Identification of surgeon burnout via a single-item measure

Background Burnout is endemic in surgeons in the UK and linked with poor patient safety and quality of care, mental health problems, and workforce sustainability. Mechanisms are required to facilitate the efficient identification of burnout in this population. Multi-item measures of burnout may be unsuitable for this purpose owing to assessment burden, expertise required for analysis, and cost. Aims To determine whether surgeons in the UK reporting burnout on the 22-item Maslach Burnout Inventory (MBI) can be reliably identified by a single-item measure of burnout. Methods Consultant (n = 333) and trainee (n = 217) surgeons completed the MBI and a single-item measure of burnout. We applied tests of discriminatory power to assess whether a report of high burnout on the single-item measure correctly classified MBI cases and non-cases. Results The single-item measure demonstrated high discriminatory power on the emotional exhaustion burnout domain: the area under the curve was excellent for consultants and trainees (0.86 and 0.80), indicating high sensitivity and specificity. On the depersonalisation domain, discrimination was acceptable for consultants (0.76) and poor for trainees (0.69). In contrast, discrimination was acceptable for trainees (0.71) and poor for consultants (0.62) on the personal accomplishment domain. Conclusions A single-item measure of burnout is suitable for the efficient assessment of emotional exhaustion in consultant and trainee surgeons in the UK. Administered regularly, such a measure would facilitate the early identification of at-risk surgeons and swift intervention, as well as the monitoring of group-level temporal trends to inform resource allocation to coincide with peak periods

Volume change of cranial arachnoid cysts after successful endoscopic fenestration in symptomatic children

Introduction: Endoscopic fenestration remains a first-line treatment option for symptomatic arachnoid cysts. After fenestration, the cyst does not collapse but reaches an equilibrium state. The aim of this study was to evaluate the change in cyst volume following successful fenestration and symptomatic improvement. Methods: Cyst volume was measured on serial MR scans of 4 children (1 female, 3 males) with symptomatic arachnoid cysts (middle fossa n = 2, choroidal fissure n = 1 and posterior fossa n = 1), who experienced symptom resolution after endoscopic fenestration. Average follow-up was 20.5 months (range 3–48). Results: Significant cyst volume reduction was seen in all four patients. In patient 1, preoperative cyst volume was 336 cm3 and decreased to 194 cm3 at 7 months (42% reduction). In patient 2, preoperative volume was 12.64 cm3 and reduced to 1.51 cm3 at 3 months (88% reduction). In patient 3, preoperative volume was 105 cm3 and reduced to 72 cm3 in 2 months (30% reduction). In patient 4, preoperative volume was 125 cm3 and reduced to 54 cm3 at 7 months (56% reduction). All remained stable after 7 months and there has been no late increase in volume. Conclusions: Significant reduction in arachnoid cyst volume at the order of 30–40% is seen after successful endoscopic fenestration. The cyst volume appears to decrease gradually in the first 3–7 months and reaches a plateau after that. Complete resolution of symptoms in the presence of residual volume may indicate that cyst volume below a threshold may not correlate directly with clinical status. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature

Oxidative status in ICU patients with septic shock

The aim of this pilot study was to investigate variability of oxidative stress during sepsis evolution. ICU patients with the diagnosis of septic shock were included. Thiobarbituric-acid reactive substances, total antioxidant capacity, protein carbonyls in plasma, reduced, oxidized glutathione and catalase activity in erythrocyte lysate were assessed in the 1st, 3rd, 5th and 8th day after sepsis appearance. A total of 17 patients were divided in two groups: survivors (n = 7) and non-survivors (n = 10). APACHE II was 11.5 +/- 5.4 and 19.9 +/- 4.97 in survivors and non-survivors respectively (p = 0.005), while mean age and SOFA score at sepsis diagnosis, were similar between the two groups. GSH levels, catalase activity and protein carbonyls presented significant different course in time between survivors and non-survivors (p < 0.05). Catalase activity was significantly higher in survivors (238.8 +/- 51.5) than non-survivors (166.4 +/- 40.2; p = 0.005), while protein carbonyls levels were significantly lower in survivors (0.32 +/- 0.09) than non-survivors (0.48 +/- 0.16; p = 0.036) on the 1st day. Yet, non-survivors exhibited a declining course in GSH levels during time, while GSH levels were maintained in survivors. Conclusively, a longstanding antioxidant deficiency in non-surviving patients was noted. This phenomenon was clearly prominent in patients' erythrocytes. (C) 2013 Elsevier Ltd. All rights reserved