Burnout and motivation to study medicine among students during the COVID-19 pandemic

AimTo investigate medical students’ burnout and motivation levels in each of the six years of their studies during the COVID-19 pandemic and identify independent predictors of burnout and motivation.MethodsAn anonymous cross-sectional survey was sent to the students of all six years within our school. Burnout was measured with the adapted Oldenburg Burnout Inventory questionnaire (OLBI-S) and motivation with the updated Strength of Motivation for Medical School (SMMS-R) questionnaire. Univariate analysis was performed with the Kruskal–Wallis test and Spearman’s correlation, while multivariable analysis with linear regression models.ResultsA total of 333 medical students (52% of student body) responded. Higher burnout levels correlated with lower motivation to study medicine (rho = −0.30, p < 0.001). Burnout levels differed between the six years of medical studies, peaking in years two and four whereas being the lowest in year one (p = 0.01). Motivation levels differed significantly as well, peaking in years one and four whereas being the lowest in years five and six (p = 0.012). In the multivariable linear regression models, being a female (b = 2.22, p = 0.016), studying in the fourth year vs. first year (b = 2.54, p = 0.049), having a perceived beginner/intermediate vs. advanced/expert technology level (b = 2.05, p = 0.032) and a perceived poor school support system (b = 6.35, p < 0.001) were independently associated with higher burnout levels. Furthermore, studying in the fifth year vs. first year (b = −5.17, p = 0.019) and a perceived poor school support system (b = −3.09, p = 0.01) were independently associated with a reduced motivation to study medicine.ConclusionOur study highlighted potential areas for intervention to decrease the rate of burnout and low motivation among medical students. However, further research is needed to unravel the full effect of the pandemic on medical students

Adrenal Aging and Its Implications on Stress Responsiveness in Humans

Normal aging results in subtle changes both in ACTH and cortisol secretion. Most notable is the general increase in mean daily serum cortisol levels in the elderly, without a noteworthy alteration in the normal circadian rhythm pattern. Glucocorticoid excess seen in the elderly population can have serious consequences in both the structural and functional integrity of various key areas in the brain, including the hippocampus, amygdala, prefrontal cortex, with consequent impairment in normal memory, cognitive function, and sleep cycles. The chronically elevated glucocorticoid levels also impinge on the normal stress response in the elderly, leading to an impaired ability to recover from stressful stimuli. In addition to the effects on the brain, glucocorticoid excess is associated with other age-related changes, including loss of muscle mass, hypertension, osteopenia, visceral obesity, and diabetes, among others. In contrast to the increase in glucocorticoid levels, other adrenocortical hormones, particularly serum aldosterone and DHEA (the precursor to androgens and estrogens) show significant decreases in the elderly. The underlying mechanisms for their decrease remain unclear. While the adrenomedullary hormone, norephinephrine, shows an increase in plasma levels, associated with a decrease in clearance, no notable changes observed in plasma epinephrine levels in the elderly. The multiplicity and complexity of the adrenal hormone changes observed throughout the normal aging process, suggests that age-related alterations in cellular growth, differentiation, and senescence specific to the adrenal gland must also be considered

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

The effect of anti-adhesion barriers on experimental intestinal anastomoses: research of the effect that the anti-adhesion barriers icodextrin and hyaluronic acid have on postoperative adhesions and on the healing of small bowel anastomoses

Background: Postoperative adhesions are dynamic regenerating structures associated with peritoneal healing after injury. As they are the leading cause of postoperative bowel obstruction, resorbable anti-adherence barriers are used for their prevention. This study looks into the effect of these biomaterials on the healing of intestinal anastomoses.Material and Methods: Thirty-three New Zealand White rabbits underwent laparotomy, transection of the terminal ileum and creation of an end to end anastomosis. They were randomized in three groups: a control group (n=11); the Icodextrin group (n=11) receiving icodextrin 4% intraperitonealy; the HA/CMC group (n=11) having the anastomosis wrapped with a Hyaluronic Acid/Carboxylmethylcellulose film. All animals were sacrificed on the 7th postoperative day. Macroscopic adhesions were graded on a five-point scale. The strength of the anastomosis was tested by means of the burst pressure and the burst wall tension (BWT). The process of histological anastomosis healing was expressed in a semiquantitative way for the presence of ulceration, reepithelisation, granulation tissue, inflammation, eosinophilic infiltration, serosal inflammation and microscopic adhesions. Results are given as medians with interquartile range.Results: The median adhesion scores were: control 1 (0-3), Icodextrin 0 (0-1), HA/CMC 0 (0-0) [p=0.017 between groups]. The BP did not differ between the groups, however, all except one bowel segments tested burst away from the anastomosis. The median BWT was: control 113 Kdyn/cm (89-123 Kdyn/cm), Icodextrin 70 Kdyn/cm (64-98 Kdyn/cm) and HA/CMC 82 Kdyn/cm (58-96 Kdyn/cm) [p=0.028 between groups]. The macroscopic healing and the histological anastomotic healing score were comparable in all three groups. The multivariate analysis showed that the histological anastomotic healing score affected significantly the adhesion grade (OR=1.92 [95% CI: 1.06-3.47], p=0.032). Also the use of HA/CMC significantly reduced the adhesion grade (OR=0.04 [95% CI: 0.01-0.52], p=0.014).Conclusion: Adhesion formation was inhibited by the materials tested without detrimental effects on the anastomotic healing. Poor anastomotic healing provokes adhesions even in the presence of resorbable anti-adhesion barriers. The adhesion severity is influenced by the anastomotic healing.Στόχος: Οι μετεγχειρητικές συμφύσεις αποτελούν δυναμικές δομές ιστικής ανάπλασης του περιτοναίου μετά από τραυματισμό. Παράλληλα, όμως, είναι το κύριο αίτιο μετεγχειρητικού αποφρακτικού ειλεού με αποτέλεσμα την ανάγκη χρησιμοποίησης αντισυμφυτικών υλικών για την πρόληψή τους. Η παρούσα μελέτη διερευνά τις συνέπειες της παρεμπόδισης δημιουργίας συμφύσεων, στην επούλωση εντερικών αναστομώσεων.Υλικό και μέθοδος: Τριάντα-τρείς κόνικλοι της φυλής New Zealand White Rabbits υποβλήθηκαν σε λαπαροτομία, διατομή του τελικού ειλεού και διενέργεια τελικο-τελικής αναστόμωσης τελικού ειλεού. Στη συνέχεια τυχαιοποιήθηκαν σε τρεις ομάδες: την ομάδα ελέγχου (n=11), την ομάδα Icodextrin (n=11) όπου τοποθετήθηκε icodextrin 4% ενδοπεριτοναϊκά, και την ομάδα HA/CMC (n=11) όπου η αναστόμωση καλύφθηκε πλήρως με μεμβράνη υαλουρονικού οξέος / καρβοξυμεθυλοκυταρρίνης. Όλα τα πειραματόζωα θυσιάστηκαν την 7η μετεγχειρητική ημέρα. Η παρουσία μετεγχειρητικών συμφύσεων βαθμολογήθηκε σε κλίμακα 5 μονάδων. Η μηχανική ισχύς της αναστόμωσης δοκιμάστηκε με τη μέτρηση της πίεσης διάσπασης (BP) και την τοιχωματική τάση διάσπασης (BWT) του τοιχώματος. Η επούλωση αξιολογήθηκε και βαθμονομήθηκε σε ιστολογικό επίπεδο με ημιποσοτική κλίμακα για την παρουσία έλκους, επανεπιθηλιοποίησης, κοκκιωματώδους ιστού, φλεγμονής, ηωσινοφιλικής αντίδρασης, ορογονίτιδας και μικροσκοπικών συμφύσεων. Τα αποτελέσματα εκφράζονται ως διάμεσοι με το ενδοτεταρτημοριακό τους εύρος.Αποτελέσματα: Ο διάμεσος βαθμός συμφύσεων ήταν: ομάδα ελέγχου 1 (0-3), Icodextrin 0 (0-1), HA/CMC 0 (0-0) [p=0.017]. Η διάμεση BWT ήταν: ομάδα ελέγχου 113 Kdyn/cm (89-123 Kdyn/cm), Icodextrin 70 Kdyn/cm (64-98 Kdyn/cm) και HA/CMC 82 Kdyn/cm (58-96 Kdyn/cm) [p=0.028]. Η διάμεση BP δεν διέφερε στις τρεις ομάδες. Όμως, όλες εκτός από μια από τις αναστομώσεις που δοκιμάστηκαν, διασπάστηκαν σε απόσταση από τη γραμμή της αναστόμωσης. Η μακροσκοπικής και ιστολογική επούλωση των αναστομώσεων ήταν συγκρίσιμη στις τρεις ομάδες. Στην πολυπαραγοντική ανάλυση ο βαθμός ιστολογικής επούλωσης της αναστόμωσης επηρέαζε το βαθμό συμφύσεων (OR=1.92 [95% CI: 1.06-3.47], p=0.032) και η χρήση HA/CMC μείωνε το βαθμό συμφύσεων (OR=0,04 [95% CI: 0,01-0,52], p=0,014).Συμπέρασμα: Τα βιοϋλικά που δοκιμάστηκαν παρεμποδίζουν τη δημιουργία συμφύσεων χωρίς να έχουν αρνητική επίδραση στην επούλωση των αναστομώσεων. Ελλιπής αναστομωτική επούλωση δημιουργεί συμφύσεις ακόμα και αν χρησιμοποιηθούν αντισυμφυτικά υλικά

A Standardized Workshop for Peer-Teaching Simple Interrupted Sutures to Medical Students: Analysis of the Student Factors That Affect Outcomes

Background: The aim of this study is to demonstrate whether the implementation of standardized Peer Assisted Learning (PAL) suturing workshops can aid the attainment of a technically competent interrupted suturing technique by medical students. Materials and Methods: The European University Cyprus (EUC) Division of Surgery and the students of the EUC Surgery Club compiled a standardized 1 hour and 15 minutes suturing workshop. During a one-week period 14 peer-teacher school of medicine students trained 147 fellow students. At the end of each workshop the students were assessed for the learning outcome of simple interrupted suturing with instruments by two peer-teachers, with the use of a standardized scoring rubric. The workshop primary outcomes were the rubric score and the time to complete a suture. These were correlated to student characteristics such as sex, year of studies, prior experience in suturing, previous participation in a similar workshop, previous training at home or in a hospital, and an interest in pursuing a surgical career. Univariate and multivariate statistical analysis was performed. Results: Statistical analysis showed that gender and previous suturing experience did not impact the rubric score of students, nor the time required. The student year of studies, having recently passed the course of General Surgery and having interest to pursue a surgical specialization positively affected the students’ score. Conclusions: Surgical peer teaching provided an effective method of teaching of the simple interrupted suturing technique. Interest in surgery, previous workshop experience and having recently completed the general surgery module helped students score higher in the assessment

A Standardized Workshop for Peer-Teaching Simple Interrupted Sutures to Medical Students: Analysis of the Student Factors That Affect Outcomes

Background: The aim of this study is to demonstrate whether the implementation of standardized Peer Assisted Learning (PAL) suturing workshops can aid the attainment of a technically competent interrupted suturing technique by medical students. Materials and Methods: The European University Cyprus (EUC) Division of Surgery and the students of the EUC Surgery Club compiled a standardized 1 hour and 15 minutes suturing workshop. During a one-week period 14 peer-teacher school of medicine students trained 147 fellow students. At the end of each workshop the students were assessed for the learning outcome of simple interrupted suturing with instruments by two peer-teachers, with the use of a standardized scoring rubric. The workshop primary outcomes were the rubric score and the time to complete a suture. These were correlated to student characteristics such as sex, year of studies, prior experience in suturing, previous participation in a similar workshop, previous training at home or in a hospital, and an interest in pursuing a surgical career. Univariate and multivariate statistical analysis was performed. Results: Statistical analysis showed that gender and previous suturing experience did not impact the rubric score of students, nor the time required. The student year of studies, having recently passed the course of General Surgery and having interest to pursue a surgical specialization positively affected the students' score. Conclusions: Surgical peer teaching provided an effective method of teaching of the simple interrupted suturing technique. Interest in surgery, previous workshop experience and having recently completed the general surgery module helped students score higher in the assessment

Outpatient Hysterectomy versus Inpatient Hysterectomy: A Systematic Review and Meta-analysis

Objective: The aim was to investigate whether outpatient hysterectomy (OH) has benefits when compared with inpatient hysterectomy (IH) regarding postoperative complications, readmissions, operative outcomes, cost, and patient quality of life. Data Sources: A systematic search for studies comparing OH with IH was conducted through PubMed, SAGE, and Scopus from January 2010 to March 2020, without limitations regarding language and study design. Methods of Study Selection: Studies reporting on the differences between same-day discharge and overnight stay after hysterectomy were included. The study outcomes were overall complication rate, type of complication, readmission after discharge, surgery duration, estimated blood loss, payer savings, hospital savings, and health-related quality of life (HrQoL). Median and range are used to describe non-normal data, while mean +/- SD and confidence interval are used to descibe data with normal distribution. A meta-analysis with sensitivity analysis and subgroup analyses was performed. Tabulation, Integration, and Results: Eight studies published between 2011 and 2019 with 104,466 patients who underwent hysterectomy were included in this systematic review and meta-analysis. All included studies except 1 were found to have a high risk of bias. OH in comparison with IH had a lower overall complication rate (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.60-0.82) and lower rates of wound infection (OR 0.60; 95% CI, 0.43-0.84), urinary tract infection (OR 0.64; 95% CI, 0.52-0.78), need for transfusion (OR 0.36; 95% CI, 0.22-0.59), sepsis (OR 0.33; 95% CI, 0.17-0.64), uncontrolled pain (OR 0.79; 95% CI, 0.66-0.95), and bleeding requiring medical attention (OR 0.82; 95% CI, 0.73-0.94). In addition, patients who underwent OH had a lower readmission rate (OR 0.81; 95% CI, 0.75-0.87), surgery duration (standardized mean difference -0.35; 95% CI, -0.61 to -0.08), and estimated blood loss (standardized mean difference -0.63; 95% CI, -0.93 to -0.33) than those who underwent IH. A qualitative analysis found that OH had a poorer patient HrQoL and a lower cost for the hospital as well as the payer. Conclusion: OHs present fewer complications and have a lower readmission rate and estimated blood loss as well as a shorter surgery duration than IHs. OHs also have a cost benefit in comparison with IHs. But patients seem to have a worse HrQoL in the first postoperative week after OH. The high risk of bias of the included studies indicates that well-designed clinical trials and standardization of surgical complication reporting are essential to better address this issue. (C) 2021 AAGL. All rights reserved