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

On-Farm Conservation of Rice Biodiversity in Nepal: A Simultaneous Estimation Approach

This paper presents an empirical case study about farmer management of rice genetic resources in two communities of Nepal, drawing on interdisciplinary, participatory research that involved farmers, rice geneticists and social scientists. The decision-making process of farm households is modelled and estimated in order to provide information for the design of community-based conservation programmes. A bivariate model with sample selection examines the simultaneous process of whether farmers decide to plant landraces or modern varieties, and whether the landraces they choose to plant constitute the genetic diversity of interest for future crop improvement. Findings show that the two landrace choices are affected by different social and economic factors, but in certain cases the decision processes are interrelated. Policies to promote the conservation of local rice diversity will need to take both processes into account. Copyright 2007 Blackwell Publishing Ltd.