[THE CONNECTION BETWEEN MORAL INJURY AND BURNOUT].

INTRODUCTION: Medical work requires complete dedication to work, long hours of absence from home and family, as well as personal sacrifice on various issues. This results in impaired quality of life, and the phenomenon of depression and suicide is more common among physicians than in the general population. The impairment in quality of life and function was defined for years as burnout, and this figure of speech reflected the physician's inability to cope with existing pressures. In recent years, the concept of 'moral injury' has been emerging to explain a significant part of the burnout phenomenon. The term describes the poor mental state of the physician who is forced to make immoral choices as part of the organizational demands. This perception fundamentally changes the concept that the poor function at work and in personal life is only the weakness of the doctor who lacks coping resources and resilience, therefore needing personal support such as yoga and mindfulness exercise. It emphasizes the organization responsibility for change, which will minimize moral dilemmas, thereby the moral injury. This will allow the doctor to live professional, as well as personal life, in an optimal way.

Radiofrequency treatment has a beneficial role in reducing low back pain due to facet syndrome in octogenarians or older.

INTRODUCTION: Chronic low back pain is a disabling phenomenon that can cause a severe reduction in quality of life, especially in elderly patients. Surgical treatment is sometimes a big challenge for these elderly patients. Radiofrequency (RF) ablation is an increasingly popular method for treating low back pain caused by facet syndrome. The purpose of this study was to evaluate whether RF neurotomy is effective in terms of pain reduction and functional outcome in elderly patients. PATIENTS AND METHODS: Fifty-eight patients aged 80 years and older who had chronic mechanical low back pain were examined after they underwent RF heat lesion of the medial branch. Follow-up occurred 1, 3, 6, and 12 months after treatment. Pain was measured on the visual analog scale and functional outcome was measured using the Oswestry Disability Index. RESULTS: After 1 month, 43 patients (74%) were satisfied with the results. After 3 months, 38 patients (66%) had clinically significant pain relief. After 6 months, 33 patients (57%) had pain relief, and at the 1-year follow-up, 30 patients (52%) showed good results while 28 patients (48%) showed no effect. The Oswestry Disability Index score was substantially improved even after 1 year. Minor complications occurred in eleven patients (19%), who had transient discomfort and burning pain. CONCLUSION: RF is a safe and partially effective procedure for treating elderly patients with mechanical back pain due to facet syndrome.

The correlation between Spurling test and imaging studies in detecting cervical radiculopathy.

BACKGROUND: Cervical spine symptoms are a major cause of visits to general or spinal orthopedic surgeons or even primary care physicians. Although in this era the imaging studies can precisely rule out or diagnose pathologies in the spine, all of these studies have limitations. Computerized tomography (CT) scan consists of radiation exposure to the patients and it should be done with caution. Magnetic resonance imaging (MRI) is a highly effective imaging tool, but in many countries it is still costly. The goal of our study was to determine whether a simple clinical test can help the clinician to identify the patients who need to be sent for these imaging studies. METHODS: Two hundred fifty-seven patients with clinical cervical radiculopathy underwent complete physical examination that also included the Spurling test. After that, all patients were sent to imaging studies of the cervical spine (CT and/or MRI). Correlation between the physical examination using the Spurling test to the imaging studies was done. RESULTS: Sensitivity of the Spurling test to nerve root pathology was 95% and specificity was 94%. CONCLUSION: This paper demonstrate that patients with positive Spurling test have probable nerve root pressure and should be sent for further imaging studies. In patients with negative Spurling test, the possibility of nerve root pressure is less likely.

Effectiveness of the Charleston bending brace in the treatment of single-curve idiopathic scoliosis.

The purpose of this study was to determine the effectiveness of the Charleston bending brace when compared with the thoracolumbosacral orthosis (TLSO or Boston) brace in the treatment of single-curve adolescent-type idiopathic scoliosis. The Charleston and TLSO braces were applied for approximately 8 nighttime hours and 18 to 22 hours per day, respectively. Treatment success was defined as improvement of curve deterioration with <5 degrees progression from the start of brace therapy until the conclusion of treatment, as well as the absence for the need to perform corrective surgery. The success rates were determined by Risser stage, initial angle, type of curvature, and sex of the patient. In addition, the success rate of the Charleston brace was assessed by analyzing the degree of initial correction. One hundred twenty-two patients (94 girls, 28 boys) were studied. Eighty-five patients were treated with the Charleston brace and 37 with the TLSO brace. Mean Cobb angle of curvature before bracing was 30.4 degrees. The curvature was lumbar in 60 patients, thoracic in 56, and thoracolumbar in 6. The average follow-up time was 23 months, with a minimum follow-up of 1 year. Surgery was performed in 11.8% and 13.5% of patients in the Charleston and TLSO groups, respectively. In this patient population, no significant difference in success rate was found between the groups.