Prevalence of burnout syndrome among unmatched trainees and residents in surgical and nonsurgical specialties: a cross-sectional study from different training centers in Palestine.

BACKGROUND: Burnout is a psychological syndrome that involves physical, mental, and emotional exhaustion. This study was conducted to determine the prevalence of burnout among unmatched trainees and residents in surgical and nonsurgical specialties in Palestine. Additionally, this study also sought to identify the associated variables and predictors of higher burnout scores. METHODS: This study was conducted in a cross-sectional design using a questionnaire in the period between October 2020 and March 2021. The questionnaire collected sociodemographic characteristics of the residents and trainees in 18 different training centers/hospitals. The Copenhagen Burnout Inventory was used to determine burnout among the residents and trainees. Pearson's correlations, analysis of variance, Student's t-test, and multiple linear regressions were used to analyze the data. RESULTS: The study tool was completed by 250 residents and trainees in surgical and nonsurgical specialties (response rate = 83.3%). Of all participants, 203 (81.2%) reported a moderate-severe degree of burnout in the personal domain, 188 (75.2%) reported a moderate-severe degree of burnout in the work-related domain, and 97 (38.8%) reported moderate-severe degree of burnout in the client-related domain. There was a moderate and positive correlation between personal and work-related burnout scores (Pearson's r = 0.69, p-value < 0.001), and client-related burnout scores (Pearson's r = 0.52, p-value < 0.001). Similarly, there was a moderate and positive correlation between work-related and client-related burnout scores (Pearson's r = 0.57, p-value < 0.001). The multiple linear regression model showed that higher burnout scores were predicted by being married, not having another paid employment, inability to financially support oneself, frequent consumption of tea/coffee, dissatisfied with the training/job, thinking to change the profession, and long working hours. CONCLUSION: The findings of this study indicated that burnout was highly prevalent among residents and trainees in surgical and nonsurgical specialties in Palestine. Decision-makers in healthcare authorities, hospital managers, professional groups, directors of residency programs, and educators/trainers should consider addressing burnout and improving the well-being of residents and trainees in surgical and nonsurgical specialties in Palestine. Future studies are still needed to determine which interventions could be effective in reducing burnout among residents and trainees in surgical and nonsurgical specialties in Palestine.

Adenocarcinoma of the appendix presenting as chronic small bowel obstruction: A case report.

Appendiceal carcinoma, a rare malignancy comprising less than 1% of gastrointestinal cancers, often presents diagnostic challenges due to its atypical symptoms. This report details a 68-year-old female with a history of severe anemia, gastrointestinal bleeding, and persistent abdominal symptoms, ultimately diagnosed with chronic small bowel obstruction caused by an appendiceal adenocarcinoma. Despite initial treatment for Helicobacter pylori-induced gastritis, her symptoms persisted, prompting further imaging that revealed a narrowed small bowel segment. Exploratory laparotomy uncovered a stricturing tumor 2 meters from the duodenojejunal junction, leading to en bloc resection of the tumor, appendix, and part of the lateral abdominal wall. Histopathology confirmed moderately differentiated adenocarcinoma. A multidisciplinary team recommended a complete right hemicolectomy, successfully performed despite extensive adhesions and a mesenteric abscess. Postoperatively, the patient recovered well, with ongoing management for anemia and close surveillance. This case highlights the importance of considering rare malignancies in differential diagnoses for chronic small bowel obstruction.

Spontaneous angiomyolipoma rupture: A case of hemorrhagic shock and urgent embolization.

This case report discusses a 64-year-old male with tuberous sclerosis complex (TSC), a genetic disorder characterized by benign tumor formation across multiple organ systems. The patient presented with a spontaneous hemorrhage from a right renal angiomyolipoma, a common and potentially life-threatening manifestation of TSC, particularly in patients with TSC2 mutations. The patient's significant comorbidities, including hypertension and dyslipidemia, further complicated his clinical course. Initial management involved aggressive fluid resuscitation and blood product transfusion, followed by urgent embolization to control active bleeding. Despite developing complications such as transfusion-associated circulatory overload (TACO), the patient was successfully stabilized. This case highlights the necessity for careful monitoring and prompt intervention in patients with TSC, given the high risk of hemorrhage from angiomyolipomas, especially those larger than 3 cm. We also emphasize the importance of differentiating TSC-associated angiomyolipomas from other renal masses, considering the variability in clinical presentation and the potential for late-onset symptoms. Additionally, it highlights the critical role of a multidisciplinary approach in managing TSC patients, addressing both acute complications and long-term surveillance to prevent recurrence and other systemic manifestations of the disease.

Spectral Shape Analysis of Human Torsos: Application to the Evaluation of Scoliosis Surgery Outcome.

This paper aims at evaluating the effect of spinal surgery on the torso shape appearance of adolescent patients. Current methods that assess the surgical outcome on the trunk shape are limited to its global asymmetry or rely on unreliable manual measurements. We introduce a novel framework to evaluate pre- to postoperative local asymmetry changes using a spectral representation of the torso shape, more specifically, the Laplacian spectrum (eigenvalues and eigenvectors) of a graph. We conduct a statistical analysis on the eigenvalues to efficiently select the spectral space and determine the significant components between preop and postop groups. On the selected eigenvectors, we propose a local analysis based on the concept of Euler characteristic to detect their local maxima and minima, which are then used to compute local left-right (L-R) asymmetries of torso shape. On 49 patients with a thoracic spinal deformity, the method captures significant pre- to postoperative changes of asymmetry at the waist, shoulder blades, shoulders, and breasts. We have evaluated average correction rates for L-R asymmetry of the waist height (67%), shoulder-blade height (64%) and depth (67%), lateral offset between shoulder and neck (61%), and breast height (52%). Spectral torso shape analysis provides a novel approach to quantify the surgical correction of the scoliotic trunk from local shape asymmetry. The proposed method could help the surgeon to understand the impact of different spinal surgery strategies on the postoperative appearance and choose the one that should provide better patient's satisfaction.