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

Platinum-group elements and gold in komatiitic rocks from the Agrilia Formation, Othrys ophiolite complex, Greece

Highly magnesian lavas (32 wt.% MgO) from the Agrilia Formation, Othrys ophiolite complex, central Greece, were analyzed for major and trace elements. Average platinum-group elements (PGE) concentrations (all in ppb) are: Os 3.6, Ir 0.68, Ru 4, Pt 1.2, Pd 8.5, Rh < 0.5 and Au 19. Although the studied lavas from the Agrilia Formation have unusually high Mg, Cr and Ni contents, they differ from boninites in respect to the dominance of olivine phenocrysts, the lack of orthopyroxene and primary hornblende and the preferential association of chromite with groundmass. The higher Pd than Pt concentrations and the lack of detectable Rh appear to be characteristic of the Agrilia ultramafic lavas. The PGE concentrations, the relatively low values of Pd/Ir ratios (∼ 12), the chondrite-normalized PGE patterns - which are almost flat, with exception of a Pt anomaly - and the mineral chemistry of the studied lavas are comparable to typical komatiites, suggesting that these lavas may represent primitive magmas. The derived parental magma for the studied lavas (in equilibrium with Fo90.5) contains ∼ 17 wt.% MgO and is similar to those which gave rise to modern analogues of the Archean komatiites from Gorgona island, Colombia. However, the variation in Ti/V and Ti/Sc ratios in Agrilia lavas and the enrichment in some incompatible elements (Sr, Rb, Ba, La) may indicate a modification of the magma composition in the mantle source region by a subduction component. The occurrence of the Triassic komatiitic (and boninitic) lavas in combination with tholeiitic lavas with mid-ocean ridge basalt (MORB) affinities of the Othrys complex, may suggest changes in the geotectonic setting during the development of the Othrys complex from a fore-arc (formation of the highly magnesian lavas) to back-arc tectonic setting (formation of the main complex). © 1989

What should I do about my patient's gall stones?

The problem of benign biliary disease is one that causes significant morbidity and social economic strain in the western world. The classical treatment, cholecystectomy, has been challenged by various medical and surgical techniques in a seemingly random nature. The development of the treatment of gall stone disease is reviewed by analysis of published studies over the last 20 years. The advantages and disadvantages are discussed as an overview and summary of the current management of gall stone disease in the light of our knowledge of its malignant potential