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

Uma outra modernização: transportes em uma província não exportadora - Minas Gerais, 1850-1870 Another modernization: transportation in a non-exporting province - Minas Gerais, 1850-1870

Entre 1750 e 1880, Minas Gerais desenvolveu economia com o predomínio de direção não exportadora da produção e relativa independência em relação a mercados externos de outros espaços regionais do Brasil e do exterior do país. Essa singular evolução histórica ensejou específica compreensão e tratamento do problema dos transportes pelos contemporâneos. No século XIX, sobretudo em seu terceiro quartel, estavam postas as condições para que o processo de modernização dos transportes em Minas, sobretudo na forma da aceleração da constituição de sistema integrado, se realizasse fora das determinações da hegemonia de modelo econômico primário-exportador. Neste escrito, são avançadas reflexões em torno da história dos transportes na província de Minas Gerais e apresentadas e analisadas evidências documentais que demonstram o quanto pode ser equivocada apreensão da modernização dos transportes no Brasil que considere modelo único ou que tenda a generalizar para o conjunto do país a experiência histórica da modernização com base no ferroviarismo.<br>Between 1750 and 1880, Minas Gerais developed an economy predominantly non-exporting as well as relatively independent of external markets of other Brazilian regions and of foreign markets. Due to such unique historical evolution, contemporaries had to develop specific understanding and ways of dealing with transportation problems. In nineteenth century, mainly in its third quarter, it were established the conditions for the modernization process of transportation in Minas. Those conditions allowed such modernization to take place apart from the determinations resulting from the hegemony of a primarily exportation economic model, specially based on hastening the construction of an integrated system. This text enlarges considerations about the history of transportation in the province of Minas Gerais. It presents and analyses documental evidences which demonstrate it can be mistaken the understanding of modernization of Brazilian transportation considering a single model as well as the tendency to generalize to the whole country the historical experience of modernization based upon a railroad system