CONTEXT: Surgical activity contributes to global warming though the production of greenhouse gases and consumption of resources. To date, no clinical practice guidelines have been made to promote and implement climate-smart actions. OBJECTIVE: To perform a systematic review of the available actions that could limit CO2 emission in the operating room (OR) and their potential benefits upon the environment, whilst preserving quality of care. EVIDENCE ACQUISITION: MEDLINE and Cochrane databases were searched from January 1, 1990 to April 2021. We included studies assessing carbon footprint (CF) in the OR and articles detailing actions that limit or reduce CF. EVIDENCE SYNTHESIS: Thirty-eight studies met the inclusion criteria. We identified six core climate-smart actions: (1) waste reduction by segregation; (2) waste reduction by recycling, reuse, and reprocessing; (3) sterilisation; (4) anaesthesia gas management; and (5) improvement of energy use. Quantitative analysis regarding the CF was not possible due to the lack of homogeneous data. For climate-smart actions, the analysis was limited by discrepancies in study scope and in the methodology of CO2 emission calculation. Improvement of education and awareness was found to have an important impact on waste segregation and reduction. Waste management is the area where health care workers could have the strongest impact, whereas the main field to reduce CF in the OR was found to be energy consumption. CONCLUSIONS: This review provides arguments for many climate-smart actions that could be implemented in our daily practice. Improving awareness and education are important to act collectively in a sustainable way. Further studies are mandatory to assess the impact of these climate-smart actions in the OR. PATIENT SUMMARY: We performed a systematic review of the available scientific literature to reference all the climate-smart actions proposed to improve the sustainability of surgical activities. Waste segregation, waste reduction and recycling, reuse and reprocessing, sterilisation, anaesthesia gas changes, and improvement of energy use in the operating room were found to be the main areas of research. There is still a long way to go to homogenise and improve the quality of our climate-smart actions.
Carbon Footprint , Operating Rooms , Environment , Waste Management
AIMS: We conducted a cross-sectional study on healthcare workers from the University Hospital in Clermont-Ferrand. They received a self-report questionnaire consisting of the Maslach Burnout Inventory, Job Demand Control Support, Effort-Reward Imbalance model, and questions about ethical conflict in order to investigate on burnout. RESULTS: We included 1774 workers. Overinvestment was the only factor explaining the increase in emotional exhaustion, depersonalization, and the decrease in personal accomplishment. Taking into account the absence of burnout as a reference, overinvestment multiplied the risk of high burnout by 22.0 (5.10 to 94.7). CONCLUSION: Some "forgotten" occupations among healthcare workers are at risk of burnout. Overinvestment was the main factor explaining the increase in the tree dimensions of burnout. Moreover, the two main models of stress at work were highly predictive of burnout.
Burnout, Professional , Job Satisfaction , Burnout, Professional/epidemiology , Cross-Sectional Studies , Humans , Occupations , Reward , Surveys and Questionnaires
OBJECTIVES: To study the prevalence of burnout among non-health care workers (NHCW), the risk and protective factors and to quantify the risk of burnout. METHOD: We conducted a cross-sectional study on the 3142 NHCW of the University Hospital of Clermont-Ferrand. They received a self-assessment questionnaire. RESULTS: Four hundred thirty seven (13.9%) NHCW completed the questionnaires. More than three quarter (75.4%) of NHCW was in burnout, with one in five (18.7%) having a severe burnout. Job demand was the main factor explaining the increase in exhaustion and overinvestment was the main factor explaining the increase in cynicism. Effort-reward imbalance (ERI) multiplied the risk of severe burnout by 11.2, job strain by 3.32 and isostrain by 3.74. CONCLUSION: NHCW from hospital staff are at high risk of burnout. The two major models of stress at work, the job demand-control-support and the ERI, were highly predictive of burnout, with strong dose-response relationships.
Burnout, Professional , Job Satisfaction , Burnout, Professional/epidemiology , Cross-Sectional Studies , Hospitals , Humans , Personnel, Hospital , Reward , Stress, Psychological/epidemiology , Surveys and Questionnaires
INTRODUCTION: Information on prostate diseases, including prostate cancer, has been promoted by the Association Française d'Urologie (AFU) for several years, but is developing slowly in France. In 2005, a first communication was targeted to the male public and identified the reasons for the fatalistic attitude of men, and paradoxically, why the prostate incarnates the vulnerability of their sexual capital. As part of a second phase, this article presents the results of a complementary study conducted among general practitioners to identify their expectations and the most appropriate levers to promote screening. MATERIAL AND METHOD: The Ipsos survey company developed a Krisis qualitative protocol in October 2005 (after the first French prostate day on 15 September 2005). Three groups of general practitioners were defined: doctors who are very active in terms of screening, doctors who are uncomfortable with this problem and doctors who systematically refer their patients to urologists. RESULTS: The management of prostate diseases often highlights the ageing process for the patient. The ability to discuss these problems during the consultation depended on the doctor's degree of comfort with this subject, which is related to his/her training and relationships with urologists. To initiate the question of screening, general practitioners involved in this process asked simple questions about everyday practices without being afraid of making jokes or basing their approach on mediatization of the disease. Digital rectal examination is one of the important clinical elements but is not always easy to perform. PSA was found to be an examination that is not always appropriate, characterized by a lack of information on the conditions for ordering this test, its usefulness and its relevance for screening. Ultrasound could be a way of alerting the patient without dramatizing the situation, letting the urologist perform digital rectal examination. Female general practitioners preferred PSA and ultrasound. The doctors surveyed relied on mediatization of prostate diseases, a high level of interactivity with urologists and documents and brochures to be placed in waiting rooms to relay screening messages. CONCLUSION: General practitioners need their authorities, specialists and public health institutions to develop and mediatize andrology in the same way as gynaecology. Urologists play a major supportive role by means of conferences, postgraduate training or AFU invitations.
Mass Screening , Prostatic Diseases/diagnosis , Prostatic Neoplasms/diagnosis , Aging/physiology , Attitude of Health Personnel , Attitude to Health , Communication , Digital Rectal Examination , Family Practice/education , Female , France , Health Education , Health Promotion , Humans , Interprofessional Relations , Male , Patient Education as Topic , Physician-Patient Relations , Prostate-Specific Antigen/analysis , Prostatic Diseases/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Public Health , Referral and Consultation , Ultrasonography , Urology
INTRODUCTION: A simplified first-line laboratory assessment is recommended by the Stones Committee of the Association Française d'Urologie (CLAFU) right from the first episode of renal stones to detect any lithogenic risk factors. This study was designed to evaluate the feasibility of this assessment in urology, to specify the frequency of risk factors and to compare the results between first stone formers and recurrent stone formers. MATERIAL AND METHODS: This prospective study included patients with a first stone or recurrent stones with no previous laboratory assessment. Known cases of secondary stones were excluded. The stone or fragments had to be analysed by infrared spectrophotometry. In addition to the usual assessment, the first-line laboratory assessment was performed two to three months after the acute episode with a blood test (calcium, phosphorus, uric acid and creatinine), 24-hour urine collection (volume, calcium, uric acid, urea, creatinine, sodium) and first morning urine sample (pH, density, crystals). RESULTS: The results are based on 115 of the 204 patients included (69 first stones, 46 recurrent stones). The assessment was performed and interpreted easily, except for collection of stone fragments. Infrared spectrophotometry was performed in only 49 patients. Whewellite was the most frequent crystalline structure. No patients presented hyperparathyroidism or renal failure. In 69% of cases, the urinary assessment identified one or several risk factors, with insufficient diuresis (42%), hypercalciuria (29%), hypernatriuria (41%), high urinary urea (29%), and hyperuricuria (20%). 25% of patients had a single abnormality, 20% had two abnormalities, the most frequent combination being hypercalciuria-hypernatriuria, and 11% had 4 or more abnormalities. Comparison of first stone formers and recurrent stone formers did not reveal any difference in the frequency of lithogenic risk factors. CONCLUSION: This easy to perform assessment identified lithogenic risk factors in many cases, in both first stone formers and recurrent stone formers, that can guide the prevention of recurrent stones.
Urinary Calculi/etiology , Feasibility Studies , Female , Humans , Male , Prospective Studies , Recurrence , Risk Factors
