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

Sleep quality assessment using polysomnography in children on regular hemodialysis

Studies examining sleep patterns in children on hemodialysis (HD) are lacking. This cross-sectional, control-matched group study was performed to assess the sleep quality in children on HD. The assessment was made using a subjective sleep assessment and sleep questionnaire and objective analysis was made using full night polysomnography. A total of 25 children with end-stage renal disease (ESRD) on HD were compared with 15 age- and sex-matched controls. The average age of the cases was 14 ± 4 years, 52% were males and the mean body mass index was 20 ± 3.8 kg/m². The average duration on dialysis was 2.6 ± 2 years. Analysis of subjective data revealed markedly affected sleep quality in HD patients, as evidenced by excessive day time sleepiness (P <0.005), night awakening (P <0.005), difficult morning arousal (P <0.005) and limb pains (P <0.005). Objective analysis showed differences in sleep architecture, less slow wave sleep in HD children, similar rapid eye movement and non-rapid eye movement, more sleep disordered breathing (P <0.0001) and more periodic limb movement disorders (P <0.0001). Our study suggests that children on regular HD have markedly affected objective as well as subjective quality of sleep

EFFECT OF BIO-FERTILIZERS AND GAMMA RADIATION ON THE ESSENTIAL OIL OF DILL AT THE VEGETATIVE, FLOWERING, FRUITING STAGES AND THEIR ANTIMICROBIAL ACTIVITIES

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EFFECT OF BIO-FERTILIZERS AND GAMMA RADIATION ON THE ESSENTIAL OIL OF DILL AT THE VEGETATIVE, FLOWERING, FRUITING STAGES AND THEIR ANTIMICROBIAL ACTIVITIES

This study was carried out to investigate the response of dill plants to gamma radiation and bio-fertilizers on the essential oils and their constituents during vegetative, flowering and fruiting stages. The results showed that the most effective treatment on the volatile oil content in the three stages was 2 k-rad + bio-fertilizers. The major compounds were found to be α-phellandrene, limonene, β-phellandrene and p-cymene (vegetative stage). In the flowering stage, p-cymene, carvone, dillether and dillapiole. Whereas, carvone, dillapiole and limonene were major compounds (fruiting stage). The results showed those dill volatile oils at different developing stages exhibited strong and a variable degree of antimicrobial activity

Egyptian recommendations for the management of systemic lupus erythematosus: a consensus, evidence-based, clinical practice guidelines for treat-to-target management

Abstract Background Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease characterized by having varying clinical presentation, severity, unpredictable course as well as outcomes. Recent disease-modifying conventional and biologic agents have enhanced rates of attaining both short- and long-term management goals, including minimization of glucocorticoid dose and use. This study was carried out to develop an up-to-date evidence-based, consensus on clinical practice guidelines for treat-to-target management of systemic lupus erythematosus in adults. Results The response rate to the online questionnaires, sent to the expert panel who participated in the three rounds, was 95.5%. At the end of round 3, a total of 14 recommendation sections were proposed for the T2T management of patients with SLE. Agreement with the recommendations (rank 7–9) ranged from 90.9–100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the proposed statements. Conclusion These recommendations provide a consensus on the treat-to-target management of patients with SLE. They provide strategies to reach optimal outcomes in common clinical scenarios, based on a combination of evidence and expert opinion