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.

The need for non-technical skills education in orthopedic surgery.

BACKGROUND: The issue of surgical safety has increased significantly over the last few decades. Several studies have established that it is linked to non-technical performance, rather than clinical competencies. Non-technical skills can be blended with technical training in the surgical profession to improve surgeons' abilities and enhance patient care and procedural skills. The main goal of this study was to determine orthopedic surgeons' requirements of non-technical skills, and to identify the most pressing issues. METHODS: We conducted a self-administered online questionnaire survey in this cross-sectional study. The questionnaire was piloted, validated, pretested, and clearly stated the study's purpose. After the pilot, minor wording and questions were clarified before starting the data collection. Orthopedic surgeons from the Middle East and Northern Africa were invited. The questionnaire was based on a five-point Likert scale, the data were analyzed categorically, and variables were summarized as descriptive statistics. RESULTS: Of the 1713 orthopedic surgeons invited, 60% completed the survey (1033 out of 1713). The majority demonstrated a high likelihood of participating in such activities in the future (80.5%). More than half (53%) of them preferred non-technical skills courses to be part of major orthopedic conferences, rather than independent courses. Most (65%) chose them to be face-to-face. Although 97.2% agreed on the importance of these courses, only 27% had attended similar courses in the last three years. Patient safety, infection prevention and control, and communication skills were ranked at the top as topics to be addressed. Moreover, participants indicated they would most likely attend courses on infection prevention and control, patient safety and teamwork, and team management. CONCLUSION: The results highlight the need for non-technical skills training in the region and the general preferences regarding modality and setting. These findings support the high demand from orthopedic surgeons' perspective to develop an educational program on non-technical skills.

Carbon-Supported Trimetallic Catalysts (PdAuNi/C) for Borohydride Oxidation Reaction.

The synthesis of palladium-based trimetallic catalysts via a facile and scalable synthesis procedure was shown to yield highly promising materials for borohydride-based fuel cells, which are attractive for use in compact environments. This, thereby, provides a route to more environmentally friendly energy storage and generation systems. Carbon-supported trimetallic catalysts were herein prepared by three different routes: using a NaBH4-ethylene glycol complex (PdAuNi/CSBEG), a NaBH4-2-propanol complex (PdAuNi/CSBIPA), and a three-step route (PdAuNi/C3-step). Notably, PdAuNi/CSBIPA yielded highly dispersed trimetallic alloy particles, as determined by XRD, EDX, ICP-OES, XPS, and TEM. The activity of the catalysts for borohydride oxidation reaction was assessed by cyclic voltammetry and RDE-based procedures, with results referenced to a Pd/C catalyst. A number of exchanged electrons close to eight was obtained for PdAuNi/C3-step and PdAuNi/CSBIPA (7.4 and 7.1, respectively), while the others, PdAuNi/CSBEG and Pd/CSBIPA, presented lower values, 2.8 and 1.2, respectively. A direct borohydride-peroxide fuel cell employing PdAuNi/CSBIPA catalyst in the anode attained a power density of 47.5 mW cm-2 at room temperature, while the elevation of temperature to 75 °C led to an approximately four-fold increase in power density to 175 mW cm-2. Trimetallic catalysts prepared via this synthesis route have significant potential for future development.