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Laviolle B, Degon PF, Gillet-Giraud C, Thiveaud D, Lechat P, Boïko-Alaux V, Fougerou C, Jolly C, Petit A, Rémy-Jouet I, Yven R, Bouret L, Marrauld L, Vaslet MP, Delay V, Gavory AL, Olle F, Langevin J, Forteau L. How can the environmental sustainability of healthcare products be taken into account throughout their life cycle? Therapie 2024; 79:61-74. [PMID: 38102030 DOI: 10.1016/j.therap.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023]
Abstract
Healthcare product procurement accounts for around 50% of the French healthcare system's greenhouse gas emissions. This lesson learned from the publication of the Shift Project's work in November 2021 has been a catalyst within the healthcare system, accelerating the consideration and implementation of actions aimed at reducing the environmental impact of the healthcare system, before, during and after care. In addition to their carbon footprint, healthcare products have a wide range of environmental impacts, including on water, air and soil, throughout their entire life cycle. We have chosen to divide this life cycle into four main stages: from research and development to production, distribution and market access, use and finally end-of-life management. Analysis of the regulatory framework at each stage and of existing initiatives described in the literature or by those in the field have structured and fuelled our thinking. We found that existing regulations focus exclusively on the health risk, with little or no consideration of the environmental risk, which is in itself a health risk. Furthermore, the implementation of certain structuring actions during the first 3 stages of the life cycle would make it possible to simplify or even eliminate the major problem of waste management associated with the end-of-life of healthcare products. With this in mind, we have produced 9 recommendations to ensure that the environmental impact of healthcare products is better taken into account throughout their life cycle.
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Affiliation(s)
- Bruno Laviolle
- CHU Rennes, Univ Rennes, Inserm, UMR_S 1085 (IRSET), CIC Inserm 1414, 35000 Rennes, France.
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Laviolle B, Degon PF, Gillet-Giraud C, Thiveaud D, Lechat P, Boïko-Alaux V, Fougerou C, Jolly C, Petit A, Rémy-Jouet I, Yven R, Bouret L, Marrauld L, Vaslet MP, Delay V, Gavory AL, Olle F, Langevin J, Forteau L. Comment prendre en compte la dimension éco-responsable des produits de santé tout au long de leur cycle de vie? Therapie 2024; 79:47-60. [PMID: 37993369 DOI: 10.1016/j.therap.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Bruno Laviolle
- CHU de Rennes, université de Rennes, Inserm, UMR_S 1085 (IRSET), CIC Inserm 1414, 35000 Rennes, France.
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Chatap G, Giraud K, Delay V, Cassereau C, Bastuji-Garin S, Vincent JP, Cornu HP. [Factors of therapeutic imbalance of antivitamins K and their haemorrhagic consequences in elderly]. Therapie 2009; 63:393-401. [PMID: 19154709 DOI: 10.2515/therapie:2008058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective. To determinate, for older subjects, specific factors of imbalance of the oral anticoagulant treatments. Method. We conducted an epidemiological and analytical case-control study, during 18 months, in 2 geriatrics centers. Each patient with excessive anticoagulation (INR>4.5) was matched with 2 controls under anticoagulant, whom the INR (international normalized ratio) had stayed in the therapeutic range. Results. One-hundred fifty nine subjects (53 cases and 106 controls) were included. Haemorrhagic complications has been observed in 19.2% of cases, versus 3.9% of the controls. Some medicines frequently prescribed to the old subjects were correlated at a risk of excessive anticoagulation: amiodarone (9.4% versus 0, p<0.004), acetaminophen (18.9% versus 0.9%, p<0.001), tramadol (5.6% versus 0, p<0.04), ofloxacine (11.3% versus 1.9%, p<0.001), and lactulose (11.3% versus 0, p<0.001). Furthermore, several acute states increase the risk of excessive INR to the old subjects: fever (p<0.001), malnutrition (p<0.001), dehydration (p=0.006), and acute diarrhea (p<0.001). Conclusion. Some specific geriatric factors raised may destabilize treatments by anticoagulants.
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Affiliation(s)
- Guy Chatap
- Service de Médecine Interne Gériatrique, Hôpital René Muret, Sevran, France.
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