Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists

The Earth’s mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists’ education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.     

An Interdisciplinary Collaboration for Environmental Education

Climate change education in advanced practice registered nursing curricula prepares nurse practitioners to respond to the health effects of climate change. Knowledge of the relationship between human and environmental health is essential for nurse practitioners to identify, teach, and respond to the health effects of climate change in clinical and community settings. This article describes a webinar hosted by the Sarah P. Duke Gardens in partnership with the Duke University School of Nursing. Our webinar provided an opportunity for attendees to understand how gardening can mitigate climate change, the important relationship between human and environmental health, and nurses’ role in climate crisis.     

A Lifestyle Intervention Program to Improve Knowledge and Health Behaviors in Women

ObjectiveTo improve health knowledge, facilitate healthy behaviors, and provide social support for a high-risk population of women by implementing a culturally tailored, gender-specific lifestyle intervention program.DesignEvidence-based practice project.Setting/Local ProblemA Chicago neighborhood in Cook County, Illinois, where there are increased rates of diabetes, heart disease, cancer, stroke, hypertension, obesity, preterm birth, and violent crime.ParticipantsFemale residents of the community, ages 19 to 45 years; 12 participants registered for the program, and 11 participants completed the entire 2-month program.Interventions/MeasurementsThe BE WISE Lifestyle Intervention, a culturally tailored, gender-specific behavior change curriculum, was used for this project. An interprofessional team was used to enhance participant experience, and neighborhood collaborations were established to create sustainability of efforts. Pre- and postintervention measures of diet, physical activity, social support, and knowledge acquisition were used to evaluate outcomes.ResultsImprovement was noted for knowledge in most of the content areas, as well as for dietary and physical activity behaviors. All participants rated the program highly and responded positively to the social support experienced in the group.ConclusionCulturally tailored lifestyle interventions can be effective in improving knowledge and encouraging behavior change, especially when delivered in group settings to enhance social support. Community-level collaborations enhance interventions by providing local support and resources for participants. Because behavior change takes time, follow-up at the 6-month and 1-year intervals is recommended to determine longer-term outcomes.     

Analyses of rare predisposing variants of lung cancer in 6,004 whole genomes in Chinese

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The Nurse Practitioners’ Role in Engaging Health Care Systems in Addressing Climate Change

A recent United Nations (UN) report concluded that the inability to curb fossil fuel emissions from burning coal, oil, and gas has resulted in a short window of time to prevent an abysmal future. The health care industry remains one of the largest contributors to climate change. NPs must not only recognize the clinical presentations resulting from climate change but must also contribute to the efforts presented by the UN report to create a health system that does not contribute to climate change. This article reviews potential ways to decrease the health care sector’s contribution to climate change.     

Visualizing changes in physical activity behavioral patterns after redesigning urban infrastructure

The aim of this study was to explore effects of a major urban reconstruction on physical activity (PA) behavior by comparing PA intensity hotspots before and after the tunneling of a highway with a new infrastructure prioritized for walking and cycling. In total, 126 individuals participated before and after the tunneling. GPS loggers and accelerometers were used to assess location and PA levels. A geographic information system (GIS) was used to perform optimized hotspot analyses on PA data, both on transport and stationary data points. The results showed several changes in PA hotspots on trip data, even if total PA levels did not change. At follow-up, PA intensity hotspots were more connected, with the new infrastructure as a central connection. This was true for higher and lower educated individuals. Therefore, if changes in the built environment do not result in changes on population-level outcomes, this does not imply that they have no impact on behavior.     

南星骨痛凝胶贴膏对兔膝骨关节炎关节形态及血清IL-1、TNF-α、MMP-13、TIMP-1表达的影响

目的观察南星骨痛凝胶贴膏对兔膝骨关节炎关节形态及血清IL-1、TNF-α、MMP-13、TIMP-1表达的影响,探讨南星骨痛凝胶贴膏治疗兔膝骨关节炎可能的作用机制。方法 18只健康6月龄新西兰兔随机分成3组:空白组(A组)、模型组(B组)、骨痛膏治疗组(C组). BC组用3%木瓜蛋白酶关节腔内注射造模后C组给予南星骨痛凝胶贴膏外敷,给药4周后,用Aloka Latheta LCT-200观察兔膝骨关节影像学改变、用ELISA法检测血清IL-1、TNF-α、MMP-13、TIMP-1含量。结果 C组兔膝关节病变程度较B组轻,C组兔血清中IL-1、TNF-α、MMP-13含量较B组降低(P<0. 05),TIMP-1含量较B组升高(P <0. 05)。结论南星骨痛凝胶贴膏能减轻兔膝关节骨关节炎病变程度,对关节软骨有保护作用,其作用机制可能与抑制炎症因子IL-1、TNF-α及MMP-13表达,增加TIMP-1表达有关。