Updated European guidelines for clinical management of familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), gastric adenocarcinoma, proximal polyposis of the stomach (GAPPS) and other rare adenomatous polyposis syndromes: a joint EHTG-ESCP revision.

BACKGROUND: Hereditary adenomatous polyposis syndromes, including familial adenomatous polyposis and other rare adenomatous polyposis syndromes, increase the lifetime risk of colorectal and other cancers. METHODS: A team of 38 experts convened to update the 2008 European recommendations for the clinical management of patients with adenomatous polyposis syndromes. Additionally, other rare monogenic adenomatous polyposis syndromes were reviewed and added. Eighty-nine clinically relevant questions were answered after a systematic review of the existing literature with grading of the evidence according to Grading of Recommendations, Assessment, Development, and Evaluation methodology. Two levels of consensus were identified: consensus threshold (≥67% of voting guideline committee members voting either 'Strongly agree' or 'Agree' during the Delphi rounds) and high threshold (consensus ≥ 80%). RESULTS: One hundred and forty statements reached a high level of consensus concerning the management of hereditary adenomatous polyposis syndromes. CONCLUSION: These updated guidelines provide current, comprehensive, and evidence-based practical recommendations for the management of surveillance and treatment of familial adenomatous polyposis patients, encompassing additionally MUTYH-associated polyposis, gastric adenocarcinoma and proximal polyposis of the stomach and other recently identified polyposis syndromes based on pathogenic variants in other genes than APC or MUTYH. Due to the rarity of these diseases, patients should be managed at specialized centres.

Perspectives and awareness of endoscopy healthcare professionals on sustainable practices in gastrointestinal endoscopy: results of the LEAFGREEN survey.

BACKGROUND: Gastrointestinal (GI) endoscopy is one of healthcare's main contributors to climate change. We aimed to assess healthcare professionals' attitudes and the perceived barriers to implementation of sustainable GI endoscopy. METHODS: The LEAFGREEN web-based survey was a cross-sectional study conducted by the European Society of Gastrointestinal Endoscopy (ESGE) Green Endoscopy Working Group. The questionnaire comprised 39 questions divided into five sections (respondent demographics; climate change and sustainability beliefs; waste and resource management; single-use endoscopes and accessories; education and research). The survey was available via email to all active members of the ESGE and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) in March 2023. RESULTS: 407 respondents participated in the survey (11% response rate). Most participants (86%) agreed climate change is real and anthropogenic, but one-third did not consider GI endoscopy to be a significant contributor to climate change. Improvement in the appropriateness of endoscopic procedures (41%) and reduction in single-use accessories (34%) were considered the most important strategies to reduce the environmental impact of GI endoscopy. Respondents deemed lack of institutional support and knowledge from staff to be the main barriers to sustainable endoscopy. Strategies to reduce unnecessary GI endoscopic procedures and comparative studies of single-use versus reusable accessories were identified as research priorities. CONCLUSIONS: In this survey, ESGE and ESGENA members acknowledge climate change as a major threat to humanity. Further improvement in sustainability beliefs and professional attitudes, reduction in inappropriate GI endoscopy, and rational use of single-use accessories and endoscopes are critically required.

Targeted intervention to achieve waste reduction in gastrointestinal endoscopy.

OBJECTIVE: Endoscopy is healthcare's third largest generator of medical waste in hospitals. This prospective study aimed to measure a single unit's waste carbon footprint and perform a pioneer intervention towards a more sustainable endoscopy practice. The relation of regulated medical waste (RMW; material fully contaminated with blood or body fluids or containing infectious agents) versus landfill waste (non-recyclable material not fully contaminated) may play a critical role. DESIGN: In a four-stage prospective study, following a 4-week observational audit with daily weighing of both waste types (stage 1), stage 2 consisted of a 1-week intervention with team education of waste handling. Recycling bins were placed in endoscopy rooms, landfill and RMW bins were relocated. During stages 3 (1 month after intervention) and 4 (4 months after intervention), daily endoscopic waste was weighed. Equivalence of 1 kg of landfill waste to 1 kg carbon dioxide equivalent (CO2e) and 1 kg of RMW to 3kgCO2e was assumed. Paired samples t-tests for comparisons. RESULTS: From stage 1 to stage 3, mean total waste and RMW were reduced by 12.9% (p=0.155) and 41.4% (p=0.010), respectively, whereas landfill (p=0.059) and recycling waste increased (paper: p=0.001; plastic: p=0.007). While mean endoscopy load was similar (46.2 vs 44.5, p=0.275), a total decrease of CO2e by 31.6% (138.8kgCO2e) was found (mean kgCO2e109.7 vs 74.9, p=0.018). The annual reduction was calculated at 1665.6kgCO2e. All these effects were sustained 4 months after the intervention (stage 4) without objections by responsible endoscopy personnel. CONCLUSION: In this interventional study, applying sustainability measures to a real-world scenario, RMW reduction and daily recycling were achieved and sustained over time, without compromising endoscopy productivity.

Pandemic, power and paradox: Improvising as the New Normal during the COVID-19 crisis.

The global COVID-19 pandemic made salient various paradoxical tensions, such as the trade-offs between individual freedom and collective safety, between short term and long-term consequences of adaptation to the new conditions, the power implications of sameness (COVID-19 was non-discriminatory in that all were affected in one way or another) and difference (yet not all were affected equally due to social differences), whereas most businesses became poorer under lockdown, others flourished; while significant numbers of workers were confined to home, some could not return home; some thrived while working from home as others were challenged by the erosion of barriers between their private and working lives. Rapid improvisational responding and learning at all levels of society presented itself as a naturally occurring research opportunity for improvisation scholars. This improvisation saw the arrival of a 'New Normal', eventually defined as 'learning to live with COVID-19'. The five articles in this special issue capture critical aspects of improvisation, paradoxes and power made salient by the COVID-19 pandemic in contexts ranging from higher-education, to leadership, to medical care and virtue ethics. In their own ways, each breaks new ground by contributing novel insights into improvisation scholarship.

Improvising resilience: The unfolding of resilient leadership in COVID-19 times.

The spread of the COVID-19 pandemic in Italy has had disastrous effects on the national economy. The hospitality sector has experienced a significant impact from the crisis: starting from March 2020 it has literally collapsed. Experts believe it will take three years for the sector to recover. Confronted with a dramatic uncertainty, which imposed rapid action, hospitality leaders need to nurture resilience. To enrich current understanding of the way resilient leadership unfolds to respond to jolts, we draw on an exploratory qualitative research involving Italian hotel managers. Following in-depth interviews, we show that resilient leadership and improvisation are deeply interconnected. Their interdependence entails two practices, namely gardening and learning. This suggests a paradoxical tension: to exercise resilience, leaders need to be at the same time in the system, by actively learning from events, and outside the system, by zooming out as they focus on ongoing planning for the next move.

Two-stage pancreatic head resection after previous damage control surgery in trauma: two rare case reports.

BACKGROUND: This study describes the successful treatment of two clinical settings of grade V pancreaticoduodenal blunt trauma only possible due to the prompt collaboration of a peripheral trauma hospital and a central hepatobiliary and pancreatic unit. CASE PRESENTATION: We reviewed the clinical records of two male patients aged 17 and 47 years old who underwent a two-stage pancreaticoduodenectomy after a previous Damage-Control Surgery (DCS). Both patients were transferred to our Hepatobiliopancreatic Unit 2 days after immediate DCS with haemostasis, debridement, duodenostomy, gastroenterostomy, external drainage and laparostomy. One day after, they both underwent a two-stage Whipple's procedure with external cannulation of the main bile duct and the main pancreatic duct with seized calibre silicone drains through the skin. The reconstructive phase was performed two weeks later. The first patient had an uneventful post-operative course and was discharged on post-operative day 8. The second patient developed a high debt biliary fistula on post-operative day 5 being submitted to a relaparotomy with extensive peritoneal lavage. After conservative measures the fistula underwent a progressive closure in 15 days, and the patient was discharged at post-operative day 50 without any limitations. CONCLUSIONS: Pancreaticoduodenectomy is a life-saving operation in selected grade V pancreaticoduodenal trauma lesions. DCS is a salvage approach, often performed in peripheral hospitals, making an early referral to an hepatobiliopancreatic centre mandatory to achieve survival in these severely injured patients. A two-staged Whipple's operation for severe duodenal / pancreatic trauma can be performed safely and may represent a life-saving option under these very unusual circumstances.

A narrative on diversity, equity, and inclusion in surgery: insights from the European Society of Coloproctology and identification of points for action.

The focus of the 2022 European Society of Coloproctology (ESCP) annual campaign was diversity, equity, and inclusion (DEI) in surgery. The ESCP "Operation Equal Access" campaign sought to interview key-opinion leaders and trainees, to raise awareness on inequalities, inform the community of the status of the topic, and to identify future areas for improvement. The ESCP Social Media Working Group interviewed experts who have made significant contributions to DEI in colorectal surgery and were acknowledged opinion leaders in the field. The interviews focused on their career, professional life, experiences, and opportunities during their training, and their views on DEI in colorectal surgery. DEI principles, education, and values need further promotion to reduce and address bias within the profession and overall improve the experience of minority community including health professionals and patients. International Societies are working to facilitate training opportunities and overcome DEI, and networking have contributed to that. Collaborations between societies will be pivotal to contribute to offering research and leadership opportunities equally. Access to advanced workshops including cadaveric training and simulation can be consistently promoted and provided globally via societies through telemonitoring. Involving patients in research should be encouraged, as it brings the perspective of a living experience.

Environmental effects of surgical procedures and strategies for sustainable surgery.

There is a bidirectional relationship between climate change and health care. Climate change threatens public health, and health care contributes to climate change. For example, surgery is the most energy-intensive practice in the health-care sector, and gastrointestinal conditions are responsible for a substantial environmental burden. However, environmental costs associated with health care are often overlooked. This issue has been examined more closely in current times. Emerging data are mainly focused on surgery, as the most resource-intensive practice. However, there is still a lack of global awareness and guidance on sustainable surgical practices. This Perspective aims to reassess the evidence on health care and surgery carbon footprints, focusing on gastrointestinal conditions, identify issues that need to be addressed to achieve a more sustainable practice and develop perspectives for future surgical procedures. The proposed framework to mitigate the environmental effects of surgery could be translated to other health-care sectors.

Becoming a Fraternal Organization: Insights from the Encyclical Fratelli Tutti.

We uncover fundamental dimensions of the process through which organizations embed the practice of fraternity through embarking on an organizational journey in the direction of the common good. Building on the latest encyclical of Pope Francis, Fratelli Tutti, about fraternal and social friendship, we offer insight into the understanding of what it means to become a fraternal organization and reflect on the key ethical and paradoxical challenges for organizations aiming at collectively contributing to the common good. We add to previous work by characterizing this journey as a process involving unique ethical challenges that emerge from the paradoxes associated with this process and how this might change the nature of the relationships between organizations and others within the organizational landscape.

Crossing barriers: the burden of inflammatory bowel disease across Western Europe.

An estimated 2.5-3 million individuals (0.4%) in Europe are affected by inflammatory bowel disease (IBD). Whilst incidence rates for IBD are stabilising across Europe, the prevalence is rising and subsequently resulting in a significant cost to the healthcare system of an estimated 4.6-5.6 billion euros per year. Hospitalisation and surgical resection rates are generally on a downward trend, which is contrary to the rising cost of novel medication. This signifies a large part of healthcare cost and burden. Despite publicly funded healthcare systems in most European countries, there is still wide variation in how patients receive and/or pay for biologic medication. This review will provide an overview and discuss the different healthcare systems within Western Europe and the barriers that affect overall management of a changing IBD landscape, including differences to hospitalisation and surgical rates, access to medication and clinical trial participation and recruitment. This review will also discuss the importance of standardising IBD management to attain high-quality care for all patients with IBD.

The impact of empowerment and technology on safety behavior: evidence from mining companies.

Major technological advances that are being introduced in the global mining industry have an impact on work and employee attitudes toward safety. The objective of this study was to analyze the impact of empowerment and technology on safety behavior. The research design was cross-sectional, and the sample was composed of 403 employees in mining companies. To measure safety behavior we used Neal, Griffin and Hart scales, and psychological empowerment was measured using the Spreitzer scale. The results indicated high levels of empowerment on safety behavior and medium levels of technology's promotion and prevention factors in the employees surveyed. Also, the study revealed that the meaning dimension of empowerment and the promotion technology factor positively affect safety behavior. A further contribution of the study is in the design of a scale to measure the impact of technology on safety behavior, as there are no known scales for this.

Strategic Encounters in Innovation and Regulation: Healthcare Transformation in the Era of Digital Connectivity Comment on "What Managers Find Important for Implementation of Innovations in the Healthcare Sector - Practice Through Six Management Perspectives".

Healthcare innovations emerge and develop in institutionally dense selective environments. New projects and propositions in healthcare sectoral ecosystems can be understood as product-service compacts, that is, complex solutions that dynamically integrate tangible and intangible elements in close interaction with users' needs and the evolving regulatory context under uncertainty and ambiguity. We advance the concept of "strategic encounters" to encapsulate, capitalise and extend the contribution by Palm and Fischier's on the key enabling managerial factors for healthcare innovation implementation under conditions of imperfect foresight. We intertwine creative assemblages that shape the formation of knowledge-intensive activities at the operators' level with scope of sectoral level interventions to underscore how the opportunities and constraints can enhance innovation for the common good. We use the case of digital data health regulatory agendas as illustration. We argue that this broader perspective on healthcare transformation is theoretically pertinent and practically useful, for management and policy.

Melt Electrospinning Writing of Mesh Implants for Pelvic Organ Prolapse Repair.

Over the past decade, melt electrospinning writing has attracted renewed attention. When combined with three-dimensional (3D) printing capabilities, complex 3D structures can be produced, from ultrafine fibers in the absence of toxic solvents, making it particularly attractive to fabricate customized scaffolds and implants for medical applications. This research aimed to develop novel less stiff vaginal mesh implants for pelvic organ prolapse (POP) repair, matching the physiological biomechanics of vaginal tissues. The main objectives, to attain that goal, were: development of a melt electrospinning writing prototype, with additive manufacturing capability, to produce complex structures from micrometer scale fibers, in a direct 3D printing mode; and design and validate new concepts of biodegradable meshes/scaffolds with new geometries, for POP repair. The melt electrospinning writing prototype was built based on different modules. Biodegradable polycaprolactone was used to produce novel implants: three geometries and two fiber configurations were employed. The commercially available Restorelle® (Coloplast) mesh was used as a benchmark. Printed implants were analyzed via scanning electron microscopy (SEM) and uniaxial tensile testing. The SEM images showed that the geometry is generally well produced; however, some minor deviations are visible due to charge interactions. The tensile test results indicated that, regardless of the geometry, the samples showed an elastic behavior for smaller displacements; aplastic behavior dominates later stages. In the physiological range of deformation, the novel meshes (80 µm fiber diameter) matched the tissue properties (p > 0.05). The Restorelle mesh was significantly stiffer than vaginal tissue (p < 0.05) and novel meshes. The precision of the various geometrical patterns and fiber diameters produced highlights the success of the designed and built prototype equipment. Results showed that the biodegradable meshes produced are biomechanically more compatible with native tissue than commercial implants.

Dogs at the Workplace: A Multiple Case Study.

As the work environment is increasing in competitiveness and stressfulness, more and more companies try to increase employee well-being. One option is allowing employees to bring their dogs to work, building on the considerable evidence that dogs have a positive influence on people's well-being. However, little is known about how a dog's presence influences the employees and the companies in offices. Therefore, we empirically scrutinize the presence of dogs in organizations and the impact of pet-friendly organizational policies, with multiple case studies with semi-structured interviews as their foundation. Based on an inductive approach for the data analysis, we found that organizational members consider that dogs can lower their stress, improve communication, and foster social cohesion when a flexible organizational culture is in place. This includes the following: Problems in the company are openly addressed; employees have job autonomy, with flexibility to take breaks; and mistakes and errors are allowed to be made by employees and their companions alike, and room to find solutions is given. The inflexible permission of pets at work can, on the contrary, create pressure and stress in employees. For the business world, this implicates that this kind of incentive only leads to success if the right framework and culture is in place, and it cannot only be seen as an instrument to increase employee well-being.

Stewardship as process: A paradox perspective.

Long-term stewardship is usually represented as a stable structural condition and portrayed as a source of competitive advantage to firms (including family businesses) that use it as a mode of governance. Less is known about how organizations engage with stewardship as a process. We embrace a process approach to report a case study about the unfolding of stewardship in a multi-business family group. We conclude that stewardship is a process marked by critical tensions and paradoxes; by exploring the nature of these we uncover further dimensions and responses to the paradoxes of stewardship.

Jackstone Calculus.

Jackstone calculus is a rare bladder stone with a unique appearance, presenting a stippled and spiculated contour. Correct diagnosis is important because it may have therapeutic implications, as this distinctive shape correlates with a specific mineral composition of calcium oxalate dihydrate, which tend to be easily fragmented by lithotripsy, allowing to attempt an endoscopic treatment instead of surgery in larger stones. We present the case of a 77-year-old male where a 2 cm bladder calculus was incidentally found on CT, with features that allowed to make straightforward the diagnosis of a jackstone calculus.

Fast Response to Superspreading: Uncertainty and Complexity in the Context of COVID-19.

Although the first coronavirus disease 2019 (COVID-19) wave has peaked with the second wave underway, the world is still struggling to manage potential systemic risks and unpredictability of the pandemic. A particular challenge is the "superspreading" of the virus, which starts abruptly, is difficult to predict, and can quickly escalate into medical and socio-economic emergencies that contribute to long-lasting crises challenging our current ways of life. In these uncertain times, organizations and societies worldwide are faced with the need to develop appropriate strategies and intervention portfolios that require fast understanding of the complex interdependencies in our world and rapid, flexible action to contain the spread of the virus as quickly as possible, thus preventing further disastrous consequences of the pandemic. We integrate perspectives from systems sciences, epidemiology, biology, social networks, and organizational research in the context of the superspreading phenomenon to understand the complex system of COVID-19 pandemic and develop suggestions for interventions aimed at rapid responses.