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

Use of sawdust Eucalyptus sp. in the preparation of activated carbons Utilização de serragem de Eucalyptus sp. na preparação de carvões ativados

Wood sawdust is a solid residue, generated in the timber industry, which is of no profitable use and can cause serious environmental problems if disposed inadequately. The aim of this study was to use the eucalyptus sawdust in the preparation of activated carbons AC) and test them as adsorbents of methylene blue (MB) and phenol, representative pollutants from aqueous effluents of various industries. The eucalyptus sawdust was characterized by instrumental analysis such as elementary analysis (CHNS-O), thermogravimetric analysis (TGA), infrared spectroscopy (FTIR) and scanning electron microscopy (SEM). The activated carbons were prepared by physical activation with carbon dioxide AC_CO2, (10º C min-1, 850º C, 1h) and by chemical activation with potassium carbonate AC_K2CO3 (10º C min-1, 850º C, 3h). The AC_CO2 and AC_K2CO3 were characterized by CHN-O, TGA, FTIR, N2 adsorption/desorption (BET) to evaluate the specific surface area and SEM. The resulting activated carbons were tested for their ability to adsorb MB and phenol in water. The activated carbons produced in this work were predominantly microporous and showed specific surface area of about 535 m² g-1. The AC_K2CO3 was more effective in the adsorption of MB (81 mg g-1) and phenol (330 mg g-1) than AC_CO2 (32 mg g-1 and 172 mg g-1, respectively, for MB and phenol).<br>A serragem é um resíduo sólido, gerado na indústria madeireira, que não tem uso rentável e pode causar sérios problemas ambientais quando disposta inadequadamente. Neste estudo, objetivou-se utilizar a serragem de eucalipto na preparação de carvões ativados (AC) e testá-los como adsorventes do corante azul de metileno (MB) e fenol; moléculas que representam poluentes de efluentes industriais. A serragem de eucalipto foi caracterizada por análises instrumentais, tais como: análise elementar (CHNS-O), análise termogravimétrica (TGA), espectroscopia na região do infravermelho (FTIR) e microscopia eletrônica de varredura (SEM). Os carvões ativados foram preparados por ativação física com dióxido de carbono AC_CO2, (10º Cmin-1, 850ºC, 1h) e pela ativação química com carbonato de potássio- AC_K2CO3 (10º Cmin-1, 850º C, 3h). O AC_CO2 e AC_K2CO3 foram caracterizados por CHN-O, TGA, FTIR, adsorção/dessorção de N2 (área BET) para avaliar a área superficial específica e SEM. Os carvões ativados resultantes foram testados quanto à capacidade de adsorver MB e fenol na água. Os carvões produzidos apresentaram características de material microporoso, apresentando área superficial média de cerca de 535 m²g-1. O AC_K2CO3 foi mais eficiente na adsorção do MB (81mgg-1) e fenol (330mgg-1) que o AC_CO2 (32mg g-1 e 172 mg g-1, respectivamente, para MB e fenol)

Baseline clinical characteristics and patient profile of the TURKMI registry: Results of a nation-wide acute myocardial infarction registry in Turkey

Objective: The TURKMI registry is designed to provide insight into the characteristics, management from symptom onset to hospital discharge, and outcome of patients with acute myocardial infarction (MI) in Turkey. We report the baseline and clinical characteristics of the TURKMI population. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of percutaneous coronary intervention selected from each EuroStat NUTS region in Turkey according to population sampling weight, prioritized by the number of hospitals in each region. All consecutive patients with acute MI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018 and November 16, 2018. Results: A total of 1930 consecutive patients (mean age, 62.0±13.2 years; 26.1% female) with a diagnosis of acute MI were prospectively enrolled. More than half of the patients were diagnosed with non-ST elevation MI (61.9%), and 38.1% were diagnosed with ST elevation MI. Coronary angiography was performed in 93.7% and, percutaneous coronary intervention was performed in 73.2% of the study population. Fibrinolytic therapy was administered to 13 patients (0.018%). Aspirin was prescribed in 99.3% of the patients, and 94% were on dual antiplatelet therapy at the time of discharge. Beta blockers were prescribed in 85.0%, anti-lipid drugs in 96.3%, angiotensin converting enzyme inhibitors in 58.4%, and angiotensin receptor blockers in 7.9%. Comparison with European countries revealed that TURKMI patients experienced MI at younger ages compared with patients in France, Switzerland, and the United Kingdom. The most prevalent risk factors in the TURKMI population were hypercholesterolemia (60.2%), hypertension (49.5%), smoking (48.8%), and diabetes (37.9%). Conclusion: The nation-wide TURKMI registry revealed that hypercholesterolemia, hypertension, and smoking were the most prevalent risk factors. TURKMI patients were younger compared with patients in European Countries. The TURKMI registry also confirmed that current treatment guidelines are largely adopted into clinical cardiology practice in Turkey in terms of antiplatelet, anti-ischemic, and anti-lipid therapy. ©Copyright 2020 by Turkish Society of Cardiolog