Vital role of clinicians in reducing the NHS carbon footprint through smarter procurement decisions.

BACKGROUND: The NHS' impact on the environment is significant, accounting for 5.9% of the national carbon footprint of the UK and 20 million tonnes of carbon dioxide equivalent (Mt CO2e) emissions a year.The procurement of goods and services is responsible for 72% of the NHS carbon footprint-equivalent to 15.2Mt CO2e. Procurement is, therefore, a priority focus area to consider, if carbon reductions are to be made. The impact of procurement decisions extends over the 'whole life'-from identification of the need for a product or service through to the provision of the product or service and including the product's 'end of life' process (disposal).From April this year, any new procurement needs to have a 10% net zero and social value weighting. From April 2023 onward, any new procurement two times per day should incorporate carbon footprint and environmental impact.This paper aims to introduce clinicians to the concept of green procurement and illustrate the potential greenhouse gases savings possible if procurement decisions were informed by the sustainability credentials such as the carbon footprint of a product or the corporate social responsibility programme of the supplier. METHODS: While seconded at the Department of Health and Social Care, the senior author on this paper collaborated with the NHS Supply Chain to pilot carbon footprinting of one clinical item. We chose to focus on the 20-gauge 'pink' cannula as a high-volume familiar article; 25 million cannulas are purchased via the NHS Supply Chain each year, of which the most commonly used size is the 20 gauge. RESULTS: Of the seven companies approached, five sent us their CSR strategies. Four companies provided product primary data, and of these four, one provided sufficient data to carry out a carbon footprint analysis. The one set of detailed data provided was for two 20-gauge cannulas, 1 with wings and 1 without. The total carbon footprint for Cannula 1 is 33.92 g CO2e. The total carbon footprint for Cannula 2 is 35.45 g CO2e. This amounts to a 1.54 g CO2e difference between the 2 cannulas. CONCLUSION: It is both necessary and possible for the NHS to demonstrate leadership in reducing the carbon footprint of healthcare.We have provided an overview of NHS procurement to empower clinicians to get involved with local and national decision-making. We have demonstrated the potential carbon savings that could be made through careful choice of products. We have also highlighted the risks if clinicians do not engage with green procurement.

Policy and pregnancy: the impact on working families in the NHS.

The NHS is the largest employer in the UK, with 77% of its workforce made up by women. The UK Health and Safety Executive clearly states that 'risks to a pregnant woman and her baby must be minimised by employers'. Recent studies demonstrate that shift work, uncontrolled working hours and night shifts increase risks to the developing fetus; however, this evidence has not been taken up by the NHS. Our analysis explores women's experience of conception and pregnancy in the NHS. The thematic analysis from the survey results identified several key areas: feeling unable to speak up to their trainers and programme directors; unable to control their work patterns; conflicting and inconsistent guidance; and being caught between occupational health and the trust or deaneries. This subsequently leads to greater stress, longer unnecessary exposure to occupational hazards, and complications in pregnancy and career outcomes.

Medical students' pattern of self-directed learning prior to and during the coronavirus disease 2019 pandemic period and its implications for Free Open Access Meducation within the United Kingdom

PURPOSE: Self-directed learning (SDL) has been increasingly emphasized within medical education. However, little is known about the SDL resources medical students use. This study aimed to identify patterns in medical students' SDL behaviors, their SDL resource choices, factors motivating these choices, and the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on these variables. Methods: An online cross-sectional survey comprising multiple-choice, ranked, and free-text response questions were disseminated to medical students across all 41 UK medical schools between April and July 2020. Independent study hours and sources of study materials prior to and during the COVID-19 pandemic were compared. Motivational factors guiding resource choices and awareness of Free Open Access Meducation were also investigated. Results: The target sample was 75 students per medical school across a total of 41 medical schools within the United Kingdom (3,075 total students), and 1,564 responses were analyzed. University-provided information comprised the most commonly used component of independent study time, but a minority of total independent study time. Independent study time increased as a result of the COVID-19 pandemic (P<0.001). All sub-cohorts except males reported a significant increase in the use of resources such as free websites and question banks (P<0.05) and paid websites (P<0.05) as a result of the pandemic. Accessibility was the most influential factor guiding resource choice (Friedman's µrank=3.97, P<0.001). Conclusion: The use of learning resources independent of university provision is increasing. Educators must ensure equitable access to such materials while supporting students in making informed choices regarding their independent study behaviors.

A short, attribution theory-based video intervention does not reduce weight bias in a nationally representative sample of registered dietitians: a randomized trial.

BACKGROUND/OBJECTIVES: Weight bias among registered dietitians (RDs) is a concern and effective interventions to reduce weight bias are sparse. Our objective was to determine if a short, attribution theory-based online video intervention would reduce weight bias in RDs. SUBJECTS/METHODS: Dietitians from a nationally representative sample were recruited for a randomized, parallel-arm study with online surveys at pre-, post-intervention and 1-month follow-up. One hundred and forty-seven RDs who watched one of three videos embedded in an online survey from June to August 2019 were considered for the analysis. RDs were randomized to watch either the intervention, positive control, or negative control video. The primary outcome was the change in the "blame" component of the Anti-Fat Attitude Test (AFAT) from pre-to immediate post-intervention. Differences in changes in AFAT and Implicit Association Test (IAT) scores across treatment groups were assessed via linear models; multiple imputation were performed for missing data. RESULTS: Baseline demographics, AFAT and IAT scores of the 147 participants who watched a video were not significantly different between the study groups (p > 0.05). The intervention group's AFAT-blame score reduced by an average of 0.05 between pre- and immediate post-intervention but was not statistically significant (p = 0.76, confidence intervals (CI) = -0.40, 0.30). Furthermore, there were no significant changes for AFAT-social, AFAT-physical subscores, and IAT within or between groups between pre- and immediate post-intervention (p > 0.05). Due to high attrition rates, the changes at 1-month follow-up are not reported. CONCLUSIONS: This study was the first to explore the effectiveness of an online video intervention to reduce weight bias in RDs. This study was unable to detect a significant impact of a short, attribution theory-based video intervention on weight bias in practicing RDs and future larger studies are needed to confirm our findings.

Fifteen-minute consultation: The toddler's fracture.

The toddler's fracture is a distinct entity among tibial shaft fractures. It is defined as a minimally displaced or undisplaced spiral fracture, usually affecting the distal shaft of the tibia, with an intact fibula. They are often difficult to diagnose due to the absence of witnessed trauma and because initial radiographs may appear normal. Moreover, the presenting complaint (a non-weight bearing child) has a wide differential diagnosis. A detailed history and examination, together with additional imaging and other investigations, is crucial to diagnose a toddler's fracture. Analgesia and immobilisation are the mainstays of treatment, with follow-up in fracture clinic recommended. Inflicted injury (Note: this article will use the term inflicted injury which is also called non-accidental injury. In the field of safeguarding, there is a move away from using the term 'non-accidental injury' due to misinterpretation of the term as being less serious than 'abusive injury' and that in child protection reports the term can be easily misread or mistyped as 'accidental' injury) should always be considered when red flags for child abuse are present. In this article, we aim to cover the differential diagnoses for toddler's fracture including indicators that might suggest an inflicted injury.

Integrating sustainability into postgraduate medical education.

The delivery of healthcare is a major contributor to the climate crisis, with the NHS being the largest public sector contributor of carbon emissions in the UK. Physicians have an important role to play in the fight against climate change through the practice of sustainable healthcare. This involves maintaining the current and future quality of healthcare through balancing environmental, social and financial constraints. To this end, integrating these skills into medical education is crucial. A large number of medical schools have already embedded planetary health and sustainability theory into their curriculum, however, there is no formal sustainability curriculum in postgraduate education and training. This is vital for enabling clinicians to translate sustainability theory taught at undergraduate level into clinical practice. This article proposes which topics should be included in a postgraduate sustainability curriculum and explores various methods that could be used to incorporate these into the current educational framework.

Paediatric Free Open Access Meducation (FOAM): behaviours, trends and implications.

INTRODUCTION: Free Open Access Meducation (FOAM) describes online resources assisting learning in medicine. Little is known about users or their behaviours. METHODS: Using Google Analytics for a popular FOAM site (www.paedatricfoam.com), we explored user demographics and patterns of behaviour. We analysed these further with descriptive and statistical tests using SPSS (version 26). Data are presented as mean (SD). RESULTS: There were 181.44 (75.16) mean daily users accessing the site throughout a 4-month period during 2018/2019. 68.9% of users were female; 44% were 25-34 years; 57.3% used a mobile device. The mean session duration was 73.55 (9.41) seconds, with more time spent per session and a greater number of pages per session observed in users accessing the site from a desktop or tablet as opposed to a mobile phone. 84.3% of mobile users left the site after viewing a single page. Referral source was also associated with device used (p<0.001). Age was not related to user behaviours (p>0.05). DISCUSSION: FOAM is a rapidly developing form of medical education, with large user numbers seen for a site just 2 years old. The site is being used by many beyond its intended readership. Rather than accessing multiple pages from a desktop, users have varied online behaviours, with the majority viewing a single page on a mobile phone, referred by social media or Google. CONCLUSIONS: Google Analytics can powerfully display usage of medical websites but has important limitations if statistical exploration is required. FOAM users are a heterogenous group, and thus content should be designed with this in mind. Further research must be prioritised focussing on the scope, curriculum coverage, accuracy of information and the effectiveness of FOAM as an educational resource.

Women speakers in healthcare: speaking up for balanced gender representation.

Women comprise the majority of the UK's health and social care workforce, yet remain underrepresented in senior leadership positions. This is reflected in the balance of speakers, chairs and panels convened for healthcare conferences, with disproportionate gender balance. Accumulating evidence suggests that greater diversity across multiple characteristics, including gender, improves staff experience, organisational performance and patient outcomes. Conferences provide opportunities for inclusivity and new ideas only when attendees feel empowered to speak up. If we are to increase diversity of our current leadership, aspiring leaders need to see relatable role models. This article explores the issue of 'manels' and male-dominated speaker lineups, offering practical suggestions for conference organisers, women speakers and male allies to address the issue. We also outline the background to 'Women Speakers in Healthcare': a grassroots initiative founded by a team of aspiring leaders, which aims to achieve balanced gender representation at all healthcare conferences and events.

Everything is awesome: Don't forget the Lego.

AIM: Children frequently ingest coins (generally with minimal reported side effects); however, the ingestion of other items has been subject to less academic study. Parental concern regarding ingestion applies across a range of materials. In this study, we aimed to determine typical transit times for another commonly swallowed object: a Lego figurine head. METHODS: Six paediatric health-care professionals were recruited to swallow a Lego head. Previous gastrointestinal surgery, inability to ingest foreign objects and aversion to searching through faecal matter were all exclusion criteria. Pre-ingestion bowel habit was standardised by the Stool Hardness and Transit (SHAT) score. Participants ingested a Lego head, and the time taken for the object to be found in the participants stool was recorded. The primary outcome was the Found and Retrieved Time (FART) score. RESULTS: The FART score averaged 1.71 days. There was some evidence that females may be more accomplished at searching through their stools than males, but this could not be statistically validated. CONCLUSIONS: A toy object quickly passes through adult subjects with no complications. This will reassure parents, and the authors advocate that no parent should be expected to search through their child's faeces to prove object retrieval.

YouTube: are parent-uploaded videos of their unwell children a useful source of medical information for other parents?

AIMS: YouTube is a vast source of freely accessible user-uploaded medical information. To our knowledge no study has analysed the quality of parent-uploaded videos which depict illness in their children. We aimed to investigate the quality and quantity of videos representing two common conditions, croup and dehydration. METHOD: YouTube was searched using the search terms 'croup+child' and 'dehydration+child'. The first 400 videos of each search were screened. Videos created by doctors or by educational institutions were excluded. The parent-uploaded videos were analysed using the validated Medical Video Rating Scale. Each video was separately evaluated for whether it represented a good clinical example of the condition featured. RESULTS: Out of 38 'croup' videos which met criteria, 15 were judged to be good clinical examples. Only 7 of these 15 'good clinical example' videos were also of high technical quality. Out of 28 'dehydration' videos which met the inclusion criteria, two were good clinical examples. One of these videos had good technical quality. CONCLUSIONS: There were very few videos of either condition which showed a good clinical example while also displaying high technical quality. It is extremely difficult and time consuming to isolate such examples from the mass of information available and therefore parents could be misled by apparently high technical quality videos which are not in fact good clinical examples. Healthcare professionals should be careful when discussing finding medical information on YouTube and consider creating repositories of good examples so they are able to direct parents towards more reputable resources.

Techniques, benefits, and challenges of PET-MR.

Positron emission tomography (PET) scans can now be acquired in unison with magnetic resonance (MR) scans as a single resource. This hybrid PET-MR solution combines the anatomic detail and functional data of MR scans with the biologic or physiological information offered by PET scans. This article describes aspects of implementing a PET-MR imaging program, including various technical and operational challenges, scheduling and workflow solutions, room construction and equipment, and finally clinical applications of this novel modality. The Directed Reading also discusses the possible future role of PET-MR in the clinical setting.