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.

The rising incidence of diabetes has become one of the major health problems worldwide. It is especially overburdening low-income countries like Pakistan which ranks 4th in diabetes prevalence. The purpose of this review article is to analyze the current approach to diabetes management in Pakistan and to highlight its deficiencies. It also discusses the future strategies that can help Pakistan to reduce the rising disease burden. Information was collected from the publications which were searched on 'Google scholar' and 'PubMed'. The latest data provided by IDF has shown diabetes prevalence in Pakistan to be 17.1% in 2019; 148% higher than previous reporting. The major obstacles in the effective management of diabetes are lack of resources, societal barriers and patient related issues. In order to reduce the load of diabetes, combined efforts of government, health care professionals and patients are required. In future, diabetes education of the patients as well as HealthCare providers, use of telemedicine for the management of chronic diseases and concept of precision medicine can be applied to decrease diabetes burden in Pakistan.

No abstract