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Stewart KT, Jafari H, Pattillo J, Santos J, Jao C, Kwok K, Singh N, Lee AYY, Kwon JS, McGinnis JM. Avoiding the needle: A quality improvement program introducing apixaban for extended thromboprophylaxis after major gynecologic cancer surgery. Gynecol Oncol 2024; 188:131-139. [PMID: 38964250 DOI: 10.1016/j.ygyno.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/20/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Patients undergoing gynecologic cancer surgery at our centre are recommended up to 28 days of enoxaparin for extended post-operative thromboprophylaxis (EP). Baseline survey revealed 92% patient adherence, but highlighted negative effects on patient experience due to the injectable route of administration. We aimed to improve patient experience by reducing pain and bruising by 50%, increasing adherence by 5%, and reducing out-of-pocket cost after introducing apixaban as an oral alternative for EP. METHODS In this interrupted time series quality improvement study, gynecologic cancer patients were offered a choice between apixaban (2.5 mg orally twice daily) or enoxaparin (40 mg subcutaneously once daily) at time of discharge. A multidisciplinary team informed project design, implementation, and evaluation. Process interventions included standardized orders, patient and care team education programs. Telephone survey at 1 and 6 weeks and chart audit informed outcome, process, and balancing measures. RESULTS From August to October 2022, 127 consecutive patients were included. Apixaban was chosen by 84%. Survey response rate was 74%. Patients who chose apixaban reported significantly reduced pain, bruising, increased confidence with administration, and less negative impact of the medication (p < 0.0001 for all). Adherence was unchanged (92%). The proportion of patients paying less than $125 (apixaban cost threshold) increased from 45% to 91%. There was no difference in bleeding and no VTE events. CONCLUSIONS Introduction of apixaban for EP was associated with significant improvement in patient-reported quality measures and reduced financial toxicity with no effect on adherence or balancing measures. Apixaban is the preferred anticoagulant for EP at our centre.
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Affiliation(s)
- Kimberly T Stewart
- University of British Columbia, Division of Gynecologic Oncology, Canada; British Columbia Cancer, Gynecologic Oncology Tumor Group, Canada.
| | - Helia Jafari
- University of British Columbia, Division of Gynecologic Oncology, Canada
| | - Jane Pattillo
- British Columbia Cancer, Gynecologic Oncology Tumor Group, Canada
| | - Jennifer Santos
- British Columbia Cancer, Gynecologic Oncology Tumor Group, Canada
| | | | | | - Navneet Singh
- University of British Columbia, Undergraduate Medical Education, Canada
| | - Agnes Y Y Lee
- University of British Columbia, Department of Medicine, Canada; British Columbia Cancer, Medical Oncology, Vancouver, Canada
| | - Janice S Kwon
- University of British Columbia, Division of Gynecologic Oncology, Canada; British Columbia Cancer, Gynecologic Oncology Tumor Group, Canada
| | - Justin M McGinnis
- University of British Columbia, Division of Gynecologic Oncology, Canada; British Columbia Cancer, Gynecologic Oncology Tumor Group, Canada
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2
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Pham KT, Hyland CJ, Malek AJ, Broyles JM. Reprocessing capabilities of newly approved devices for use in surgery. Surgeon 2024:S1479-666X(24)00087-8. [PMID: 39160120 DOI: 10.1016/j.surge.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/26/2024] [Accepted: 08/08/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Single-use medical devices used in surgery can create environmental waste and increased costs. Reprocessed medical devices may reduce cost and environmental impact. This study investigated the reprocessing capabilities of newly FDA-approved devices in surgery. METHODS Devices were identified using the publicly-available FDA Releasable 510(k) Database from 2018 to 2023 using the instrument product codes for laparoscope, general, and plastic surgery (GCJ); and electrosurgical (GEI) devices. GCJ and GEI devices were categorized based on usage, and the number of devices (total, single, and reprocessed) were extracted. Costs were obtained from public websites. RESULTS There were 658,510(k) applications for surgical devices, representing 3.8 % (658/16723) of total applications. Reprocessing capabilities existed for 29 % of GCJ devices and 14 % of GEI devices. Among GCJ devices, 5 (56 %) laparoscopy and 16 (38 %) camera devices had reprocessing capabilities. For GEI devices, 7 (50 %) laparoscopic and 5 (50 %) cable devices had reprocessing capabilities. Only one (6 %) tissue ablation device had reprocessing capabilities. The average cost of GCJ and GEI single-use devices ($11314; $8554, respectively) was less than reprocessed counterparts ($17206; $16134, respectively). CONCLUSION Reprocessing capabilities for newly approved surgical devices are variable and overall limited. To enhance adoption of reprocessing in surgical practice, future efforts will likely be needed to expand the reprocessing potential of new surgical devices.
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Affiliation(s)
| | - Colby J Hyland
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, USA.
| | - Andrew J Malek
- Louisiana State University Health Sciences Center, School of Medicine - New Orleans, USA
| | - Justin M Broyles
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, USA
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Chang JH, Woo KP, Silva de Souza Lima Cano N, Bilec MM, Camhi M, Melnyk AI, Gross A, Walsh RM, Asfaw SH, Gordon IO, Miller BT. Does reusable mean green? Comparison of the environmental impact of reusable operating room bed covers and lift sheets versus single-use. Surgeon 2024; 22:236-241. [PMID: 38862376 DOI: 10.1016/j.surge.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION As hospitals strive to reduce their environmental footprint, there is an ongoing debate over the environmental implications of reusable versus disposable linens in operating rooms (ORs). This research aimed to compare the environmental impact of reusable versus single-use OR bed covers and lift sheets using life cycle assessment (LCA) methodology. METHODS LCA is an established tool with rigorous methodology that uses science-based processes to measure environmental impact. This study compared the impacts of three independent system scenarios at a single large academic hospital: reusable bed covers with 50 laundry cycles and subsequent landfill disposal (System 1), single-use bed covers with waste landfill disposal (System 2), and single-use bed covers with waste disposal using incineration (System 3). RESULTS The total carbon footprint of System 1 for 50 uses was 19.83 kg carbon dioxide equivalents (CO2-eq). System 2 generated 64.99 kg CO2-eq. For System 3, the total carbon footprint was 108.98 kg CO2-eq. The raw material extraction for all the material to produce an equivalent 50 single-use OR bed cover kits was tenfold more carbon-intensive than the reusable bed cover. Laundering one reusable OR bed cover 50 times was more carbon intensive (12.12 kg CO2-eq) than landfill disposal of 50 single-use OR bed covers (2.52 kg CO2-eq). DISCUSSION Our analysis demonstrates that one reusable fabric-based OR bed cover laundered 50 times, despite the carbon and water-intensive laundering process, exhibits a markedly lower carbon footprint than its single-use counterparts. The net difference is 45.16 kg CO2-eq, equivalent to driving 115 miles in an average gasoline-powered passenger vehicle. This stark contrast underscores the efficacy of adopting reusable solutions to mitigate environmental impact within healthcare facilities.
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Affiliation(s)
- Jenny H Chang
- Cleveland Clinic, Department of General Surgery, Cleveland, OH, USA; Yale University, School of Public Health, USA.
| | - Kimberly P Woo
- Cleveland Clinic, Department of General Surgery, Cleveland, OH, USA
| | | | - Melissa M Bilec
- University of Pittsburgh, Department of Civil and Environmental Engineering, Pittsburgh, PA, USA; Mascaro Center for Sustainable Innovation, Pittsburgh, PA, USA
| | - Maya Camhi
- Cleveland Clinic, Lerner Research Institute, Biomedical Engineering, Cleveland, OH, USA
| | | | - Abby Gross
- Cleveland Clinic, Department of General Surgery, Cleveland, OH, USA; Cleveland Clinic, Safety, Quality, Patient Experience, Digestive Disease Institute, Cleveland, OH, USA
| | - R Matthew Walsh
- Cleveland Clinic, Department of General Surgery, Cleveland, OH, USA
| | - Sofya H Asfaw
- Cleveland Clinic, Department of General Surgery, Cleveland, OH, USA; Cleveland Clinic, Safety, Quality, Patient Experience, Digestive Disease Institute, Cleveland, OH, USA
| | - Ilyssa O Gordon
- Cleveland Clinic, Department of Pathology and Laboratory Medicine, Cleveland, OH, USA; Cleveland Clinic, Sustainability, Cleveland, OH, USA
| | - Benjamin T Miller
- Cleveland Clinic, Department of General Surgery, Cleveland, OH, USA; Cleveland Clinic, Safety, Quality, Patient Experience, Digestive Disease Institute, Cleveland, OH, USA
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4
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Abeles SR, Kline A, Lee P. Climate change and resilience for antimicrobial stewardship and infection prevention. Curr Opin Infect Dis 2024; 37:270-276. [PMID: 38843434 DOI: 10.1097/qco.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW This review covers recent research regarding the challenges posed by climate change within the areas of antimicrobial stewardship and infection prevention, and ways to build resiliency in these fields. RECENT FINDINGS Infectious disease patterns are changing as microbes adapt to climate change and changing environmental factors. Capacity for testing and treating infectious diseases is challenged by newly emerging diseases, which exacerbate challenges to antimicrobial stewardship and infection prevention.Antimicrobial resistance is accelerated due to environmental factors including air pollution, plastic pollution, and chemicals used in food systems, which are all impacted by climate change.Climate change places infection prevention practices at risk in many ways including from major weather events, increased risk of epidemics, and societal disruptions causing conditions that can overwhelm health systems. Researchers are building resilience by advancing rapid diagnostics and disease modeling, and identifying highly reliable versus low efficiency interventions. SUMMARY Climate change and associated major weather and socioeconomic events will place significant strain on healthcare facilities. Work being done to advance rapid diagnostics, build supply chain resilience, improve predictive disease modeling and surveillance, and identify high reliability versus low yield interventions will help build resiliency in antimicrobial stewardship and infection prevention for escalating challenges due to climate change.
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Affiliation(s)
- Shira R Abeles
- Division of Infectious Diseases and Global Public Health, Department of Medicine
| | - Ahnika Kline
- Associate Director, Clinical Microbiology Laboratory, Department of Pathology, University of California, San Diego
| | - Pamela Lee
- Division of Infectious Diseases, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
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Bhutta M, Rizan C. The Green Surgery report: a guide to reducing the environmental impact of surgical care, but will it be implemented? Ann R Coll Surg Engl 2024; 106:475-477. [PMID: 38683381 PMCID: PMC11214859 DOI: 10.1308/rcsann.2024.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Affiliation(s)
- M Bhutta
- Brighton and Sussex Medical School, UK
| | - C Rizan
- Brighton and Sussex Medical School, UK
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6
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Rogowski W. Accounting for planetary boundaries in health economic evaluation. Expert Rev Pharmacoecon Outcomes Res 2024:1-11. [PMID: 38904091 DOI: 10.1080/14737167.2024.2364047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/31/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Health economic evaluation (HEE) provides guidance for decision-making in the face of scarcity but ignores ecological scarcities as long as they involve external costs only. Following the imperative to account for planetary health, this study explores how this blind spot can be addressed. AREAS COVERED The study is based on a critical review of relevant work, particularly in the fields of HEE and life cycle assessment (LCA). LCA can provide information on a technology's environmental impacts which can be accounted for on both the effect and cost sides of HEE. Cost-benefit analyses can incorporate environmental impacts in case vignettes used for eliciting consumers' willingness to pay. Existing LCA impact models can be used to estimate human health risks associated with environmental impacts and add them to the health benefits in cost-utility analyses. Many jurisdictions offer lists of shadow prices that can be used to incorporate environmental impacts on the cost side of HEE. Also, environmental impacts can be reported in a disaggregated manner. EXPERT OPINION Accounting for planetary boundaries is likely to become a key field of methodological innovation in HEE. Decision relevance is likely to be highest for technologies with similar cost-effectiveness but different ecological impacts.
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Affiliation(s)
- Wolf Rogowski
- Research Unit Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Bremen, Germany
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7
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Rocco G. A measurement of eco-friendly, sustainable significance. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00523-3. [PMID: 38879116 DOI: 10.1016/j.jtcvs.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/07/2024]
Affiliation(s)
- Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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8
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Vanderwee K, Demarré L, Malfait S, Kieckens E, De Waegemaeker P, Duprez V, Fraeyman N. How to choose between single-use and reusable medical materials for sustainable nursing: Methodological lessons learned from a national study. J Adv Nurs 2024. [PMID: 38812214 DOI: 10.1111/jan.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
AIM To demonstrate and reflect upon the methodological lessons by which healthcare organizations can address questions of environmental sustainability related to single-use healthcare materials. DESIGN A cross-sectional multi-centre study in hospitals was performed, followed by an exploratory analysis of the sustainability of commonly used healthcare materials. METHODS A hospital survey was conducted to collect the procurement data for single-use medical materials. Based on consumption and cost, five single-use medical materials with sustainable alternatives were selected using different reuse strategies. Single-use and reusable materials were assessed through an exploratory literature review and document study based on four parameters: environmental sustainability, safety, cost and efficiency. RESULTS A pragmatic method emerged from this study, providing healthcare facilities with tools to select environmentally sustainable alternatives to replace single-use options. First, an inventory of single-use medical materials consumed was collected. Next, single-use materials were prioritized for further study based on criteria such as cost, volume of the material, feasibility and input of stakeholders. We then analysed the prioritized single-use materials and their alternatives based on life cycle assessments or available information on their different life stages. Finally, we assessed safety, costs and efficiency related to the process following the use of the medical material. CONCLUSION This pragmatic method can guide healthcare institutions in making the most sustainable choices of medical materials and achieving sustainability goals within their institutions and nationwide. IMPACT Patient care involves a large consumption of single-use medical materials with considerable environmental impact. A pragmatic method was developed to guide healthcare institutions in making the most sustainable choices regarding the use of single-use healthcare materials. Healthcare institutions, ideally represented by a green team including nurses and other relevant professionals, can use this method to reduce the use of single-use medical materials, thereby yielding positive outcomes for the entire population. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Liesbet Demarré
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Simon Malfait
- Nursing Department, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Evelien Kieckens
- Environmental Department, Ghent University Hospital, Ghent, Belgium
| | | | - Veerle Duprez
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Norbert Fraeyman
- Nursing Department, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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9
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Rizan C. Environmental impact of hybrid (reusable/single-use) ports versus single-use equivalents in robotic surgery. J Robot Surg 2024; 18:155. [PMID: 38564052 DOI: 10.1007/s11701-024-01899-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024]
Abstract
Given the rise in robotic surgery, and parallel movement towards net zero carbon, sustainable healthcare systems, it is important that the environmental impact of robotic approaches is minimised. The majority of greenhouse gas emissions associated with robotic surgery have previously been associated with single-use items. Whilst switching from single-use products to hybrid equivalents (predominantly reusable, with a small single-use component) has previously been found to reduce the environmental impact of a range of products used for laparoscopic surgery, the generalisability of this to robotic surgery has not previously been demonstrated. In this life cycle assessment, use of hybrid 5 mm ports compatible with emerging robotic systems (143 g CO2e) was found to reduce the carbon footprint by 83% compared with using single-use equivalents (816 g CO2e), accompanied by reductions in fifteen out of eighteen midpoint environmental impact categories. For endpoint categories, there was an 81% reduction in impact on human health and species loss, and 82% reductions in resource depletion associated with using hybrid robotic 5 mm ports. Whilst the carbon footprint of 5 mm hybrid ports compatible with emerging robotic equipment was 70% higher than previous estimates of ports appropriate for conventional laparoscopic approaches, the six-fold reductions seen with hybrids in this analysis point to the generalisability of the finding that reusable or hybrid products have a lower carbon footprint when compared with single-use equivalents. Surgeons, procurement teams, and policy makers should encourage innovation towards clinically safe and effective robotic instruments with maximal reusable components.
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Affiliation(s)
- Chantelle Rizan
- Brighton and Sussex Medical School, Department of Global Health and Infection, Brighton, UK.
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10
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Affiliation(s)
- K Kanal
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Fang
- North West School of Anaesthesia, Manchester, UK
- Royal College of Anaesthetists, London, UK
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11
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Jacob S, Schust SA, Angele M, Werner J, Guba M, Börner N. A long road ahead. A German national survey study on awareness and willingness of surgeons towards the carbon footprint of modern surgical procedures. Heliyon 2024; 10:e25198. [PMID: 38327395 PMCID: PMC10847866 DOI: 10.1016/j.heliyon.2024.e25198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
Background Climate change may well be the "largest threat" to humankind. Changes to our climate system lead to a decrease in global health. The healthcare sector presents one of the largest carbon footprints across all industries. Since surgical departments have one of the largest carbon footprints within the healthcare sector, they represent an area with vast opportunities for improvement. To drive change, it is vital to create awareness of these issues and encourage engagement in changes among people working in the healthcare industry. Methods We conducted an anonymous cross-sectional survey study to assess awareness among surgeons regarding the impact of healthcare systems on climate change. The questions were designed to investigate surgeons' willingness to accept and promote changes to reduce carbon footprints. Participants included surgical professionals of all ages and levels of expertise. Results A total of 210 participants completed the survey in full and were included in the evaluation. Sixty percent emphasized a lack of information and the need for personal education. Over 90 % expressed concern for the environment and a strong desire to gain new insights. Provided that clinical performance remains the same, more than 70 % are willing to embrace carbon-friendly alternatives. In this context, all participants accepted the additional time required for training and initially increased personal efforts to achieve equal performance. Conclusion Limited awareness and information about carbon footprints were observed in surgical departments in German hospitals. Nevertheless, the vast majority of surgeons across all age groups are more than willing to acquire new insights and adapt to changes in order to reduce energy consumption and carbon dioxide production.
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Affiliation(s)
- Sven Jacob
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Sophie Anne Schust
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Martin Angele
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Jens Werner
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Markus Guba
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Nikolaus Börner
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
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12
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Tan E. Sustainable dermatology-A practical guide for the Australian dermatologist. Australas J Dermatol 2024; 65:14-23. [PMID: 37902158 DOI: 10.1111/ajd.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 10/31/2023]
Abstract
Globally, healthcare systems can account for up to 10% of national CO2 emissions. There is increasing awareness of the need to act to reduce the impact on our planet by living sustainably in our personal and professional lives. Literature on sustainability can be complex, and with so many demands on our attention and time, it is challenging for the practising dermatologist to grasp where to begin. This manuscript provides a practical guide with quantifiable impacts for each action. With mindful use of resources, both profitability and the well-being of patients and doctors can align with environmental protection.
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Lam L, Bradbrook D, Gale J. Tracing the barriers to decarbonising ophthalmology: A review. Clin Exp Ophthalmol 2024; 52:78-90. [PMID: 38213078 DOI: 10.1111/ceo.14349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.
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Affiliation(s)
- Lydia Lam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Darren Bradbrook
- Surgery and Perioperative Medicine Division, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Southern Adelaide Local Health Network (SALHN), Bedford Park, South Australia, Australia
| | - Jesse Gale
- Department of Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
- Ophthalmology, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, New Zealand
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Alkatout I, O’Sullivan O, Peters G, Maass N. Expanding Robotic-Assisted Surgery in Gynecology Using the Potential of an Advanced Robotic System. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:53. [PMID: 38256313 PMCID: PMC10818539 DOI: 10.3390/medicina60010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Minimally invasive surgery (MIS) in gynecology was introduced to achieve the same surgical objectives as traditional open surgery while minimizing trauma to surrounding tissues, reducing pain, accelerating recovery, and improving overall patient outcomes. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have become the standard for many gynecological procedures. In this review, we aim to summarize the advantages and main limitations to a broader adoption of robotic-assisted surgery compared to laparoscopic surgeries in gynecology. We present a new surgical system, the Dexter Robotic System™ (Distalmotion, Switzerland), that facilitates the transition from laparoscopy expertise to robotic-assisted surgery.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
| | - Odile O’Sullivan
- Distalmotion SA, Route de la Corniche 3b, 1066 Epalinges, Switzerland;
| | - Göntje Peters
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospitals Schleswig-Holstein, Campus Kiel, D-24105 Kiel, Germany
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McGain F, McAlister S. Reusable versus single-use ICU equipment: what's the environmental footprint? Intensive Care Med 2023; 49:1523-1525. [PMID: 37962641 DOI: 10.1007/s00134-023-07256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Forbes McGain
- Departments of Anaesthesia and Intensive Care Medicine, Western Health, Footscray, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Department of Critical Care Medicine, University of Melbourne, Parkville, VIC, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Scott McAlister
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
- Centre for Health Policy, University of Melbourne, Parkville, VIC, Australia.
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16
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Drayton R, Smith H, Ratnappuli A. Sustainable practice: Switching to reusable vaginal speculums. BMJ 2023; 383:e075779. [PMID: 37931923 DOI: 10.1136/bmj-2023-075779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Rachel Drayton
- Department of Sexual Health, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Ayoma Ratnappuli
- Department of Sexual Health, King's College University Hospital NHS Foundation Trust, London UK
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17
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Rizan C, Lillywhite R, Reed M, Bhutta MF. The carbon footprint of products used in five common surgical operations: identifying contributing products and processes. J R Soc Med 2023; 116:199-213. [PMID: 37054734 PMCID: PMC10331364 DOI: 10.1177/01410768231166135] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/12/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Mitigating carbon footprint of products used in resource-intensive areas such as surgical operating rooms will be important in achieving net zero carbon healthcare. The aim of this study was to evaluate the carbon footprint of products used within five common operations, and to identify the biggest contributors (hotspots). DESIGN A predominantly process-based carbon footprint analysis was conducted for products used in the five highest volume surgical operations performed in the National Health System in England. SETTING The carbon footprint inventory was based on direct observation of 6-10 operations/type, conducted across three sites within one NHS Foundation Trust in England. PARTICIPANTS Patients undergoing primary elective carpal tunnel decompression, inguinal hernia repair, knee arthroplasty, laparoscopic cholecystectomy, tonsillectomy (March 2019 - January 2020). MAIN OUTCOME MEASURES We determined the carbon footprint of the products used in each of the five operations, alongside greatest contributors through analysis of individual products and of underpinning processes. RESULTS The mean average carbon footprint of products used for carpal tunnel decompression was 12.0 kg CO2e (carbon dioxide equivalents); 11.7 kg CO2e for inguinal hernia repair; 85.5 kg CO2e for knee arthroplasty; 20.3 kg CO2e for laparoscopic cholecystectomy; and 7.5 kg CO2e for tonsillectomy. Across the five operations, 23% of product types were responsible for ≥80% of the operation carbon footprint. Products with greatest carbon contribution for each operation type were the single-use hand drape (carpal tunnel decompression), single-use surgical gown (inguinal hernia repair), bone cement mix (knee arthroplasty), single-use clip applier (laparoscopic cholecystectomy) and single-use table drape (tonsillectomy). Mean average contribution from production of single-use items was 54%, decontamination of reusables 20%, waste disposal of single-use items 8%, production of packaging for single-use items 6% and linen laundering 6%. CONCLUSIONS Change in practice and policy should be targeted towards those products making greatest contribution, and should include reducing single-use items and switching to reusables, alongside optimising processes for decontamination and waste disposal, modelled to reduce carbon footprint of these operations by 23%-42%.
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Affiliation(s)
- Chantelle Rizan
- Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, BN25BE, UK
| | - Robert Lillywhite
- School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Malcom Reed
- Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, BN25BE, UK
| | - Mahmood F Bhutta
- Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, BN25BE, UK
- ENT Department, University Hospitals Sussex NHS Foundation Trust, Brighton, BN2 5BE, UK
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