Cayley E Velazquez, Jennifer L Black, Naseam Ahmadi
Food and beverage promotions in Vancouver schools: A study of the prevalence and characteristics of in-school advertising, messaging, and signage
Preventive medicine reports
synthesise available evidence effects interventions designed improve delivery healthcare reduces greenhouse gas ghg emissions healthcare systematic review structured synthesis cochrane central register controlled trials pubmed web science embase inception 3 may 2023 randomised quasirandomised nonrandomised controlled trials interrupted time series controlled uncontrolled beforeafter studies assessed interventions primarily designed improve delivery healthcare reduces ghg emissions healthcare initiated clinicians healthcare services within setting primary outcome ghg emissions secondary outcomes financial costs effectiveness harms patientrelevant outcomes engagement acceptability paired authors independently selected studies inclusion extracted data assessed risk bias using modified checklist observational studies certainty evidence using grades recommendation assessment development evaluation data could pooled clinical methodological heterogeneity synthesised results structured summary intervention effects vote counting based direction effect 21 observational studies included interventions targeted delivery anaesthesia 12 21 wasterecycling 5 21 unnecessary test requests 3 21 energy 1 21 primary intervention type clinician education 20 21 studies judged unclear high risk bias least one criterion studies reported effect estimates favouring intervention ghg emissions 17 18 costs 13 15 effectiveness 18 20 harms 1 1 staff acceptability 1 1 studies evidence uncertain outcomes downgraded predominantly observational study design risk bias studies reported patientrelevant outcomes death engagement intervention interventions designed improve delivery healthcare reduces ghg emissions may reduce ghg emissions costs reduce anaesthesia use waste unnecessary testing acceptable staff little effect energy use unintended harms evidence uncertain rigorous studies measure ghg emissions using goldstandard life cycle assessment needed well studies diverse areas healthcare also important future interventions reduce ghg emissions evaluate effect beneficial harmful patient outcomes crd42022309428