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

Viability kinetics of Lactobacillus casei Shirota strain in a commercial fermented milk drink during refrigerated storage

© 2017 Derick Erl P Sumalapao, et al. Background: One of the most important parameters in a commercial fermented milk drink containing probiotics is the viability of the microorganisms. Aims and Objectives: This study described the viability kinetics of Lactobacillus casei Shirota strain in a commercial fermented milk drink during refrigerated storage using nonlinear models. Materials and Methods: Viability of L. casei Shirota strain was monitored during refrigerated storage using standard bacterial plate count method. Several nonlinear mathematical models such as the zero-order, first-order, and second-order kinetic equations were employed in describing the population dynamics. Best-fit models were selected based on prescribed criteria including sum of squares of the error, p-value, and coefficient of determination. Results: The viable counts of L. casei Shirota strain in the fermented milk samples stored under refrigerated conditions decreased from 3.73 × 108 colony forming units per ml (CFU/ml) to 2.70 × 108 CFU/ml when monitored every 3-4 days interval over 10 different monitoring points within the product’s indicated shelf life. The counts significantly differed between the monitoring points that were at least 14 days apart. The lowest viable count was still within the recommended therapeutic dose. The decrease in the bacterial population behaved under a second-order kinetic relationship. Conclusion: The viability of L. casei Shirota strain in a commercial fermented milk product during refrigerated storage is governed in accordance with the second-order kinetic mechanism