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

If you go down to the woods today you are in for a big surprise: seeing the wood for the trees in online delivery of career guidance

Arguments about online delivery of career development are too frequently couched in polarising terms setting traditional face-to-face guidance practice against online systems. The focus has been on the alleged dehumanising impact of technology and the speed, economy and efficiency of online systems. The possible synergies delivered by the appropriate integration of online systems into career development need exploring. The potential of eguidance, elearning, social media and online information and assessment systems has been insufficiently explored. The user experience has been overlooked, despite evidence that user-interface issues and usability are critical factors in the effectiveness of online systems. The application of artificial intelligence remains largely under-researched in career development. The potential for online systems to assist individuals respond to their chaotic careers has yet to be adequately addressed