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

Acompanhamento da vida escolar dos alunos ingressantes no curso de graduação em enfermagem numa escola brasileira: período 1984 a 1988 Acompañamiento de la vida escolar de los alumnos ingresantes en el curso de graduación en enfermería en una escuela brasileña Completion of undergraduate nursing training at a Brazilian nursing college from 1984 to 1988: período 1984 a 1988

Foi realizado um estudo da vida escolar dos alunos que se matriculavam na EERP-USP nos anos de 19840 1988, num total de 336 alunos, visando identificar a forma de ingresso, egressão e tempo deformação. Através de um levantamento identificou-se todos os que se matricularam em cada ano, procedendo a análise e acompanhamento de cada aluno, até sua saída da Escola. Durante o período estudado, 197 (58,6%) alunos concluíram o curso; 2 permaneceram cursando e 137 (40,7%) evadiram-se. Desses, 26 (7,7%,) se transferiram; 15 (4,4%,) trancaram a matrícula e 96 (28,5%) abandonaram o curso.<br>Fue realizado un estudio de la vida escolar de los alumnos que se matriculaban en la EERP-USP en los años 1984 a 1988, en un total de 336 alumnos, procurando identificar informa de ingreso, egreso y tiempo de formación. A través de un levantamiento se identificó a todos los que se matricularon en cada año, procediendo a un análisis y acompañamiento de cada alumno, hasta su salida de la escuela. Durante el período estudiado, 197 (58,6%) alumnos concluyeron el curso; 2 permanecieron cursando y 137 (40,7%) se evadieron. De esos, 26 (7,7%) se transfirieron; 15 (4,4%,) palarizaron momentaneamente sus estudios y 96 (28,5%) abandonaron el curso.<br>An investigation of professional nursing training was carried out by examining the time spent in nursing school of the 336 students registered at the Nursing College of Ribeirão Preto at University of São Paulo from 1984 to 1988. The data showed that during this time 197 (58.6%) students graduated, two students were still enrolled, 26 (7.7%) transferred to other schools, 15 (4.4%) officially interrupted their course of study, and 96 (28.5%) abandoned the school

O agente comunitário de saúde e aconsolidação do Sistema Único de Saúde: reflexões contemporâneas The community health agent and the consolidation of the Unified Health System: contemporary reflections

Os agentes comunitários de saúde (ACS) são personagens-chave na implantação de políticas voltadas para a reorientação do modelo de saúde, tendo como base a atenção primária. Este estudo apresenta uma revisão de literatura, dirigida à análise crítica sobre a contribuição deste profissional para a consolidação do Sistema Único de Saúde (SUS). Considerando que as concepções acerca do processo saúde-doença dão sentido à prática sanitária e às ações dos profissionais de saúde, inicialmente discutiu-se a evolução dos paradigmas sanitários e a influência das correntes de pensamentos neste processo, apresentando as principais diferenças entre o paradigma flexneriano e o paradigma da produção social da saúde. Neste contexto, o SUS desponta como um novo sistema de saúde, com princípios e diretrizes que configuram o Programa Saúde da Família como estratégia revolucionária, por apresentar respostas aos problemas não solucionados pelo sistema sanitário hegemônico, baseado no paradigma até então dominante. Assim, por colocar em foco o cuidado, a atenção primária, a prática sanitária da vigilância à saúde e o trabalho em equipe multiprofissional, a formação dos profissionais para a abordagem do processo saúde-doença com enfoque em saúde da família surge como desafio para o êxito do modelo sanitário proposto. Destarte, a reflexão crítica sobre a função do ACS aponta para conflitos entre pressupostos teóricos do modelo e a prática deste profissional, destacando a necessidade de capacitação permanente, crítico-reflexiva e baseada em metodologias problematizadoras, como estratégia de potencialização para a efetiva mudança do modelo de saúde, no contexto da práxis do PSF.<br>The community health agents (ACS) are key players in the implementation of policies related to the reorientation of health model, based on primary care. This study presents a literature review, led to critical analysis on the contribution of this work for the consolidation of the Unified Health System (SUS). Whereas the conception of health-disease process gives meaning to the practice and actions of health professionals, first we discussed the evolution of the paradigms of health and the influence of currents of thought in this process, presenting the main differences between the paradigm and Flexnerian paradigm of social production of health. In this context, the SUS emerged as a new health system, with principles and guidelines that make up the Family Health Program a revolutionary strategy which presents answers to the unsolved problems by the hegemonic health system, based on the paradigm dominant so far. So, focusing on care, primary care, health surveillance practices and multi-professional teamwork, professional training to address the health-disease process with a focus on family health poses a challenge to the success of the proposed public health model. Thus, critical reflection on the role of the ACS points to conflicts between the theoretical model and professional practice, highlighting the need for ongoing training, critical and reflective and based on questionable methodology, such as augmentation strategy for the effective change in the health model in the context of the praxis of the Family Health Program