D3 Lymphadenectomy for Right Colon Cancer: Feasibility, Safety, and Early Outcomes from a District General Hospital in London.

BACKGROUND AND OBJECTIVES: Observational studies suggest a link between D3 lymphadenectomy and improved disease-free survival in some colon cancer patients. However, high-quality randomized controlled trials are needed to confirm its advantage over D2 lymphadenectomy. Concerns about potential complications with D3 have limited its use outside of Japan. This study examines short-term outcomes following D3 lymphadenectomy for right-sided colon cancer compared to the established D2 procedure. Materials and Methods: This retrospective cohort single center study analyzed data on patients with right-sided colon cancer who underwent curative surgery within our healthcare trust between January 2019 and November 2022. Only patients treated by surgeons who routinely perform D3 lymphadenectomy were included for a homogenous study population. The decision to perform D3 was at the discretion of the operating surgeon. Data were collected from both paper charts and electronic medical records. Non-parametric statistical tests were used for data analysis. Results: A total of 214 patients met the criteria, with 170 undergoing D2 lymphadenectomy and 44 undergoing D3 lymphadenectomy. There were no significant differences between the groups in terms of surgery duration, blood loss, postoperative hemoglobin levels, or transfusion needs. Interestingly, the D3 group had a lower complication rate (25%) compared to the D2 group (41.2%). However, the D3 group also had a higher rate of lymph node spread (45.5% vs. 30.6% for D2) and more lymph nodes removed (19 [16, 25] vs. 23 [18, 28]). Importantly, both groups achieved similar complete tumour removal rates. Conclusions: This study suggests D3 lymphadenectomy for right-sided colon cancer might be safe with potential benefits, especially for younger patients with suspected lymph node involvement. However, the limited sample size necessitates larger, randomized trials to confirm these findings and potentially establish D3 lymphadenectomy as standard care.

Triptan non-response in a London tertiary headache centre: What can we learn? A retrospective study.

BACKGROUND: Triptans revolutionized the acute treatment of migraine; however, varied responses to triptans, as a result of poor efficacy and tolerability, are reported. A standardized definition of triptan non-response was recently proposed by the European Headache Federation (EHF). There is currently limited data available on the prevalence of triptan non-response. METHODS: We used clinic letters over a two-year duration to evaluate the triptan response and triptan efficacy or tolerability failure, or both, in a London-based tertiary headache service. RESULTS: In total, 419 adult migraine patients (females: 83.8%, age: 46 ± 18 years, chronic migraine: 88.5%) were included in a service evaluation. In line with the EHF definitions, "triptan non-response" was seen in 63.8% of patients (264/414), whereas 37.7% of patients (156/414) had failed at least two triptans (EHF "triptan resistant") and 4.6% of patients (19/414) had failed at least three triptans, including a subcutaneous formulation (EHF "triptan refractory"). Notably, 21.3% of patients (88/414) had failed at least three triptans inclusive and exclusive of subcutaneous triptan use. Advancing age (p < 0.001) and the presence of medication overuse (p = 0.006) increased the probability of triptan response, whereas an increased number of failed preventives (p < 0.001) and the use of calcitonin gene-related peptide monoclonal antibodies (p = 0.022) increased the probability of triptan non-response. The largest proportion of patients responded to eletriptan (49.5%), followed by nasal zolmitriptan (44.4%) and rizatriptan (35.7%). CONCLUSIONS: Our findings highlight an alarming prevalence of triptan non-response among adult migraineurs receiving treatment in a London-based tertiary headache service. It is imperative for clinicians to explore methods to optimize acute medication efficacy, whether this comprises changing to a triptan with a superior response rate, advocating for early intervention or considering alternative acute medication classes, such as gepants or ditans.

Polypharmacy in primary care: A population-based retrospective cohort study of electronic health records.

BACKGROUND: Polypharmacy, prescription of multiple medications to a patient, is a major challenge for health systems. There have been no peer-reviewed studies of polypharmacy prevalence and medication cost at a population level in England. AIMS: To determine prevalence and medication cost of polypharmacy, by patient characteristics. Design and setting: Retrospective cohort study of North West London electronic health records. METHOD: We quantified prevalence and direct cost of polypharmacy (five or more regular medications), stratified by demographics and frailty. We fitted a mixed-effects logistic regression for polypharmacy. RESULTS: Of 1.7 million adults, 167,665 (9.4%) were on polypharmacy. Age and socio-economic deprivation were associated with polypharmacy (OR 9.24 95% CI 8.99 to 9.50, age 65-74 compared with 18-44; OR 0.68 95% CI 0.65 to 0.71, least deprived compared with most). Polypharmacy prevalence increased with frailty (OR 1.53 95% CI 1.53 to 1.54 per frailty component, for White women). Men had higher odds of polypharmacy than women at average frailty (OR 1.26 95% CI 1.24 to 1.28) and with additional frailty components (OR 1.10 95% CI 1.09 to 1.10). Black people had lower odds of polypharmacy at average frailty (OR 0.82 95% CI 0.79 to 0.85, compared with White), but along with other ethnicities, saw greater odds increases with increasing frailty (OR 1.02 95% CI 1.01 to 1.03). Annual medication cost 8.2 times more for those on polypharmacy compared with not (£370.89 and £45.31). CONCLUSION: Demographic characteristics are associated with polypharmacy, after adjusting for frailty. Further research should explore why, to reduce health inequities and optimise cost associated with polypharmacy.

Children's Health in London and Luton (CHILL) cohort: a 12-month natural experimental study of the effects of the Ultra Low Emission Zone on children's travel to school.

BACKGROUND: The Ultra-Low Emission Zone (ULEZ), introduced in Central London in April 2019, aims to enhance air quality and improve public health. The Children's Health in London and Luton (CHILL) study evaluates the impact of the ULEZ on children's health. This analysis focuses on the one-year impacts on the shift towards active travel to school. METHODS: CHILL is a prospective parallel cohort study of ethnically diverse children, aged 6-9 years attending 84 primary schools within or with catchment areas encompassing London's ULEZ (intervention) and Luton (non-intervention area). Baseline (2018/19) and one-year follow-up (2019/20) data were collected at school visits from 1992 (58%) children who reported their mode of travel to school 'today' (day of assessment). Multilevel logistic regressions were performed to analyse associations between the introduction of the ULEZ and the likelihood of switching from inactive to active travel modes, and vice-versa. Interactions between intervention group status and pre-specified effect modifiers were also explored. RESULTS: Among children who took inactive modes at baseline, 42% of children in London and 20% of children in Luton switched to active modes. For children taking active modes at baseline, 5% of children in London and 21% of children in Luton switched to inactive modes. Relative to the children in Luton, children in London were more likely to have switched from inactive to active modes (OR 3.64, 95% CI 1.21-10.92). Children in the intervention group were also less likely to switch from active to inactive modes (OR 0.11, 0.05-0.24). Moderator analyses showed that children living further from school were more likely to switch from inactive to active modes (OR 6.06,1.87-19.68) compared to those living closer (OR 1.43, 0.27-7.54). CONCLUSIONS: Implementation of clean air zones can increase uptake of active travel to school and was particularly associated with more sustainable and active travel in children living further from school.

Greenspace exposure and the retinal microvasculature in healthy adults across three European cities.

BACKGROUND: Emerging evidence points to the beneficial role of greenspace exposure in promoting cardiovascular health. Most studies have evaluated such associations with conventional cardiovascular endpoints such as mortality, morbidity, or macrovascular markers. In comparison, the microvasculature, a crucial compartment of the vascular system where early subclinical signs of cardiovascular problems appear, has not been studied in association with greenspace exposure. The current study assessed the association between surrounding greenness and microvascular status, as assessed by retinal vessel diameters. METHODS: This study included a sample of healthy adults (n = 114 and 18-65 years old) residing in three European cities [Antwerp (Belgium), Barcelona (Spain), and London (UK)]. The exposures to greenspace at the home and work/school locations were characterized as average surrounding greenness [normalized difference vegetation index (NDVI)] within buffers of 100 m, 300 m, and 500 m. The central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were calculated from fundus pictures taken at three different time points. We developed linear mixed-effect models to estimate the association of greenspace exposure with indicators of retinal microvasculature, adjusted for relevant individual and area-level covariates. RESULTS: We observed the most robust associations with CRVE. Higher levels of greenspace at work/school were associated with smaller retinal venules [(seasonal NDVI) 300m: 3.85, 95%CI -6.67,-1.03; 500m: 5.11, 95%CI -8.04, -2.18]. Findings for surrounding greenness and CRAE were not conclusive. CONCLUSION: Our study suggests an association of greenspace exposure with better microvascular status, specifically for retinal venules. Future research is needed to confirm our findings across different contextual settings.

Development of the face-to-face component and recruitment strategy of a primary care digital social intervention for patients with asthma: Qualitative focus groups and interviews with stakeholders.

BACKGROUND: 5.4 million people in the UK have asthma, with one third experiencing suboptimal control, leading to co-morbidities and increased healthcare use. A quarter of people with long-term conditions informally access peer support through online health communities (OHCs). However, integrating online peer support into primary care services to facilitate self-management is a new concept. OBJECTIVES: To develop together with stakeholders the content, delivery, and recruitment strategy of a digital social intervention to promote use of online peer support amongst asthma patients in primary care. METHODS: Data was collected by qualitative, audio-recorded, one-to-one interviews with clinicians, and focus groups with patients with asthma from East London general practices. The topic guide was informed by patient and public involvement work. Data collected was iterative (i.e. new ideas were added to subsequent interviews and focus groups). Verbatim transcripts were uploaded to NVivo12 and thematically analysed. RESULTS: Twenty patients from several ethnicities participated across five focus groups, and three general practitioners and three practice nurses were interviewed. The study's outputs included: the intervention's face-to-face content; content of clinician training; patient-facing leaflets/material; and a survey to recruit eligible patients. An intervention consisting of a structured consultation with a primary care clinician followed by OHC engagement, was developed based on three generated themes: 'introducing OHCs', describing how clinicians should introduce OHCs; 'OHC engagement', describing factors influencing OHC engagement; and 'clinician training'. CONCLUSION: Findings will assist clinicians in consultations about supporting self-management of patients through OHCs. Future research should evaluate feasibility, effectiveness, and cost-effectiveness of such support.

Promoting online peer support in primary care consultations is a novel concept.The study developed the content of a digital social intervention for patients with asthma.The findings of the current study will inform primary care clinicians' consultations on digital social interventions and will be tested in a trial.

Validity of an ICD-10 Coding Algorithm for Acute Heat Illness in the Emergency Department: A Retrospective Cohort Study.

Acute heat illness (AHI) from extreme environmental heat exposure can lead to emergency department (ED) visits, hospitalization, and even death. While the ICD ninth revision codes for AHI have been validated in the U.S., there have been no studies on the validity of ICD-10 codes for AHI in Canada. The objective of this study was to assess the validity of an ICD-10 coding algorithm for ED encounters for AHI. We conducted a retrospective cohort study of children and adults who had ED encounters at two large academic, tertiary hospitals in London, Canada, between May and September 2014-2018. We developed an algorithm of ICD-10 codes for AHI based upon a literature review and clinical expertise. Our "gold-standard" definition of AHI was patient-reported heat exposure and documentation of at least one heat-related complaint. To establish positive predictive value (PPV), we reviewed 62 algorithm-positive records and noted which met our "gold-standard" definition. To calculate negative predictive value (NPV), sensitivity (Sn), and specificity (Sp), we randomly reviewed 964 ED records for associated ICD-10 codes and diagnoses. Two independent reviewers completed blinded data abstraction, with duplicate abstraction in 20% of the sample. Of the 62 algorithm-positive records, mean (SD) age was 38.8 (23.8) years; 37% were female. PPV was 61.3 ± 12.1% (95% CI). Of the 964 randomly selected records, mean (SD) age was 41.7 (26.5) years; 51.1% were female. The NPV was 99.7 ± 0.4%, sensitivity 25.0 ± 42.4%, and specificity 100.0 ± 0.0%. An ICD-10 coding algorithm for AHI had high specificity but was limited in sensitivity. This algorithm can be used to assemble and study cohorts of patients who have had an AHI, but may underestimate the true incidence of AHI presentations in the ED.

The Impacts of COVID-19 Lockdowns on Road Transport Air Pollution in London: A State-Space Modelling Approach.

The emergence of the COVID-19 pandemic in 2020 led to the implementation of legal restrictions on individual activities, significantly impacting traffic and air pollution levels in urban areas. This study employs a state-space intervention method to investigate the effects of three major COVID-19 lockdowns in March 2020, November 2020, and January 2021 on London's air quality. Data were collected from 20 monitoring stations across London (central, ultra-low emission zone, and greater London), with daily measurements of NOx, PM10, and PM2.5 for four years (January 2019-December 2022). Furthermore, the developed model was adjusted for seasonal effects, ambient temperature, and relative humidity. This study found significant reductions in the NOx levels during the first lockdown: 49% in central London, 33% in the ultra-low emission zone (ULEZ), and 37% in greater London. Although reductions in NOx were also observed during the second and third lockdowns, they were less than the first lockdown. In contrast, PM10 and PM2.5 increased by 12% and 1%, respectively, during the first lockdown, possibly due to higher residential energy consumption. However, during the second lockdown, PM10 and PM2.5 levels decreased by 11% and 13%, respectively, and remained unchanged during the third lockdown. These findings highlight the complex dynamics of urban air quality and underscore the need for targeted interventions to address specific pollution sources, particularly those related to road transport. The study provides valuable insights into the effectiveness of lockdown measures and informs future air quality management strategies.

A tale of two cities: London and New York City during Covid-19.

Using publicly available data, this paper investigates the diffusion of COVID-19 across neighborhoods in two major cities, London and New York. We link neighborhood demographics to incidence, and we investigate patterns of change over time in conjunction with changing policy responses to the pandemic. By comparing and contrasting these two cities, we are able to exploit surveillance and policy differences, demonstrating how each contributes information to the other. We conclude that better coordination can be translated into improved health policy.

Ten years trajectories of estimated glomerular filtration rate (eGFR) in a multiethnic cohort of people with type 1 diabetes and preserved renal function.

OBJECTIVES: We aim to evaluate estimated glomerular filtration rate (eGFR) patterns of progression in a multiethnic cohort of people with type I diabetes mellitus and with baseline eGFR ≥45 mL/min/1.73 m2. DESIGN: Observational cohort. SETTING: People with a clinical diagnosis of type 1 diabetes, attending two university hospital-based outpatient diabetes clinics, in South London between 2004 and 2018. PARTICIPANTS: We studied 1495 participants (52% females, 81% white, 12% African-Caribbean and 7% others). PRIMARY AND SECONDARY OUTCOME MEASURES: Clinical measures including weight and height, systolic blood pressure, diastolic blood pressure and laboratory results (such as serum creatinine, urine albumin to creatinine ratio (ACR), HbA1c were collected from electronic health records (EHRs) and eGFR was estimated by the Chronic Kidney Disease-Epidemiology Collaboration. Ethnicity was self-reported. RESULTS: Five predominantly linear patterns/groups of eGFR trajectories were identified. Group I (8.5%) had a fast eGFR decline (>3 mL/min/1.73 m2 year). Group II (23%) stable eGFR, group III (29.8%), groups IV (26.3%) and V (12.4%) have preserved eGFR with no significant fall. Group I had the highest proportion (27.6%) of African-Caribbeans. Significant differences between group I and the other groups were observed in age, gender, HbA1C, systolic and diastolic blood pressure, body mass index, cholesterol and urine ACR, p<0.05 for all. At 10 years of follow-up, 33% of group I had eGFR <30 and 16.5%<15 (mL/min/1.73 m2). CONCLUSIONS: Distinct trajectories of eGFR were observed in people with type 1 diabetes. The group with the highest risk of eGFR decline had a greater proportion of African-Caribbeans compared with others and has higher prevalence of traditional modifiable risk factors for kidney disease.

Developing films to support vaccine-hesitant, ethnically diverse parents' decision-making about the human papillomavirus (HPV) vaccine: a codesign study.

OBJECTIVE: To illustrate an evidence-, theory- and person-based approach to codesign the COMMUNICATE films that support parental decision-making about the human papillomavirus (HPV) vaccine for their teenagers. DESIGN: Codesign study. SETTING: Localities covered by two immunisation teams in London and the south-west of England. METHODS: The intervention planning phase involved combining evidence from a literature review with qualitative interview data to identify barriers and facilitators to HPV vaccine uptake, as well as design features that should be incorporated within the COMMUNICATE films. The intervention development phase involved identifying guiding principles for the COMMUNICATE films, mapping behaviour change techniques onto the behaviour change wheel and codesigning the COMMUNICATE films. Feedback from users informed modifications to maximise acceptability and feasibility and to support behaviour change. RESULTS: The primary and secondary evidence highlighted important content to include within the COMMUNICATE films: emphasise the benefits of the HPV vaccine, provide transparent information about the safety profile and side effects and emphasise the universality and commonality of HPV infection. A series of scripts were used to guide 4 film shoots to create the content in multiple community languages with 16 participants, including vaccine-hesitant, ethnically diverse parents and professionals. Overall, participants were positive about the films. Potential messengers and ways the films could be distributed, identified by parents, include local social media networks or text messages from general practices. The need for information about the HPV vaccine to be shared by schools ahead of consent being sought was also raised. CONCLUSIONS: By using an integrated approach to intervention development, this study has begun to address the need for an intervention to support vaccine-hesitant, ethnically diverse parents' decision-making about the HPV vaccination programme. A future study to codesign, implement and evaluate a communication strategy for the COMMUNICATE films is planned.

Air pollution, traffic noise, mental health, and cognitive development: A multi-exposure longitudinal study of London adolescents in the SCAMP cohort.

BACKGROUND: There is increasing evidence that air pollution and noise may have detrimental psychological impacts, but there are few studies evaluating adolescents, ground-level ozone exposure, multi-exposure models, or metrics beyond outdoor residential exposure. This study aimed to address these gaps. METHODS: Annual air pollution and traffic noise exposure at home and school were modelled for adolescents in the Greater London SCAMP cohort (N=7555). Indoor, outdoor and hybrid environments were modelled for air pollution. Cognitive and mental health measures were self-completed at two timepoints (baseline aged 11-12 and follow-up aged 13-15). Associations were modelled using multi-level multivariate linear or ordinal logistic regression. RESULTS: This is the first study to investigate ground-level ozone exposure in relation to adolescent executive functioning, finding that a 1 interquartile range increase in outdoor ozone corresponded to -0.06 (p < 0.001) z-score between baseline and follow-up, 38 % less improvement than average (median development + 0.16). Exposure to nitrogen dioxide (NO2), 24-hour traffic noise, and particulate matter < 10 µg/m3 (PM10) were also significantly associated with slower executive functioning development when adjusting for ozone. In two-pollutant models, particulate matter and ozone were associated with increased externalising problems. Daytime and evening noise were associated with higher anxiety symptoms, and 24-hour noise with worse speech-in-noise perception (auditory processing). Adjusting for air pollutants, 24-hour noise was also associated with higher anxiety symptoms and slower fluid intelligence development. CONCLUSIONS: Ozone's potentially detrimental effects on adolescent cognition have been overlooked in the literature. Our findings also suggest harmful impacts of other air pollutants and noise on mental health. Further research should attempt to replicate these findings and use mechanistic enquiry to enhance causal inference. Policy makers should carefully consider how to manage the public health impacts of ozone, as efforts to reduce other air pollutants such as NO2 can increase ozone levels, as will the progression of climate change.

Educator perceptions of the complex needs of young people in Pupil Referral Units: An exploratory qualitative analysis.

BACKGROUND: Alternative education provision such as Pupil Referral Units support young people who have been excluded from mainstream school settings and often from disadvantaged backgrounds. However, there is limited research to date exploring educators' perceptions of the complex needs of young people in PRUs, and the extent to which PRUs as currently configured can meet such needs. METHODS: Between March 2019 and October 2020 twenty-two participants holding various educational roles from five different Pupil Referral Units across London and Southeast England were interviewed. The interviews aimed to explore the participants' experiences of working with students in PRU's and examine some of the challenges that they might encounter. Semi-structured interviews were analysed using Reflexive thematic analysis. RESULTS: The three identified themes and their sub-themes highlighted the complex needs of these young people and identified significant barriers to effective service provision. The first theme 'Complexities of PRU population' highlighted the challenges that young people in PRUs face and perceived systemic short falls in addressing such complexity. The second theme 'Challenges of the PRU environment' highlights the frustrations that educators experience when it comes to providing adequate support to young people in PRU's, the absence of agency support, and the uncertainty that these educational settings can bring. The third theme 'Peer Group Influences' highlights the impact of peer groups from beyond the classroom on engagement within the classroom. CONCLUSIONS: Despite the clear complex needs of young people in PRUs, staff reported feeling ill-equipped to support these individuals and lacked access to effective inter-agency support. Participants reported that pupils' mental health difficulties were exacerbated by exclusion and reintegration practices, an over-zealous focus on educational outcomes and the impact of gang influences on their school lives. Implications include more specific mental health training for staff working in PRU's, improved inter-agency working and the incorporation of trauma-informed approaches in educational practice.

Highlights from the Biocatalysis Faraday Discussion, May 2024, London, United Kingdom.

The Biocatalysis Faraday Discussion was held from May 22 to 24, 2024, at the Royal Society of Chemistry in Burlington House, London. This meeting brought together established and early-career scientists, PhD students, and industrial researchers from around the world to engage in rigorous scientific dialogue on the latest advancements in biocatalysis. The conference featured a unique format, where speakers submitted full papers in advance and presented concise summaries, sparking in-depth discussions among participants. This report summarises the event, the presented results, and the concluding remarks, underscoring the collaborative and intellectually stimulating atmosphere of the Faraday Discussions.

Reducing single-use plastics in dental practice: a quality improvement project.

Introduction Climate change is a major issue facing the global population. Healthcare services, including dentistry, have an obligation to examine current practice and reduce the carbon footprint of their services. Single-use plastics, for example, those used to cover dental equipment, are not necessarily essential for cross-infection purposes.Materials and methods This quality improvement project was carried out in 2023 across 12 dental practices in the North London dental foundation training scheme. Baseline financial and environmental costs were estimated for the weekly single-use barrier plastics used in each practice. This was communicated to each practice. Practices using single-use plastics were contacted three months later to see if they had made any changes.Results In total, 10 out of 12 practices were using one or more of the single-use plastics at baseline, with an estimated carbon footprint ranging from 0.07-27.02 kg carbon dioxide equivalent (CO2e) per week. Three practices reduced or eliminated their single-use plastics as a result of this quality improvement project, which resulted in an equivalent saving of 46.87 kg CO2e per week.Discussion and conclusion The use of single-use plastic barriers varies widely between dental practices and is associated with a financial and environmental cost. Infection control guidelines are unclear with their recommendations. The authors urge dental services to reduce their single-use plastic barriers and would encourage infection control guidelines to consider the environmental impact when making recommendations.

Developing a validated methodology for identifying clozapine treatment periods in electronic health records.

BACKGROUND: Clozapine is the only recommended antipsychotic medication for individuals diagnosed with treatment-resistant schizophrenia. Unfortunately, its wider use is hindered by several possible adverse effects, some of which are rare but potentially life threatening. As such, there is a growing interest in studying clozapine use and safety in routinely collected healthcare data. However, previous attempts to characterise clozapine treatment have had low accuracy. AIM: To develop a methodology for identifying clozapine treatment dates by combining several data sources and implement this on a large clinical database. METHODS: Non-identifiable electronic health records from a large mental health provider in London and a linked database from a national clozapine blood monitoring service were used to obtain information regarding patients' clozapine treatment status, blood tests and pharmacy dispensing records. A rule-based algorithm was developed to determine the dates of starting and stopping treatment based on these data, and more than 10% of the outcomes were validated by manual review of de-identified case note text. RESULTS: A total of 3,212 possible clozapine treatment periods were identified, of which 425 (13.2%) were excluded due to insufficient data to verify clozapine administration. Of the 2,787 treatments remaining, 1,902 (68.2%) had an identified start-date. On evaluation, the algorithm identified treatments with 96.4% accuracy; start dates were 96.2% accurate within 15 days, and end dates were 85.1% accurate within 30 days. CONCLUSIONS: The algorithm produced a reliable database of clozapine treatment periods. Beyond underpinning future observational clozapine studies, we envisage it will facilitate similar implementations on additional large clinical databases worldwide.

Anaesthesia and climate change: time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane.

BACKGROUND: The National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital's anaesthesia department is actively reducing desflurane use and transitioning towards total intravenous anaesthesia (TIVA) as a sustainable alternative, contributing to environmentally responsible practices within the healthcare sector. METHODS: We conducted a rapid qualitative appraisal through online interviews with 17 anaesthetic practitioners to explore their perspectives regarding this climate change mitigation strategy. Data analysis was undertaken through the use of rapid appraisal sheets and a framework analysis method. RESULTS: Participants highlighted the disadvantages of TIVA, including the increased effort, heightened monitoring requirements, operational challenges, and a lack of clinical confidence associated with its use. Despite these reservations, participants acknowledged TIVA's potential to reduce postoperative nausea. There were perceptions that senior staff members might resist this change due to habits and scepticism over its impact on climate change. To facilitate greater TIVA adoption, participants recommended enhanced training, the implementation of a dashboard to raise awareness of greenhouse gas (GHG) emissions, and the presence of strong climate change leadership within the department. Participants believed that a shift to TIVA should be followed by specific measures such as addressing waste management which is crucial for GHG reduction, emphasising the perceived link between waste and emissions. CONCLUSIONS: The evaluation examines stakeholder attitudes, perceptions, and behaviours, focusing on transitioning from desflurane to TIVA. The study highlights the importance of staff engagement, organisational support, and underscores the crucial role that healthcare practitioners and leadership play in fostering sustainability within the healthcare sector.