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

Effect of the local friction and contact nature on the Built-Up Edge formation process in machining ductile metals

International audienceThe \BUE\ can affect the tool wear and surface integrity when machining ductile metals. The main goal of the present work is to investigate the close link between the \BUE\ formation and the tribological behaviour at the tool–workmaterial interface when machining ductile metals. Machining AA2024-T351 aluminium alloy with cemented carbide tool WC–Co is considered as a case study. A new method based on the contact conditions variation (i.e. introduction of a time-dependent friction coefficient) at the tool–workmaterial interface is proposed to predict the \BUE\ formation in the frame of a finite element (FE) modelling. A 2D ALE-FE model of orthogonal cutting has been developed for this purpose. Two cases have been considered, which correspond respectively to an abrupt change and a gradual evolution of the friction at the tool–workmaterial interface. Results are discussed based on the effects of the friction change on predicted thermomechanical fields at the cutting zone

Dry Machining Aeronautical Aluminum Alloy AA2024-T351: Analysis of Cutting Forces, Chip Segmentation and Built-Up Edge Formation

In this paper, machining aeronautical aluminum alloy AA2024-T351 in dry conditions was investigated. Cutting forces, chip segmentation, and built-up edge formation were analyzed. Machining tests revealed that the chip formation process depends on cutting conditions and tool geometry. So continuous and segmented chips are generated. Under some cutting conditions, built-up edge formation occurs. A predictive machining theory, based on a finite elements method (FEM), was applied to reproduce and explain these phenomena. Thermomechanical behaviors of the work material and the tool-work material interface were considered. Results of the proposed modelling were compared to experimental data for a wide range of cutting speed. It was shown that the feed force is well reproduced by the ALE-FE (arbitrary lagrangian-eulerian finite element) formulation and highly underestimated by the lagrangian finite element (LAG-FE) one. While, the periodic localized shear band, leading to a chip segmentation, is well reproduced with the Lagrangian FE formulation. It was found that the chip segmentation can be correlated to the cutting force evolution using the defined chip segmentation intensity parameter. For the built-up edge (BUE) phenomenon, it was shown that it depends on the contact/friction at the tool-chip interface, and this is possible to simulate by making the friction coefficient time-dependent

Intención de recibir la vacuna contra la COVID-19 y sus factores predictivos asociados : estudio transversal entre el público general en Argelia

Background: Hesitancy towards COVID-19 vaccination and its rejection remains a major public health concern worldwide, especially in the Middle East and North African countries. The current study aimed to assess the intentions to get COVID-19 vaccines and its determinants among the general public in Algeria. Methods: A self-administered online survey was distributed during August-September 2021 using a convenience-based sampling approach. Data were collected anonymously and analyzed using IBM SPSS v22.0 software. Results: The study sample comprised a total of 656 participants, with 51.1% being in favor of COVID-19 vaccines while 18.5% and 30.5% were against or hesitant respectively. Only 38.6% among the study participants got vaccinated. Factors associated with higher odds of acceptance were: male sex, healthcare profession, the belief in natural origin of the pandemic and previous COVID-19 infection in family. The most common cited reasons for COVID-19 vaccine acceptance were the belief that vaccination is the only way to fight COVID-19 and the fear of getting infected by the virus; while the most common reasons of rejection were lack of trust in proper vaccine testing and fear of side effects. Conclusion: The overall level of COVID-19 vaccine acceptance in this study was below the levels required to achieve population immunity. Besides certain socio-demographic characteristics, the determinants of COVID-19 vaccine rejection included the embrace of conspiratorial ideas regarding the virus and its vaccination. This should be considered in implementation of interventional measures aiming to promote COVID-19 vaccination in the country

Middle Eocene vertebrates from the sabkha of Gueran, Atlantic coastal basin, Saharan Morocco, and their peri-African correlations

International audienc