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

Efeito do estresse climático sobre os parâmetros produtivos e fisiológicos de ovinos Santa Inês mantidos em confinamento na região litorânea do Nordeste do Brasil Effects of environmental stress on physiological parameters of feedlot sheep in the Northeast of Brazil

O presente estudo foi conduzido objetivando-se avaliar a influência do estresse climático sobre o desempenho produtivo e as respostas fisiológicas de ovinos da raça Santa Inês em confinamento. Foram avaliados dois ambientes (sombra e sol) e duas dietas com duas relações volumoso:concentrado (70C:30V: 70% de concentrado e 30% de volumoso; 30C:70V: 30% de concentrado e 70% de volumoso). Os animais mantidos à sombra e alimentados com dieta contendo alto teor de concentrado (70C:30V) apresentaram maior consumo de matéria seca (1258 g/animal/dia) e de proteína bruta (0,8% do peso vivo [PV] e 18 g/PV0,75) e maior ganho de peso (247 g/animal/dia). A temperatura nos ambientes de sol e sombra durante a tarde foi de 32,1 e 30,6:C e os valores do índice de temperatura e umidade (ITU), 82,3 e 81,1, respectivamente. Os animais alimentados com alto teor de concentrado (70C:30V) apresentaram maior freqüência respiratória (FR), tanto à sombra quanto ao sol (87 e 71 mov/min, respectivamente). Durante a tarde, a temperatura retal (TR) dos animais foi maior (39,1:C) que pela manhã (38,9:C). Porém, a TR mais elevada (39,3:C) foi observada nos animais mantidos à sombra e alimentados com alto percentual de concentrado (70C:30V). Independentemente do ambiente, os animais alimentados com alto teor de concentrado (70C:30V) apresentaram maior TR (39,2:C) do que aqueles alimentados com reduzido teor de concentrado (30C:70V) (38,8:C). O tipo de dieta teve efeito sobre a susceptibilidade dos animais ao estresse causado pelas condições ambientais críticas durante o experimento. Os animais da raça Santa Inês mostraram-se sensíveis ao estresse ambiental, uma vez que apresentaram menor desempenho produtivo, quando expostos a condições de ausência de sombra.<br>A study was conducted to determine the effect of environmental stress on physiological criteria of feedlot sheep. Treatments consisted of two different housing conditions (shade and no shade) and two levels of concentrate in the diet: high concentrate (70% of concentrate and 30% of roughage-70C:30R); low concentrate (30% of concentrate and 70% of roughage-30C:70R). Animals raised under shade and fed a high concentrate diet (70C:30R) had greater dry mater intake (1258 g/animal/day) and crude protein (0.8% of body weight (BW) and 18 g/BW0.75), as well as weight gain (247 g/animal/day). Air temperature in the afternoon was 30.6:C, under shade, and 32.1:C, under sun and values of temperature humidity index(THI), 82.3 and 81.1, respectively. Animals fed more concentrate (70C:30R) had also higher respiratory frequency (RF), either raised under shade (87 mov/min) or under the sun (71 mov/min.). Rectal temperature (RT) was higher in the afternoon (39.1:C) than in the morning (38.9:C), but animals raised under shade and fed diets with 70% concentrate (70C:30R) had the highest value of RT (39.3:C). Regardless of type of housing conditions, the animals that received more concentrate (70C:30R) had greater rectal temperature (39.2:C) than those fed a diet with less concentrate (30C:70R) (38.8:C). Therefore, the type of diet influenced the response of the animals to housing conditions. Moreover, Santa Inês sheep are susceptible to environmental stress because had lower performance when raised under no shade