Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Study on the effect of sublethal concentrations of antimicrobials on the growth and development of probiotic lactobacilli

The objective of this study was to investigate the effect of sublethal concentrations of 5 antibiotics (tetracycline, erythromycin, penicillin G, lincomycin, ciprofloxacin) and 2 preservatives (benzoic and sorbic acid) on the growth and development of 8 probiotic Lactobacillus strains. All lactobacilli were subjected to a large range of concentrations, growth curves were plotted and MICs were determined for each antimicrobial. The results showed correlation between the sublethal concentrations and the growth rate of the studied microorganisms. Based on the obtained data two groups of strains could be defined – sensitive and relatively resistant. The first group includes L. bulgaricus S2. L. bulgaricus S4. L. bulgaricus S19 and L. gasseri S20. The most resistant of this group was L. gasseri S20. The second group showed more sensitivity and the most affected by the antimicrobials was L. bulgaricus S28

In vitro simulation of the gastrointestinal tract environment and its interaction with probiotic lactobacilli

The harshest conditions of the human gastrointestinal tract were simulated in order to study probiotic bacteria in their intended environment. Eight Lactobacillus strains were cultivated in MRS broth with added bile in different concentrations and their growth was monitored as optical density. The gathered data was used to determine the MIC of bile for each strain. The recovery of the strains in MRS broth after 3 h in simulated gastric juice solution (pH 1.8, 5000 U/cm3 pepsin) was investigated. Lactobacillus gasseri S20 exhibited the best survival rate and reached OD 600 0,490, while Lactobacillus acidophilus S11 could not survive the conditions of the stomach (OD 600 0,076)

Design and Volatile Compound Profiling of Starter Cultures for Yogurt Preparation

Stable symbiotic starter cultures were created using selected strains of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus salivarius subsp. thermophilus with antimicrobial activity against pathogens and necessary antibiotic sensitivity, growth kinetic parameters, and metabolic profiles. The volatile compound profiles of the obtained starter cultures were determined and their specificity was proven depending on the ratio of monocultures in each combination. The influence of the freeze-drying process on the starter cultures in relation to the production of aromatic components was investigated and it was demonstrated that this process had a significant effect on the content of the aroma-forming substances in the fermented milk. However, the influence of the pre-cooling process and crude fat content from 1.5 to 3.0% did not notably affect the levels of volatile compounds synthesized by the selected starter cultures. Comprehensive data for all volatile aromatic metabolites in the fermented milk were also obtained. These designed symbiotic starter cultures can be used to produce traditional Bulgarian yogurt with increased functional and probiotic properties

Monitoring of Water Spectral Pattern of lactobacilli development as a tool for rapid selection of probiotic candidates

Nowadays a quick and inexpensive method, which allows rapid, in vivo comprehensive probiotic bacteria identification, is needed. To elucidate a new concept to evaluate probiotic bacteria, near infrared spectroscopy with aquaphotomics were applied to monitor the growth of eight Lactobacillus bulgaricus and one Lactobacillus gasseri bacteria strains. Their resistance to low pH (1.8) in the presence of pepsin and bile were measured and further used as reference data for analysis of the simultaneously acquired spectral data. The acquired spectral data in the region of 1100–1300 nm were subjected to various methods for multivariate data analyses—principal component analysis, linear discriminant analysis, soft independent modeling of class analogy, and partial least squares regression. The results showed high accuracy of bacteria strains classification according to their resistance and the potential of the tested wavelength region for rapid selection and prediction of some basic phenotypic characteristics of probiotic candidates. Results of the current study also revealed different suitability of each growth stage when using near infrared spectra for the classification of bacteria strains