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

A utilização da lousa mágica na comunicação do traqueostomizado La utilización del tablero mágico en la comunicación del traqueostomizado The magic blackboard in the promotion of written communication by tracheostomized patients

Com a finalidade de favorecer a comunicação do traqueostomizado, este estudo foi desenvolvido com o objetivo de avaliar a adequação e a aceitação da lousa mágica como recurso para a comunicação do paciente. A lousa foi fornecida a 15 traqueostomizados no 2º dia pós-operatório e no 5º dia foi aplicado um instrumento focalizando os objetivos. Os resultados mostram que 73% dos pacientes consideram o recurso adequado para as suas condições, 86% consideram que ela favoreceu a comunicação com a equipe de saúde e foi aceito por 96% dos pacientes. Os resultados destacam a importância de os enfermeiros buscarem recursos criativos e de baixo custo para favorecer a comunicação dos pacientes.<br>Con la finalidad de facilitar la comunicación del traqueostomizado, este estudio fue desarrollado con el objetivo de evaluar la adecuación y aceptación del tablero mágico como recurso para la comunicación del paciente. El tablero fue ofrecido a 15 traqueostomizados en el 2º día pós-operatorio y en el 5º día fue aplicado un instrumento enfocando los objetivos. Los resultados muestran que 735 de los pacientes consideran el recurso adecuado para sus condiciones, 86% consideran que éste favorece la comunicación con el equipo de salud y fue aceptado por el 96% de los pacientes. Los resultados destacan la importancia de los enfermeros buscar recursos creativos y de bajo costo para facilitar la comunicación de los pacientes.<br>With the purpose of improving the communication of the tracheostomized patients, the present study was developed aiming at evaluating the acceptance of the magic blackboard as a resource for these patients's written communication. From the second day after the surgery, the blackboard was used by 15 tracheostomized patients. Subsequently, the authors applied an instrument to evaluate its acceptance. Results showed that 73% of the patients considered the resource appropriate for their conditions, 86% considered that it favoured the communication with the health team and the blackboard was accepted by 96% of the patients. Based on the results, the authors emphatize the importance of the nurses' attitude to search for creative and low cost resources in order to facilitate these patients' communication

Assistência multiprofissional na reabilitação da comunicação da pessoa laringectomizada

Este artigo tem como objetivo divulgar a experiência de um grupo de profissionais envolvidos na reabilitação e na reabilitação vocal dos laringectomizados que participam do GARPO- Laringectomizados. São descritas as diferentes possibilidades de reabilitação vocal para o laringectomizado como também, os pressupostos que permeiam todas as atividades e etapas do processo. Destaca-se as características da pessoas laringectomizadas, as conseqüências da cirurgia, o significado de ser laringectomizado que direcionam a assistência do enfermeiro no processo, em integração com o fonoaudiólogo.The purpose of this study was to bring basic information about the work of a multiprofissional group involved with the laryngectomees rehabilitation, and vocal rehabilitation. Those patients take part in the GARPO-Laryngectomees. The authors describe the different possibilities of vocal rehabilitation for the patients and the framework of the activities and steps of the process. They emphasize the laryngectomees characteristics, the surgical results, and the meaning of being a laryngectomee, as the basis to direct the nurses and the speech therapeutists assistance