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.Peer reviewe

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

The Large Imaging Spectrometer for Solar Accelerated Nuclei (LISSAN): A next-generation solar γ-ray spectroscopic imaging instrument concept

Models of particle acceleration in solar eruptive events suggest that roughly equal energy may go into accelerating electrons and ions. However, while previous solar X-ray spectroscopic imagers have transformed our understanding of electron acceleration, only one resolved image of γ-ray emission from solar accelerated ions has ever been produced. This paper outlines a new satellite instrument concept—the large imaging spectrometer for solar accelerated nuclei (LISSAN)—with the capability not only to observe hundreds of events over its lifetime, but also to capture multiple images per event, thereby imaging the dynamics of solar accelerated ions for the first time. LISSAN provides spectroscopic imaging at photon energies of 40 keV–100 MeV on timescales of ≲10 s with greater sensitivity and imaging capability than its predecessors. This is achieved by deploying high-resolution scintillator detectors and indirect Fourier imaging techniques. LISSAN is suitable for inclusion in a multi-instrument platform such as an ESA M-class mission or as a smaller standalone mission. Without the observations that LISSAN can provide, our understanding of solar particle acceleration, and hence the space weather events with which it is often associated, cannot be complete

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reprocessing of the Hartebeesthoek 2014 co-location survey

International audienceA local tie survey was carried out at Hartebeesthoek observatory (South Africa) in February 2014 by surveyors from Rural Development & Land Reform, University of KwaZulu-Natal, NASA and IGN. Hartebeesthoek observatory is one of the few sites in the world which currently hosts instruments from the four space geodesy techniques, namely DORIS, GNSS, SLR and VLBI. A first adjustment of the survey observations was carried out in 2014 and the tie vectors between instrument reference points were published.As the precision of the VLBI axis offsets was requested by the International VLBI Service and a new version of the IGN adjustment software COMP3D was released, it was decided to reprocess the survey data of the main Hartebeesthoek observatory sub-site HartRAO. Indeed, the new software package allows processing in one step complex survey data, specifically in case of indirect determination of VLBI and SLR telescope reference points. The new processing strategy will be described and the tie vectors compared with 2014 results

Automatic Determination of the SLR Reference Point at Côte d’Azur Multi-Technique Geodetic Observatory

International audienceAbstract The Satellite Laser Ranging (SLR) station known as GRSM-7845 in the International Laser Ranging Service (ILRS) is hosted by the Observatoire de la Côte d’Azur (OCA) located in Caussols, France. Its reference point is the intersection of the telescope axes, which is supposed to be static. Measuring devices and a data processing chain were set up to automatically determine this point, more quickly and accurately than traditional local survey. In order to use an indirect approach (circular fitting), circular and motorized prisms were fixed on the station to be always visible during the telescope rotation. A software package was developed to control the telescope, the dome and the total station motions for fully automatic measurements. In addition to providing an easy determination of the cross-axis for local ties, this system will allow to study the potential motion of the telescope’s axes intersection throughout the year

InSAR Corner Cube at GRSM.

International audienc

A quelles altitudes se trouvent les horloges atomiques de l'observatoire de Paris ?

International audienceThe accuracy of atomic clocks is becoming small enough to determine altitude differences at the centimeter level in the near future. Current research activities consist in developing and comparing clock frequencies, and in setting up time transfer techniques with the required precision. Today, surveyor still has to provide clock altitude differences by traditional methods to allow these comparisons. This article reports levelling carried out by IGN at Paris Observatory for two European scientific projects in which the SYRTE Laboratory is involved.L'exactitude des horloges optiques permet d'envisager dans le futur leur utilisation pour déterminer des différences d'altitudes à une précision centimétrique. Les développements actuels consistent à comparer les fréquences d'horloges en cours de développement. Ainsi, la mise en place de protocoles de comparaison constitue une première étape vers cet objectif. Aujourd'hui, c'est encore au géomètre, au moyen des techniques traditionnelles, de déterminer l'altitude des horloges pour permettre ces comparaisons et fournir une mesure de référence. Cet article décrit les opérations de nivellement effectuées par l'IGN à l'Observatoire de Paris dans le contexte de projets scientifiques européens impliquant le laboratoire SYRTE de l'Observatoire de Paris. Abstract (english) : The accuracy of atomic clocks is becoming small enough to determine altitude differences at the centimeter level in the near future. Current research activities consist in developing and comparing clock frequencies, and in setting up time transfer techniques with the required precision. Today, surveyor still has to provide clock altitude differences by traditional methods to allow these comparisons. This article reports levelling carried out by IGN at Paris Observatory for two European scientific projects in which the SYRTE Laboratory is involved