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

A simple and rapid method for collecting saliva to assess sodium status in sheepum Um método simples e rápido de colheita de saliva para avaliar estados normais ou deficientes de sódio, em ovinos

Fifteen lambs were fed diet with normal (0.11%) or deficient levels of sodium ( 0.035%), respectively, for five weeks on each diet. At the end of each period saliva was collected by three different methods: swabbing with a 5 x 5 x 1.25cm synthetic sponge, aspiration with a 15cm long plastic tube connected to a 20ml syringe and sucking with a 4mm x 45cm long plastic tube through a water-jet aspirator pump or an eletric motor pump. The volume of saliva collected/min and the salivary sodium: potassium ratio were analysed. Larger volume of saliva was obtained with the developed sucking apparatus than with the sponge or the syringe. There was no influence of the method of saliva collection on the values of salivary Na:K ratio in both periods. Nevertheless, the lower the sodium dietary level was, the smaller the salivary Na:K ratio. Five weeks of low sodium diet intake resulted in a decrease in the salivary Na:K ratio values by half. However, the lambs did not exhibit any clinical sign of sodium deficiency. The advantages of the developed method to collect saliva are discussed.<br>Neste experimento foram utilizados 15 cordeiros os quais receberam dietas com níveis adequados de sódio (0,11%) ou deficientes deste elemento (0,035%), respectivamente, por dois períodos de cinco semanas cada. Ao término de cada período, foram colhidas amostras de saliva, de todos animais, por três diferentes métodos: absorção com o uso de uma esponja sintética com as seguintes medidas 5 x 5 x 1,25cm; aspiração com um tubo plástico de 15cm de comprimento conectado a uma seringa de 20ml; e através de sucção por tubo plástico, com 4mm x 45cm de comprimento, ligado a uma trompa de vácuo conectada a uma torneira ou a uma bomba motora elétrica geradora de vácuo. Foram avaliados o volume de saliva colhida por minuto e a razão das concentrações de sódio:potásio salivar. Quantidades muito maiores de saliva (p < 0,001) foram colhidas através do método utilizando trompa ou bomba motora de vácuo que com o auxílio de esponja ou de seringa. Não existiu diferença entre a razão das concentrações Na:K salivar nas amostras colhidas pelos três diferentes métodos, nos períodos experimentais. A ingestão de uma dieta pobre em sódio, pelos ovinos, provocou uma queda, de cerca de 50%, nos valores da razão Na:K salivar, comparado com os valores encontrados na dieta normosódica. Porém, os animais submetidos a dieta carente em sódio não apresentaram quaisquer sinais clínicos sugestivos de deficiência deste elemento. As vantagens do método desenvolvido para colheita de saliva são apresentadas e discutidas