Sustainability

Global warming and social justice issues are increasing the complexity of global healthcare delivery. Health systems significantly contribute to environmental harm through carbon emissions, medical waste, and resource overuse. Nurses, as the largest group in healthcare, face workplace hazards and environmental challenges, highlighting the need for institutions to promote sustainable practices and workplace safety. The United Nations' Sustainable Development Goals (SDGs) emphasize integrated social, economic, and environmental sustainability, with health and universal health coverage as key themes. The International Council of Nurses (ICN) underscores nurses' vital role in achieving these goals by linking nursing care to public health, sustainability, climate action, and education. Developing sustainability competencies in nursing education requires practical training in environmentally responsible behaviors within healthcare settings, beyond theoretical knowledge.

* Introduction: Greenhouse gases threaten the health and safety of humanity. The Declaration of Helsinki seeks to protect human health and emphasizes the urgency of implementing sustainable strategies. Sustainability is defined by three pillars: economic (costs), social (clinical effectiveness), and environmental (environmental impact). Clinical effectiveness in cardiac surgery has a new paradigm: "optimized recovery," which translates into fewer complications, earlier extubation, shorter ICU stays, and potential cost reductions. The objective of this study is to compare the sustainability of the optimized recovery anesthetic technique with standard anesthetic practice in coronary artery bypass graft surgery, using a non-randomized interventional study design. * Methods: Patients aged 18 years or older with coronary artery disease scheduled for elective coronary artery bypass graft surgery will be recruited. Combined procedures and reinterventions will be excluded. Sample size: The optimized recovery group is expected to reduce postoperative mechanical ventilation by two hours. With a 95% confidence interval, 80% power, and a 1:3 ratio between the groups, a sample size of 29 and 87 patients was estimated for the optimized recovery and standard anesthesia groups, respectively. * The optimized recovery technique includes, preoperatively, oral pregabalin 75 mg, fasting, no benzodiazepines, total intravenous anesthesia, low-dose intravenous fentanyl, methadone 0.1-0.2 mg/kg IV, erector spinae plane block with 0.25% bupivacaine (20 mL per side), and postoperative nausea and vomiting prophylaxis with dexamethasone. Postoperatively, administer paracetamol 1 g IV every 6 hours, NSAIDs, and methadone 1 mg IV as needed. The standard anesthetic technique involves the anesthesiologist administering anesthesia as they have routinely done prior to the study, without changes. * Four anesthesiologists will participate in the study. Only one anesthesiologist will perform the OR technique, and their results will be compared with those of the other three, who will use their standard anesthetic technique. Patient assignment is independent, based on the hospital's schedule. * Analysis: The clinical effectiveness of each technique will be evaluated based on ICU extubation time. An economic analysis will be conducted based on average costs, and critical environmental impacts will be estimated through a life-cycle assessment. * Outcome: The performance of the indicator "Costs in Euros/CO2e/Extubation Time" will be studied. These will contribute to the estimation of an anesthetic strategy that addresses the challenges of sustainable medicine, reduces emissions, and enables the rational use of resources and their associated costs, offering environmentally friendly and clinically effective health solutions.

The healthcare sector contributes significantly to climate change. Reducing the number of patients receiving resource-intensive procedures such as surgery can lower carbon emissions, particularly when two treatments with comparable clinical outcomes are available. Nevertheless, the impact of incorporating environmental considerations into patients' decision-making processes remains underexplored. The investigators examine how including information about the environmental impact of treatment options in a gallstone decision aid affects patients' real-life choice between surgery and the more sustainable alternative of conservative treatment. Moreover, the investigators examine whether factors such as severity of symptoms moderate the relation between sustainability information and patients' treatment choice. An exploratory vignette study informed the hypotheses that will be tested among actual patients with gallstones making actual treatment decisions. The results of this ecologically valid study have implications for both clinical practice and healthcare policy by offering insight into the effectiveness of pathways to include patients in the transition towards sustainable healthcare.

This is a five-year hybrid type 3 effectiveness-implementation study evaluating multilevel strategies to sustain a nationwide implementation of an evidence-based HIV prevention curriculum in schools. Advanced machine learning methods are being used to enhance implementation strategies. A Sequential, Multiple Assignment, Randomized Trial (SMART) design will be employed.

Background: Climate change awareness among nurse managers is crucial for enhancing healthcare efficiency and mitigating environmental and societal impacts. This study aims to develop and implement an educational program to improve nurse managers' awareness of climate change. Methods: A randomized controlled trial will be conducted with 108 nurse managers (54 experimental, 54 control) from two major hospitals in Istanbul, Turkey: Kartal Dr. Lütfi Kırdar City Hospital (n=71) and Göztepe Prof. Dr. Süleyman Yalçın City Hospital (n=58). Sample size was determined using G\*Power 3.1.9.7, referencing the study by Alvarez-Nieto et al. (2022), assuming an effect size of 0.79, a significance level of α=0.05, and 95% power. The required sample size was calculated as 90, increased by 20% to account for potential attrition, resulting in 108 participants. Participants will be recruited through full enumeration sampling due to the limited number of nurse managers. Data will be collected via face-to-face administration of a Demographic Information Form (12 items) and the Climate Change Awareness Scale (Ataklı \& Kuran, 2022), which consists of 52 items rated on a 5-point Likert scale, with a reliability coefficient (α) of 0.92. Intervention: Following institutional approval from the Provincial Health Directorate, education nurses will disseminate information about the study via digital communication platforms. Nurse managers will be enrolled in separate digital groups for experimental and control conditions. Pre-test data will be collected face-to-face before the intervention. The educational program will be delivered to the experimental group, while the control group will receive no intervention. Post-test data collection will occur four weeks after the intervention. Statistical Analysis: Nominal and ordinal data will be presented as frequencies and percentages, while scale scores will be reported as means and standard deviations or medians and ranges. Normality of data distribution will be assessed using the Kolmogorov-Smirnov test. Independent Samples T-Test and One-Way ANOVA will be used for normally distributed variables, while Mann-Whitney U and Kruskal-Wallis tests will be used for non-normally distributed data. Analyses will be conducted using SPSS 26 with a significance level set at p\<0.05. Expected Outcomes: The study will evaluate the effectiveness of the educational program in enhancing climate change awareness among nurse managers. Findings will contribute to the development of targeted training programs to integrate environmental awareness into nursing leadership. Ethical Considerations: Ethical approval and institutional permissions will be obtained prior to study commencement.

The research will be conducted to determine the effect of the sustainable environmental health program on environmental sensitivity, sustainable environmental awareness, environmental attitudes and behaviors in high school students. The purpose of this study is to develop and sustain environmental sensitivity, sustainable environmental awareness, environmental attitudes and behaviors in high school students with the Sustainable Environmental Health Program.

The Cohort on Plant-based Diets (COPLANT) study is a multi-centre cohort study that starts baseline recruitment from 2024 to 2027 with approximately 6,000 participants in Germany and Austria. The COPLANT study focuses on vegan (no animal products), vegetarian (no meat and fish, but dairy products and eggs), pescetarian (no meat, but fish) and omnivorous (mixed diet including all possible animal products) diets. The aim of the COPLANT study is to gain new insights on health benefits and risks as well as social, ecological and economic effects of different plant-based diets in comparison to a mixed diet. In addition to a detailed dietary survey using an app adapted to the needs of this study, the baseline examination includes measurements of body composition, bone health, cardiovascular risk factors, diabetes risk, contaminants and lifestyle. For the basic laboratory program, fasting blood, 24-hour urine collection and a stool sample are taken from all study participants. Furthermore, specific aspects of dietary behavior, physical activity and other lifestyle factors are collected via questionnaires. Follow-up studies are planned at intervals of 5, 10 and 20 years after the baseline visit.