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

Postoperative Pain After Different Root Canal Irrigant Activation Methods; (Randomized Clinical Trial)

Objective: This study was designated to evaluate postoperative pain in irreversible symptomatic teeth after different irrigation activation methods using visual analogue scale. Materials and Methods:78 Patients having symptomatic irreversible pulpitis in mandibular first molar (vital pulp) with no periapical involvement were involved in the study. Cases were classified into three groups according to the the final irrigation agitation method used, twenty-six patients each group (n=26). Group A: Root canals were irrigated using NaOCl2* 2.6% with NaviTip (31-gauge 27mm) with double side port irrigator tip (SVN). Group B: Root canals were irrigated using 2.6% NaOCl with manual dynamic agitation using master cone for 60 seconds. Group C: Root canals were irrigated using 2.6% NaOCl with mechanical agitation using ultrasonic device ultra-x for 60 seconds. Postoperative pain was evaluated after 6,12,24, 48, and 72 hours and 1 week. Data were explored for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests and showed parametric (normal) distribution. Statistical analysis was performed with IBM® SPSS® Statistics Version 20 for Windows. Results: Severity of postoperative pain was more intense at 6- 12and 24-hour time intervals in group 2 patients than those patients in groups 1and 3 (P \u3c .05). There was no significant difference among the groups at the other time intervals (P \u3e .05). Severity of postoperative pain in all groups decreased over time. Conclusion: After endodontic therapy in lower molars with acute pulpitis manual dynamic agitation caused greater postoperative pain in comparison with the other methods in the first 24 hours

Detection of simulated vertical root fractures; which is better multi-detector computed tomography or cone beam computed tomography?

Objectives: Multi-detector computed tomography (MDCT) and cone beam computed tomography (CBCT) were compared regarding their ability to detect vertical root fractures. Methods: Sixty four extracted posterior teeth were included in this study. Using a diamond disc, thirty six teeth were cut vertically to simulate a VRF. Twenty eight teeth were used as control. Fractured and non-fractured teeth were randomly positioned in 4 skulls and mandibles. Scanning was performed first on a 16 slice Siemens MDCT, then by i-CAT Next Generation CBCT. Two observers assessed the multiplanar images for vertical root fractures using a 3-point scale. The first observer repeated the assessment after 1 week. Later, the 2 observers re-assessed the images together to reach a consensus score. Results: CBCT showed higher sensitivity, accuracy as well as negative predictive value compared to MDCT. The mean area under the curve was 0.917 for MDCT and 0.972 for CBCT. The difference in diagnostic accuracy between the 2 modalities was statistically significant P = .036. Inter-observer agreement was 0.971 for MDCT and 0.994 for CBCT, whereas intra-observer agreement was 0.981 for MDCT and 0.985 for CBCT. Conclusion: Using the specified scanners at the specified exposure parameters, the diagnostic accuracy of CBCT in detecting vertical root fractures was significantly higher than MDCT. Keywords: Multi-detector computed tomography, Cone-beam computed tomography, Root fractur