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

ESTUDO DE CASO: TERAPIA COGNITIVO-COMPORTAMENTAL PARA INFANTE COM DIAGNÓSTICO DE MUTISMO SELETIVO

O Mutismo seletivo constitui-se como um transtorno de ansiedade que apresenta condição caracterizada pela dificuldade em se comunicar, mesmo quando já possuem habilidades linguísticas desenvolvidas. O presente relato de caso apresenta o tratamento psicoterapêutico de uma paciente feminina, de nove anos, diagnosticada com mutismo seletivo, a partir da abordagem cognitivo-comportamental. De acordo com os dados iniciais do contexto familiar, a principal queixa se destinava à dificuldade que a criança experimentava ao interagir com outras pessoas, limitando sua comunicação aos genitores e irmão. Foram realizados até o momento 114 sessões com a paciente. Enquanto estratégias terapêuticas, foram utilizadas as seguintes técnicas: vínculo terapêutico, habilidades sociais de sociabilidade e comunicação, modelagem, role-play, imaginação dirigida, controle excitatório e estratégias de exposição. Ao longo das sessões, progressivamente a paciente tem aumentado o grau de comunicação interpessoal, estabelecendo comunicação com familiares de segundo grau e recém conhecidos, o que representa um avanço significativo em sua capacidade de interagir com um círculo social mais amplo