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

Abstract 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

Daniel E. Salazar, La evolución de las ideas de Domingo F. Sarmiento

Avellaneda Andrés. Daniel E. Salazar, La evolución de las ideas de Domingo F. Sarmiento . In: Caravelle, n°50, 1988. 25 ans d'Amérique latine. pp. 218-221

Novela e ideología en « Sobre héroes y tumbas » de Ernesto Sábato

Partiendo del análisis de los personajes como organizaciones significantes, este artículo trata de develar el entramado ideológico de Sobre héroes y tumbas como medio de acercamiento a la totalidad de sus elementos. El personaje Bruno posee, además de una función estructural, la de ser una especie de comentador teorético dentro de la obra. Su pensamiento sustancialista, tanto en lo ontológico como en lo epistemológico, adquiere una derivación antropológico-social : la búsqueda de una condición humana y de una condición nacional. Cuando analiza a esta última, efectúa una dicotomía en que lo pasado (lo incorrupto) se enfrenta a lo presente (lo corrupto), y en que el embellecimiento de un patriciado en decadencia insinúa la propuesta ideológica de un esquema de reconstrucción que emana de la creencia en una indebida ruptura axiológica y en un rescate de valores que debe ser realizado. Tal propuesta, hecha desde una perspectiva esencialista y transhis- tórica, termina por invadir toda la novela. El análisis de los restantes personajes (fundamentalmente Martín, Alejandra y Fernando, pero también los rostros secundarios) y la exploración de otros desarrollos literarios, permite percibir la homogeneidad de la obra en tal sentido, a pesar de la oscuridad aparente de muchos de sus elementos. Esta verificación, y también la de la existencia de diversos rasgos y modelos tradicionales bajo la superficie de las novedades técnicas empleadas, revela el contexto ideológico de la novela conectándola con una etapa más de cierre que de apertura dentro del actual panorama de la narrativa hispanoamericana.Avellaneda Andrés O. Novela e ideología en « Sobre héroes y tumbas » de Ernesto Sábato. In: Bulletin Hispanique, tome 74, n°1-2, 1972. pp. 92-115

Daniel E. Salazar, La evolución de las ideas de Domingo F. Sarmiento

Avellaneda Andrés. Daniel E. Salazar, La evolución de las ideas de Domingo F. Sarmiento . In: Caravelle, n°50, 1988. 25 ans d'Amérique latine. pp. 218-221

Memorias del primer Simposio Nacional de Ciencias Agronómicas

Primer simposio nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

Memorias del primer Simposio Nacional de Ciencias Agronómicas

Primer simposio nacional de Ciencias Agronómicas: El renacer del espacio de discusión científica para el Agro colombiano

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era