A cross-sectional study of stressors and coping mechanisms used by radiation therapists and oncology nurses: resilience in cancer care study

Introduction: Occupational stress and burnout are well-recognised experiences reported by cancer care workers. The aim was to describe the frequency and severity of potential stressors as well as the effectiveness of coping skills of radiation therapists (RTs) and oncology nurses (ONs), which make up the two largest occupational groups in cancer care. Methods: A questionnaire was distributed to RTs and ONs in two large tertiary hospitals in Queensland. Descriptive data regarding severity of potential stressors at home and work as well as the perceived effectiveness of preferred coping styles for each stressor was compared for each professional group. Respondents were asked questions about their personal circumstances and to also complete five standardised questionnaires measuring resilience, mental well-being, depression, anxiety and burnout. Results: There were 71 respondents representing a response rate of 26%. The types of stressors differed between the two groups but both reported that heavy workload was the most severe workplace stressor. RTs reported higher stressor and coping strategy frequency than ONs. There were no identifiable differences between RTs and ONs in the types or effectiveness of coping strategies employed at home or work. Mental well-being for both groups was inversely correlated with depression, anxiety and burnout and positively correlated with resilience. Conclusions: RTs experienced higher mean scores for stressors and coping than ONs. There were no significant between-group differences for anxiety, depression, burnout, mental well-being or resilience

A prospective case series evaluating use of an in-line air detection and purging system to reduce air burden during major surgery

Abstract Background Intravascular air embolism (AE) is a preventable but potentially catastrophic complication caused by intravenous tubing, trauma, and diagnostic and surgical procedures. The potentially fatal risks of arterial AE are well-known, and emerging evidence demonstrates impact of venous AEs on inflammatory response and coagulation factors. A novel FDA-approved in-line air detection and purging system was used to detect and remove air caused by administering a rapid fluid bolus during surgery. Methods A prospective, randomized, case series was conducted. Subjects were observed using standard monitors, including transesophageal echocardiography (TEE) in the operating room. After general anesthesia was induced, an introducer and pulmonary artery catheter was inserted in the right internal jugular to administer fluids and monitor cardiac pressures. Six patients undergoing cardiac surgery were studied. Each patient received four randomized fluid boluses: two with the in-line air purging device, two without. For each bolus, a bulb infuser was squeezed three times (10–15 mL) over 5 s. The TEE was positioned in the mid-esophageal right atrium (RA) to quantify peak air clearance, and images were video recorded throughout each bolus. Air was quantified using optical densitometry (OD) from images demonstrating maximal air in the RA. Results All subjects demonstrated significantly lower air burden when the air reduction device was used (p = 0.004), and the average time to clear 90% of air was also lower, 3.7 ± 1.2 s vs. 5.3 ± 1.3 s (p < 0.001). Conclusion An air purging system reduced air burden from bolus administration and could consequently reduce the risk of harmful or fatal AEs during surgery

Repair of Rare Direct Gerbode Defect Secondary to Aortic and Tricuspid Valve Endocarditis

<p>Direct Gerbode defects (GD) are rare, especially those secondary to endocarditis. Only 10.7% involve both the aortic and tricuspid valves. The authors present a direct GD secondary to aortic and tricuspid valve endocarditis and discuss the surgical management of the defect with sliding tricuspid valve annuloplasty.<br></p><p>The preoperative echocardiogram shows what was thought to be a perimembranous ventricular septal defect (VSD), a large amount of endocarditis involving the aortic and tricuspid valves, and significant tricuspid regurgitation. GDs are depicted as left ventricle (LV) to right atrium (RA) communication.</p><p>As mentioned, the preoperative working provisional diagnosis was a perimembranous VSD. The authors felt that the endocarditis was slightly secondary to this congenital defect. They explored the aortic valve first as part of the procedure. Upon examination, the valve had an extremely significant amount of pannus involving all three leaflets, which was carefully resected. It was a very considerable burden of endocarditis on the valve, which was grossly incompetent.</p><p>The leaflets were resected sequentially, and after resection the authors progressively found a significant amount of pannus involving the left ventricle outflow tract. This was carefully debrided. The vegetation was gelatinous and friable, and as it was gently resected, the authors saw that it extended down into the septum. They carefully debrided the entire area to ensure that an adequate margin of good tissue was available to sew the valve into and confidently have a good repair. After seeing the GD and how friable and necrotic the tissue was, the authors further debrided the area.</p><p>Next, the RA was opened to look under the tricuspid valve, where the authors expected to find a communication at that level. They planned to subsequently repair it and the tricuspid valve. After approaching through the aortic valve, the authors turned to the RA, which revealed a defect that communicated with the RA as opposed to the right ventricle. The septum on the right side was intact, so this was a direct GD from the LV into the RA through erosion. The original diagnosis was wrong, but that is what GDs do; the defect is a great masquerader.</p><p>The authors observed the GD and repaired it with a patch, then examined the tricuspid valve. The posterior and septal leaflets of the tricuspid valve were badly involved with the endocarditis process, so this tissue was resected. The authors began to adequately mobilize the valve in order to obtain a satisfactory repair rather than replacement. They used a sliding annuloplasty of the septal leaflet of the tricuspid valve. A bit more was incised in order to provide better mobilization and ultimately better coaptation of the valve without any undue tension on the repaired valve. The authors then repaired the septal leaflet back to the annulus using 5-0 Prolene® sutures in two layers.</p><p>After the septal leaflet was reattached and the GD repaired, the repair was checked to ensure the tricuspid valve was functional. By inflating the RV with a red rubber catheter, the authors could see that the valve itself functioned well and would likely provide the patient with good repair. In the video, the patched GD can again be seen with the completed valve repair after the septal leaflet tricuspid valve mobilization and reattachment to the annulus.</p><p>The next part of the procedure involved aortic valve replacement. The authors sewed in a bioprosthesis. The patient also had ischemic heart disease involving left anterior descending arteries, which was not associated with this endocarditis but was revascularized with left internal mammary artery harvest. The patient was weaned from cardiopulmonary bypass.</p><p>The patient showed very good ventricular function. A postoperative echocardiogram was done, which demonstrated a competent aortic bioprosthesis with no evidence of leak. Additionally, the septum was intact with no evidence of GD or any VSD, and the tricuspid valve function was normal.</p><p><strong>Suggested Reading</strong></p><ol><li>Yuan SM. A systematic review of acquired left ventricle to right atrium shunts (Gerbode defects). <em><a href="https://www.ncbi.nlm.nih.gov/pubmed/26429364">Hellenic J Cardiol.</a></em><a href="https://www.ncbi.nlm.nih.gov/pubmed/26429364"> 2015;56(5):357-372</a>.</li><li>Alphonso N, Dhital K, Chambers J, Shabbo F. Gerbode’s defect resulting from infective endocarditis. <em><a href="https://www.ncbi.nlm.nih.gov/pubmed/12754046">Eur J Cardiothorac Surg</a></em><a href="https://www.ncbi.nlm.nih.gov/pubmed/12754046">. 2003;23(5):844-846</a>.</li><li>Roughneen PT, Conti VR. Tricuspid septal leaflet detachment for ventricular septal defect repair in adults. <em><a href="https://doi.org/10.1016/j.athoracsur.2016.01.032">Ann Thorac Surg</a></em><a href="https://doi.org/10.1016/j.athoracsur.2016.01.032">. 2016;102(2):e93-95</a>.</li></ol