Merck Animal Health Veterinary Team study reveals factors associated with well-being, burnout, and mental health among nonveterinarian practice team members.

OBJECTIVE: To assess the levels of burnout, well-being, and mental health of nonveterinarian employees of veterinary practices and, for context, compare them to veterinarians and the general population by use of validated instruments. METHODS: An online survey of 2,271 nonveterinary practice employees drawn from members of the North American Veterinary Technicians Association, members of the Veterinary Hospital Managers Association, referrals from veterinarian respondents to a companion survey, and a large hospital group that owns several hundred US veterinary practices. The study was fielded from September 11 to October 9, 2023. RESULTS: A majority of practice team members were satisfied with their work in veterinary medicine. However, serious psychological distress was twice as prevalent among team members as among veterinarians and well-being was lower than that of veterinarians. Burnout was similar to veterinarians. Personality played a role: team members on average were more likely to score higher in neuroticism than veterinarians and the general population, and neuroticism was a predictor of low well-being, poor mental health, and burnout. There was also evidence of substantial financial stress among team members. CONCLUSIONS: Serious psychological distress was common among practice team members. Financial stress may play a role. Burnout and low levels of well-being were also common. CLINICAL RELEVANCE: This study provided a useful profile of the psychological conditions that many practice employees may be experiencing.

Work-life balance is essential to reducing burnout, improving well-being.

OBJECTIVE: To assess levels of burnout, well-being, and mental health of veterinarians and compare them to those of nonveterinarians by use of validated instruments, and to identify the predictive values of techniques individuals can use to help reduce burnout and/or improve well-being and mental health. SAMPLE: An online survey of 4,636 veterinarians from a random sample of 40,000 US veterinarians provided by the AVMA. METHODS: The study was fielded from September 11 to October 9, 2023. RESULTS: Burnout and well-being of veterinarians were generally consistent with that of employed US adults. Serious psychological distress was more common among veterinarians than in the general population. Veterinarians on average were more likely to score higher in neuroticism than nonveterinarians, and neuroticism was a predictor of low well-being, poor mental health, and burnout. Work-life balance, an effective coping mechanism for stress, and working in a positive clinic culture were among the significant factors that predicted good well-being and mental health and reduced burnout. CLINICAL RELEVANCE: The higher percentage than the norm of veterinarians with serious psychological distress was a concern. Focusing on maintaining a good work-life balance and adopting a reliable coping mechanism can potentially help reduce distress. Veterinary medicine is an inherently stressful profession. The purpose of this study was to identify key factors that contribute to burnout, well-being, and mental health and to determine what behaviors and management techniques help reduce stress and burnout and contribute to well-being and mental health, thus improving job satisfaction and personal fulfillment.

Army Combat Fitness Test Scores Moderate Cognitive Function Improvements After a Ruck March: A Hierarchical Linear Model Approach.

ABSTRACT: Sax van der Weyden, M, Merrigan, JJ, Newman, K, Hahn, J, and Martin, J. Army Combat Fitness Test scores moderate cognitive function improvements after a ruck march: A hierarchical linear model approach. J Strength Cond Res 38(7): 1314-1320, 2024-Heavy load carriage is a common task for military personnel and can lead to undue physical and mental fatigue. The purpose of this study was to assess effects of load carriage on cognitive function (CF) and the role individual characteristics play in CF responses. Anthropometrics/body composition, demographics, and Army Combat Fitness Test (ACFT) scores were gathered from 47 Reserve Officers' Training Corps cadets. Cadets' CF was assessed through the concentration task grid (CTG) before (preruck), immediately after (postruck), and 3 weeks after (follow-up) a 16.09- to 19.31-km ruck march. Hierarchical linear modeling was used, with α < 0.05. The final model revealed growth, or improvement, in CF from preruck to postruck with growth decelerating, but still improved, at follow-up. The load carriage bout improved CF in most cadets, with average growth from 5.67- to 7.20-grid squares found. However, postruck CF did not return to the same level as a controlled follow-up (9.69). Sex (2.46, female), familiarity with the CTG (1.99), ACFT total scores (0.009), and relative ruck mass (-0.09) were all significant predictors of postruck CF. Army Combat Fitness Test scores (0.008) were also significant predictors of the slope between preruck and postruck, such that an ACFT score 59 points above average would result in a 1-grid square greater improvement in CF postruck. The significance of ACFT scores, lower relative ruck mass, and familiarization highlights the importance physical and mental preparation for desirable CF outcomes after occupational tasks.

Executive summary of the Merck Animal Health Veterinarian Wellbeing Study III and Veterinary Support Staff Study.

OBJECTIVE: Merck Animal Health Veterinarian Wellbeing Study III was conducted to continue to monitor mental health and well being within the veterinary profession in the US and to identify factors associated with high levels of wellbeing and lack of serious psychological distress. METHODS: A questionnaire consisting of several instruments and questions for measurement of mental health and wellbeing was completed by 2,495 veterinarians and 448 veterinary support staff. Results for veterinarians were weighted to the US AVMA membership. RESULTS: This study revealed that wellbeing and mental health of some veterinarians declined over the past 2 years, driven in part by the COVID-19 pandemic and extreme labor shortages. Burnout remained at a high level, but there was no increase in suicide ideation. A new companion survey of veterinary support staff demonstrated that staff scored lower in wellbeing and mental health, and higher in burnout than veterinarians. CLINICAL RELEVANCE: Importantly, these studies identified techniques that both individuals and employers may find useful in fostering wellbeing and good mental health. A healthy method for coping with stress and good work-life balance was important, as was engaging a financial adviser for those with student debt or other financial stresses. Employers should create safe environments where employees feel comfortable seeking help, reducing the stigma associated with mental health issues. In addition, employers can provide Employee Assistance Programs and health insurance that covers mental health treatment. Fostering a healthy work culture was also important, one with good communication, teamwork, trust, and adequate time allotted to provide quality patient care.

Antibiotic related acute kidney injury in patients treated for open fractures.

OBJECTIVE: Antibiotic administration during the treatment of open fractures has been shown to reduce infection rates and is considered a critical step in the management of these injuries. The purpose of this study was to determine if aminoglycoside administration during the treatment of open fractures leads to acute kidney injury. METHODS: Patient records at a level I trauma centre were reviewed for adult patients who presented in 2014 with open fractures were screened for inclusion. Patients were excluded with fractures of the phalanges, metatarsals, and metacarpals, with isolated traumatic arthrotomies, or pre-existing renal dysfunction. Charts were reviewed for patient age, gender, race, past medical history, medication history, injury severity score, intravenous dye studies and fracture type. Patients were divided into those given cefazolin (Group A) and cefazolin with gentamicin (Group B). Laboratory values were used to determine which patients developed kidney dysfunction as measured using the RIFLE criteria. Wilcoxon-Mann-Whitney test and Chi-square were used to compare interval and categorical variables, respectively. Significance was set at P<0.05. RESULTS: One-hundred and fifty-nine patients met inclusion criteria. Forty-one (25%) patients were given cefazolin alone and 113 (68%) patients were given cefazolin with gentamicin. Ten (18%) patients with Gustilo-Anderson type III fractures were given cefazolin alone and 67 (67%) patients with types I or II fractures were given a cefazolin with gentamicin. Baseline characteristics and risk factors for renal dysfunction did not vary between groups. Two (4.8%) patients in Group A and 5 (4%) patients in Group B developed acute kidney injury (P=0.599). CONCLUSIONS: Gentamicin use during the treatment of open fractures does not lead to increased rates of renal dysfunction when used in patients with normal baseline renal function.

Biomechanical comparison of Krackow locking stitch versus nonlocking loop stitch with varying number of throws.

BACKGROUND: Common suture configuration techniques used for ligament and tendon grafts and repair are the Krackow locking stitch and a nonlocking loop stitch, such as a whipstitch. Clinically, the preferences of orthopaedic surgeons vary. HYPOTHESIS: The Krackow locking stitch and the nonlocking whipstitch, with varying suture loops, produce different biomechanical and physical effects on the tendon end. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 52 fresh-frozen porcine flexor digitorum tendons were used and assigned into 10 groups. Two stitch configurations (Krackow stitch [K] and whipstitch [W]) with varying number of loops (2 throws, n = 6; 4 throws, n = 5; 6 throws, n = 5; 8 throws, n = 5; 10 throws, n = 5) were tested. No. 2 FiberWire was used. Each sample was preloaded to 5 N and then cyclically loaded for 200 cycles to 200 N at 1 Hz, and then the tendon-suture construct was analyzed for gap formation, tendon elongation, and tendon end width. Next, each tendon was loaded to failure, and ultimate strength and mode of failure were recorded. Data were evaluated with 2-way analysis of variance. RESULTS: For gap formation, the Krackow stitch produced less gap compared with the whipstitch (15.2 ± 4.0 mm [K] vs 18.9 ± 6.8 mm [W]; P = .012). Gap formation was larger when the number of loops increased from 2 to ≥6 (P = .015). For elongation, the Krackow technique increased the tendon length after cyclic loading. In contrast, the whipstitch was noted to shorten the length of the tendon (1.17 ± 0.97 mm [K] vs -0.14 ± 1.13 mm [W]; P < .001). For tendon end width, the Krackow better preserved the transverse width (-0.64 ± 0.81 mm [K] vs -1.39 ± 0.64 mm [W]; P = .001). Both stitch types had similar ultimate strength (322.1 ± 20.3 N [K] vs 319.7 ± 20.4 N [W]; P = .676) and modes of failure (all by suture breakage; therefore, no statistical calculation was performed). There was no statistical difference in tendon elongation, width, failure load, or mode regardless of the number of throws. CONCLUSION/CLINICAL RELEVANCE: Given the finding that the Krackow suture had less gap formation and better preservation of tendon architecture (length and width) compared with the whipstitch, coupled with the finding that ultimate strength is similar with both types of sutures, the Krackow stitch is recommended for tendon reconstruction when these parameters are important.

The role of adjuvant radiation therapy in the treatment of spinal myxopapillary ependymomas.

OBJECT: the goal in this study was to determine the role of radiation therapy (RT) in the treatment of spinal myxopapillary ependymomas (MPEs). METHODS: thirty-seven patients with histologically verified spinal MPEs were reviewed. Kaplan-Meier analyses and Cox proportional hazard regression were used to determine what patient and treatment factors influenced overall survival (OS) and recurrence. RESULTS: at the time of initial diagnosis, the median age was 33 years and the Karnofsky Performance Scale score was 80. In 86.5% of cases, the most common presenting symptom was pain. All patients received surgery as their initial treatment. Nine patients also received RT along with surgery, with a median total dose of 50.2 Gy. The mean survival time was 12.2 years; however, only 4 of 37 patients had died at the time of this study. None of the patient or treatment parameters significantly correlated with OS. Sixteen patients (43.2%) were found to have a recurrence, with a median time to recurrence of 7.7 years. None of the patient or treatment parameters correlated with recurrence-free survival for an initial recurrence. The median time to the second recurrence (recurrence following therapy for initial recurrence) was 1.6 years. Use of RT as salvage therapy after initial recurrence significantly correlated with longer times to a second recurrence. The median recurrence-free survival time before the second recurrence was 9.6 years for those who received RT versus 1.1 years for those who did not receive RT (p = 0.0093). None of the other parameters significantly correlated with a second recurrence. CONCLUSIONS: radiation therapy may have a role as salvage therapy in delaying recurrences of spinal MPEs.

Surgically induced brain injury in rats: the effect of erythropoietin.

Brain tissue at the edge of a surgical resection site is at risk for damage from direct trauma, retractor stretch, hemorrhage, edema, and electrocautery. In this study we used a new rodent model of surgically induced brain injury (SBI) to study this tissue at the edge of a resection site. The SBI model entails stereotaxic resection of part of the right frontal lobe. We tested pretreatment with erythropoietin, a known neuroprotectant, for protective effects in this model. Three groups of male Sprague-Dawley rats (280-330g) were used: SBI without treatment (n=63), SBI with EPO treatment (n=76), and Sham surgery (n=12). Rats were sacrificed 24h, 72h, and 7 days after SBI or Sham surgery. Postoperative assessment included mortality, histology, immunohistochemistry, Evans blue exudation, brain water content, and magnetic resonance imaging. No difference was found between untreated and EPO-treated groups in mortality, histology, TUNEL, magnetic resonance imaging, or blood-brain-barrier breakdown. The EPO-treated group had statistically more brain water content at 24h than the untreated group. Immunohistochemistry demonstrated a qualitative increase in VEGF in the EPO-treatment group. We conclude that EPO does not ameliorate damage in SBI, and may increase brain edema early after surgery.

Long-term survival and functional status of patients with low-grade astrocytoma of spinal cord.

PURPOSE: To determine survival and changes in neurologic function and Karnofsky performance status (KPS) in a series of patients treated for low-grade astrocytoma of the spinal cord during the past two decades. METHODS: This study consisted of 14 patients with pathologically confirmed low-grade astrocytoma of the spinal cord who were treated between 1980 and 2003. All patients underwent decompressive laminectomy followed by biopsy (n = 7), subtotal resection (n = 6), or gross total resection (n = 1). Ten patients underwent postoperative radiotherapy (median total dose 50 Gy in 28 fractions). The overall survival, progression-free survival, and changes in neurologic function and KPS were measured. RESULTS: The overall survival rate at 5, 10, and 20 years was 100%, 75%, and 60%, respectively. The progression-free survival rate at 5, 10, and 20 years was 93%, 80%, and 60%, respectively. Neither overall survival nor progression-free survival was clearly correlated with any patient, tumor, or treatment factors. Neurologic function and KPS worsened after surgery in 8 (57%) of 14 and 9 (69%) of 13 patients, respectively. At a mean follow-up of 10.2 years, neurologic function had stabilized or improved in 8 (73%) of 11 remaining patients, but the KPS had worsened in 5 (50%) of 10. Most patients who were employed before surgery were working at last follow-up. CONCLUSION: Patients who undergo gross total resection of their tumor may be followed closely. Patients who undergo limited resection should continue to receive postoperative RT (50.4 Gy in 1.8-Gy fractions). The functional measures should be routinely evaluated to appreciate the treatment outcomes.