Indications and Coverage of Metabolic and Bariatric Surgery: A Worldwide IFSO Survey Comparing Different National Guidelines.

INTRODUCTION: Knowing how metabolic and bariatric surgery (MBS) is indicated in different countries is essential information for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). AIM: To analyze the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries. METHODS: All IFSO societies were asked to fill out a survey asking whether they have, and which are their national guidelines, and if MBS is covered by their public health service. RESULTS: Sixty-three out of the 72 IFSO national societies answered the form (87.5%). Among them, 74.6% have some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones, and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries. CONCLUSIONS: Most of the IFSO member societies have MBS guidelines. While more than a third of them have already shifted to the most updated ASMBS/IFSO 2022 ones, another significant number of countries are still following the NIH 1991 guidelines or even do not have any at all. Besides, there is a significant number of countries in which surgical treatment is not yet financially covered. More effort is needed to standardize indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS.

Needlestick injuries. A multidisciplinary concern.

This article outlines a variety of steps implemented by the medical center in an effort to reduce the number of needlestick injuries among nurses within our institution. Overall, we have seen a decline in needlestick injuries with the greatest decline among the nursing staff. We attribute this decline to staff education, improved needle-disposal containers, and the addition of needleless products for IV infusions. More important, a rigorous quality-management approach, including employee involvement, the sharing of data throughout the institution, and management commitment to the issue, has enabled continuous improvement. We are in the process of refining our methods so that future decisions regarding neddlestick injury reduction-activities will more specifically address problem areas.

The unification model: a collaborative effort.

The Rush unification model unites clinical practice with nursing education. In this system, nursing faculty possess joint responsibilities to the college of nursing and to a specific unit in the medical center. Collaboration among managers, clinical specialists, educators, and researchers leads to achievement of unit, college, and departmental goals. The collaborative process among the leadership group members in the medical intensive care unit, consisting of the unit leader, the assistant unit leader, the clinical nurse specialists, and the practitioner-teachers, is described in detail to show how utilization of the skills and strengths of each team member increases the benefits to the unit and the patient.