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

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

ANIMALES ENVENENADOS: LA EXPERIENCIA DE DIEZ AÑOS DEL SERVICIO DE TOXICOLOGÍA DE LA UNIVERSIDAD DE MURCIA

Data on 10-y of chemical toxicological analyses carried out the Toxicology Service in Veterinary Faculty from Murcia (Spain) for suspected wild and domestic animal poisonings are summarized. Of the 123 cases confirmed like deliberate, 102 could be analysed and 50 of them were positive to intentional poisoning, with a total of 107 dead animals. Pesticides, especially insecticides (72%) and rodenticides (26%), were frequently involved. Aldicarb (n=15), anticoagulant rodenticides (n=8) and strychnine (n=4) were the most usual toxic agents in baits prepared for intentional poisonings; also were carbofuran, methomyl, endosulfan or paraquat. Seven of the nine Laboratories of Veterinary Toxicology from Spain, agree with the creation of a coordinated network of collaboration in order to improve the quality of the supplied services.Se revisan los datos seleccionados de 10 años de análisis químico toxicológico realizados en el Servicio de Toxicología de Murcia (España), por la sospecha de envenenamientos en animales domésticos y silvestres. De los 123 casos seleccionados y confirmados como intencionados, se pudieron analizar 102 de los cuales 50 fueron positivos a envenenamiento, con un balance de 107 animales muertos. Plaguicidas, sobre todo insecticidas (72%) y rodenticidas (26%), fueron los más frecuentemente involucrados. Aldicarb (n=15), rodenticidas anticoagulantes (n=8) y estricnina (n=4) fueron los tóxicos más utilizados en la preparación de cebos para envenenamientos; también se encontró carbofurano, metomilo, endosulfán o paraquat. Siete de los nueve Laboratorios de Toxicología de las Facultades de Veterinaria de España coinciden en señalar que la creación de una red coordinada de colaboración entre dichos centros, mejoraría la calidad de los servicios ofertados

Cromatografia em camada delgada para o diagnóstico da intoxicação por aldicarb ("chumbinho") em cães e gatos Thin-layer chromatography for aldicarb poisoning diagnosis in dogs and cats

Avaliou-se a cromatografia em camada delgada (CCD) como método de diagnóstico toxicológico para os casos de intoxicação por aldicarb em cães e gatos, utilizando-se 50 amostras de conteúdo gástrico obtidas durante a necropsia e 50 amostras de alimentos utilizados como iscas para intoxicar criminalmente os animais. Todas as amostras resultaram positivas para o aldicarb, mostrando ser a CCD uma técnica qualitativa eficiente, rápida e de baixo custo, com uso potencial na toxicologia veterinária forense.<br>The present study concerns about the identification of aldicarb residues using thin-layer chromatography (TLC) in 50 samples of gastric content obtained from the necropsy of dogs and cats and 50 samples of foods suspected of being used as baits. All samples resulted positive for aldicarb showing that the TLC is an efficient, fast and not expensive qualitative method for the detection of aldicarb, being useful for this purpose in the forensic veterinary toxicology