Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Role of lignocellulolytic enzymes in the process of plant residue biodegradation in soil : Influence of residue quality on the efficacity of enzymes and their dynamics

La décomposition des résidus végétaux joue un rôle essentiel dans le cycle biogéochimique des éléments nutritifs et influence le fonctionnement des écosystèmes. La composition biochimique intrinsèque des résidus végétaux est un facteur clé qui influe sur les processus de décomposition dans le sol tandis que la majorité des réactions biochimiques dans le sol, liées à la biodégradation des résidus végétaux, sont catalysées par des enzymes extracellulaires produites par les microorganismes. L'objectif global de cette étude était d'acquérir des connaissances fondamentales concernant l'impact de la qualité des résidus sur les fonctions microbiennes du sol et les modes d'intervention des enzymes du sol interviennent dans la décomposition des résidus végétaux. Cet objectif a été atteint en trois parties visant à : 1) déterminer le rôle des communautés initiales des résidus i.e. les microorganismes et leurs enzymes provenant des compartiments épiphytes et endophytes, et l'effet de la qualité des résidus végétaux sur les cinétiques des enzymes extracellulaires au cours du processus de décomposition dans le sol 2) étudier l'effet des fonctions microbiennes du sol (biomasse microbienne et enzymes extracellulaires) liées à la minéralisation sur la décomposition ultérieure de résidus introduits dans le même sol 3) explorer les interactions entre la disponibilité en azote et la décomposition des composés phénoliques par l'action des activités oxydo-réductases, et développer une méthode pour mesurer ces activités dans des sols contrastés en utilisant un seul substrat. L'approche générale de cette étude a été de sélectionner les résidus végétaux de qualité chimique variable pour obtenir des cinétiques contrastées de minéralisation du C. Le maïs (Zea mays L.) a été choisi comme plante modèle en raison de variations chimiques et structurales (Mexxal, F2, F2bm1, F292bm3) des parties aériennes (feuilles, entre-nœuds) et souterraines (racines). Des tiges de lin marqué au 13C ont été utilisées pour quantifier avec précision la minéralisation du carbone dans les différents réservoirs de carbone. Afin d'évaluer les relations entre la qualité des résidus végétaux et les fonctions biologiques associées au sol, des expériences en microcosmes contrôlés ont été réalisées en utilisant des sols agricoles et forestiers. La minéralisation du carbone, les caractéristiques chimiques des résidus (teneurs en C et N, les sucres totaux et lignine), la biomasse microbienne et les activités enzymatiques (L-leucine aminopeptidase (LAP), cellobiohydrolase (CBH-1), xylanase, cellulase et la laccase) ont été déterminées à différents stades de décomposition. Les résultats de la première étude ont indiqué que les activités de micro-organismes épiphytes et endogènes étaient du même ordre de grandeur dans le cas des racines, tandis que les activités des enzymes spécifiques (cellulase, xylanase et laccase) étaient fortement corrélées à la dégradation de leurs substrats cibles (glucanes, xylanes et lignine, respectivement). Dans la seconde étude, l'addition répétée de résidus a eu peu d'effet sur la biomasse microbienne et la dynamique enzymatique, sauf la LAP et la laccase. Ces résultats suggèrent que la qualité des résidus végétaux est le principal facteur déterminant les modes d'action de la biomasse microbienne et de leurs enzymes extracellulaires durant le processus de décomposition dans le sol. Les résultats de la dernière étude ont démontré que l'addition d'azote réprimait la minéralisation du carbone des résidus les moins lignifiés (F2, F2bm1), mais n'a pas affecté celle du résidu plus lignifié (F292bm3) au cours de la décomposition à long terme. L'ABTS est apparu comme un meilleur substrat que le L-DOPA, le pyrogallol et le TMB pour estimer les activités phénoloxydase et peroxydase.Mots clés: décomposition, biomasse microbienne, enzymes extracellulaires, qualité des résidus, maïs.Plant residue decomposition plays a pivotal role in the biogeochemical cycling of nutrients and influences ecosystem functioning. The intrinsic biochemical composition of plant residues is a key factor influencing decomposition processes in soil while the majority of biochemical reactions in soil, related to the biodegradation of plant residues, are catalyzed by extracellular enzymes produced by microorganisms. The overall goal of this research study was to gain fundamental knowledge regarding the impact of residue quality on soil microbial functions and the principles by which soil enzymes mediate plant residue decomposition. This goal was achieved in three parts: 1) to determine the role of the initial residue community i.e. microorganisms and enzymes from the epiphytic and endophytic compartments and effect of plant residue quality on the extracellular enzyme kinetics during the decomposition process in soil 2) to investigate the effect of soil microbial functions (microbial biomass and extracellular enzymes) on the subsequent residue decomposition in the same soil 3) to explore the interactions between nitrogen availability and the decomposition of phenolic compounds through the action of oxydo-reductase enzymes activities and to develop a method to measure these activities in contrasted soils using a single substrate. The general approach of this study was to select plant residues with variations in their chemical quality to obtain contrasted C mineralization kinetics. Maize (Zea mays L.) was selected as a model plant because of variations in chemical and structural characteristics (Mexxal, F2, F2bm1, F292bm3) of aerial (leaves, internodes) and underground parts (roots). 13C-labeled flax stems were used to quantify accurately carbon mineralization in different carbon pools. To assess the relationships between plant residue quality and associated soil biological functions, controlled microcosm experiments were performed using agricultural and forest soils. Carbon mineralization and chemical characteristics (C and N contents, total sugars and lignin contents) of the plant residue, microbial biomass and enzyme activities (L-leucine aminopeptidase (LAP), cellobiohydrolase (CBH-1), xylanase, cellulase and laccase) were determined at different stages of decomposition. The results of first study indicated that activities of epiphytic and endogenic microorganisms were of the same order of magnitude in case of roots while the activities of specific enzymes (cellulase, xylanase and laccase) were highly correlated to the degradation of their target substrates (glucans, xylans and lignin, respectively). In the second study, little effect of repeated residue addition was observed on microbial biomass and enzyme dynamics except LAP and laccase. These results suggest that plant residue quality is the main factor which determines the fate/patterns of microbial biomass and their extracellular enzymes during decomposition process in soil. The results of last study demonstrated that nitrogen addition repressed the carbon mineralization of less lignified residues (F2, F2bm1) but did not affect more lignified residue (F292bm3) in long term decomposition. For estimation of phenol oxidase and peroxidase activities, ABTS appeared as a better substrate than L-DOPA, pyrogallol and TMB.Key words: decomposition, microbial biomass, extracellular enzymes, residue quality, maize

Metal tolerant bacteria enhanced phytoextraction of lead by two accumulator ornamental species

International audienceMicrobially enhanced availability and phytoextraction is a promising technique for phytoremediation of lead (Pb). In this study, Pb resistant strains were isolated and investigated for potential effects on plant growth and Pb phytoextraction. Incubation experiments were carried for inoculated and un–inoculated soil containing different levels of Pb. Results revealed that 20% of the isolated bacteria could tolerate Pb up to 800 mg L−1. Five Pb resistant strains with plant growth promoting (PGP) abilities were evaluated for possible influence on water soluble Pb through soil incubation experiments and significant increase i.e. 1.85– and 1.49–folds in water soluble Pb was observed for NCCP–1848 and NCCP–1862 strains, respectively. Pot experiments indicated significantly higher uptake by Pelargonium hortorum than that by Mesembryanthemum criniflorrum at all levels of soil Pb concentrations with the highest increase (1.9–folds) in plants inoculated with NCCP–1848 followed by NCCP–1862 (1.8–folds increase) compared to the control (Pb and without bacterial strain). The strains NCCP–1848 and NCCP–1862 were identified by 16S rRNA gene sequencing as Microbacterium sp. and Klebsiella sp. The results of present study suggest that Pb resistant plant growth promoting bacteria can serve as an effective bio–inoculant through wide action spectrum for maximizing efficiency of phytoremediation system

Equilibrium, kinetics and thermodynamic study of the adsorptive removal of methylene blue from industrial wastewater by white cedar sawdust

The study evaluated the adsorption potential of white cedar sawdust (WCS) for dye removal. WCS was chosen from five preferred, abundant waste biomasses from Pakistan. Various parameters such as contact time, adsorbent dose, dye concentration, pH, and particle size were optimized for methylene blue (MB) dye adsorption. The adsorbent was characterized by FTIR, SEM, EDX and BET analyses. The surface area of the adsorbent was 1.43 m2·g-1 and pore volume was 0.000687 cm3·g-1. The adsorption data best fitted the isotherm models of Langmuir, Temkin, Dubinin–Radushkevich, and Freundlich. The maximum experimental adsorption capacity obtained was 55.15 mg·g-1, which was in close agreement to the calculated adsorption capacity. Fitness of the pseudo-second order kinetics suggested chemisorption as the rate-limiting step. Thermodynamic study for adsorption was carried out to evaluate the Gibbs free energy (ΔG°), enthalpy (ΔH°) and entropy (ΔS°). The negative values ΔG° at the examined temperature range confirmed the spontaneous adsorption of MB onto WCS