Evaluation of Peri-operative Outcomes Associated With Resident Involvement on Tumor Resection and Renorrhaphy During Robotic-assisted Partial Nephrectomy.

OBJECTIVE: To evaluate perioperative outcomes of resident trainee involvement in tumor resection and renorrhaphy during robotic assisted partial nephrectomy (RAPN). MATERIALS AND METHODS: We analyzed 500 consecutive RAPN in a single surgeon prospectively maintained database. Cases with resident performed tumor resection and renorrhaphy (N = 71) were case matched on R.E.N.A.L. score and RAPN year using a greedy matching algorithm. Perioperative variables were compared to attending cases. RESULTS: There were no statistically significant differences in high grade postoperative complications (resident: 3% vs attending: 6%, P = .68), positive margins (resident: 1% vs attending: 3%, P = .31), length of stay (resident: 2.0 vs attending: 2.0 days, P = .73), and 30 day readmission (resident: 7% vs attending: 11%, P = .56). However, residents had a statistically significant longer warm ischemia time (median 21 vs 15 minutes, P <.001), thus less likely to achieve trifecta (66% vs 85%, P = .02). Resident involvement had longer median operative time (197 vs 184 minutes, P = .03). No statistically significant difference in functional volume loss (P = .12) or surface intermediate base margin score (P = .66) between residents and attending was found. No difference in post-operative creatinine change was found at 1 day and 1 month (resident: 0.2 vs attending: 0.1 mg/dL, P = .4 and resident: 0.1 vs attending: 0.1 mg/dL, P = .6, respectively). CONCLUSION: Supervised resident console involvement in tumor resection and renorrhaphy during RAPN is safe and does not increase rates of complications. Residents have longer median warm ischemia time compared to attending only cases, but this does not appear to impact post-operative renal function.

El covid-19 y sus consecuencias en la vida y el trabajo de médicos residentes de La Paz, Bolivia / Covid-19 and its consequences in the life and the work of medical residents of La Paz, Bolivia

Este artículo es un apretado resumen de los principales resultados de una investigación mayor realizada por MEDICON, cuantitativa y cualitativa, en línea, a médicos residentes de 2º año del Sistema Departamental de Salud La Paz, en Bolivia. Los datos y relatos recogidos tienen que ver con la pandemia, el cumplimiento de las medidas de bioseguridad, la afectación experimentada por la cuarentena, la donación de plasma, el desempeño del personal de salud, entre otros. En el 55% la enfermedad fue confirmada por laboratorio. No hubo hospitalizados y la mayoría se automedicó. No recibieron soporte psicológico, por lo que es factible que algunos hubieran desarrollado el síndrome de burnout. Los que se enfermaron o tuvieron allegados con covid-19 dieron a conocer sus vivencias sobre la manera en que ellos y sus familiares enfrentaron el problema. (AU)

This article is a tight summary of the main results of a major investigation conducted by MEDICON, quantitative and qualitative, online, to second-year resident physicians of the La Paz Departmental Health System, in Bolivia. The data and reports collected have to do with the pandemic, compliance with biosecurity measures, the impact experienced by quarantine, plasma donation, the performance of health personnel, among others. In 55% the disease was confirmed by laboratory. There were no hospitalized and most self-medicated. They did not receive psychological support, so it is possible that some had developed ­ burnout syndrome. Those who became ill or had relatives with covid-19 shared their experiences about the way that they and their relatives faced the problem. (AU)

Participación de residentes de cirugía plástica de Chile en la publicación científica: revisión de los últimos 20 años / Participation of chilean plastic surgery residents in scientific publications: review of the last 20 years

Resumen Objetivo: Analizar la participación de los residentes de cirugía plástica de Chile en la publicación científica de los últimos 20 años y evaluar su experiencia durante la residencia. Materiales y Método: Revisión de la literatura desde 1998-2018 bajo los términos: Cirugía Plástica, Plastic Surgery y Chile. Se incluyeron aquellos con al menos un autor cirujano plástico con filiación en Chile. Se registró la participación reportada de residentes y analizaron sus autores según su período de residencia y fecha de publicación, agregándolos como residentes no reportados. Se analizó tema, año de publicación y revista. Se aplicó una encuesta a residentes de cirugía plástica y postbecados recientes para conocer la percepción sobre su participación en actividades científicas. Se comparó la participación entre residentes con y sin año de investigación mediante el test exacto de Fisher. Resultados: Predominó la temática reconstructiva (48,2%), en adultos (68,6%) y en centros universitarios (48,7%). La participación reportada de residentes fue de 8,4%, subiendo a 38,2% al ampliarla a los no explicitados como residentes. Los encuestados expusieron la falta de tiempo como principal impedimento a la publicación y participación en congresos. Discusión: La participación en actividades científicas resulta beneficiosa para residentes, sus tutores y la reputación académica de sus centros. La mayoría de los residentes cree que su participación podría haber sido mayor en caso de que se hubiesen dado más facilidades. Conclusiones: La participación de residentes de cirugía plástica se encuentra subreportada. Programas de investigación, tiempos protegidos y mayor tutorización podrían aumentar esta cifra.

Aim: Evalúate the participation of Chilean plastic surgery residents in scientific publication in the last 20 years and assess their experience during residency. Materials and Method: Literature review from 1998-2018 under the terms: Cirugia Plastica AND Plastic Surgery AND Chile. Publications with at least one plastic surgeon author with filiation reported in Chile were considered. Those with reported participation of residents were registered and their authors were also analyzed according to their period of residence and date of publication, adding them as unreported residents. Subjects, year of publication and journals were analyzed. A survey was applied to plastic surgery residents and recent plastic surgery graduates to evaluate the perception of their participation in scientific activities. Residents participation with and without a previous research fellow was compared using Fisher's exact test. Results: Reconstructive themed studies (48.2%), in adults (68.6%) and in university centers (48.7%) prevailed among the included articles. The reported participation of residents was 8.4%, which rised to 38.2% when it was extended to those not explicitly reported as residents among the authors. Residents exposed the lack of time as the main barrier to publication and congress participations. Discussion: Participation in scientific activities is beneficial for residents, their mentors and the academic reputation of their centers. The majority of residents believe that their participation could have been greater if more facilities had been given. Conclusions: Participation of plastic surgery residents in scientific publications is under reported. The implementation of research programs, protected times and active mentoring could increase this number.

Enfoque de género en las residencias médicas de un hospital universitario / Gender approach in medical residences of a university hospital

Se observa un proceso de feminización de la profesión médica, sin embargo, el acceso masivo de las mujeres se asocia a nuevas desigualdades de género, denominadas segregación horizontal y vertical. La segregación horizontal se manifiesta en la desigual distribución de hombres y mujeres en ciertas especialidades médicas y la segregación vertical, en la escasa representación de las mujeres en la mayoría de los altos cargos profesionales. El objetivo de este estudio fue determinar cómo se distribuyen hombres y mujeres en las distintas instancias del proceso que implica el ingreso al sistema de residencias médicas de un hospital universitario de Buenos Aires, Argentina y analizar la segregación horizontal y vertical de género en el proceso de ingreso a las residencias médicas. A partir de datos de postulantes a un hospital universitario, en el período 2015-2017, se realizó un análisis de regresión logística múltiple para ajustar el odds ratio de ser hombre o mujer con potenciales confundidores. No se observó asociación entre ser hombre o mujer y la realización del examen, su aprobación y el ingreso a entrevista. El odds ratio ajustado para el ingreso a la residencia de los hombres con respecto a las mujeres fue 2.03 (1.44-2.85). Para las residencias quirúrgicas fue 2.75 (1.54-4.92) y para las clínicas fue 1.89 (1.17-3.00). En la inscripción, las mujeres optaron mayormente por residencias clínicas, y los hombres por quirúrgicas. Se observó segregación horizontal y vertical en el proceso de ingreso a la residencia. Visibilizar la segregación de género permitirá generar una sociedad equitativa.

A process of feminization of the medical profession is observed, however, the massive access of women is associated with new gender inequalities named horizontal and vertical segregation. Horizontal segregation manifests itself in the unequal distribution of men and women in certain medical specialties and vertical segregation, in the limited representation of women in most high professional positions. The objective of this study was to determine how men and women are distributed in the different stages of the process that involves entering the medical residency system of an universitary hospital from Buenos Aires, Argentina, and to analyze the horizontal and vertical segregation of gender in the process of admission to medical residencies. Based on data from applicants to an universitary hospital, in the 2015-2017 period, a multiple logistic regression analysis was conducted to adjust the odds ratio of being male or female with potential confounders. There was no association between being man or woman and the performance of the exam, its approval and the admission to the interview. The adjusted odds ratio for the admission to the residency of men with respect to women was 2.03 (1.44-2.85). For the surgical residencies it was 2.75 (1.54-4.92) and for clinical it was 1.89 (1.17-3.00). In the inscription, women opted mainly for clinical residencies, and men for surgical purposes. Horizontal and vertical segregation was observed in the process of the residency. Making gender segregation visible will allow generating an equitable society.

'Defensive medicine among different surgical disciplines: A descriptive cross-sectional study.

BACKGROUND: The term defensive medicine refers to medical behaviors that avoid physician liability without providing increased benefits to the patient. High rates of defensive medicine ranging from 54% to 98% have been reported in different countries. AIM: This study aimed to evaluate the defensive medicine knowledge, attitudes, and behaviors of physicians working in the surgical departments of a Turkish university hospital. METHODS: All 220 physicians working at the Atatürk University Hospital were invited to participate in this cross-sectional study. Responses from 190 participants were analyzed. Data were collected by face-to-face interview using six demographic questions and the Defensive Medicine Behavior Scale. RESULTS: The frequency of application of at least one positive or negative aspect of defensive medicine was 94.2% (n = 179). The highest Defensive Medicine Behavior Scale scores were among participants from the pediatric surgery department (median: 43.0, IQR: 4.0). Factors affecting Defensive Medicine Behavior Scale scores were academic title, specialty, and a history of lawsuits because of malpractice. A history of medical malpractice litigation was encountered among 24.7% of participants (n = 47). CONCLUSION: This study determined high rates of defensive medicine among physicians. Defensive medicine can harm patients, physicians, and also the healthcare system. Efforts should be made to keep health worker anxiety and risk perception in balance in order to prevent defensive medicine.

Prevalence of occupational exposure and its influence on job satisfaction among Chinese healthcare workers: a large-sample, cross-sectional study.

OBJECTIVES: This study had three objectives: (1) describe the prevalence of occupational exposure among Chinese medical personnel in detail, (2) verify the partial mediating role of work environment satisfaction in the relationship between occupational exposure and job satisfaction, and (3) examine if stress symptoms moderate the relationship between occupational exposure and job satisfaction. DESIGN: A large cross-sectional online survey was conducted in July 2018 in China. SETTING: A survey was conducted in 54 cities across 14 provinces of China. PARTICIPANTS: A total of 12 784 questionnaires were distributed, and 9924 healthcare workers (HCWs) completed valid questionnaires. The response rate was 77.63%. OUTCOME MEASURES: A confidential questionnaire was distributed to HCWs. The relationships among and the mechanisms of the variables were explored using descriptive statistical analyses, Pearson's correlation coefficient and multiple linear regression analysis. RESULTS: The most common occupational exposures among HCWs in the past 12 months were psychosocial and organisational hazards (85.93%). Overall, physicians (93.7%) and nurses (89.2%) were the main victims of occupational exposure. Occupational exposure correlated negatively with work environment satisfaction and job satisfaction, and positively with stress symptoms. Moreover, work environment satisfaction fully mediated the relationship between occupational exposure and job satisfaction, and stress symptoms moderated the relationship between occupational exposure and job satisfaction. CONCLUSION: The incidence of occupational exposure among HCWs is generally high. The high frequency of psychosocial and organisational hazards among physicians and nurses should be taken seriously and dealt with in a timely manner by hospital managers. The negative impact of occupational exposure on job satisfaction must be buffered by measures to reduce stress symptoms and enhance working environment satisfaction, ultimately improving the overall quality of life of HCWs and promoting comprehensive development of the medical team.

Safety of tympanoplasty and ossiculoplasty performed by otorhinolaryngology trainees.

OBJECTIVE: This study aimed to examine the impact of trainee involvement in performing tympanoplasty or tympano-ossiculoplasty on outcomes. METHODS: A retrospective analysis was performed of a prospective database of all patients undergoing tympanoplasty and tympano-ossiculoplasty in a single centre during a three-year period. Patients were divided into three primary surgeon groups: consultants, fellows and residents. The outcomes of operative time, surgical complications, length of hospital stay, and air-bone gap improvement were compared among the groups. RESULTS: The study included 398 tympanoplasty and tympano-ossiculoplasty surgical procedures, 71 per cent of which were performed by junior trainees (residents). The junior trainee group was associated with a significantly longer surgical time, without adverse impact on outcomes. CONCLUSION: Trainee participation in tympanoplasty and tympano-ossiculoplasty surgery was associated with longer surgical time, but did not negatively affect the peri-operative course or hearing outcome. Therefore, resident involvement in these types of surgery is safe.

A survey on clinical pathways of patients with epilepsy and cerebrovascular diseases or brain tumors.

OBJECTIVE: Patients with seizures and epilepsies comorbid with cerebrovascular disorders (CVDs) or brain tumors (BTs) are managed by different specialists, including neurologists with expertise in epilepsy (epileptologists), CVDs, and neuro-oncology, as well as neurologists without special expertise (general neurologists), and also emergency room physicians (EPs), intensive care physicians, and neurosurgeons. It has never been studied how these specialists interact for the treatment of seizures or epilepsy in these patients. METHODS: A survey was used to investigate how patients with such comorbidities are managed in hospitals in Italy. RESULTS: One hundred and twenty-eight specialists from hospitals in all parts of Italy filled in a questionnaire. Epileptologists were in charge of treatment of epilepsy in about 50% of cases while acute seizures were treated mainly by general neurologists (52% of cases). Diagnostic, therapeutic, and assistance pathways (PDTAs) for CVD and BT epilepsies were declared by physicians in about half of the hospitals while in about a quarter, there were only informal agreements and, in the remaining hospitals, there were no agreements between specialists. CVD neurologists, specialists in internal medicine, and EP were most often in charge of treatment of epilepsy comorbid with CVD. General neurologists, neuro-oncologists, and neurosurgeons were included in teams that manage BT epilepsies while epileptologists were included only in a small percentage of hospitals. CONCLUSIONS: Clinical decisions on epilepsy or seizures in patients with such comorbidities are often handled by different specialists. A new team culture and PDTAs are needed to guarantee high standards of diagnostic and therapeutic procedures.

Postoperative opioid-prescribing patterns among surgeons and residents at university-affiliated hospitals: a survey study

Background: Overprescribing of opioids to patients following surgery is a public health concern, as unused pills may be diverted and contribute to opioid misuse and dependence. The objectives of this study were to determine current opioid-prescribing patterns for common surgical procedures, factors that affect surgeons' prescribing behaviour and their perceived ability to manage patients with opioid use disorder. Methods: Survey participants included all consultant and trainee surgeons at the University of Toronto. The survey, which was administered electronically, included 52 multiple-choice, rank-order and open-text questions eliciting information on current prescribing patterns, prescribing of adjunct pain medications, and education and other factors related to opioid prescribing. Staff surgeons were also asked about how they manage patients with a suspected opioid issue. Results: Eighty surgical trainees and 40 staff surgeons responded to the survey (response rate 32%). Five staff surgeons (12%) felt adequately educated to prescribe pain medications (including opioids) at discharge. Staff surgeons prescribed Tylenol 3 more frequently than other opioids. Twenty (51%) of 39 staff surgeons reported that they sought further help for their patients when an opioid use disorder was suspected. Conclusion: Our results support existing studies showing a large degree of variability in postoperative opioid prescribing. Institutional guidelines have been shown to be effective in curbing excessive opioid prescribing without increasing unnecessary emergency department visits for uncontrolled pain. Thus, there is an opportunity to develop institutional guidelines to educate surgical teams in the prescribing of opioids and about services available for patients with a substance use disorder.

Contexte: La surprescription d'opioïdes aux patients après une chirurgie représente un problème de santé publique car il y a un risque que les comprimés inutilisés soient détournés et utilisés à mauvais escient, voire qu'ils causent la dépendance. Cette étude avait pour objectif d'identifier les modes actuels de prescription des opioïdes pour les chirurgies courantes, les facteurs qui influent sur les habitudes de prescription des chirurgiens et leur capacité perçue à prendre en charge les cas de mésusage des opioïdes. Méthodes: Les participants au sondage étaient tous les chirurgiens en poste et en formation à l'Université de Toronto. Ce sondage administré par voie électronique comprenait 52 questions (choix multiples, échelles ordinales et ouvertes) qui visaient à recueillir des renseignements sur les modes actuels de prescription, la prescription d'analgésiques d'appoint, l'enseignement au patient et autres éléments relatifs à la prescription des opioïdes. Les chirurgiens en poste ont aussi été interrogés sur leur gestion des cas présumés de mésusage des opioïdes. Résultats: Quatre-vingt chirurgiens en formation et 40 chirurgiens en poste ont répondu au sondage (taux de réponse, 32 %). Cinq chirurgiens en poste (12 %) se sont estimés adéquatement renseignés sur la façon de prescrire les analgésiques, (y compris les opioïdes) au moment du congé. Les chirurgiens en poste prescrivaient Tylenol 3 fois plus souvent que d'autres opioïdes. Vingt (51 %) chirurgiens en poste sur 39 ont dit consulter s'ils avaient besoin d'aide pour la prise en charge de patients soupçonnés de présenter un problème de mésusage des opioïdes. Conclusion: Nos résultats viennent étayer les conclusions d'études existantes selon lesquelles les modes de prescription des opioïdes en postopératoire varient grandement. Il a été démontré que l'adoption de lignes directrices institutionnelles permet de limiter efficacement la surprescription des opioïdes sans accroître indument le nombre de consultations aux urgences pour douleur non maîtrisée. Il y a donc là une possibilité d'adopter à plus grande échelle les lignes directrices institutionnelles pour sensibiliser les équipes chirurgicales à l'utilisation judicieuse des opioïdes et à l'existence des services à l'intention des patients qui présentent un problème de mésusage.

Surgeon attitudes toward point of care ultrasound for biliary disease: a nationwide Canadian survey

Summary: Multiple studies confirm that point of care ultrasound (PoCUS) has a high sensitivity and specificity for cholelithiasis and cholecystitis. However, there is poor perceived reliability of biliary PoCUS by surgeons. This survey was performed to assess surgeons' opinions on using PoCUS in gallstone disease and barriers that exist for its institution. The majority (60.3%) of respondents reported a total lack of confidence in PoCUS for the diagnosis of biliary disease. Most felt the sensitivity of PoCUS was poor and had concerns about the user-dependent nature of the test and the lack of imaging details provided. If offered ideal clinical/laboratory findings with PoCUS results, only 4.7% of surgeons would definitely operate for unremitting biliary colic and 5.4% for cholecystitis. The ability to replicate findings independently increased confidence in clinical decision-making. Our findings suggest there is substantial distrust in biliary PoCUS but that specific ultrasound training for the surgical workforce may prove tremendously beneficial for its utilization.

Survey of Contemporary Cardiac Surgery Intensive Care Unit Models in the United States.

BACKGROUND: Intensive care unit (ICU) structure and intensive care physician staffing (IPS) models are thought to influence outcomes after cardiac surgery. Given limited information on staffing in the cardiothoracic ICU, The Society of Thoracic Surgeons Workforce on Critical Care undertook a survey to describe current IPS models. We hypothesized that variability would exist throughout the United States. METHODS: A survey was sent to The Society of Thoracic Surgeons centers in the United States. Center case volume, ICU census, procedure profiles, and the primary specialties of consultants were queried. Definitions of IPS models were open (managed by cardiac surgeons), closed (all decisions made by dedicated intensivists 7 days a week), or semiopen (intensivist attends 5-7 days a week with surgeons cosharing management). Experience level of bedside providers and after-hours provider coverage were also assessed. RESULTS: Of the 965 centers contacted, 148 (15.3%) completed surveys. Approximately 41% of reporting centers used a dedicated cardiothoracic ICU for immediate postoperative management. The most common IPS model was open (47%), followed by semiopen (41%) and closed (12%). The primary specialties of intensivists varied, with pulmonary medicine/critical care being predominant (67%). Physician assistants were the most common after-hours provider (44%). More than one-third of responding centers described having no house staff, other than bedside nurses, for nighttime coverage. CONCLUSIONS: Cardiothoracic ICU models vary widely in the United States, with almost half being open, often with no in-house coverage. In-house nighttime coverage was (1) not driven by case complexity and (2) most commonly provided by a physician assistant. Clinical outcomes associated with different ISPS models require further evaluation.

Autoavaliação do conhecimento em cuidados paliativos por médicos residentes de um hospital universitário / Self-assessment of knowledge in paliative care by physicians resident of a university hospital / Autoevaluación de conocimientos en atención paliativa por médicos residentes de un hospital universitario

Objective: The study's purpose has been to verify the knowledge self-assessment of resident physicians at Hospital Universitário Lauro Wanderley (HULW) [University Hospital] regarding Palliative Care (PC). Methods: It is a quantitative, observational, and cross-sectional study that was carried out involving resident physicians at HULW who answered a questionnaire with sociodemographic and Palliative Care-related questions. Results: From a total of 172 physicians, 99 (57.6%) took part in this research, 47.5% were between 28 and 32 years old and 54.5% were female. Most of the participants claimed to have learned about the control of common symptoms in palliative assistance, although 97% needed improving their PC knowledge. Only 16.2% knew about the current PC Basic Law; However, over 80% understood the bioethical aspects of the research. Yet, over 75% of the answers which were compatible with PC knowledge occurred in only 5 out of the 16 questions (31.2%). Conclusion: There is a relative lack of knowledge regarding PC among the interviewed physicians, making further studies on curricular interventions imperative to contribute to the improvement of these professionals

Objetivo: Verificar a autoavaliação do conhecimento de médicos residentes do Hospital Universitário Lauro Wanderley (HULW) acerca de Cuidados Paliativos (CP). Métodos: Realizou-se um estudo observacional, transversal, quantitativo, envolvendo médicos residentes do HULW, que responderam ao questionário com perguntas sociodemográficas e conhecimentos em CP. Resultados: Dos 172 médicos, 99 (57,6%) participaram da pesquisa, 47,5% entre 28 e 32 anos e 54,5% do sexo feminino. A maioria respondeu que aprendeu sobre o controle dos sintomas comuns na assistência paliativista, embora 97% necessitassem aperfeiçoar seus conhecimentos sobre CP. Apenas 16,2% conheciam a atual Lei de Bases dos CP, porém mais de 80% compreendiam os aspectos bioéticos pesquisados. Contudo, mais de 75% de respostas compatíveis com conhecimento sobre CP ocorreram em apenas 5 das 16 questões (31,2%). Conclusão: Existe relativa escassez de conhecimento acerca dos CP entre os médicos entrevistados, tornando indispensáveis estudos adicionais de intervenções curriculares que possam contribuir para o aperfeiçoamento desses profissionais

Objetivo: verificar la autoevaluación del conocimiento de los médicos residentes en el Hospital Universitario Lauro Wanderley (HULW) sobre Cuidados Paliativos (CP). Métodos: se realizó un estudio observacional, transversal y cuantitativo con médicos residentes de HULW, que respondieron un cuestionario con preguntas sociodemográficas y conocimiento de los CP. Resultados: De los 172 médicos, 99 (57,6%) participaron en la investigación, 47,5% entre 28 y 32 años y 54,5% mujeres. La mayoría de los residentes respondieron que aprendió a respecto del control de los síntomas comunes en los CP, aunque el 97% respondieron que necesitaban mejorar su conocimiento de CP. Solo el 16,2% respondieron conocer la Ley Básica de CP actual, pero más del 80% conocían los aspectos bioéticos investigados. Sin embargo, los porcentajes superiores al 75% de las respuestas compatibles con el conocimiento de los CP ocurrieron en solo 5 de las 16 preguntas (31,2%). Conclusión: existe una relativa falta de conocimiento en el enfoque de los cuidados paliativos entre los médicos residentes entrevistados y a respecto de la ley actual de CP, haciendo necesidad de estudios adicionales de intervenciones curriculares que pueden contribuir para la mejora de habilidades y competencias de estos profesionales

A comparative evaluation of the publications of French public teaching hospitals from 2004 to 2014.

Care, teaching, and research are all priorities of the French public teaching hospitals. In 2004, the remuneration method evolved from a global endowment to a fee-for-services system, based on the use of bibliometric tools. These were used in the present study to describe the research patterns of public teaching hospitals in regards to care and teaching activities. The present study was based on data from the 32 French public teaching hospitals, between 2004 and 2014. Records concerning the publications number, hospital stays, full-time equivalent (FTE) practitioners, and residents per FTE physician were accessed. Statistical analyses were performed using means, Pearson correlation coefficients, and regression lines. The mean number of publications per FTE physician was 0.73, the mean number of hospital stays per FTE physician was 235.8 and the mean number of residents per FTE physician was 0.63. There was a moderate positive correlation between the number of publications per FTE physician and the number of residents per FTE physician (R=0.53) and a negligible correlation between the number of residents per FTE physician and the number of hospital stays per FTE physician (R=0.12). There was a low negative correlation between publication numbers per FTE physician and the number of stays per FTE physician (R=-0.41). All public teaching hospitals presented different patterns in terms of care, teaching, and research activities. None of the 32 hospitals performed well in all three activities. Only nine performed well in at least two out of the three missions.

Red cell transfusion practices after stage 1 palliation: a survey of practitioners from the Pediatric Cardiac Intensive Care Society.

INTRODUCTION: Neonates may require increased red cell mass to optimise oxygen content after stage 1 palliation; however, data informing transfusion practices are limited. We hypothesise there is a patient-, provider-, and institution-based heterogeneity in red cell transfusion decision-making after stage 1 palliation. METHODS: We conducted an online survey of Pediatric Cardiac Intensive Care Society practitioners in 2016. Respondents answered scenario-based questions that defined transfusion indications and identified haematocrit transfusion thresholds. Respondents were divided into restrictive and liberal groups based on a haematocrit score. Fisher's exact test was used to determine the associations between transfusion likelihood and patient, provider, and institutional characteristics. Bonferroni correction was applied to adjust the p-value to 0.004 for multiple comparisons. RESULTS: There was a 21% response rate (116 responses). Most were male (58.6%), attending physicians (85.3%) with >5 year of intensive care experience (88.7%) and subspeciality training in critical care medicine (47.4%). The majority of institutions were academic (96.6%), with a separate cardiac ICU (86.2%), and performed >10 stage 1 palliation cases annually (68.1%). After Bonferroni correction, there were no significant patient, respondent, or institutional differences between the restrictive and liberal groups. No respondent or institutional characteristics influenced transfusion decision-making after stage 1 palliation. CONCLUSIONS: Decision-making around red cell transfusion after stage 1 palliation is heterogeneous. We found no clear relationships between patient, respondent, or institutional characteristics and transfusion decision-making among surveyed respondents. Given the lack of existing data informing red cell transfusion after stage 1 palliation, further studies are necessary to inform evidence-based guidelines.

Consideraciones sobre la necesidad de supervisión a los ingresantes a las residencias médicas / On the need for supervision of the entrants to medical residences

Según la Asociación Americana de Facultades de Medicina existen 13 actividades profesionales confiables que los graduados de medicina deberían poder realizar en su primer día de residencia sin supervisión directa. Esas actividades no están claramente definidas en nuestro país. Además, no existen datos locales sobre la necesidad de su supervisión. Nuestro objetivo fue evaluar la opinión de residentes y docentes acerca del nivel de supervisión que requieren los médicos ingresantes al sistema de residencias para realizar esas actividades. Se efectuó un estudio de corte transversal. Se incluyeron residentes de primer año de especialidades clínicas y quirúrgicas y sus docentes. Se enviaron encuestas electrónicas o en papel, con participación voluntaria y anónima. Se investigó la estimación sobre el nivel de supervisión que requerían los médicos ingresantes durante el primer mes de formación para 13 actividades. Se observaron diferencias significativas entre la evaluación hecha por residentes (n = 71) y los docentes (n = 39) en 11 de 13 de esas actividades. Más de la mitad de los docentes consideró que los residentes requerían supervisión directa para realizarlas, con las excepciones de formular interrogatorios clínicos y buscar evidencia. La mayoría de los residentes consideró que se requería supervisión directa solo en seis de ellas. En conclusión, los residentes estimaron requerir menor supervisión que sus docentes, quienes pensaban que los ingresantes al sistema de residencia no eran capaces de realizar la mayoría de las competencias clínicas de manera autónoma. Sería importante mejorar esta evaluación en los recién graduados, para definir con mayor precisión los niveles de supervisión.

According to the Association of American Medical Colleges, there are thirteen core Entrustable Professional Activities (EPAs) that medical graduates should be able to perform in their first day of residency, without direct supervision. In Argentina EPAs are not clearly defined. Moreover, there is no local data about the need of supervision regarding these activities. The aim of this study was to assess residents' and teaching physicians' estimations about the level of supervision that physicians in their first month of residency needed in order to perform EPAs. A cross-section study was conducted. First-year medical residents and teaching physicians were included. Electronic or paper surveys were sent, asking the level of supervision the participants estimated that residents needed to perform the 13 core EPAs, during their first month of residency. Participation was voluntary and anonymous. There were significant differences between the opinion of residents (n = 71) and teaching physicians (n = 39), for 11 out of 13 EPAs. More than half of the teaching physicians considered that residents needed direct supervision when performing EPAs, except for asking clinical questions and looking for evidence. Most residents thought that they required direct supervision in 6 EPAs. In conclusion, medical residents perceived the need of lower levels of supervision when compared to teaching physicians, who considered that medical graduates were not capable of performing most EPAs without direct supervision upon entering residency. Thus, it would be important to improve the procedures to evaluate the competences of medical graduates in order to establish more accurate supervision levels.

Demographic, occupational, and societal features associated with burnout among medical oncology staff members: Cross-sectional results of a Cancer Center in Beijing, China.

BACKGROUND: There is a growing recognition that medical staff members are exposed to job and life stressors that increase the risk of burnout. This study aimed to investigate the potential stressors among medical staff members working at a Cancer Center in Beijing and to explore the demographic, occupational, and societal features associated with burnout. METHODS: This was a cross-sectional study. The Maslach Burnout Inventory (MBI) survey was distributed to all medical staff members, along with an anonymous questionnaire to collect general information about demographic, occupational, and societal characteristics. The data were analyzed using T test, ANOVA, and multivariable linear regression. RESULTS: A total of 1096 of 1208 (91%) medical staff members completed the questionnaires, including 285 (26%) doctors and 572 (52%) nurses. The scores for emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were 14.51 ± 9.78, 5.78 ± 5.59, and 35.07 ± 10.43, respectively. Domicile, being a nurse, working overtime, and low self-rated QoL were predictors of EE; Domicile, being a researcher, low self-rated health, low self-rated QoL, and bad colleague relationships were predictors of DP; Age, being a doctor or a nurse, low self-rated health, and low self-rated interpersonal relationships were predictors of low PA. CONCLUSION: Compared with the other occupations, doctors and nurses are more likely to experience burnout. Additionally, cultivating a better work environment, promoting the health and quality of life of staff, and improving rapport with colleagues may help to prevent burnout.

Perceptions of a night float system for intern doctors in an internal medicine program: an Asian perspective.

Long duty hours have been associated with significant medical errors, adverse events, and physician "burn-out". An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors' perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician "burn-out" (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician "burn-out".

Preparation for the next major incident: are we ready? A 12-year update.

OBJECTIVES: A major incident is any emergency that requires special arrangements by the emergency services and generally involves a large number of people. Recent such events in England have included the Manchester Arena bombing and the Grenfell Tower disaster. Hospitals are required by law to keep a major incident plan (MIP) outlining the response to such an event. In a survey conducted in 2006 we found a substantial knowledge gap among key individuals that would be expected to respond to the enactment of an MIP. We set out to repeat this survey study and assess any improvement since our original report. METHODS: We identified NHS trusts in England that received more than 30 000 patients through the emergency department in the fourth quarter of the 2016/2017 period. We contacted the on-call anaesthetic, emergency, general surgery, and trauma and orthopaedic registrar at each location and asked each individual to answer a short verbal survey assessing their confidence in using their hospital's MIP. RESULTS: Of those eligible for the study, 62% were able to be contacted and consented to the study. In total 50% of respondents had read all or part of their hospital's MIP, 46.8% were confident that they knew where their plan was stored, and 36% knew the role they would play if a plan came into effect. These results show less confidence among middle-grade doctors compared with 2006. CONCLUSIONS: Confidence in using MIPs among specialty registrars in England is still low. In light of this, we make a number of recommendations designed to improve the education of hospital doctors in reacting to major incidents.