Climate drivers of global wildfire burned area

Wildfire is an integral part of the Earth system, but at the same time it can pose serious threats to human society and to certain types of terrestrial ecosystems. Meteorological conditions are a key driver of wildfire activity and extent, which led to the emergence of the use of fire danger indices that depend solely on weather conditions. The Canadian Fire Weather Index (FWI) is a widely used fire danger index of this kind. Here, we evaluate how well the FWI, its components, and the climate variables from which it is derived, correlate with observation-based burned area (BA) for a variety of world regions. We use a novel technique, according to which monthly BA are grouped by size for each Global Fire Emissions Database (GFED) pyrographic region. We find strong correlations of BA anomalies with the FWI anomalies, as well as with the underlying deviations from their climatologies for the four climate variables from which FWI is estimated, namely, temperature, relative humidity, precipitation, and wind. We quantify the relative sensitivity of the observed BA to each of the four climate variables, finding that this relationship strongly depends on the pyrographic region and land type. Our results indicate that the BA anomalies strongly correlate with FWI anomalies at a GFED region scale, compared to the strength of the correlation with individual climate variables. Additionally, among the individual climate variables that comprise the FWI, relative humidity and temperature are the most influential factors that affect the observed BA. Our results support the use of the composite fire danger index FWI, as well as its sub-indices, the Build-Up Index (BUI) and the Initial Spread Index (ISI), comparing to single climate variables, since they are found to correlate better with the observed forest or non-forest BA, for the most regions across the globe

It is time to define an organizational model for the prevention and management of infections along the surgical pathway : a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.Peer reviewe

It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

Background The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants' perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened

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

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Λοιμώξεις χειρουργικού πεδίου στην επείγουσα χειρουργική

Οι λοιμώξεις χειρουργικού πεδίου (ΛΧΠ) σχετίζονται με αυξημένη νοσηρότητα και θνητότητα και εμφανίζονται συχνότερα σε επείγουσες (μη προγραμματισμένες) χειρουργικές επεμβάσεις παρά σε τακτικές. Συνεπώς, η αναγνώριση των ασθενών που πρόκειται να υποβληθούν σε επείγουσα χειρουργική επέμβαση και είναι υψηλού κινδύνου για εμφάνιση ΛΧΠ, μπορεί να οδηγήσει σε ομαλότερη μετεγχειρητική πορεία, με μειωμένη νοσηρότητα και θνητότητα. Ο σκοπός της μελέτης μας είναι να καθορίσει την επίπτωση των ΛΧΠ στις επείγουσες χειρουργικές επεμβάσεις, καθώς και τους παράγοντες κινδύνου για την ανάπτυξη τους. Ασθενείς και Μέθοδος: Για τη μελέτη αυτή συγκεντρώθηκαν και αναλύθηκαν προοπτικά, δεδομένα από ασθενείς που υπεβλήθησαν σε επείγουσες χειρουργικές επεμβάσεις σε ένα διάστημα 5 ετών, στο κέντρο μας. Αποτελέσματα: Στη μελέτη συμπεριλήφθησαν 838 ασθενείς που υπεβλήθησαν σε επείγουσα χειρουργική επέμβαση κατά το διάστημα αυτό. Η μέση ηλικία αυτών ήταν τα 58 έτη (IQR 25-71) και οι 368 (44%) ήταν γυναίκες. Οι 157 (18,7%) ασθενείς ανέπτυξαν ΛΧΠ. Tο πιο συχνό παθογόνο που απομονώθηκε ήταν το E.Coli (54%), ακολουθούμενο από τον Staphylococcus Aureus (40,1%) και τον Enterococcus spp (21,6%). H θνητότητα στις 30 ημέρες στους ασθενείς που εμφάνισαν ΛΧΠ ήταν 14,6%, έναντι 6,8% στους ασθενείς που δεν εμφάνισαν ΛΧΠ. Η πολυπαραγοντική ανάλυση έδειξε ότι η κατηγορία του χειρουργικού τραύματος κατά CDC, το American Society of Anesthesiology (ASA) score, η βαρύτητα της χειρουργικής επέμβασης και διάρκεια της χειρουργικής επέμβασης μεγαλύτερη από 90 λεπτά αποτελούν ανεξάρτητους παράγοντες κινδύνου για την εμφάνιση ΛΧΠ. Συμπεράσματα: Η αναγνώριση των τροποποιήσιμων παραγόντων κινδύνου για την εμφάνιση ΛΧΠ είναι επιτακτική, αφού μπορεί να επηρεάσει δραστικά την μετεγχειρητική πορεία. Τροποποίηση της μετεγχειρητικής φροντίδας και εντατικότερη παρακολούθηση των ασθενών που έχουν παράγοντες κινδύνου για την ανάπτυξη ΛΧΠ, μπορεί να οδηγήσει σε μείωση της νοσηρότητας και θνητότητας των.Background/Aim: Surgical site infections (SSI) are associated with increased morbidity and mortality, and they occur more frequently during unplanned surgical procedures rather than elective. Identification of patients undergoing emergency surgery (ES) who are at higher risk for developing SSI may thus translate to an improved postoperative course with reduced morbidity and mortality. The objective of our study was to determine the incidence of SSI within our ES practice and to identify risk factors for SSI. Patients and Methods: Data from consecutive patients undergoing ES in a single institution during a 5-year period were prospectively collected and analyzed. Results: A total of 838 consecutive patients who underwent ES during the study period were included. The median age was 52 (IQR 25-71) years and 368 (44%) of them were female. 157 (18.7%) of those patients developed SSI. The most commonly isolated pathogen was E. Coli (55.4%) followed by Staphylococcus Aureus (40.1%) and Enterococcus spp (21.6%). The 30-day mortality rate of patients who presented SSIs was 14.6% compared to 6.8% of patients without SSI (p=0.002). Multivariable analysis showed the type of wound, American Society of Anesthesiology score, severity and duration of surgery >90 min were independent risk factors for the occurrence of SSI. Conclusion: Identification of modifiable causative factors for SSI within an ES unit is paramount as they can critically impact postoperative outcomes. Modification of postoperative care and closer follow-up of patients who exhibit risk factors for SSI may lead to improved morbidity and mortality of those patients

Surgical site infections in emergency surgery

Background/Aim: Surgical site infections (SSI) are associated with increased morbidity and mortality, and they occur more frequently during unplanned surgical procedures rather than elective. Identification of patients undergoing emergency surgery (ES) who are at higher risk for developing SSI may thus translate to an improved postoperative course with reduced morbidity and mortality. The objective of our study was to determine the incidence of SSI within our ES practice and to identify risk factors for SSI. Patients and Methods: Data from consecutive patients undergoing ES in a single institution during a 5-year period were prospectively collected and analyzed. Results: A total of 838 consecutive patients who underwent ES during the study period were included. The median age was 52 (IQR 25-71) years and 368 (44%) of them were female. 157 (18.7%) of those patients developed SSI. The most commonly isolated pathogen was E. Coli (55.4%) followed by Staphylococcus Aureus (40.1%) and Enterococcus spp (21.6%). The 30-day mortality rate of patients who presented SSIs was 14.6% compared to 6.8% of patients without SSI (p=0.002). Multivariable analysis showed the type of wound, American Society of Anesthesiology score, severity and duration of surgery >90 min were independent risk factors for the occurrence of SSI. Conclusion: Identification of modifiable causative factors for SSI within an ES unit is paramount as they can critically impact postoperative outcomes. Modification of postoperative care and closer follow-up of patients who exhibit risk factors for SSI may lead to improved morbidity and mortality of those patients.Οι λοιμώξεις χειρουργικού πεδίου (ΛΧΠ) σχετίζονται με αυξημένη νοσηρότητα και θνητότητα και εμφανίζονται συχνότερα σε επείγουσες (μη προγραμματισμένες) χειρουργικές επεμβάσεις παρά σε τακτικές. Συνεπώς, η αναγνώριση των ασθενών που πρόκειται να υποβληθούν σε επείγουσα χειρουργική επέμβαση και είναι υψηλού κινδύνου για εμφάνιση ΛΧΠ, μπορεί να οδηγήσει σε ομαλότερη μετεγχειρητική πορεία, με μειωμένη νοσηρότητα και θνητότητα. Ο σκοπός της μελέτης μας είναι να καθορίσει την επίπτωση των ΛΧΠ στις επείγουσες χειρουργικές επεμβάσεις, καθώς και τους παράγοντες κινδύνου για την ανάπτυξη τους. Ασθενείς και Μέθοδος: Για τη μελέτη αυτή συγκεντρώθηκαν και αναλύθηκαν προοπτικά, δεδομένα από ασθενείς που υπεβλήθησαν σε επείγουσες χειρουργικές επεμβάσεις σε ένα διάστημα 5 ετών, στο κέντρο μας. Αποτελέσματα: Στη μελέτη συμπεριλήφθησαν 838 ασθενείς που υπεβλήθησαν σε επείγουσα χειρουργική επέμβαση κατά το διάστημα αυτό. Η μέση ηλικία αυτών ήταν τα 58 έτη (IQR 25-71) και οι 368 (44%) ήταν γυναίκες. Οι 157 (18,7%) ασθενείς ανέπτυξαν ΛΧΠ. Tο πιο συχνό παθογόνο που απομονώθηκε ήταν το E.Coli (54%), ακολουθούμενο από τον Staphylococcus Aureus (40,1%) και τον Enterococcus spp (21,6%). H θνητότητα στις 30 ημέρες στους ασθενείς που εμφάνισαν ΛΧΠ ήταν 14,6%, έναντι 6,8% στους ασθενείς που δεν εμφάνισαν ΛΧΠ. Η πολυπαραγοντική ανάλυση έδειξε ότι η κατηγορία του χειρουργικού τραύματος κατά CDC, το American Society of Anesthesiology (ASA) score, η βαρύτητα της χειρουργικής επέμβασης και διάρκεια της χειρουργικής επέμβασης μεγαλύτερη από 90 λεπτά αποτελούν ανεξάρτητους παράγοντες κινδύνου για την εμφάνιση ΛΧΠ. Συμπεράσματα: Η αναγνώριση των τροποποιήσιμων παραγόντων κινδύνου για την εμφάνιση ΛΧΠ είναι επιτακτική, αφού μπορεί να επηρεάσει δραστικά την μετεγχειρητική πορεία. Τροποποίηση της μετεγχειρητικής φροντίδας και εντατικότερη παρακολούθηση των ασθενών που έχουν παράγοντες κινδύνου για την ανάπτυξη ΛΧΠ, μπορεί να οδηγήσει σε μείωση της νοσηρότητας και θνητότητας των