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

Escala diagramática para avaliação da severidade da mancha-de-micosferela em morangueiro Diagramatic scale to evaluate the mycosphaerella blight severity in strawberry

Uma escala diagramática com cinco níveis: 0,11; 0,51; 2,4; 10,2 e 34,9% foi desenvolvida e validada para quantificar a severidade da mancha-de-micosferela do morangueiro, causado por Mycosphaerella fragariae (Tul.) Lin. A escala considerou os limites de severidade mínima e máxima da doença observados no campo e os níveis intermediários seguiram incrementos logarítmicos, obedecendo-se à "Lei do estímulo de Weber-Fechner". Inicialmente, a estimativa da severidade foi feita sem auxílio da escala em 30 folíolos com diferentes níveis de severidade, por sete indivíduos, sem experiência na avaliação da mancha-de-micosferela do morangueiro . Em seguida, os mesmos avaliadores utilizaram a escala diagramática proposta. As avaliações com a escala diagramática foram mais precisas e acuradas nas estimativas de todos os avaliadores, não ocorrendo erro sistemático na superestimativa ou subestimativa da doença entre estes. A escala diagramática proposta foi considerada adequada para estimar a severidade de mancha-de-micosferela em morangueiro.<br>A diagramatic scale with five levels of disease severity: 0.11; 0.51; 2.4; 10.2 and 34.9% was developed and validated to assess mycosphaerella blight in strawberry, caused by Mycosphaerella fragariae. The scale was developed considering the maximum and minimum limits of disease severity observed in the field and the intermediate values followed logarithmic increments according to the "Stimulus Law by Weber-Fechner". Initially the estimates of severity were performed without the use of the scale in 30 leaves with different levels of severity. Validation was carried out by seven appraisers, without previous pratice in assessing mycosphaerella blight in strawberry. Then, the appraisers estimated the severity of the same leaves previously assessed using the proposed diagrammatic scale. Assessments with the diagrammatic scale were of great precision for all raters and did not constitute systematic mistakes in over or underestimating the disease severity. The proposed diagrammatic scale was considered adequate to estimate mycospharela blight severity in strawberry