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

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 17

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 17 de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada, de acceso abierto a todas las áreas del conocimiento, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico. Con esta colección, se aspira contribuir con el cultivo, la comprensión, la recopilación y la apropiación social del conocimiento en cuanto a patrimonio intangible de la humanidad, con el propósito de hacer aportes con la transformación de las relaciones socioculturales que sustentan la construcción social de los saberes y su reconocimiento como bien público

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

A survey of amino acids and amines content in some European vinegars with Protected Denomination of Origin.

Vinegar is a widely known fermented product, which is appreciated for its distinct organolectic properties, food preservative features and versatility in modern cooking. It can be obtained from virtually any fermentable carbohydrate, including hydroalcoholic solutions, various fruits, cereals or amidaceous agricultural produces, after a yeast-driven alcoholic fermentation and a subsequent acetification carried out by acetic acid bacteria. However, in Europe, the highest prized quality vinegars derive from grape and wines obtained therefrom, some of them being commercialized under a specific protected designation of origin (PDO) or a protected geographical indication (PGI). Different technological processes are used for their production and, due to this, sensory and constitutive characteristics of the different marketed vinegars largely differ each other. In particular, the composition in amino acids and amines in the final product largely depends on the starting raw material and the microbiota specific of the diverse producing processes. In this work, thirty-six Italian and Spanish vinegars representing all the European DPO or GPI specialties currently marketed, have been analyzed for their content in amino acids and amines, with the aim to characterize the products and provide information on the presence of molecules such as biogenic amines, which may cause adverse physiological effects in sensitive consumers. A RP HPLC-UV method based on sample pre-column derivatization with diethylethoxymethylenmalonate (DEEMM) was used for the simultaneous quantification of 23 amino acids and 11 biogenic amines. Based on the entire dataset, Anova and cluster analysis provided a clear discrimination between Italian and Spanish vinegars, while no univocal differentiation was found for vinegars undergone to increasing ageing times. Balsamic vinegar of Modena samples demonstrated to contain the highest amount of aminoacids (being particularly richer in alanine, GABA, threonine and arginine) while Spanish vinegars tended to share higher amounts of putrescine and total amines. Hystamine was found at levels not representing a safety issue for consumers. Serotonine was also detected in all the PDO or PGI vinegars at amounts < 1 mg/L

Evaluation of volatile aldehydes as discriminating parameters in quality vinegars with protected European geographical indication

Thirty-six high-quality vinegars with geographical indication belonging to Sherry and Modena areas (vinegars of Jerez, balsamic vinegars of Modena and traditional balsamic vinegars of Modena) with all possible aging periods were analyzed to determine the content of volatile aldehydes. A solid-phase extraction method with in-cartridge derivatization using O-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine followed by gas chromatography-mass spectrometry was employed

Aroma compounds in wines from Malvasia aromatica di Candia

Malvasia aromatica di Candia (Vitis vinifera L.) is an Italian aromatic grapevine cultivated between Emilia Romagna and Lombardy regions. This grape has an aromatic intensity comparable to Muscat1, and it gives different type of wine: semi-sparkling, semi-dry or sweet wines and, more recently, dry or passito wines. In this study the evolution of aromatic compounds during the fermentation of semi-sparkling sweet and dry wine samples was studied. The extraction of free and glycosylated compounds was carried out by solid phase extraction onto C18-endcapped cartridges, while the detection was performed by gas chromatography coupled with mass spectrometry. Fermentative and varietal compounds were detected, observing similar profiles for both wines. The former compounds showed an increasing trend during the fermentation process, while the latter showed an opposite trend. In particular, the decrease of glycosylated terpenoids during the fermentation does not entail a corresponding increase of free fraction2. These compounds can be converted into other different, or absorbed onto yeast cell wall, or else stripped away due to gas development. Free and glycosylated varietal component was characterized by a prevalence of diol 1, diol 2, geraniol and its derivatives. These compounds make different the aroma profiles of Malvasia aromatica wines from Muscat white ones. In fact, the latter are characterized by a prevalence of linalool and its derivatives. Considerable free and bound contents of citronellol were also detected as well as linalool and its derivatives. In addition, the presence of other free compounds such as C13-norisoprenoids and benzenoids was observed. The main identified fermentative compounds were higher alcohols and their acetates as well as medium-chain fatty acids and their corresponding ethyl esters. Knowledge acquired through this study are useful in order to characterize the wines obtained from Malvasia aromatica di Candia and set up variety-oriented wine making protocols

Location effects on the aromatic composition of Monovarietal cv. Carignan wines

The aromatic profile of monovarietal Carignan wine has been characterized, and the influence of the geographic origin of the wine on the volatile composition wines from six different zones of Chile and from two different seasons has been studied. The solid-phase microextraction conditions employed were previously studied. An extraction temperature of 45 degrees C, 40 min of incubation, 1.5 g of salt, and 180 sec of fiber desorption were employed for the analysis of the 28 wine samples studied. Sixty-three volatile compounds were determined in cv. Carignan wines, and they were characterized as substantial amounts of ethyl esters and small amounts of volatile acid compounds, among others. Analysis of variance showed significant effects on the "location" factor (p < 0.05), which was corroborated by principal component analysis and linear discriminant analysis, where clear groups were observed regarding wine production area. The geographical origin of the wine affected the volatile composition of the wines studied, and production areas that were closer to the Andes Mountains showed lower concentrations of esters and acids than those wines produced in regions that were closer to the ocean.Comision Nacional de Ciencia y Tecnologia (CONICYT) / FONDECYT, 11140403, 11140275, 1140882 / FONDEQUIP, EQM-13012

Study of aroma profile in Malvasia di Candia Aromatica

Malvasia di Candia aromatica is a grapevine (Vitis vinifera L.) cultivar (cv.) that produces aromatic white grape, cultivated in the Emilia Romagna provinces of Reggio Emilia, Parma, and Piacenza, while in Lombardy it is cultivated in the area of Oltrepò Pavese. This cv. is an aromatic cultivar used to produce semi-sparkling, semi-dry or sweet wines and, more recently, still, dry or passito wines. For this reason, Malvasia di Candia aromatica was studied under different aspects. In particular, some studies were carried out on the aromatic compounds that influence the sensory quality of products obtained from this grape. In different studies, aromatic profile of this cv. was widely studied in relation to cultivation techniques, terroir, as well as to winemaking techniques. This study aimed at evaluating different accessions of Malvasia di Candia aromatica in relationship to different altitudes where the grapevines are grown. The method included the extraction of the volatile aromatic fractions, both free and glycosylated, by solid phase extraction (SPE) onto C18-endcapped cartridges and by stir bar sorptive extraction (SBSE). Separation and quantification of volatiles were carried out by gas chromatography coupled with mass spectrometry (GC-MS) analysis. Seven different Malvasia di Candia aromatica accessions, and one Malvasia aromatica di Parma coming from different local vineyards were collected inside the area around Reggio Emilia at three different altitudes. The samples show a high concentration of free aroma compounds as well as glycosylated ones that represent a reserve of grape flavor, therefore the latter are generally more abundant than the former. Terpenoids, C13-norisoprenoids, and benzenoids, are the main classes of aroma compounds identified in Malvasia grapes. Terpenoid profile is particularly rich and varied, being the geraniol the compound with the highest concentration. The difference found among samples collected at different altitudes show how this factor can influence the aroma profile