No abstract

Objectives Use of Personal Protective Equipment (PPE) has been central to controlling spread of SARS-CoV2. This study aims to quantify the environmental impact of this, and to model strategies for its reduction. Methods Life cycle assessment was used to determine environmental impacts of PPE supplied to health and social care in England during the first six months of the COVID-19 pandemic. The base scenario assumed all products were single-use, air freighted, and disposed via clinical waste. Scenario modelling was used to determine the effect of 1) switching mode of, or eliminating, international travel during supply, 2) reducing glove use 3) using reusable alternatives, 4) maximal recycling. Results The carbon footprint of PPE supplied during the study period totalled 158,838 tonnes CO2e, with greatest contributions from gloves, aprons, face shields, and Type IIR surgical masks. The estimated damage to human health was 314 DALYs (disability adjusted life years), impact on ecosystems was 0.67 species.year (loss of local species per year), and impact on resource depletion costing US $ 20.4 million. Scenario modelling indicated one-third of the carbon footprint could be avoided through switching to shipping, and by 41% through manufacturing PPE in the UK. The carbon footprint was reduced by 83% compared with the base scenario through a combination of UK manufacturing, reducing glove use, using reusable gowns and reuse of face shields, and maximal recycling, estimated to save 259 DALYS, 0.54 species.year, and US $ 15 million due to resource depletion. Conclusions The environmental impact of PPE could be reduced through shipping supplies or domestic manufacture, rationalising glove use, using reusables where possible, and optimising waste management.

Background: Lung cancer management is characterised by a high disease burden, poor survival and substantial variation in management and outcomes. Service redesign provides opportunities for quality improvement (QI) and this improvement may be leveraged across multiple sites using QI collaboration.Aim: This initiative targeted Quality Improvement (QI) in lung cancer management, engaging a QI collaborative using service redesign methodologies in five Victorian hospitals. QI targets included timeliness from referral and diagnosis to treatment, multi-disciplinary meeting (MDM) presentation and supportive care screening. Redesign strategies targeted process sustainability through enhanced team capability.Methods: This study engaged a prospective quality improvement cohort design targeting newly diagnosed tissue confirmed lung cancer with 6-month pre-intervention period and 6-month redesign implementation period, between September 2016 and August 2017, evaluated using Interrupted Time Series Analysis. Hospital sites included three regional and two metropolitan hospitals in Victoria. QI redesign targeted time intervals from referral to first specialist appointment (FSA), referral to diagnosis, diagnosis to first treatment (any intent), MDM documented in medical records and Supportive Care Screening Tool documented in medical records.Results: There was a marked reduction in referral to FSA interval across all sites, with median (interquartile range) falling from 6 (0-15) to 4 (1-10) days, and proportion seen by a specialist within 14 days increased from 74.3% to 84.2%. The interval between diagnosis and treatment was not substantively changed in the 6-month implementation period. The proportion of subjects with documented presentation to the MDM increased from 61% to 67%. The proportion for which Supportive Care Screening documentation remained low at 26.3% post-intervention.Conclusions: Data-driven redesign initiatives enable identification and analysis of clinical practice variation and may be utilised to enhance timeliness of cancer care and improve local data service capabilities.

This is a repository copy of P065: "Bridging the age gap in breast cancer" : an analysis of the decision-making preferences of older women with operable breast cancer in the UK.