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

Sorção de fósforo em função do teor inicial e de sistemas de manejo de solos

A relação entre o P sorvido/P solução do solo pode ser influenciada pelo teor de P previamente sorvido e pelos sistemas de manejo. Este trabalho teve o objetivo de avaliar as modificações na capacidade de sorção máxima (Pmax) e na constante relacionada com a energia de ligação de P com os colóides (k) da isoterma de Langmuir, provocadas (a) pela inclusão do teor de P previamente sorvido (Ppre) e (b) por sistemas de manejo de solos. Coletaram-se, em maio de 1997, amostras de solo (Latossolo Vermelho distroférrico típico, Latossolo Vermelho distrófico típico e Argissolo Vermelho distrófico típico), em três camadas (0-2,5, 2,5-7,5 e 7,5-17,5 cm), de três experimentos instalados a partir de 1979, envolvendo os sistemas plantio direto e cultivo convencional com diferentes sucessões de cultura. O solo foi equilibrado com oito concentrações de P em solução de CaCl2 0,001 mol L-1. Após a agitação por 16 h, avaliou-se a concentração de P no sobrenadante. Os dados de P-sorvido e P-solução foram ajustados à equação de Langmuir, obtendo-se a Pmax e a k, considerando ou não o Ppre. A inclusão do Ppre no modelo de Langmuir aumenta, em média, 2,9 vezes o valor da k e não afeta a Pmax, no LVdf, e aumenta em todas as camadas, no LVd, e na camada superficial, no PVd. A Pmax é pouco influenciada pelos métodos de preparo do solo, sucessões de culturas e camadas amostradas