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

Hierarchical Clustering based optimal PMU placement for power system fault observability

Optimal number and location of phasor measurement units (PMUs) in the power system networks faces challenges for achieving the full network observability during fault conditions. Achieving fault observability approach requires more constraints than normal system observability and consequently suffers from complex analysis and heavy computational burden for the large-scale networks. A new algorithm for determining the optimal PMU placement considering the network fault observability is introduced. The proposed algorithm is achieved through four stages. The first stage is achieved through the network fault simulation to obtain the post fault change in voltage (ΔV) at each bus. Then, the post fault change in voltage (ΔV) is used to build the network connectivity matrix (CM) and forming a new developed Faulted Connectivity Matrix (FCM) that describes the power system topology during the fault conditions. The correlation between the buses is obtained, in the second stage, by applying Pearson correlation coefficient. Hierarchical Clustering technique is given, in the third stage, to cluster the network into coherent zones to find the most correlated buses. Finally, the optimal location of the PMUs is identified within each zone based on simple proposed placement rules. The proposed algorithm is tested under a variety of fault events applied on different standard test systems. The results show the simplicity and the effectiveness of the proposed algorithm

Efficacy and safety of transradial percutaneous coronary intervention using sheathless guide catheter technique

To evaluate the safety and efficacy of transradial (TR) percutaneous coronary intervention (PCI) using sheathless hydrophilic-coated guiding catheter (GC) technique compared to the standard TR PCI via 6F GC. Methods and results: 67 patients (93 lesions) who underwent TR PCI using sheathless GC technique (6.5 or 7.5 Fr GC) or standard TR PCI (6Fr GC) were included. They were divided into two groups; sheathless TR PCI group (27 patients with 28 lesions) and standard TR PCI group (49 patients with 65 lesions). Baseline clinical, lesion and procedural characteristics were recorded. Radial artery was assessed clinically and using Doppler ultrasound before discharge and after one month. All patients were elective or ad-hoc PCI. The procedure success rate was 100% in both groups. The Sheathless TR PCI patients were older and male sex than standard TR PCI group. ACC/AHA lesion type B2 and C and bifurcation lesions were significantly high at Sheathless TR PCI group. In addition, using IVUS and performing final kissing balloon for bifurcation lesion were significantly common in sheathless TR PCI patients. One patient required rotational atherectomy and another one underwent hugging balloon technique in sheathless TR PCI group but non in the other group. There were no procedure complications or access-site complications in both groups. One patient in sheathless TR PCI group and another in standard TR PCI group (3.7% and 2.1% respectively) experienced radial artery occlusion after the procedure at one-month follow-up without clinical sequelae. Conclusions: TR PCI via standard and sheathless hydrophilic-coated GC techniques are effective and safe with high rate of procedural success and low rate of asymptomatic radial artery occlusion. Moreover, TR PCI using sheathless GC technique has the advantage of performing complex intervention requiring large bore catheters that can not be performed via standard TR PCI using 6F GC

Institutional Reform of Economic Legislation in Egypt

The relationship between institutional and economic reform has dominated the field of development research since the 1990s. However, there is unclarity on the significance of reform of institutions of legislation and representation (whether in the form of interest groups or other civil society organizations). Similarly, there is unclarity regarding the sequence of reform of such institutions. There are, for example, four unresolved contentions about institutional reform. (1) If economic reform partly means economic legislation, is it necessary to reform parliament even when economic legislation is mainly done by the executive? (2) If economic reform requires efficient allocation of resources, is it necessary to strengthen special interest groups and increase societal representation/participation, running the risk of increasing clientelistic lobbying? (3) If one is to answer both questions positively, how should the reformation of the institution of parliament and that of interest representation happen and (4) in which sequence? This study focuses on the institutional environment of economic law-making in Egypt in a decade of intensive economic reform. It highlights the phases that characterized the relationship between economic reform and economic legislation, uncovers the macro-political factors that influence the institution of legislation, and unravels the institutional weakness embedded in the informational base of legislation. The argument is that economic legislation involves an intricate process of judgement. This process of judgement may require redundant channels of information processing and opinion-making that go beyond a linear and simple expert-executive relationship. Hence, the institutional reform of parliament and of interest representation become necessary even in politico-economic systems where the executive is dominant. This study relies on analyses of parliamentary discussions of nine major economic laws between 1989 & 1997 as well as on opinion surveys and extensive interviews with parliamentarians and interest group representatives

Relation Between Erectile Dysfunction and Silent Myocardial Ischemia in Diabetic Patients: A Multidetector Computed Tomographic Coronary Angiographic Study

AbstractIntroductionErectile dysfunction (ED) can precede coronary artery disease. In addition, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and death.AimTo evaluate the presence of SMI in patients with diabetes and ED using multidetector computed tomographic coronary angiography (MDCT-CA).MethodsThis study evaluated patients with diabetes and ED without any history of cardiac symptoms or signs. Erectile function was evaluated with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erectometer. MDCT-CA was used for the detection of coronary artery stenosis.Main Outcome MeasuresSexual Health Inventory for Men score, EHS, maximal penile circumferential change, and coronary artery stenosis by MDCT-CA.ResultsOf 20 patients (mean age = 61.45 ± 10.7 years), MDCT-CA showed coronary artery stenosis in 13 (65%) in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Fifty percent of patients showed at least 50% vessel lumen obstruction of the left anterior descending coronary artery, which was the most commonly affected vessel (55%). Fifteen percent (3 of 20) of patients had greater than 90% stenosis, and two of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age (P = 0.016, r = 0.529) and negatively correlated with EHS (P = .046, r = −0.449). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P = .04).ConclusionMDCT-CA can be a useful tool to identify SMI in diabetic patients with ED, especially in those of advanced age and/or with severe ED

Comparative effects of minimally invasive approaches vs. conventional for obese patients undergoing aortic valve replacement: a systematic review and network meta-analysis

Abstract Background Minimally invasive approaches like mini-thoracotomy and mini-sternotomy for Aortic Valve Replacement (AVR) showed impressive outcomes. However, their advantages for obese patients are questionable. We aimed in this network meta-analysis to compare three surgical approaches: Full sternotomy (FS), Mini-sternotomy (MS), and Mini-thoracotomy (MT) for obese patients undergoing AVR. Methods We followed the PRISMA extension for this network meta-analysis. PubMed/Medline, Scopus, Web of Science, and Cochrane searched through March 2023 for relevant articles. The analysis was performed using R version 4.2.3. Results Out of 344, 8 articles met the criteria with 1392 patients. The main outcomes assessed were perioperative mortality, re-exploration, atrial fibrillation, renal failure, ICU stay, hospital stay, cross-clamp time, and bypass time. In favor of MS, the length of ICU stay and hospital stay was significantly lower than for FS [MD -0.84, 95%CI (-1.26; -0.43)], and [MD -2.56, 95%CI (-3.90; -1.22)], respectively. Regarding peri-operative mortality, FS showed a significantly higher risk compared to MS [RR 2.28, 95%CI (1.01;5.16)]. Also, patients who underwent minimally invasive approaches; MT and MS, required less need of re-exploration compared to FS [RR 0.10, 95%CI (0.02;0.45)], and [RR 0.33, 95%CI (0.14;0.79)], respectively. However, Intraoperative timings; including aortic cross-clamp, and cardiopulmonary bypass time, were significantly lower with FS than for MS [MD -9.16, 95%CI (-1.88; -16.45)], [MD -9.61, 95%CI (-18.64; -0.59)], respectively. Conclusion Our network meta-analysis shows that minimally invasive approaches offer some advantages for obese patients undergoing AVR over full sternotomy. Suggesting that these approaches might be considered more beneficial alternatives for obese patients undergoing AVR

Institutional reform of economic legislation in Egypt

'The relationship between institutional and economic reform has dominated the field of development research since the 1990s. However, there is unclarity an the significance of reform of institutions of legislation and representation (whether in the form of interest groups or other civil society organizations). Similarly, there is unclarity regarding the sequence of reform of such institutions. There are, for example, four unresolved contentions about institutional reform. 1. If economic reform partly means economic legislation, is it necessary to reform parliament even when economic legislation is mainly done by the executive? 2. If economic reform requires efficient allocation of resources, is it necessary to strengthen special interest groups and increase societal representation/ participation, running the risk of increasing clientelistic lobbying? 3. If one is to answer both questions positively, how should the reformation of the institution of parliament and that of interest representation happen and 4. in which sequence? This study focuses on the institutional environment of economic law-making in Egypt in a decade of intensive economic reform. It highlights the phases that characterized the relationship between economic reform and economic legislation, uncovers the macro-political factors that influence the institution of legislation, and unravels the institutional weakness embedded in the informational base of legislation. The argument is that economic legislation involves an intricate process of judgement. This process of judgement may require redundant channels of information processing and opinion-making that go beyond a linear and. simple expert-executive relationship. Hence, the institutional reform of parliament and of interest representation become necessary even in politico-economic systems where the executive is dominant. This study relies an analyses of parliamentary discussions of nine major economic laws between 1989 and 1997 as well as on opinion surveys and extensive interviews with parliamentarians and interest group representatives.' (author's abstract)'Seit den 90er Jahren ist das Verhaeltnis von institutionellen zu oekonomischen Reformen zentraler Untersuchungsgegenstand der Entwicklungsforschung. Doch noch immer ist die Bedeutung von institutionellen Reformen der Legislative und nicht-staatlichen Vertretungseinrichtungen - sei es in der Form von Interessensgruppen oder anderen Organisationen der Zivilgesellschaft - nicht eindeutig geklaert. Zugleich besteht Unklarheit hinsichtlich der zeitlichen Abfolge solcher institutionellen Reformen. Es existieren zum Beispiel vier Themen zur Debatte bezueglich der Reform von Institutionen. 1. Wenn oekonomische Reformen zumindest teilweise auch oekonomische Gesetzgebung bedeuten, ist es dann notwendig, das Parlament zu reformieren, selbst wenn die Gesetzgebung vornehmlich durch die Exekutive erfolgt? 2. Wenn oekonomische Reformen die effiziente Verteilung von Ressourcen erforderlich macht, ist es dann notwendig, bestimmte Interessensgruppen zu staerken und die gesellschaftliche Vertretung/ Beteiligung zu foerdern, auch wenn die Gefahr bestuende, dass wir dadurch klientelistische Lobbyisten foerdern? 3. Wenn beide Fragen bejaht werden, wie sollte die Reform der Institution des Parlaments und die der Interessensvertretung geschehen und 4. in welcher Reihenfolge? Diese Studie konzentriert sich auf die institutionellen Bedingungen der Wirtschaftsgesetzgebung in Aegypten in einem Jahrzehnt intensiver Wirtschaftsreform. Sie beleuchtet Phasen, die durch das Verhaeltnis zwischen wirtschaftlicher Reform und oekonomischer Gesetzgebung charakterisiert sind, erkundet die makro-politischen Faktoren, die die Institutionen der Legislativen beeinflussen und entlarvt die institutionelle Schwaeche, die der Informationsbasis der Gesetzgebung zu Eigen ist. Es wird argumentiert, dass die oekonomische Gesetzgebung einem komplizierten Urteilsprozess einhergeht. Dieser Urteilsprozess kann redundante Kanaele der Informationsverarbeitung und Meinungsfuehrung erfordern, was ueber ein lineares und einfaches Experten-Exekutive-Verhaeltnis hinaus geht. Damit wird die institutionelle Reform des Parlaments und der Interessensvertretung sogar in polit-oekonomischen Systemen notwendig, in denen die Exekutive dominiert. Diese Studie basiert auf Analysen der parlamentarischen Diskussionen ueber neun grundlegende Wirtschaftsgesetze zwischen 1989 und 1997, sowie auf Meinungsumfragen und umfangreichen Interviews mit Parlamentariern und Vertretern von Interessensgruppen.' (Textauszug)German title: Institutionelle Reform des aegyptischen WirtschaftsrechtsSIGLEAvailable from http://www.zef.de/zef englisch/f publ.html / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman