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

Autogestão e poder: esquema de análise das relações de poder em organizações com características autogestionárias

O objetivo deste artigo é apresentar uma proposta de análise das relações de poder em organizações coletivistas de trabalho, ou seja, que apresentam características predominantemente autogestionárias. A proposta elaborada é fruto de um projeto de pesquisa atualmente em andamento sobre Autogestão e Poder, cuja corrente teórica situa-se na Economia Política do Poder (FARIA, 2004). Buscou-se abordar as principais temáticas necessárias ao entendimento de como as formas de controle social e as relações de poder intervêm nos processos e relações de trabalho, na gestão e nas articulações políticoestratégicas das organizações coletivistas de trabalho. Assim, propõe-se enfrentar o desafio de compreender as possibilidades históricas de construção de um modelo alternativo de gestão, embora inserido no contexto capitalista, o que inclui uma concepção teórica que permita visualizar as relações de poder em função das características autogestionárias constituintes, e não em torno da heterogestão