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

Letters of Theophilus Lindsey,

On verso of t.-p.: Publications of the University of Manchester, no. CXXXIV.Mode of access: Internet

Le Partage De La Pologne : En Sept Dialogues En Forme De Drame, Ou Conversation Entre Des Personnages Distingues, Dans laquelle on fait parler les Inteslocuteurs conformément à leurs Principes & à leur Conduite / Par Gotlieb Pansmouser [i. e. Theophilus Lindsey], Neveu du Baron de ce Nom. Traduit De L'Anglois Par Miladi *** Duchesse De ***

LE PARTAGE DE LA POLOGNE : EN SEPT DIALOGUES EN FORME DE DRAME, OU CONVERSATION ENTRE DES PERSONNAGES DISTINGUES, DANS LAQUELLE ON FAIT PARLER LES INTESLOCUTEURS CONFORMÉMENT À LEURS PRINCIPES & À LEUR CONDUITE / PAR GOTLIEB PANSMOUSER [I. E. THEOPHILUS LINDSEY], NEVEU DU BARON DE CE NOM. TRADUIT DE L'ANGLOIS PAR MILADI *** DUCHESSE DE *** Le Partage De La Pologne : En Sept Dialogues En Forme De Drame, Ou Conversation Entre Des Personnages Distingues, Dans laquelle on fait parler les Inteslocuteurs conformément à leurs Principes & à leur Conduite / Par Gotlieb Pansmouser [i. e. Theophilus Lindsey], Neveu du Baron de ce Nom. Traduit De L'Anglois Par Miladi *** Duchesse De *** (1) Einband (1) Titelseite (9) Avertissement (10) Interlocuteurs / Dialogue I. (11) Dialogue II. (18) Dialogue III. (24) Dialogue IV. (27) Dialogue V. (33) Dialogue VI. (37) Dialogue VII. (46

Outbreak of Rabbit Hemorrhagic Disease Virus 2 Infections, Ghana

In September 2019, high mortality in commercial rabbits was reported in the Greater Accra Region of Ghana. Rabbit hemorrhagic disease virus 2 phylogenetically related to isolates from 2015–2017 outbreaks in the Netherlands was confirmed as the causative agent. The virus has not yet been detected in native rabbits in Ghana