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

Altos níveis de fitase em rações para frangos de corte

Avaliaram-se o desempenho, o coeficiente de digestibilidade da matéria seca (CDMS), da proteína bruta (CDPB), a retenção aparente de cálcio (Ca) e fósforo (P) e a energia metabolizável aparente corrigida para balanço de nitrogênio (EMAn) de dietas suplementadas com altos teores de fitase (FTU) para frangos, até 35 dias de idade. Foram utilizados 1848 pintos, distribuídos em delineamento inteiramente ao acaso, com sete tratamentos e oito repetições de 35 aves. Os tratamentos foram: T1: dieta-controle; T2: dieta com inclusão de 1.500FTU/kg; T3: 3.000FTU/kg; T4: 4.500FTU/kg; T5: 6.000FTU/kg; T6: 8.000FTU/kg e T7: 10.000FTU/kg de ração. No 10º e 28º dias de experimento, quatro e três aves, respectivamente, foram transferidas para gaiolas de metabolismo. A partir da inclusão de 4.500FTU/kg, o desempenho das aves de 1 a 35 dias foi semelhante ao das aves do grupo-controle (P>0,05). Não houve diferença (P>0,05) entre os tratamentos nos CDPB e nos valores de EMAn, porém, na fase inicial, observou-se maior aproveitamento da MS com os altos níveis de fitase (P<0,05). Em relação à retenção de Ca e P, houve efeito positivo da suplementação enzimática, com aumento significativo do uso desses minerais pelas aves. Concluiu-se que é possível suplementar altos teores de fitase valorando adequadamente os nutrientes da dieta