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

Corrigendum: WHO draft guidelines on dietary saturated and trans fatty acids: Time for a new approach?

While revising this Analysis article (BMJ 2019;366:l4137, doi:10.1136/bmj.l4137) the authors mistakenly included a section on the reanalysis of the Minnesota Coronary Experiment. The authors had originally agreed among themselves not to include the section in the final manuscript for two reasons. First, the key message of the article is to move from recommendations of single nutrients into food based recommendations because saturated fat is a heterogeneous group of fatty acids with divergent health effects, and the effect is furthermore dependent on the food matrix they exist in. For that reason, the authors felt the section was redundant. Second, for a discussion of the health effects of polyunsaturated fat, the authors did not feel that the section provided a balanced and complete analysis of the issue. Soon after publication the authors contacted The BMJ to notify the journal of the mistake and request correction of the article by removing the following paragraphs, which does not substantially change the message or argument of the Analysis: “Reanalysis of the Minnesota Coronary Experiment (a double blind randomised controlled trial that tested whether replacing saturated fat with polyunsaturated fat reduced coronary heart disease and death) also supports the claim that serum cholesterol is not a valid surrogate biomarker for cardiovascular disease risk when making dietary changes.10 Despite the finding that the polyunsaturated fat diet produced a 13% greater reduction in serum cholesterol than the saturated fat diet, there was no reduction in cardiovascular disease endpoints.10 “The reanalysis found a 22% higher mortality for each 0.78 mmol/L reduction in serum cholesterol caused by the polyunsaturated diet.10 A meta-analysis found that cholesterol lowering using polyunsaturated fat diets did not show any evidence of benefit on mortality from coronary heart disease (1.13, 0.83 to 1.54) or all cause mortality (1.07, 0.90 to 1.27).10” These paragraphs have been removed from the article online

Comparative dataset Africa

<p>Birds of southern Africa identifying hosts of brood parasites and cooperatively breeding species</p

Comparative dataset - Australia

<p>Passerine birds of Australia classified as hosts or non-hosts of brood parasites and cooperative or non-cooperative breeders (see Science 20 Dec 2013)</p

Corrigendum: WHO draft guidelines on dietary saturated and trans fatty acids:Time for a new approach?

While revising this Analysis article (BMJ 2019;366:l4137, doi:10.1136/bmj.l4137) the authors mistakenly included a section on the reanalysis of the Minnesota Coronary Experiment. The authors had originally agreed among themselves not to include the section in the final manuscript for two reasons. First, the key message of the article is to move from recommendations of single nutrients into food based recommendations because saturated fat is a heterogeneous group of fatty acids with divergent health effects, and the effect is furthermore dependent on the food matrix they exist in. For that reason, the authors felt the section was redundant. Second, for a discussion of the health effects of polyunsaturated fat, the authors did not feel that the section provided a balanced and complete analysis of the issue. Soon after publication the authors contacted The BMJ to notify the journal of the mistake and request correction of the article by removing the following paragraphs, which does not substantially change the message or argument of the Analysis: “Reanalysis of the Minnesota Coronary Experiment (a double blind randomised controlled trial that tested whether replacing saturated fat with polyunsaturated fat reduced coronary heart disease and death) also supports the claim that serum cholesterol is not a valid surrogate biomarker for cardiovascular disease risk when making dietary changes.10 Despite the finding that the polyunsaturated fat diet produced a 13% greater reduction in serum cholesterol than the saturated fat diet, there was no reduction in cardiovascular disease endpoints.10 “The reanalysis found a 22% higher mortality for each 0.78 mmol/L reduction in serum cholesterol caused by the polyunsaturated diet.10 A meta-analysis found that cholesterol lowering using polyunsaturated fat diets did not show any evidence of benefit on mortality from coronary heart disease (1.13, 0.83 to 1.54) or all cause mortality (1.07, 0.90 to 1.27).10” These paragraphs have been removed from the article online

Fairy-wren parasitism vs group size - Campbell Park

<p>Superb fairy-wren nests at Campbell Park showing the breeding female, whether the nest was parasitized by a cuckoo, which cuckoo territory the nest was within and the fairy-wren group size.</p