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

Seasonal influence on phenolic-mediated antihyperglycemic properties of Canadian sugar and red maple leaves using in vitro assay models

Red and sugar maple leaves collected in the summer and fall from Canada, were evaluated for phenolic content, antioxidant, α-glucosidase, and α-amylase inhibitory activities variation. The phenolic contents of summer red maple leaves (RML-S) and summer sugar maple leaves (SML-S) were higher than red and sugar maple leaves collected in fall (RML-F and SML-F, respectively). HPLC analyses showed differences in phenolic compounds present in the SML samples compared to the RML samples. The extracts were assayed for yeast and rat α-glucosidase inhibitory activities. Both results showed that SML-S extracts had the highest inhibitory activity which could possibly be attributed to the unique phenolics present therein. Milder effects were observed in terms of α-amylase inhibitory activity, with RML-F having the highest inhibitory activity. These results suggest that maple tree leaf extracts may have potential for phenolic-mediated α-glucosidase inhibition, relevant to type 2 diabetes management, with SML-S extract having the highest bioactivity