980
KLINICKÁ341804001074588109168189242288347
FARMAKOLOGIE709804001074291138211265312372415474533554598
A13288040010753
FARMACIE1403804001074191138210265316336380
/18298040010732
Klin190680400107446583131
Farmakol2057804001074278105179220258305325
Farm.2402804001074178104179195
2026;40(2):108-1112617804001074487128170185229275299342364379416455500529567602636
/32988040010732
www.klinickafarmakologie.cz4568804001076513320121425327329234035839843647950254457164568672477179183988990895196610061045
1101378020012657107161
HLAVNÍ341200012670127198263336370
TÉMA733200012657114204274
Environmental34136001063071110127162203245299330372404440471
sustainability82836001063171103136172189231270306324355373405444
in128836001061556
clinical13603600106326481122140174216247
research162336001063365100131173208243284
it34362001092253
does423620010953105153190
not640620010952104135
encompass80262001094799142193271325371408445
broader127462001095385136182236283315
ecological161662001094690140164216269292334380403
aspects.34376001094480132179222254292312
Therefore,68176001094698144175221248299330376395
emissions1102760010945122144180216238288340376
estimates150476001094682114135212256287332369
are189976001094474120
likely3439000109214183126147189
underrepresented54890001094998148193222251295346375419455499549577621672
and123590001094392142
the139390001092978123
total153190001092977106150171
ecological171790001094485132154203253274343104001094084105
impact464104001092196147191231263
will743104001096687108129
be888104001095197
even1001104001094588132182
higher1199104001095071121171216246
(17,1461104001092567106116
20).1593104001094691116133
Further1742104001094391120152202247277
progress343118001095384136189220267305342
can712118001094288140
then879118001093183130183
be10891180010952101
made12171180010977123176224
in1468118001092174
accordance1569118001094487128179210263309361403450
with343132001096586116165
the523132001093079123
strategies66213200109356594137166210260281325360
set1038132001093580110
out1163132001094998127
in1306132001092069
various1391132001094286114135184233268
guidance1674132001095099119170212261301345
documents.3431460010951101142192267313363393430449
In483160001092273
the583160001093081128
context737160001094191143173219263296
of1060160001095077
the1163160001093182129
above-mentioned1318160001094497149193238269347394446476498549601648701
information,34317400109217197146176251294324345394444463
digital822174001095071122143172216238
and1075174001094493144
decentralized1235174001095096137181231260290333354375414459510
clinical176117400109406182132152193236258
trial34318800109316285130153
(DCT)523188001092688143193223
models7731880010977129183231254291
should1091188001093789141193216269
offer1388188001095178110157189
one16041880010951103151
of1782188001095179
the1888188001093183131
most3432020010975125161192
effective560202001094572102147189221242286330
approaches916202001094394146176226270311361406442
for1384202001092676106
reducing1515202001093075127176217238288339
carbon18792020010941851143432160010951100150
emissions.5082160010944118139173208228277327361380
Kohl903216001094896145166
et1084216001094574
al.117421600109426381
estimate1271216001094479109130203246275319
that1605216001092978121149
typical1770216001092973124145185228249
paper-based343230001095195146192221246298342377423474
study833230001093566115166209
can1057230001094184134
lead1207230001092166109160
to1383230001093078
approximately1477230001094394145175224265286361404433478499542
4,885343244001094665113160206
kg574244001094392
of692244001094976
CO2;79324400109521129032500064279302440010919
transitioning974244001093060104154189210240262311362383433484
to1484244001092979
a15882440010943
fully165724400109267798120163
digitized184524400109517212314434325800109315394141195
clinical56525800109426486138161203249272
trial86425800109316284130152
can1044258001094187139
reduce1210258001093178132183226273
emissions15102580010946125147184221243295348385
by1922258001095397
approximately343272001094598152184235278301379425456502526570
90%.941272001094797172193
Digitization1161272001096285138160192214255302333355407460
alone1648272001094567119172220
(by1895272001092680124
migrating3432860010977100153185231263285338391
informed766286001092174102154186265313367
consent1165286001094192145183231284315
forms,1511286001092780112190228249
forms1791286001092780111190228
and343300001094495148
questionnaires,5173000010951102149186217239290342393437459490536573592
case1136300001094186122169
report1331300001093076129181212245
forms,1603300001092677108185222242
and1871300001094495148
essential343314001094581117162213242263307328
documents6893140010950100142192267313363393429
such1136314001093685126176
as1329314001094479
master14263140010975119154185230260
files170331400109265072117153
and1874314001094393145
site34332800109355685129
files48732800109264970115150
to652328001093078
electronic745328001094466110151182211260309330370
platforms)1130328001095072114143171220250324359381
can1526328001094083132
eliminate167432800109446586160181230272301345
the343342001093080126
need495342001095096142195
for715342001092777107
vast847342001094488124155
amounts10283420010943119169219270299336
of1390342001095076
paper1492342001095196148194224
–17423420010945
up18133420010949101
to1940342001093079
164,800343356001094688136155203250298
sheets657356001093585131177207244
of917356001094976
paper1009356001095195146192222
in1247356001092171
an1334356001094494
average1444356001094385129159203254300
clinical176035600109406182132153193237259
trial34337000109306082126147
(equivalent516370001092669121172193237282304350401430
roughly972370001093080130182232254298
to1295370001093080
a14003700010944
stack1470370001093667112153195
of1691370001095077
paper1793370001095297148195226
higher343384001095072123173220250
than619384001093080124174
16819384001094789
metres9343840010975122153182228264
and1224384001094494146
7991396384001094691139
kg1561384001094292
CO2)16793840010953113178939000642718163840010926
(21).1867384001092671114134151
Decentralization3433980010961108150195246276307351373395434480511532583634
facilitates1003398001092772113135157178209254284330366
remote1395398001093076153204234279
data1701398001095195125170
collection189839800109409034341200109214288130162183233283
by643412001095193
allowing75341200109446586136202224274325
participants1095412001095195125157179219240292336386415452
to1564412001093079
complete1660412001094089164216238284314359
some343426001093686161207
study569426001093667117168211
procedures800426001095181130172216268318347392428
without1248426001096688118168218268298
travelling1565426001093060104146191213234255305356
to1940426001093079
clinical34344000109416283134156197241263
trial63244000109306082126147
sites,80544000109365788133170189
with1020440001096789119170
telemedicine121644000109307597143220266319340381403453499
consultations1741440001094190141177227249343454001093074104125175225260
replacing621454001093075127149192233254304355
in-person994454001092171100153199229266316366
visits.1378454001094465101122152189208
This1604454001094596117152
model17744540010975125177223245
not3434680010951102133
only5034680010950102124168
reduces698468001093076130181223268305
emissions10304680010946123145182218240291343379
–14364680010946
an1508468001094596
estimated1631468001094683114136213258289335388
237343482001094591133
kg491482001094290
of596482001094975
CO26864820010951110793488006427
emissions8344820010944118139173208228277326361
per1210482001095095124
an1349482001094392
average1456482001094384128157200249294
clinical176548200109406081129150189232253
trial34349600109305980123144
with503496001096688117167
96864960010946
visits747496001094365100121150187
–9504960010944
but10104960010951101131
also115749600109436499149
decreases1321496001095196137166211254290335371
the1707496001093080125
time1848496001092950125170
and343510001094393145
financial509510001092650100144194235256299321
burden8515100010951101131182228278
placed1150510001095274117158202254
on14255100010950100
participants.1547510001095195125157178219240291336386415452472
Remote343524001094894169218248292
physiological6515240010951101142178199248270320371392432476497
monitoring11645240010974124174195225273303325374425
(e.g.,160552400109256886136155174
blood1795524001095173122172224
pressure343538001095079123157192239268312
or669538001094977
heart761538001094993136164195
rate)971538001092972100143165
can1151538001094082131
be1297538001095095
performed1406538001095095124152201229303347398
using1818538001094983103152201
digital343552001095274126149180226248
health618552001095198143165196248
technologies893552001093076119171222274297348401423470508
and1427552001094596149
wearables,16035520010968114159190235288311358396416
offering343566001094976106151181203253304
additional670566001094495146168198219269319363384
benefits1078566001095198148194221245275312
such1414566001093585125175
as1613566001094479
longitudinal1716566001092171122172194224274343580001095274126170193
monitoring,5625800010977129181203234284316338390442462
monitoring10515800010976128180202233284315337389441
in1519580001092173
real-world1618580001093177122144175244294325348401
environments,343594001094494135156184233282356400450478514533
and891594001094391142
immediate1048594001092094168212263284326355398
transmission1461594001093058101150185258279313347368416466
to1942594001092977
investigators.343608001092171112156192223243294337366415444481500
Biological859608001094870119141190241262302346367
samples,1242608001093579154205227272308327
such1584608001093685125175
as1775608001094378
saliva,1869608001093579100121343622001094387107
stool466622001093667116166188
or671622001094979
urine,767622001094979100151196215
can998622001094185135
be1149622001095298
collected1263622001094189111133178220252297349
via1628622001094365109
courier1753622001094089139169191236266
services343636001093580109154176215259294
and652636001094392142
delivered809636001095195116137180223253297348
directly117263600109507099143184215236278
to1465636001093077
laboratories,1558636001092163114163193236264312342363407442461
while3436500010966117138159205
the566650001092979125
sample-collection709650001093580155206228274304347396418439485527559580630680
materials14076500010975118148193223244288309344
can1769650001094085135
be1921650001095198
sent343664001093681132161
directly522664001095172101147188220241285
to824664001093079
participants.920664001095296125158179220241292336387416453472
Clinical141066400109527394144165206250272
research1699664001093075111156200230270320
associates343678001094378113163204225268297341377
can735678001094184134
likewise88567800109214183127193214249295
conduct1195678001094089139190239279311
site152267800109355686130
oversight1668678001094991135165201222272322351
remotely343692001092975150200230275297340
through702692001093080109159209260310
virtual103169200109436594127177221242
meetings.12926920010975121167198219269320355375
It1686692001092151
can1756692001094085135
save1910692001093580343706001094388
an452706001094494
additional567706001094495146167198219268319363384
3,808972706001094765113160207
kg1201706001094292
of1314706001094976
CO2141170600109531121520712006427
per1569706001095198128
average1718706001094386130160204255301
clinical34372000109406182131152192236257
trial61572000109305980123144
with775720001096687117166
five95772000109265093137
monitoring11107200010974124174195224273302323373423
visits154972000109436499120150186
of1751720001094975
each1842720001094488128177
of343734001094976
ten436734001093074125
centres578734001094084135164194239275
by870734001095193
car980734001094085114
depending1111734001095196148195245296318368418
on15467340010950100
travelling1663734001093060104146190212234255305356
distance343748001095070104134176225264307
(16,665748001092566107125
21,804748001094687100
22).919748001094590113129
Beyond1062748001094893134181230280
these1357748001092977121156200
approaches,1572748001094392143171219262301350394429447
other343762001094877125170198
emerging5567620010944117162190239259308357
trends927762001093058102150200234
(e.g.,117676200109256684132150169
integration135976200109216998141191219262290310358407
of1780762001094974
artificial186976200109427010212234377600109264989109152173
intelligence53177600109217099143164185205255300349389433
for979776001092675104
trial109877600109305980122143
optimization,12567760010949100130150224245283327356376425475493
increased1765776001092069110138183225213862001093579130
use228362001094883127
of242562001094874
real-world251462001092972115135163229276305326376
data,290562001094992120163182
virtual31016200109436492124172214235
clinical33516200109396080128149188231251
trials)36176200109295878120141175197
can213876001094084134
be228976001095197
expected240276001094588140186228260305356
to277576001092978
further286976001092777107139189235265
enhance315076001094596146189239280325
both3491760010951102131181
the368976001092979125
efficiency213890001094571100124164184229279319364
and251790001094392143
environmental267690001094494135157186235284359404454483526547
performance323990001095196126154204233308351400440484
of373990001094975
clinical213810400109406283133154194239260
trials.241710400109305981124146181201
However,22781180010960114183230276323355372
DCT26861180010962118168
models28901180010977130185233257295
introduce3221118001092274106138190245297340387
new36441180010952100170
forms2138132001092779111190227
of2394132001095179
energy2503132001094699147179231277
demand28091320010953101179225277331
–31691320010947
computer3245132001094293172225278310357388
and3663132001094497150
server2138146001093681111157202232
operation,23861460010949101147177221251272321372391
digital2793146001095172123144174218239
communication,3049146001094088164239289339360400444474495545595614
etc.3679146001094576115135
Kohl2138160001094997147168
et2322160001094575
al.241316000109436483
provided2512160001095180130172194244290341
approximate2869160001094394145175224265287361405434478
estimates3363160001094581111132207250279324359
of3738160001094975
these2138174001092979124159204
alternative235817400109426393137166216259288308352395
sources2769174001093584134163202246281
of3066174001094975
emissions:31561740010945119140175210230279329364382
energy3553174001094594139169218261
needed2138188001095095141192237289
for2443188001092675105
filling25641880010926497091112162212
out2792188001094999128
questionnaires29361880010951100145181211232281331381424445474519555
on3506188001094999
computers362118800109408916421382020010951102132176206243
or2401202001094979
smartphones25002020010935110154184216268318368419465501
(counted3020202001092664112162213242287339
as3378202001094479
134772020010946
minute3543202001097596146196226271
per2138216001095196125
page),2278216001095194144189212228
video2521216001094364115159209
consultations2745216001094088137172220241270313342363412461495
(approximately3256216001092565115166195244284305379422451494516558
121382300010946
hour22082300010950100150179
with2411230001096688118168
each2602230001094589130180
centre),2805230001094185135165195240263280
email31092300010945120164185207
communication33392300010940891652402903403614024462138244001093153105158
(estimated2324244001092771109142164242288319366420
at2772244001094576
122876244001094890
per29942440010953101133
participant),3155244001095399131165187230252306352404435461480
and3663244001094597151
server2138258001093784116164211242
operation24082580010951104153184230261284336388
(assuming2824258001092669106143195273295347400
0.043252258001094767116166
kW/h)34452580010944124153206231
for3703258001092779111
maintaining21382720010976120141192222267288339360411463
the2626272001093081127
trial277927200109306082126148
platform2953272001095174118148177228258335
over3313272001095094139169
a35082720010944
2-year3578272001094673116162206236
period.2138286001095198128150200252272
In2435286001092273
total,2533286001093080110154176195
these2754286001093080126162208
activities2988286001094384117138182204235256302338
generate3351286001095197148194224268298343
an3720286001094394
estimated2138300001094580110130204247276320370
4862524300001094592138
kg2678300001094190
of2783300001094975
CO2,28733000010952110298130600642730083000010918
which30423000010965115135175224
is3281300001092155
still335230000109356585106127
substantially3494300001093584134169199242292213831400109305194116137180
less2337314001092167103138
compared2494314001094089165216260290335387
to2900314001093079
the2998314001092979125
traditional3142314001093060104155176206227277328371393
clinical355431400109406182132153194238260
trial213832800109306081125146
(21).2310328001092671113133150
DCTs24863280010960113161191
also2703328001094365100150
support2879328001093685137189240270303
inclusivity,3207328001092172113134184220241285307337382397
even3630328001094588133184
though2138342001092978127176226274
disparities2428342001095070104154197226247276297341376
in2819342001092170
digital2904342001095070120140169213233
literacy,315234200109214271114143186226270284
variability3451342001094386114135178228249269290319363
in2138356001092171
internet2233356001092171101145175226272302
access,2559356001094384124168204240259
device2842356001095096139161202246
validation3112356001094387109130181225254275325376
requirements351135600109307512717719822727221383700010975120171200236
to2390370001093079
bring2485370001095181102152202
accurate2703370001094384123173202246275320
results,3039370001092974110159180210246265
and3320370001094493144
the3480370001093080125
need3621370001095095141193
for2138384001092676106
robust2268384001093079131181217248
data2540384001095194124168
protection2733384001095181130160205247279300350400
frameworks3157384001092757101176222289338368411449
pose36303840010952102138184
additional2138398001094496148170201222273324368390
challenges2554398001094192136158180226278329376412
(23,2992398001092672119137
24).3155398001094792116134
Higher3315398001095981133184230261
initial360239800109217294124146190212
costs2138412001094087121151186
for2338412001092674103
digital2456412001094970119139168211231
health2701412001094994136156185233
technologies,2949412001092972112160209257278326376396440475493
alongside3457412001094263111160209243263313357
other2138426001094979129174204
challenges2358426001094090133154175221271321367403
(e.g.,277742600109256886136155175
resistance2967426001093075110131166197241291331376
from3359426001092656105181
clinical355642600109406182131152193237258
sites,213844000109365788134170190
regulatory2354440001093075128178200244274324355401
uncertainties,27814400010950101143188218252297318369399421467503523
the3330440001093081127
need3483440001095197144197
for3706440001092777108
staff2138454001093667111138168
training2332454001093059104125176197247299
and2656454001094494146
infrastructure282845400109217198128173209240269320361394444473519
adaptation)3373454001094395139190221265295317367418441
can2138468001094187139
be23044680010953101
another2432468001094597148180232279310
issue.276946800109225996147194214
However,30104680010960113181227272319350366
ultimately,3403468001095173105127205250281327351395411
DCTs21384820010961115164195
have2359482001095196139185
the2570482001093081128
potential27254820010952104134180232262284328350
to3102482001093080
yield3208482001094466113135188
long-term3422482001092273125177207238284314392
cost2138496001094089125156
savings2313496001093580122144194245280
(16).2612496001092668110134151
An22785100010954102
illustration239351000109214161109143172200243271291339388
is2794510001092054
provided2861510001095079127168188238282332
by3206510001095090
the3309510001093078122
PROMOTE3444510001094793153224284326370
study,2138524001093666116168211226
a23855240010944
DCT24505240010960114161
conducted2633524001094089139191240281313358410
during30645240010951101130152202253
the3339524001092979125
Covid-1934865240010952100143165216245287328
pandemic2138538001095195146197243318339380
among25385380010943118169219270
pregnant2828538001095181126178228272322351
women.31995380010966115191237287307
The3526538001094495141
decentralized36875380010951962138552001094083132160189231252272310354404
design2557552001095094129149198247
reduced2819552001092872123171210254304
the3138552001092978122
environmental3275552001094493134155183231280354398447475518539
burden21385660010950100128178223272
from2425566001092656104178
approximately2618566001094393144173221261282356399428471492534
123.93168566001094584129147191
kg3374566001094290
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CO235695660010951110152
to3736566001093078
321385800010946
kg2206580001094292
of2320580001094976
CO2241858000109521122528586006427
(a2577580001092666
41-fold2665580001094788112140189211263
reduction).2950580001092974126176217249270320370394411
In3383580001092171
addition,3476580001094495147168198219269319338
the2138594001092978122
decentralized2274594001095094134177225254282325345365402446496
design2784594001095094129149198246
improved3044594001092194144173220262305355
participant3413594001095093121153173212232281324373401
recruitment2138608001092975116146196217247323368419448
(22).2605608001092671117141158
Regulatory21386330014361119186249274328364426461519
framework,2686633001433168123221280366429465516540
initiatives,3255633001432589113151176229265290344402446467
and21386470014354118184
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in2866647001432588
the29836470014337102160
field3172647001432958117142208
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“green”2263661001433596131188247311345
clinical2637661001435378102166190244299324
trials299066100143377298151176220
Although2278678001095677108158209260311362
many26666780010975119170212
countries2904678001094090140191221251273319355
have3285678001095195137182
committed34936780010941901672432642952138692001093075127
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achieving2394692001094484134156201244266316367
net2787692001095096126
zero2939692001093884113163
by3127692001095294
2050,3246692001094792138184202
sustainability3473692001093686121152196218268311213870600109517394115145191
considerations2351706001094189140175196247293323367397418468518553
for2927706001092776106
clinical305670600109416283133154195239260
trials333970600109306081125146181
are3543706001094373118
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incorporated2138720001092171112161191243293323367397442494
in2654720001092172
their2748720001093080126147177
regulatory2948720001092974126175197240270319349395
frameworks3365720001092757101176222289338368410449
or2138734001094979
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Major27887340010973117139189219
bodies30277340010951102154175221257
acknowledge3304734001094384126178228294316361413464510
the2138748001093080126
importance2289748001092196147198228261305355396441
of2755748001094976
clinical285674800109406283133154195239260
trial314174800109306081125146
sustainability3312748001093685121152196217267311362384405426457502
and2138762001094392143
have2296762001095093134178
begun2490762001095196147196245
to2751762001092978
work28447620010966114144186
on3045762001094999
guidelines3159762001095099120171215237258307352387
to3562762001092978
promote365576200109518012921387760010976127158204
more23687760010976128158205
efficient2599776001094673104128170192238290320
and2945776001094496148
lower-carbon3119776001092273140186217243287332363415467519
trial366477600109306183128150
design393462001095196132153204254
(25).420562001092670117141158
However,4380620010959109175220263308338353
the474962001093080126
absence489262001094394130176226267312
of522162001094976
binding531362001095273123175196246297
legal393476001092269121166188
framework414976001092758103180228296346377421
means4596760010977124169220257
that487976001093082126157
“greener”506376001093281112158206257304335370
trial54607600109306183128150
practices393490001095080123162193214253297332
still42819000109356585105126
remain442290001092973147190210259
voluntary.469690001094390111160209237281309354368
Unfortunately,5079900010958106132180210241290339381410454475517531
even3934104001094486129178
the4127104001092977122
ethics4263104001094574122142182217
committees4495104001094087160234254283314357402437
have4946104001094991132175
not5136104001094997126
yet5277104001094185114
received54061040010929721121551763934118001094388140
guidelines40911180010950100121173218240261311357393
on45011180010950100
how46191180010950100166
to4802118001093079
properly4898118001095181131183229259281324
formulate5239118001092676106182232253297326371
recommendations3934132001092975116165240316362412463507537558608658693
and4644132001094393145
assess4805132001094479115161197232
environmental5054132001094595138159189238289364410461490534556
aspects3934146001094379130176218250287
in4240146001092171
clinical433014600109416283133154195239260
trials460914600109306081125146181
(25,4809146001092671117135
26).4963146001094691115132
Multiple40741600010973123144175196247270316
groups4415160001095180130180232268
and4709160001094393145
activities4880160001094384116138182204234255301337
are5243160001094373118
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environmental4594174001094697140163193244295372419470500546568
sustainability5188174001093687123155200222273317370392393418800109224374120
within4080188001096789120171192243
clinical434918800109416384135157198243265
research.4640188001093076113159204234275326345
The5012188001094597143
Sustainable5181188001094290124152199220269317365387429
Healthcare39342020010958101151173202252292340371413
Coalition4372202001095299149171193223244293344
plays4745202001095376122165203
a49772020010945
central5051202001094289141172204250273
role5353202001093082105153
in5536202001092174
accelerating3934216001094486126172194241272317347369420472
and4432216001094496148
amplifying46062160010944121174196218246293315366418
decarbonizing5051216001095198140185216269320372394433456507559
action3934230001094384116137187238
(27).4191230001092671115141158
The4368230001094596142
strength453023000109356696141191242273323
of4872230001095076
their4968230001093080126147177
voice5164230001094493114155199
in5383230001092171
this5474230001093079101136
area3934244001094475122167
is4128244001092158
demonstrated4213244001095299177229281318350381426457503557
by4797244001095296
the4920244001093082129
fact5076244001092773115148
that5251244001093182127158
they5436244001093182130173
were39342580010967113144190
invited4150258001092273116138169215268
to4444258001093181
collaborate4551258001094190113135180232284315360390436
with5013258001096790121172
the5211258001093081128
global5365258001095173124177223245
platform3934272001095173116145173222252327
of4277272001094975
Sustainable4368272001094288120148193214262308355376417
Markets47982720010970117145186226254287
Initiative509927200109216989116136183211230271311
(SMI)5425272001092567138160185
(16,3934286001092567109128
18,4078286001094688107
28,4201286001094692111
29).4328286001094692116133
Similarly,4477286001094465140161182225255276319334
the4827286001092979125
Institute4968286001092169102130150178225253292
of5274286001094773
Cancer5360286001095096144182221250
Research3934300001094788122162209238276324
(ICR),427530000109264699147172190
in4482300001092171
collaboration4571300001094089111132176227278308352382403452503
with5091300001096788119169
the5277300001093080126
NIHR5420300001095981141190
and3934314001094496148
the4109314001093081128
UK42643140010959110
Clinical440031400109537597148170212257280
Research4706314001094996133180225256297348
Collaboration50813140010953103126148193245297328374404426477529
(UKCRC),3934328001092684134185234287314332
is4292328001092157
actively4375328001094485117139183228251294
integrating4695328001092172102147199229274304326376428
sustainability51493280010936861221531982192703143663884104313934342001093075
principles4031342001095181102153193215266288334370
into4422342001092171101150
healthcare4594342001095095139160190240281325355400
and5016342001094393145
clinical518234200109416283133154195239260
trial546434200109305981124146
designs3934356001095196132153204254290
(30).4242356001092570116141158
SMI44183560010944116138
and4574356001094494145
ICR4737356001092275123
are4878356001094373118
both50143560010951102132182
part5214356001095196125158
of5390356001094976
the5484356001093080126
iLCCT3934370001092161108155200
consortium4155370001093884132165212241271291339412
that4592370001093080123153
developed4769370001095197140185207257308355407
the5200370001093080126
clinical535037000109416283133154195239260
trials393438400109306081125147182
carbon4142384001094084114166217268
calculator4435384001094185107148198219263293342372
(18,4833384001092568110129
19).4988384001094688112129
The5143384001094596142
Medical53113840010972119171192233277299
Research3934398001095098135183229260302354
Council43153980010953104156209251274296
and4638398001094597151
National48163980010961107138160212265310333
Institute5176398001092274111144166198249281328
of5531398001095179
Health39344120010960107152175206257
and4218412001094496148
Care4393412001095399129176
Research4595412001095097134181226257298350
(MRC-NIHR)4971412001092699150204228291314375425451
Trial544941200109467194138161
Methodology39344260010974121152203255308359382433486530
Research4490426001095097134181225256297348
Partnership4865426001094892123156208255285323374396449
has5340426001095196132
established54984260010946833934440001092972122143163197245289340
the4288440001092978122
Greener4424440001095583122162209248276
Trials471344000109416484130150181
Group4907440001095583128174220
which51424400010965114134173221
shares5378440001093583125153197232
methodologies39344540010975121151201251303353375425477498543579
for4536454001092676106
reducing4664454001093075127176217238288339
emissions,50254540010946121142178213234284335370389
waste,54374540010966110145393446800109307493
and4048468001094494145
water42154680010966110140184214
use4451468001094985131
in4603468001092171
clinical469646800109406283133154194239260
trials497846800109295981124145181
or5180468001095080
provides5281468001095282131174196247293329
guidance39344820010952104126180226278321368
for4331482001092880111
carbon4472482001094288119173226279
footprint4781482001092779132164217249272325356
estimation.5167482001094684116139217263294317369422443
Their3934496001094597143165195
online41554960010950101123144195241
resources4422496001093075112163213243284329366
represent4813496001093076128159204241287338368
one52074960010950101147
of5380496001095077
the5483496001093081127
most39345100010976128164196
comprehensive4156510001094191168221252298350397448484506551597
repositories4779510001093076129181218239270320351373420457
currently5262510001094192123153200251282304348
available3934524001094386130151172216267289335
(20,4291524001092671116135
30,4448524001094692111
31).4581524001094688108125
The4728524001094596142
Breast4893524001094776116164197225
International513752400109217097137166214261289310357405452473
Group3934538001095888137187236
(BIG)4198538001092677100161187
is4413538001092158
another4498538001094597149181233280312
group4837538001095283135187240
active5104538001094588121144189236
in5367538001092274
this5468538001093183105142
field,393455200109265096118169188
organizing4138552001094979130173223244283305355406
events4560552001094588133183212249
to4825552001093079
discuss4920552001095172107148198233269
challenges5205552001094090134155176222272323369405
ranging3934566001092972121170191240289
from4238566001092656104178
CO2443156600109521104538572006426
emissions45805660010944118139173208228277326360
in4955566001092170
cancer5040566001094083131171215244
research5299566001092973108152195223262311
to3934580001093079
climate-related403658000109406283158202231276306337382404448477522574
disruptions4633580001095172107137187238269290340390425
of5082580001094976
clinical518158000109406182133154194238260
trial546458000109305981124146
operations39345940010950103150181226256277328380416
(32).4376594001092671116140158
The4560594001094597144
Health47305940010960106151173204254
Research5011594001094995132179223253294345
Board53825940010950101146176228
of3934608001094976
the4030608001093080126
Trials417660800109446990134155191
Methodology43876080010972118149199248300350372422474517
Research4924608001094994130176220249290339
Network52846080010959105135204253283326
(HRB-TMRN)3934622001092687138190222265340392454481
discussed4444622001095375112155207244282330384
sustainable4857622001093789126158205227280325379403450
clinical533762200109416486139161204250273
trials393463600109305981124146181
in4134636001092171
their4224636001093080126147177
online44206360010950100122143193238
conference,4678636001094089139165211241286337377422440
too5137636001093079130
(33).5286636001092570114137154
These4074650001094698145182229
examples4329650001094690135212265287334371
illustrate472765000109214365116152184215260290336
only50906500010950102124168
a52856500010944
subset5355650001093787140177224255
of3934664001094976
the4035664001093080126
efforts4186664001094572102151181214251
currently4462664001094090120150195245275296339
devoted4826664001095197140189219263315
to5166664001093079
sustainability5270664001093685121152196217267311393467800109527496118148194
in4154678001092273
clinical425367800109416384135157198243265
trials.454467800109306183127149185205
It4775678001092253
is4854678001092157
encouraging4937678001094697139189240270315367388439491
that5454678001093181126156
sustainable3934692001093584119149193214263306357379424
clinical437369200109406182131152192235256
research4645692001092974109154197226266315
has4976692001094992127
been5119692001095096142192
gaining5326692001095093114163184233284
increasing3934706001092170111140185228263283333383
recognition.4333706001092974115163214263284314335384434453
Although4802706001095475105154204253304353
many51717060010975118167208
of5395706001094975
the5486706001092979124
above-mentioned3934720001094394144186230260335381430459480529579624675
groups4625720001095079128177228263
are4904720001094372116
primarily5036720001095180101176219248269290332
based5384720001095194129174226
in3934734001092170
the4019734001092978123
UK,41577340010957105126
they4298734001093078123165
maintain44787340010974116137186214258278327
international482073400109217098142171221263292312361410453474
collaborations53097340010939871081291712222713934748001092974103124174225260
and4213748001094393145
outreach.4377748001094999130159204248289339358
Unfortunately,40747620010958110138190221256308359405436483507551568
there4667762001093082129161208
remains4901762001092976153199222274311
a52377620010943
notable53067620010950101133179232256304
lack3934776001092167109153
of4112776001094978
comprehensive,4214776001094191169222254301353401453490513558605625
structured486477600109356899151194228279311358412
training5300776001093061107130182205257310