Burnout and motivation to study medicine among students during the COVID-19 pandemic

AimTo investigate medical students’ burnout and motivation levels in each of the six years of their studies during the COVID-19 pandemic and identify independent predictors of burnout and motivation.MethodsAn anonymous cross-sectional survey was sent to the students of all six years within our school. Burnout was measured with the adapted Oldenburg Burnout Inventory questionnaire (OLBI-S) and motivation with the updated Strength of Motivation for Medical School (SMMS-R) questionnaire. Univariate analysis was performed with the Kruskal–Wallis test and Spearman’s correlation, while multivariable analysis with linear regression models.ResultsA total of 333 medical students (52% of student body) responded. Higher burnout levels correlated with lower motivation to study medicine (rho = −0.30, p < 0.001). Burnout levels differed between the six years of medical studies, peaking in years two and four whereas being the lowest in year one (p = 0.01). Motivation levels differed significantly as well, peaking in years one and four whereas being the lowest in years five and six (p = 0.012). In the multivariable linear regression models, being a female (b = 2.22, p = 0.016), studying in the fourth year vs. first year (b = 2.54, p = 0.049), having a perceived beginner/intermediate vs. advanced/expert technology level (b = 2.05, p = 0.032) and a perceived poor school support system (b = 6.35, p < 0.001) were independently associated with higher burnout levels. Furthermore, studying in the fifth year vs. first year (b = −5.17, p = 0.019) and a perceived poor school support system (b = −3.09, p = 0.01) were independently associated with a reduced motivation to study medicine.ConclusionOur study highlighted potential areas for intervention to decrease the rate of burnout and low motivation among medical students. However, further research is needed to unravel the full effect of the pandemic on medical students

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Short-term effects of manual therapy plus capacitive and resistive electric transfer therapy in individuals with chronic non-specific low back pain : a randomized clinical trial study

Background and Objectives: Chronic non-specific low back pain (CNSLBP) is defined as back pain that lasts longer than 12 weeks. Capacitive and resistive electric transfer (TECAR) therapy utilizes radiant energy to generate endogenous heat and is widely used for the treatment of chronic musculoskeletal pain. The aim of this study was to investigate the efficacy of manual therapy (MT) program combined with TECAR therapy in individuals with CNSLBP. Materials and Methods: Sixty adults with CNSLBP were randomly divided equally into three groups. The first group followed an MT protocol in the lumbar region (MT group), the second group followed the same MT protocol combined with TECAR therapy (MT + TECAR group) using a conventional capacitive electrode as well as a special resistive electrode bracelet, and the third group (control group) received no treatment. Both intervention programs included six treatments over two weeks. Pain in the last 24 h with the Numeric Pain Rating Scale (NPRS), functional ability with the Roland–Morris Disability Questionnaire (RMDQ), pressure pain threshold (PPT) in the lumbar region with pressure algometry, and mobility of the lumbo-pelvic region through fingertip-to-floor distance (FFD) test were evaluated before and after the intervention period with a one-month follow-up. Analysis of variance with repeated measures was applied. Results: In the NPRS score, both intervention groups showed statistically significant differences compared to the control group both during the second week and the one-month follow-up (p 0.05). Conclusions: The application of an MT protocol with TECAR therapy appeared more effective than conventional MT as well as compared to the control group in reducing pain and disability and improving PPT in individuals with CNSLBP. No further improvement was noted in the mobility of the lumbo-pelvic region by adding TECAR to the MT intervention

Study of angiogenesis and lymphangiogenesis, in pancreatic ductal adenocarcinoma, with immunomistochemistry techniques

Tumor angiogenesis and lymphangiogenesis, based on microvessel density(MVD) assessment have been associated with poor prognosis, in several studies ofsolid tumors. Expression of endoglin (CD105), a tumor-induced vascularizationmarker, has been found to represent a negative prognostic factor in many malignanttumors. Similarly, D2-40 is considered the most accurate, recent marker for tumorlymphangiogenesis. The aim of our study was to assess the value of tumoralmicrovascularity regarding angio- & lympangiogenesis with pan-endothelial markers,endoglin and D2-40 as well, in correlation with clinical outcome of patients withpancreatic ductal adenocarcinoma (PDAC).Fifty eight patients with PDAC, were included in the study. Deparaffinizedsections from formalin fixed areas both from center and periphery (invasion front) ofthe tumors were immunostained for CD105 and D2-40, as well as for the endothelialmarkers CD31 and CD34. Tumoral angiogenesis/lymphangiogenesiw were assessedbased on MVD (number of vessels/mm2) and on microvascular area (MVA, μm2) aswell.High intratumoral MVA (IMVA), in endoglin-stained sections, was found tobe of marginal prognostic significance for recurrence (log rank, P 0.05). Survival wasalso marginally associated with CD31-IMVA (log rank, P 0.05). There was nosignificant association of tumor lymphangiogenesis with D2-40 stainings neither withclinicopathological parameters nor with the outcome of the disease.In conclusion, there is no solid evidence that endoglin and D2-40 couldrepresent robust prognostic markers of clinical significance in pancreatic ductal adenocarcinoma.Η βασισμένη στη μικροαγγειακή πυκνότητα νεοπλασματική αγγειογένεση καιλεμφαγγειογένεση θεωρείται αρνητικός προγνωστικός δείκτης σε διάφορους συμπαγείς όγκους. Η έκφραση της ενδογλίνης (CD105), ως δείκτη της νεοπλασματικής αγγειογένεσης έχει άμεσα συσχετιστεί ως δείκτης πρόγνωσης σε ποικίλες νεοπλασίες. Παρόμοια, το αντίσωμα D2-40/ ποδοπλανίνη, θεωρείται ο πιο πρόσφατος και αξιόπιστος δείκτης της νεοπλασματικής λεμφαγγειογένεσης. Ο σκοπός της μελέτης είναι να εκτιμηθεί η πιθανή προγνωστική αξία των πλέον ειδικώνδεικτών της αγγειογένεσης και λεμφαγγειογένεσης σε σύγκριση με γνωστούς παν-ενδοθηλιακούς δείκτες στο αδενοκαρκίνωμα του παγκρέατος (ΠΑ).Εξετάστηκαν δείγματα ιστών από 58 ασθενείς με χειρουργηθέν ΠΑ. Δείγματα ιστού, τόσο από το κέντρο όσο και από την περιφέρεια του όγκου, υποβλήθηκαν σε επεξεργασία με τα αντισώματα έναντι της ενδογλίνης και της ποδοπλανίνης καθώς και με τους ενδοθηλιακούς δείκτες CD31, CD34. Η εκτίμηση της νεοπλασματικής αγγειογένεσης και λεμφαγγειογένεσης έγινε τόσο με τη μέτρηση της μικροαγγειακής πυκνότητας όσο και με τη μέτρηση της μικροαγγειακής επιφάνειας.Η αυξημένη μικροαγγειακή επιφάνεια με χρώση έναντι της ενδογλίνης, εντός του όγκου, διαπιστώθηκε ότι σχετίζεται αρνητικά μόνο με την υποτροπή της νόσου(p<0,05). Καμία στατιστικά σημαντική συσχέτιση με τις κλινικοπαθαλογικές παραμέτρους και την έκβαση της νόσου δεν παρατηρήθηκε από τη μελέτη της λεμφαγγειογένεσης με το D2-40.Τα έως τώρα ερευνητικά δεδομένα δεν επαρκούν για να χαρακτηριστούν τόσο η ενδογλίνη όσο και το D2-40 ως σημαντικοί προγνωστικοί δείκτες στο αδενοκαρκίνωμα του παγκρέατος

The effects of an Integrated neuromuscular Inhibition technique (I.N.I.T.) on therapeutic exercise in patients with chronic mechanical neck pain

The aim of this PhD dissertation was to investigate the effects of the combination of Therapeutic Exercise (TE) and Integrated Neuromuscular Inhibition Technique (INIT) on the clinical picture and the quality of life of patients with chronic mechanical neck pain. 40 participants with chronic mechanical neck pain were divided into two groups of 20 people. Participants followed the same 10-week therapeutic treatment protocol for neck and upper limb muscles adapted to the most recent guidelines. In the first group (intervention group), INIT was applied immediately after each exercise session, while in the second (control group), only relaxation exercises were performed. The subjective perception of pain with the Visual Analog Scale (VAS), the functionality with the Neck Disability Index (NDI), the local vulnerability of neck muscles with an algometer, the active neck range with a round goniometer, the maximum isometric strength of neck muscles with a hand dynamometer, the resistance to fatigue of the neck flexors with special tests and the quality of life with the SF-36 questionnaire, were evaluated before, during and after the intervention, while follow-up checks were performed 1, 3 and 6 months after the intervention. According to the results, both groups experienced a significant improvement in all examined variables after the intervention (p <.05), which were maintained for both groups 6 months after. However, the intervention group showed a further improvement over the control group in the visual analogue pain score (from week 2), in the neck disability index (from week 6), in the pain threshold values of the trapezius (from week 2) and the splenius capitis (from week 4), in the maximum isometric strength of the neck flexion (from week 4), and in “Total Physical Health” and “Bodily Pain” (from week 10). All the above differences between the groups were statistically significant 6 months after the intervention (p <.05). In other variables such as the lateral neck flexion range, the Cranio-cervical flexion endurance test (CCFT) score, and the pain threshold values of the levator scapulae and the sternocleidomastoid, the differences between the groups were detected only in intermediate measurements (weeks 4 and 6) while in terms of ‘Total Mental Health” score, differences between groups were detected only during the six-month follow-up check. In conclusion, the combination of TE and the INIT was found to be more effective than TE alone as it improved to a greater extent and faster the clinical picture and the quality of life of individuals with chronic mechanical neck pain. It is suggested that further research combining therapeutic exercise with neuromuscular techniques be used in patients with chronic neck pain as there is evidence that this combination is more appropriate for these particular patients.Σκοπός της διδακτορικής διατριβής ήταν να διερευνηθεί η επίδραση του συνδυασμού της Θεραπευτικής Άσκησης (ΘΑ) και της Ολοκληρωμένης Νευρομυϊκής Αναστολής (INIT) στην κλινική εικόνα και στην ποιότητα ζωής ασθενών με χρόνια αυχεναλγία μηχανικής αιτιολογίας. Σαράντα (40) συμμετέχοντες με χρόνια αυχεναλγία μηχανικής αιτιολογίας χωρίστηκαν σε δύο ομάδες των 20 ατόμων. Οι συμμετέχοντες ακολούθησαν το ίδιο πρωτόκολλο ΘΑ διάρκειας 10 εβδομάδων για τους μύες του αυχένα και των άνω άκρων, προσαρμοσμένο στις πιο πρόσφατες κατευθυντήριες γραμμές. Στην πρώτη ομάδα (ομάδα παρέμβασης) εφαρμόστηκε η ΙΝΙΤ αμέσως μετά από κάθε συνεδρία άσκησης, ενώ στη δεύτερη (ομάδα ελέγχου) εφαρμόστηκαν μόνο ασκήσεις χαλάρωσης. Η υποκειμενική αντίληψη του πόνου με την αναλογική οπτική κλίμακα, η λειτουργικότητα με το δείκτη ανικανότητας του αυχένα, η τοπική ευπάθεια των μυών του αυχένα με αλγόμετρο, το ενεργητικό εύρος του αυχένα με κυκλικό γωνιόμετρο, η μέγιστη ισομετρική δύναμη των μυών του αυχένα με δυναμόμετρο χειρός, η αντοχή στην κόπωση των καμπτήρων του αυχένα με ειδικές δοκιμασίες και η ποιότητα ζωής με το ερωτηματολόγιο 36-Item Short Form Survey (SF-36) αξιολογήθηκαν πριν, κατά τη διάρκεια και μετά τη παρέμβαση, ενώ πραγματοποιήθηκαν επανέλεγχοι στον ένα, στους τρεις και στους έξι μήνες μετά την παρέμβαση. Σύμφωνα με τα αποτελέσματα και οι δύο ομάδες παρουσίασαν σημαντική βελτίωση σε όλες τις προς εξέταση μεταβλητές μετά την παρέμβαση (p <.05), οι οποίες διατηρήθηκαν και για τις δύο ομάδες 6 μήνες μετά. Ωστόσο, η ομάδα παρέμβασης εμφάνισε περαιτέρω βελτίωση σε σχέση με την ομάδα ελέγχου στο σκορ της οπτικής αναλογικής κλίμακας πόνου (από την 2η εβδομάδα), στο δείκτη ανικανότητας του αυχένα (από την 6η εβδομάδα), στις τιμές του ουδού του πόνου του τραπεζοειδή (από τη 2η εβδομάδα) και του σπληνοειδή κεφαλικού (από 4η εβδομάδα), στη μέγιστη ισομετρική δύναμη της κάμψης του αυχένα (από την 4η εβδομάδα) και στη «συνολική σωματική υγεία» και τον «σωματικό πόνο» (από την 10η εβδομάδα). Όλες οι παραπάνω διαφορές μεταξύ των ομάδων διατηρήθηκαν στατιστικά σημαντικές 6 μήνες μετά την παρέμβαση (p<.05). Σε άλλες μεταβλητές, όπως στο εύρος της πλάγιας κάμψης του αυχένα, στο σκορ του Cranio-cervical flexion endurance test (CCFT) και στις τιμές του ουδού του πόνου του ανελκτήρα μυ της ωμοπλάτης και του στερνοκλειδομαστοειδή, οι διαφορές μεταξύ των ομάδων εντοπίστηκαν μόνο σε ενδιάμεσες μετρήσεις (4η και 6η εβδομάδα), ενώ ως προς το σκορ της συνολικής ψυχικής υγείας διαφορές μεταξύ των ομάδων εντοπίστηκαν μόνο κατά τον εξάμηνο επανέλεγχο. Συμπερασματικά, ο συνδυασμός της ΘΑ και της INIT βρέθηκε ότι ήταν περισσότερο αποτελεσματικός απ’ ότι η ΘΑ μόνη της, καθώς βελτίωσε σε μεγαλύτερο βαθμό και ταχύτερα την κλινική εικόνα και την ποιότητα ζωής των ατόμων με χρόνια αυχεναλγία μηχανικής αιτιολογίας. Προτείνεται η εφαρμογή περαιτέρω έρευνας, που να συνδυάζει τη ΘΑ με την εφαρμογή νευρομυϊκών τεχνικών σε ασθενείς με χρόνια αυχεναλγία, καθώς υπάρχουν ενδείξεις ότι αυτός ο συνδυασμός είναι περισσότερο κατάλληλος για τη συγκεκριμένη κατηγορία ασθενών