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

Photocatalytic H2 production from glycerol aqueous solutions over fluorinated Pt-TiO2 with high 001 facet exposure

An optimized fluorinated TiO2 catalyst with high 001 facet exposure loaded with platinum (TiO2-PtFAC) was tested in the photocatalytic hydrogen production from glycerol solution under UV light irradiation. The samples were synthesized by direct hydrothermal treatment starting from two different types of precursors that are titanium tetraisopropoxide (I) or titanium butoxide (B), while platinisation was performed by photodeposition method. The obtained catalysts were characterised by different techniques (XRD, FESEM, TEM, BET, UV–vis DRS, XRF and XPS) and the results evidenced that anatase is the only crystalline phase present in all TiO2 samples. The morphology of the samples was seen as rectangular platelets particles where Pt particles were was observed all over the surface. The presence of Pt and F in the platinised samples was also confirmed by XRF and XPS analysis. The photocatalytic results have shown that the presence of Pt on TiO2001facet surface remarkably enhanced the hydrogen production from aqueous solution at 5 wt % of glycerol. Comparing the results obtained from the photocatalysts prepared by the two different precursors, it was found that the best performances in terms of H2 production was achieved with TiO2-PtFAC(I) (about 13 mmol L−1 after 4 h of irradiation time), while the H2 production was lower for TiO2-PtFAC(B) (about 9 mmol L−1 after 4 h of irradiation time). The effect of the operating conditions using TiO2-PtFAC(I) evidenced that the highest H2 production was obtained with a photocatalyst dosage equal to 1.5 g L−1, initial glycerol concentration at 5 wt% and a pH value equal to 7. Finally, a photocatalytic test was also performed on glycerol solution prepared with a real water matrix. Despite the presence of ions scavengers (chlorides and carbonates) in solution, TiO2-PtFAC(I) was able to reach a photocatalytic H2 production of about 6 mmol L−1 after 4 h of UV light irradiation

Enhanced photocatalytic removal of phenol from aqueous solutions using ZnO modified with Ag

Different photocatalysts based on commercial ZnO modified by silver photodeposition were prepared in this work. The samples were characterized by X-ray fluorescence spectrometry (XRF), specific surface area (SSA), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD) and UVâ\u80\u93vis diffuse reflectance (UVâ\u80\u93vis DRS). XRD and XPS showed that Ag/ZnO samples are composed of metallic Ag (Ag0) and ZnO structure was identified. Furthermore, TEM analysis evidenced that the number of silver particles increased with the Ag content. At last, UVâ\u80\u93vis DRS results revealed a reflectance band for Ag/ZnO samples, ascribed to the surface plasmon resonance (SPR) absorption of metal silver particles. Commercial ZnO and Ag/ZnO samples were evaluated in the phenol removal under UV light irradiation. It was observed an enhancement of photocatalytic phenol removal from aqueous solutions by silver addition in comparison to commercial ZnO. In particular, the phenol removal increased with the silver content from 0.14 to 0.88 wt%, after this content (i.e 1.28 wt%) the phenol degradation significantly decreased indicating that the optimal Ag content was equal to 0.88 wt%. The influence of the best photocatalyst dosage and the change of the initial phenol concentration in solution were also investigated in this work and the best photocatalytic performance was obtained by using 50 mg Lâ\u88\u921of phenol initial concentration and 0.15 g Lâ\u88\u921of photocatalyst dosage. Finally, the optimized Ag/ZnO photocatalyst was employed for the treatment of a real drinking wastewater containing phenol in which the almost total phenol removal was achieved after 180 min of UV irradiation time

Safety profile of immune checkpoint inhibitors: An analysis of the Italian spontaneous reporting system database

Aims: To provide an overview of immune checkpoint inhibitors (ICIs) safety profile using the Italian spontaneous adverse drug reaction (ADR) reporting system. Methods: We selected all ADR reports attributed to ipilimumab (CTLA-4 inhibitor), nivolumab, pembrolizumab, atezolizumab (PD-1/PD-L1 inhibitors) from the Italian spontaneous reporting system (2011\u20132018). Descriptive analyses of reports for ICIs have been conducted. Time to onset of adverse effects was stratified by system organ class. Reporting odds ratio was used as measure of ADR reporting disproportionality. ICI-related ADR reports were compared with 2 reference groups, i.e. all other suspected drugs or all other antineoplastic agents. Results: Overall, 2217 (0.7%) reports were related to ICIs (nivolumab: 72.2% of those reports; ipilimumab: 14.3%; pembrolizumab: 10.3%; and atezolizumab: 3.5%). ICI-related ADR reports mostly involved males (65%) and median age was 67 (interquartile range 59\u201373) years. Serious reports accounted for 48.8%. Frequencies of endocrine, general, hepatobiliary, metabolism, musculoskeletal, respiratory disorders, infections and neoplasms were significantly higher for ICIs than for all other drugs (P <.001). Except for infections, similar results emerged through comparison with other anticancer drugs. Colitis, hypophysitis and skin disorders were more frequently reported for anti-CTLA-4 drugs than PD-1/PD-L1 ICIs, and the opposite for musculoskeletal effects, pneumonia, and thyroid dysfunctions. ICIs were disproportionally associated also with less known risks, e.g. ischaemic heart disease, cardiac failure and optic nerve disorders. Conclusion: The most frequently reported safety issues were probably immune-related adverse events including general, gastrointestinal and respiratory disorders. Potentially emerging safety signals, such as ischaemic heart disease and cardiac failure, requiring further investigation were detected

Augmented reality (AR) in minimally invasive surgery (MIS) training: where are we now in Italy? The Italian Society of Endoscopic Surgery (SICE) ARMIS survey

Minimally invasive surgery (MIS) is a widespread approach in general surgery. Computer guiding software, such as the augmented reality (AR), the virtual reality (VR) and mixed reality (MR), has been proposed to help surgeons during MIS. This study aims to report these technologies' current knowledge and diffusion during surgical training in Italy. A web-based survey was developed under the aegis of the Italian Society of Endoscopic Surgery (SICE). Two hundred and seventeen medical doctors’ answers were analyzed. Participants were surgeons (138, 63.6%) and residents in surgery (79, 36.4%). The mean knowledge of the role of the VR, AR and MR in surgery was 4.9 ± 2.4 (range 1–10). Most of the participants (122, 56.2%) did not have experience with any proposed technologies. However, although the lack of experience in this field, the answers about the functioning of the technologies were correct in most cases. Most of the participants answered that VR, AR and MR should be used more frequently for the teaching and training and during the clinical activity (170, 80.3%) and that such technologies would make a significant contribution, especially in training (183, 84.3%) and didactic (156, 71.9%). Finally, the main limitations to the diffusion of these technologies were the insufficient knowledge (182, 83.9%) and costs (175, 80.6%). Based on the present study, in Italy, the knowledge and dissemination of these technologies are still limited. Further studies are required to establish the usefulness of AR, VR and MR in surgical training