Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice

INTRODUCTION

Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research.

METHODS

A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings.

RESULTS

A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel.

CONCLUSIONS

Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare.

IMPLICATIONS FOR PRACTICE

Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice.

Current sickle cell disease management practices in Nigeria

BACKGROUND

Although Nigeria has the highest burden of sickle cell disease (SCD) worldwide, there is still variable and poor utilisation of standard-of-care practices for SCD patients in the country.

METHODS

This was a questionnaire survey of doctors in some dedicated SCD clinics in Nigeria in order to document the facilities available and common management practices.

RESULTS

There were responses from 18 clinics based in 11 institutions. The number of patients being followed in each centre ranged from 15 to approximately 11 000. All clinics provided malaria prophylaxis and folic acid routinely to their patients. Only eight clinics prescribe penicillin prophylaxis. Eight prescribe hydroxyurea to patients who can afford it when indicated. All of the centres except three have electronic cell counters, but all had access to haemoglobin electrophoresis. Three had high-performance liquid chromatography machines installed but none was being routinely used. One institution had a functioning molecular biology laboratory. There is no official newborn screening programme in the country. All had access to microbiology and chemistry laboratories. Nine institutions had CT, six had MRI and three had transcranial Doppler facilities.

CONCLUSION

The care available for SCD in Nigeria is still suboptimal and there is an urgent need for concerted effort to tackle the problem, but to make a significant impact on the burden of the disease would require more focus at the primary care level. Some steps to achieving this are outlined.

Drug utilization and blood pressure control in a population where antihypertensives are given free: effect of policy change

OBJECTIVES

To assess the current utilization pattern of antihypertensive drugs and blood pressure (BP) control among treated hypertensives where there is a change in payment policy for antihypertensive drugs and to compare with a previous study when drugs were given free in the same setting.

METHODS

A cross sectional study of hypertensive subjects being followed-up in the medical clinic of International Institute for Tropical Agriculture.

RESULTS

One hundred and sixteen consecutive hypertensive subjects aged 50.9+/-8.6 years were studied. Eighty two (70.7%) of the subjects were fully controlled on the treatment, while 15 (12.9%) were not controlled at all. Systolic BP alone was controlled in 14 (12.1%) while in 5 (4.3%) subjects the Diastolic BP alone was controlled. Systolic BP was 133.4+/-14.0 (106-186) mmHg, while diastolic was 83.5+/-9.1 (59-110) mmHg. Salt use correlated with and was predictive of BP control, r = 0.336 and r2 = 3.383, p=0.001. Frequency of drug use: Diuretics 79.8%, calcium channel blockers (CCB) 51.8%, alpha-methyldopa 21.9%, angiotensin converting enzyme inhibitors 17.5%, beta-blockers 15.8%, vasodilator 1.8%, and prazosin 0.9%.

CONCLUSION

In this study, twice as many patients as in the previous study had fully controlled blood pressure in spite of the new policy of co-payment. Health education and patient counselling along with availability of free drug could have contributed to improve adherence to antihypertensive drugs. Physicians managing hypertensive patients should pay attention not only to adequate dosing and appropriate combination of drugs but also to health education and patient counselling.

Spontaneous pre-labour rupture of membranes at term: immediate versus delayed induction of labour

BACKGROUND

Spontaneous pre-labour rupture of membranes (SPROM) at term is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality, particularly because it is associated with a latency period from membrane rupture to delivery.

OBJECTIVE

To compare the outcome of labour in women who had immediate induction of labour, with those who had delayed induction following SPROM at term.

METHODS

A prospective case control study of 200 women who had either immediate induction of labour with intravaginal misoprostol tablets, or delayed induction with intravenous oxytocin infusion after an expectant period of 12 hours, at Aminu Kano Teaching Hospital, Kano, Nigeria. The outcome of labour was compared in the two groups using the Z test and Chi square test, while, p-value of less than 0.05 was taken as significant. The odds ratio (OR) and 95% confidence interval were also determined where appropriate.

RESULTS

Immediate induction of labour with intravaginal misoprotol resulted in lower rates of caesarean section and operative vaginal delivery, with a higher rate of spontaneous vaginal delivery. The duration of latent phase of labour and hospital stay before delivery was statistically significantly shorter in the immediate induction group. Neonatal and maternal morbidity were insignificant and comparable between the two groups.

CONCLUSION

Immediate induction of labour with intravaginal misoprotol resulted in significantly lower rates of intervention without compromising fetomaternal outcome. We recommend the immediate induction of labour with proper use of intravaginal misoprotol in women with SPROM at term.