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Tavabie O, Clough J, King J, Nicholas V, Kumar A. Challenges of developing a green gastroenterology evidence base and how trainee research networks can fill the gaps. Frontline Gastroenterol 2024; 15:e37-e48. [DOI: 10.1136/flgastro-2023-102497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Abstract
Trainee research networks are a collaborative effort to enable high-quality multicentre audits or research that is more widely accessible to trainees. Such networks lead, design and deliver research at a far higher scale than could be achieved locally and are carried out solely by trainees. There is an increasing focus on delivering research that is not only environmentally sustainable but also focuses on areas that can reduce the carbon footprint of service provision in gastroenterology and hepatology. In this manuscript, we performed a scoping review to understand the current evidence base of the impact of gastroenterology and hepatology services on the environment as well as exploring any association between pollution and climate change with gastrointestinal and liver disease. We further discuss the barriers that researchers face in delivering environmentally sustainable research, the limitation in clinical guidelines related to practicing environmentally sustainable gastroenterology and hepatology and how the trainee research networks are ideally placed to initiate change by developing, disseminating and implementing best practice in ‘green Gastroenterology’.
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Valverde-López F, Librero-Jiménez M, Fernández-García R, Vezza T, Heredia-Carrasco C, López de Hierro Ruiz M, Galvez J, Jiménez-Rosales R, Redondo-Cerezo E. Impact of an Evidence-Based Prioritization System and Electronic Consultation in Early Diagnosis of Colorectal Cancer. Healthcare (Basel) 2024; 12:194. [PMID: 38255082 PMCID: PMC10815471 DOI: 10.3390/healthcare12020194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Colorectal cancer (CRC) is one of the most common causes of cancer. Timely diagnosis is critical, with even minor delays impacting prognosis. Primary care providers face obstacles in accessing specialist care. This study investigates the impact of implementing an electronic consultation (eConsult) system combined with a specific prioritization system on CRC diagnosis delay and tumor staging. (2) Methods: The study analyzes 245 CRC patients from November 2019 to February 2022, comparing those referred before and after the eConsult system's implementation during the COVID-19 pandemic. Data on referral reasons, pathways, diagnosis delays, and staging were collected. Multivariate analysis aimed to identify independent risk factors for advanced staging at diagnosis. (3) Results: The eConsult system significantly reduced CRC diagnosis delay from 68 to 26 days. The majority of patients referred via eConsult presented with symptoms. Despite expedited diagnoses, no discernible difference in CRC staging emerged between eConsult and traditional referrals. Notably, patients from screening programs or with a positive fecal immunochemical test (FIT) experienced earlier-stage diagnoses. A positive FIT without symptoms and being a never-smoker emerged as protective factors against advanced-stage CRC. (4) Conclusions: This study highlights eConsult's role in reducing CRC diagnosis delay, improving diagnostic efficiency and prioritizing urgent cases, emphasizing FIT effectiveness.
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Affiliation(s)
- Francisco Valverde-López
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Department of Medicine, Universidad de Granada, 18016 Granada, Spain
| | - Marta Librero-Jiménez
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Servicio de Aparato Digestivo, Hospital de Motril, 18600 Granada, Spain
| | - Raúl Fernández-García
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Teresa Vezza
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Clara Heredia-Carrasco
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Mercedes López de Hierro Ruiz
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
| | - Julio Galvez
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Department of Medicine, Universidad de Granada, 18016 Granada, Spain
| | - Rita Jiménez-Rosales
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Department of Medicine, Universidad de Granada, 18016 Granada, Spain
| | - Eduardo Redondo-Cerezo
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, 18014 Granada, Spain; (F.V.-L.); (M.L.-J.); (R.F.-G.); (T.V.); (C.H.-C.); (M.L.d.H.R.); (E.R.-C.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain;
- Department of Medicine, Universidad de Granada, 18016 Granada, Spain
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Rodler S, Ramacciotti LS, Maas M, Mokhtar D, Hershenhouse J, De Castro Abreu AL, Fuchs G, Stief CG, Gill IS, Cacciamani GE. The Impact of Telemedicine in Reducing the Carbon Footprint in Health Care: A Systematic Review and Cumulative Analysis of 68 Million Clinical Consultations. Eur Urol Focus 2023; 9:873-887. [PMID: 38036339 DOI: 10.1016/j.euf.2023.11.013] [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: 09/21/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT Carbon footprint (CF) has emerged as an important factor when assessing health care interventions. OBJECTIVE To investigate the reduction in CF for patients utilizing telemedicine. EVIDENCE ACQUISITION The PubMed, Scopus, and Web of Science databases were queried for studies describing telemedicine consultation and reporting on carbon emissions saved and the carbon emissions of telemedicine devices as primary outcomes, and travel distance and time and cost savings and safety as secondary outcomes. Outcomes were tabulated and calculated per consultation. Carbon emissions and travel distances were also calculated for each total study cohort. Risk of bias was assessed using the Newcastle-Ottawa scale, and the Oxford level of evidence was determined. EVIDENCE SYNTHESIS A total of 48 studies met the inclusion criteria, covering 68 465 481 telemedicine consultations and savings of 691 825 tons of CO2 emissions and 3 318 464 047 km of travel distance. Carbon assessment was mostly reported as the estimated distance saved using a conversion factor. Medical specialties used telemedicine to connect specialists with patients at home (n = 25) or at a local center (n = 6). Surgical specialties used telemedicine for virtual preoperative assessment (n = 9), follow-up (n = 4), and general consultation (n = 4). The savings per consultation were 21.9-632.17 min and $1.85-$325. More studies focused on the COVID-19 time frame (n = 33) than before the pandemic (n = 15). The studies are limited by calculations, mostly for the travel distance for carbon savings, and appropriate follow-up to analyze the real impact on travel and appointments. CONCLUSIONS Telemedicine reduces the CF of the health care sector. Expanding the use of telemedicine and educating providers and patients could further decrease CO2 emissions and save both money and time. PATIENT SUMMARY We reviewed 48 studies on the use of telemedicine. We found that people used their cars less and saved time and money, as well as CO2 emissions, if they used teleconsultations. Some studies only looked at how much CO2 from driving was saved, so there might be more to learn about the benefits of teleconsultations. The use of online doctor appointments is not only good for our planet but also helps patients in saving time and money. This review is registered on the PROSPERO database for systematic reviews (CRD42023456839).
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Affiliation(s)
- Severin Rodler
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA; Department of Urology, University Hospital of LMU Munich, Munich, Germany
| | - Lorenzo Storino Ramacciotti
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Marissa Maas
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Daniel Mokhtar
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Jacob Hershenhouse
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Andre Luis De Castro Abreu
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Gerhard Fuchs
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Christian G Stief
- Department of Urology, University Hospital of LMU Munich, Munich, Germany
| | - Inderbir S Gill
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Artificial Intelligence Center, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.
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