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 ICT Skills upon Legal Professionals of Lahore High Court Bar Association and Their Practice

Abstract: Objective: Objective of this research was to investigate the impact of ICT skills upon Legal Professionals of Lahore High Court Bar Association and their Practice. Methodology: In view of the suitability and usability as well as the previous studies conducted in the field, the survey research method was adopted for this study. The population of was Advocates of Lahore High Court, Pakistan. Simple random sampling technique was adopted to conduct this study. The survey questionnaire was adapted as a data collection tool for this study. After collection of data, a numerical analysis using SPSS was performed to present the data into tangible results. Several tests were then performed to get maximum findings from the collected data. The t-test was performed in order to find out the impact of ICT skills and the information use & access upon practice of the Legal Professionals. Key Findings: Findings of the study reveal that digital media has a great impact on information seeking digital resources enhanced information searching capabilities of users. When Legal Professionals use digital information resources it makes easy to prepare the case. E-resources have a positive impact on their professional efficiency. They prefer digital resources over print resources if they are well trained to use these digital resources. Rationale of the Study Legal Professionals need to be more and more responsible in order to get the mastery of legal research in digital environment. The clients in general and the profession of law in particular demand the lawyers to be professionally sound with the latest tools and techniques in the practical field. Therefore, in order to survive in an information and knowledge society, it is important that Legal Professionals learn the required digital skills. Key Words: ICT skills and advocates, Impact of IT upon legal practice, Legal Professionals and digital expertis

Impact of ICT Skills upon Legal Professionals of Lahore High Court Bar Association and Their Practice

Abstract: Objective: Objective of this research was to investigate the impact of ICT skills upon Legal Professionals of Lahore High Court Bar Association and their Practice. Methodology: In view of the suitability and usability as well as the previous studies conducted in the field, the survey research method was adopted for this study. The population of was Advocates of Lahore High Court, Pakistan. Simple random sampling technique was adopted to conduct this study. The survey questionnaire was adapted as a data collection tool for this study. After collection of data, a numerical analysis using SPSS was performed to present the data into tangible results. Several tests were then performed to get maximum findings from the collected data. The t-test was performed in order to find out the impact of ICT skills and the information use & access upon practice of the Legal Professionals. Key Findings: Findings of the study reveal that digital media has a great impact on information seeking digital resources enhanced information searching capabilities of users. When Legal Professionals use digital information resources it makes easy to prepare the case. E-resources have a positive impact on their professional efficiency. They prefer digital resources over print resources if they are well trained to use these digital resources. Rationale of the Study Legal Professionals need to be more and more responsible in order to get the mastery of legal research in digital environment. The clients in general and the profession of law in particular demand the lawyers to be professionally sound with the latest tools and techniques in the practical field. Therefore, in order to survive in an information and knowledge society, it is important that Legal Professionals learn the required digital skills

Effects of 6cm versus 2cm Resection Margin from Pylorus on Excess Weight Loss & Complication Rate for Laparo- Scopic Sleeve Gastrectomy: A Nine-Year Experience

Introduction: LSG is the gold standard sole bariatric procedure for morbid obesity. Small (2cm) and large (6cm) distance of resection margin from pylorus are both being used for neogastric sleeve formation however what is optimal distance remains controversial. Aims & Objectives: To assess excess weight loss results and complication rate with 6cm and 2cm distance of staple line from pylorus during a prolonged surveillance period. Place and Duration of Study: This retrospective cohort study was conducted at Fatima Memorial Hospital from Dec 2013 to Dec 2022 spanning 9 years. Material & Methods: Medical records of 50 morbidly obese patients aged 41- 50 yrs were segregated into two groups of 25 each based on the LSG procedure conducted. Group 1 had LSG with 6cm resection margin from pylorus while group 2 had a staple line distance of 2cm from pylorus for neogastric sleeve formation. The patients were subsequently followed up for excess weight loss (EXL) and BMI at 6 months, 1 year, 2 years, 3 years & 4-year interval. Data was entered and analyzed using SPSS version 21.P value ? 0.05 was considered significant. Results: EWL in Group 1 & 2 was 39.2± 6.77kg & 41.9± 4.35kg at 6 months,73.64± 6.49kg & 71.06± 7.77kg at 1 year, 65.52± 5.53kg & 63.92± 7.07kg at 2 years,58.16± 4.97kg & 57.28± 5.75kg at 3 years and 55.48± 3.39kg & 55.36± 3.72kg for 4 years were, not significant statistically. BMI in group 1 & 2 were 39.47± 5.11 & 35.88± 4.40 at 6 months, 29.22± 2.68 & 29.12± 2.00 at 1 year, 25.44± 1.96 & 24.73± 2.86 at 2 years, 22.84± 1.79 & 22.40±2.20 at 3 years and 21.66± 1.32, 21.67± 1.62 at 4 years were found to be statistically insignificant. Conclusion: With regards to extra weight loss, distance of resection margin from pylorus of 2cm or 6cm have identical effects but the latter has lowest complication incidence after 4 yrs of surveillance. Hence, a distance of 6cm is favoured to ensure safety of LSG for morbidly obese patients. And the findings of this study will help bariatric surgeons to improve technique of LSG in a safe and successful way for effective weight loss in morbidly obese patients

Intraoperative Peritoneal Lavage in Peritonitis: Normal Saline vs Metronidazole

Introduction: Globally, acute generalized peritonitis ranks among the top surgical emergencies. Different studies have been conducted to show the amplitude of peritonitis worldwide eliciting a huge impact on overall patient morbidity and mortality. Largely peritonitis is caused by a gastrointestinal perforation or anastomotic leak. In peritonitis, anaerobes & gram-negative organisms are mostly responsible for sepsis and morbidity due to the overactive inflammatory cascade by endotoxins which is amenable to timely intervention. Aims & Objectives: The study's aim was to evaluate whether using normal saline or metronidazole solution during intraoperative peritoneal lavage (IOPL), results in a lower rate of postoperative wound infection. Place and Duration of Study: This study was undertaken at the South Surgical Ward, Mayo Hospital Lahore for 6 months from February 2nd, 2021, to August 1st, 2021. Material & Methods: Consecutive sampling strategy followed by a randomized controlled trial were used to induct and provide intervention to 90 patients aged 15-65 years with peritonitis caused by hollow viscus perforation. The patients were subdivided into 2 groups A& B(n=45 each).Two liters of normal saline were used for peritoneal lavage in group A, while two liters of normal saline were combined with 200 mL of metronidazole solution and administered to group B. intraoperatively.Baseline physiological parameters such as age, sex, BMI , intra operative surgical parameters as duration of operation and post-operative course were recorded till discharge. On 10th POD, patients returned to OPD for further monitoring. An infection was diagnosed if the patient had post-operative symptoms such as a high temperature, increased TLC, wound discharge, redness, or pain. Data was entered and analyzed using SPSS version 23. Results: A majority (54.44%) of the patients were young adults. Mean age of 37.33 ± 10.53 years of patients in the metronidazole group was comparable to mean age 40.04 ± 11.96 years in the saline group, difference was not significant (p=0.067). Male/female ratio in Metronidazole and Saline groups were 17/25 and 10/18, respectively. Patients who received intraperitoneal lavage with normal saline were more likely to develop wound infections (17/45) (37.78%), while only 3/45) (6.67% of those who received metronidazole solution did so (p 0.0001). Conclusion: Based on the results of this experiment, using metronidazole solution for intraoperative peritoneal lavage instead of normal saline reduces the occurrence of postoperative wound infection