Sustainability across the Medical Device Lifecycle: A Scoping Review

Round 1

Reviewer 1 Report

This is a good review study! It gives comprehensive and systematic overview of sustainability issues during the entire medical device lifecycle. I have two suggestions:

1.    Add a table with all the references and indicate which issues are addressed in each article. I think such a table is an important addition to this article. It is now in the supplementary files.

2.    Add a figure in the discussion section showing how the authors have abstracted and categories their findings leading to a model or theory about sustainability. Now the authors have written this as a list of principles at pages 16-17. For me this suggestion is not conditional for accepting this paper, but I would welcome it.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Thank you for allowing me to review your article. This is a significant work and original.

Recommendations

1.      Make a table which will include the details of the  41 papers  selected by the review process

2.      Provide a frequency table of the country of origin of the 41 articles

3.      Can you create categories for the 41 articles? How many? Report them. For example, how many articles from 41 are related to a circular economy?

4.      How do you relate the 41 articles to 9Rs

5.      What is the relation of the 41 studies and the medical ethics? Can you explore medical ethics issues more? 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

This review addresses an important issue of environmental impact on medical devices and equipment. This review presents the key findings from a scoping review of academic researches on these topics, which focuses on reducing the environmental impact of medical devices and equipment. Material and methods followed in the review are based on PRISMA statement for scoping review.

The following are my comments:

1.     The Introduction section does not clearly provide the justification for this review (although the abstract provides a clear picture). The authors abruptly introduced lifecycle of medical devices (MDs) and the climate crisis (Line 101) and then followed by the aims of the review.

2.     Introduction heading 1.1 Global emissions, net zero policies and the healthcare industry- here inadequate attention given to health industry.

3.     Page 109-110 mentions “This scoping review on sustainability across the MD lifecycle was performed with the following objectives in mind”. This is also mentioned as second objective of this review.  Please mention about MD life cycle and its likely impact on sustainability in earlier paragraph (although these are presented in 161-170).

4.     Article addressing “End-of-life” stages were too little. Therefore, future studies also need to address on this aspect.

5.     In many places in the manuscript, the authors fail to mention the source of information. Therefore, it is essential to mention sources wherever appropriate.  For example, please see line 82-83. “The aggregate healthcare industry emissions may cause a  loss of up to 3,060,000 DALYs (measured again in a loss in human health annually)”.

6.     Conclusion section may need little elaboration on advances (strengths) related to the sustainability of MD industry from this review.

Minor Corrections

Line 614 -15 references required

Line 668- starting with serial number-2 (but serial no. 1 is missing)

Minor English editing is required  

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

1. At page number 3 line number 140 correct the spelling of 'recycl' to "recycle"

2. Update the time frame to include publications until  January 2024

3. Inclusion/exclusion/selection criteria would be better presented in a table with two columns. For example: 1st row (merged cells): Article type; 2nd row splitting into 2 columns with left cell having the inclusion criteria for article type and right cell having the respective exclusion criteria; 3rd row (merged cells) language; 4th row splitting into 2 columns with left cell having the inclusion criteria for language/article types and right cell having the respective exclusion criteria, for other document types, drugs, vaccines etc.

4. Please structure your Discussion section as follows:

• First paragraph of the discussion should be a brief summary of the main study findings relative to the stated objectives/aims/hypotheses from the last paragraph of the introduction

• Following, a more detailed discussion of those findings, including interpretations, implications, and comparisons to existing literature

• Next, please include the paragraph(s) on limitations

• The last paragraph(s) should be conclusions that don’t just summarize the findings, but speak to the broader health implications

minor english 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Thank you for this work, which is more apparent after the additional information.