ABSTRACT
Introduction: The COVID-19 pandemic has increased resident anxiety regarding surgical performance. The number of surgical cases they perform has been reduced, increasing the importance of each procedure. This is compounded by the numerous stressors residents face in their daily lives. High stress can make it difficult to focus in the operating room, impacting learning and surgical performance. Mindfulness-based stress reduction (MBSR) can decrease anxiety and improve learning, executive function, and well-being. Incorporation of MBSR courses into residency curriculum faces barriers, most significantly time pressures and program buy-in. Objective: This project aimed to develop and assess a feasible and meaningful modified MBSR curriculum for surgical residents. Methods: Obstetrics and gynecology (OBGYN) residents in years two to five were invited to participate in a 12-week modified MBSR curriculum tailored to busy surgical trainees. Modifications included a reduction in the required course hours and additional sessions focused on mindfulness in surgery. A mixed methods embedded design was employed to assess the feasibility and desirability of the curriculum. Secondary outcomes were measured in a pre- and postintervention design assessing surgical performance, anxiety, confidence, and burnout using previously validated survey tools. Qualitative components assessed how mindfulness techniques are used in the operating room. Results: Twelve out of sixty-one residents enrolled in the program (20%) and eight completed the course (67%). There was a statistically significant decrease in anxiety (p < 0.001) and increase in surgical confidence (p = 0.007) following the MBSR curriculum. There was no change in burnout or surgical evaluations. The major qualitative themes identified that mindfulness tools were regularly incorporated into the operating room and had a perceived beneficial impact by residents. This change was sustained 3 months post intervention. The biggest barrier to mindfulness was time. Participants felt the residency program should support ongoing MBSR training to promote a positive culture shift in the department. Conclusions: A modified MBSR program for surgical trainees is feasible and desirable for OBGYN residents and positively impacts anxiety and surgical confidence. Trainees noted a sustained benefit from the course. The major limitation of this study was the small sample size. Future work should focus on expanding this study to other surgical specialties and addressing the barriers to mindfulness raised by participants.
ABSTRACT
Background and aims: Liver injury is common in patients with coronavirus disease-2019 (COVID-19) infection. Recently, few studies have reported the development of autoimmune hepatitis (AIH) following COVID-19 vaccination. However, there is a lack of studies reporting the outcomes of AIH following ChAdOx1 (vector-based) and BBV152 (inactivated virus) from India. Herewe aimed to describe the clinical profile of patients who developed AIH following COVID-19 vaccination. The causal association is attributed based on the temporal relationship in patients with no prior liver diseases. Method: Patients presenting with deranged liver functions following COVID-19 vaccination to hepatology clinic were included. Virus infections were ruled out in all patients either by serology or viral quantification methods. We aimed to assess the demographics, clinical profile, and outcome of patients with vaccine-induced AIH (V-AIH) in the absence of known liver disease. Results: A total of 31 patients presented with altered liver chemistries following vaccination. Seventeen patients were diagnosed with VAIH (age-39.8 ± 11.4 years;males-70.4%). None of the patient had history of alcohol overconsumption. Seventy six percent of patients had received ChAdOx1 and 23.53% had received BBV152 vaccine (Table). Seventy six percent of patients following first dose of vaccine and 23.5% following second dose of vaccinewere diagnosed as V-AIH. Mean duration for development of symptoms after first dosewas 25.7 days. Common symptom at presentation was jaundice in 82.3% of patients. Antinuclear antibodywas positive in 71% of patients and 17% patients were negative for all serological markers of autoimmune hepatitis but had elevated IgG levels. Fifty-nine percent of patients required immunosuppression of which 41% percet of patients received oral steroids, 17% patients received intravenous steroids for 3 days followed by oral steroid, 12% patients received azathioprine. One patient succumbed to pneumonia with multiorgan failure by day 30. At 3 months, it was observed that only 17% patients needed prolonged immunosuppression and had deranged liver functions until last follow-up. Mean duration of recovery amongst rest of 76.4% patients was 5.15 ± 3.1 weeks.