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

Brick cladding to steel framed buildings

2 vols.; Volume 1: Commentary; Volume 2: Design ExamplesAvailable from British Library Document Supply Centre- DSC:87/09191-2(Brick) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Brick cladding to steel framed buildings

2 vols.; Volume 1: Commentary; Volume 2: Design ExamplesAvailable from British Library Document Supply Centre- DSC:87/09191-2(Brick) / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

The effect of organisational culture perceptions on the relationship between budgetary participation and managerial job-related outcomes

We examine the impact of managers\u27 perceptions of their organisational culture (OC) on the relationship between budgetary participation (BP) and managerial job-related outcomes, operationalised as managerial performance and job-related tension (JRT). Does the relationship between BP and job-related outcomes would depend on managers\u27 perceptions of innovation and attention to detail? Data supported predictions that increasing BP would lower JRT for managers perceiving a high emphasis on innovation within their OC, regardless of their perceptions of an emphasis on attention to detail. When managers perceived low innovation, however, their perception of level of attention to detail had a significant effect on the relationship between BP and JRT. More specifically, increasing BP was found to decrease JRT for managers who perceived low innovation and low attention to detail. For managers who perceived low innovation and high attention to detail, however, this effect was attenuated. Finally, the positive relationship between BP and managerial performance was not found to he affected significantly by managers\u27 OC perceptions.<br /