Barriers and facilitators of adherence to low-dose aspirin during pregnancy: A co-produced systematic review and COM-B framework synthesis of qualitative evidence.

INTRODUCTION: Women at increased risk of developing pre-eclampsia are advised to take a daily low-dose of aspirin from 12 weeks of pregnancy to reduce their risks. Despite the well-established prophylactic effect of aspirin, adherence to this therapy is low. This systematic review aimed to summarise evidence on the barriers and facilitators of adherence to low-dose aspirin to inform intervention development to support decision making and persistence with aspirin use for pre-eclampsia prevention. MATERIALS AND METHODS: A systematic review and meta-synthesis of qualitative research was co-produced by representatives from charities, and public, clinical and academic members. Eight electronic databases (MEDLINE, PsycINFO, CINAHL, Web of Science, Scopus, EMBASE, Prospero, OpenGrey), archives of charities and professional organisations were searched (between October and November 2023 and re-run in August 2023) using predefined search terms. Studies containing qualitative components related to barriers and facilitators of adherence to low-dose aspirin during pregnancy were included. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. A combination of the COM-B framework with phases of adherence process as defined by international taxonomy was used as the coding framework. Co-production activities were facilitated by use of 'Zoom' and 'Linoit'. RESULTS: From a total of 3377 papers identified through our searches, five published studies and one dissertation met our inclusion criteria. Studies were published from 2019 to 2022 covering research conducted in the USA, Canada, UK, Netherlands and Australia. Barriers and facilitators to adherence were mapped to six categories of the COM-B for three phases of adherence: initiation, implementation, and discontinuation. The discontinuation phase of adherence was only mentioned by one author. Four key themes were identified relating to pregnancy: 'Insufficient knowledge', 'Necessity concerns balance', 'Access to medicine', 'Social influences', and 'Lack of Habit'. CONCLUSIONS: The COM-B framework allowed for detailed mapping of key factors shaping different phases of adherence in behavioural change terms and now provides a solid foundation for the development of a behavioural intervention. Although potential intervention elements could be suggested based on the results of this synthesis, additional co-production work is needed to define elements and plan for the delivery of the future intervention. TRIAL REGISTRATION: PROSPERO CRD42022359718. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359718.

Health and social care professional standards need to be updated to advance leadership and action for environmental sustainability and planetary health.

BACKGROUND: Human health is inextricably linked to planetary health. The desire to nurture and protect both concurrently requires the mitigation of healthcare-associated environmental harms and global initiatives that support sustainable lifestyles. Health leadership is important to bring adequate attention and action to address planetary health challenges. Health professionals are central to this endeavour, but the will and energy of a few will not be adequate to address this urgent challenge. STUDY: We present an appraisal of the current UK health professional standards, frameworks and curricula to identify content related to planetary health and environmental sustainability. RESULTS: No current UK health professional standard provides statements and competencies to guide practising and trainee health professionals to focus on and advance the sustainability agenda within their clinical practice and across wider healthcare systems. CONCLUSION: Update of health professional standards is needed to ensure that health professionals in every specialty are supported and encouraged to lead the implementation of environmentally sustainable practices within the health sector and advocate for planetary health.

Towards estimating the carbon footprint of external beam radiotherapy.

PURPOSE: The National Health Service (NHS) in the United Kingdom (UK) is aiming to be carbon net zero by 2040 to help limit the dangerous effects of climate change. Radiotherapy contributes to this with potential sources quantified here. METHOD: Activity data for 42 patients from within the breast IMRT and prostate VMAT pathways were collected. Data for 20 prostate patients was also collected from 3 other centres to enable cross centre comparison. A process-based, bottom-up approach was used to calculate the carbon footprint. Additionally, patients were split into pre-COVID and COVID groups to assess the impact of protocol changes due to the pandemic. RESULTS: The calculated carbon footprint for prostate and breast pre-COVID were 148 kgCO2e and 101 kgCO2e respectively, and 226 kgCO2e and 75 kgCO2e respectively during COVID. The energy usage by the linac during treatment for a total course of radiotherapy for prostate treatments was 2-3 kWh and about 1 kWh for breast treatments. Patient travel made up the largest proportion (70-80%) of the calculated carbon footprint, with linac idle power second with âˆ¼ 10% and PPE and SF6 leakage were both between 2 and 4%. CONCLUSION: These initial findings highlight that the biggest contributor to the external beam radiotherapy carbon footprint was patient travel, which may motivate increased used of hypofractionation. Many assumptions and boundaries have been set on the data gathered, which limit the wider application of these results. However, they provide a useful foundation for future more comprehensive life cycle assessments.

Total skin electron beam therapy rationalization and utility of in vivo dosimetry in a high-volume centre.

OBJECTIVE: This paper reports on the rationalization of a substantial pool of in vivo dosimetry (IVD) data from patients treated with total skin electron beam therapy (TSEBT) and the application of this to verify the accurate delivery of TSEBT when changing linac manufacturer. METHODS: Thermoluminescent dosimeter IVD data from 149 patients were analyzed comparing the population mean and standard deviation for each site. The number of sites required to confirm the prescribed dose were reviewed considering both dosimetric and clinical relevance. The reduced sites were then used to assess the continued dosimetric accuracy on new equipment and the results were compared statistically using the Mann-Witney test. RESULTS: The trunk dose measurement points were reduced from nine to six and five extra trunk sites were identified and reviewed clinically prior to removal.Following change in manufacturer the trunk dose points showed no statistically significant change and confirmed that patients had received within 1.3% of the intended mean trunk dose using both delivery methods.A statistically significant change in 4 out of the 13 extra trunk sites was seen following the move to the new centre. However, all but one site showed a change of less than 1 standard deviation. CONCLUSION: The total number of measurement points per patient were reduced from 27 to 19 which constituted a 25% saving in preparation and read out.Accurate delivery of prescribed dose was confirmed following measurement point reduction for treatments delivered on linacs from two different manufacturers. ADVANCES IN KNOWLEDGE: Proven methodology for rationalization of IVD measurements for TSEBT.