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

Sources of individual differences in the speed of naming objects and actions: The contribution of executive control

Item does not contain fulltextWe examined the contribution of executive control to individual differences in response time (RT) for naming objects and actions. Following Miyake et al., executive control was assumed to include updating, shifting, and inhibiting abilities, which were assessed using operation span, task-switching, and stop-signal tasks, respectively. Experiment 1 showed that updating ability was significantly correlated with the mean RT of action naming, but not of object naming. This finding was replicated in Experiment 2 using a larger stimulus set. Inhibiting ability was significantly correlated with the mean RT of both action and object naming, whereas shifting ability was not correlated with the mean naming RTs. Ex-Gaussian analyses of the RT distributions revealed that updating ability was correlated with the distribution tail of both action and object naming, whereas inhibiting ability was correlated with the leading edge of the distribution for action naming and the tail for object naming. Shifting ability provided no independent contribution. These results indicate that the executive control abilities of updating and inhibiting contribute to the speed of naming objects and actions, although there are differences in the way and extent these abilities are involved