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

Palladium catalysed asymmetric hydroxy- and alkoxycarbonylation of alkenes

Palladium catalysed asymmetric hydroxy- and alkoxycarbonylation reactions of alkenes have the potential to deliver valuable chiral carboxylic acid and ester building blocks from cheap feedstocks: alkenes, carbon monoxide and water (alcohols in the case of alkoxycarbonylation). Despite the attractive nature of these reactions, extensive research has so far been unable to produce effective catalysts which are capable of controlling both regio- and enantioselectivity. Building on exciting recent results involving the use of highly enantioselective palladium catalysts derived from Phanephos-type ligands, this research focuses on paracyclophane-diphosphines and their use in asymmetric hydroxy- and alkoxycarbonylation reactions. An investigation into reaction conditions analysed several factors, including solvents, CO-pressure, acidic additives and halide sources, to provide optimal activity and selectivities. Two novel electron-poor paracyclophane-diphosphines and their mono- and di-palladium complexes were synthesised and shown to provide exceptional levels of regioselectivity while maintaining high levels of asymmetric induction. These are the first such examples of hydroxy- or alkoxycarbonylation catalysts to facilitate simultaneous control over both regio- and enantioselectivity. The most effective catalyst was used to promote the reactions of a selection of aryl alkenes and was shown to be tolerant of several different functional groups. A selection of non-symmetric paracyclophane-diphosphine ligands and their palladium complexes were also synthesised and assessed for their performance in hydroxy- and alkoxycarbonylation. We also report the use of Phanephos-type ligands to promote the highly enantioselective hydroxycarbonylation of N-(p-toluenesulfonyl)-3-pyrroline to deliver a chiral proline derivative in high ee

Simultaneous control of regioselectivity and enantioselectivity in the hydroxycarbonylation and methoxycarbonylation of vinyl arenes

Using a family of novel mononuclear and dinuclear palladium complexes of phanephos ligands, the simultaneous control of regioselectivity and enantioselectivity in the hydroxycarbonylation and alkoxycarbonylation of styrene derivatives has been realised for the first time.Publisher PDFPeer reviewe