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

Adição de bentonita sódica como adsorvente de aflatoxinas em rações de frangos de corte Utilization of sodium bentonite as adsorbent of aflatoxins in broiler feed

A presença de micotoxinas nas matérias-primas, principalmente no milho utilizado para rações para aves, é uma das maiores preocupações atuais devido aos danos causados por essa substâmcia não só aos animais, mas também aos produtores e às empresas do setor avícola. Considerando a utilização de adsorvente ou seqüestrante na ração para minimizar os efeitos deletérios, realizou-se um experimento para avaliar o efeito da adição de um adsorvente, baseado em bentonita sódica, na ração de frangos de corte, a fim de reduzir os efeitos de aflatoxinas. Foram utilizados 960 pintos Cobb de um dia de idade, distribuídos em oito repetições de 20 animais nos tratamentos: T1=sem aflatoxina;T2=3mg kg-1 de aflatoxina;T3=sem aflatoxina+0,5% de bentonita; T4=3mg kg-1 de aflatoxina+0,1% de bentonita; T5=3mg kg-1 de aflatoxina+0,3% de bentonita e T6=3mg kg-1 de aflatoxina+0,5% de bentonita. O consumo alimentar, o peso corporal e a conversão alimentar foram afetados pela presença da toxina na ração. A adição de bentonita sódica na ração sem aflatoxina não causou nenhum efeito depressivo nas aves. Nos tratamentos que continham 3mg kg-1 de aflatoxinas, a adição do adsorvente promoveu um melhor desempenho das aves, sendo que 0,3% de adição de bentonita apresentou melhores resultados.<br>High concentrations of micotoxins in raw materials, mainly in corn used in poultry rations of food, is an important subject of study due to hazardous problems not only to the animals themselves but also to the producer and to the poultry industry due to the reduction of performance by aflatoxins. Taking into account the lack of efficient tecnique for its elimination, from the feed, an adsorbent was added to the diets in order to reduce the effects of aflatoxins. Nine hundred sixty day old Cobb chicks, distributed in 8 replicates of 20 birds per pen the following treatments: T1=No aflatoxin; T2=3mg kg-1 of aflatoxin; T3=no aflatoxin+0.5% of bentonite; T4=3mg kg-1 of aflatoxin+0,1% of bentonite;T5=3mg kg-1 of aflatoxin+0.3% bentonite and T6=3mg kg-1 aflatoxin+ 0.5% of bentonite. Feed intake, body weight and feed conversion were depressed by aflatoxin in the feed. The addition of bentonite to the feed without aflatoxin did not caused negative effecs to the broilers. In treatments carried out with 3mg kg-1 of aflatoxins, the addition of the adsorbent promoted a better performance of the broilers with best results for those receiving 0.3% of bentonite