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 opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Virulence Range and New Pathological Pictures of Salmonella enteridits and Salmonella typhimurium Isolated from Ducklings in Experimental Infected Chicks

Salmonellosis is a major global pathogen in the poultry industry and is a significant public health concern. Ducks are known to be carriers of Salmonella. Therefore, monitoring salmonellosis is the most important strategy for preventing the disease. An experimental design was planned to study the pathogenicity of two Salmonella strains. One hundred and fifty chicks were divided into three groups; group one was inoculated with the Salmonella enteritidis strain, group two was inoculated with the Salmonella typhimurium strain, and group three was UN inoculated. Symptoms, postmortem lesions and mortality rate were recorded. The chick growth performance parameters were also determined. Using ANOVA for statistical analysis, there was a significant difference in body weight, body gain, feed consumption, and feed conversion ratio between the two infected groups and the blank group (uninoculated group). In this study, the prevalence of Salmonella enteritidis was (1.73%) and Salmonella typhimurium (0.43%) in imported ducklings in Egypt. Both Salmonella strains were subjected to an antimicrobial sensitivity test. It showed that Salmonella enteritidis had a 60% antimicrobial resistance profile and Salmonella typhimurium had a 20% antimicrobial resistance profile. Furthermore, genotypic characterization was performed and the seven virulence genes(stn, avrA, sopB, ompF, invA, Mgtc, Ssaq) were found. New pathological lesions of Salmonella infection were discovered, such as skull hemorrhage at 3 days and 6 days of age, and a liver similar to a button shape in necropsied infected chicks with Salmonella typhimurium at 21 days of age. Furthermore, hemorrhagic spots were observed on the duodenum. In the presence of Salmonella, Clostridium perferingens was discovered in a bacteriological investigation of duodenal lesions samples from infected chicks. At 30 days of age, administration of acetic acid (1%) as an alternative tool for controlling Salmonella. In conclusion, salmonellosis is a risk factor for necrotic enteritis, and using acetic acid to eliminate salmonella infection is insufficient