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

As Câmaras Municipais no Império Português: o exemplo do Rio de Janeiro

O presente artigo visa analisar o papel representado pelas Câmaras Municipais Ultrama-rinas no interior do Império Colonial Português. Ele centra sua análise sobre a Câmara do Rio de Janeiro ao longo dos séculos XVII e XVIII, no sentido de ilustrar a composição das municipalidades, suas funções rotineiras, sua ação nos tempos de crise e de guerra, e o tipo de suas demandas dirigidas aos representantes da Coroa nos dois lados do Atlântico. Enquanto centro político-administrativo, de imposição de tributos, de comércio e defesa, o Rio de Janeiro se tornou locus privilegiado do exercício do domínio metropolitano sobre a vasta região do Atlântico-Sul. Este artigo pretende discutir as tensões, negociações e compro-missos entre a política metropo-litana e o papel de uma das mais importantes municipalidades no mundo luso-americano.<br>The present article analises the role played by the overseas municipal councils in Portuguese Colonial Empire. It focus the Municipal Council of Rio de Janeiro during the seventeenth and eighteenth centuries, in order to illustrate the composition of the municipalities, their routine functions, their action in times of crisis and war, and the kind of it's demands to the Crown representatives on both sides of the Atlantic. As the center of political administration, tax collection, commerce, and defense, Rio de Janeiro was the privileged stage for the exercise of metropolian dominance over the vast South-Atlantic world. This article intends to discuss the tensions, negociations, and compromises between metropolitan politics and the role of one of the most important luso-american municipalities