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

Comparison between skeleton-based and atlas-based approach in the assessment of corpus callosum damages in Mild Cognitive Impairment and Alzheimer Disease

The damage of specific bundles in the brain white matter (WM) is currently assessed in Alzheimer Disease (AD) and amnestic Mild Cognitive Impairment (aMCI) by tractography based on diffusion tensor imaging (DTI) and the consequent evaluation of diffusion parameters in reconstructed tracts. Controversial results may be due to the use of different techniques. This work aims at comparing an atlas-based technique to compute fractional anisotropy (FA) in specific tracts with the voxelwise approach of Tract-Based Spatial Statistics (TBSS). FA was evaluated in 7 portions of the corpus callosum (CC) of 10 elderly healthy controls (HC), 10 aMCI and 10 mild AD patients with both approaches. Atlas-based tractography revealed concordant results with TBSS, displaying the same significant differences between AD and HC and no significant difference between aMCI and HC. However, as regards the AD to aMCI contrast only the atlas-based method was able to find significantly lowered FA in AD in frontal and parietal CC portions. This finding shows that a proper analysis which considers a higher number of voxels, not restricting the observation to the skeleton in the assessment of CC damages, could be useful for AD to aMCI differential diagnosis and prognosis