Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

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

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

Stres and burnout related to work with special education needs students in elementary school teachers

Namen raziskave je bil preveriti napovedno vrednost nekaterih značilnosti delovnega mesta osnovnošolskih učiteljev za doživljanje poklicnega stresa in izgorelosti. Značilnosti delovnega mesta so bile v raziskavi opredeljene kot zahteve in viri, ki smo jih nadalje delile na splošne in na specifične, vezane na delo z učenci s posebnimi potrebami. Preverjale smo, ali spremenljivke, povezane z delom z učenci s posebnimi potrebami, pojasnijo dodaten delež variance v doživljanju stresa in izgorelosti, ki ga ni mogoče pojasniti s splošnimi značilnostmi delovnega mesta. V raziskavi so sodelovali osnovnošolski učitelji iz vseh dvanajstih regij v Slovenijištevilo sodelujočih variira od 439 do 886. Rezultati kažejo, da specifične značilnosti delovnega mesta samostojno napovedujejo pomemben del variance stresa, emocionalne izčrpanosti in depersonalizacije. Splošne delovne obremenitve in specifična delovna obremenjenost z učenci s posebnimi potrebami predstavljata najbolj stabilna napovednika vseh treh proučevanih kriterijev. Na osnovi ugotovitev predlagamo tudi nekatere ukrepe za zmanjšanje stopnje doživljanja stresa ter za učinkovitejše spoprijemanje z njim.The aim of the present study was to examine the predictive value of elementary school teachers\u27 workplace characteristics on work stress and burnout. Workplace characteristics were defined as job demands and resources, which were further divided into general and specific, related to work with special education needs students. We examined whether variables related to work with special education needs students explained incremental variance in stress and burnout above and beyond general workplace characteristics. Elementary school teachers from all twelve regions of Slovenia (N ranges from 439 to 886) took part in the study. The results have shown that workplace characteristics independently predict a significant amount of variance in stress, emotional exhaustion and depersonalization among teachers. General job demands and specific demands related to special education needs students are the highest and most stable predictors of all three studied criteria. Based on our findings, we suggest several measures which can help to alleviate stress and foster efficient coping strategies

Vzgoja in izobraževanje otrok s posebnimi potrebami

Kot vsi drugi otroci s težavami pri učenju, tudi otroci z vedenjskimi težavami že pred usmeritvijo potrebujejo ustrezno podporo in pomoč v vrtcu oziroma v šoli. Pravočasna strokovna pomoč učiteljev in šolske svetovalne službe bi pri nekaterih učencih lahko odpravila njihove težave in usmeritev (v skupino otrok čustvenimi in vedenjskimi motnjami) morda ne bi bila potrebna. Tudi za ostale skupine OPP, kot je na primer skupina otrok s čustvenimi in vedenjskimi težavami idr., bi bilo treba pripraviti konceptualne podlage in dopolniti obstoječe podzakonske akte. Poudariti torej velja, da podporo in pomoč v vrtcu ali šoli potrebujejo tudi otroci s čustvenimi in vedenjskimi težavami, da bi lahko preprečevali, omejevali oziroma odpravili nadaljnji razvoj njihovih težav, čeprav učencev, ki imajo prehodne težave na področju čustvovanja in vedenja, ne usmerjamo. Da bi v šolskem sistemu bolj uspešno kot doslej uresničevali načelo inkluzije, je treba okrepiti in spodbujati delo vrtcev in šol (vzgojiteljev, učiteljev, svetovalne službe), tako da bo vsem otrokom, ki pomoč in podporo potrebujejo, ta zagotovljena v integriranem pedagoškem prostoru, torej da bo, če je le mogoče, vključena v redne pedagoške in vzgojne dejavnosti

Vzgoja in izobraževanje otrok s posebnimi potrebami

Kot vsi drugi otroci s težavami pri učenju, tudi otroci z vedenjskimi težavami že pred usmeritvijo potrebujejo ustrezno podporo in pomoč v vrtcu oziroma v šoli. Pravočasna strokovna pomoč učiteljev in šolske svetovalne službe bi pri nekaterih učencih lahko odpravila njihove težave in usmeritev (v skupino otrok čustvenimi in vedenjskimi motnjami) morda ne bi bila potrebna. Tudi za ostale skupine OPP, kot je na primer skupina otrok s čustvenimi in vedenjskimi težavami idr., bi bilo treba pripraviti konceptualne podlage in dopolniti obstoječe podzakonske akte. Poudariti torej velja, da podporo in pomoč v vrtcu ali šoli potrebujejo tudi otroci s čustvenimi in vedenjskimi težavami, da bi lahko preprečevali, omejevali oziroma odpravili nadaljnji razvoj njihovih težav, čeprav učencev, ki imajo prehodne težave na področju čustvovanja in vedenja, ne usmerjamo. Da bi v šolskem sistemu bolj uspešno kot doslej uresničevali načelo inkluzije, je treba okrepiti in spodbujati delo vrtcev in šol (vzgojiteljev, učiteljev, svetovalne službe), tako da bo vsem otrokom, ki pomoč in podporo potrebujejo, ta zagotovljena v integriranem pedagoškem prostoru, torej da bo, če je le mogoče, vključena v redne pedagoške in vzgojne dejavnosti

Vzgoja in izobraževanje otrok s posebnimi potrebami

Vzgoja in izobraževanje otrok s posebnimi potrebam

Infections Caused By Community-Associated Methicillin-Resistant Staphylococcus Aureus European Clone (ST80) In Slovenia Between 2006 And 2013

According to the existing literature, a heterogeneous sequence type (ST) or clones of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) circulate in Europe. In Europe, the European clone that belongs to sequence type ST80 is predominant