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

Nutritional Efficiency of Forest Species in Natural Regeneration of Tropical Forest in Brazil

The knowledge of the nutritional aspects of native species, mainly in natural regeneration, may be important for understanding their establishment, particularly in areas with low nutrient availability soils, such as tropical soils. This study aimed to determine the biological utilization efficiency (BUE) of the nutrients N, P, K, Ca, and Mg of forest species of natural regeneration in a Lowlands Dense Ombrophilous forest fragment in Pernambuco, Brazil. A phytosociological study of the fragment was carried out and were defined the ten species with the highest absolute density (AD). Three individuals per species were selected. The N, P, K, Ca, and Mg contents were determined in the sample leaves of the species, and the foliar biomass was determined “in loco”. Nine individuals of each species were collected according to the following diameter intervals at the base (DBs): DBsMg>K>Ca>N. The highest BUE of nutrients was of the species Protium heptaphyllum. In tropical soils of low natural fertility, the use of these species can be recommended in environmental reforestation projects. The difference in the nutritional demand of the forest species can indicate the planting of those with greater capacity of absorption and BUE of nutrients, being more efficient in areas of soils with low natural fertility like in the tropical forests