Effectiveness of combined dorsal root ganglion and spinal cord stimulation: a retrospective, single-centre case series for chronic focal neuropathic pain.

OBJECTIVE: This case series retrospectively reviewed the outcomes in patients implanted with combined, synchronous dorsal root ganglion stimulation (DRGS) and spinal cord stimulation (SCS) connected to a single implantable pulse generator (IPG) in a tertiary referral neuromodulation centre in the United Kingdom. METHODS: Twenty-six patients underwent a trial of DRGS+SCS for treating focal neuropathic pain between January 2016 and December 2019, with a follow-up in February 2022. A Transgrade approach was employed for DRGS. Patients were provided with 3 possible stimulation programs: DRGS-only, SCS-only, or DRGS+SCS. Patients were assessed for pain intensity, patients' global impression of change (PGIC), preferred lead(s) and complications. RESULTS: Twenty patients were successful and went on for full implantation. The most common diagnosis was Complex Regional Pain Syndrome. After an average of 3.1 years follow-up, 1 patient was lost to follow-up, and 2 were non-responders. Of the remaining 17 patients, 16 (94%) continued to report a PGIC of 7. The average pain intensity at Baseline was 8.5 on an NRS scale of 0-10. At the last follow-up, the average NRS reduction overall was 78.9% with no statistical difference between those preferring DRGS+SCS (n = 9), SCS-only (n = 3) and DRGS-only (n = 5). The combination of DRGS+SCS was preferred by 53% at the last follow-up. There were no serious neurological complications. CONCLUSIONS: This retrospective case series demonstrates the potential effectiveness of combined DRGS+SCS with sustained analgesia observed at an average follow-up of over 3 years. Implanting combined DRGS+SCS may provide programming flexibility and therapeutic alternatives.

Interventional Pain Procedures: A Narrative Review Focusing On Safety and Complications. PART 2 Interventional Procedures For Back Pain.

In patients where conservative approaches have failed to relieve from chronic pain, interventional procedures may be an option in well selected patients. In recent years there has been an increase in the use and development of invasive procedures. Concomitantly, there has also been an increase in the complications associated with these procedures. Taken this into consideration, it is important for healthcare providers to take a cautious and vigilant approach, with a focus on patient safety, in order to minimize the risk of adverse events and ensure the best possible outcome for the patient. This may include careful selection of patients for procedures, use of proper techniques and equipment, and close monitoring and follow-up after the procedure. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopy or ultrasound-guided) interventional procedures and provide strategies to reduce the risk of these complications. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.

Prevalence of burnout among intensive care physicians: a systematic review. / Prevalência de burnout entre médicos atuantes em terapia intensiva: uma revisão sistemática.

OBJECTIVE: We performed a systematic review to summarize the knowledge regarding the prevalence of burnout among intensive care unit physicians. METHODS: We conducted a systematic review of the MEDLINE and PubMed® databases (last update 04.02.2019) with the goal of summarizing the evidence on burnout among intensive care unit physicians. We included all studies reporting burnout in intensive care unit personnel according to the Maslach Burnout Inventory questionnaire and then screened studies for data on burnout among intensive care unit physician specifically. RESULTS: We found 31 studies describing burnout in intensive care unit staff and including different healthcare profiles. Among these, 5 studies focused on physicians only, and 12 others investigated burnout in mixed intensive care unit personnel but provided separate data on physicians. The prevalence of burnout varied greatly across studies (range 18% - 49%), but several methodological discrepancies, among them cut-off criteria for defining burnout and variability in the Likert scale, precluded a meaningful pooled analysis. CONCLUSION: The prevalence of burnout syndrome among intensive care unit physicians is relatively high, but significant methodological heterogeneities warrant caution being used in interpreting our results. The lower reported levels of burnout seem higher than those found in studies investigating mixed intensive care unit personnel. There is an urgent need for consensus recommending a consistent use of the Maslach Burnout Inventory test to screen burnout, in order to provide precise figures on burnout in intensive care unit physicians.

OBJETIVO: Realizar uma revisão sistemática para sumarizar o conhecimento relativo à prevalência de burnout entre médicos atuantes na unidade de terapia intensiva. MÉTODOS: Conduzimos uma revisão sistemática nas bases de dados MEDLINE e PubMed® (última atualização em 4 de fevereiro de 2019), com o objetivo de resumir a evidência a respeito de burnout entre médicos atuantes em unidades de terapia intensiva. Incluímos todos os estudos que relatavam burnout em trabalhadores na unidade de terapia intensiva, segundo o Inventário de Burnout de Maslach e, a seguir, triamos os estudos quanto a dados relativos a burnout especificamente em médicos atuantes na unidade de terapia intensiva. RESULTADOS: Encontramos 31 estudos que descreviam burnout em membros da equipe da unidade de terapia intensiva e incluíam diferentes perfis de profissionais de saúde. Dentre estes, cinco estudos se focalizavam apenas em médicos, e 12 outros investigavam burnout em uma mescla de profissionais atuantes na unidade de terapia intensiva, mas forneciam dados à parte relativos aos médicos. A prevalência de burnout teve grande variação entre os estudos (variando entre 18% e 49%), porém diversas discrepâncias metodológicas, dentre elas os critérios de corte para definição de burnout e variabilidade da escala de Likert, impediram uma análise agrupada significativa. CONCLUSÃO: A prevalência da síndrome de burnout entre médicos atuantes na unidade de terapia intensiva é relativamente alta, porém heterogeneidades metodológicas significantes exigem precauções na interpretação de nossos resultados. Os níveis mais baixos de burnout relatados parecem mais elevados do que os identificados em estudos que investigaram uma mescla de profissionais da unidade de terapia intensiva. Há uma necessidade urgente de consenso que recomende o uso consistente do Inventário de Burnout de Maslach para triar a presença de burnout a fim de fornecer dados precisos a respeito de burnout entre médicos atuantes na unidade de terapia intensiva.

Prevalência de burnout entre médicos atuantes em terapia intensiva: uma revisão sistemática / Prevalence of burnout among intensive care physicians: a systematic review

RESUMO Objetivo: Realizar uma revisão sistemática para sumarizar o conhecimento relativo à prevalência de burnout entre médicos atuantes na unidade de terapia intensiva. Métodos: Conduzimos uma revisão sistemática nas bases de dados MEDLINE e PubMed® (última atualização em 4 de fevereiro de 2019), com o objetivo de resumir a evidência a respeito de burnout entre médicos atuantes em unidades de terapia intensiva. Incluímos todos os estudos que relatavam burnout em trabalhadores na unidade de terapia intensiva, segundo o Inventário de Burnout de Maslach e, a seguir, triamos os estudos quanto a dados relativos a burnout especificamente em médicos atuantes na unidade de terapia intensiva. Resultados: Encontramos 31 estudos que descreviam burnout em membros da equipe da unidade de terapia intensiva e incluíam diferentes perfis de profissionais de saúde. Dentre estes, cinco estudos se focalizavam apenas em médicos, e 12 outros investigavam burnout em uma mescla de profissionais atuantes na unidade de terapia intensiva, mas forneciam dados à parte relativos aos médicos. A prevalência de burnout teve grande variação entre os estudos (variando entre 18% e 49%), porém diversas discrepâncias metodológicas, dentre elas os critérios de corte para definição de burnout e variabilidade da escala de Likert, impediram uma análise agrupada significativa. Conclusão: A prevalência da síndrome de burnout entre médicos atuantes na unidade de terapia intensiva é relativamente alta, porém heterogeneidades metodológicas significantes exigem precauções na interpretação de nossos resultados. Os níveis mais baixos de burnout relatados parecem mais elevados do que os identificados em estudos que investigaram uma mescla de profissionais da unidade de terapia intensiva. Há uma necessidade urgente de consenso que recomende o uso consistente do Inventário de Burnout de Maslach para triar a presença de burnout a fim de fornecer dados precisos a respeito de burnout entre médicos atuantes na unidade de terapia intensiva.

Abstract Objective: We performed a systematic review to summarize the knowledge regarding the prevalence of burnout among intensive care unit physicians. Methods: We conducted a systematic review of the MEDLINE and PubMed® databases (last update 04.02.2019) with the goal of summarizing the evidence on burnout among intensive care unit physicians. We included all studies reporting burnout in intensive care unit personnel according to the Maslach Burnout Inventory questionnaire and then screened studies for data on burnout among intensive care unit physician specifically. Results: We found 31 studies describing burnout in intensive care unit staff and including different healthcare profiles. Among these, 5 studies focused on physicians only, and 12 others investigated burnout in mixed intensive care unit personnel but provided separate data on physicians. The prevalence of burnout varied greatly across studies (range 18% - 49%), but several methodological discrepancies, among them cut-off criteria for defining burnout and variability in the Likert scale, precluded a meaningful pooled analysis. Conclusion: The prevalence of burnout syndrome among intensive care unit physicians is relatively high, but significant methodological heterogeneities warrant caution being used in interpreting our results. The lower reported levels of burnout seem higher than those found in studies investigating mixed intensive care unit personnel. There is an urgent need for consensus recommending a consistent use of the Maslach Burnout Inventory test to screen burnout, in order to provide precise figures on burnout in intensive care unit physicians.