Surgical trainee burnout during the COVID-19 pandemic: a systematic review.

INTRODUCTION: The impact of the COVID-19 pandemic has been particularly significant for surgical trainees. The aim of this study was to systematically review the prevalence of burnout in surgical trainees during the pandemic, to compare rates of burnout between different specialties and to identify factors that may modify the risk of burnout. METHODS: A systematic review was undertaken following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to identify articles related to the keywords "surgeons burnout COVID-19" and "surgical trainees burnout COVID-19". A search was carried out on the PubMed/MEDLINE® and ScienceDirect® databases for articles published from January 2020 to August 2022. RESULTS: A total of 19 articles met the inclusion criteria, with 3,866 surgical trainees included across all the studies. The overall prevalence of burnout in surgical trainees across the globe during the pandemic was between 9.1% and 95.2%. Burnout rates were higher in general surgery (33.1-95.2%) than in urology (17.6-54.6%), neurosurgery (16.2-44.1%) and orthopaedic surgery (9.1-44.1%). Otolaryngology trainees had the lowest burnout rate (10.9%). Factors associated with an increased risk of burnout included being a female trainee, being a more junior trainee and increased working hours. CONCLUSIONS: There has been a high level of burnout among surgical trainees across the globe during the pandemic. In light of the devastating effect of COVID-19 on surgical training and the serious consequences of surgeon burnout (both for the individual and for the patients), targetted interventions for the prevention and treatment of burnout in surgical trainees are urgently needed, and must be prioritised by healthcare institutions and training programmes.

Non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prevention, are they safe in congenital heart disease? Results of a worldwide study.

BACKGROUND: Current guidelines consider vitamin K antagonists (VKA) the oral anticoagulant agents of choice in adults with atrial arrhythmias (AA) and moderate or complex forms of congenital heart disease, significant valvular lesions, or bioprosthetic valves, pending safety data on non-VKA oral anticoagulants (NOACs). Therefore, the international NOTE registry was initiated to assess safety, change in adherence and quality of life (QoL) associated with NOACs in adults with congenital heart disease (ACHD). METHODS: An international multicenter prospective study of NOACs in ACHD was established. Follow-up occurred at 6 months and yearly thereafter. Primary endpoints were thromboembolism and major bleeding. Secondary endpoints included minor bleeding, change in therapy adherence (≥80% medication refill rate, ≥6 out of 8 on Morisky-8 questionnaire) and QoL (SF-36 questionnaire). RESULTS: In total, 530 ACHD patients (mean age 47 SD 15 years; 55% male) with predominantly moderate or complex defects (85%), significant valvular lesions (46%) and/or bioprosthetic valves (11%) using NOACs (rivaroxaban 43%; apixaban 39%; dabigatran 12%; edoxaban 7%) were enrolled. The most common indication was AA (91%). Over a median follow-up of 1.0 [IQR 0.0-2.0] year, thromboembolic event rate was 1.0% [95%CI 0.4-2.0] (n = 6) per year, with 1.1% [95%CI 0.5-2.2] (n = 7) annualized rate of major bleeding and 6.3% [95%CI 4.5-8.5] (n = 37) annualized rate of minor bleeding. Adherence was sufficient during 2 years follow-up in 80-93% of patients. At 1-year follow-up, among the subset of previous VKA-users who completed the survey (n = 33), QoL improved in 6 out of 8 domains (p ≪ 0.05). CONCLUSIONS: Initial results from our worldwide prospective study suggest that NOACs are safe and may be effective for thromboembolic prevention in adults with heterogeneous forms of congenital heart disease.

Ethnomycological studies of edible and medicinal mushrooms in the Mount Cameroon region (Cameroon, Africa).

Inhabitants of the Mount Cameroon region depend on the forest resources of the region for their livelihood, including the diverse use of macrofungi. With the increasing loss of forest due to exploitation and urbanization, they are liable to rapidly lose their indigenous knowledge of the forest resources, especially of mushrooms. An ethnomycological survey was conducted with the aim of documenting the indigenous knowledge of mushrooms as a prelude to conservation efforts. We also sought to assess the mycophilic and mycophobic tendencies of the inhabitants. It was revealed that traditionally, mushrooms were used as food, medicine, for mythological purposes, for aesthetics, and some poisonous species were also recorded. At least 15 different species were identified to be edible among the Bakweri people. Species used for ethnomedicine among the Bakweris belonged to several genera, including Termitomyces, Auricularia, Agaricus, Daldinia, Dictyophora, Pleurotus, Russula, Trametes, Chlorophyllum, and Ganoderma. Mushrooms were used as love charms, for dispelling evil spirits, and as part of cultural festivals.

Surgical management of multiple bilateral fibroadenoma of the breast: the Ribeiro technique modified by Rezai.

BACKGROUND: Fibroadenomas are hyperplasia arising from the terminal ductulo-lobular unit and adjacent tissue of the breast. As single fibroadenoma, even giant ones are easily manageable, however multiple fibroadenomas pose a particular challenge. CASE REPORT: In 1971, Liacyr Ribeiro described his new technique for reduction mammaplasty. Four years later, the first 20 cases were published. This technique was introduced by Rezai in oncoplastic surgery. With free hand design, preoperative marking is performed- and the inferior pedicle modulated. RESULTS: Selective resection of more than seventy fibroadenomas was performed on two patients. The technique allowed a modelling of the breast like a mastopexy through the inferior pedicle. CONCLUSION: Multiple fibroadenomas of the breast are safely removable with the Ribeiro technique modified by Rezai.

Venous coupler for free-flap anastomosis.

Free-flap surgery has become a routine procedure in breast reconstruction. The microvascular surgical anastomosis remains one of the technically sensitive aspects of free-tissue transfers. Between December 2006 and September 2007, 12 anastomoses were performed with a venous coupling device from Synovis. There were no free-flap failures. Venous congestion occurred in only one case and was managed successfully with leeches. No major complications were observed. The Synovis venous coupling device system allowed a time-efficient and safe venous anastomosis in breast reconstruction.

Treatment of endometriosis of uterosacral ligament and rectum through the vagina: description of a modified technique.

BACKGROUND: Endometriosis is common in women of childbearing age, whereas involvement of the rectosigmoid requiring resection is rare. Laparoscopy has become a standard procedure in the management of endometriosis. The optimum way to diagnose endometriosis is by direct visualization of the implants. Usually for the removal of the specimen, an additional larger abdominal incision is needed. METHODS: Here we report on cases of four patients with a uterosacral ligament and rectal endometriosis who were successfully treated with combined laparovaginal resection, using a modification of an existing technique. They had been complaining of rectal bleeding and lower abdominal pain in relation to their menstrual cycle. The aim of this technique is to achieve a careful and margin-free resection of the area involved. This can be done without any large incisions of the abdominal wall. The hypogastric nerves remain preserved on both sides. RESULTS: The intra- and post-operative courses were uneventful. No blood transfusions were needed. Haemoglobin decrease was usually < or =1 mmol/l. The average tumour diameter was 3.5 cm. CONCLUSIONS: Our technique circumvents a larger abdominal incision. This combined laparoscopic-transvaginal approach, avoiding the extension of port-site incisions, represents a viable option for the treatment of bowel endometriosis.

Sentinel lymph node biopsy in vulvar cancer: a pilot study.

BACKGROUND: The aim of the pilot study was to assess the feasibility, efficacy, and accuracy of the sentinel lymph node biopsy (SLNB) procedure in vulvar cancer. PATIENTS AND METHODS: From February 2003 to March 2007, 17 patients with vulvar cancer, clinical Stages I and II, underwent SLN (sentinel lymph node) detection, followed by a complete inguinal-femoral lymphadenectomy. Demographic, surgical, and pathologic data on all patients were reviewed. RESULTS: 17 patients underwent the SLNB procedure. Sixteen had vulvar carcinoma and one patient suffered from melanoma of the vulva. Midline localisation was done in 11 patients (64.7%). A total of 371 lymph nodes were resected. The median number of removed lymph nodes was 15 (range 2 to 81). Nineteen lymph nodes were positive with a maximum of six in one patient. Overall the detection rate for the sentinel lymph node was 88.2% (15 out of 17). One of the two patients with a non detectable sentinel node had positive lymph nodes. Eighty lymph nodes were detected as the sentinel node. The median number of sentinel nodes was five (range 0 to 11). Seventeen sentinel nodes were involved. The sentinel node was negative in nine patients; one of these had involved lymph nodes. CONCLUSIONS: SLNB is feasible and safe to perform in vulvar cancer. Further evaluation is needed until new guidelines allow the use in early-stage vulvar cancer.

The relevance of circulating epithelial tumor cells (CETC) for therapy monitoring during neoadjuvant (primary systemic) chemotherapy in breast cancer.

BACKGROUND: Having demonstrated in a previous report that the response of circulating epithelial tumor cells (CETC) during the first cycles of primary (neoadjuvant) chemotherapy perfectly reflects the response of the tumor, in the present study the changes in cell numbers during subsequent cycles and their possible impact on the therapy's outcome were examined. PATIENTS AND METHODS: In 58 breast cancer patients CETC were quantified during therapy with either EC (epirubicin/ cyclophosphamid) or dose intensified E (epirubicin) followed by taxane, with or without trastuzumab, and subsequent CMF (cyclophosphamid/methorexate/ fluorouracil). RESULTS: CETC numbers declined more than 10-fold (good response) in 65% (her2/neu-negative) and 55% (her2/neu-positive) of patients during EC, and in 60% during dose intensified E, respectively, followed by an increase of CETC in all patients. CETC remained increased, decreasing only when adding CMF. A good initial response correlated with estrogen-receptor negativity, a poor response with early distant relapse (P < 0,0001, hazard ratio = 11.91). CONCLUSION: Response of CETC already during the first cycles of neoadjuvant treatment predicts the final response of the tumor. Hitherto unknown effects of the release of tumor cells during therapy further our understanding of tumor-blood interaction and may improve access of agents like antibodies to cells. The impact on the further course of disease remains to be evaluated.