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This scoping review aims to map the social dimensions of kidney care pathways. End-stage kidney disease places significant demands on patients, caregivers, healthcare professionals, and the broader healthcare system. Kidney replacement therapy and conservative kidney management are the common management pathways for end stage kidney disease, but its delivery entails substantial time, financial, and social costs. Research has documented some social aspects of kidney care pathways, but findings are fragmented across disciplines and have not been synthesised coherently. A scoping review is therefore needed to map the existing evidence, identify key domains of social impact, and highlight gaps to inform future research and policy. Eligible studies will include primary research that reports on the social dimensions of managing end-stage kidney disease (ESKD) in adults. Studies from all settings, involving relevant stakeholder groups including patients with end stage kidney disease, informal caregivers, healthcare staff, and Industrial and supply chain workers engaged in different roles associated with kidney replacement therapy and/or conservative kidney management, will be included. The review will follow JBI methodology. Peer-reviewed and grey literature will be identified through searches of electronic databases (MEDLINE, CINAHL, PsycInfo, SocINDEX, EconLit, Web of Science) and grey literature sources (including Google Scholar and organisational reports). Reference lists of relevant reviews and identified articles will also be screened to identify any other relevant articles. Two reviewers will independently screen records and extract data using a predefined form. Results will be synthesised narratively and presented in thematic and tabular formats. This scoping review aims to generate evidence on the social impact of kidney replacement therapy and conservative management across multiple stakeholder groups. The review will provide a structured overview of how social outcomes are conceptualised, measured, and reported across the kidney care continuum. Open Science Framework osf.io/63wpk.

Introduction Healthcare professionals should consider environmental sustainability when recommending medical devices to patients, although there is currently little quantitative data available. The toothbrush is a widely recommended healthcare device worldwide. The aim of this study was to compare the sustainability of different types of toothbrush.Materials and methods Four types of toothbrush were studied: a traditional plastic and electric toothbrush, as well as a plastic manual toothbrush with replaceable heads and a bamboo manual toothbrush. Life cycle assessment (LCA) methodology was applied to quantify the environmental impact of these toothbrushes over five years.Results The electric toothbrush performed consistently poorly compared to the three manual toothbrush types and had the greatest impact in 15 out of 16 environmental categories. The bamboo and replaceable-head plastic toothbrushes had the lowest impact in all categories. The climate change potential of the electric toothbrush was 11 times greater than the bamboo toothbrush.Discussion Switching toothbrushes from the traditional toothbrushes to bamboo or replaceable-head plastic is more environmentally sustainable. These results could be used to inform individual consumer choice, oral health recommendations, procurement of toothbrushes for public health programmes and toothbrush manufacturers. LCA methodology can be used to make healthcare more sustainable.

Objectives Dental graduates must graduate with high levels of clinical skills. Education in the clinical environment needs to be more than didactic supervision of practice by clinical teachers. Appropriate feedback in this context, is therefore critical to the development of student competence and confidence. This study was conducted to enhance and develop the assessment and feedback processes during clinical sessions in a Dental University Hospital in an effort to contribute to the development of students’ self-assessment skills, reflective ability and clinical competence. Methods A new evidence-based model of feedback was introduced between clinical teachers and dental students. The implementation of this model was evaluated by students through a survey and focus groups. Descriptive and inferential statistics were applied to the quantitative data, while thematic analysis applied to the qualitative data. Results Findings from the survey indicated that students perceived the new model of feedback to be a positive addition to their learning experiences. The majority indicated a preference to continue using it. Quantitative analysis also demonstrated that students placed a high value on the feedback they received through the new model and associated it with improved individual performance. Five themes generated from the qualitative analysis echoed the perception that the model of feedback enhanced learning opportunities, especially when it was focused on individual performance and incorporated peer feedback. Students’ preferences in relation to feedback processes were also gleamed from quantitative and qualitative analyses, that is, provision of positive and constructive feedback, both in dialogue and in written formats, delivered during and after each clinical session and addressing their individual competency learning goals for the future. Some challenges to be addressed were also identified (e.g., time constraints, inter-personal issues, and non-conducive environments). Conclusions Feedback is central to learning and remains a complex and challenging area. By adopting effective and evidence-based feedback practices through the introduction of a feedback model, students can be supported in regulating their own learning in the clinical learning environment.

This paper forms part of a series of papers, seven in total, which have been requested by colleagues to help them as clinicians understand sustainability as it relates to dentistry. This paper focuses on waste and how the dental team can influence how waste is processed and disposed of. It is the authors' hope that this series of papers stimulates interest, debate and discussion and, as well as being economically responsible, ultimately motivates and inspires the dental team to be more socially and environmentally sustainable which in turn will help promote health and illness prevention.

Background To analyse via life cycle analysis (LCA) the global resource use and environmental output of the endodontic procedure. Methodology An LCA was conducted to measure the life cycle of a standard/routine two-visit RCT. The LCA was conducted according to the International Organization of Standardization guidelines; ISO 14040:2006. All clinical elements of an endodontic treatment (RCT) were input into OpenLCA software using process and flows from the ecoinvent database. Travel to and from the dental clinic was not included. Environmental outputs included abiotic depletion, acidification, freshwater ecotoxicity/eutrophication, human toxicity, cancer/non cancer effects, ionizing radiation, global warming, marine eutrophication, ozone depletion, photochemical ozone formation and terrestrial eutrophication. Results An RCT procedure contributes 4.9 kg of carbon dioxide equivalent (CO2 eq) emissions. This is the equivalent of a 30 km drive in a small car. The main 5 contributors were dental clothing followed by surface disinfection (isopropanol), disposable bib (paper and plastic), single-use stainless steel instruments and electricity use. Although this LCA has illustrated the effect endodontic treatment has on the environment, there are a number of limitations that may influence the validity of the results. Conclusions The endodontic team need to consider how they can reduce the environmental burden of endodontic care. One immediate area of focus might be to consider alternatives to isopropyl alcohol, and look at paper, single use instrument and electricity use. Longer term, research into environmentally-friendly medicaments should continue to investigate the replacement of current cytotoxic gold standards with possible natural alternatives. Minimally invasive regenerative endodontics techniques designed to stimulate repair or regeneration of damaged pulp tissue may also be one way of improving the environmental impact of an RCT.

A significant amount of dentistry's carbon emissions originate from travel (64.5%). Dental-associated travel affects air quality, releasing over 443 tonnes of nitrogen oxides (NOx) and 22 tonnes of particulate matter (PM2.5) annually. This reduction in air quality reduces over 325 quality-adjusted life years (QALY) per year. Wider health impacts associated with noise and traffic incidents doubles the impact on health in QALYs. Dental procedures that require shorter appointment times have disproportionately higher emissions due to patient travel. The dental team can reduce appointment times by combining visits for family members or combining operative procedures, or reducing appointment frequency based on patient risk. Community oral health programmes and preventive programmes reduce travel emissions. The number of physical dental appointments can be reduced using information technology such as global positioning systems (GPS), telemedicine and teleconferencing. The mode of travel is important, with the air and carbon emissions generated by active travel negligent compared to a private car. Travel plans can help encourage active travel, as can flexible working hours, cycle to work schemes, cycle racks and shower facilities. Practices should consider purchasing locally sourced or sustainably transported goods and, ideally, use local dental laboratories.

BackgroundThe NHS has the target of reducing its carbon emission by 80% by 2032. Part of its strategy is using pharmaceuticals with a less harmful impact on the environment. Nitrous oxide is currently used widely within the NHS. Nitrous oxide, if released into the atmosphere, has a significant environmental impact. Methoxyflurane, delivered through the Penthrox ‘green whistle’ device, is a short-acting analgesic and is thought to have a smaller environmental impact compared with nitrous oxide.MethodsLife cycle impact assessment (LCIA) of all products and processes involved in the manufacture and use of Penthrox, using data from the manufacturer, online sources and LCIA inventory Ecoinvent. These data were analysed in OpenLCA. Impact data were compared with existing data on nitrous oxide and morphine sulfate.ResultsThis LCIA found that Penthrox has a climate change effect of 0.84 kg carbon dioxide equivalent (CO2e). Raw materials and the production process contributed to majority of the impact of Penthrox across all categories with raw materials accounting for 34.40% of the total climate change impact. Penthrox has a climate change impact of 117.7 times less CO2e compared with Entonox. 7 mg of 100 mg/100 mL of intravenous morphine sulfate had a climate change effect of 0.01 kg CO2e.ConclusionsThis LCIA has shown that the overall ‘cradle-to-grave’ environmental impact of Penthrox device is better than nitrous oxide when looking specifically at climate change impact. The climate change impact for an equivalent dose of intravenous morphine was even lower. Switching to the use of inhaled methoxyflurane instead of using nitrous oxide in certain clinical situations could help the NHS to reach its carbon emission reduction target.

Prior to 1966, consumers purchased food items with very little (if any) nutritional labels. Now, nutritional labelling is an integral part of informed consumer choice. This paper advocates for a similar approach for healthcare-related products, using the toothbrush as an example, with the need to quantify and publish data on their clinical efficacy and environmental impact. In this paper, we consider different manufacturing models and measure the environmental impact (carbon footprint) and also the human health impact (disability-adjusted life years [DALYs]) for the most commonly used oral health product: the toothbrush.

Biological materials can be shipped off-site for diagnostic, therapeutic and research purposes. They usually are kept in certain environments for their final application during transportation. However, active reagent handling during transportation from a collection site to a laboratory or biorepository has not been reported yet. In this paper, we show the application of a micro-controlled centrifugal microfluidic system inside a shipping container that can add reagent to an actively cultured human blood sample during transportation to ensure a rapid biodosimetry of cytokinesis-block micronucleus (CBMN) assay. The newly demonstrated concept could have a significant impact on rapid biodosimetry triage for medical countermeasure in a radiological disaster. It also opens a new capability in accelerated sample processing during transportation for biomedical and healthcare applications.

We report a shipping container that enables a disruptive logistics for cytogenetic biodosimetry for radiation countermeasures through pre-processing cell culture during transportation. The container showed precise temperature control (< 0.01 °C) with uniform sample temperature (< 0.1 °C) to meet the biodosimetry assay requirements. Using an existing insulated shipping box and long shelf life alkaline batteries makes it ideal for national stockpile. Dose curve of cytogenetic biodosimetry assay using the shipping container showed clear dose response and high linear correlation with the control dose curve using a laboratory incubator (Pearson’s correlation coefficient: 0.992). The container’s ability of pre-processing biological samples during transportation could have a significant impact on radiation countermeasure, as well as potential impacts in other applications such as biobanking, novel molecular or cell-based assays or therapies.