Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines

Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods: Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results: A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion: Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions

Особливості викладання біоорганічної та біологічної хімії у медичних ВНЗ

Вивчення біоорганічної та біологічної хімії, анатомії, гістології та фізіології складає фундамент освіти майбутнього лікаря, а отримані знання становлять основу клінічного мислення, глибокого розуміння механізмів розвитку хвороб, сприяють призначенню адекватного патогенетично обґрунтованого лікування. У вітчизняних медичних ВНЗ біоорганічну та біологічну хімію вивчають на 1-2 курсах, коли ще більшість студентів не має знань з клінічних дисциплін та практичного досвіду, через що вони не вмотивовані на детальне вивчення предмету, не бачать його практичного спрямування та важливості для майбутньої практики. Глибоке вивчення біоорганічної та біологічної хімії ускладнюється тим, що кількість аудиторних годин, відведених на вивчення предмету, у 2-3 рази менше у порівнянні із закордонними університетами, великий обсяг матеріалу виноситься на самостійне вивчення, кількість лекційних годин критично мала і не дозволяє якісно розкрити суть теми та довести до аудиторії сучасні положення та досягнення у галузі біохімії. Також складність для студентів у вивченні предмету складає відсутність «універсального» вітчизняного підручника, де було б викладено усі темі згідно питань модуля достатньо повно та інформативно. В умовах великої кількості матеріалу, що необхідно розібрати зі студентами під час аудиторного заняття, складним є проведення практичної складової навчання. Таким чином, покращення вивчення біологічної хімії у медичних ВНЗ вимагає більш ретельного відбору абітурієнтів із високими балами іспитів згідно ЗНО, збільшення годин на аудиторну роботу та на лекційний курс, покращення матеріально-технічної бази, практична спрямованість при вивченні дисципліни

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

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

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Experimental correction of changes in proteinase-inhibitory potential of rat oral organs under conditions of toxic neuropathy

Метою нашого дослідження було вивчити вплив кокарніту на розвиток змін протеїназно-інгібіторного потенціалу тканин пародонта та слинних залоз тварин за умов токсичної нейропатії. За умов токсичної нейропатії у тканинах слинних залоз протеїназно-інгібіторний потенціал вірогідно змінювався у 2 рази порівняно з контролем. Введення кокарніту протягом 9 днів призвело до нормалізації протеїназно-інгібіторного потенціалу піднижньощелепних слинних залоз тварин. У м’яких тканинах пародонта щурів протеїназно-інгібіторний потенціал зростав у 1,4 рази, що свідчить про активацію протеолізу. Введення Кокарніту протягом 9 днів призводило до зменшення протеїназно-інгібіторного потенціалу тканин пародонта за умов розвитку токсичної нейропатії.Целью нашего исследования было изучить влияние Кокарнита на развитие изменений протеиназно-ингибиторного потенциала тканей пародонта и слюнных желез животных в условиях токсической нейропатии. В условиях токсической нейропатии в тканях слюнных желез протеиназно-ингибиторный потенциал достоверно изменялся в 2 раза по сравнению с контролем. Введение Кокарнита в течении 9 дней привело к нормализации протеиназно-ингибиторного потенциала поднижнечелюстных слюнных желез животных. В мягких тканях пародонта крыс протеиназно-ингибиторный потенциал вырос в 1,4 раза, что свидетельствует об активации протеолиза. Введение Кокарнита в течении 9 дней привело к уменьшению протеиназно-ингибиторного потенциала тканей пародонта в условиях развития токсической нейропатии.The aim of our research was to study the effect of Cocarnite on the development of changes in the proteinase-inhibitory potential of periodontal tissues and salivary glands of animals under conditions of toxic neuropathy. Under conditions of toxic neuropathy in the tissues of the salivary glands, the proteinase-inhibitory potential significantly changed 2-fold compared to the control. The injection of Cocarnite for 9 days led to the normalization of the proteinase-inhibitory potential of the salivary glands of animals. In the soft tissues of the periodontium of rats, the proteinase-inhibitory potential increased by 1.4 times, which indicates the activation of proteolysis. The injection of Cocarnite for 9 days led to a decrease in the proteinase-inhibitory potential of periodontal tissues in conditions of the development of toxic neuropathy

WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The cornerstones of effective treatment of IAIs include early recognition, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using a critical care environment, combined with an optimal surgical approach. Together, the World Society of Emergency Surgery (WSES), the Global Alliance for Infections in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) have jointly completed an international multi-society document in order to facilitate clinical management of patients with IAIs worldwide building evidence-based clinical pathways for the most common IAIs. An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting information was shared by an international task force from 46 countries with different clinical backgrounds. The aim of the document is to promote global standards of care in IAIs providing guidance to clinicians by describing reasonable approaches to the management of IAIs