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      Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy

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          Abstract

          GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.

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          Evaluating barriers to adopting telemedicine worldwide: A systematic review

          Introduction and objective Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to maximize the results.
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            Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2018.

            Estimates of disease burden can inform national health priorities for research, clinical care, and policy. We aimed to estimate health care use and spending among gastrointestinal (GI) (including luminal, liver, and pancreatic) diseases in the United States.
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              Nitrous oxide (N2O): the dominant ozone-depleting substance emitted in the 21st century.

              By comparing the ozone depletion potential-weighted anthropogenic emissions of N2O with those of other ozone-depleting substances, we show that N2O emission currently is the single most important ozone-depleting emission and is expected to remain the largest throughout the 21st century. N2O is unregulated by the Montreal Protocol. Limiting future N2O emissions would enhance the recovery of the ozone layer from its depleted state and would also reduce the anthropogenic forcing of the climate system, representing a win-win for both ozone and climate.
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                Author and article information

                Journal
                Gut
                Gut
                gutjnl
                gut
                Gut
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0017-5749
                1468-3288
                January 2023
                13 October 2022
                : 72
                : 1
                : 12-26
                Affiliations
                [1 ] departmentDepartment of Gastroenterology , Hull University Teaching Hospitals NHS Trust , Hull, East Riding of Yorkshire, UK
                [2 ] departmentClinical Sciences Centre , Hull York Medical School , Hull, UK
                [3 ] departmentDepartment of Gastroenterology , Darlington Memorial Hospital , Darlington, UK
                [4 ] departmentSchool of Health & Life Sciences , Teesside University , Middlesbrough, UK
                [5 ] Institute for Therapeutic Endoscopy, King's College Hospital , London, UK
                [6 ] departmentDepartment of Gastroenterology , St Mark's National Bowel Hospital & Academic Institute , London, UK
                [7 ] departmentDepartment of Gastroenterology , Northumbria Healthcare NHS Foundation Trust , North Shields, UK
                [8 ] departmentDepartment of Gastroenterology , Ninewells Hospital & Medical School , Dundee, UK
                [9 ] departmentApplied Biological and Experimental Sciences , Coventry University , Coventry, UK
                [10 ] departmentDepartment of Gastroenterology , University Hospitals Coventry & Warwickshire NHS Trust , Coventry, UK
                [11 ] departmentDepartment of Gastroenterology , Taunton and Somerset NHS Foundation Trust , Taunton, UK
                [12 ] departmentDepartment of Gastroenterology , Brecon War Memorial Hospital , Brecon, UK
                [13 ] departmentDepartment of Gastroenterology , Airedale NHS Foundation Trust , Keighley, UK
                [14 ] Centre for Sustainable Healthcare , Oxford, UK
                [15 ] departmentBowel Cancer Screening & Endoscopy , London North West University Healthcare NHS Trust , Harrow, UK
                [16 ] Joint Advisory Group on GI Endoscopy , London, UK
                [17 ] departmentDepartment of Gastroenterology , Hillingdon Hospitals NHS Foundation Trust , Uxbridge, UK
                [18 ] departmentDepartment of Gastroenterology , Royal Free Hospitals , London, UK
                [19 ] departmentDepartment of Gastroenterology , NHS Grampian , Aberdeen, UK
                [20 ] departmentDepartments of Gastroenterology & Endoscopy , Royal Cornwall Hospital , Truro, UK
                [21 ] departmentDepartments of Gastroenterology & Endoscopy , Taunton and Somerset NHS Foundation Trust , Taunton, UK
                [22 ] departmentDepartment of Gastroenterology , Norfolk and Norwich Hospitals NHS Trust , Norwich, UK
                [23 ] departmentDepartment of Gastroenterology , Glagow Royal Infirmary , Glasgow, UK
                [24 ] departmentDepartment of Gastroenterology , Norfolk and Norwich University Hospital NHS Trust , Norwich, UK
                [25 ] departmentDepartment of Colorectal Surgery , Plymouth University Hospitals Trust , Plymouth, UK
                [26 ] departmentDepartment of Gastroenterology , New Cross Hospital , Wolverhampton, UK
                [27 ] departmentKing's Health Partners Institute for Therapeutic Endoscopy , King's College Hospital NHS Foundation Trust , London, UK
                Author notes
                [Correspondence to ] Professor Shaji Sebastian, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, HU3 2JZ, UK; shaji.sebastian4@ 123456nhs.net

                SS and AD are joint first authors.

                Author information
                http://orcid.org/0000-0002-3670-6545
                http://orcid.org/0000-0001-8964-2031
                http://orcid.org/0000-0002-2231-3062
                http://orcid.org/0000-0003-3120-4500
                http://orcid.org/0000-0001-8803-5969
                http://orcid.org/0000-0003-0497-1755
                http://orcid.org/0000-0002-5632-4050
                http://orcid.org/0000-0002-6326-9651
                http://orcid.org/0000-0002-9738-9942
                http://orcid.org/0000-0001-8822-6249
                http://orcid.org/0000-0001-7902-3130
                http://orcid.org/0000-0002-7870-7984
                http://orcid.org/0000-0001-5418-2370
                http://orcid.org/0000-0003-1670-8815
                Article
                gutjnl-2022-328460
                10.1136/gutjnl-2022-328460
                9763195
                36229172
                d3912337-74f9-4ae7-8b0d-41a41fd090ff
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 10 August 2022
                : 12 September 2022
                Categories
                Guideline
                1506
                2312
                Custom metadata
                unlocked

                Gastroenterology & Hepatology
                endoscopic procedures,endoscopy
                Gastroenterology & Hepatology
                endoscopic procedures, endoscopy

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