Katrine Bitsch Johansen

Climate change poses a significant challenge for global health. The World Health Organization estimates 250,000 additional annual deaths between 2030 and 2050 due to global warming. The healthcare sector is a major contributor to greenhouse gas (GHG) emissions, accounting for approximately 4.4-5.5% of a country’s total carbon footprint, with medicines contributing 5–10%. Research on the climate impact of medicines is needed to identify areas for emission reduction. This scoping review aimed to provide an overview of existing literature on the climate impact of medicines in the hospital sector and identify knowledge gaps. A comprehensive literature search was conducted, with articles categorized based on the type of medicine or therapeutic area, enabling a structured mapping of current areas of evidence. The review followed PRISMA-ScR guidelines, searching PubMed and Embase for peer-reviewed articles published in the last 20 years that reported original data on GHG emissions from medicines in the hospital sector. Of the 2,986 studies identified, 33 were included. Most focused on emissions from inhaled anaesthetic gases (n=16), followed by inhaler therapies (n=6), healthcare systems or whole-hospital emissions (n=5), ophthalmology (n=3), surgical procedures (n=2), and other areas (n=2). The findings show that while certain areas, particularly anaesthetic gases and inhaler therapy, have been more researched the overall research on the climate impact of medicines in the hospital sector remains limited. Knowledge gaps persist across most therapeutic areas, highlighting the need for further systematic investigations to inform effective mitigation strategies and support climate-conscious decision-making in the hospital sector.

Background: Computerized tomography-guided transthoracic needle biopsy (CT-TTNB) plays an important role in the diagnostic work-up of lung lesions. The literature reports varying results on complication rates, severity of complications, and diagnostic yield. Purpose: To evaluate CT-TTNB as a radiological outpatient clinic procedure and explore diagnostic yield and complication rates. Material and methods: Between January 2017 and October 2019, a total of 559 patients underwent CT-TTNB. Patient records and CT scans were retrospectively reviewed and patient characteristics, lesion characteristics, biopsy procedure, and per- and post-procedural complications, as well as pathological diagnosis, were registered. Results: Of 559 patients included, 511 had biopsies performed. Thereby, 48 biopsies (8.6%) were discontinued because of patient compliance issues and/or the occurrence of pneumothorax before the biopsy was performed. The overall pneumothorax rate was 49.2% ( n = 275 of 559 patients). Insertion of a drainage catheter was needed in 85 of the 275 patients with pneumothorax. Parenchymal bleeding was seen in 26.5% of the patients and haemoptysis in 5.5%. No cases of bleeding or haemoptysis required intervention or admission. Small mean lesion size and increased distance from pleura to the lesion were associated with a higher occurrence of complications. A conclusive pathological diagnosis was obtained in 278 of 511 (54.4%) biopsies. No patients were re-admitted after the two-hour observational period in the radiological department. Conclusion: CT-TTNB as an outpatient clinic procedure is feasible but has a moderate diagnostic yield and relatively high complication rates for minor complications.

The healthcare sector is a major contributor of greenhouse gas emissions, and reduction and proper sorting of healthcare waste is essential to achieve sustainable healthcare. This study aimed to characterize the quantity and composition of pharmaceutical waste from a major Danish hospital. Pharmaceutical waste was collected from Odense University Hospital, including departments located in both Odense and Svendborg. The average daily production of pharmaceutical waste was 1150 g/day in Odense and 5967 g/day in Svendborg, with the operating rooms in Svendborg contributing 3143 g/day. The amount and composition of pharmaceutical waste varied greatly between departments, but some common patterns were identified. Propofol accounted for about one third of the pharmaceutical waste obtained from operating rooms. Antibiotics for systemic use constituted a significant proportion of the pharmaceutical waste from several departments and were the therapeutic group from which most different drugs were identified. Paracetamol accounted for 33.5% of the discarded tablets/capsules in Odense and 12.6% in Svendborg. Medications dispensed by automated dose dispensing accounted for a significant proportion of the discarded tablets/capsules in departments using this service. This study highlights some key areas for reduction and management of pharmaceutical waste and contributes to the currently limited evidence within this area.

The healthcare sector is a major contributor of greenhouse gas emissions, and reduction and proper sorting of healthcare waste is essential to achieve sustainable healthcare. This study aimed to characterize the quantity and composition of pharmaceutical waste from a major Danish hospital. Pharmaceutical waste was collected from Odense University Hospital, including departments located in both Odense and Svendborg. The average daily production of pharmaceutical waste was 1150 g/day in Odense and 5967 g/day in Svendborg, with the operating rooms in Svendborg contributing 3143 g/day. The amount and composition of pharmaceutical waste varied greatly between departments, but some common patterns were identified. Propofol accounted for about one third of the pharmaceutical waste obtained from operating rooms. Antibiotics for systemic use constituted a significant proportion of the pharmaceutical waste from several departments, and were the therapeutic group from which most different drugs were identified. Paracetamol accounted for 33.5% of the discarded tablets/capsules in Odense and 12.6% in Svendborg. Medications dispensed by automated dose dispensing accounted for a significant proportion of the discarded tablets/capsules in departments using this service. This study highlights some key areas for reduction and management of pharmaceutical waste, and contributes to the currently limited evidence within this area.