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

Synthesis, Characterization, In-Vitro Antimicrobial and Antioxidant Activities of Co+2, Ni+2, Cu+2 and Zn+2 Complexes of 3-(2-(2-hydroxy- 3-methoxybenzylidene)hydrazono)indolin-2-one

Four novel complexes of “3-(2-(2-hydroxy-3-methoxybenzylidene)hydrazono)indolin-2-one” have been synthesized with Co+2, Ni+2, Cu+2 and Zn+2. Physical and analytical techniques including CHN, IR, UV-Vis, AAS, molar conductivity values and magnetic susceptibility data were used to characterize all complexes. The bis Schiff base ligand i.e. 3-(2-(2-hydroxy-3-methoxybenzylidene)hydrazono)indolin-2-one, acted as a tridentate ligand and coordinated through phenolic oxygen, azomethine nitrogen and carbonyl group. Low values of molar conductance suggested the non-electrolyte nature of all complexes. Elemental analysis of complexes indicated the 1:1 metal to ligand mole ratios for [Cu(Inh)(OAc)] and [Zn(Inh)(OAc)] metal complexes and 1:2 metal to ligand mole ratios for [Co(Inh)2] and [Ni(Inh)2] metal complexes. Square planner geometry is proposed for [Cu(Inh)(OAc)] and distorted tetrahedral geometry is proposed for [Zn(Inh)(OAc)] while octahedral geometries are proposed for [Co(Inh)2] and [Ni(Inh)2] metal complexes. Antimicrobial and antioxidant studies were performed for all compounds and it was discovered that the complexes are more potent antibacterial and antifungal agents while the ligand exhibited comparatively more DPPH (1,1-diphenyl-2-picryl-hydrazil) radical scavenging activity than the complexes