Does a self-referral counselling program reach doctors in need of help? A comparison with the general Norwegian doctor workforce

BACKGROUND: Doctors have a relatively high degree of emotional distress, but seek help to a lesser degree and at a later stage than other academic groups. This can be deleterious for themselves and for their patients. Prevention programs have therefore been developed but it is unclear to what extent they reach doctors in need of help. This study describes doctors who participated in a self-referrral, easily accessible, stress relieving, counselling program in Norway, and compares them with a nationwide sample of Norwegian doctors. METHODS: Two hundred and twenty seven (94%) of the doctors, 117 women and 110 men, who came to the resort centre Villa Sana, Modum, Norway, between August 2003 and July 2005, agreed to participate in the study. Socio-demographic data, reasons for and ways of help-seeking, sick-leave, symptoms of depression and anxiety, job stress and burnout were assessed by self-reporting questionnaires. RESULTS: Forty-nine percent of the Sana doctors were emotionally exhausted (Maslach) compared with 25% of all Norwegian doctors. However, they did not differ on empathy and working capacity, the other two dimensions in Maslach's burnout inventory. Seventy-three percent of the Sana doctors could be in need of treatment for depression or anxiety based on their symptom distress scores, compared with 14% of men and 18% of women doctors in Norway. Twenty-one percent of the Sana doctors had a history of suicidal thoughts, including how to commit the act, as compared to 10% of Norwegian doctors in general. CONCLUSION: Sana doctors displayed a higher degree of emotional exhaustion, symptoms of depression and anxiety as well as job related stress, compared with all Norwegian doctors. This may indicate that the program at Villa Sana to a large extent reaches doctors in need of help. The counselling intervention can help doctors to evaluate their professional and private situation, and, when necessary, enhance motivation for seeking adequate treatment

Hypnosis Antenatal Training for Childbirth (HATCh): a randomised controlled trial [NCT00282204]

BACKGROUND: Although medical interventions play an important role in preserving lives and maternal comfort they have become increasingly routine in normal childbirth. This may increase the risk of associated complications and a less satisfactory birth experience. Antenatal hypnosis is associated with a reduced need for pharmacological interventions during childbirth. This trial seeks to determine the efficacy or otherwise of antenatal group hypnosis preparation for childbirth in late pregnancy. METHODS/DESIGN: A single centre, randomised controlled trial using a 3 arm parallel group design in the largest tertiary maternity unit in South Australia. Group 1 participants receive antenatal hypnosis training in preparation for childbirth administered by a qualified hypnotherapist with the use of an audio compact disc on hypnosis for re-enforcement; Group 2 consists of antenatal hypnosis training in preparation for childbirth using an audio compact disc on hypnosis administered by a nurse with no training in hypnotherapy; Group 3 participants continue with their usual preparation for childbirth with no additional intervention. Women > 34 and < 39 weeks gestation, planning a vaginal birth, not in active labour, with a singleton, viable fetus of vertex presentation, are eligible to participate. Allocation concealment is achieved using telephone randomisation. Participants assigned to hypnosis groups commence hypnosis training as near as possible to 37 weeks gestation. Treatment allocations are concealed from treating obstetricians, anaesthetists, midwives and those personnel collecting and analysing data. Our sample size of 135 women/group gives the study 80% power to detect a clinically relevant fall of 20% in the number of women requiring pharmacological analgesia – the primary endpoint. We estimate that approximately 5–10% of women will deliver prior to receiving their allocated intervention. We plan to recruit 150 women/group and perform sequential interim analyses when 150 and 300 participants have been recruited. All participant data will be analysed, by a researcher blinded to treatment allocation, according to the "Intention to treat" principle with comprehensive pre-planned cost- benefit and subgroup analyses. DISCUSSION: If effective, hypnosis would be a simple, inexpensive way to improve the childbirth experience, reduce complications associated with pharmacological interventions, yield cost savings in maternity care, and this trial will provide evidence to guide clinical practice

The use of bidirectional barbed suture during robotic assisted radical prostatectomy : impact on the perioperative and functional outcomes

Bidirectional barbed self-retaining sutures represent a new advancement in the application of suture materials used in reconstructive urology. This analysis represents our preliminary effort to examine the intraoperative, postoperative and intermediate functional outcome of bidirectional sutures during robot assisted radical prostatectomy (RARP). Materiali e metodi Between January 2008 and December 2010, 2168 RARP procedures were performed at our institution by a single surgeon (VP). In this cohort there were 97 patients in whom a bidirectional-barbed suture (AngiotechQuill\u2122) was used for bladder neck reconstruction, posterior reconstruction and urethrovesical anastomosis (Group 1). These 97 patients were then computer-matched using multivariable analysis to those who did not undergo bidirectional-barbed suture during the procedure (Group 2). Retrospective analysis of the perioperative and functional outcomes was conducted. Risultati There were no differences between the preoperative clinical and demographic variables between the two matched groups. The anastomosis subjectively evaluated by the surgeon was easier in the group 1 ( Discussione barbed suture have been recently introduced with the aim of make it easier for the surgeons to perform sutures, particularly anastomosis. Also in the hands of an experienced and skilled operator, barbed suture make sutures faster. Conclusioni Usage of bidirectional barbed suture during RARP results in easier and quicker urethrovesical anastomosis and in a lower incidence of radiologic urinary leakage. These preliminary results are encouraging and provide the impetus to conduct further studies with an increased sample size to more clearly define the outcomes in the use of Quill bidirectional barbed suture

NUANCES IN NERVE SPARING DURING RARP

INTRODUCTION & OBJECTIVES: We have previously published our work identifying anatomical landmarks for grading of nerve sparing. We now demonstrate further nuances in nerve preservation during RARP. MATERIAL & METHODS: The present study is a combination of a single surgeon experience after 5000 patients and a compilation of videos detailing some possible scenarios that surgeons might face when performing nerve sparing. RESULTS: Case 1: 55 year old man with PSA of 5, SHIM score 25, DRE reveals T1c with and low volume disease. Complete bilateral nerve sparing is performed. Case 2: 60 year old man with SHIM score of 25, PSA of 7.2, and normal DRE. During the dissection of NVB, the surgeon initially misses the correct plane then correcting it to proceed more medially and preserve the capsular artery, thereby achieving a full nerve spare. Case 3: is a 47 year old man with a SHIM score of 25, and an intermediate risk grade cancer having a partial nerve sparing. In Case four, we show you the technique to protect the base during robot-assisted radical prostatectomy. All patients had negative surgical margins. CONCLUSIONS: Case 1: 55 year old man with PSA of 5, SHIM score 25, DRE reveals T1c with and low volume disease. Complete bilateral nerve sparing is performed. Case 2: 60 year old man with SHIM score of 25, PSA of 7.2, and normal DRE. During the dissection of NVB, the surgeon initially misses the correct plane then correcting it to proceed more medially and preserve the capsular artery, thereby achieving a full nerve spare. Case 3: is a 47 year old man with a SHIM score of 25, and an intermediate risk grade cancer having a partial nerve sparing. In Case four, we show you the technique to protect the base during robot-assisted radical prostatectomy. All patients had negative surgical margins