Identifying and Addressing Burnout in the Orthopaedic Surgeon.

Throughout the career of a physician, they are subjected to long working hours, high stress, life and death situations, risk of malpractice, significant financial debt, and an increasing bureaucratic load. This, in turn, has led to significant rates of burnout and potential suicidal ideation. Suicide prevalence has increased roughly 30% over the past 2 decades, with surgeon suicide rates reaching as high as 3x that of the general cohort. Orthopedic surgeons are most severely affected, composing 28.2% of physician suicides and seeing one third of their suicides from 2003 to 2017 occurring in the last 2 years alone. We provide the latest data and the current trends in orthopedic burnout and suicide rates, delve into the possible inciting factors driving their increase, and provide recommendations to identify their early signs and mitigate progression.

Antibiotic-Resistant Gram-negative Bacteria Carriage in Healthcare Workers Working in an Intensive Care Unit / 감염과화학요법

Little is known about antibiotic-resistant Gram-negative bacteria (GNB) intestinal carriage among healthcare workers (HCWs) in Vietnam. All HCWs at a tertiary intensive care units were asked to undertake weekly rectal swabs. Among 40 participants, 65% (26/40) carried extended spectrum β-lactamases (ESBL)/AmpC β-lactamase-producing Escherichia coli. Two HCWs colonized with ESBL/AmpC β-lactamase-producing Klebsiella pneumoniae. One HCW colonized with Acinetobacter baumannii. No one carried Pseudomonas spp.. A quarter (10/40) of HCWs were identified as persistent and frequent carriers. There is an urgent need to screen antibiotic-resistant GNB among HCWs and improve HCWs' hand hygiene compliance to reduce the transmission of antibiotic-resistant GNB in the hospital.

Antibiotic-Resistant Gram-negative Bacteria Carriage in Healthcare Workers Working in an Intensive Care Unit / 감염과화학요법

Little is known about antibiotic-resistant Gram-negative bacteria (GNB) intestinal carriage among healthcare workers (HCWs) in Vietnam. All HCWs at a tertiary intensive care units were asked to undertake weekly rectal swabs. Among 40 participants, 65% (26/40) carried extended spectrum β-lactamases (ESBL)/AmpC β-lactamase-producing Escherichia coli. Two HCWs colonized with ESBL/AmpC β-lactamase-producing Klebsiella pneumoniae. One HCW colonized with Acinetobacter baumannii. No one carried Pseudomonas spp.. A quarter (10/40) of HCWs were identified as persistent and frequent carriers. There is an urgent need to screen antibiotic-resistant GNB among HCWs and improve HCWs' hand hygiene compliance to reduce the transmission of antibiotic-resistant GNB in the hospital.

Reproducibility and accuracy of visual estimation of polyp size in large colorectal polyps.

BACKGROUND: Previous studies indicate that visual size estimation (in situ) of polyp size tends to differ from postfixation measurements, which effects allocation to surveillance intervals. Little is known about interobserver variation of in-situ measurements of large polyps. The primary objective was to assess interobserver variation of in situ measurements of large colorectal polyps. Secondary objectives were the agreement of in situ measurements with postfixation measurements, and the agreement on detection of ≥20 mm polyps between these measurements. MATERIAL AND METHODS: Interobserver variability of in situ polyp size measurements was assessed between a diagnostic colonoscopy and the secondary therapeutic colonoscopy by dedicated endoscopists, in patients that were referred for an advanced polypectomy. After excision pre- and postfixation polyp sizes were measured with a ruler in three dimensions. RESULTS: A total of 40 patients, with 45 polyps, were included in the study. The average difference between the two in situ measurements was 2.4 mm (95% confidence interval (CI): -0.4-5.2). The differences between the first in situ, second in situ and pre-fixation measurement in comparison to postfixation measurements were 1.8 mm (95% CI: -1.2-4.9), 0.1 mm (95% CI: -1.5-1.8) and 1.0 mm (95% CI: -0.2-2.2). Cohen's Kappa on detection of ≥20 mm polyps in agreement with postfixation measurements was 0.65 in the primary and 0.88 in the secondary in situ measurements. CONCLUSION: This study shows a variation between in situ size measurements of large polyps. Improvements in daily clinical routines can be made by using an instrument to compare polyp size with and refraining from rounding sizes up or down. A randomized controlled trial assessing which instruments should be used for in-situ measurements of large polyps is warranted, in order to optimize size measurements of large colorectal polyps.

Sexual harassment: Have we made any progress?

Sexual harassment (SH) is a continuing, chronic occupational health problem in organizations and work environments. First addressed in the Journal of Occupational Health Psychology through a 1998 Special Section on Sexual Harassment, we return to this consequential issue. If the goal is to reduce SH in organizations, and we believe that it should be, then a key question is whether we have made progress in 2 decades. The answer is mixed. Yes, there is a 28% decline in SH complaints. No, there is an increase in complaints by males. No, there has been an increase in the percentage of merit resolutions and monetary benefits. Maybe, because how do we explain the complexity of SH with emergent gay, lesbian, and transgender workforce members. One persistent problematic aspect of SH lack of agreement on definition. We address 2 of the 3 definitional approaches. We consider the broad, negative consequences for organizations and for individual victims. Harassers and aggressors destroy lives, leaving long legacies of suffering. In addition, we offer some suggestions for moving forward in science and practice, with emphasis on the role of the bystander. We conclude that SH is a preventable, if not always predictable, occupational health problem. (PsycINFO Database Record

Occupational Stress: Preventing Suffering, Enhancing Wellbeing.

Occupational stress is a known health risk for a range of psychological, behavioral, and medical disorders and diseases. Organizations and individuals can mitigate these disorders through preventive stress management and enhanced wellbeing. This article addresses, first, the known health risk evidence related to occupational stress; second, the use of preventive stress management in organizations as the framework for intervention; and third, the emerging domain of enhancing wellbeing, which strengthens the individual. Premature death and disability along with chronic suffering from occupational stress are not inevitable, despite being known outcome risks.

Missing: critical and skeptical perspectives on comprehensive soldier fitness.

The author read with interest, and concern, the January 2011 issue of the American Psychologist. The Special Issue on Comprehensive Soldier Fitness addressed a hugely consequential national issue and offered a vision for psychological resilience along with an elaborate set of supporting articles, concluding with some comments on "Objections" to psychologists working with the military. While a bold vision was offered and a game plan presented, no data or evidence are yet available (it is far too early in the process), and that should concern us all. The author hopes the American Psychological Association (APA) and the American Psychologist offer skeptical and critical views in future issues on the issue of the psychological health of our military and as evidence emerges regarding the Comprehensive Soldier Fitness program.

Vascular surgical antibiotic prophylaxis study (VSAPS).

This prospective, randomized study was performed at a single institution. Low-risk patients undergoing elective vascular procedures were enrolled (August 2007 to June 2009). Participants were randomized into 3 separate arms. They received cefazolin, cefazolin + vancomycin, or cefazolin + daptomycin prior to surgery. In total, 169 patients were included in the analysis. Mean age was 64 (range, 26-85), and the patients' comorbidities were similar across all groups. Only Szilagyi II and III infections were analyzed. Any infection/methicillin-resistant Staphylococcus aureus (MRSA) infections was seen in 8 (12.9%)/2 (3.23%) in the cefazolin group, 7 (12.5%)/4 (7.14%) in the cefazolin + vancomycin group, and 2 (3.92%)/(0%) in the cefazolin + daptomycin group. In this study, population of low-risk patients undergoing elective vascular procedures, there was a trend toward fewer infectious complications in the cefazolin + daptomycin group. Adding anti-MRSA agents to the current standard prophylaxis regimen does not appear to reduce the incidence of MRSA infection in low-risk patients.

Sabbatical leave: who gains and how much?

A rigorous quasi-experiment tested the ameliorative effects of a sabbatical leave, a special case of respite from routine work. We hypothesized that (a) respite increases resource level and well-being and (b) individual differences and respite features moderate respite effects. A sample of 129 faculty members on sabbatical and 129 matched controls completed measures of resource gain, resource loss, and well-being before, during, and after the sabbatical. Among the sabbatees, resource loss declined and resource gain and well-being rose during the sabbatical. The comparison group showed no change. Moderation analysis revealed that those who reported higher respite self-efficacy and greater control, were more detached, had a more positive sabbatical experience, and spent their sabbatical outside their home country enjoyed more enhanced well-being than others.

Recognizing and preventing burnout among orthopaedic leaders.

Stress, emotional exhaustion, and burnout are widespread in the medical profession in general and in orthopaedic surgery in particular. We attempted to identify variables associated with burnout as assessed by validated instruments. Surveys were sent to 282 leaders from orthopaedic surgery academic departments in the United States by e-mail and mail. Responses were received from 195 leaders for a response rate of 69%. The average surgeon worked 68.3 hours per week and more than (1/2) of this time was allocated to patient care. Highest stressors included excessive workload, increasing overhead, departmental budget deficits, tenure and promotion, disputes with the dean, and loss of key faculty. Personal-professional life imbalance was identified as an important risk factor for emotional exhaustion. Withdrawal, irritability, and family disagreements are early warning indicators of burnout and emotional exhaustion. Orthopaedic leaders can learn, and potentially model, ways to mitigate stress from other high-stress professions. Building on the strength of marital and family bonds, improving stress management skills and self-regulation, and improving efficiency and productivity can combine to assist the orthopaedic surgery leader in preventing burnout and emotional exhaustion.

Stress e qualidade de vida no trabalho: o positivo e o negativo / Stress and quality of work life: positive and negative

Este livro oferece 13 capítulos organizados em três partes que abordam o stress ocupacional e a qualidade de vida no trabalho, destacando tanto conhecimentos centrais quanto novas tendências nas pesquisas sobre stress e qualidade de vida no trabalho, campo este que está se desenvolvendo rapidamente. Além disso, deve representar uma percepção renovada para as organizações para que comecem a pensar e a agir de forma a promover um ambiente menos estressante para seus funcionários, conscientizando-os das causas e dos custos do stress ocupacional e da má qualidade de vida no trabalho. A Parte 1 contém os capítulos 1 a 5 que tratam dos custos organizacionais e individuais do stress ocupacional. Os custos são humanitários e econômicos; tanto o sofrimento humano quanto o ônus financeiro são importantes. Os quatro capítulos seguintes (6 a 9) que integram a Parte 2 enfocam formas de mitigar os efeitos negativos do stress ocupacional. Precisamos ajudar as pessoas que estão sofrendo, mas precisamos fazer mais, impedindo o distresse onde podemos e nos baseando em fatores positivos e de força onde possível. A Parte 3 traz os quatro capítulos finais (10 a 13), que examinam e expandem nossa compreensão da qualidade de vida no trabalho. A qualidade de vida no trabalho é muito importante por causa dos efeitos que tem sobre os trabalhadores e líderes, incluindo o impacto do transbordamento para famílias e comunidades.

Application of immunomagnetic cell enrichment in combination with RT-PCR for the detection of rare circulating head and neck tumor cells in human peripheral blood.

Detection of rare, circulating tumor cells (CTC's) in human peripheral blood is a potential indicator of prognosis and diagnosis in oncology. Typical methods to detect these CTC's are either by immunocytochemistry (ICCS) or RT-PCR. However without accurate, rapid, and reproducible enrichment processes, these detection techniques are labor intensive and/or unreliable. In this article, a repeatable enrichment process that included a flow-through immunomagnetic cell separation system, the quadrupole magnetic sorter (QMS) was optimized with the aid of a statistical analysis software package. The QMS was operated in a negative mode of operation by immunomagnetically targeting normal human peripheral blood lymphocytes (PBL) through the CD45 surface marker. Three head and neck squamous carcinoma cell lines (HNSCC), Detroit-562, SCC-4, and CAL-27, were used to determine the sensitivity of RT-PCR for the epidermal growth factor receptor (EGFR) in spiked PBL. The detection purity needed for detection was found to be one cell in 10(4), one cell in 10(3), and one cell in 10(5) for the Detroit-562, SCC-4, and CAL-27, respectively. The actual number of cancer cells needed for RT-PCR detection ranged from 30 to 1 cell. To mimic the potential concentration of rare CTC present in peripheral blood of cancer patients, the spiking concentration was chosen to be one cancer cell per 10(5) total leukocytes from healthy donors. Using a single step immunomagnetic labeling, the final, optimized enrichment process produced a 57.6 +/- 30.3-fold (n = 6) enrichment of the rare cancer cells with a final cancer cell recovery of (77.8 +/- 6.6)%.

Creating healthier workplaces: The American Psychological Association/National Institute of Occupational Safety and Health cooperative agreement. Introduction and historical overview.

This article introduces the special section on the American Psychological Association/National Institute for Occupational Safety and Health (APA/NIOSH) collaboration. The section includes an overview statement of National Institute for Occupational Safety and Health research by Linda Rosenstock and 5 competitively peer-reviewed articles submitted to the Journal of Occupational Health Psychology following their presentation in an earlier form at the 3rd APA/NIOSH conference in September 1995. This article provides a brief history of the APA/NIOSH collaboration forged at the turn of this decade.

Advancing public policy, social science, and biomedical inquiry: state-of-the-art reviews. IV.

In this article, the author introduces the fourth special section of state-of-the-art reviews. He discusses the public policy and epistemological contributions of the 2 articles in this section in terms of the translation of scientific research findings into public policy actions.

Contributing concepts and methods across disciplinary boundaries: state-of-the-art reviews. III.

This article introduces the third special section of state-of-the-art reviews. The conceptual and methodologic contributions of the 3 articles in this section are framed, noting the importance of the public health, preventive medicine, and sociological disciplines represented.