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

Covid-19 e salute mentale del personale infermieristico in prima linea: una revisione della letteratura

Objective. The Coronavirus (Covid-19) pandemic caused a severe health crisis that has affected millions of people and quarantined half of the world's population. The health emergency from Covid-19 has seen health workers on the front line face all the difficulties related to the burden of care and the reorganization of procedures, roles, and tools at the hospital level. One of the most significant and probably underestimated aspects is the psychological stress of frontline nurses. The article aims to analyze the literature relating to the impact on the mental health of nurses engaged in the management and care of Covid-19 patients. Methods. A systematic review of the published articles on the subject was conducted from January 2020 to November 2020. The search for papers was conducted on scientific databases like PubMed, Scopus and Embase. Results. The results show the onset of anxiety, depression and stress and insomnia in healthcare workers. These aspects are closely related to numerous factors, including the fear of contracting the disease and infecting family members, stressful shifts and little rest, leading to a state of psychological and physical tension capable of activating pathological behaviours. The literature highlights the importance of support interventions for frontline personnel to avoid the onset of psycho-pathophysical severe problems. Conclusion: The review suggests that frontline nurses during the emergency phase of Covid-19 may be prone to psychological disorders that can compromise mental health. Therefore, the surveillance and monitoring of symptoms, together with targeted support interventions, should be guaranteed daily to all professionals involved to prevent the onset of psychological disorders.Obiettivo. La pandemia da Coronavirus (Covid-19) ha causato una grave crisi sanitaria che ha coinvolto milioni di persone e messo in quarantena metà della popolazione mondiale. L'emergenza sanitaria da Covid-19 ha visto gli operatori sanitari in prima linea affrontare tutte le difficoltà legate all'onere della cura e alla riorganizzazione delle procedure, ruoli, e strumenti a livello ospedaliero. Uno degli aspetti più significativi e probabilmente sottovalutati è lo stress psicologico del personale infermieristico in prima linea. L'obiettivo dell’articolo è quello di analizzare la letteratura relativa all’impatto sulla salute mentale del personale infermieristico impegnato nella gestione e cura di pazienti affetti da Covid-19. Metodi. È stata condotta una revisione sistematica degli articoli pubblicati sull'argomento da gennaio 2020 a novembre 2020. La ricerca degli articoli è stata condotta sui database scientifici Pub Med, Scopus e Embase. Risultati. I risultati mostrano l’insorgenza nel personale sanitario di ansia, depressione e stress e insonnia. Tali aspetti risultano strettamente correlati a numerosi fattori, tra cui la paura di contrarre la malattia e di trasmetterla alle famiglie, turni stressanti e poco riposo, portando ad uno stato di tensione psicologica e fisica in grado di attivare comportamenti patologici. La letteratura evidenzia l’importanza di interventi di sostegno al personale in prima linea al fine di evitare l'insorgere di gravi problemi di natura psico-patofisica. Conclusione. La revisione condotta suggerisce come gli infermieri in prima linea durante la fase di emergenza di Covid-19 possano essere soggetti a disturbi psicologici in grado di compromettere la salute mentale. Pertanto, la sorveglianza e il monitoraggio dei sintomi, congiuntamente a mirati interventi di sostegno, dovrebbero essere garantiti quotidianamente a tutti i professionisti coinvolti ai fine di prevenire l'insorgenza di disturbi psicologici

La frontiera delle cure a distanza. Assetto normativo ed il caso Doctor@Home

Introduction: In recent years, and even more following the need for social distancing generated by the global COVID-19 pandemic, e-health has become an increasingly widespread reality in clinical practice, especially for those clinicians operating in the front-line, like nurses. Its growing importance has been followed by increasing attention both by the literature as well as in the generation of specific rules aimed at regulating the phenomenon. Methods: A regulatory review of the literature aims to outline the current regulatory framework relating to telemedicine. Telemedicine, especially in a pandemic context, calls for regulation that runs parallel to the rapid evolution of the phenomenon itself. The paper traces the European, Italian, and Regional legislation, focusing then on a practical experience of telemedicine, called Doctor @ Home, active at the IRCCS National Cancer Center in Aviano (Italy). Discussion: First, the need for regulatory harmonization emerges. Secondly, the potential of co-production and co-learning processes for healthcare professionals and patients arises to adapt to the outpatient needs of patients in a post-pandemic "new normal," exploiting the new technological tools made available by the National Health Service. Key words: Telemedicine, e-health, regulation, Doctor@Home, National Health ServiceIntroduzione: Negli ultimi anni, ed ancor più, a seguito delle necessità di distanziamento sociale generatesi a causa della pandemia mondiale COVID-19, l’e-health si è trasformata in una realtà sempre più concreta e diffusa nella pratica clinica anche per il personale infermieristico, che lavora in prima linea a contatto diretto con i pazienti. A tale rilevanza è seguita un’attenzione sempre maggiore sia in ambito di letteratura, che di generazione di norme specifiche finalizzate a disciplinare il fenomeno. Metodi: Questa revisione normativa della letteratura punta a disegnare l’attuale assetto normativo relativo alla telemedicina, tema, soprattutto in un contesto pandemico come quello attuale, in forte crescita e con necessità di regolamentazione che corra pari passo con la rapida evoluzione del fenomeno stesso. L’articolo ripercorre la normativa europea, nazionale e regionale, focalizzandosi poi su un’esperienza pratica di telemedicina, denominata Doctor@Home, attiva presso l’IRCCS CRO di Aviano (Pordenone). Discussione: L’analisi fa emergere innanzitutto una necessaria armonizzazione normativa per la regolamentazione ed attivazione di piani condivisi, che possano essere comuni ai diversi territori e realtà. In secondo luogo, si sottolinea la potenzialità di processi co-produttivi e di apprendimento al fine di adattare le esigenze ambulatoriali dei pazienti nella “nuova normalità”, sfruttando i nuovi strumenti tecnologici a disposizione del Servizio Sanitario. Parole chiave: Telemedicina, e-health, normativa, Doctor@Home, servizio sanitario nazional

New frontiers in e-health. Policies and the Doctor@Home case study

INTRODUCTION: In recent years, and even more following the need for social distancing generated by the global COVID-19 pandemic, e-health has become an increasingly widespread reality in clinical practice, especially for those clinicians operating in the front-line, like nurses. Its growing importance has been followed by increasing attention both by the literature as well as in the generation of specific rules aimed at regulating the phenomenon. METHODS: A regulatory review of the literature aims to outline the current regulatory framework relating to telemedicine. Telemedicine, especially in a pandemic context, calls for regulation that runs parallel to the rapid evolution of the phenomenon itself. The paper traces the European, Italian, and Regional legislation, focusing then on a practical experience of telemedicine, called Doctor @ Home, active at the IRCCS National Cancer Center in Aviano (Italy). DISCUSSION: First, the need for regulatory harmonization emerges. Secondly, the potential of co-production and co-learning processes for healthcare professionals and patients arises to adapt to the outpatient needs of patients in a post-pandemic "new normal," exploiting the new technological tools made available by the National Health Service. KEY WORDS: Telemedicine, e-health, regulation, Doctor@Home, National Health Servic

La percezione delle competenze trasversali e delle dinamiche di traduzione della conoscenza nella chirurgia d’urgenza e del trauma. Uno studio quantitativo sul territorio nazionale

La chirurgia d'urgenza e del trauma è un contesto particolarmente complesso, in cui il personale sanitario deve lavorare sotto pressione, spesso con limitata conoscenza ri-spetto alla causa del trauma, all'identità del paziente, alle sue patologie pregresse e preferenze di cura. I team di chirurgia d'urgenza sono multidisciplinari e coordinati da un trauma leader, che deve assicurare la massima efficienza ed efficacia nella resa per il paziente, prendendo le giuste decisioni. Le dinamiche nei team di chirurgia d'urgenza e del trauma ap-paiono particolarmente interessanti rispetto alla percezione delle competenze trasversali richieste e al processo di tradu-zione della conoscenza. L'articolo utilizza un approccio quantitativo basato su un questionario online condotto in Italia con il patrocinio della World society of emergency surgery (Wses). L'analisi, effet-tuata tramite il software R, si concentra su 133 questionari anonimi. I risultati sono finalizzati ad approfondire le dinamiche per-cepite di traduzione della conoscenza, competenze trasver-sali e difficoltà nel lavoro di gruppo da parte dei chirurghi d'urgenza e del trauma. Per quanto riguarda le dinamiche di traduzione della conoscenza, solo una parte dei chirurghi d'urgenza è consapevole del concetto e del relativo signifi-cato, o almeno, di alcune sue sfumature. Diversi strumenti vengono utilizzati quali facilitatori, incluse le competenze trasversali, che agevolano anche un processo di decisione condivisa con il paziente, qualora possibile. Molte barriere vengono riconosciute nel lavorare in gruppo. Il ruolo della formazione appare fondamentale per aumenta-re la consapevolezza rispetto a tematiche quali la traduzione della conoscenza e la rilevanza delle competenze trasversali per l'ottimale gestione sia del lavoro che del risultato clini-co con il paziente. Le società scientifiche si pongono come attori fondamentali per facilitare tale consapevolezza attra-verso corsi, condivisione di buone pratiche, attivazione di call specifiche a congressi e su riviste scientifiche di settore. The perception of non-technical skills and knowledge translation dynamics in trauma and acute care surgery. A quantitative study in Italy Abstract. Emergency and trauma surgery stands as a particularly complex context. Clinicians must work under enormous pressure, often with limited knowledge about the cause of the trauma, the patient's identity, the existing conditions, and treatment preferences. Emergency surgery teams are multidisciplinary and coordinated by a trauma leader, who must ensure maximum efficiency and effectiveness for the patient, making the right decisions. With respect to this context, team dynamics appear particularly interesting, especially concerning the perception about the role of non-technical skills and the knowledge translation process. The article uses a quantitative approach based on an on-line survey conducted with the endorsement of the World society of emergency surgery (Wses). The analysis, carried out using the software 'R', focuses on the 133 anonymous questionnaires collected in Italy. The results aim to deepen the dynamics of knowledge translation, non-technical skills, and difficulties in teamwork as perceived by emergency and acute care surgeons. As for the dynamics of knowledge translation, only a part of emergency surgeons is aware of the concept and its meaning, or at least some of its nuances. Several tools are used as fa-cilitators, including soft skills, which also facilitate a shared decision process with the patient, whenever possible. Many barriers are recognized in teamwork. The role of training appears to be fundamental in raising awareness of issues such as the translation of knowledge and the relevance of non-technical skills for the optimal management of both work and clinical outcomes for the patient. Scientific societies appear as key players in facilitating the awareness through courses, sharing of good practices, specific calls and tracks at congresses and in scientific journals

Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation

Abstract Background The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons’ perception, acceptance, and employment of environmentally friendly habits. Methods An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society’s website and Twitter/X profile. Results 450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care. Discussion The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach