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Braithwaite J, Smith CL, Leask E, Wijekulasuriya S, Brooke-Cowden K, Fisher G, Patel R, Pagano L, Rahimi-Ardabili H, Spanos S, Rojas C, Partington A, McQuillan E, Dammery G, Carrigan A, Ehrenfeld L, Coiera E, Westbrook J, Zurynski Y. Strategies and tactics to reduce the impact of healthcare on climate change: systematic review. BMJ 2024; 387:e081284. [PMID: 39379104 PMCID: PMC11459334 DOI: 10.1136/bmj-2024-081284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE To review the international literature and assess the ways healthcare systems are mitigating and can mitigate their carbon footprint, which is currently estimated to be more than 4.4% of global emissions. DESIGN Systematic review of empirical studies and grey literature to examine how healthcare services and institutions are limiting their greenhouse gas (GHG) emissions. DATA SOURCES Eight databases and authoritative reports were searched from inception dates to November 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Teams of investigators screened relevant publications against the inclusion criteria (eg, in English; discussed impact of healthcare systems on climate change), applying four quality appraisal tools, and results are reported in accordance with PRISMA (preferred reporting items for systematic reviews and meta-analyses). RESULTS Of 33 737 publications identified, 32 998 (97.8%) were excluded after title and abstract screening; 536 (72.5%) of the remaining publications were excluded after full text review. Two additional papers were identified, screened, and included through backward citation tracking. The 205 included studies applied empirical (n=88, 42.9%), review (n=60, 29.3%), narrative descriptive (n=53, 25.9%), and multiple (n=4, 2.0%) methods. More than half of the publications (51.5%) addressed the macro level of the healthcare system. Nine themes were identified using inductive analysis: changing clinical and surgical practices (n=107); enacting policies and governance (n=97); managing physical waste (n=83); changing organisational behaviour (n=76); actions of individuals and groups (eg, advocacy, community involvement; n=74); minimising travel and transportation (n=70); using tools for measuring GHG emissions (n=70); reducing emissions related to infrastructure (n=63); and decarbonising the supply chain (n=48). CONCLUSIONS Publications presented various strategies and tactics to reduce GHG emissions. These included changing clinical and surgical practices; using policies such as benchmarking and reporting at a facility level, and financial levers to reduce emissions from procurement; reducing physical waste; changing organisational culture through workforce training; supporting education on the benefits of decarbonisation; and involving patients in care planning. Numerous tools and frameworks were presented for measuring GHG emissions, but implementation and evaluation of the sustainability of initiatives were largely missing. At the macro level, decarbonisation approaches focused on energy grid emissions, infrastructure efficiency, and reducing supply chain emissions, including those from agriculture and supply of food products. Decarbonisation mechanisms at the micro and meso system levels ranged from reducing low value care, to choosing lower GHG options (eg, anaesthetic gases, rescue inhalers), to reducing travel. Based on these strategies and tactics, this study provides a framework to support the decarbonisation of healthcare systems. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42022383719.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- International Society for Quality in Health Care, Dublin, Ireland
| | - Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Elle Leask
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Shalini Wijekulasuriya
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Kalissa Brooke-Cowden
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Romika Patel
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Lisa Pagano
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Hania Rahimi-Ardabili
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Christina Rojas
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Andrew Partington
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, 5042, Australia
| | - Ella McQuillan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Lauren Ehrenfeld
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Enrico Coiera
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Johanna Westbrook
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, 2109, Australia
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Devis L, Closset M, Degosserie J, Lessire S, Modrie P, Gruson D, Favaloro EJ, Lippi G, Mullier F, Catry E. Revisiting the Environmental Impact of Inappropriate Clinical Laboratory Testing: A Comprehensive Overview of Sustainability, Economic, and Quality of Care Outcomes. J Appl Lab Med 2024:jfae087. [PMID: 39360969 DOI: 10.1093/jalm/jfae087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/11/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND The use of laboratory resources has seen a substantial increase in recent years, driven by automation and emerging technologies. However, inappropriate use of laboratory testing, encompassing both overuse and underuse, poses significant challenges. CONTENT This review explores the complex interplay between patient safety, economic, and environmental factors-known as the "triple bottom line" or "3Ps" for people, profit, and planet-associated with inappropriate use of laboratory resources. The first part of the review outlines the impact of inappropriate laboratory testing on patient safety and economic outcomes. Then the review examines the available literature on the environmental impact of laboratory activities. Several practical solutions for mitigating the environmental impact of laboratories are discussed. Finally, this review emphasizes how decreasing unnecessary laboratory testing results in cost savings and environmental benefits, as evidenced by interventional studies, without compromising patient safety. SUMMARY The implementation of sustainable practices in laboratories can create a virtuous circle in which reduced testing enhances cost-efficiency, reduces the environmental footprint, and ensures patient safety, thereby benefiting the 3Ps. This review highlights the critical need for appropriate laboratory resource utilization in achieving sustainability in healthcare.
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Affiliation(s)
- Luigi Devis
- Department of Laboratory Medicine, Biochemistry, CHU UCL Namur, UCLouvain, Yvoir, Belgium
| | - Mélanie Closset
- Department of Laboratory Medicine, Biochemistry, CHU UCL Namur, UCLouvain, Yvoir, Belgium
| | - Jonathan Degosserie
- Department of Laboratory Medicine, Molecular Biology, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- Namur Research Institute for Life Sciences, Université de Namur, CHU UCL Namur, Namur, Belgium
| | - Sarah Lessire
- Namur Research Institute for Life Sciences, Université de Namur, CHU UCL Namur, Namur, Belgium
- Blood Transfusion Center, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- Namur Thrombosis and Hemostasis Center, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium
| | - Pauline Modrie
- Sustainability Consultant, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- Institute of Health and Society, UCLouvain, Brussels, Belgium
| | - Damien Gruson
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc, UCLouvain, Brussels, Belgium
| | - Emmanuel J Favaloro
- Department of Haematology, Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - François Mullier
- Namur Research Institute for Life Sciences, Université de Namur, CHU UCL Namur, Namur, Belgium
- Namur Thrombosis and Hemostasis Center, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- Institute of Experimental and Clinical Research, UCLouvain, Brussels, Belgium
- Department of Laboratory Medicine, Hematology, CHU UCL Namur, UCLouvain, Belgium
| | - Emilie Catry
- Department of Laboratory Medicine, Biochemistry, CHU UCL Namur, UCLouvain, Yvoir, Belgium
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Thakur A, Mukhopadhyay T, Ahirwar AK. Approaching sustainability in Laboratory Medicine. Clin Chem Lab Med 2024; 62:1787-1794. [PMID: 38557335 DOI: 10.1515/cclm-2023-0973] [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: 09/04/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Clinical laboratories and the total testing process are major consumers of energy, water, and hazardous chemicals, and produce significant amounts of biomedical waste. Since the processes in the clinical laboratory and the total testing process go hand in hand it mandates a holistic, and comprehensive approach towards sustainability. CONTENT This review article identifies the various sources and activities in Laboratory Medicine that challenge sustainability and also discusses the various approaches that can be implemented to achieve sustainability in laboratory operations to reduce the negative impact on the environment. SUMMARY The article highlights how the integration of technological advancements, efficient resource management, staff training and sensitization, protocol development towards sustainability, and other environmental considerations contributes significantly to a sustainable healthcare ecosystem. OUTLOOK Variables and resources that negatively impact the environment must be identified and addressed comprehensively to attain a long-lasting level of carbon neutrality.
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Affiliation(s)
- Anjali Thakur
- Department of Laboratory Medicine, All India Institute Medical Sciences, New Delhi, India
| | - Tapasyapreeti Mukhopadhyay
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute Medical Sciences, New Delhi, India
| | - Ashok Kumar Ahirwar
- Department of Laboratory Medicine, All India Institute Medical Sciences, New Delhi, India
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Rawashdeh M, Ali MA, McEntee M, El-Sayed M, Saade C, Kashabash D, England A. Green radiography: Exploring perceptions, practices, and barriers to sustainability. Radiography (Lond) 2024; 30 Suppl 1:62-73. [PMID: 38981301 DOI: 10.1016/j.radi.2024.06.019] [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: 04/27/2024] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Previous research has delved into the attitudes and behaviors of diverse professions regarding environmental sustainability. However, there needs to be more research specifically targeting radiographers. This study aims to survey radiographers' perceptions, practices, and barriers to change concerning environmental sustainability in radiology. METHODS Institutional ethical approval was obtained (IRB-COHS-FAC-110-2024) and data collection was conducted using Google Forms (Google Inc., Mountain View, CA). The survey targeted 104 practicing radiographers across several countries. Questions were structured around five domains to gather insights into demographics, training in global warming and climate change, perceptions of sustainability and climate change, sustainability barriers, and current radiology practices on sustainability. Data analysis utilized descriptive and d inferential statistics. RESULTS One hundred and four radiographers completed the study. Females had a significantly higher attendance rate in environmental protection campaigns (P = 0.01). The majority of respondents (68%) believe in climate change's knowledge and impact on the natural world. Our survey findings demonstrate that 74% of respondents believe there's a need to improve sustainability practices. The most commonly used strategies to decrease energy consumption and emissions were low-energy lighting (60%), real-time power monitoring tools (41%), and energy-efficient heating systems (32%). A significant concern regarding sustainability emerges among respondents: time (50%) and lack of leadership (48%) are prevalent concerns among the identified barriers. CONCLUSION Participants are recognising the importance of environmental sustainability in radiology, but lack of leadership, support, authority, and facility limitations hinder their adoption. IMPACT ON PRACTICE Radiology must prioritize environmental sustainability by providing resources and training for radiographers and collaborating with healthcare professionals, policymakers, and environmental experts to develop comprehensive strategies for a sustainable healthcare system.
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Affiliation(s)
- M Rawashdeh
- Medical Imaging Sciences, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates; Faculty of Health Sciences, Jordan University of Sciences and Technology, Irbid, Jordan.
| | - M A Ali
- Medical Imaging Sciences, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - M McEntee
- The Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Cork, Ireland; Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - M El-Sayed
- Faculty of Applied Health Sciences Technology, Galala University, Suez, 43511, Egypt
| | - C Saade
- The Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Cork, Ireland
| | - D Kashabash
- Medical Imaging Sciences, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - A England
- The Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Cork, Ireland
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Bojko B. Emerging technologies: analytical lab vs. clinical lab perspective. Common goals and gaps to be filled in the pursuit of green and sustainable solutions. Anal Bioanal Chem 2024; 416:2117-2124. [PMID: 38246907 DOI: 10.1007/s00216-024-05139-6] [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: 11/16/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
Analytical chemistry is a broad area of science comprised of many sub-disciplines. Although each sub-discipline has its own dominant trends, one trend is common to all of them: greenness and sustainability. Efforts to develop more ecological and environmentally friendly methods have been ongoing for over a decade with initial attempts largely focusing on limiting the necessary volume of solvents required and eliminating the use of toxic solvents. Over time, the miniaturization of analytical devices gained popularity as a way of not only reducing chemical usage, but also enabling analyses using smaller sample volumes and more "remote" applications (e.g., on-site sampling and analysis). Of course, miniaturization poses numerous challenges for researchers, for instance, in relation to the method's sensitivity and reproducibility. Developments in the design of detection systems have largely helped to mitigate these issues, but they also often restrict the potential for on-site analysis. Therefore, attempts have been made to improve analysis throughout the entire analytical process, from sampling through sample preparation and instrumental analysis to data handling. Furthermore, clinical chemistry labs must adhere to certain regulations and use certified protocols and materials, which precludes the rapid implementation of solutions developed in research labs. What are the obstacles in translating such innovations to practical applications, and what inventions can make a difference in the future? The answers to these two questions define the trends in analytical chemistry in the field of medical analysis.
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Affiliation(s)
- Barbara Bojko
- Department of Pharmacodynamics and Molecular Pharmacology, Faculty of Pharmacy, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Dr. A. Jurasza 2, 85-089, Bydgoszcz, Poland.
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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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Wu B, Tang Q. A sustainable scheduling system for medical equipment: Towards net zero goals for green healthcare. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:18960-18986. [PMID: 38052585 DOI: 10.3934/mbe.2023839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Shortages of medical equipment, growth in medical waste and carbon emissions have increased healthcare pressures and has a huge impact on the environment. An efficient scheduling of medical equipment will effectively reduce the pressure on healthcare and improve the healthcare system's ability to respond to unexpected disasters. A medical equipment scheduling system was established to improve the sustainable utilization of medical equipment within the healthcare network and to reduce the carbon emissions of the healthcare process. First, this paper combines medical equipment information to establish a medical equipment scheduling decision model that considers pollution to filter qualified medical equipment for scheduling. Then, this paper constructs and solves a multi-objective robust optimization model by collecting the patient's travel information and the medical pressure information of each region. In addition, to meet dynamic healthcare needs, a dynamic medical equipment configuration framework was constructed to enhance the flexibility of equipment scheduling and the resilience of the healthcare network. Combined with case studies, the results show that the medical equipment scheduling system can help decision makers make quick scheduling decisions and achieve sustainable use of medical equipment, with a corresponding increase in medical equipment utilization of 12.25% and a reduction in carbon emissions of 26.50%. The study will help enhance healthcare resource utilization and contribute to the net-zero goal of green healthcare.
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Affiliation(s)
- Baotong Wu
- School of management, Shenyang University of Technology, Shenyang, 110870, China
| | - Qi Tang
- School of management, Shenyang University of Technology, Shenyang, 110870, China
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Ozben T. SMART and GREEN LABORATORIES. How to implement IVDR, emerging technologies and sustainable practices in medical laboratories? Clin Chem Lab Med 2023; 61:531-534. [PMID: 36749317 DOI: 10.1515/cclm-2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Tomris Ozben
- Medical Faculty, Department of Medical Biochemistry, Akdeniz University, Antalya, Türkiye.,Medical Faculty, Clinical and Experimental Medicine, Ph.D. Program, University of Modena and Reggio Emilia, Modena, Italy
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