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

Effect of homotaurine in patients with cognitive impairment: Results from an Italian observational retrospective study

Background & Aims: This observational retrospective study aimed at evaluating the effects of one-year administration of homotaurine (tramiprosate) in a sample patients presenting with symptoms of mild cognitive impairment. Methods: Patient’s demographic data and medical history are reported. Each patient performed brain imaging and neuropsychological assessment to reach the diagnosis. Each patient assumed 100 mg total dose of homotaurine/day. The evolution of the cognitive decline over time was evaluated my means of the Mini Mental State Examination (MMSE). Results: 245 patients from 28 different centres in Italy were recruited. Significant improvements from baseline expressed as mean MMSE total score were observed in patients with aMCI at months 8 and 12 (p < 0.0001), and in those with mMCI at month 4 (p < 0.05). Conclusions: Administration of homotaurine revealed beneficial effects in our sample population of MCI patients. Our results indicate clearly that homotaurine may well be considered as a potential symptomatic treatment for cognitive symptoms. Further research is however needed to clarify whether this compound could influence the progression of cognitive decline