How can the environmental sustainability of healthcare products be taken into account throughout their life cycle?

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.

A comparison of bicarbonate kinetics and acid-base status in high flux hemodialysis and on-line post-dilution hemodiafiltration.

OBJECTIVES: To compare bicarbonate kinetics and acid base status in HD and HDF for the same patient; and to investigate the effect of patient physiologic parameters on these kinetics. METHODS: In order to monitor HCO3- kinetics during dialysis, acid-base parameters, pH, blood gases partial pressures, and HCO3- concentrations were recorded during 3 regular dialysis (HD) and 3 on-line post-dilution HDF sessions performed on 12 patients, using same dialysis fluid with a 38 mmol/l HCO3- concentration. HCO3- mass transfers through the hemodialyzers membranes and into the patients were continuously calculated during the sessions from HCO3- concentrations, together with HCO3-dialysance. The"apparent" HCO3-gain was calculated by integrating over time the instantaneous mass transfer from dialyzer and re-infusion fluid to the patient. A second method consisted in calculating the patient apparent bicarbonate space (ABS) and HCO3- mass (ABS times plasma concentration) at beginning and end of session. RESULTS: No significant differences were observed between acid base parameters at the end of HD and HDF sessions. In contrast to urea clearances, HCO3- dialysances decayed with time during sessions from 110 to 140 ml/min to about 40 ml/min after one hour. The net HCO3- gain was taken as the difference between final and initial HCO3-masses. This net gain was in average 63% of apparent gain in HD and 74% in HDF. CONCLUSIONS: Uremic acidosis was well corrected without risk of alkalosis. An unexpected result was the continuous decay of bicarbonate dialysance both in HD and HDF during runs.

Medical and economic interest of the use of cryosurgery in the instrumental treatment of atrial fibrillation.

INTRODUCTION: In order to definitively integrate cryosurgery for the surgical treatment of atrial fibrillation (AF) into the therapeutic armamentarium, the medical and economic impact of its use on a population of patients with a high risk of recurrence of postoperative AF must be evaluated. METHOD: An observational study of patients who benefited from cryosurgery between July 2006 and December 2008 was performed. The cost of consumables and hospitalization was determined and compared to that of a control group of 27 patients with preoperative AF that had not benefited from cryosurgery. RESULTS: Twenty-nine patients benefited from cryosurgery during a mitral (65.5%) or aortic intervention (37.9%) to treat a paroxystic (44.8%) or permanent AF (55.2%). More than half of them (58.6%) had a 12-month follow-up; 82.4% of these patients showed a permanent sinus rhythm and 32.6% had stopped their antiarrhythmic medication. There was no significant difference between the duration and cost of hospitalization for the 2 groups. CONCLUSION: Cryosurgery provides a clear clinical and economic advantage with no recurrence of AF, and it reduces antiarrhythmic medication treatment.

[A medical and economic study about use of hemostatic glues in cardiac surgery]. / Etude médicoéconomique en chirurgie cardiaque : application aux colles hémostatiques.

INTRODUCTION: The impact of the use of biological and synthetic glues in cardiac surgery was assessed by an economic and medical study. MATERIAL AND METHODS: The observational prospective study had duration of three months. All the patients undergoing cardiac surgery were included in the study. The end points were medical (blood transfusion) and economic (duration and cost of the stay in hospital). There were 2 groups: treated or not by glues. STATISTICAL ANALYSIS: T Student tests. RESULTS: Among 154 patients, the 2 principal indications were valvular replacement (48%) and coronary artery bypass grafting (37%). Fifty seven (37%) patients received a glue. The number of transfused globular units and the duration of the stay in the intensive care unit were significantly higher (p<0.05) by treated patients. CONCLUSION: Not only the use of glues did not decrease the post-operative bleedings but it increased also the cost of the stay in hospital. Guidelines were validated by the hospital Commission on drugs.

[Drug-induced hyperprolactinemia: a case-non-case study from the national pharmacovigilance database]. / Hyperprolactinémies d'origine médicamenteuse: étude cas/non-cas dans la banque nationale de pharmacovigilance.

Hyperprolactinaemia is a relatively common endocrine abnormality caused by an increased secretion of prolactin from the pituitary gland. There are many causes of hyperprolactinaemia; drug therapy is a common cause in clinical practice. The present pharmacoepidemiological study conducted an analysis of the French Pharmacovigilance Database from January 1, 1985, to December 2000. We investigated the rates of hyperprolactinaemia according to therapeutic drug class, particularly where the Summaries of Product Characteristics (SPC) did not mention hyperprolactinaemia, and estimated the risk of developing hyperprolactinaemia during treatment. We calculated the odds ratio (OR) of reports associated with hyperprolactinaemia for all drugs. Of the 182,836 spontaneous adverse drug reactions reported to the French Pharmacovigilance network, 159 were hyperprolactinaemia. The sex ratio was 5.9 (136 women and 29 men), and mean age was 40 (range 14-85) years. Of the total number of adverse reactions, 31% were associated with neuroleptics, 28% with neuroleptic-like drugs, 26% with antidepressants, 5% with H2-receptor antagonists, and 10% with other drugs. Neuroleptics are not the only class of drugs for which hyperprolactinaemia is reported. Some drugs are clearly associated with an increased risk of hyperprolactinaemia, particularly the following: veralipride (OR = 108.7; IC 95%: 51.82-228), indoramin (OR = 78.68; IC 95%: 33.93-182.48), sertraline (OR = 15.74; IC 95%: 5.80-42.75), and ranitidine (OR = 4.43; IC 95%: 1.82-10.81). All these drugs are reported in the literature as inducing hyperprolactinaemia, although this adverse effect is not mentioned in the SPC. It is thus necessary to harmonise the SPC and encourage health professionals to notify all adverse reactions to their pharmacovigilance centres.