Review studies

Einleitung / Introduction

One of the most common outpatient procedures in urology practices is cystoscopy, for which the flexible cystoscope is an important diagnostic tool. Since their introduction in the 1970s, reusable cystoscopes have undergone steady development, but ongoing costs in particular for device processing, as well as sterilization errors and repairs, pose challenges for smaller facilities (Kemble et al. BJU Int 2023; 131: 617–622). The manufacturers of a new disposable device advertise the elimination of costs for reprocessing, which is complex and additionally subject to external quality controls.

Methode / Method

Focused information gathering was applied and highly specific database searches for a Scoping Review were carried out.

Ergebnisse / Results

The database searches yielded 40 results. In their analysis comparing the environmental footprint of disposable and reusable flexible cystoscopes, Hogan et al. (J Endourol 2022; 36(11): 1460–1464) conclude that the environmental impact of reusable flexible cystoscopes is significantly greater than that of disposable cystoscopes when a fleet of devices is used. This is contradicted by the results of the lifetime analysis of another group of researchers and a further analysis of the methodological approach (Kemble et al. 2023; Rizzan and Bhutta. J Endourol 2022; 36(11): 1466–1467). Even from the perspective of sustainability and corporate and medical responsibility, the conclusion for rural clinics and individual practices cannot be that disposable cystoscopes are more economically and ecologically efficient. On the contrary, the amount of medical waste generated and the environmental impact of manufacturing, transporting, using, and disposing of a new product for one of the most commonly performed procedures in urology should drive manufacturers and hygiene regulators to develop and accept alternative and more efficient reprocessing methods. Energy consumption for automatic reprocessing of reusable cystoscopes should be compensated by renewable energy sources and solutions for central reprocessing should be found such as collection and re-delivery of processed cystoscopes for resource-limited clinical settings by couriers or drones following the model of drone-assisted delivery of medical goods.

Zusammenfassung / Conclusion

Our example shows the urgent need to standardise the methods for environmental impact assessment in order to prevent easily possible manipulations as well as to better inform decision makers based on reliable data.

Authors

Barbara Buchberger

Matthias Perleth, Verein zur Förderung der Technologiebewertung im Gesundheitswesen (HTA.de)

Volker Rohde, Helios Agnes Karll Krankenhaus

Einleitung / Introduction

Rapid climate change, causing extreme weather events, requires the deployment of early warning systems to mitigate the health burden. Although the focus is often limited to heat warnings, accurate health risk prediction requires a comprehensive understanding of the interactions among various environmental risk factors, particularly weather and air pollution. The existing evidence on the interactive effects of weather and air pollution parameters on health risks is insufficient and inconclusive, and a systematic review is lacking. Therefore, this paper aims to comprehensively review the synergetic impact of air pollution and weather on morbidity and mortality and provides insights into the methodologies, assumptions and study quality.

Methode / Method

The systematic review followed the PRISMA guidelines and was previously registered in PROSPERO. A comprehensive search of the PubMed and Web of Science databases was conducted in July 2023, focusing on English peer-reviewed studies from Europe or Northern America published since 2012. Using the Rayyan software, two reviewers performed all critical steps in a blinded manner. Discrepancies were resolved through discussion. The risk of bias was assessed using the WHO's risk of bias assessment instrument. The "Synthesis without Meta-analysis (SWiM)" methodology was utilized to consolidate study outcomes.

Ergebnisse / Results

Among the 4,505 studies identified, 72 were included; the majority were time series (n=28) or case-crossover studies (n=16). Studies mainly analyzed all-cause mortality, with fewer focusing on disease-specific mortality. The studies varied by modeling lag effects, addressing time-varying confounders, and dealing with spatial misalignment. The interaction between air pollution and weather events was stronger in older individuals or those with pre-existing diseases. Most studies indicated an interactive effect between hot days and ozone on all-cause mortality, especially during extreme heat. The interactive effect of air temperature and particulate matter was inconclusive for all-cause mortality. After stratifying for disease groups, the effect of particulate matter on cardiovascular mortality increased on cold days, while the effect on respiratory mortality increased on hot days.

Zusammenfassung / Conclusion

This review synthesized studies on the combined impact of air pollution and weather on health, revealing significant interactive effects. These effects were more evident when analyses distinguished between disease groups, vulnerable populations, and extreme temperatures. Future research should focus on: 1) employing simulation studies to identify effective methodologies, 2) incorporating comprehensive wetter patterns beyond air temperature and 3) distinguishing mortality by disease group and risk factors.

Authors

Britta Rackow, Universitätsklinikum Hamburg Eppendorf

Hans-Helmut König, Universitätsklinikum Hamburg Eppendorf

Maurice Wall, Universitätsklinikum Hamburg Eppendorf

Claudia Konnopka, Universitätsklinikum Hamburg Eppendorf

Einleitung / Introduction

This scoping review analyses the different definitions of economic efficiency used in the scientific literature on various healthcare settings. As health care costs are rising in many countries, the concepts of efficiency and inefficiency in health care receive growing attention. Because the terms leave much room for interpretation, researchers have different understandings of “economic efficiency” or simply “efficiency”. This is problematic as studies might be lacking comparability if they are based on vastly different definitions or understandings of the term. Especially in health care research, comparability over time, over different settings, different regions or countries is of great interest to researchers and policymakers alike.

Methode / Method

The literature search was conducted in five different databases (Medline, EMBASE, CINAHL, Business Source Premier and EconLit) and included results from 1929 to 2022. The topic is addressed in the form of a scoping review, which was conducted in accordance to the Joana Briggs Institute (JBI) methodology for scoping reviews. A medical librarian was consulted for the formulation of the research strategy and adaptation to the different databases.

Ergebnisse / Results

Of 1441 individual sources identified, 389 were included in the review. Included papers were published between 1974 and 2022. Most papers using the term “efficiency” do not include explicit definitions or explanations of their understanding of it. Almost all papers are interested in productive efficiency (vs. allocative efficiency) and more specifically in technical efficiency, therefore comparing the number of inputs used and outputs produced. While many papers include some elements of quality of care in their discussion, only a few include aspects of quality in their measurement of efficiency. Over the last decades, efficiency research in health care has become strongly focused on applications of Data Envelopment Analysis (DEA) or Stochastic Frontier Analysis (SFA), while the use of efficiency indicators such as "length of stay" have become less frequent.

Zusammenfassung / Conclusion

To allow for better comparability and potential policy implications, researchers in health care should use the term “efficiency” more judiciously and state explicitly what they understand by the term and what exactly they are measuring or comparing.

Authors

Mélanie Lötscher-Stamm, ZHAW Zürcher Hochschule für Angewandte Wissenschaften

Golda Lenzin, ZHAW Zürcher Hochschule für Angewandte Wissenschaften