Topics

Medical practices

Environmental health Research 4 May 2020 Free

The carbon footprint of pathology testing

Objectives: To estimate the carbon footprint of five common hospital pathology tests: full blood examination; urea and electrolyte levels; coagulation profile; C‐reactive protein concentration; and arterial blood gases. Design, setting: Prospective life cycle assessment of five pathology tests in two university‐affiliated health services in Melbourne. We included all consumables and associated waste for venepuncture and laboratory analyses, and electricity and water use for laboratory analyses. Main outcome measure: Greenhouse gas footprint, measured in carbon dioxide equivalent (CO2e) emissions. Results: CO2e emissions for haematology tests were 82 g/test (95% CI, 73–91 g/test) for coagulation profile and 116 g/test (95% CI, 101–135 g/test) for full blood examination. CO2e emissions for biochemical tests were 0.5 g/test CO2e (95% CI, 0.4–0.6 g/test) for C‐reactive protein (low because typically ordered with urea and electrolyte assessment), 49 g/test (95% CI, 45–53 g/test) for arterial blood gas assessment, and 99 g/test (95% CI, 84–113 g/test) for urea and electrolyte assessment. Most CO2e emissions were associated with sample collection (range, 60% for full blood examination to 95% for coagulation profile); emissions attributable to laboratory reagents and power use were much smaller. Conclusion: The carbon footprint of common pathology tests was dominated by those of sample collection and phlebotomy. Although the carbon footprints were small, millions of tests are performed each year in Australia, and reducing unnecessary testing will be the most effective approach to reducing the carbon footprint of pathology. Together with the detrimental health and economic effects of unnecessary testing, our environmental findings should further motivate clinicians to test wisely.

Scott McAlister · Alexandra L Barratt · Katy JL Bell · Forbes McGain

Mja2 50583
Cancer Letters 16 March 2020 Free

The increasing use of shave biopsy for diagnosing invasive melanoma in Australia

To the Editor: De Menezes and colleagues1 report increasing use of shave biopsy for melanoma diagnosis in association with significant rates of base transection. They cite a wide range of base transection rates in the literature (7–68%), giving pause for thought: what is at play here besides the shave biopsy itself? This is an important question, as the incidence of invasive melanoma rose significantly over the study period along with a doubling of the frequency of shave biopsy. Particularly in Queensland, dubiously honoured with the title of “melanoma capital of the world,” we must be cautious about dismissing this efficient and low cost procedure. De Menezes and colleagues1 could not assess clinician intent regarding biopsy depth, and we do not know whether melanoma was the provisional diagnosis. There is an important distinction between superficial shave biopsies and saucerisation, which is acknowledged but not examined. Saucerisation would be expected to produce lower rates of base transection and tumour upstaging. The authors have not stratified the base transection rate by year. It would be useful to know whether better education, increasing use of dermoscopy and improved shave tools have influenced base transection over the 10‐year period. What is the standard of care for evaluating potential melanomas? Should more excisional biopsies be performed to increase microstaging accuracy when base transection has not been proven to reduce survival? We agree that excisional biopsy is the best way to evaluate a highly suspicious lesion. However, the role of the shave biopsy must be defended, particularly in patients with many lesions, in older and relatively immobile patients, and in rural populations. De Menezes and colleagues1 acknowledge the benefits of shave biopsy in terms of cost and reduced risk of missed or delayed diagnosis when the index of suspicion is low. Better training and improved shave equipment are the keys to ensuring better results.

Lachlan A Byth · Jenny Byth

Neurology Letters 13 January 2020 Free

Advances in stroke medicine

To the Editor: Reperfusion therapies in acute ischaemic stroke have become well recognised in recent years. The article by Campbell1 summarises current practice and addresses the benefits and challenges of several reperfusion therapies, but it misses one key prevention strategy. Carotid stenosis is a significant cause of ischaemic stroke — it is present in about 20% of patients with stroke2 — and can lead to the formation of thromboembolism or haemodynamic failure from hypoperfusion.3 Multidisciplinary care is vital to the management of acute stroke, and carotid endarterectomy is a safe and effective procedure that significantly reduces the risk of stroke and improves perfusion to the brain.4 Carotid endarterectomy plays an important role as reperfusion therapy in acute ischaemic stroke and is integral clinical practice in the management of stroke.5

Suk Cheng · Toby Richards

Subscribe to MJA email alerts

No spam, you can unsubscribe anytime you want.

By providing your information, you agree to our Terms of Use and our Privacy Policy.

Thanks for Subscribing! Tell us more

Your email updates will use your name.

Good one! Your updates are coming

Thank you for subscribing to the MJA email alerts. Receive the latest content in your inbox.