Открытые вопросы удовлетворенности жизнью и профессионального выгорания в анестезиологии и реанимации

Abstract Anesthesiologists and resuscitators are at high risk of developing burnout, which can lead to various unfavorable consequences, such as suicide and/or medical errors. The aim of the study The dependence between happiness (satisfaction with life) and burnout in staff of anesthesiology and intensive care departments. Multicenter, anonymous, blind observational study.Materials and methods Maslach Burnout Inventory (MBI), Flourishing Scale (FS), Satisfaction with Life Scale (SWLS), the study also included a series of general questions (gender, age, specialization, subjective definition of “happiness”). The study included 361 participants, including 311 specialists from the departments of anesthesiology and intensive care, and a control group of 50 non-medical workers.Results According to the MBI, high burnout scores were registered for all three subscales: 15% of anesthetists, 17.5% of resuscitators, 9.9% of nursing staff, 0% in the control group. The high figures of some of the three subscales of burnout: 82% of anesthesiologists, 66.25% of resuscitators, 59.4% of nurses and nursing assistants, 14% in the control group. The life satisfaction level was significantly lower in all groups of health care staff in the study, compared to the control group. Only a little more than half of the medical workers (56.59%) never thought about suicide, which means that almost half of the staff of the anesthesiology and resuscitation departments thought to some extent about suicide.Conclusion There is a growing awareness of the problem of occupational stress and burnout in anesthesiology and resuscitation. The timely identification of the first symptoms of burnout, and the provision of anesthesiology-resuscitation staff with psychological tools/psychological support to deal with occupational stress and burnout are required today.Анестезиологи и реаниматологи находятся в группе высокого риска развития выгорания, которое может приводить к различным неблагоприятным последствиям, таким как суицид и/или медицинские ошибки.Цель исследования Изучение зависимости счастья (удовлетворенность жизнью) и эмоционального выгорания сотрудников отделений анестезиологии и реанимации.Материал и методы Мультицентровое анонимное слепое наблюдательное исследование. В ходе работы использован опросник Maslach Burnout Inventory (MBI) и шкалы Flourishing Scale (FS), Satisfaction with Life Scale (SWLS), в анализ также были включены ответы на серию общих вопросов (пол, возраст, специализация, субъективное определение понятия «счастье»). В исследование включен 361 участник, из них 311 специалистов отделений анестезиологии и интенсивной терапии, контрольная группа — 50 человек немедицинских работников.Результаты По данным MBI, высокие баллы эмоционального выгорания отмечены по всем трем субшкалам: 15% анестезиологов, 17,5% реаниматологов, 9,9% медсестер и младших медсестер, 0% в контрольной группе. Высокие показатели наблюдались по некоторым из трех субшкал выгорания: 82% анестезиологов, 66,25% реаниматологов, 59,4% медсестер и младших медсестер, 14% в контрольной группе. Уровень удовлетворенности жизнью оказался статистически значимо ниже у всех групп медицинских работников в исследовании по сравнению с контрольной группой. Только чуть больше половины медицинских работников (56,59%) никогда не задумывались о самоубийстве, а это значит, что почти половина сотрудников отделений анестезиологии и реанимации в той или иной степени задумывались о суициде.Заключение Растет осознание проблемы профессионального стресса и выгорания в анестезиологии-реаниматологии. Необходимым сегодня является своевременное выявление первых симптомов выгорания и предоставление сотрудникам анестезиологии-реанимации психологических инструментов/психологической поддержки для борьбы с профессиональным стрессом и выгоранием.

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

Open Questions of Life Satisfaction and Burnout in Anesthesiology and Resuscitation

Abstract Anesthesiologists and resuscitators are at high risk of developing burnout, which can lead to various unfavorable consequences, such as suicide and/or medical errors. The aim of the study The dependence between happiness (satisfaction with life) and burnout in staff of anesthesiology and intensive care departments. Multicenter, anonymous, blind observational study.Materials and methods Maslach Burnout Inventory (MBI), Flourishing Scale (FS), Satisfaction with Life Scale (SWLS), the study also included a series of general questions (gender, age, specialization, subjective definition of “happiness”). The study included 361 participants, including 311 specialists from the departments of anesthesiology and intensive care, and a control group of 50 non-medical workers.Results According to the MBI, high burnout scores were registered for all three subscales: 15% of anesthetists, 17.5% of resuscitators, 9.9% of nursing staff, 0% in the control group. The high figures of some of the three subscales of burnout: 82% of anesthesiologists, 66.25% of resuscitators, 59.4% of nurses and nursing assistants, 14% in the control group. The life satisfaction level was significantly lower in all groups of health care staff in the study, compared to the control group. Only a little more than half of the medical workers (56.59%) never thought about suicide, which means that almost half of the staff of the anesthesiology and resuscitation departments thought to some extent about suicide.Conclusion There is a growing awareness of the problem of occupational stress and burnout in anesthesiology and resuscitation. The timely identification of the first symptoms of burnout, and the provision of anesthesiology-resuscitation staff with psychological tools/psychological support to deal with occupational stress and burnout are required today

Analysis of drug prevention of venous thromboembolic complications in hip arthroplasty (review)

The retrospective analysis of 131 medical records of patients who underwent surgery for total hip arthroplasty in two large hospitals in Krasnoyarsk in 2013 was made. All patients received anticoagulants for the purpose of thromboprophylaxis. In the structure of these drugs prevails prescriptions anticoagulant with a low risk of bleeding, requiring no laboratory control, such as low molecular weight heparins and direct oral anticoagulants. The assessment of anticoagulant dosing regimens revealed defects related to non-compliance as a single dose and duration of use after discharge from hospital. To eliminate the detected defects is necessary to conduct training seminars, the approval of the local protocol of prevention and formation of the VTEC system audit

Preop endovascular embolization in juvenile nasal angiofibroma management

Introduction. Juvenile nasal angiofibroma (JNA) is an aggressively expanding fibro-vascular benign tumor, which occurs in male adolescents. Surgical management of JNA is considered as one of the most difficult in rhinology, because it very often has accompanied with profuse, streaming bleeding. Endovascular embolization has successfully used for reducing the operative blood loss since 2000th. Nevertheless, there is no consensus in the literature about its expediently using because of complications, which may occur.Objective is to evaluate the effectiveness of selective angiography and endovascular embolization in reducing bleeding when removal of JNA of different stages.Materials and methods. In the N.N. Burdenko National Medical Research Center of Neurosurgery 134 patients with JNA had been treated surgically.Results. 110 patients with JNA, who underwent embolization, managed to perform total, subtotal or partial devascularization of the tumor. Total devascularization was achieved in JNA blood supply variant only from the external carotid artery (ECA) system from 1 or 2 sides  (in primary patients or in patients who had not previously been embolized) (n = 39); subtotal devascularization, if the blood supply was carried out from the ECA system, internal carotid artery (ICA) on the 1 side (n = 52) and partial, if there was blood supply from the ECA and significant from the ICA system from 2 sides (in patients with relapse after previous embolization with microspirals or the ECA ligations from 1 or 2 sides, as well as with giant JNA (n = 19). Since the vast majority of patients admitted to our clinic were previously operated on, and JNA blood supply in relapses was more pronounced, we performed the comparison of the degree of tumor devascularization depending on its blood supply in primary patients and patients with relapse. It turned out, as could be expected, that with the primary JNA often managed  to execute a total devascularization than with JNA with continued increase, the difference was statistically significant (p = 0.009).Conclusion. It accurately proved that embolization decreases intraoperative blood loss and reduce surgical risks even in later stages JNAs  (r = –0,51, p &lt;10–7). Ligation of ECA as well as proximal occlusion of its branches leads to rapid reconstruction blood supply from ICA and inability of its embolization if recurrence of JNA occurs