Team dynamics in emergency surgery teams: results from a first international survey

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma\u2019s causes or the patient\u2019s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients\u2019 and stakeholders\u2019 engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey\u2019s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions

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

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

Recenti progressi nello studio dell’attivazione e dell’aggregazione delle piastrine

L\u2019interazione tra l\u2019adenosin-difosfato (ADP) e il suo recettore piastrinico P2Y12 svolge un ruolo cruciale nell\u2019attivazione piastrinica e nella trombogenesi. Farmaci che inibiscono il P2Y12 sono potenti agenti antitrombotici in pazienti con patologia coronarica. Il clopidogrel appartiene alla famiglia delle tienopiridine ed \ue8 il farmaco inibitore del P2Y12 pi\uf9 comunemente utilizzato in pazienti coronaropatici, che, tuttavia, presenta alcuni importanti svantaggi: 1) \ue8 un pro-farmaco che necessita di essere trasformato in un metabolita attivo; 2) dopo la sua sospensione, la normalizzazione della funzione piastrinica si verifica solo dopo alcuni giorni, poich\ue9 esso inibisce irreversibilmente le piastrine; 3) vi \ue8 un\u2019elevata variabilit\ue0 inter-individuale di risposta farmacologica. Il prasugrel \ue8 un\u2019altra tienopiridina, con un inizio di azione pi\uf9 rapido e pi\uf9 uniforme inibizione piastrinica rispetto al clopidogrel. Queste caratteristiche ne spiegano la maggior efficacia antitrombotica in pazienti con sindrome coronarica acuta sottoposti ad angioplastica coronarica, ma anche la minor sicurezza, in quanto al suo utilizzo si associa una maggior incidenza di complicanze emorragiche. I due antagonisti diretti del P2Y12, cangrelor e ticagrelor, sono caratterizzati da un rapido inizio di azione e dalla reversibilit\ue0 dell\u2019inibizione piastrinica. Il cangrelor non \ue8 risultato superiore al clopidogrel nella prevenzione di eventi trombotici nei pazienti sottoposti a PTCA. Il ticagrelor, primo inibitore diretto del P2Y12 somministrabile per via orale, si \ue8 dimostrato superiore al clopidogrel nella prevenzione di eventi avversi cardiaci maggiori nei pazienti con sindrome coronarica acuta. Inoltre, il ticagrelor ha ridotto l\u2019incidenza di mortalit\ue0 sia vascolare che totale. Tuttavia, anche il ticagrelor era associato a una maggior incidenza di eventi emorragici maggiori spontanei. A differenza del prasugrel, esso non si \ue8 associato a un aumento delle complicanze emorragiche di interventi di bypass aorto-coronarico.The interaction of ADP with its platelet receptor P2Y12 plays a crucial role in platelet activation and thrombogenesis. This article reviews the pharmacology and clinical trials of specific antagonists of P2Y12. Clopidogrel is a thienopyridine with proven antithrombotic efficacy, but it has some important drawbacks: i) it is a pro-drug that needs to be metabolized to its active metabolite; ii) it has a delayed onset and offset of action; iii) there is high inter-individual variability in pharmacological response. Prasugrel is also a thienopyridine, with faster onset of action andmore uniforminhibition of platelet function compared to clopidogrel, accounting for lower incidence of ischemic events in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) and higher incidence of both non-CABG (Coronary Artery Bypass Grafting) related bleeding complications. Two direct and reversible P2Y12 antagonists, cangrelor and ticagrelor, are characterized by rapid onset and reversal of platelet inhibition. Cangrelor did not prove superior to clopidogrel in preventing thrombotic events in patients undergoing PCI. Ticagrelor proved to be superior to clopidogrel in preventing-major adverse cardiac events in ACS patients, but was, like prasugrel, was associated with higher frequency of non-CABG-related bleeding complications. A shorter period of drug discontinuation before surgery was necessary in ticagrelor-treated patients compared to clopidogrel-treated patients to limit the severity of post-surgical bleeding