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

Ameloblastoma as criterion for Nevoid Basal Cell Carcinoma (Gorlin) Syndrome identification

Introduction & Objectives: Ameloblastomas are considered to be aggressive and locally invasive neoplasms derived from odontogenic epithelium and with a tendency for recurrence and bone destruction. Although the relationship between NBCCS and ameloblastoma is infrequent it constitutes a peculiar stigmata of this hereditary disorder. The objective of the current study was to evaluate whether a combined clinical and biomolecular approach could be useful for the identification of NBCCS among patients with a diagnosis of ameloblastoma. Material and Methods: The authors collected ameloblastoma tumors recorded in the databases of the Pathology Departments of the University during the period 1991-2011. Family trees were drawn for 41 patients affected by these peculiar odontogenic tumors. Results: Two patients with ameloblastoma were also affected by multiple basal cell carcinoma and OKCTs, thus meeting the clinical criteria for the diagnosis of NBCCS. This was confirmed by the identification of two different novel PTCH1 germline mutations (c.2186A>T [p.K729M]; c.931insA) in those unrelated patients. Conclusions: The clinical characterization of the ameloblastoma can be used as screening for the identification of families at risk of NBCCS. Ameloblasomas diagnosis warrants the search for associated cutaneous basal cell carcinomas and other benign and malignant tumors related to NBCCS. We propose the inclusion of ameloblasoma as criterion for the identification of NBCCS