Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, everyone. Welcome to this session. Um is on sort of attitudes and barriers of different healthcare professionals and it comes sustainability. My name's CIA. I, I'm doing sort of an MD and sustainability in theaters. I work with Sean. Tell reason. She's one of my supervisors. So that's how I sort of involved. And we've got Shavon who's our co chair here. I'll let her introduce herself to you. Yeah. Hi, everyone. I'm so Yvonne, I'm the quality improvement education leader. It's the S H uh and I'll be co chairing today. So we've got some really interesting posters to go through today. So starting off our session is Ebeneezer. So I'll hand it over to him now. Okay. All right. Thank you very much. So, my name is Agnes and I'm with the Center for Healthcare Research and Communities at Coventry University. I'm presenting on perception, attitude awareness and perspective towards sustainability practices and climate change. It's a systematic literature review, basically. So, um there's an outline of my presentation today and a bit about me which we can share later with the slides. So, um it is quite known that climate change is the biggest threat that humanity is actually dealing with presently and through some mathematical modeling and satellite retrieve all scientific techniques, we tend to realize that human activities are the major cause of climate change. And we notice by plastic consumption, all use of fossil fuels and deforestation is as well. We see the impact of climate change, flat heat waves, droughts, hurricanes, and even the UK recording the highest temperature ever last year, 40.3 causing a lot of damage. And we see the impact of it also on the health of humanity leading to vectors ecology. When presently there is an influx of a breed of an of less mosquito into the United Kingdom as a result of changes in this climate um uh aspect of it. But there is this element that is being propagated or let me say some researchers are fighting for definition in this and call climate injustice. If you look at the map, I do have the, the it talks about the countries which actually contribute highest, the ones with colored red contribute highest when it comes to carbon emissions and countries which um highly vulnerable in the be colored right there. So you see that the global North which is the United State Candida, then Europe, Australia actually contributing highest. But when it comes to the impact of it, the dangers of it, those who did the global South, South America, Africa and Asia actually suffering the most. So if you look at images here these are some of the impact of climate change, a whole family being displaced, sleeping outside. This is kind of worrying and you'll be asking yourself how is this is being the consent of the healthcare system? The lancet recently reported that the healthcare system contribute to 5.2% of it. If you look at that 5.2 and just oppose compare with countries admission, you realize that this percentage, if the healthcare system were to be a country will be among that of five nations, the NHS contributing 5.4%. Then also when it comes to the public sector mission, 40% of it. Now you'll be asking yourself, how is this even the concern of nurses. So the NHS has been seen to be actually be the Europe slightest consumer of single use plastic. So in 2019 22% of the NHS plastic waste were produced, but 5% were recovered. It then raises the question, what happened to the source of generation, what happened to the source of segregation and who had a major consumers of this? And research has noted that necessarily the higher proportion when it comes to the healthcare um workforce and we could do something. So we did a systematic literature review to inform our study. So um it actually looked uh we took a mixed method systematic review and followed to Anna Breaks Institute methodology for conducting systematic review, went through 18 papers, came out and at the end of the day, we're able to use the J be integrated approach to have five teams coming out. So basically, the next slide is talking about the findings or the teams that emerged from all those papers that came out. So we have the knowledge and awareness of climate e some of the papers reported at about 50% of nurses were aware of climate eight and its impact that there was a study in Manchester in 2015 that stated that nurses, we're not even aware of the sustainable healthcare actions and which was kind of worried. And when we look at people's, we had awareness among ness's. The media was the major source of awareness necessary reporting that humans were perpetrators of climate change, which is in consensus with the Global Agreement. And there was a recognition of climate impact among this is and this is also a platform for behavior reacting while nous is actually recognize this climate impact. But one worry inside of it that came out of the papers was that nurses did not see the link between your practice and carbon footprint, which was kind of worrying. So why is this perception existences all the papers it needs to be further looked into, we need to do more research into that to find out a lot. And even in situations where papers reported a link was the care they're necessarily provide the climate's of rest. But the point is the cover for, they are not able to see the link there. But in some papers, there were reports of um sustainable practices somewhere riding bicycle, somewhere like we are reducing the um goods that we use at the hospital and that it was beneficial having economic impact and also public health impact. But in all these things, there were limitations as the necessary ability to be able to contribute highest when it comes to sustainable practices in the papers that we came about. So in some of the papers necessary reported, their duty is to the patient immediately. It raises the question, our nurses over stretch and we haven't stopped shortage. Why is that a problem? There was four implementation policy in that some necessary like we don't have the right color coded beings to help us with segregation. So what is the healthcare institution leaders doing about these? There were procurement which were on essentially can stay over the shelf for so long and they were not even use and it ends up increasing the carbon footprint of the healthcare system. Then one last bit of it, which is actually um putting me on the spot to actually look more interim with the lack of organizational support, the paper reported and nurses were able to suggest ideas but healthcare leaders, we're not actually taking that into consideration, which is kind of worried. But in all these things were able to realize that the nurses were exhibiting readiness to be sustainable in their practices. And some of the options were too go through professional development as well. So in conclusion, uh would say that there is this need to increase awareness of the net zero healthcare targets among ness's and mobilize activism relating to the healthcare um practices in relation to climate change. And when it comes to those perception that were noted, there is a need for us to consent, eyes nurse's role in climate change. There is a need for nest leadership in every organization or let me say in every climate policy institutions, when it comes to health care sector so that they can contribute their quota and help have a voice for Nelson. And there is a need to eradicate some of these barriers in the UK because the UK is um is a pioneer or let me say the first health system to be able to have um and a zero plan and also achieving coercive. So basically, this is um the findings that came out of a summary of it, of our systematic literature review. Thank you very much. Thank you very much money. So that was really interesting. Um Any questions, put them in the chat, we'll move over to our next presentation now and then we'll do the discussion at the end. So you can see if joy your next. Yes, I'm happy to go next. Um I've had a slight tech issue. Um So I've not been able to share my screen. Um but I have sent my slides to the Comms team. If you're, if someone's happy to share them, it's gorgeous. We got someone from the Comms team here. If not, we can move on to the gym and come back to your pinkie. Is that okay with you, Jim? Yeah, of course. Sorry. Yeah, I am happy to go next uh email the Comms team. Thanks very much, Jeff. Uh Should I stressed up? Yeah. So I'm presenting uh some research that I did entitled exploring consultant perceptions of education, sustainable healthcare in the clinical environment. And I'm 1/4 year medical student at Brighton Sussex Medical School. And the project was supervised by Doctor Veneta Flood. So why education sustain well, why is this important for students to them? Well, climate change and ecological destruction is the greatest threat to human health. Um The NHS has a net zero goal of 2040 of which students will play a vital role in achieving this and it's mandated by the G M C um sustainable principles, the principles of sustainable healthcare. Although somewhat vaguely how it's currently taught, Bevan has out published a recent study in which he used student auditors to look at the curriculums of 14 medical schools and assessing or 13 sustainable healthcare outcomes and found pretty good coverage at 9.9 um you coverage of 9.9 outcomes. Um Although the Planetary Health Report card of the same year which assesses medical schools are much broader planetary health and climate change metrics found only 47.6% coverage having said that things are improving. So the latest edition of that report um this year with up to 60%. So that's great progress. Um looking at the literature on sort of pedigrees, how what modalities is sustainable healthcare taught um in the published literature. And there's some group case discussion, online modules called curriculum lectures, skills workshops. What's missing? Um And what's there's a gap in the literature on specific inclusion of this material in the clinical environment. How can we get this material from the lecture theater into the clinical environment? And so we're missing out on a key learning opportunity for students to participate in practice in sustainable healthcare. And if we want students to go on to be sustainable clinicians and when we need to include this in in the clinical environment. So to what? So to fill this problem, our research question was what are consultants perceptions and ideas regarding increasing the quality and quantity of education, sustainable healthcare in the clinical environment? And we um tackle this using a qualitative approach running two online focus groups with a purpose of sample of consultants interested in sustainability and involved in teaching medical students. The study was approved by B S M S's Research Government Governance and Ethics Committee and we use brawling clerks thematic analysis with an inductive approach to analyze our data. So what did we find three things. We found three themes, clinicians, knowledge and attitudes, clinical setting as a learning environment and stakeholders in E S H development. So starting with theme one, um clinicians, knowledge and attitudes and knowledge. The group identified a perceived lack of confidence and knowledge, the consultants to deliver this education. If they don't know themselves, they don't know sustainable healthcare themselves. How are they going to teach students and then partnered with this, um the group identified sort of negative attitudes towards it. You know, there was a lack of perceived importance amongst consultant colleagues on the on including sustainability within teaching. Moving up the theme to the clinical setting as a learning environment, there are pros and cons of the clinical setting for for teaching this material benefits being you, you're able to situate this learning in real world context, bring the bring sustainability into cases in front of you. Um and also to kind of witness positive role modeling. If you're seeing clinicians practicing sustainable healthcare, then that's a really positive learning experience, there's unique MDT learning opportunities. So a lot of medical education is delivered by clinicians. But in the clinical environment, we learn from everyone, we learn from the wider health professional team. So there are negatives to this environment and the sort of major one being time, this is a very time, busy time, pressured environment. There's only so many topics that can be covered. Um And if you're on a sort of war ground, then you may not, sustainability may not be the top priority, lack of shared vision. So while the ent department might may be really hot on sustainability, um other departments maybe less so, so you get a large disparity in the quality of education received. So lastly, stakeholders in S H development, the group identified that medical students, the medical school assessment bodies affiliated institutions all had their role to play in developing this education. So starting with medical students, it was sort of put to the group that medical students um sort of drivers of this education, the students could come to the wards with sustainability and ask the consultant about it. Ask the clinicians at it. Actually the counter argument which raised we can't, we can't expect students to know what they need to learn. So while you do have the keen students who want to learn about it this way, you'll miss out on lots of other students, the medical school themselves. So it was felt that the medical schools could do a better job of communicating the sort of urgency and the importance of this education to their consultant colleagues. Um the medical schools got their agenda in sustainable healthcare education. But if that's not communicated clinical educators, then that sort of attitude and that importance is not going to be realized affiliated institution. So this is the trusts in the hospitals. This comes from the idea that if the if the environment itself becomes a sustainable place. So you're sort of if your ward is a sustainable ward, then this will translate down into teaching and lastly assessment bodies. And this is differentiated from the medical school as we moved to um standardized assessments in the UK. So the with the medical licensing assessment coming in, um the writers of that have a role in making sure it's included an assessment because it was, it was strongly felt that without inclusion in assessment and you wouldn't get the motivation to teach it or for the students to learn it. So from, so from our results, we came up with three recommendations, education for clinicians. If clinicians don't know, sustainable healthcare, how are they going to teach me? Communicate TSH curricula? So this is about the medical schools role in communicating the importance of the sustainable healthcare education to the commission's stakeholders. Take ownership. So without a shared vision of all those stakeholders, then this really kind of comes in pockets, you get the sustainability and pockets. But what we need is a shared vision from all the stakeholders. And so the study provides novel insight to share group cultures of consultants with a limitation of the somewhat small sample size. So that's my conclusion. Like the clinical environment requires a shared vision among stakeholders and and up skilling of clinical educators. And that is my side of references. Thanks very much. Listen, thanks very much James. That's really interesting. I'm sure it will sparks the discussion later on, but for now if we can move on to the pinkie. Hi, I'm just, I'm just helping out pinky. Um thinking I'm just uploading your slides and is that right? You're not able to share your slides? Yeah, exactly. I've tried to, you is just due next slide, please. Okay. So, um yeah, slide deck is uploading if you just give me a present. Now, can you all see that? Yeah. Okay. So thank you. Just finish out the next slide, please. And I'll look forward when you need it. Okay. And I mean, obviously if you need anything further and uh any other secrets seems to be in the list here as well. Uh Right. Uh Thank you, Heather once again, I'm sorry for the uh technical difficulties. Um but it wouldn't be an online conference otherwise. Um My name's Pinky. I'm one of the academic, junior doctors at Brighton um working on medical education and sustainability. Um And one of the projects I've carried out this year has been a systematic review looking at the attitudes knowledge and barriers of healthcare towards um sustainability. So next slide please, Heather. Uh um So after screening over 700 studies, we included 12 studies in our report, eight of which were surveys to were pure qualitative research and two were mixed methods from a variety of countries overall. We included over 3500 participants um and have an X slide, please. Um and overall, our results show that um from an attitude point of view, one of our themes identified was that there's an indifference about sustainability. So it's usually not considered the first priority in the daily work of a health care professional, even though it was felt that sustainability was an important issue. Um There's also a positive influence on behavior. So many individuals are willing to make personal changes to practice um such as switching to reusable equipment or recycling and some of these have been adopted. Um The other theme identified was around effect infection control and environmental issues of valued, less than protection qualities. Um And it is uh the general view from the studies collated was that there was um we don't want to compromise patient safety. There was also concerned about pathogen transfer. For example, one of the studies was was with mask use and this was one of the big concerns very relevant during the COVID pandemic. As last um knowledge was the second aspect that we were looking at. So firstly, we identified that there was a lack of knowledge um due to possible no prior formal training. Um So for example, people were unsure of what to recycle. And from a survey study, half of the UK and Irish surgeons felt they had the knowledge to improve surgical sustainability. But the other half were lacking at um there's a need for more training and education. Um And this was welcomed by most healthcare professionals, including surgeons, nurses and nursing students in the different countries. Um only very few received training. Um but surgeons were very willing to dedicate research products and audits to sustainability. And one of the studies specifically showed that knowledge improved attitudes as well. So, uh in terms of the barriers identified from the studies, um one of the main things was the inability to make a difference and many of test that felt it wasn't their responsibility. Um So there was a sense of apathy, um disempowered staff uh included sort of a lack of authority, a feeling of helplessness um to be able to make these changes. Um Another very common theme was feeling of a hierarchy in the decision making with certain healthcare professionals feeling they had little impact on the decision making as well as both the lack of time and resources in already a very busy environment. Lack of leadership was another important theme um as identified as a barrier. Um So healthcare professionals felt they made more of an effort at an individual level rather than institutional level. Um And they felt they had little support from colleagues and department and actually would welcome more National Guidance um which is definitely an area that can be worked on um practical aspects. Um Heather, are we okay to just get the slides back on? Sorry. Uh My whole computer just froze and I, I lost uh let me just get, I missed about it. I don't know, a minute or something there. Which slide were you on? Was it the third one? Pinky? I think it's the same result slide. Okay. Just give a second foot to warm up. Fingers crossed. My internet doesn't drop again, but I don't know if there's in some interference because I'm just in a ward office as well because I'm not being able to proper space to do. Yeah. And actually you've just explained why you couldn't get in. We're finding that a lot of anybody to work saying that the firewalls in the initial system, they block a lot of why they were blocked, but I seem to be back in. Is that ok now? Okay. Yeah, that's perfect. So I think we're just speaking about the barriers um of sustaining the barriers that we encountered um in the studies. And we've summarized it into three main themes. Uh First, the, the inability to make a difference, which I've spoken about already, the lack of leadership and the fact that healthcare professionals would welcome more national guidance as well and the practical aspects that can be a barrier. And I'm sure a lot of people who work in the NHS. And um we can see that a lack of facilities um is a practical aspect that as a barrier for all of us, um higher cost or perceived higher cost of equipment as well um as well as infection control is something that again is mentioned as a barrier which again, um also shows the lack of knowledge. So next slide Heather, please. Um so this is all something that we can, you know, apply to the combined model. Um And we're still in the process of collecting sort of our own local data to understand what healthcare staff understand um about sustainability specifically um in the surgical environment. Um But from preliminary analysis, even though there are multiple positive thoughts about reusable equipment, including better quality of reusable equipment, there are the barriers identified a very similar to the systematic review and that those include the lack of leadership, the lack of education and the practical aspects that we encounter on a day to day basis. Um Our research and our data collection will inform which aspect of this comedy model that can be targeted to sort of enable, enable behavior change and for people to implement behavior um to create change, they need to be motivated and this needs to be linked with both the opportunity and the capability as well, which we can see in this nice model. Um And I think that is the only next slide heather. Mm So these are my references of all the studies that we've used, which was essentially all the studies that we found on the attitudes knowledge and barriers of healthcare staff towards sustainability. Our focus in the trust um or the focus of my particular study um is single use equipment in theater. Um And it's something we're carrying on. But I think what are we taking questions at the end or now? Yeah. Thank you very much, Pinky. That was very interesting. We've got one more presentations and we'll do questions. Yeah. Keep praising them in the chat if you have any questions with Pinky. Um, I think the last presentation is from Sarah. Uh, do you have Sarah here? Yeah. Hi. Hi, Sarah. You able to share your slides? Cool. Perfect. Yeah, I start. Wanna be already cool. Right. Hi, everyone. I'm Sarah and one of the doctors at University Hospital Wales, like just like to mention Doctor Abbott as well who supervise this project. So I'll be um doing presentational surveying the attitudes of dermatologists regarding sustainability. So looking at the background and a um there is increasing concern on how climate change is affecting our environment through higher temperatures, increased pollution and also decrease protection against UV radiation. And studies have shown this can cause flares of several skin conditions and this includes atopic dermatitis, pemphigus, lupus, and also increased rates, rates of skin cancer. Therefore, it's important for us to be aware of our effect on climate change. Additionally, as clinicians, it's important to be aware of what we do within our specialties. There's been limited number of studies assessing dermatologist attitudes towards sustainability. And so our aim was to assess the attitudes of UK dermatologists regarding sustainability. So an online questionnaire was created using Google Forms and this was used to explore the opinions and actions of UK Dermatologists on sustainability. And this included 15 questions and distributed to members of the British Association of Dermatologists. And this is the professional body for Dermatologists within the UK. And this was distributed by email. The questioner contained multiple choice checkbox response questions and also free text answer questions and the results were then analyzed. And here you can see a few examples of the type of questions we asked. So um just looking at the results and the demographics, um in total, we had 100 and 28 responses. And the majority of the respondents were aged between 30 to 60 and majority of the participants were in the age bracket. 51 to 60 followed by 41 to 50 and then 31 to 40. These age brackets are respected with the majority of participants being consultant to dermatologists. And if you look at the other roles in the current role section, there, um there are registrars and special associates, GPS with special interests, nurses, retired consultants, and pre registrar level doctors as well. So exploring the participants thoughts on climate change, the majority felt that global climate change was happening and they also felt that global climate change was mostly caused by human activities. More than half felt that global climate change was impacted patient's. Although a third were ensure, looking and exploring the changes in the participants personal and work life in response to climate change. Um At work, there was use of tele dermatology, um increased efforts reduce waste energy consumption and also increase in recycling. Some were also involved in sustainability groups and in their personal life, people also reduce their energy consumption, change their food habits, their method of waste disposal and also method of travel. Some also made donations and investments to green projects. In our survey, we then explore the responsibility dermatologists felt that they had and a majority felt that there was responsibility for us to be aware of the environmental impact of dermatological services. However, more wanted to read about sustainability in dermatology then exploring the barriers to sustainable practice, several were identified. So cost is one and this can be because some most of transport can be cheaper than others. So for example, traveling for courses and conferences, for example, in Edinburgh, going by plane can sometimes cheaper than by train. It can also be cheaper to use single use plastics and gowns for procedures compared to reusable resources. Another example is inadequate education. So lack of articles and journals, journals specifically looking at sustainability in dermatology. Another is a lack of recycling facilities and in reality, if facilities are unavailable, it can be difficult to implement. Leadership is also important to promote and implement these ideas. But we also need institutional support to bring these to fruition. Some commented on also Black Swan practices. So this is when we stick to what we're used to instead of changing practice with new evidence. So for example, some clinicians are still using sterile fields and gowns when there is no evidence that this improves infection rates in dermatological procedures. Mhm. So at the end of our survey, we provided an area for additional comments and a few topics were highlighted by several participants. So demand for national guidance for dermatological Services that can be adopted locally, involvement of management to be part of these developments. Cutting down international travel to dermatology meetings or holding virtual meetings like we are today going paperless having better I T teleworking tele consults, having more education lectures at annual Dermatologic all meetings was a quite a popular comment that we had and also switching to online journals. Other comments also were to reduce packaging. So having engagements from industry um and also for our organization British Association of Dermatologists to lobby companies to do this re refill emollients for patient's. Obviously patient's go through a lot of emollients. So just reduce those packaging, maximize recycling at the workplace and again, organizational push. So the B A D and the NHS promoting the single practice. So I'm actually commented that this is all a drop in the ocean and actually voted for Green Party might actually make the real difference. So what is the importance of our study? So our study has shown that there are UK dermatologists who are conscious of global climate change and its potential effects on patients' through the study, we have a better understanding of current personal and working sustainable practice of dermatologists in the U K. We've also identified barriers for better sustainable practice and we now know the areas we need to tackle such as better education, working with farmers, national organizations, pushing for sustainable practice and educating our managers. And key highlights from the study is that there is demand for more education and guidance on sustainable practice. I just like to thank Doctor Rosenbach for giving us permission to use an adapted form of their survey. And this are the references and then I think we're going to questions anyway. Great. Thank you very much. Uh As we said before, any questions, pop them in the church and I don't know if you've got any or seen any, if not, I've dropped it down a few listening to the presentations. I can't see it. So if I'm, I've got one for James, I thought that was really interesting. And obviously at the end, you said consultants, conditions basically need to be educated more. I'd agree with that. I only left university seven years ago. There was nothing on sustainability my curriculum. Do you have any ideas on how to bring that into play? How to educate clinicians, sustainability? Yeah. So that's a, that's a good question. Something weird with actually. Uh So in Brighton, there's the Green Representatives group which meat um they're kind of leads from each department they meet and I think our plan is to approach them and ask them um possibly about doing that kind of like lunchtime, like 10 minute sort of lecture series where sort of people can drop I/O. And it's just about kind of very basic sustainable healthcare principle stuff because I think a lot of the sustainability sort of stuff we see at the moment, it's very like carbon footprint ing and life cyclist doesn't, it's all very technical. Um But actually just those basic principles about environment, economic and social sustainability are things that most clinicians would already know but not necessarily put them onto a sustainable banner. So it's about just I think back to basics and then hopefully kind of short drop in sessions is kind of the plan. Do you have any sort of timeline on when you might roll that out at Brighton? Very, very early stages? Yeah, so no timeline. Can I just come in there and just make a comment on that? Actually, just as a sort of um is that okay? See. Uh but you know, I think you made a really good point um gym and you're talking about, you know, this theory to practice and sort of and we can teach in the classroom. But so what if it doesn't actually make a difference in the real world and in healthcare education, the sort of type of education as often bridges that gap is in simulation and clinical skills teaching. And um so the medical school has been coming up with some guidance. Um And um there's a number of universities that are coming together, so I'm just putting it out there. I'll post this later or do an announcement. If you're interested, any educators, our students want to engage in this type of discussion. We're going to be gathering very soon to come up with some standards and guidance and the association of I might say this wrong sp association of stimulation and practice and healthcare. Is that right? They're National conference is in um October November sometime on the theme of sustainability. And they'd like to come up with some guidance, but they don't know what to recommend. So if you, if you're interested in contributing, so that, you know, people that are in this sort of space or are sort of working together to help with that kind of theory, to practice gap and using the simulation sessions as a way of um embedding that into practical things within university health care courses, which then hopefully, then um leads out into the future as well. It's really interesting to know ahead of. Thanks and yeah, and if anybody's interested, they can contact either the medical school or, or me or the specialist group. Thank you very much Heather. Um So we have this follow on question for James. Do you think there's space for co created learning with consultants, trainees and medical students? The idea that senior colleagues can teach junior colleges actually unlikely given how uninformed many colleagues are. Yeah. Yeah, definitely. So, I mean, this is something um Sanya raise written about as well, actually about Koehler earning about um sort of students and clinicians learning together or indeed clinicians learning from students. Um And again, it's something we thought about in Brighton, but actually the, the sort of logistics of putting together a session requires heavily on kind of volunteer time of students. Um So I think it's a great idea and sort of in principle sort of flattening that hierarchy and everyone learning together from each other is great. Um Definitely space for it, but they're kind of logistics and time. Is it big investment? So possibly something we're gonna look at. Sure. And then we've got a couple of questions for Sarah. The first one was, is there any significant variation in the responses you got by age group? Yep. Um So the majority of the age group, as I said was kind of between the 40 to 60 bracket um within that there wasn't really any variants um in the comments. Um So we didn't really specifically um analyze it in that way and that, that is actually quite an interesting point. Um But we didn't see any particular patterns or anything to pursue that avenue, but I think that's quite a good point actually, that's been raised. Okay. And then another one for you again, Sara is um did you encounter any discussion on the use of emollients being paraffin based that often presumably linked to extraction. Are there any better alternatives or any discussion on the impact on wastewater, etcetera? Yep. Um, so there weren't any discussions on the use of emollients. And I think, um, partly, um it's because of the way the survey really was to get a base over the idea of the opinions of dermatologists. So we weren't really focusing on certain treatments per se but on the general opinion. Um So the comments that we have that I shared with you guys was more the free box comments. So if people wanted to about immediate they could have, but it was actually not the case. The only real comments that we got were about recycling the packages and reusing the packaging for Imodiums. But I think that is definitely um an interesting comment about alternatives. I don't think there are better alternatives because Imodium are very effective ensuring to be very effective for treatment. Um But with regards to um the extraction and alternative, the impact of water waste and such, I think that's something that as a sustainably sustainability group, within the British Association of Dermatologist, we can definitely discuss, but this wasn't explored within the survey. Thank you very much. Um Ebony, you've got a question for you a couple actually, firstly at it review, when you looked at the attitudes of nurses, were most of your studies from the UK or they sort of all global. Oh, I think you're muted. Hi. Yeah. So we, we had a spread globally. Um, actually we have one paper from Africa and we had three from Asia where we had two from China. Then Indonesia also had one where we had a lot of people was the North America because USA had about five papers, you know, we had Candida having to of it in the UK. We had only to pay passageways specifically talking about neces in the UK at the moment of it, a collection and we've been talking a lot about sort of medical student education is anything on the nursing curriculum at the moment that involves sustainability to get nurses or better just need. So for now, uh as part of NMC professional uh requirement for the midriff free uh qualification, they have something like that before the Nessen it is yet to be done. So I think other researchers are moving up or propagating for changing that line for it to be included in the curriculum. And I know Royal College of Nursing is also having a cause that they are about to run in September on sustainability for nurses. So there are those things that they are doing to help educate our people. Uh I think Heather is also just shared a link um of a resource for embedding sustainability to sing education. So that's something else we can look at which is good. Um Zoey's mentioned that there's nothing a curriculum and not in sustainability. And her and a colleague are trying to put materials forwards. That's good. Hopefully she can get some ideas from this course, how to do that successfully. Uh um Also if you guys have any questions for each other being sort in the same department, feel free to go ahead. Yeah. Uh uh um Pinky, you said you're doing sort of your own interviews at the moment. Have you found the barriers or the attitudes are similar to your systematic review? Yeah, I think the attitudes and barriers are very similar, interestingly, the barriers over all of us say very much on lack of leadership. And I think um Tim mentioned as well, so we need a top down leadership and it's actually something very interesting that, you know, consultants are like it's up to the new generation for then obviously, people who are involved in procurement are consultants and um there is a bit of a lack of knowledge and a big gap on how we procure things um and how to make those systems more sustainable. So it's been very interesting carrying out the interviews and analyzing the data on um how uh surgical staff, so anyone involved in theaters and how we procure equipment? Because actually one of the recent guidelines published, I think last year show that single use equipment is probably one of the most, you know, carbon intensive parts of the obviously including anesthetic gases and everything else. But um it is a big focus and an area that requires a lot of research and a lot of work with industry as well, which, you know, I think conversations have started in the last few months of liaising with industry and really trying to cut down on our plastic packaging and considering moving away from single use and going back to reusable, you know, cystoscope and, you know, that's just the name of you. Yeah, I think that industry point is very interesting because I do something quite similar. I've been speaking to industry a bit and they're saying that obviously I just have these goals for 2040 but as of yet, there's no mandate on what we do so that they're, they're developing reason things. But then if they're not getting the, the film and in the ordering and it's not really worth it for them to keep developing it to such high standards. So it's almost like a catch 22 you gonna like, try and, you know, order it first and then, then if we keep ordering, then industry will go better and have better alternatives for us. Yeah. And actually speaking to industry, I think one of the things that was really highlighted to me is there sort of like a checklist essentially that industry has and the carbon footprint or, you know how green something is, is actually such a small part that they can be outweighed but, you know, cost or something else that actually it's part of the tick box now? Yes, but is it just a tick box or are we actually trying to achieve a change by, you know, actually paying importance to it? Um So I think, you know, working with industry colleagues is really important and gives us a really different perspective. Um And I think something that our consultant colleagues and you know, not just consultant but leadership nurses in charge, you know, a different multidisciplinary team and hospital needs to be involved in as well. Definitely Sarah, have you found that, that you involved at all with industry and how those changes are made when it comes to dermatology or it was more looking at within the department, what they can do. Sorry. Did you mean the, the serve a purpose? So this was more um for um the practice in general for dermatology is across the UK and it's more about their own practices in there in centers. Um And I think one of the big themes that we found from our survey was um the need to push the industry um to be more sustainable, especially in dermatology. I don't know if only if you've been to um dermatology um courses or conferences, but you get a lot of um companies with a lot of samples, there are a lot of plastic and a lot of things that they give away papers, pens, you know, even other conferences and things. And I think it's really pushing them to think of sustainable practice. Um But, you know, they're not going to listen to just a couple of doctors. I think it has to come from another big organisms such as the A D um or, you know, if you're a different specialty, um your own organization to really push these industries, industries, to um promote sustainable practice. I think everyone kind of has to shout a little bit, I think to make change. No, I think there's been some good comments in the chat. Um Got one from Melanie Madison from King's College London Nursing. Um And they've been given the first beacon site status with TSH as the first school of Nursing to embed sustainability and all their curriculum. And she said she's happy to share her journey and actions and she put her email in there. That's great. It was just a question for Ebony Za. Um I think you mentioned how there was an inadequate link between climate and nurses and a need to increase awareness. And I just wondered if you have any ideas in terms of ways that we can increase this awareness amongst our nursing colleagues height. All right. So basically, these findings came from some papers actually in Canada's to and also China to Maine paper scheme from that. So at this moment of my phd, I am actually about two, I have piloted a survey about to rule that out where we want to actually hear the voices of the nurses and basically the UK certain because when you look at the NHS. Greener, greener, NHS, they did a survey and they were able to bring out some of the things that nurses can do. But it's kind of, it seems to be a generic, getting a normal thing, but I am looking at the specific things that necessary thing they can do to reduce the carbon footprint at the moment. So, from that survey and we'll move on with a qualitative interview. At the end of the day, I will be able to come out something come up with something so specific to our nurses. Yeah. Okay. Yeah. Any other questions? Yes. Well, thank you all for, for excellent talks, really informative. It's a good discussion we had after it has no more questions that we can sort of break 10 minutes earlier. That's absolutely fine. Unless any of you have any questions for each other, there's nothing popping up in the chat at the moment. No, last minute burning questions. I think 1 45 is the next session on the main stage. So feel free to join the last 10 minutes. Another breakout session if you want or just have a little break until then. That was really good. Thank you very much. Yeah. Thank you. Thank you, sweetie. Thank you both for moderating. All right, thank you. Okay. That was the last question that's coming. But it's nice. Do we have to take it off live. Yeah. Should I, I think we just end it. Do we leave? Just leave? I guess. So. I can't like what, whether live button is, there's nothing that says like end or on live or anything enough. Uh, okay. Thank you. Yeah, you too. Right.