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

Poultry viscera and bone meal in broiler pre-starter and starter diets

The use of viscera and bone meal in poultry pre-starter and starter diets and its effects on performance, digestive organ development and digestibility and nutrient retention were evaluated. In the first assay, 280-day-old Avian Cobb® chicks were allotted in four experimental groups with five replicates of 14 birds each, in the pre-starter phase; in the second assay, 280 eight-day-old Avian Cobb 48® chicks were allotted in four experimental groups with five replicates of 12 birds each. The experimental diet consisted of increasing levels of viscera and bone meal: 0% (control diet), 3%, 6% and 9% in pre-starter (Assay 1) and starter (Assay 2) diets, to meet nutritional requirements and feed composition proposed by the Brazilian Tables, all of them isonutritive and isoenergetic. A metabolic assay was developed and the total excreta collection was performed from the 4th to the 7th days in Assay 1 and from the 14th to the 17th days in Assay 2. On these days, one chick per experimental unit, representing the mean body weight of the parcel, was euthanized to perform digestive organ morphometry. Mean body weight was 45.4±0.4 on the 1st day in Assay 1 and 179.5±0.8 at 8 days of age in Assay 2. In Assay 1, a negative linear effect was observed for weight gain. Levels of viscera and bone meal influenced quadratically nitrogen digestibility index (Y = 66.0101 + 0.482425X - 0.0481086X²) and linearly the digestibility of dry matter (Y = 71.7775 - 0.615792X) and ether extract (Y = 78.3678 - 0.309136X). Morphometric measures of digestive organs were not influenced by viscera and bone meal levels. For Assay 2, negative and linear effect was observed for viscera and bone meal levels on weight gain (Y = 551.667 - 5.08341X) and feed intake (Y = 955.961 - 7.48435X). Quadratic effect was observed for ether extract digestibility (Y = 82.557 + 1.12021X - 0.150117X²) and maximum point was obtained at 3.7% viscera and bone meal inclusion for ether extract retention. Mortality was not affected by treatments in either of the assays. Viscera and bone meal can be used at 3 or 4% inclusion in broiler pre-starter and starter diets

Estimating global injuries morbidity and mortality: Methods and data used in the Global Burden of Disease 2017 study

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC B Y. Published by BMJ