Surgical treatment of pulmonary metastases. Review of the literature a propos of a case-series of 25 recent cases

Surgery is the optimal treatment for pulmonary metastases from certain extrathoracic tumors (soft tissue sar­comas, colorectal and renal cancer, breast cancer and others) which fulfill some strict criteria, such as control of the primary site, long disease free interval and absence of other extrathoracic metastases (with the exception of hepatic metastases from colorectal cancer that can be also eradicated with surgery). Prolonged survival is expected after metastasectomy (even if repeated metastasectomies are required), if the number of the metastases to be resected is low (<3), if complete eradication of the metastatic deposits can be achieved during surgery and if mediastinal lymph nodes are not involved by the tumor. Limited pulmonary resection with the form of wedge resection or enucleation or typical segmentectomy is the standard surgical in­tervention for pulmonary metastases. Major lung parenchyma resection such as lobectomy, bilobectomy or pneumonectomy at instances required in larger, deeply situated within the lung parenchyma, metastases. Formal thoracotomy is the access of choice, while thoracoscopic resection can be applied in selected patients with solitary, peripherally located metastases. Enucleation of the metastatic deposits can be performed using the cautery or preferably using the new generation Nd:YAG lasers. Sparing lung parenchyma is crucial during pulmonary metastasectomy

Identification of Surgeon Burnout via a Single-Item Measure

BackgroundBurnout 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.AimsTo 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.MethodsConsultant (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.ResultsThe 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.ConclusionsA 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

Burnout Among Surgeons in the UK During the COVID-19 Pandemic: A Cohort Study

BackgroundSurgeon burnout has implications for patient safety and workforce sustainability. The aim of this study was to establish the prevalence of burnout among surgeons in the UK during the COVID-19 pandemic.MethodsThis cross-sectional online survey was set in the UK National Health Service and involved 601 surgeons across the UK of all specialities and grades. Participants completed the Maslach Burnout Inventory and a bespoke questionnaire. Outcome measures included emotional exhaustion, depersonalisation and low personal accomplishment, as measured by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS).ResultsA total of 142 surgeons reported having contracted COVID-19. Burnout prevalence was particularly high in the emotional exhaustion (57%) and depersonalisation (50%) domains, while lower on the low personal accomplishment domain (15%). Burnout prevalence was unrelated to COVID-19 status; however, the greater the perceived impact of COVID-19 on work, the higher the prevalence of emotional exhaustion and depersonalisation. Degree of worry about contracting COVID-19 oneself and degree of worry about family and friends contacting COVID-19 was positively associated with prevalence on all three burnout domains. Across all three domains, burnout prevalence was exceptionally high in the Core Trainee 1–2 and Specialty Trainee 1–2 grades.ConclusionsThese findings highlight potential undesirable implications for patient safety arising from surgeon burnout. Moreover, there is a need for ongoing monitoring in addition to an enhanced focus on mental health self-care in surgeon training and the provision of accessible and confidential support for practising surgeons

Groupware Tools for Asynchronous Collaboration in Academic Sector

While academics have continued to rely largely on email, numerous groupware products are now in use in many commercial environments, for example, Lotus Notes, Microsoft Exchange, IBM&apos;s WorkGroup, Novel&apos;s GroupWise, Collabra Share, etc. These systems typically integrate a number of tools for communication, workflow, database-sharing, contact management, and group scheduling, and operate across a variety of environments. In this paper, we survey a range of popular groupware tools that appear to be potentially useful in the academic sector. 1. Introduction Groupware is now a sizeable market sector dedicated to technological support for workgroups, a break with traditional computing which has always focused on the user as an individual whose data must be protected and isolated from other users. Groupware is about informationsharing, contact management (group diaries, etc.), group document management, workflow, and group communication. Most current tools support different-place, different-..