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

Mielografia de cães sadios com o meio de contraste ioversol: resultados liquóricos e anatomo-histopatológicos Myelography in normal dogs with ioversol contrast medium: cerebrospinal fluid and anatomohistopathological results

O meio de contraste ioversol 240mg de iodo(I) por ml foi administrado na dose de 0,5ml/kg de peso por via intracisternal em 30 cães sadios, com o objetivo de verificar as possíveis alterações liquóricas e histopatológicas geradas pelo mesmo. Foram realizadas no líquor, análises físicas, contagens total e diferencial de leucócitos e determinação da concentração total de proteínas. A análise do líquor pós-mielográfica revelou aumento no número de leucócitos totais em três animais e da concentração de proteína em quatro. Alterações histopatológicas foram observadas em dois deles: infiltrado de células inflamatórias mononucleares na fissura ventral e no canal central da medula espinhal e infiltrado discreto de células inflamatórias mononucleares no canal central da medula espinhal, respectivamente. Concluiu-se que a mielografia com o meio de contraste ioversol 240mg I/m<img src="http:/img/fbpe/cr/v32n3/a10img01.gif" align="absmiddle"> pode causar alterações citológicas e na concentração de proteínas no líquor, e histopatológicas, porém discretas, durante o período estudado.<br>Ioversol contrast agent, at a concentration of 240mg of iodine/ml, was administered via intrathecal routes to 30 normal dogs at a dose of 0.5ml/kg weight to determine possible cerebrospinal fluid and histopathological changes. Physical analysis, total and differential white cell counts and quantitative protein determination of the cerebrospinal fluid were done. Cerebrospinal fluid analysis revealed increase in the total white cell count in three animals, and protein in four animals of different groups post-myelography. Histopathological changes were seen in spinal cords of two dogs: mononuclear infiltrate in the ventral fissure and in the central canal, and mononuclear infiltrate in the central canal, respectively. Myelography with ioversol 240mg I/m<img src="http:/img/fbpe/cr/v32n3/a10img01.gif" align="absmiddle"> can cause mild cytological and protein alterations, and histopathological changes under the experimental conditions