Faecal incontinence—a comprehensive review

IntroductionFaecal incontinence (FI) is a distressing and often stigmatizing condition characterised as the recurrent involuntary passage of liquid or solid faeces. The reported prevalence of FI exhibits considerable variation, ranging from 7 to 15% in the general population, with higher rates reported among older adults and women. This review explores the pathophysiology mechanisms, the diagnostic modalities and the efficiency of treatment options up to date.MethodsA review of the literature was conducted to identify the pathophysiological pathways, investigation and treatment modalities.Result and discussionThis review provides an in-depth exploration of the intricate physiological processes that maintain continence in humans. It then guides the reader through a detailed examination of diagnostic procedures and a thorough analysis of the available treatment choices, including their associated success rates. This review is an ideal resource for individuals with a general medical background and colorectal surgeons who lack specialized knowledge in pelvic floor disorders, as it offers a comprehensive understanding of the mechanisms, diagnosis, and treatment of faecal incontinence (FI)

Time for change: compliance with RCS green theatre checklist?facilitators and barriers on the journey to net zero

Background: Climate change is an era-defining health concern, with healthcare related emissions paradoxically compounding negative impacts. The NHS produces 5% of the UK's carbon footprint, with operating theatres a recognised carbon hotspot. NHS England aims to become Net Zero by 2045. Consequently, UK Royal Colleges of Surgery have published guidance to foster an evidence-based sustainable transformation in surgical practice. Methods: A single-centre quality improvement project was undertaken, aiming to provide an overview of sustainable practice locally. The Intercollegiate “Green Theatre Checklist” was taken as an audit standard, focusing on “preparing for surgery” and “intraoperative equipment” subsections. Any general surgical procedure was eligible for inclusion. Usage of reusable textiles, non-sterile gloves, catheters, antibiotics, alcohol vs. water-based scrub techniques, skin sterilisation choices, and skin closure materials were recorded. Baseline data collection occurred over a 3 week period, followed by dissemination of results locally via clinical governance meetings and poster displays. A re-audit of practice was conducted using the same methodology and duration. Results: Datasets 1 (n = 23) and 2 (n = 23) included open (n = 22), laparoscopic (n = 24), elective (n = 22) and non-elective (n = 24) cases. Good practice was demonstrated in reusable textiles (trolley covers 96%, 78%, drapes 100%, 92%) however procurement issues reduced otherwise good reusable gown use in Dataset 2 in (90%, 46%). No unnecessary catheter use was identified, and loose skin preparations were used unanimously. Uptake of alcohol-based scrubbing techniques was low (15%, 17%) and unnecessary non-sterile glove use was observed in >30% of procedures. All laparoscopic ports and scissors were single use. Carbon footprints were 128.27 kgCO2e and 117.71 kgCO2e in datasets 1 and 2 respectively. Conclusion: This project evidences good practice alongside future local focus areas for improved sustainability. Adoption of hybrid laparoscopic instruments, avoiding unnecessary equipment opening, and standardising reusable materials could reduce carbon and environmental impact considerably. Successful implementation requires considered procurement practices, improved awareness and education, clear leadership, and a sustained cultural shift within the healthcare community. Collaboration among professional institutions and access to supporting evidence is crucial in driving engagement and empowering clinicians to make locally relevant changes a reality

Innovation in gastrointestinal surgery: the evolution of minimally invasive surgery—a narrative review

Background Minimally invasive (MI) surgery has revolutionised surgery, becoming the standard of care in many countries around the globe. Observed benefits over traditional open surgery include reduced pain, shorter hospital stay, and decreased recovery time. Gastrointestinal surgery in particular was an early adaptor to both laparoscopic and robotic surgery. Within this review, we provide a comprehensive overview of the evolution of minimally invasive gastrointestinal surgery and a critical outlook on the evidence surrounding its effectiveness and safety. Methods A literature review was conducted to identify relevant articles for the topic of this review. The literature search was performed using Medical Subject Heading terms on PubMed. The methodology for evidence synthesis was in line with the four steps for narrative reviews outlined in current literature. The key words used were minimally invasive, robotic, laparoscopic colorectal, colon, rectal surgery. Conclusion The introduction of minimally surgery has revolutionised patient care. Despite the evidence supporting this technique in gastrointestinal surgery, several controversies remain. Here we discuss some of them; the lack of high level evidence regarding the oncological outcomes of TaTME and lack of supporting evidence for robotic colorectalrectal surgery and upper GI surgery. These controversies open pathways for future research opportunities with RCTs focusing on comparing robotic to laparoscopic with different primary outcomes including ergonomics and surgeon comfort

Polycyclic Aromatic Hydrocarbons in Air

Policiklički aromatski ugljikovodici (PAU) spojevi su koji se sastoje od dva ili više kondenziranih aromatskih prstenova. Nastaju prilikom nepotpunog izgaranja ili pirolize organskih tvari. Dokazano je da neki PAU imaju kancerogena, a neki mutagena svojstva, pa je stoga potrebno kontinuirano pratiti koncentracije PAU u zraku, vodi i tlu, te pokušati sanirati izvore PAU. PAU s dva ili tri aromatska prstena postojani su u plinovitoj fazi, dok se PAU s više aromatskih prstenova nalaze u zraku uglavnom vezani na čestice. Visoke koncentracije PAU prisutne su u atmosferi urbanih područja, a najviše su zimi kada su pojačane emisije iz kućnih ložišta. U ljetno doba koncentracije su niže jer je većina policikličkih aromatskih ugljikovodika nestabilna na visokim temperaturama, a osim toga dolazi do njihove oksidacije i fotooksidacije. Metode mjerenja PAU u zraku uključuju uzorkovanje prosisavanjem na filterski papir ili kruti adsorbens, ekstrakciju i kromatografsku analizu. U ovom radu prikazani su rezultati mjerenja benzo[a]pirena (BaP) kao glavnog predstavnika PAU na nekim lokacijama u svijetu. Razine BaP u svijetu uspoređene su s rezultatima mjerenja provedenim do sada u Hrvatskoj.Polycyclic aromatic hydrocarbons (PAHs) are a large group of organic compounds consisting of two or more condense aromatic rings. They are products of incomplete combustion or pyrolysis of organic matter. Because some PAHs such as Benzo[a]pyrene (BaP) are proven carcinogens and mutagens, it is necessary to continuously monitor their concentrations in the air, water, and soil. PAHs with two or three aromatic rings are stable in the gas phase, while most PAHs with five or more aromatic rings bond to particles. Higher concentrations of PAHs are present in the atmosphere of urban areas, mostly in the winter, due to heating. In the summer, these concentrations drop because most PAHs are unstable at high temperatures and break down by oxidation and photooxidation. Measurements of PAHs in the air include sampling on the filter paper or solid adsorbent, extraction, and chromatographic analysis. This review presents the measurements of BaP in some locations in the world and compares them with the findings in Croatia

Chemical reactivity and long-range transport potential of polycyclic aromatic hydrocarbons – a review

Polycyclic aromatic hydrocarbons (PAHs) are of considerable concern due to their well-recognised toxicity and especially due to the carcinogenic hazard which they present. PAHs are semi-volatile and therefore partition between vapour and condensed phases in the atmosphere and both the vapour and particulate forms undergo chemical reactions. This article briefly reviews the current understanding of vapour-particle partitioning of PAHs and the PAH deposition processes, and in greater detail, their chemical reactions. PAHs are reactive towards a number of atmospheric oxidants, most notably the hydroxyl radical, ozone, the nitrate radical (NO3) and nitrogen dioxide. Rate coefficient data are reviewed for reactions of lower molecular weight PAH vapour with these species as well as for heterogeneous reactions of higher molecular weight compounds. Whereas the data for reactions of the 2-3-ring PAH vapour are quite extensive and generally consistent, such data are mostly lacking for the 4-ring PAHs and the heterogeneous rate data (5 and more rings), which are dependent on the substrate type and reaction conditions, are less comprehensive. The atmospheric reactions of PAH lead to the formation of oxy and nitro derivatives, reviewed here, too. Finally, the capacity of PAHs for long range transport and the results of numerical model studies are described. Research needs are identified

Dimensionering av platta på mark : En jämförelse mellan hand- och datorberäkningar

The digital revolution has introduced several tools for structural engineers in the form of computer programs. These computer tools have partly transformed the role of structural engineers from their performing manual calculations to using different computer programs, evaluating the results, and checking codes.  Advanced computer-based calculation programs are often relied on when dimensioning structural parts. However, these are associated with certain consequences, especially when using black box software, which increases the need for an estimated model.  The purpose of this paper is to examine how the design of a concrete slab is estimated and how the results of such an estimate calculation relate to the results from computer calculations. The research method involves three main steps: gathering facts from references to learn how to design a concrete slab; developing a calculation model; and learning how to use PEPS, which is a type of black box software for performing calculations. In the analysis, PEPS is compared with manual calculations and the following conclusions are drawn based on the results: The estimate dimensioning of an edge-stiffened concrete slab can be simplified by using the equilibrium equation based on the edge beam. Results from this simplified method will differ from results produced by the computer program.  Simplified calculations are used to check the reasonableness of the PEPS results: Although PEPS indicates the cause of the bearing capacity of the concrete slab, the program fails to demonstrate how the results are calculated.Den digitala revolutionen har fått till följd att det utvecklats en mängd olika datorverktyg som konstruktörer använder i konstruktionsarbetet. Dessa datorverktyg har förändrat konstruktörens roll från att använda handberäkningar till att använda olika dataprogram som hjälper till med utvärdering av resultat och kontroll av koder.  Vid dimensionering av bärverksdelar är det vanligt förekommande att i hög grad förlita sig på avancerade datorbaserade beräkningsprogram. Det finns dock konsekvenser med det, särskilt vid användning av blackbox-mjukvaror, vilket gör att behovet av överslagsberäkning ökar. För att undvika inkorrekt konstruktionsdesign behöver konstruktörer därmed ett sätt att kunna kontrollera rimligheten av de resultat som framkommer med hjälp av dataprogram. Syftet med detta arbete är att undersöka hur konstruktionen platta på mark kan överslagdimensioneras, samt undersöka hur resultaten av sådan överslagsdimensionering förhåller sig till resultat från datorberäkningar med etablerade mjukvaror. Metoden innehåller tre huvudmoment: 1) genomförandet av en litteraturstudie för att lära sig handberäkna grundplattor, 2) framtagningen av en beräkningsmodell för överslagsberäkning samt 3) lära sig använda PEPS som är ett beräkningsprogram som kan användas vid dimensionering av betongplatta. Programmet verkar vara en blackbox-mjukvara. I resultat- och analysdelen jämförs PEPS med handberäkningar och följande slutsatser dras utifrån resultaten: En överslagsdimensionering av kantförstyvad platta på mark kan utföras med hjälp av jämviktsekvation baserad på kantbalken. Resultaten från denna förenklade överlagsmetod skiljer sig från resultaten i själva PEPS programmet. Överslagsberäkningar bör användas för att kontrollera rimligheten för PEPS resultaten. PEPS visar orsaken till bärförmågan i grundplattor, däremot visar programmet inte hur resultaten räknas fram.  Ökningen av bärförmågan hos platta på mark kan ske på olika sätt beroende på lasttyp (linje- och punktlast) samt vilken placering denna last har. Genom att ha en bättre förståelse för konstruktionens verkningssätt är det möjligt att designa platta på mark på ett mer materialeffektivt sätt

Dimensionering av platta på mark : En jämförelse mellan hand- och datorberäkningar

The digital revolution has introduced several tools for structural engineers in the form of computer programs. These computer tools have partly transformed the role of structural engineers from their performing manual calculations to using different computer programs, evaluating the results, and checking codes.  Advanced computer-based calculation programs are often relied on when dimensioning structural parts. However, these are associated with certain consequences, especially when using black box software, which increases the need for an estimated model.  The purpose of this paper is to examine how the design of a concrete slab is estimated and how the results of such an estimate calculation relate to the results from computer calculations. The research method involves three main steps: gathering facts from references to learn how to design a concrete slab; developing a calculation model; and learning how to use PEPS, which is a type of black box software for performing calculations. In the analysis, PEPS is compared with manual calculations and the following conclusions are drawn based on the results: The estimate dimensioning of an edge-stiffened concrete slab can be simplified by using the equilibrium equation based on the edge beam. Results from this simplified method will differ from results produced by the computer program.  Simplified calculations are used to check the reasonableness of the PEPS results: Although PEPS indicates the cause of the bearing capacity of the concrete slab, the program fails to demonstrate how the results are calculated.Den digitala revolutionen har fått till följd att det utvecklats en mängd olika datorverktyg som konstruktörer använder i konstruktionsarbetet. Dessa datorverktyg har förändrat konstruktörens roll från att använda handberäkningar till att använda olika dataprogram som hjälper till med utvärdering av resultat och kontroll av koder.  Vid dimensionering av bärverksdelar är det vanligt förekommande att i hög grad förlita sig på avancerade datorbaserade beräkningsprogram. Det finns dock konsekvenser med det, särskilt vid användning av blackbox-mjukvaror, vilket gör att behovet av överslagsberäkning ökar. För att undvika inkorrekt konstruktionsdesign behöver konstruktörer därmed ett sätt att kunna kontrollera rimligheten av de resultat som framkommer med hjälp av dataprogram. Syftet med detta arbete är att undersöka hur konstruktionen platta på mark kan överslagdimensioneras, samt undersöka hur resultaten av sådan överslagsdimensionering förhåller sig till resultat från datorberäkningar med etablerade mjukvaror. Metoden innehåller tre huvudmoment: 1) genomförandet av en litteraturstudie för att lära sig handberäkna grundplattor, 2) framtagningen av en beräkningsmodell för överslagsberäkning samt 3) lära sig använda PEPS som är ett beräkningsprogram som kan användas vid dimensionering av betongplatta. Programmet verkar vara en blackbox-mjukvara. I resultat- och analysdelen jämförs PEPS med handberäkningar och följande slutsatser dras utifrån resultaten: En överslagsdimensionering av kantförstyvad platta på mark kan utföras med hjälp av jämviktsekvation baserad på kantbalken. Resultaten från denna förenklade överlagsmetod skiljer sig från resultaten i själva PEPS programmet. Överslagsberäkningar bör användas för att kontrollera rimligheten för PEPS resultaten. PEPS visar orsaken till bärförmågan i grundplattor, däremot visar programmet inte hur resultaten räknas fram.  Ökningen av bärförmågan hos platta på mark kan ske på olika sätt beroende på lasttyp (linje- och punktlast) samt vilken placering denna last har. Genom att ha en bättre förståelse för konstruktionens verkningssätt är det möjligt att designa platta på mark på ett mer materialeffektivt sätt