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

Características de latossolos roxos desenvolvidos de rochas alcalinas e básicas de Jaboticabal, SP Characteristics of dusky red latosols developed from alcaline and basic rocks in Jaboticabal, SP

Comparou-se as características químicas, físicas e mineralógicas de Latossolos Roxos desenvolvidos de rocha alcalina (LRe) e de rocha eruptiva básica (LRd), da região de Jaboticabal, SP. Os resultados indicaram que o LRe apresenta-se num estádio de desenvolvimento, comparativamente, menos evoluído que o LRd, enquanto esse se apresenta com tendência para a maturidade. Os menores teores de argila e ferro total e maiores teores de saturação por bases, Ki e CTC da fração argila apresentados pelo LRe comprovam esta tendência. Conclui-se que a ocorrência de Latossolo Roxo eutrófico no campus da UNESP-Jaboticabal, pode estar associada a participação de rochas alcalinas na sua pedogênese.<br>A comparative study was carried out on chemical, physical and mineralogical characteristics of dusky red latosols originated from the weathering of alcaline (LRe) and basic eruptive rocks (LRd), of the Jaboticabal country Brazil The results showed that the LRe presented a younger development stage than LRd, while this soil showed a tendency to maturity. This trend was corraborated through the lower clay and total Fe2O3, contents and higher base saturation contents, Si2O/Al2O3 molecular ratio (Ki) and clay f ration CEC presented by LRe. It can be concluded that the occurrence of eutrophic dusky red latosols hi the UNESP-Jaboticabal campus may be due to the influence of alcaline rocks

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors