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BackgroundMore evidence shows that primary surgery for de novo metastatic breast cancer (BC) prolongs overall survival (OS) in selected cases. The aim of this study was to evaluate the role of locoregional treatment (LRT) in BC patients with de novo stage IV bone only metastasis (BOM).MethodsThe prospective, multicenter registry study BOMET MF14-01 was initiated in May 2014. Patients with de novo stage IV BOM BC were divided into two groups: those receiving systemic treatment (ST group) and those receiving LRT (LRT group). Patients who received LRT were further divided into two groups: ST after LRT (LRT + ST group) and ST before LRT (ST + LRT group).ResultsWe included 505 patients in this study; 240 (47.5%) patients in the ST group and 265 (52.5%) in the LRT group. One hundred and thirteen patients (26.3%) died in the 34-month median follow-up, 85 (35.4%) in the ST group and 28 (10.5%) in LRT group. Local progression was observed in 39 (16.2%) of the patients in the ST group and 18 (6.7%) in the LRT group (p = 0.001). Hazard of death was 60% lower in the LRT group compared with the ST group (HR 0.40, 95% CI 0.30–0.54, p < 0.0001).ConclusionIn this prospectively maintained registry study, we found that LRT prolonged survival and decreased locoregional recurrence in the median 3-year follow-up. Timing of primary breast surgery either at diagnosis or after ST provided a survival benefit similar to ST alone in de novo stage IV BOM BC patients.

Complications are plausible events during surgical operations. Surgical complications profoundly impact surgeons, often called “second victims” of adverse events. These complications trigger a range of emotional and psychological responses, including guilt, anxiety, heightened empathy, and the looming threat of burnout. Moreover, the toll extends to physical health, with chronic stress and sleep disturbances taking their toll. Surgeons’ social lives are not immune to the fallout, and their career satisfaction may wane, pushing some towards defensive medicine practices. While mentorship, counselling, and peer support are crucial support mechanisms, they encounter barriers such as time constraints and the fear of negative perceptions. This paper suggests practical recommendations, including comprehensive wellness programmes, a streamlined badge card system for easy access to resources, and mindfulness training to mitigate stress and burnout. Recognising and proactively addressing these multifaceted impacts is imperative for cultivating a resilient medical community capable of providing optimal patient care.

In Botswana, sport is positioned as a potential driver of economic and social development. In particular, there are numerous discussions about increasing the socio-economic impact of sport and the need to professionalise Botswana sport. Knowledge Management (KM) can play a critical role in achieving this greater professionalisation and impact. Despite this importance, there have only been a small number of studies on KM in sports, and none of this literature explores the topic in sub-Saharan Africa. Against this background, the goals of our paper are two-fold. Firstly, we wish to map out the current knowledge management landscape in the Botswana sport sector. Secondly, we aim to propose concrete, evidence-based avenues to improve KM within the sector. This paper relies on findings generated through semi-structured qualitative interviews with individuals connected to Botswana sport. To allow for triangulation, these interviews are further supported by other, previous qualitative research as well as relevant academic and policy literature. The Knowledge Management framework from Sunassee and Sewry (2002) is used to analyse and structure the results. Overall, we see that KM in Botswana sport is somewhat present at the individual, organisational level, but numerous obstacles and inefficiencies exist in creating and sharing knowledge at the sectoral level. To support the growth of KM in the sector, numerous concrete recommendations are presented. In particular, we highlight a need to communicate the value of KM better and obtain the necessary buy-in.

There are increasing connections made between sport and sustainable development, both internationally and within Botswana's national policies. However, these policy documents are vague and overly broad. There is no focus on where or how sport can be positioned to support sustainable development within Botswana's unique national context. Using policy coherence as a theoretical framework, the goal of this paper is to analyse the current policy as well as propose national policy objectives and instruments to support sport's contribution to sustainable development in Botswana. This paper relies on findings generated through semi-structured qualitative interviews, policy documents and academic literature. We propose that sport should be re-oriented to achieve objectives related to economic development, education, and health. Numerous concrete policy instruments are likewise suggested, including investing in small-scale sport infrastructure, public awareness campaigns and better sport educator training. Ultimately, these instruments enhance the coherence of the overall policy and create synergies by addressing multiple overarching objectives simultaneously. (Autor).

The global refugee community, including those forced to flee due to persecution, conflict, or violence, faces significant challenges in accessing healthcare, resulting in a higher prevalence of surgical disease. These challenges have a profound impact on morbidity and mortality rates, particularly in low- and middle-income countries where many immigrants seek refuge. Limited availability of medical facilities, an inadequate surgical workforce, financial constraints and linguistic and cultural barriers all contribute to reduced access to healthcare. Limited access to competent healthcare leads to poor health outcomes, increased morbidity and mortality rates and suboptimal surgical results for refugees. To address these challenges, a multifaceted approach is necessary. This includes increased funding for healthcare initiatives, workforce recruitment and training and improved coordination between aid organisations and local healthcare systems. Strategies for managing surgical conditions in the global refugee community encompass the development of targeted public health programmes, removing legal barriers, establishing healthcare facilities to enhance surgical access and prioritising disease prevention among refugees.

Background Around five billion people globally lack access to safe, timely, and affordable surgical facilities and care in low-income and middle-income countries (LMICs). Global initiatives have been launched, including efforts led by organizations. Also, regional efforts have shed light on the unique challenges faced by different areas within LMICs. Despite these efforts, many countries still face significant challenges, including inadequate infrastructure, limited availability of trained surgical personnel, lack of essential medical equipment, and insufficient financial resources allocated to healthcare and their related possible factors. Here is that we aim to identify the progress made in areas such as capacity building, training programs, infrastructure development, and policy reforms, as well as highlight the gaps that persist, providing a foundation for future research. Such a comprehensive scoping review will be crucial to enhance surgical care services and ultimately improve health outcomes in LMICs. Methods A comprehensive literature search up to November 2024 will be conducted across six major databases. PubMed, Scopus, Ovoid, Web of Science, Cochrane Central, CNKI (China National Knowledge Infrastructure) database. The methodology will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. The first version of this project will not include a quality appraisal.

Surgical site infections (SSIs) are the most common adverse event occurring in surgical patients. Optimal prevention of SSIs requires the bundled integration of a variety of measures before, during, and after surgery. Surgical antibiotic prophylaxis (SAP) is an effective measure for preventing SSIs. It aims to counteract the inevitable introduction of bacteria that colonize skin or mucosa into the surgical site during the intervention. This document aims to guide surgeons in appropriate administration of SAP by addressing six key questions. The expert panel identifies a list of principles in response to these questions that every surgeon around the world should always respect in administering SAP.

Acrokeratosis paraneoplastica, also known as Bazex syndrome, is a relatively understudied yet clinically important dermatological condition that is inextricably associated with squamous cell carcinoma, predominantly of the upper respiratory and gastrointestinal tracts. Manifesting as unique psoriasis-like cutaneous lesions, Bazex syndrome functions as an early warning signal for underlying malignancies, underscoring the urgent need for its timely diagnosis and intervention. Notwithstanding its clinical relevance, the molecular and cellular mechanisms underpinning its pathogenesis are not fully understood. To address these gaps, this comprehensive literature review undertook a meticulous search across reputable databases such as EMBASE, MEDLINE/PubMed, and Web of Science. Our analysis ventures into multiple putative pathogenic pathways, including shifts in Th2 immune responses, aberrant secretion of growth factors, and immunological reactions to tumor-specific antigens. We also detail the clinical phenotypes of Bazex syndrome and their chronological linkage with the corresponding malignancies. Finally, the review evaluates the therapeutic effectiveness of various approaches, including but not limited to targeted cancer treatments, PUVA therapy, and topical corticosteroids. This synthesis aims to arm healthcare providers with a nuanced understanding of Bazex syndrome, facilitating more accurate diagnosis and tailored treatment paradigms.