in the aqueous extracts of the whole plant, the leaves and the rhizome of T. testudinum during the seasons of the year (northern, dry and rainy) in Champotón, Campeche, Mexico. The presence of phenols, flavonoids, phytosterols, coumarins, diterpenes, triterpenes, saponins, and reducing sugars was determined by qualitative tests and the saponins contain in these extracts was quantified, as well as its hemolytic capacity. The extracts of the leaves of the northern period presented the highest concentration of constituents. Reducing sugars content in rhizome extracts was present throughout the annual cycle, while the content of saponins was higher in the leave extracts of the northern season, as well as its hemolytic capacity. The results indicate that the northern season is the most suitable for obtaining biological material of T. testudinum to prepare aqueous extracts with biotechnological or pharmacological applications, collected in Champoton, Campeche, Mexico.RESUMEN: Thalassia testudinum Banks ex Köning et Sims es una fanerógama marina, monocotiledónea, dioica, que se distribuye desde Florida y Golfo de México, hasta las costas de Colombia y Venezuela. Recientes investigaciones han mostrado que T. testudinum presenta actividad antiinflamatoria, antinociceptiva, antioxidante, antiviral, dermorregeneradora, hipoglucemiante, hipolipidémica y neuroprotectora. El objetivo de la presente investigación fue analizar la variabilidad estacional en el contenido de metabolitos de los extractos acuosos de la planta completa, las hojas y el rizoma de T. testudinum de tres épocas del año (Nortes, Secas y Lluvias) en la localidad de Champotón Campeche, México. Se determinó la presencia de fenoles, flavonoides, fitoesteroles, cumarinas, diterpenos, triterpenos, saponinas, y azúcares reductores mediante pruebas cualitativas y se cuantificaron las saponinas contenidas en estos extractos, así como su capacidad hemolítica. Los extractos de las hojas de la época de Nortes presentaron la mayor concentración de constituyentes. El contenido de azúcares reductores en los extractos del rizoma estuvo presente durante todo el ciclo anual, mientras que contenido de saponinas fue mayor en los extractos de hojas de la época de Nortes, al igual que su capacidad hemolítica. Los resultados indican que la época de Nortes es la más adecuada para la obtención de material biológico de T. testudinum para preparar extractos acuosos con posible aplicación biotecnológica o farmacológica, colectado en la localidad de Champotón, Campeche, México