A narrative review of the current available literature on the intersection between the climate crisis and paediatric surgical care

The climate crisis exacerbates health inequities, including in paediatric surgery, creating a vicious cycle. We sought to review (a) existing evidence on the connection between paediatric surgery and climate and (b) how this addresses the vicious cycle. A PubMed search was conducted on 23-08-2023. Articles not commenting on "climate change" and "paediatric surgery" were excluded. Included papers were categorised into emerging themes. Out of 151 search results, seven articles were included. The emerging themes related to "Effect of climate on paediatric surgical illness" (n = 3), "Effect of surgery on climate" (n = 2), and "Mitigating impact of paediatric surgery" (n = 2). Five articles were observational studies, and two were literature reviews, all papers published after 2020. We found limited primary research focusing on the intersection between climate change and paediatric surgery. Articles tend to focus on quantifying impact and mitigation, which does not lend itself to climate justice. The syndemic model of health focuses on the complex interconnections and pathways through which health conditions interact within populations to exacerbate adverse health outcomes. We suggest future research needs to be reframed, with the interconnection between health inequities, the climate crisis, and the wider health system addressed together

Tray Rationalization in Pediatric Day Surgery: A Sustainable Quality Improvement Project

Background: Climate change poses a major threat to human health. The decontamination of used surgical equipment has been identified as a “carbon hotspot” in theaters. Surgical tray rationalization, which removes enough instruments to shrink the tray size, has a significant impact on carbon footprint, providing that there is not an increase in individually wrapped instruments used. Methods: Using the sustainability in quality improvement framework, we rationalized the surgical tray used for pediatric open herniotomies at the Oxford University Hospitals John Radcliffe site. Data on instrument utilization and individually wrapped instruments were prospectively collected. Our tray redesign had no threshold utilization rate for instrument exclusion and focused on removing enough instruments to reduce the tray size. To calculate impact, we used established data on carbon emissions and financial cost and surveyed staff attitudes toward the redesigned tray. Results: The tray at baseline included 55 instruments. The tray size was reduced by 50% with the removal of 22 instruments. Following our intervention, the median instrument utilization rate increased from 27% to 74% with no significant increase in individually wrapped instruments. The redesigned tray reduced carbon emissions from 4243 gCO2e to 2559 gCO2e and reduced financial cost from £48.66 to £29.63 per tray per decontamination cycle, approximating to 383,952 gCO2e and £4338.84 saved annually. All surveyed staff members (n = 25) agreed that the redesigned tray was easy to prepare and felt positive about the effort to reduce environmental impact. Conclusions: This quality improvement project shows the impact possible by using an established simple and effective framework that can be replicated by healthcare professionals without a background in planetary health to ensure future surgical tray rationalization efforts that maximize environmental impact

Integrating intensified case finding of tuberculosis into HIV care: an evaluation from rural Swaziland

Background Swaziland has the highest HIV prevalence in the world and the highest estimated tuberculosis incidence rate in the world. An estimated 80% of TB patients are also infected with HIV. TB detection through intensified case finding (ICF) has yet to become a routine aspect of integrated tuberculosis and HIV care. The purpose of this study was to evaluate implementation of ICF for TB into routine integrated tuberculosis and HIV care at 16 community clinics and one district hospital in Swaziland. Methods Nurses and lay counsellors conducted ICF using a TB screening tool and patient pathway at all HIV service entry points in clinics and the hospital. The patient pathway had three-stages; screening, sputum smear diagnosis and TB treatment initiation. Outcomes and losses to follow up were monitored at each stage. Patient demographics, access, and service feasibility and effectiveness were compared at hospital and clinic sites. Results 1467 HIV patients at clinics and the hospital were screened over a 3 month period. Large losses to follow up occurred prior to the sputum diagnosis stage; only 47% (n = 172) of TB suspects provided a specimen. 28 cases of smear positive TB were diagnosed and 24 commenced treatment. People screened at clinics were significantly more likely to be female, older, and from rural or geographically remote areas (p < 0.001). There was no significant difference between the hospital and clinics sites in the proportion of all participants screened who were smear positive (x2 = 1.909; p = 0.16). The number needed to screen to detect one sputum positive TB case was 34 at clinics and 63 at the district hospital. Conclusions ICF was operationally feasible and became established as a routine aspect of tuberculosis and HIV integrated care. ICF in community clinics was potentially more accessible to an underserved, rural population and was as effective as the hospital service in detecting smear positive TB

Equity in UK perioperative health registries: a scoping review of case report forms

There is strong evidence that the wider determinants of health impact perioperative care and outcomes. As perioperative registry data enables evidence based practice, we aim to undertake a scoping review of British perioperative registries to investigate to what extent they include health equity variables as identified and promoted by the COCHRANE Health Equity Group. The health equity variables are collectively referred to by their acronym PROGRESS-Plus, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus: personal characteristics and relationships associated with discrimination

Protocol for a Rapid Review of sustainability publications in anaesthetic journals

This pre-registration contains the protocol for a Rapid Review of sustainability publications in anaesthetic journal

An evidence-based approach towards sustainable anaesthesia

Health and social care currently account for between 4-5% of UK annual emissions1. Recognising this, the NHS has set a net zero goal for direct emissions by 2040, alongside an 80% reduction goal before 20322. Net zero here refers to a balance between residual emissions and carbon offsets. To this end, trusts are exploring measures to reduce their direct emissions through changes in practice, renewable electricity generation, and energy efficiency improvements. The NHS will then offset any remaining emissions after 2040. Surgery and anaesthesia together account for 8% of the carbon footprint associated with acute trusts at present, with nearly half of this due to the use of anaesthetic vapours and gases, predominantly nitrous oxide and desflurane3. The NHS net zero panel expect 2% of its total emissions reduction will be achieved through changes to the delivery of anaesthesia4. This raises the question: what changes can be made to anaesthetic practise to achieve this goal?</jats:p

Protocol for a Rapid Review of sustainability publications in anaesthetic journals

This pre-registration contains the protocol for a Rapid Review of sustainability publications in anaesthetic journal