Burnout and well-being of medical and surgical residents in relation to emotional intelligence: A 3-year study.

BACKGROUND: This study aims to examine the relationship of emotional intelligence to physician burnout and well-being and compare these changes between medical and surgical residents during training. METHODS: The longitudinal study used survey data, collecting measures on burnout and emotional intelligence in residents. Postgraduate year 1 residents at a community-based Michigan hospital completed the following surveys: Maslach Burnout Inventory, Physician Wellness Inventory, and Trait Emotional Intelligence Questionnaire-Short Form survey. These measures were given quarterly in postgraduate year 1 and once during subsequent years. RESULTS: Seventy-seven residents completed measurements during their first 3 years. Forty-two (54.5%) were in the medical resident group; the remaining 35 (45.5%) were in the surgical resident group. Significant increases in measured burnout during the first year improved in subsequent years but did not return to baseline (P < .01). Emotional exhaustion (Maslach Burnout Inventory-Emotional Exhaustion) increased a relative 44% the first year (P = .000) and decreased 23% by the third year (P < .01). The Physician Wellness Inventory subscales also had significant decreases (P = .01) but less than the Maslach Burnout Inventory subscales (improvement ≤25%). Both medical and surgical groups had similar decreases in the Physician Wellness Inventory subscales (-25%) in their first year. The emotional intelligence score significantly correlated with exhaustion (Maslach Burnout Inventory-Emotional Exhaustion: r = -0.243; P = .002) and distress (Physician Wellness Inventory-Distress: r = -0.197; P = .014). CONCLUSION: The risk for burnout increased sharply at the beginning of training for this hospital resident participant group and remained high throughout residency. Emotional intelligence is an important factor associated with less emotional exhaustion during residency.

Small bowel obstruction secondary to metastatic urothelial bladder cancer.

Small bowel obstruction secondary to primary cancer, such as carcinoid and adenocarcinoma, is not unusual. Less frequently, hematological metastasis from breast, lung, and melanoma can occur. However, metastasis from urothelial bladder carcinoma is extremely rare. In this index case, we describe a 71-year-old Caucasian man with a prior history of urothelial bladder carcinoma. He was treated successfully with chemoradiation and local resection a year prior to his current presentation with small bowel obstruction which required surgical resection of a loop of jejunum, which was found to be caused by obstructive, metastatic urothelial bladder carcinoma on pathology. Therefore, one should consider the possibility of secondary obstructive malignant lesions arising from the urinary bladder in such a patient when presented with bowel obstruction and a history of urothelial bladder carcinoma.

Rib Plating Outcomes in Elderly Trauma Patients With Multiple Rib Fractures: A Community Hospital Experience.

Rib fractures in the elderly are one of the most common injuries in trauma patients admitted to the hospital, accounting for over 350,000 patients annually in the United States. Rib plating has been shown to be most beneficial among certain populations. Early surgical intervention is important to utilize approaches that limit the use of pain medications. This is a retrospective data analysis to determine the efficacy of rib plating in elderly trauma patients with rib fractures. A total of 253 patients were seen with rib fractures, 63% were male and 37% were female. The mean age is 64 ± 18.5 years. Of these patients analyzed, 76% had an associated comorbid condition. A majority of patients (95%) presented to the emergency department (ED) with mild GCS range (13-15). Moderate GCS range (9-12) was 4%, and 3% of patients were with severe GCS (3-8.) The mean ISS was 10. The overall mortality rate was 4.5%. Patients were divided into 2 groups: group I consisted of patients who received open reduction and fixation of the fractured ribs, and group II was patients managed conservatively without surgery. Statistical analyses using Student's t-test and Chi-square test were performed. Institutional Review Board approval was obtained for this study. Rib plating in elderly trauma patients with multiple rib fractures has shown to be beneficial in terms of mortality. Furthermore, geriatric patients with comorbidities will benefit from early open reduction and fixation of rib fractures, though a larger study is needed to establish clearer criteria for rib plating.

Value of Thoracic CT in Blunt Trauma Patients With High Glasgow Coma Scale and Low Injury Severity Scale.

OBJECTIVE: To determine the value of ordering a routine chest CT (CCT) in patients with blunt trauma presenting to the emergency department with a high GCS and low ISS, we retrospectively collected patient data including CT scan results, when physical examination and initial chest X-ray were normal in the trauma bay area. METHODS: A retrospective data collection of 901 consecutive blunt trauma patients seen in the ED between 2017 and 2019 was analyzed. Data included physical examination, age, gender, current use of anticoagulation therapy, comorbid conditions, as well as the result of radiologic images, hospital length of stay, surgical intervention, and mortality. The patients were divided into two groups: group one (patients with negative physical examination; chest x-ray and CT) and group 2 (negative physical examination, positive or negative chest x-ray, and positive CT). Statistical analysis was performed using student's t-test and chi-square test. RESULTS: Of the 901 patients there were 489 (54%) males and 412 (46%) females with a mean age of 56 years. There were 461 patients who had a physical examination, chest x-ray, abdominal and CCT done. Group one included 442 (96%) patients, with negative physical examination, negative chest X-ray and CT scan. In group 2, 19 (4%) patients who had positive CT and or chest x-ray. Both groups were similar in GCS and ISS. Of the 19 patients, sixteen patients had a positive CCT, and thirteen of those had a positive chest x-ray. In the three patients who had negative physical examination and chest x-ray, the CT findings included one with a nondisplaced 10th rib fracture and two patients with osteoporotic compression fractures of dorsal vertebrae. The rate of both chest x-ray and CCT being positive among a group of screened patients was 16% (3/19) and the rate of a negative chest x-ray but positive CT was 16% (3/19). The odds ratio between the two outcomes was one. CONCLUSION: In blunt trauma patients presenting to the ED with a high GCS and low ISS score, when initial physical examination and chest x-ray are negative, routine CCT is of little value.

Rib Plating Outcomes in Elderly Trauma Patients with Multiple Rib Fractures: A Community Hospital Experience.

Rib plating has been shown to be beneficial among certain populations, such as patients with flail chest and failure to wean from the ventilator in patients without primary pulmonary pathology. Surgical intervention has been shown to decrease ventilatory requirements, decrease pain management modalities, and lower costs. A retrospective data analysis was done to determine the efficacy of rib plating in elderly trauma patients with rib fractures on a total of 244 patients, 63% male and 37% female, mean age is 64 ± 18.5 years, 76% had an associated comorbid condition, such as Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD), Chronic Kidney Disease (CKD), or any combination, with 111 (46%) on anticoagulant therapy. 95% patients presented to the emergency department (ED) with Mild GCS range (13-15). Moderate GCS (9-12) was 4% and 3% of patients Severe GCS (3-8). The overall mortality rate was 4.5%.

Validation of Brain Injury Guidelines in the Elderly Trauma Patient Presenting at a Level Two Trauma Center.

Retrospective analysis, validating the brain injury guideline (BIG) in the management of traumatic head injury in our level II trauma center after implementation of the protocol, and compare the outcomes to those seen before the protocol, of 542 patients seen in the Emergency Department (ED), with head injury between 2017 and 2021 was completed. Those patients were divided into two groups: Group 1 (pre BIG protocol implementation) and Group 2 (post BIG protocol implementation). Data included age, race, length of stay (hospital and ICU), comorbid conditions, anticoagulant therapy, surgical intervention, GCS, ISS, findings of head CT and any subsequent progression, mortality, and readmission within one month. Student's t-test and Chi-square test were used for statistical analysis. There were 314 patients in group 1 and 228 patients in group 2. Mean age of group 2 was significantly higher than group 1 (67 vs 59 years, p=0.0001), however their gender was similar. Data available on 526 patients were classified as BIG 1=122, BIG 2=73, and BIG 3=331 patients. Post-implementation group were older (70 vs 44 years, P=0.0001) with more females (67% vs 45%, P=0.05) and had significantly more than 4 comorbid conditions (29% vs 8%, P=0.004), with the majority presented with a size of 4 mm or less of acute subdural or subarachnoid hematoma. No patient in either group had progression of their neurological examination, neurosurgical intervention, or readmission.. Elderly trauma patients may benefit from implementation of BIG criteria protocol, thus reducing cost of patient care, however a larger sample size is needed.

The Impact of Alcohol Level on Elderly Trauma Patients Presenting to the Emergency Department.

Alcohol is a chemical substance that alters cognitive ability and judgment. We looked at our elderly patients that arrived at the Emergency Department (ED) following trauma and evaluated the factors that may influence outcome. Retrospective analysis of patients seen in ED with positive alcohol was performed. Statistical analysis was performed to identify the confounding factors for outcomes. Records collected on 449 patients with a mean age of 42 ± 16.9 years. There were 314 males (70%) and 135 females (30%). Average GCS was 14, and average ISS was 7.0. Mean alcohol level was 176 g/dL ± 91.6. There were 48 patients aged 65 years and older with significantly higher hospital stay (4.1 and 2.8 days, P = .019) and ICU stay (2.4 and 1.2 days, P = .003) compared to the 64 and younger group. Elderly trauma patients had a higher mortality and length of stay due to a higher number of comorbidities.

Longitudinal Study of Emotional Intelligence, Well-being, and Burnout of Surgical and Medical Residents.

INTRODUCTION: Emotional intelligence (EI) as a concept is becoming increasingly relevant in the healthcare industry. In order to examine the relationship between EI, burnout, and wellness, we administered these measures quarterly in resident physicians and analyzed the variables in each subset to gain insights and understanding of their relationship. METHODS: In 2017 and 2018, all residents entering the training programs in year one (PGY-1) were administered The Emotional Intelligence Questionnaire - Short Form (TEIQue-SF), The Maslach Burnout Inventory (MBI), and The Physician Wellness Inventory (PWI). The questionnaires were completed quarterly. Statistical analysis included ANOVA and ANCOVA. RESULTS: The overall combined PGY-1 resident year (n = 80) had an EI global trait mean score of 5.47 (SD: 0.59) at the beginning of their first year. The domains of burnout and physician wellness were examined across four different time points during the resident's first year. Domain scores changed significantly over the four time points during the first year. There was a relative 46% increase in exhaustion (P < .001), 48% increase in depersonalization (P < .001), and an 11% decrease in personal achievement (P < .001). Physician wellness domains also changed significantly between time 1 and the end of the year (time 4). There was a relative 12% decrease in career purpose (P < .001), a 30% increase in distress (P < .001), and 6% decrease in cognitive flexibility (P < .001). Each burnout domain and physician wellness domain were highly correlated with emotional quotient (EQ). Emotional quotient was independently assessed with each domain at baseline and with changes overtime. The lowest EQ group reported their distress increased significantly over time (P = .003) and a decline in career purpose (P < .001) and cognitive flexibility (P = .04). The response rate was 100%. CONCLUSION: Emotional intelligence is associated with well-being and burnout in individual residents; therefore, it is important to identify those who require increased support during residency in order to succeed.

Can Time to Treatment Reduce In-Hospital Mortality and Morbidity Among Surgical and Nonsurgical Elderly Patients With Sepsis.

Sepsis mortality remains high and efforts to reduce it are continuing. We collected data from our patients presented to the emergency department (ED) with sepsis and performed a retrospective analysis of 1079 patients seen in the ED with sepsis during 2018 and 2020, before and after implementation of the new CDC protocol. Statistical analysis was performed using Student's t-test and chi square test as well as Cox regression analysis. The patients were divided into pre-protocol (group 1) and post-protocol (group 2). A total of 1079 patients were included in the study. The mean age was 65 + 16.86 years, divided equally between gender (male 49%, female 51%). Patients with certain comorbidities showed statistically significant survival rate in the protocol group. The current protocol for sepsis when implemented will improve patients' survival, in both surgical and medical patients and significantly in those with comorbid conditions.

Acute Traumatic Subdural Hematoma in the Elderly and Associated Factors that May Influence Chronicity.

Traumatic acute subdural hematomas (TASDH) is by far the most common traumatic brain injury in adult patients with blunt trauma, who presented to the Emergency Department (ED). One of the serious sequale of TASDH is the development of Chronic Subdural Hematomas (CSD) with associated deterioration in mental status and convulsion.1,2 Studies to identify the risk factors that favors development of chronicity of TASDH are few and inconclusive. As seen in our prior initial study, there were few factors which were common in those who developed chronicity of their TASDH, and we elected to expand our pool of patients to include those admitted between the years of 2015 and 2021 with ATSDH and identify the common factors associated with development of CSD.

Role of Fracture Liaison Service Program in Reducing Refracture Rate in the Elderly Osteoporotic Trauma Patients Presenting With Vertebral Compression Fracture: A Six-Year Study.

INTRODUCTION: As the elderly population of the United States and the world increases, so does the incidence of osteoporotic fragility fractures from a fall or minor injury. This results in a large cost to the health care system. This cost is further increased as more than 50% of individuals will have refractures within the first year. In order to reduce the refracture rate in such patients, we enrolled our elderly trauma patients with vertebral compression fractures and vertebral augmentation in a Fracture Liaison Service (FLS) clinic for two years and reevaluated their refracture rate. METHOD: This is a retrospective analysis of 720 patients. 142 patients (Group A) were seen between 2012 and 2014 before establishing the FLS program and 578 patients (Group B) were seen between 2015 and 2020 after implementation of the FLS program. The patients enrolled in the FLS program were followed for two years after sustaining a vertebral compression fracture. The data collected included age, sex, serum calcium and vitamin D levels, dual energy X-ray absorptiometry (DXA) scan, 10-year fracture risk (FRAX) score, pressure measurements in PSI taken during vertebral augmentation, as well as the refracture rate. The data collected were analyzed and compared between the two groups using the Student's t-test and chi-square test. RESULTS: There was significant reduction in the refracture rate of pre-FLS vs post-FLS vertebral, as well as other fractures in the FLS group (pre-FLS: 48.9% vs post-FLS: 37.0%; P = .01). There was no significant difference between groups A and B in regard to the mean serum level of calcium (9.44 mg/dL vs 9.53 mg/dL), vitamin D level (35.04 ng/mL vs 41.39 ng/mL), DXA scan for spine (-.52 vs -.76) and for femur (-1.77 vs -1.52), and 10-year refracture risk for osteoporotic major fracture (FRAX score-mean: 22.6% vs 19.2%) and for hip fracture (9.18% vs 7.53%). There was a significant difference in the mean age between the groups (79.5 vs 73.5 years; P = .01). Of those who underwent vertebral augmentation, 235 had Pressure Scale Index (PSI) measurements taken. There was a trend in increasing refracture rate when PSI ≤199 compared with those who had PSI ≥200, although statistical significance was not met (33.9% vs 27.0%, P = .21). CONCLUSION: A Fracture Liaison Service program will improve the bone health of geriatric osteoporotic patients presenting to the trauma service with vertebral compression fractures and thus reduces the subsequent refracture rate. Further study is needed to evaluate the best PSI used to impact reduction in refracture rate.

The Value of Abdominal and Pelvic CT Scan in Trauma Patients With Low Injury Severity Score and High Glasgow Coma Scale.

INTRODUCTION: Computed tomography scans became the mainstay of emergency department (ED) evaluation of trauma patients including those with a high Glasgow Coma Scale (GCS) and a low Injury Severity Score (ISS). We elected to find the value of abdominal and pelvic CT in patients with negative physical examination and Focused Assessment of Sonography for Trauma (FAST) on arrival to the ED. METHODS: This study is a retrospective analysis of 901 consecutive patients from 2017 to 2019 who presented to the ED with level 2 and 3 activation criteria. Each patient received a physical examination, CT abdomen and pelvis, and FAST exam. Data were collected on external factor including GCS, ISS, age, sex, comorbidities, anticoagulation use, and surgical intervention. The patients were divided into 2 groups, Group A and B. Group A consisted of patients with a negative physical exam, FAST, and CT result. Group B included patients with a negative physical exam and FAST exam with positive CT findings. Statistical analysis was done using a Student's t-test and chi-square test for significance value of P < .05. Institutional Review Board approval was obtained for this study. RESULTS: A total of 901 patients were analyzed which included 489 (54.3%) male and 412 (45.7%) female with a mean age of 56.2 (SD = 22.62) years. Out of the 901 patients, 461 patients received a physical, FAST, and CT exam. Group A consisted of 442 (95.9%) patients and Group B had 19 (4.1%) patients. Both groups were similar in GCS and ISS scoring with no significance difference in age, sex, comorbidities, and anticoagulation use. There was a significant difference in the ICU and hospital mean length of stay when CT scan was positive [2 (SD = 4.23) days vs. .6 (SD = 1.33) days with P < .0001 and 4.57 (SD ± 4.17) days vs. 2.5 (SD = 2.00) days with P < .0001, respectively]. The CT findings of the 19 patients in group B consisted of 6 incidentalomas, 5 vertebral compression fractures, 4 pelvic bone fractures, 1 minor liver contusion, 1 non-specific bowel thickening, 1 non-displaced rib fracture, and 1 case of small amount of free fluid in the pelvis. None of the CT findings required surgical intervention. CONCLUSION: Computed tomography of the abdomen and pelvis in trauma patients with high GCS and low ISS with initial negative physical and FAST examination did not provide additional critical information.

Endometrioma Causing Near-Complete Obstruction of the Sigmoid Colon.

Endometriosis is characterized by extra-uterine endometrial gland and stroma implantation. Intestinal endometriosis is believed to affect about one-third of patients with endometriosis4; 72-95% of patients experience recto-sigmoid involvement.2,3 Occasionally, endometriotic lesions precipitate mass effect or infiltrate the bowel wall, mimicking a neoplasm. In the index case, we evaluated a G0P0 41-year-old perimenopausal female with near obstructing sigmoid endometrioma, clinically presented, investigated, and managed in the lines of sigmoid colon carcinoma. Computed Tomography revealed marked distention of the distal descending and proximal sigmoid colon to the level of a [possible] intraluminal mass. CA-125 was 247.4. Transvaginal ultrasound revealed a heterogeneous irregularity adjacent the left adnexa. Flexible sigmoidoscopy to 12-15 cm was unable to pass liquid or visualize the lumen secondary to extrinsic colonic obstruction. She underwent exploratory laparotomy with sigmoidectomy, oversew of rectal stump, and descending colostomy. Left fallopian tube and ovary were adherent to sigmoid mass, therefore, removed en-bloc. Histopathological report revealed extensive endometriosis involving the muscularis propria and serosal surface of colon and ovary, with fibrinous serosal adhesions of the sigmoid colon. While inconsistent clinical presentation, similar radiographic features, and colonoscopy with other inflammatory or malignant lesions of the bowel makes the preoperative diagnosis challenging, colonic endometriosis is to always be considered as one of the differential diagnoses in reproductive age women with patterned, cyclic gastrointestinal symptoms, and intestinal masses of uncertain etiology or diagnosis.

Colonic Endometriosis: A Study of Near Obstructing Sigmoid Endometrioma.

A 41-year-old woman had a near-obstructing endometrioma involving the distal sigmoid colon treated with en bloc removal of the involved segment of colon and the adherent adnexa.

Unusual Presentation of Perforated Acute Appendicitis: A Case Report.

BACKGROUND Acute appendicitis is by far the most common surgical emergency encountered in the United States and with this in mind, unusual presentations are also frequent, thus improper diagnosis, which roughly occurs in 20-40% of cases, can lead to a delayed treatment and bad outcomes. We present this unusual case of abdominal pain secondary to extraperitoneal compartmentalized abscess following perforated appendicitis, diagnosed and managed as ascites secondary to alcoholic liver cirrhosis with subsequent delay in the treatment of the underlying cause, which was appendicitis. CASE REPORT A 45-year-old man presented to the Emergency Department with pain and distention for 1 week duration, who was treated with frequent paracentesis, with worsening pain following the latest drainage, raising suspicion of perforated viscus. Initial abdominal X-ray and computed tomography (CT) scan revealed free air and large tubular fluid sac collection along the right, left, and lower abdominal wall. Surgical drainage of the abscess was performed. A subsequent follow-up CT with oral contrast of the abdomen revealed perforated right lower abdominal viscus, possible perforated appendicitis with pre-peritoneal and retroperitoneal space occupying the abscess cavity compartmentalized along the right, left, and lower abdominal wall and creating a separate space where the inflammatory purulent material was collected. This was followed by a second procedure for ileocecectomy and ileostomy with excision of the extra-preperitoneal compartment space. CONCLUSIONS Abdominal pain secondary to acute appendicitis is by far the commonest surgical condition; therefore, it should be considered high in the differential diagnosis of any patients presenting with unusual abdominal complaints.

Role of Abdominal Ultrasound and Magnetic Resonance Imaging in Pregnant Women Presenting With Acute Abdominal Pain.

Background and Purpose: Abdominal pain during pregnancy is quite common; however, surgical pathology such as acute appendicitis as a cause of such pain is not. Diagnostic tests used in addition to history and physical examination (PE) are ultrasound (US) and magnetic resonance imaging (MRI). We elected to find the role of these tests in pregnant patients who presented to our emergency department with acute abdominal pain.Materials And Methods: Retrospective analysis of 136 pregnant women with acute abdominal pain presented to the emergency department (ED). We reviewed PE, US, MRI, gestational age, comorbid conditions, and length of stay. Statistical analysis was done using student's t-test and chi-square test. Institutional review board approval was obtained.Results: Mean age was 26 (±4.6) and the mean gestational age was 24 (±9.9) weeks. Of those patients, there were 81 patients who had an US and MRI performed. The US was positive in 16 patients, while the MRI was positive in 25 patients. Three patients went for appendectomy. The US sensitivity was 0% and specificity 79%. Positive predictive value for US was 0% and negative predictive value was 95%, which was less than 100%. The MRI likelihood ratios were calculated for each test's clinical application and demonstrated that the US test result was indeterminate for ruling in and for ruling out appendicitis while the MRI allowed for high ability to rule out the disease.Conclusion: In pregnant women with acute abdominal pain and a positive PE highly suggestive of surgical pathology, US had limited value and patients should proceed to MRI.

Effect of Implementation of an Early Treatment of Sepsis Protocol on Surgical Outcomes.

Sepsis outcomes remain high regarding mortality and morbidity, despite efforts to reduce them. We retrospectively evaluated a protocol in the first 6 months of implementation to measure outcomes. Retrospective data collection and analysis was performed of 200 consecutive patients seen in the ED during the first 4 months of 2020 after implementation of the sepsis protocol (group 1) and compared to another 200 consecutive patients during the same time frame in 2019 before the sepsis protocol (group 2). The collected parameters included age, gender, race, length of stay comorbid conditions, mortality, and therapy received. Statistical significance was determined at a p-value ≤.05. Mean age and gender of the groups were similar, 64 vs 66 years for group 1 and 2, respectively. Each group was 45% male. Mean length of stay were 8.9 and 8.6 days in group 1 and 2, respectively. Group 1 had a mortality rate of 13% vs 18% in group 2 (p = .21). Comorbid conditions including cardiovascular disease, diabetes, renal failure, and COPD were analyzed regarding mortality that influenced outcomes using Cox regression analysis. COPD and diabetic patient mortality were significantly lower in the protocol group. Surgical patients had a survival rate of 92.4%. Therefore, the current protocol for sepsis management did improve mortality. Further studies with a larger number of patients are in progress.