Pelvic Exenteration - Past, Present and Future.

Background: Bearing in mind that the open procedure is already validated by multiple studies, the article aims to prove that pelvic exenteration performed in a minimally invasive fashion might offer better survival and to potentially identify prognostic factors for the outcome of these patients. Material and Methods: Data regarding past and present classifications and surgical indications are presented. Patient data were collected retrospectively. Results: The most frequent diseases treated with pelvic exenteration, in terms of the hystological type, were gynecological malignancy and squamous cell carcinoma. Recurrent pelvic disease was found in 68.2% of patients. R0 resection was achieved in 72.7% of patients in the MI group, and in 73.7% of patients in the OP group. Peri-operative morbidity was reported to be 56.6% for open surgery, and 18.1% for minimally invasive. Average DFS was 20.15 months, ranging from 1.5 to 70.3 months, while the OS was calculated to be 38.1 months (0.33 1508) up until November 2023. Conclusion: Pelvic exenteration is a continuously improving surgical procedure, open approach being favored to minimally invasive one. On the other hand, hospitalization and morbidity are reduced when choosing the latter. R0 and lymph node status are important predictors for overall survival, as well as major early postoperative complications. All in all, pelvic exenteration is still a promising surgical procedure to extend cancer patients lives.

Assessment of Physicians' Willingness to Work with Patients Not Yet Diagnosed with COVID-19 in a Romanian Sample.

BACKGROUND: The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk. METHODS: In the summer of 2020, 1285 Romanian physicians participated in a single-center study. Participants (mean age = 48.21 years; 302 males and 982 females, all specialties) completed a series of single-item measures adapted from previous studies on work ethics and responsibility. This study used Mann-Whitney comparisons between physicians who reported that they knowingly had direct contact with COVID patients and those who did not regarding their willingness to work. RESULTS: Compared with their colleagues, physicians who reported not knowingly having direct contact with COVID patients reported less access to protective equipment, less overall willingness to respond when asked to work with infected patients, more likely to work out of fear of losing their jobs, and fear of legal repercussions. They received less training in the use of protective equipment. CONCLUSIONS: Physicians who worked with patients not yet diagnosed with COVID-19 were significantly less willing to work. The perception of invisible risk may explain the observed differences.

Factors Associated with Burnout in Medical Staff: A Look Back at the Role of the COVID-19 Pandemic.

Despite the significant consequences for medical practice and public health, burnout in healthcare workers remains underestimated. Pandemic periods have increased the reactivity to stress by favoring some changes whose influence are still felt. PURPOSE: This study aims to identify opportune factors during pandemic periods that predispose medical personnel to burnout and the differences between medical staff which worked with COVID-19 patients and those who did not work with COVID-19 patients. MATERIAL AND METHODS: This is a prospective study on 199 subjects, medical staff and auxiliary staff from national health units, COVID-19 and non-COVID-19, who answered questions using the Google Forms platform about the level of stress related to the workplace and the changes produced there. All statistical analyses were conducted using IBM SPSS Statistics (Version 28). RESULTS: The limited equipment and disinfectant solutions from the lack of medical resources category, the fear of contracting or transmitting the infection from the fears in relation to the COVID-19 pandemic category and the lack of personal and system-level experience in combating the infection due to the lack of information on and experience with COVID-19 were the most predisposing factors for burnout. No significant differences were recorded between those on the front line and the other healthcare representatives. CONCLUSIONS: The results of this study identify the stressors generated in the pandemic context with prognostic value in the development of burnout among medical personnel. At the same time, our data draw attention to the cynicism or false-optimism stage of burnout, which can mask a real decline.

Physicians' Trust in Relevant Institutions during the COVID-19 Pandemic: A Binary Logistic Model.

Little research has been done on professionals' perceptions of institutions and governments during epidemics. We aim to create a profile of physicians who feel they can raise public health issues with relevant institutions during a pandemic. A total of 1285 Romanian physicians completed an online survey as part of a larger study. We used binary logistic regression to profile physicians who felt they were able to raise public health issues with relevant institutions. Five predictors could differentiate between respondents who tended to agree with the trust statement and those who tended to disagree: feeling safe at work during the pandemic, considering the financial incentive worth the risk, receiving training on the use of protective equipment, having the same values as colleagues, and enjoying work as much as before the pandemic. Physicians who trusted the system to raise public health issues with the appropriate institutions were more likely to feel that they shared the same values as their colleagues, to say they were trained to use protective equipment during the pandemic, to feel that they were safe at work during the pandemic, to enjoy their work as much as before the pandemic, and to feel that the financial bonus justified the risk.

A comparison using standardized measures for patients with irritable bowel syndrome: Trust in the gastroenterologist and reliance on the internet.

BACKGROUND: Irritable bowel syndrome (IBS) patients' use of the Internet for health information interacts with the way they trust their gastroenterologist. No standardized measure has targeted IBS patients and gastroenterologists specifically, nor their use of the Internet. The aims of this paper were as follows: the development of a scale that measures an IBS patient's trust in their gastroenterologist, the development of a scale measuring an IBS patient's reliance on Internet health information, and testing the hypothesis that IBS patients, who use the Internet for IBS-related information, trust their gastroenterologist less than those who do not. METHOD: A total of 82 patients (mean age 49, SD = 14.62) diagnosed with IBS completed two questionnaires: one about trust in their gastroenterologist and the other about the reliance on Internet health information regarding IBS. The two questionnaires were built using current literature as well as our previous qualitative research. The statistical computations were performed using the SPSS 20 program. KEY RESULTS: Both questionnaires proved to be reliable in measuring gastroenterologist-IBS patient trust (alpha = 0.87) and Internet information reliance (alpha = 0.88), respectively. The IBS patients who did not look for information about IBS over the Internet had significantly higher trust in their gastroenterologist compared with those who did (U = 535.5; z = -2.26; P < 0.05). CONCLUSIONS: We developed two ready-to-use scales to measure both the gastroenterologist-IBS patient's trust and the IBS patient's reliance on the Internet. Further studies will be able to explore the interaction among all variables in IBS patients' trust.

Transanal Total Mesorectal Excision - A Case Report.

Transanal total mesorectal excision (TaTME), first introduced in 2010, represents a relatively new approach in the surgical treatment of rectal cancer. A case of a 65-years-old patient diagnosed with moderately differentiated adenocarcinoma of the middle rectum (cT2N0M0) is presented. Taking into consideration patient's characteristics and tumour features, the surgical team decided to use transanal total mesorectal excision technique. The surgical technique, as well as potential postoperative complications and oncological issues are discussed in the article. Patient selection and extensive experience in minimally invasive colorectal surgery are the bases for an optimal technique implementation. Although further studies are required in order to confirm its superiority over the laparoscopic total mesorectal excision, TaTME seems to be a safe and feasible option in the surgical approach of rectal cancer.

Mind the Gap Between Scientific Literature Recommendations and Effective Implementation. Is There Still a Role for Surgery in the Treatment of Locally Advanced Cervical Carcinoma?

According to evidence accumulated in the last years, many cancer centers recommend a treatment plan based solely on chemo-radiotherapy and exclude surgery from the treatment options in locally advanced cervical cancer (LACC). In Romania, surgery was at the forefront of therapeutic options. Nevertheless, current data shows that in fact, a large number of patients are still referred to surgery in various stages of diagnosis and treatment. It was noted that recommendations may differ, in spite of the wide dissemination of the literature data.Works published so far, discussing the role of surgery in LACC treatment shows a lack of consensus. A group of experts in oncology (SURCECAN research group - Surgery of Cervical Cancer) met for a session of the Romanian Surgical Society (Bucharest) on April 18, 2018. They found that LACC therapeutic strategy in Romania may differ somewhat from the European recommendations.On top of that, late enrolement to RT and low acces to specialized centers are the problem. Performing surgery not only allows the evaluation of the pathological response to chemo-radiotherapy, but also achieves a better local control. In conclusion, there is still a place for surgery within locally advanced cervical cancer treatment options. More trials need to be carried out in order to confirm the findings and establish high levels of confidence for each piece of information provided.

A Meta-Analysis for the Efficacy of Hypnotherapy in Alleviating PTSD Symptoms.

A systematic review and meta-analysis of the efficacy of hypnotherapy in the treatment of PTSD used literature searches to obtain 47 articles. However, only 6 were experiments testing the efficacy of hypnosis-based treatments. A fixed-effects meta-analysis was applied to postintervention assessment results and 4-week follow-ups. A large effect in favor of hypnosis-based (especially manualized abreactive hypnosis) treatment was found for the studies that reported the posttest results (d = 1.17). The temporal stability of the effect remains strong, as reflected by the 4-week follow-up assessments (d = 1.58) and also by long-term evaluations (e.g., 12 months). Hypnosis appears to be effective in alleviating PTSD symptoms.