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

Estudio de las cifras económicas del turismo en Ecuador, evolución y efecto de la crisis sanitaria

The investigative work is part of a documentary review of the economic data of the Ecuadorian tourism sector, a situation that allows us to appreciate how it contributes to employment and the impact of the health crisis; a multiple correlation is used to verify the relationship of the main variables and a description of the data that rests in the Ministry of Tourism; Among the main results, it is evident that tourism grew sustainably even before the pandemic, but the health crisis did affect tourism companies, even causing some cities to have adverse results.El trabajo investigativo se enmarca en una revisión documental de los datos económicos del sector turístico del Ecuador, situación que permite apreciar como contribuye al empleo y la afectación por la crisis sanitaria; se utiliza una correlación múltiple para verificar la relación de las principales variables y una descripción de los datos que reposan en el Ministerio de Turismo; entre los principales resultados se evidencia que el turismo creció de manera sostenible hasta antes de la pandemia, pero la crisis sanitaria si afectó a las empresas turísticas, llegando incluso a que unas ciudades  tengan resultados adversos