healthcare sustainability

医疗保健可持续性
  • 文章类型: Journal Article
    背景本研究旨在使用层次分析法(AHP)方法确定阿曼医疗保健部门的可持续性优先事项。主要是,它侧重于评估经济的相对重要性,环境,社会因素及其在维持阿曼医疗体系中的子要素。方法学半定量,采用横断面设计,从阿曼5家不同公立医院至少有10年经验的23名阿曼医疗保健专家那里收集数据.AHP方法用于分析可持续性因素的成对比较,并得出它们的优先级。计算一致性比率以确保分析的可靠性,并应用传递性规则来解决成对比较中的不一致问题。结果研究结果表明,人们非常重视环境和社会的可持续性,经济方面的考虑相对较低。循环做法成为环境领域的一个关键优先事项,而患者满意度在社会领域中脱颖而出。分析表明,医疗保健之间的整合,环境卫生,和社会福祉,强调需要采取整体的可持续性方法。结论本研究通过提供阿曼医疗保健系统中利益相关者偏好的经验证据,有助于对医疗保健可持续性的理解。通过定量评估经济的相对重要性,环境,和社会因素,它为可持续医疗保健发展提供决策和资源分配信息。研究结果还支持了医疗保健可持续性综合方法的论点,该方法可以平衡经济效率与环境保护和社会包容。
    Background This study aimed to identify sustainability priorities within Oman\'s healthcare sector using the analytical hierarchy process (AHP) methodology. Mainly, it focused on assessing the relative importance of economic, environmental, and social factors and their sub-elements in sustaining Oman\'s healthcare system. Methodology A semi-quantitative, cross-sectional design was employed to collect data from 23 Omani healthcare experts with at least 10 years of experience in five different public hospitals in Oman. The AHP methodology was used to analyze pairwise comparisons of sustainability factors and derive their priorities. The consistency ratio was calculated to ensure the reliability of the analysis, and the transitivity rule was applied to address inconsistencies in pairwise comparisons. Results The findings revealed a strong emphasis on environmental and social sustainability, with economic considerations ranking comparatively lower. Circular practices emerged as a key priority within the environmental domain, while patient satisfaction stood out within the social domain. The analysis showed the integration between healthcare, environmental health, and societal well-being, emphasizing the need for holistic approaches to sustainability. Conclusions This study contributes to the understanding of healthcare sustainability by providing empirical evidence of stakeholder preferences within Oman\'s healthcare system. By quantitatively assessing the relative importance of economic, environmental, and social factors, it informs decision-making and resource allocation toward sustainable healthcare development. The findings also support the argument for integrated approaches to healthcare sustainability that balance economic efficiency with environmental protection and social inclusion.
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  • 文章类型: Journal Article
    背景:随着医院努力减少其环境足迹,关于手术室中可重复使用床单与一次性床单(ORs)对环境的影响一直存在争论.这项研究旨在使用生命周期评估(LCA)方法比较可重复使用与一次性使用OR床罩和升降板的环境影响。
    方法:LCA是一种具有严格方法论的既定工具,该工具使用基于科学的过程来衡量环境影响。本研究比较了一家大型学术医院的三种独立系统方案的影响:可重复使用的床罩和50个洗衣周期以及随后的垃圾填埋处理(系统1),带垃圾填埋处理的一次性床罩(系统2),和一次性床盖,并使用焚化处理废物(系统3)。
    结果:系统1的50种用途的总碳足迹为19.83千克二氧化碳当量(CO2-eq)。系统2产生了64.99千克二氧化碳当量。对于系统3,总碳足迹为108.98千克二氧化碳当量。所有材料的原材料提取以生产相当于50个单次使用OR床罩套件的碳强度比可重复使用的床罩高十倍。清洗一个可重复使用的OR床罩50倍的碳强度(12.12kgCO2-eq)比填埋处理50个一次性使用OR床罩(2.52kgCO2-eq)高。
    结论:我们的分析表明,一种可重复使用的织物或床罩洗涤了50次,尽管有碳和水密集型洗涤过程,表现出明显低于一次性使用的碳足迹。净差异为45.16千克二氧化碳当量,相当于普通汽油动力乘用车行驶115英里。这种鲜明的对比强调了采用可重复使用的解决方案以减轻医疗机构对环境的影响的有效性。
    BACKGROUND: 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).
    CONCLUSIONS: 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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  • 文章类型: Journal Article
    医疗保健部门占荷兰温室气体(GHG)排放量的7%。然而,这在组织层面上还没有得到很好的理解。这项研究旨在评估伊拉斯谟大学医学中心的碳足迹,以确定驾驶活动和来源。
    使用了混合方法,结合生命周期影响评估和基于支出的方法,根据范围1(直接排放),量化医院2021年的碳足迹,2(来自购买能源的间接排放),和温室气体议定书的3(间接排放的其余部分)。结果按购买的商品和服务类别分类,药物,特定的产品组,和医院部门。
    医院排放了209.5千吨二氧化碳当量,范围3(72.1%)是最大的贡献者,其次是范围2(23.1%)和范围1(4.8%)。范围1主要由固定燃烧决定,范围2由购买电力决定。范围3由购买的商品和服务驱动,其中药品占41.6%。其他重要类别是医疗产品,实验室材料,假体和植入物,和建设投资。主要贡献部门是儿科,房地产,神经病学,血液学,和信息技术。
    这是对学术医院在其所有活动和部门中的环境影响进行的首次混合分析。很明显,足迹主要由外部供应链的上游效应决定。这项研究强调了碳足迹在组织层面的重要性,指导未来的可持续发展战略。
    UNASSIGNED: The healthcare sector is responsible for 7% of greenhouse gas (GHG) emissions in the Netherlands. However, this is not well understood on an organizational level. This research aimed to assess the carbon footprint of the Erasmus University Medical Center to identify the driving activities and sources.
    UNASSIGNED: A hybrid approach was used, combining a life cycle impact assessment and expenditure-based method, to quantify the hospital\'s carbon footprint for 2021, according to scope 1 (direct emissions), 2 (indirect emissions from purchased energy), and 3 (rest of indirect emissions) of the GHG Protocol. Results were disaggregated by categories of purchased goods and services, medicines, specific product groups, and hospital departments.
    UNASSIGNED: The hospital emitted 209.5 kilotons of CO2-equivalent, with scope 3 (72.1%) as largest contributor, followed by scope 2 (23.1%) and scope 1 (4.8%). Scope 1 was primarily determined by stationary combustion and scope 2 by purchased electricity. Scope 3 was driven by purchased goods and services, of which medicines accounted for 41.6%. Other important categories were medical products, lab materials, prostheses and implants, and construction investment. Primary contributing departments were Pediatrics, Real Estate, Neurology, Hematology, and Information & Technology.
    UNASSIGNED: This is the first hybrid analysis of the environmental impact of an academic hospital across all its activities and departments. It became evident that the footprint is mainly determined by the upstream effects in external supply chains. This research underlines the importance of carbon footprinting on an organizational level, to guide future sustainability strategies.
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  • 文章类型: Journal Article
    美国医疗体系对温室气体排放和气候变化的贡献不成比例地高,损害了公众。现在,一些医学专业正在重新评估如何减轻医疗保健对环境的有害影响。医疗保健可持续性被广泛定义为减少温室气体排放的措施,废物,以及医疗保健提供过程中产生的其他污染物。传染病(ID)专业人员的先前努力和计划,例如抗菌药物管理和感染预防和控制可以为ID专业人员形成一个框架,以帮助将这些专业知识更广泛地应用于医疗保健环境可持续性。这项行动呼吁为ID协会和专业人员提出了战略,以纳入对学员的气候变化教育,增加医疗保健可持续性方面的研究和资助机会,并呼吁ID协会采取行动,倡导系统变革,以减少温室气体排放。
    The US healthcare system\'s contribution to greenhouse gas emissions and climate change is disproportionately high and harms the public. Several medical specialties are now reassessing how they can mitigate healthcare\'s harmful environmental impact. Healthcare sustainability is broadly defined as measures to decrease greenhouse gas emissions, waste, and other pollutants generated during the healthcare delivery process. Prior efforts and programs by infectious diseases (ID) professionals, such as antimicrobial stewardship and infection prevention and control can form a framework for ID professionals to help apply this expertise to healthcare environmental sustainability more broadly. This call to action proposes strategies for ID societies and professionals to incorporate climate change education for trainees, increase research and funding opportunities in healthcare sustainability, and calls for action by ID societies to champion system changes to decrease greenhouse gas emissions.
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  • 文章类型: Journal Article
    目标:自2013年KenLee纪念奖学金(KLMF)成立以来,我们的机构已经完成了10年的培训生领导的可持续发展项目。卫生保健组织推动可持续发展的能力取决于组织和人的能力。这项定性研究介绍了可持续发展研究员项目的第一个十年,与实施它们相关的挑战,以及这些举措对环境和成本的影响。
    方法:克利夫兰诊所普外科住院医师计划的所有住院医师,第四纪医院,无论研究生年级(PGY)水平如何,被邀请以简短的项目提案申请KLMF计划。每年选一个人。自该计划开始以来的每个项目都经过了定性审查,依靠观察得出的数据,采访先前的研究员,监督工作人员,以及对年度同行介绍和摘要中的文档的分析,大回合录音,和团契领导。
    结果:鼓励每个可持续发展研究员采取有针对性的方法,在整个为期1年的研究金中,有以下变更实施的行动周期:识别和发现问题,干预的协作计划,实施干预措施,和评价。项目范围从减少水和废物到外科工作人员的教育,对我们医院的环境管理具有积极意义。然而,完成的多重障碍,缩放,保持可持续性举措仍然存在,我们的肯·李研究员面临的挑战证明了这一点。
    结论:我们的目标是,在研究生医学教育课程框架内的这种强化教育经验将确保未来几代外科医生在环境管理方面具有深思熟虑的领导者。
    OBJECTIVE: Since the inception of Ken Lee Memorial Fellowship (KLMF) in 2013, our institution has achieved 10 years of trainee led sustainability projects. The ability of health care organizations to drive sustainability depends on organizational and human capacity. This qualitative study presents the first decade of sustainability fellows\' projects, the challenges associated with implementing them, and the environmental and cost impact of these initiatives.
    METHODS: All residents in the General Surgery residency program at the Cleveland Clinic, a quaternary hospital, regardless of postgraduate year (PGY) level, are invited to apply for the KLMF program with a short project proposal. One fellow is selected per year. Each project since the program\'s inception was reviewed qualitatively, relying on data derived from observation, interview of prior fellows, and supervising staff, and analysis of documentation from the annual fellow presentation and abstract, Grand Rounds recording, and fellowship leadership.
    RESULTS: A targeted approach by each sustainability fellow is encouraged, with the following action cycle for change implementation throughout the 1-year fellowship: identification and discovery of an issue, collaborative planning of an intervention, implementation of the intervention, and evaluation. Projects range from water and waste reduction to education of surgical staff, with positive implications for environmental stewardship in our hospital. However, multiple barriers to completing, scaling, and maintaining sustainability initiatives remain, as demonstrated by challenges faced by our Ken Lee Fellows.
    CONCLUSIONS: Our goal is that this intensive educational experience within the framework of a graduate medical education curriculum will ensure future generations of surgeons who are thoughtful leaders in environmental stewardship.
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  • 文章类型: Journal Article
    全球对改善医疗保健环境可持续性以及转向低碳和有弹性的医疗保健系统的日益关注和紧迫感日益反映在关于卫生技术评估(HTA)作用的讨论中。本观点考虑了HTA如何最有效地促进这些目标,以及其他政策工具在推动可持续性方面可能更有效的地方。特别是考虑到可用于在HTA内部进行环境评估的资源非常有限。它表明,HTA可能最有效地专注于评估那些具有可能导致特定环境危害或脆弱性的内在特征的技术,而大多数其他产品的通用环境影响可以通过其他政策和监管机制得到更好的解决。
    The growing global focus on and sense of urgency toward improving healthcare environmental sustainability and moving to low-carbon and resilient healthcare systems is increasingly mirrored in discussions of the role of health technology assessment (HTA). This Perspective considers how HTA can most effectively contribute to these goals and where other policy tools may be more effective in driving sustainability, especially given the highly limited pool of resources available to conduct environmental assessments within HTA. It suggests that HTA might most productively focus on assessing those technologies that have intrinsic characteristics which may cause specific environmental harms or vulnerabilities, while the generic environmental impacts of most other products may be better addressed through other policy and regulatory mechanisms.
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  • 文章类型: Editorial
    产品或设备的可持续性目前主要与其环境足迹有关。这里,在医疗设备及其组成部分中引入了更广泛的可持续性概念。由于其材料成分的质量规格,此类设备可维持医疗保健和患者健康,产品设计和性能。质量一词必须用最全面的术语来表示,包括材料的纯度和生物相容性,设备可靠性,召回次数有限,风险降低,患者可接受性降低。仔细观察医疗器械规格显示,然而,额外的参数,比如社会,人口和经济因素也决定了医疗器械的可持续性。医疗器械的生命周期,从设计阶段开始,生产过程到临床应用和最终处置,也决定了它的影响。对医疗保健运营商和管理者的建议将完成本文的假设,彻底概述的设备选择和操作以及对废旧医疗设备及其组件的仔细废物管理会对医疗设备的可持续性产生积极影响。作为一个例子,废物数量有限,不良反应风险降低,对环境污染以及医疗机构和社区的成本都有积极影响。这些因素决定了两者,医疗保健策略的成功和相关的环境足迹。
    Sustainability of a product or device is currently primarily related to its environmental footprint. Here, a wider concept of sustainability is introduced for medical devices and their components in healthcare provision. Such devices sustain healthcare and patient wellbeing due to their quality specifications for material composition, product design and performance. The term quality must be intended in the most comprehensive term, including purity and biocompatibility of materials, device reliability, limited number of recalls and reduced risks as well as acceptability for patients. A close look on medical device specification shows, however, that additional parameters, such as societal, demographic and economic factors also determine medical device sustainability. The medical device life cycle, from design phase, production process to clinical application and the final disposal, also determines its impact. Recommendations for healthcare operators and managers will complete the hypothesis of this paper, that a thoroughly outlined device choice and operation together with a careful waste management of spent medical devices and their components positively affects medical device sustainability. As an example, the limited quantity of wastes and the reduced risks for adverse reaction have a positive impact on both the environmental pollution and on the costs sustained by the healthcare organisations and by the community. These factors determine both, the success of healthcare manoeuvres and the related environmental footprint.
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  • 文章类型: Editorial
    与其他影响材料性能的主题相比,医疗器械的可持续性尚未成为公众讨论中的主要问题。临床应用,生产经济和环境污染。由于其独特的性质,聚合物(塑料)允许多种,在医疗器械技术中的灵活应用。聚合物是大多数一次性和一次性医疗设备的一部分,占全球塑料生产的3%。2022年全球医用聚合物市场规模为199亿美元,其2023年的价值预计将达到430.3亿美元。医疗设备及其聚合物组件引入了更广泛的相关可持续性概念。对医疗器械规范的仔细观察表明,需要额外的性能来提供可持续性,如生物降解性,设备设计质量(QBD),以及为患者提供的内置表演服务,医疗保健专业人员和医疗保健提供者。慢性和非传染性疾病的全球数量不断增加,需要对一次性医疗设备的巨大需求。需要仔细查看聚合物规格及其性能特性,包括废物处置过程中可能的化学修饰和降解过程。负责医疗设备设计和生产的生物工程师只有在将整体和跨学科的方法应用于医疗设备的可持续性时才会成功。
    Sustainability of a medical device has not yet become a major issue in public discussions compared to other topics with impact to material performance, clinical application, production economy and environmental pollution. Due to their unique properties, polymers (plastics) allow for multiple, flexible applications in medical device technology. Polymers are part of the majority of disposable and single use medical device and contribute with 3% to the worldwide production of plastics. The global medical polymer market size was valued 19.9 billion US-$ in 2022 and its value projection for 2023 is expected to reach 43.03 billion US-$ Here, a wider concept of related sustainability is introduced for medical devices and their polymer components. A close look on medical device specification reveals that additional properties are required to provide sustainability, such as biodegradability, quality by device design (QbD), as well as an inbuild performance service for patients, healthcare professionals and healthcare providers. The increasing global numbers for chronic and non-communicable diseases require a huge demand for single use medical devices. A careful look at polymer specification and its performance properties is needed, including possible chemical modifications and degradation processes during waste disposal. Bioengineers in charge of design and production of medical devices will only be successful when they apply a holistic and interdisciplinary approach to medical device sustainability.
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  • 文章类型: Journal Article
    尽管明确识别和考虑决策内容和背景等或有因素的重要性已被广泛接受,以确保对手头的特定任务进行决策分析的有效性,很少有研究包括这一点。本研究使用应急理论方法来研究影响土耳其特定病例的医生(MD)移民决定的因素。进行这项研究的动机来自以下观察:来自土耳其的MD移民的增长趋势对该国的医疗保健系统产生了重大影响。处理MD的移民对于确保有效和可持续的医疗保健系统至关重要,特别是在服务的可用性方面,满意,以及医护人员的雇佣。通过与专家协商,明确确定了背景因素,而一般因素是从专门的医学迁移文献中检索的。采用层次分析法对各因素进行优先排序。对73名参与者进行了调查,了解他们在国外学习或工作的意图。调查结果表明,由于该国的政治局势,低报酬和对未来的焦虑是推动移民决定的两个最重要因素。
    While the importance of explicitly identifying and considering contingent factors such as decision content and context is widely accepted as a way to ensure the validity of the decision analysis for the specific task at hand, few studies include this. This research uses a contingency theoretical approach to study factors affecting the emigration decision of medical doctors (MDs) for the specific case of Turkey. The motivation for conducting this study arises from the observation that the growing trend in emigration among MDs from Turkey is having a significant impact on the country\'s healthcare system. Dealing with the emigration of MDs is crucial for ensuring an effective and sustainable healthcare system, especially in terms of the availability of services, satisfaction, and employment of the healthcare staff. Contextual factors were explicitly identified through consultation with experts, while the generic factors were retrieved from the specialized medical migration literature. The Analytic Hierarchy Process method was utilized to prioritize the factors. Seventy-three participants were surveyed about their intention to either study or work abroad. The findings reveal that low remuneration and anxiety about their future due to the political situation in the country constitute the two most important factors driving the decision to emigrate.
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  • 文章类型: Journal Article
    三重底线(TBL)包括经济,社会,和环境维度,它提供了一种改变当代医疗保健系统的战略。这项研究在COVID-19大流行相关挑战和机遇的焦点下,将当前TBL在医疗保健领域的发展背景化。本文分为五个部分,包括概述TBL概念及其与医疗保健的相关性的介绍性部分。在此之后,我们概述了TBL的三大支柱,包括它的经济,社会,以及与医疗保健相关的环境维度。本节还包括几个案例研究,以说明不同医疗保健环境中基于TBL的实践,重点关注这些措施是如何实施的,以及采用这些做法的结果和障碍。除了展示当前的TBL实践之外,我们回顾了TBL面临的三个重大挑战,并强调了未来研究的潜在领域,例如创新实践,教育改革,以及开发稳健的TBL指标的必要性。总体结论是,TBL提供了一种深刻的方法来概念化当代医疗保健,以满足更有弹性的迫切需要,公平,和对环境负责的医疗系统。
    A triple bottom line (TBL) encompasses economic, social, and environmental dimensions, which provides a strategy for transforming contemporary healthcare systems. This study contextualized current TBL developments in healthcare under the spotlight of COVID-19 pandemic-related challenges and opportunities. The paper has five sections, including an introductory section that outlines the TBL concept and its relevance to healthcare. Following this, we provide an overview of the three pillars of the TBL, including its economic, social, and environmental dimensions as they relate to healthcare. This section also includes several case studies to illustrate TBL-based practices in diverse healthcare settings, focusing on how these were implemented and the outcomes and barriers to adopting such practices. In addition to showcasing current TBL practices, we review three significant challenges to TBL and highlight potential areas for future research, such as innovative practices, educational reform, and the need for the development of robust TBL metrics. The overarching conclusion is that the TBL provides a profound approach to conceptualizing contemporary healthcare to meet the urgent requirements for a more resilient, equitable, and environmentally responsible healthcare system.
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