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Sustainability in the IVF laboratory: recommendations of an expert panel

Farlie, Francesca; Palmer, Giles A; Cohen, Jacques; Calcagni, Charles; Gorbunova, Anna; Lawford Davies, James; Loscher, Carol; O'Raghallaigh, Roisin; Sharp, Timothy; Smale, Daniela; Sörme, Pernilla; Thiel, Cassandra L; Alteri, Alessandra; Campbell, Alison; Crompton, Kirsty; Mortimer, Sharon; Pisaturo, Valerio; Tolpe, Annelies; Alikani, Mina
The healthcare industry is a major contributor to greenhouse gas emissions. Assisted reproductive technology is part of the larger healthcare sector, with its own heavy carbon footprint. The social, economic and environmental costs of this collective carbon footprint are becoming clearer, as is the impact on human reproductive health. Alpha Scientists in Reproductive Medicine and the International IVF Initiative collaborated to seek and formulate practical recommendations for sustainability in IVF laboratories. An international panel of experts, enthusiasts and professionals in reproductive medicine, environmental science, architecture, biorepository and law convened to discuss the topics of importance to sustainability. Recommendations were issued on how to build a culture of sustainability in the workplace, implement green design and building, use life cycle analysis to determine the environmental impact, manage cryostorage more sustainably, and understand and manage laboratory waste with prevention as a primary goal. The panel explored whether the industry supporting IVF is sustainable. An example is provided to illustrate the application of green principles to an IVF laboratory through a certification programme. The UK legislative landscape surrounding sustainability is also discussed and a few recommendations on 'Green Conferencing' are offered.
PMID: 38039562
ISSN: 1472-6491
CID: 5616792

How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take

Sherry, Brooke; Lee, Samuel; Ramos Cadena, Maria De Los Angeles; Laynor, Gregory; Patel, Sheel R; Simon, Maxine dellaBadia; Romanowski, Eric G; Hochman, Sarah E; Schuman, Joel S; Prescott, Christina; Thiel, Cassandra L
TOPIC/OBJECTIVE:Understanding approaches to sustainability in cataract surgery and their risks and benefits CLINICAL RELEVANCE: In the United States, healthcare is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. METHODS:We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. RESULTS:Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single use supplies to reusables or implementing a hub-and-spoke style theatre setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. CONCLUSIONS:Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery.
PMID: 36889466
ISSN: 1549-4713
CID: 5432802

Telemedicine and the environment: life cycle environmental emissions from in-person and virtual clinic visits

Thiel, Cassandra L; Mehta, Natasha; Sejo, Cory Sean; Qureshi, Lubna; Moyer, Meagan; Valentino, Vincent; Saleh, Jason
Concern over climate change is growing in the healthcare space, and telemedicine has been rapidly expanding since the start of the COVID19 pandemic. Understanding the various sources of environmental emissions from clinic visits-both virtual and in-person-will help create a more sustainable healthcare system. This study uses a Life Cycle Assessment with retrospective clinical data from Stanford Health Care (SHC) in 2019-2021 to determine the environmental emissions associated with in-person and virtual clinic visits. SHC saw 13% increase in clinic visits, but due to the rise in telemedicine services, the Greenhouse Gas emissions (GHGs) from these visits decreased 36% between 2019 and 2021. Telemedicine (phone and video appointments) helped SHC avoid approximately 17,000 metric tons of GHGs in 2021. Some departments, such as psychiatry and cancer achieved greater GHG reductions, as they were able to perform more virtual visits. Telemedicine is an important component for the reduction of GHGs in healthcare systems; however, telemedicine cannot replace every clinic visit and proper triaging and tracking systems should be in place to avoid duplicative care.
PMCID:10169113
PMID: 37160996
ISSN: 2398-6352
CID: 5544542

Environmental Impact of Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Guided Prostate Biopsy

Leapman, Michael S; Thiel, Cassandra L; Gordon, Ilyssa O; Nolte, Adam C; Perecman, Aaron; Loeb, Stacy; Overcash, Michael; Sherman, Jodi D
BACKGROUND:Reducing low-value clinical care is an important strategy to mitigate environmental pollution caused by health care. OBJECTIVE:To estimate the environmental impacts associated with prostate magnetic resonance imaging (MRI) and prostate biopsy. DESIGN, SETTING, AND PARTICIPANTS/METHODS:We performed a cradle-to-grave life cycle assessment of prostate biopsy. Data included materials and energy inventory, patient and staff travel contributed by prostate MRI, transrectal ultrasound guided prostate biopsy, and pathology analysis. We compared environmental emissions across five clinical scenarios: multiparametric MRI (mpMRI) of the prostate with targeted and systematic biopsies (baseline), mpMRI with targeted biopsy cores only, systematic biopsy without MRI, mpMRI with systematic biopsy, and biparametric MRI (bpMRI) with targeted and systematic biopsies. We estimated the environmental impacts associated with reducing the overall number and varying the approach of a prostate biopsy by using MRI as a triage strategy or by omitting MRI. The study involved academic medical centers in the USA, outpatient urology clinics, health care facilities, medical staff, and patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS/METHODS:e), and equivalents of coal and gasoline burned were measured. RESULTS AND LIMITATIONS/CONCLUSIONS:emissions, the equivalent of 700 000 l of gasoline consumed. This analysis was limited to prostate MRI and biopsy, and does not account for downstream clinical management. CONCLUSIONS:A prostate biopsy contributes a calculable environmental footprint. Modifying or reducing the number of biopsies performed through existing evidence-based approaches would decrease health care pollution from the procedure. PATIENT SUMMARY/RESULTS:We estimated that prostate magnetic resonance imaging (MRI) with a prostate biopsy procedure emits the equivalent of 80.7 kg of carbon dioxide. Performing fewer unnecessary prostate biopsies or using prostate MRI as a tool to decide which patients should have a prostate biopsy would reduce procedural greenhouse gas emissions and health care pollution.
PMID: 36635108
ISSN: 1873-7560
CID: 5434432

Conservation Practices for Personal Protective Equipment: A Systematic Review with Focus on Lower-Income Countries

Thiel, Cassandra L; Sreedhar, Pallavi; Silva, Genevieve S; Greene, Hannah C; Seetharaman, Meenakshi; Durr, Meghan; Roberts, Timothy; Vedanthan, Rajesh; Lee, Paul H; Andrade, Gizely; El-Shahawy, Omar; Hochman, Sarah E
During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic approaches for conserving single-use PPE, expecting that lower-income countries or developing contexts may already be uniquely conserving PPE. However, of the 50 included studies, only 3 originated from middle-income countries and none originated from low-income countries. Data from the included studies suggest PPE remained effective with extended use and with multiple or repeated use in clinical settings, as long as donning and doffing were performed in a standard manner. Multiple decontamination techniques were effective in disinfecting single use PPE for repeated use. These findings can inform healthcare facilities and providers in establishing protocols for safe conservation of PPE supplies and updating existing protocols to improve sustainability and overall resilience. Future studies should evaluate conservation practices in low-resource settings during non-pandemic times to develop strategies for more sustainable and resilient healthcare worldwide.
PMCID:9915410
PMID: 36767940
ISSN: 1660-4601
CID: 5427022

What Would It Mean for Health Care Organizations to Justly Manage Their Waste?

Silva, Genevieve S; Thiel, Cassandra
Waste generated by health care includes harmful emissions and often disproportionately affects already vulnerable communities. Justly restructuring health care waste management involves better understanding key drivers of waste production, using sustainability as an ethical value to guide disposal decisions and practices, and reducing overall disposal quantity. Restructuring can be facilitated by making existing waste audit data transparent, incorporating waste accounting into social responsibility metrics used to evaluate health care organizational performance, and implementing policies that prioritize frontline workers' safety.
PMID: 36215185
ISSN: 2376-6980
CID: 5360742

Differences in reuse of cataract surgical supplies and pharmaceuticals based on type of surgical facility

Thiel, Cassandra L; Zhang, Jinchun; Chang, David F
PMID: 35383659
ISSN: 1873-4502
CID: 5204902

Transitioning to Environmentally Sustainable, Climate-Smart Radiation Oncology Care [Editorial]

Lichter, Katie E; Anderson, Justin; Sim, Austin J; Baniel, Claire C; Thiel, Cassandra L; Chuter, Robert; Collins, Amy; Carollo, Erin; Berg, Christine D; Coleman, C Norman; Abdel-Wahab, May; Grover, Surbhi; Singer, Lisa; Mohamad, Osama
PMID: 35841919
ISSN: 1879-355x
CID: 5278512

Addressing the climate impacts of healthcare

Silva, Genevieve S; Schimek, Cassandra A; Lighter, Jennifer L; Thiel, Cassandra L
PMID: 35527513
ISSN: 1553-5606
CID: 5212882

Environmentally sustainable brachytherapy care [Editorial]

Lichter, Katie E; Baniel, Claire C; Anderson, Justin; Bhatia, Rohini; Frick, Melissa A; Thiel, Cassandra L; Gandhi, Seema; Sarria, Gustavo R; Bagshaw, Hilary P; Petereit, Daniel; Chino, Junzo; Grover, Surbhi; Singer, Lisa; Hsu, I-Chow; Mohamad, Osama
PMID: 35794032
ISSN: 1873-1449
CID: 5280462