Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation.

BACKGROUND: The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons' perception, acceptance, and employment of environmentally friendly habits. METHODS: An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society's website and Twitter/X profile. RESULTS: 450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care. DISCUSSION: The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach.

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.

Opioid Misuse: A Review of the Main Issues, Challenges, and Strategies.

In the United States, from 1999 to 2019, opioid overdose, either regularly prescribed or illegally acquired, was the cause of death for nearly 500,000 people. In addition to this pronounced mortality burden that has increased gradually over time, opioid overdose has significant morbidity with severe risks and side effects. As a result, opioid misuse is a cause for concern and is considered an epidemic. This article examines the trends and consequences of the opioid epidemic presented in recent international literature, reflecting on the causes of this phenomenon and the possible strategies to address it. The detailed analysis of 33 international articles highlights numerous impacts in the social, public health, economic, and political spheres. The prescription opioid epidemic is an almost exclusively North American problem. This phenomenon should be carefully evaluated from a healthcare systems perspective, for consequential risks and harms of aggressive opioid prescription practices for pain management. Appropriate policies are required to manage opioid use and prevent abuse efficiently. Examples of proper policies vary, such as the use of validated questionnaires for the early identification of patients at risk of addiction, the effective use of regional and national prescription monitoring programs, and the proper dissemination and translation of knowledge to highlight the risks of prescription opioid abuse.

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.

Artificial Intelligence and Surgery: Ethical Dilemmas and Open Issues.

BACKGROUND: Artificial intelligence (AI) applications aiming to support surgical decision-making processes are generating novel threats to ethical surgical care. To understand and address these threats, we summarize the main ethical issues that may arise from applying AI to surgery, starting from the Ethics Guidelines for Trustworthy Artificial Intelligence framework recently promoted by the European Commission. STUDY DESIGN: A modified Delphi process has been employed to achieve expert consensus. RESULTS: The main ethical issues that arise from applying AI to surgery, described in detail here, relate to human agency, accountability for errors, technical robustness, privacy and data governance, transparency, diversity, non-discrimination, and fairness. It may be possible to address many of these ethical issues by expanding the breadth of surgical AI research to focus on implementation science. The potential for AI to disrupt surgical practice suggests that formal digital health education is becoming increasingly important for surgeons and surgical trainees. CONCLUSIONS: A multidisciplinary focus on implementation science and digital health education is desirable to balance opportunities offered by emerging AI technologies and respect for the ethical principles of a patient-centric philosophy.

The impact of particle radiotherapy on the functioning of cardiac implantable electronic devices: a systematic review of in vitro and in vivo studies according to PICO criteria.

The number of oncological patients who may benefit from proton beam radiotherapy (PBT) or carbon ion radiotherapy (CIRT), overall referred to as particle radiotherapy (RT), is expected to strongly increase in the next future, as well as the number of cardiological patients requiring cardiac implantable electronic devices (CIEDs). The management of patients with a CIED requiring particle RT deserves peculiar attention compared to those undergoing conventional photon beam RT, mostly due to the potential generation of secondary neutrons by particle beams interactions. Current consensus documents recommend managing these patients as being at intermediate/high risk of RT-induced device malfunctioning regardless of the dose on the CIED and the beam delivery method used, despite the last one significantly affects secondary neutrons generation (very limited neutrons production with active scanning as opposed to the passive scattering technique). The key issues for the current review were expressed in four questions according to the Population, Intervention, Control, Outcome criteria. Three in vitro and five in vivo studies were included. Based on the available data, PBT and CIRT with active scanning have a limited potential to interfere with CIED that has only emerged from in vitro study so far, while a significant potential for neutron-related, not severe, CIED malfunctions (resets) was consistently reported in both clinical and in vitro studies with passive scattering.

A year of pandemic for European particle radiotherapy: A survey on behalf of EPTN working group.

OBJECTIVES: To provide an overview of the impact of the pandemic on the clinical activity and take a snapshot of the contingent challenges that European particle therapy centers are called to face, we surveyed the members of the European Particle Therapy Network (EPTN). MATERIAL AND METHODS: A 52-question survey was conducted from 4th April 2021 to 30th July 2021 using the Google Forms platform. Three dedicated sections analysed the clinical context of each participating institution, the staff management, and the clinical changes in the oncological workflow. RESULTS: Out of the 23 contacted European hubs of particle radiotherapy, a total of 9 (39%) responded to the survey. The number of in-person first evaluations and follow-up visits decreased, but telemedicine was implemented. Multidisciplinary tumour board discussions continued during the outbreak using web-based solutions. A delay in cancer diagnosis and oncological staging leading to an increment in more advanced diseases at first presentation was generally observed. Even if the total number of treatments (photons and particles) in the responding institutions showed a trend of decrease, there was or a stable situation or slight increase in particle treatments. The clinical treatment choices followed the national and international scientific recommendations and were patient/disease-oriented. Hypofractionation and short-schedule of chemotherapy, when applicable, were preferred. CONCLUSIONS: Our findings show a rapid and effective reaction of European particle RT hubs to manage the healthcare crisis. Considering the new waves and virus variants, the vaccination campaign will hopefully reduce the oncological impacts and consequences of the prolonged outbreak.

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's causes or the patient's 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' and stakeholders' 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's 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.

Non-pharmaceutical Interventions and the Infodemic on Twitter: Lessons Learned from Italy during the Covid-19 Pandemic.

The COVID-19 pandemic changed expectations for information dissemination and use around the globe, challenging accepted models of communications, leadership, and social systems. We explore how social media discourse about COVID-19 in Italy was affected by the rapid spread of the virus, and how themes in postings changed with the adoption of social distancing measures and non-pharmaceutical interventions (NPI). We used topic modeling and social network analysis to highlight critical dimensions of conversations around COVID-19: 1) topics in social media postings about the Coronavirus; 2) the scope and reach of social networks; and 3) changes in social media content as the nation moved from partial to full social distancing. Twitter messages sent in Italy between February 11th and March 10th, 2020. 74,306 Tweets sent by institutions, news sources, elected officials, scientists and social media influencers. Messages were retweeted more than 1.2 million times globally. Non-parametric chi-square statistic with residual analysis to identify categories, chi-square test for linear trend, and Social Network Graphing. The first phase of the pandemic was dominated by social media influencers, followed by a focus on the economic consequences of the virus and placing blame on immigrants. As the crisis deepened, science-based themes began to predominate, with a focus on reducing the spread of the virus through physical distancing and business closures Our findings highlight the importance of messaging in social media in gaining the public's trust and engagement during a pandemic. This requires credible scientific voices to garner public support for effective mitigation. Fighting the spread of an infectious disease goes hand in hand with stemming the dissemination of lies, bad science, and misdirection.

Population Health Strategies to Support Hospital and Intensive Care Unit Resiliency During the COVID-19 Pandemic: The Italian Experience.

Italy was one of the countries most affected by the number of people infected and dead during the first COVID-19 wave. The authors describe the rapid rollout of a population health clinical and organizational response in preparedness and capabilities to support the first wave of the COVID-19 pandemic in the Italian province of Modena. The authors review the processes, the challenges faced, and describe how excess demand for hospital services was successfully mitigated and thus overwhelming the healthcare services avoided the collapse of the local health care system. An analysis of bed occupancy in the region predicted during the first weeks of the epidemic. The SEIR model estimated the number of infected people under different containment measures. Community resources were mobilized to reduce provincial hospitals' burden of care. A population health approach, based on a radical reorganization of the workflow and emergency patient management, was implemented. The bed saturation of the Modena Healthcare Agency was measured by an ad hoc, newly implemented intensive care unit (ICU) bed occupancy and COVID-19 centralized governance dashboard. ICU bed occupancy increased by 114%, avoiding saturation of the Modena Healthcare Agency system. The Emilia-Romagna region achieved a higher rate of ICU bed availability at 2.15 ICU beds per 10,000 inhabitants as compared with community 1 ICU bed availability prior to the pandemic. Rapid and radical local reorganization of regional efforts helped inform the successful development and implementation of strategic choices within the hospital and the community to prevent the saturation of key facilities.

The Digital Transformation of Business Model Innovation: A Structured Literature Review.

This paper has a two-fold aim: to analyze the development of the digital transformation field, and to understand the impact of digital technologies on business model innovation (BMI) through a structured review of the literature. The results of this research reveal that the field of digital transformation is still developing, with growing interest from researchers since 2014. Results show a need for research in developing countries and for more collaboration between researchers and practitioners. The review highlights that the field is fragmented among disruptive technologies, shared platforms and ecosystems, and new enabling technologies. We conclude that digital transformation has impacted value creation, delivery, and capture in almost every industry. These impacts have led to the employment of a variety of new business models, such as those for frugal innovation and the circular economy.

Síndrome de persistencia de los conductos müllerianos: reporte de caso / Persistent müllerian duct syndrome: case report

El factor inhibidor del conducto mülleriano (FICM) es también conocido como hormona antimülleriana. Si este no se produce en los fetos masculinos, el útero y las trompas de Falopio completan su desarrollo y coexisten con genitales externos masculinos. En el artículo se muestran dos casos en los que se identifica la persistencia de las estructuras de los conductos müllerianos en hermanos fenotípicamente masculinos. Los pacientes tienen 35 y 30 años de edad. Ambos tenían antecedente de criptorquidia y hernia inguinal, por lo cual fueron operados. En los dos se identificaron útero y trompas de Falopio en la resonancia magnética. El desarrollo de los genitales masculinos internos depende de la testosterona y la diferenciación de los conductos de Wolff, al tiempo que los conductos müllerianos involucionan por la presencia del FICM. La insuficiencia de este factor es tambiénconocida como síndrome de persistencia de los conductos müllerianos (SPCM). Los pacientes con SPCM desarrollan estructuras müllerianas y wolffianas.

Müllerian duct inhibiting factor (MDIF) is also known as anti-Müllerian hormone. If it is not produced in a male fetus the uterus and fallopian tubes complete their developmentcoexisting with normal male external genitals. Two cases showing persistence of Müllerian duct structures in phenotypic male brothers are reported. The patients were 35 and 30years old. Both patients had cryptorchidism and inguinal hernia for which they were operated. In both patients uterus and fallopian tubes were identified in pelvis MRI. The normal development of the internal male genital system depends on testosterone andwolffian ducts differentiation while the Müllerian ducts regress in the presence of MDIF. MDIF insufficiency is also known as persistent Müllerian duct syndrome (PMDS). PMDS patients develop both wolffian and Müllerian structures.

Hemangioma cavernoso del páncreas: reporte de caso / Cavernous hemangioma of the pancreas: case report

La literatura ha reportado muy pocos casos de hemangiomas pancreáticos. En este artículo se presenta uno de ellos, con su respectiva descripción en las imágenes ecográficas y tomográficas, así como su comprobación histológica. Generalmente, los tumores vasculares se encuentran en el hígado y descubrirlos en el páncreas es muy raro, pues pertenecen al grupo de los tumores no epiteliales del páncreas e incluyen el linfoma maligno y los tumores de tejidos blandos tanto malignos como benignos. Además, representan entre el 1% y el 2% de todos los tumores pancreáticos. Por lo anterior, estas lesiones deben incluirseen el diagnóstico diferencial de los tumores hipervasculares del páncreas.

Very few cases of pancreatichemangiomas have been reported in the literature. We present one patient with this entity and the ultrasound and tomographic images as well as histological confirmation. Vascular tumors are frequently found in the liver, it is unusual to find them in the pancreas, these are included in the group of non epithelial tumors of thepancreas include malignant lymphoma and soft tissue tumors. They represent 1% to 2% of all pancreatic tumors. Pancreatic hemangioma should be included in the list of differentialdiagnoses in case of a hypervascular pancreatic lesion.

Accessory hepatic lobe mimicking an intra-abdominal tumor.

We present an accessory hepatic lobe case in which the axial computed tomographic images were mimicking an intra-abdominal tumor. The multiplanar reconstruction, 3-dimensional, and maximum intensity projection images suggested the diagnosis of an accessory hepatic lobe connected to the sixth liver segment through a highly irrigated pedicle. The diagnostic impression was confirmed by surgery and pathological examination.

Displasia aural: presentación de un caso / Aural dysplasia: one case presentation

En este artículo se presenta el caso de una niña con displasia aural, con afectación del conducto auditivo externo y de la cadena osicular. Se describen los hallazgos por tomografía computarizada y por resonancia magnética.

Manifestacion de Aspergilosis Pulmonar Angioinvasiva como Sindrome de Vena Cava Superior / Angioinvasive aspergilosis as superior cava vein syndrome

En este artículo se presenta el caso de un paciente de diez años de edad con diagnóstico previo de anemia de Fanconi y antecedente de trasplante de médula ósea, manejado con inmunosupresores, quien manifiesta un cuadro clínico respiratorio rápidamente progresivo, acompañado de síndrome de vena cava superior secundario a infección por Aspergillus, variedad angioinvasiva. No se conocen casos similares reportados en el medio colombiano ni en la bibliografía médica actual.Aquí se refieren los hallazgos por imagen, el resultado histológico y la revisión bibliográfica