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

Morphology and taxonomic position of the bizarre Permian pachydomid bivalve Leinzia from Western Gondwana

The genus Leinzia is a typical member of the renowned Artinskian–Wuchiapingian (Permian) endemic bivalve fauna of the Passa Dois Group, Paraná Basin, Brazil. The extraordinary shells of Leinzia, characterized by a rostrum extending from the anterior cardinal margin led certain authors to regard them as bivalved arthropods (Spinicaudata). Due to the unusual morphology and typically poor preservation of the available specimens, the taxonomic position of Leinzia still remains obscure. Leinzia has been variously referred either to the Pterioida, the Crassatelloidea, the Sanguinolitidae, or the Megadesmidae, or to the Pholadomyida. Herein, based on a detailed review of the topotype material and description of newly found specimens of Leinzia from the Serrinha Member, Rio do Rasto Formation, southern Brazil, we shed light on the taxonomic position of this genus. The hinge of the right valve with its large, blunt, anteriorly inclined subumbonal tooth and corresponding socket in the left valve coupled with the absence of true lateral teeth indicate close affinities to Pyramus and Cowperesia. Thus, the data here strongly suggest a Pachydomidae (Edmondioidea) rather than a Crassatelloidea affinity for Leinzia. Conversely, Leinzia differs from all other known Pachydomidae due to its anteriorly rostrate and posteriorly elongated shell. Finally, detailed stratigraphic data indicate that the vertical distribution of Leinzia is constrained to the middle part of the Guadalupian Serrinha Member of the Rio do Rasto Formation

Alternative interpretations of some earliest Ediacaran fossils from China

In a letter to Nature (February, 2011), Xunlai Yuan and col− laborators recorded carbon compression fossils from black shales of the Lantian Formation (Ediacaran), southern Anhui Province, South China. The new fossils, described under five morphological types (Types A to E), exhibit de− grees of morphological differentiation suggesting that they were multicellular eukaryotes. Some of the Lantian macro− fossils were interpreted as algae, but others are of unknown affinities. For reasons noted in this discussion, Type A fossils attracted our particular attention, and we suggest an alter− native interpretation of their affinities. According to our view, some of them (at least those with three faces and no globose holdfast at their base) may represent conulariid cni− darians or close medusozoan relatives. The undistorted or− ganism probably was a three−sided cone in life. We believe that our suggested alternative interpretations of the anat− omy and affinities of the fossils in question can be useful in guiding future research on the oldest currently known fossil assemblage of multicellular organisms