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

Efficient removal of low-arsenic concentrations from drinking water by combined coagulation and adsorption processes

Combined separation and purification processes are gaining considerable attention in the water engineering community as they have the potential to integrate several treatment stages in a single, space-efficient and multifunctional process able to act as a multi-barrier against a wide spectrum of recalcitrant pollutants. In this paper, the efficiency of a combined physico-chemical process, previously validated as a tertiary treatment for municipal wastewater reclamation and successfully tested at pilot scale for the removal of total phenols, chemical oxygen demand (COD) and Escherichia coli, was tested for the precipitation of low-arsenic (V) concentration (<100 μg/L) from drinking water. The combined process, consisting of simultaneously dosing, in various proportions and according to a Latin square design-of-experiment scheme, aluminum polychloride (AP), zeolite (Z), powder activated carbon (PAC) and sodium hypochlorite (SH) into dechlorinated tap water spiked with arsenic (V), was assessed at laboratory scale in order to elucidate the mechanism of arsenic (V) removal as well as to identify the optimal mixing conditions using variable-speed jar-test experiments. Results indicated that the combined process was very effective in removing low arsenic (V) concentration from drinking water in the range of 25–100 μg/L. Moreover, it was found that, among the tested variables, high-velocity gradient conditions led to an improved removal efficiency which reached 89% under optimized process conditions. Although all treating agents played a statistically significant role in terms of process performance, arsenic (V) co-precipitation by AP was found to be the dominating removal mechanism contributing up to an 85% at 1400 rpm, with Z and PAC co-operating for the remaining 5% and mostly functioning as enhancing agents for ballasted settling. Notably, the process investigated in this study was also found to be robust against variation in initial arsenic concentration, showing similar arsenic (V) removal efficiency (85.9%) when the initial arsenic (V) concentration was further reduced from 100 to 25 μg/L. In conclusion, it was demonstrated that the combined treatment process was able to efficiently and simultaneously remove not only organic micropollutants such as phenols, COD and E. coli (as demonstrated in previous studies) but also inorganic contamination by arsenic (V) from a typical drinking water matrix via co-precipitation on aluminum polychloride, a treating agent that is worldwide accessible and typically used in water treatment applications

Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments

Study Objective. To evaluate the efficacy of, and patients’ satisfaction with, office hysteroscopic treatment of benign intrauterine pathologies using 5F hysteroscopic instruments. Design. Observational clinical study (Canadian Task Force classification II). Setting. University center. Patients. Four thousand eight hundred sixty-three (4863) women. Intervention. Office hysteroscopy without analgesia or anesthesia. Measurements and Main Results.We used 5F mechanical instruments (scissors, grasping forceps) to treat cervical and endometrial polyps ranging between 0.2 and 3.7 cm, as well as intrauterine adhesions and anatomic impediments. From 71.9% to 93.5% of women underwent the procedure without discomfort for all pathologies treated except endometrial polyps larger than the internal cervical os, for which 63.6% experienced low or moderate pain. At 3-month follow-up, pathology persisted in 364 patients (5.6%). Conclusion. Simple instruments enable us to perform many operative procedures in an office setting with excellent patient satisfaction, provided that the indications are correct