Correlation between psychosocial work factors and the degree of stress.

BACKGROUND: Psychosocial risks and work-related stress are one of the most complex, most significant and most challenging problems that organizations around the world are facing. Stress negatively affects all participants in the organization and significantly contributes to negative health consequences and economic outcomes. OBJECTIVE: With timely identification and adequate assessment of psychosocial risks, it is possible to create healthy workplaces and healthy organizations where employees are satisfied and motivated. The paper will present the results of the research of psychosocial risks on a large sample of respondents in the Republic of Serbia. METHODS: A questionnaire was distributed to 1,212 participants of which 1,140 answered all the questions asked. Data from the questionnaire were analyzed using multiple regression analysis, Kolmogorov-Smirnov test, Spearman's correlation coefficient and Pearson's chi-square test (χ2). RESULTS: The results of multiple regression analysis showed that all psychosocial risks taken together are statistically significantly (p < .001) and explain 24%of the variance of the criteria. CONCLUSIONS: Psychosocial risks identified as statistically significant predictors are Labor Demands, Interpersonal Relations, Lack of Support, Work Role and Job Uncertainty. All predictors are statistically significant predictors at the level.01.

Education: The Heart of the Matter.

There are inadequate numbers of anesthesia providers in many parts of the world. Good quality educational programs are needed to increase provider numbers, train leaders and teachers, and increase knowledge and skills. In some countries, considerable external support may be required to develop self-sustaining programs. There are some key themes related to educational programs in low- and middle-income countries:(1) Programs must be appropriate for the local environment-there is no "one-size-fits-all" program. In some countries, nonuniversity programs may be appropriate for training providers.(2) It is essential to train local teachers-a number of short courses provide teacher training. Overseas attachments may also play an important role in developing leadership and teaching capacity.(3) Interactive teaching techniques, such as small-group discussions and simulation, have been incorporated into many educational programs. Computer learning and videoconferencing offer additional educational possibilities.(4) Subspecialty education in areas such as obstetric anesthesia, pediatric anesthesia, and pain management are needed to develop leadership and increase capacity in subspecialty areas of practice. Examples include short subspecialty courses and clinical fellowships.(5) Collaboration and coordination are vital. Anesthesiologists need to work with ministries of health and other organizations to develop plans that are matched to need. External organizations can play an important role.(6) Excellent education is required at all levels. Training guidelines could help to standardize and improve training. Resources should be available for research, as well as monitoring and evaluation of educational programs.

The Safety and Efficacy of the Continuous Peripheral Nerve Block in Postoperative Analgesia of Pediatric Patients.

Postoperative analgesia is imperative in the youngest patients. Pain, especially if experienced during childhood, has numerous adverse effects-from psychological, through complications of the underlying disease (prolonged treatment, hospital stay, and increased costs of the treatment) to an increase in the incidence of death due to the onset of the systemic inflammatory response. Peripheral blocks provide analgesia for 12-16 h, and are safer due to rare side effects that are easier to treat. The continuous peripheral block (CPNB) has been increasingly used in recent years for complete and prolonged analgesia of pediatric patients, as well as a part of multidisciplinary treatment of complex regional pain syndrome. It has been shown that outpatient CPNB reduces the need for parenteral administration of opioid analgetics. It has also been proved that this technique can be used in pediatric patients in home conditions. Safety of CPNB is based on the increasing use of ultrasound as well as on the introduction of single enantiomers local anesthetics (ropivacaine and levobupivacaine) in lower concentrations. It is possible to discharge patient home with catheter, but it is necessary to provide adequate education for staff, patients, and parents, as well as to have dedicated anesthesiology team. Postoperative period without major pain raises the morale of the child, parents. and medical staff.

High rate of burnout among anaesthesiologists in Belgrade teaching hospitals: Results of a cross-sectional survey.

BACKGROUND: Decisions by anaesthesiologists directly impact the treatment, safety, recovery and quality of life of patients. Physical or mental collapse due to overwork or stress (burnout) in anaesthesiologists may, therefore, be expected to negatively affect patients, departments, healthcare facilities and families. OBJECTIVES: To evaluate the prevalence of burnout among anaesthesiologists in Belgrade public teaching hospitals. DESIGN: A cross-sectional survey. SETTING: Anaesthesiologists in 10 Belgrade teaching hospitals. MAIN OUTCOME MEASURES: Burnout was assessed using Maslach Burnout Inventory-Human Services Survey. RESULTS: The response rate was 76.2% (205/272) with the majority of respondents women (70.7%). The prevalence of total burnout among anaesthesiologists in Belgrade teaching hospitals was 6.34%. Measured level of burnout as assessed by high emotional exhaustion, high depersonalisation and low personal accomplishment was 52.7, 12.2 and 28.8%, respectively. More than a quarter of the studied population responded in each category with symptoms of moderate burnout. We detected that sex, additional academic education, marital status and working conditions were risk factors for emotional exhaustion and depersonalisation. Ageing increased the likelihood of burnout by 21.3% with each additional year. Shorter professional experience and increased educational accomplishment increased the risk of total burnout by 272%. CONCLUSION: Burnout rates in Belgrade teaching hospitals among anaesthesiologists are higher than in foreign hospitals. Emotional and/or physical breakdowns can have serious effects when these individuals care for patients in extremely stressed situations that may occur perioperatively. Causes for burnout should be examined more closely and means implemented to reverse this process.

Psychometric Properties of the Serbian Version of the Maslach Burnout Inventory-Human Services Survey: A Validation Study among Anesthesiologists from Belgrade Teaching Hospitals.

We report findings from a validation study of the translated and culturally adapted Serbian version of Maslach Burnout Inventory-Human Services Survey (MBI-HSS), for a sample of anesthesiologists working in the tertiary healthcare. The results showed the sufficient overall reliability (Cronbach's α = 0.72) of the scores (items 1-22). The results of Bartlett's test of sphericity (χ(2) = 1983.75, df = 231, p < 0.001) and Kaiser-Meyer-Olkin measure of sampling adequacy (0.866) provided solid justification for factor analysis. In order to increase sensitivity of this questionnaire, we performed unfitted factor analysis model (eigenvalue greater than 1) which enabled us to extract the most suitable factor structure for our study instrument. The exploratory factor analysis model revealed five factors with eigenvalues greater than 1.0, explaining 62.0% of cumulative variance. Velicer's MAP test has supported five-factor model with the smallest average squared correlation of 0,184. This study indicated that Serbian version of the MBI-HSS is a reliable and valid instrument to measure burnout among a population of anesthesiologists. Results confirmed strong psychometric characteristics of the study instrument, with recommendations for interpretation of two new factors that may be unique to the Serbian version of the MBI-HSS.

Preventive effect of ursodeoxycholic acid on parenteral nutrition-associated liver disease in infants.

INTRODUCTION: Parenteral nutrition-associated cholestasis is well recognized phenomenon in the term and preterm infant receiving long-term parenteral nutrition. OBJECTIVES: The aim of this study was to evaluate the effect of ursodeoxycholic acid (UDCA) use on cholestasis in newborns on prolonged TPN. METHODS: A total of 56 infants were enrolled in this retrospective study: control group consisted of lower (1500 g) birth weight infants (n = 30), as well as the group of pediatric (n = 11) and surgical patients (n = 15) treated with UDCA. Blood chemistries were obtained two times weekly. RESULTS: All of 56 newborns developed cholestasis but duration of parenteral nutrition (PN) before onset of cholestasis was significantly longer in UDCA treated patients. Average duration of PN before the onset of cholestasis in control group of patients was 25 days in distinction from treated pediatric and surgical patients (39 and 34 days, respectively).The peak serum conjugated bilirubin (CB), AST, ALT and alkaline phosphatase (AP) levels were significantly lower in the treated groups.There was no significant difference among treated pediatric and surgical patients and between lower and higher birth weight infants considering the CB, ALT, AST and AP peak. Duration of cholestasis was significantly decreased in all treated groups.There was a significant difference in time needed to achieve complete enteral intake between pediatric and surgical patient group. CONCLUSION: Cholestasis developed significantly later in treated groups than in the controls. UDCA appears to be very successful in reducing the symptoms of cholestasis. The difference in efficacy of UDCA treatment between lower and higher birth weight infants could not be proven.

Preoperative preparation of patients with infectious and restrictive respiratory diseases as comorbidities.

In patients with respiratory pathology changes in respiratory physiology may lead to clinical problems during the conduct of anesthesia and the perioperative period. An understanding of the disease processes that can affect the lungs and pleura allows the anesthesiologist to account for the potential complications of these conditions and manage the anesthetic accordingly. This article describes the initial evaluation of a patient with respiratory problems. A thorough medical history, physical examination and some functional tests are the keys in decision-making in preparation for anesthesia and surgery. The burden of respiratory disease is reviewed, and some important areas of current interest are highlighted.

Preoperative preparation of patients with renal diseases.

If patients with renal diseases had to undergo surgical intervention, they should be prepared in such a way to be in a stable phase of the underlying surgical disease, without any infection, euvolemic, with satisfactory blood pressure and corrected electrolyte balance. These patients need to be hydrated well before intervention, the fall of blood pressure during intervention should be avoided and adequate hydration after the intervention must be continued (taking into account the condition of the kidneys, heart and age of patient). It is assumed that nephrotoxic drugs are to be evaded in renal patients or, if they were necessary, the dosage and dosing interval should be adjusted and prolonged, respectively. The use of radiographic contrast is not advisable, but if required, plentiful hydration will be needed, the least workable contrast dose and, if possible, with lower ionic charge and lower osmolarity will be administered. If surgical intervention was urgent and if there was not enough time for conservative therapy, i.e., correction of electrolytes, volemia, blood pressure and higher values of nitrate substances, a renal patient would be temporarily dialyzed in the immediate preoperative and postoperative course. Any surgical intervention in these patients may aggravate the renal function and bring the patient closer to dialysis treatment. Nevertheless, sometimes the benefit of surgical treatment for the acute surgical disease is higher (especially if it was life-threatening) than the risk of renal function exacerbation and coming closer to dialysis.

Preoperative assessment and management of patient with psychiatric comorbidity.

This article explains the most frequent psychiatric disorders such as co-morbidity in the acute surgical treatment, along with its position and importance for the surgical procedure. Besides basic features of these disorders, epidemiology and clinical expression, this article holds the latest therapeutic approach, side effects, toxicity and drug interactions, during the surgical procedure. Frequent postoperative problems, delirium, and postoperative cognitive disorders are noted in these patients. To avoid these complications, it is recommended to use a mini-mental score examination to re-evaluate the decision and indication for high risk surgery patient.

Preoperative preparation of alcohol and psychoactive substances-addicted patients.

Proper diagnosis of psychoactive substance abuse and addiction, as well as acute intoxication, withdrawal syndrome and overdosing are of great importance in patients who are preparing for surgical intervention. There are some specific details in their preoperative preparation whether they underwent emergency or elective surgery. Good knowledge of the characteristics of psychoactive substance abuse and addiction, interaction of psychoactive substances and anesthetics and any other drugs that could be used in the perioperative period is important especially for anastesiologist. In this work we present key issues for recognizing theese patients as well as some guidelines for adequate preoperative preparation and postoperative care.