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

Análisis de las bases terapéuticas del cannabis y su aplicación en medicina

This review compiles information on the therapeutic applications of cannabinoids as a basis for their application in medicine as a treatment strategy. The main objective of this review was to analyze the therapeutic benefits of cannabinoids such as: pain relief, antitumor effect, cell cycle regulation and immune stimulation. Information was compiled from various scientific databases, such as PubMed, BioCell, Scielo, Elsevier, Redalyc, MDPI, PLOS, JAFC, BJPS and Medicinal Chemistry Research, searching by keywords and selecting according to the inclusion criteria. It was possible to identify the therapeutic potential of those that endorse their interaction in receptors, thus the remarkable antitumor effect, pain relief and immune stimulation. However, the effectiveness of cannabis products varies according to the stage of the disease and dosage. It was concluded that the endocannabinoid system (ECS) offers important therapeutic activities for some diseases, whose molecular mechanisms of action have been assessed in different experimental models. The clinical applications of cannabis have been documented in several pathologies such as: cancer, epilepsy, glaucoma, arthritis, asthma, Alzheimer, Crohn, sclerosis, insomnia and Parkinson, the current legislation has opened the way for its industrial production and therapeutic use under the control of regulatory entitiesEn esta revisión se compila información de las aplicaciones terapéuticas de los cannabinoides como fundamento para su aplicación en medicina como estrategia de tratamiento. El objetivo principal de esta revisión fue analizar los beneficios terapéuticos de los cannabinoides como es: alivio del dolor, efecto antitumoral, regulación del ciclo celular y estimulación inmunológica. Se compiló información de diversas bases de datos científicas, como PubMed, BioCell, Scielo, Elsevier, Redalyc, MDPI, PLOS, JAFC, BJPS y Medicinal Chemistry Research, buscando por palabras claves y seleccionando acorde a los criterios de inclusión. Se pudo identificar el potencial terapéutico de los que avalan su interacción en receptores, por ello el notable efecto antitumoral, alivio del dolor y estimulación inmunológica. Sin embargo, la efectividad de los productos del cannabis varía según el estadio de la enfermedad y dosis. Se concluyó que el sistema endocannabinoide (ECS) ofrece importantes actividades terapéuticas para algunas enfermedades, cuyos mecanismos moleculares de acción han sido valorados en diferentes modelos experimentales. Se ha documentado las aplicaciones clínicas del cannabis en diversas patologías como: Cáncer, epilepsia, glaucoma, artritis, asma, Alzheimer, Crohn, esclerosis, insomnio y Parkinson, la legislación actual ha dado apertura para su producción industrial y uso terapéutico bajo el control de entidades regulatoria

Análisis de las bases terapéuticas del cannabis y su aplicación en medicina

This review compiles information on the therapeutic applications of cannabinoids as a basis for their application in medicine as a treatment strategy. The main objective of this review was to analyze the therapeutic benefits of cannabinoids such as: pain relief, antitumor effect, cell cycle regulation and immune stimulation. Information was compiled from various scientific databases, such as PubMed, BioCell, Scielo, Elsevier, Redalyc, MDPI, PLOS, JAFC, BJPS and Medicinal Chemistry Research, searching by keywords and selecting according to the inclusion criteria. It was possible to identify the therapeutic potential of those that endorse their interaction in receptors, thus the remarkable antitumor effect, pain relief and immune stimulation. However, the effectiveness of cannabis products varies according to the stage of the disease and dosage. It was concluded that the endocannabinoid system (ECS) offers important therapeutic activities for some diseases, whose molecular mechanisms of action have been assessed in different experimental models. The clinical applications of cannabis have been documented in several pathologies such as: cancer, epilepsy, glaucoma, arthritis, asthma, Alzheimer, Crohn, sclerosis, insomnia and Parkinson, the current legislation has opened the way for its industrial production and therapeutic use under the control of regulatory entitiesEn esta revisión se compila información de las aplicaciones terapéuticas de los cannabinoides como fundamento para su aplicación en medicina como estrategia de tratamiento. El objetivo principal de esta revisión fue analizar los beneficios terapéuticos de los cannabinoides como es: alivio del dolor, efecto antitumoral, regulación del ciclo celular y estimulación inmunológica. Se compiló información de diversas bases de datos científicas, como PubMed, BioCell, Scielo, Elsevier, Redalyc, MDPI, PLOS, JAFC, BJPS y Medicinal Chemistry Research, buscando por palabras claves y seleccionando acorde a los criterios de inclusión. Se pudo identificar el potencial terapéutico de los que avalan su interacción en receptores, por ello el notable efecto antitumoral, alivio del dolor y estimulación inmunológica. Sin embargo, la efectividad de los productos del cannabis varía según el estadio de la enfermedad y dosis. Se concluyó que el sistema endocannabinoide (ECS) ofrece importantes actividades terapéuticas para algunas enfermedades, cuyos mecanismos moleculares de acción han sido valorados en diferentes modelos experimentales. Se ha documentado las aplicaciones clínicas del cannabis en diversas patologías como: Cáncer, epilepsia, glaucoma, artritis, asma, Alzheimer, Crohn, esclerosis, insomnio y Parkinson, la legislación actual ha dado apertura para su producción industrial y uso terapéutico bajo el control de entidades regulatoria