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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Find the special characteristics of the Millat of Muslims

In this article, the investigator draws the attention to the importance of studying the characteristics of the "Millat" among Moslems. Since Islam regulates all spheres of life for moslems, and moulds all moslems, of different colors, nationalities, and localities in one unified form, and if western scholars have been quite active in the study of national character and stereotypes, it is highly essential that moslem research workers in the behavioral sciences should investigate the characteristics peculiar to moslems everywhere. The writer, then, proceeds to lay the basic methodological outline necessary for the undertaking of such a note¬worthy academic endeavour

Development of 3D erosion-corrosion maps using CFD techniques

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Reproductive Performance And Economic Efficiency Of Finn And Rahmani Ewes And Their Crosses

ABSTRACT: One hundred and fifty Finn (F) and Rahmani (R) ewes and their crosses including 10 F, 60 R, 50 1/4F 3/4R, 20 1/2F 1/2R and 10 3/4F 1/4R were allotted to fed traditional forage diet (D1) contained concentrate mixture + wheat straw plus fresh berseem, (winter diet) or plus berseem hay and green sorghum (summer diet) or agricultural by-product diet (D2) contained concentrate mixture plus fresh berseem, fresh sugar beet tops or green reed plants (winter diet) or plus dried sugar beet tops or green or dried reed plants (summer diet). Results showed that 81% of ewes were mating during the period from April to August reaching the maximum in July. However, 83% of ewes were lambing from October to April reaching maximum in December. The fertility expressed as ewe lambing per ewe exposed (EL/EE) was higher in crossbred that pure Finn and Rahmani ewes and increased with increasing Rahmani blood. The number of lamb born and weaned per ewe exposed (LB/EE and LW/EE) was higher in the first ewes crossbred of 1/2F 1/2R than the pure breeds and other crosses. Pure Finn recorded the highest number of lamb born and weaned per ewe lambing (LB/EL and LW/EL), lambing ewe per year (EL/Y) and lamb born and weaned per lambing ewe per year (LB/EL/Y and LW/EL/Y), but Rahmani had the lowest values and increased in crossbred ewes with increasing Finn blood. Pure Rahmani breed showed the lowes

Epidemiology of Neonatal Sepsis and Implicated Pathogens: A Study from Egypt

Prospective analytic study was conducted in NICUs of three Egyptian Neonatal Network (EGNN) participants in Mansoura Hospitals in Egypt over a period of 18 months from March 2011 to August 2012. By using EGNN 28-day discharge form, all demographic, clinical, and laboratory data were recorded and studied. During the study period, 357 neonates were diagnosed as suspected sepsis with an incidence of 45.9% (357/778) among the admitted neonates at the three neonatal intensive care units. 344 neonates (sex ratio = 1.3:1) were enrolled in the study in which 152 (44.2%) were classified as early onset sepsis EOS (≤72 hr) and 192 (55.8%) as late onset sepsis LOS (>72 hr). Among the LOS cases, 33.9% (65/192) were caused by nosocomial infections. In 40.7% (140/344), sepsis was confirmed by positive blood culture. The total mortality rate for the proven neonatal sepsis was 51% (25/49) and 42.9% (39/91) for EOS and LOS, respectively. Coagulase negative staphylococci were predominant isolates in both EOS and LOS, followed by Klebsiella pneumoniae. Most of the bacterial isolates had low sensitivity to the commonly used empiric antibiotics. However, 70.1% (89/127) exhibited multidrug resistance. Best sensitivities among Gram-positive isolates were found against imipenem, ciprofloxacin, vancomycin, and amikacin

Some risk factors of chronic gastroenteritis among preschool children in a rural area in Basyun District, Gharbia governorate

Background: Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract the stomach and small intestine. Symptoms may include diarrhea, vomiting and abdominal pain. The aim of this work was to reduce morbidity and mortality from chronic gastroenteritis among preschool children. Methods: This case control study was carried out on 100 study children < five years having chronic gastroenteritis and 100 control children were healthy children chosen randomly from children attending nurseries and from the same family health care unit, they were matched by age and sex with cases. Results: Age of child, residence, fathers education and job and mothers age and education were not found to significantly affect occurrence of chronic diarrhea among studied children. Crowding index and family size had high odds ratio whereas the odds of exposure to a high crowding index (more than or equal to 2) among cases were double that among the control. Odds of exposure to a large family size (more than or equal to 5) among cases were double that among the control (p>0.05). Fathers age >40 years in cases was 25% which was higher than 13% of control (OR=2.231).&nbsp