Burnout en funcionarios de salud en tiempos de pandemia

Background: Coronavirus Disease (COVID-19) exposed health personnel worldwide to high stress levels, which increases the phenomenon of burnout. Aim: To evaluate burnout, its risk, and protective factors in our health team, which has been exposed for months to greater work stress and changes in their usual tasks due to the pandemic. Material and Methods: An online survey including the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and sociodemographic questions, was carried out among health care personnel who continued working during the pandemic. Results: A total of 209 surveys were obtained. Seventy six percent of respondents presented some degree of burnout in the time of the pandemic. Only one protective factor was observed: living with one or more children at home (Odds ratio (OR) 0.21, 95% confidence intervals (CI) 0.05 - 0.87; p = 0.03). Having night shifts (OR 2.72, 95% CI 1.02 - 7.28; p = 0.04), having more than six years in the workplace (OR 3.58, 95% CI 1.18 - 10.8; p = 0.023) and maintaining a regular or poor diet during the pandemic (OR 4.52, 95% CI 1.51-13.48; p < 0.01) were identified as risk factors. Conclusions: A high incidence of burnout was observed in the surveyed population. Living with one or more children in the home stands out as a protective factor and working night shifts, having more than 6 years in the workplace, and maintaining a poor diet as risk factors.

[Burnout syndrome in healthcare workers during COVID-19 pandemic]. / Burnout en funcionarios de salud en tiempos de pandemia.

BACKGROUND: Coronavirus Disease (COVID-19) exposed health personnel worldwide to high stress levels, which increases the phenomenon of burnout. AIM: To evaluate burnout, its risk, and protective factors in our health team, which has been exposed for months to greater work stress and changes in their usual tasks due to the pandemic. MATERIAL AND METHODS: An online survey including the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and sociodemographic questions, was carried out among health care personnel who continued working during the pandemic. RESULTS: A total of 209 surveys were obtained. Seventy six percent of respondents presented some degree of burnout in the time of the pandemic. Only one protective factor was observed: living with one or more children at home (Odds ratio (OR) 0.21, 95% confidence intervals (CI) 0.05 - 0.87; p = 0.03). Having night shifts (OR 2.72, 95% CI 1.02 - 7.28; p = 0.04), having more than six years in the workplace (OR 3.58, 95% CI 1.18 - 10.8; p = 0.023) and maintaining a regular or poor diet during the pandemic (OR 4.52, 95% CI 1.51-13.48; p < 0.01) were identified as risk factors. CONCLUSIONS: A high incidence of burnout was observed in the surveyed population. Living with one or more children in the home stands out as a protective factor and working night shifts, having more than 6 years in the workplace, and maintaining a poor diet as risk factors.

Niveles de vitamina D en médicos: ¿son los anestesiólogos el único grupo de riesgo? / Vitamin D levels among anesthesiologists and other physicians

Background Sun exposure is the main source of 25-hydroxy-vitamin D. Since anesthesiologists work inside operating rooms, they are identified as a deficiency risk group. As medical activity in general occurs indoors, added to the work excess and sedentary lifestyle, physicians in general have low sun exposure. Aim To investigate the determinants of vitamin D levels in physicians. Material and Methods Anesthesiologists and physicians not working in operating rooms were included. A survey that comprised working hours, diet, skin color, sunscreen use and outdoor activities was also applied. Measurements of vitamin D and parathormone levels in blood were performed. Results We analyzed samples from 81 volunteers. Median vitamin D values of the whole sample were in the range of insufficiency (25.3 [interquartile range 12.4] ng/ml). Multiple linear regression analysis detected no differences between anesthesiologists and non-anesthesiologists. A higher body mass index was a risk factor for vitamin D deficiency, (p = 0.025). The only protective factor was the intake of a vitamin D supplement (p < 0.01). Conclusions Anesthesiologists and other specialists were both at risk for vitamin D deficiency. Obesity was a risk factor and the use of a vitamin D supplement was the only protective factor.

[Vitamin D levels among anesthesiologists and other physicians]. / Niveles de vitamina D en médicos: ¿son los anestesiólogos el único grupo de riesgo?

Background Sun exposure is the main source of 25-hydroxy-vitamin D. Since anesthesiologists work inside operating rooms, they are identified as a deficiency risk group. As medical activity in general occurs indoors, added to the work excess and sedentary lifestyle, physicians in general have low sun exposure. Aim To investigate the determinants of vitamin D levels in physicians. Material and Methods Anesthesiologists and physicians not working in operating rooms were included. A survey that comprised working hours, diet, skin color, sunscreen use and outdoor activities was also applied. Measurements of vitamin D and parathormone levels in blood were performed. Results We analyzed samples from 81 volunteers. Median vitamin D values of the whole sample were in the range of insufficiency (25.3 [interquartile range 12.4] ng/ml). Multiple linear regression analysis detected no differences between anesthesiologists and non-anesthesiologists. A higher body mass index was a risk factor for vitamin D deficiency, (p = 0.025). The only protective factor was the intake of a vitamin D supplement (p < 0.01). Conclusions Anesthesiologists and other specialists were both at risk for vitamin D deficiency. Obesity was a risk factor and the use of a vitamin D supplement was the only protective factor.

Índice C en médicos de dos centros hospitalarios chilenos según el test de competencia moral de Lind / Assessment of moral competence of physicians

Background: Moral competence (MC) in physicians is fundamental, given the increasing complexity of medicine. The "Moral Competence Test" (MCT © Lind) evaluates this feature and its indicator is the C Index (CI). Aim: To explore moral competence and its associated factors among physicians working in Chile. Material and Methods: The MCT was answered by 236 physicians from two medical centers who voluntarily participated in the study. Besides the test, participants completed an encrypted form giving information about gender, years in practice and post-graduate studies. Results: The average CI value of the participants was 20,9. Post-graduate studies had a significant positive influence on CI. There was a significant decrease in CI, between 16 and 20 years of professional exercise. Gender and the area of post-graduate studies did not have a significant influence. Conclusions: The studied physicians showed a wide range of CI which was positively affected by the postgraduate studies performed. The years of professional practice had a negative influence. Expanding training opportunities during professional practice could have a positive effect on CM as measured by CI.

[Assessment of moral competence of physicians]. / Índice C en médicos de dos centros hospitalarios chilenos según el test de competencia moral de Lind.

BACKGROUND: Moral competence (MC) in physicians is fundamental, given the increasing complexity of medicine. The "Moral Competence Test" (MCT © Lind) evaluates this feature and its indicator is the C Index (CI). AIM: To explore moral competence and its associated factors among physicians working in Chile. MATERIAL AND METHODS: The MCT was answered by 236 physicians from two medical centers who voluntarily participated in the study. Besides the test, participants completed an encrypted form giving information about gender, years in practice and post-graduate studies. RESULTS: The average CI value of the participants was 20,9. Post-graduate studies had a significant positive influence on CI. There was a significant decrease in CI, between 16 and 20 years of professional exercise. Gender and the area of post-graduate studies did not have a significant influence. CONCLUSIONS: The studied physicians showed a wide range of CI which was positively affected by the postgraduate studies performed. The years of professional practice had a negative influence. Expanding training opportunities during professional practice could have a positive effect on CM as measured by CI.

Tubos endotraqueales con cuff en anestesia pediátrica: ¿aumentan el riesgo de estridor post-extubación? Estudio observacional, cohorte prospectiva / Do cuffed endotracheal tubes raise post-extubation stridor risk in pediatric anesthesia? A prospective cohort study

The traditional pediatric airway model precludes the use of cuffed endotra-cheal tubes because of concerns regarding subglottic mucosal injury. Cuffed tubes have advantages which together with a change in the pediatric airway paradigm have made the practitioners to consider its use in children. Nevertheless some uneasiness remains about cuff employ in the neonatal population, specially preterms. A study was designed to determine if cuffed tracheal tubes increased the post-extubation stridor risk in children. Methods: Information concerning 535 children under 11 years old undergoing general anesthesia with tracheal intubation was prospectively recollected during a year. The choice of the type of tube was left to the anesthesiologist in charge. The post-extubation stridor risk was compared with logistic regression between those intubated with and those without cuffed tubes. Results: The post-extubation stridor incidence was 19·1,000 patients-year; Conf. Interval 95 percent [9-34·1,000]. The cuffed tracheal tubes effect on stridor risk, (adjusting for confounders), was non-significant: OR = 2,2; Conf. Interval 95 percent [0,2-20]; p = 0,5. Conclusions: The use of cuffed endotracheal tubes did not increase the risk of post-extubation stridor in children.

El concepto tradicional de vía aérea pediátrica es incompatible con el uso de tubo traqueales con cuff puesto que el área de menor circunferencia se ubica en la zona subglótica. Sin embargo, los tubos con cuff tienen ventajas, lo que unido a cambios en el paradigma de la vía aérea infantil han impulsado su uso entre los anestesiólogos. Pero aún persisten dudas respecto a su utilización, especialmente en recién nacidos prematuros. El principal objetivo de esta investigación es determinar si el uso de tubos con cuff aumenta la incidencia de estridor post-extubación en la población pediátrica. Materiales y Métodos: Se diseñó un estudio prospectivo observacional que incluyó pacientes menores de 11 años de edad, sometidos a anestesia general que requiriera intubación traqueal y el riesgo de estridor post-extubación fue comparado en pacientes en los que se usaron tubos con y sin cuff. Resultados: Se registró información de 535 pacientes durante 1 año. La incidencia de estridor post-extubación fue de 19 x 1.000 pacientes-año; (Int. Confianza 95 por ciento. [9-34 x 1.000]). El análisis controlando por las variables de confusión demostró que el uso de tubo con cuff no influyó en el riesgo de estridor post-extubación (Odds Ratio: 2,2; Intervalo Confianza 95 por ciento [0,2 -20]; p = 0,5). Conclusiones: El uso de tubos endotraqueales con cuff no aumentó el riesgo de estridor post-extubación en la población pediátrica estudiada.

Movimientos convulsivos durante la inducción inhalatoria con sevoflurano / Convulsive movements during inhalational induction with sevoflurane

La inducción inhalatoria con sevoflurano se ha asociado con actividad epileptógena y movimientos convulsivos. Se diseñó un estudio para determinar la incidencia de movimientos convulsivos durante la inducción inhalatoria con sevoflurano y sus posibles factores de riesgo. Para llevar a cabo estos objetivos, desde marzo a julio de 2011 se solicitó a los anestesiólogos de Clínica Dávila registrar la ocurrencia de movimientos convulsivos en todo paciente en que se realizara inducción inhalatoria con sevoflurano, en el período comprendido entre la etapa III de la anestesia y la inyección de drogas endovenosas. El tamaño muestral calculado fue de 400 pacientes para obtener un intervalo de confianza de 95 por ciento con un error menor a 2,5 por ciento. Se obtuvo información de 405 pacientes con una mediana de edad de 4 años (rango: 2 días a 16 años de edad), predominantemente hombres y ASA I. La incidencia de convulsiones fue de 3,5 por ciento (IC 95 por ciento: 1,9 por ciento; 5,7 por ciento) y fueron más frecuentes en mujeres (5,9 por ciento versus 2 por ciento en hombres, p = 0,039). En conclusión, la incidencia de convulsiones durante la inducción inhalatoria con sevoflurano fue de 3,5 por ciento y su único factor de riesgo fue pertenecer al género femenino...

Introduction: Mask induction with Sevoflurane has been associated with epileptic form changes of the EEG and sometimes with tonic-clonic movements. Objectives: To determine the incidence rate of convulsive movements during the induction of anesthesia with Sevoflurane and its risk factors. Methods: From march 1st to july 31st 2011, we asked to the anesthesiologists of our institution to watch the occurrence of tonic-clonic movements during Sevoflurane induction, after the loss of eyelash reflex and before the injection of intravenous drugs. The sample size was calculated in 400 patients to obtain a 95 percent confidence interval with an error lesser than 2.5 percent. Results: We obtain data from 405 patients with a median age of 4 years old (range 2 days to 16 years old), predominantly males and ASA physical status I. The incidence rate of convulsions was 3.5 percent (CI 95 percent 1.9; 5.7), more frequent in females (5.9 percent versus 2.0 percent in males, p = 0.039). Conclusions: The incidence rate of convulsions during inhalatory induction with Sevoflurane was 3.5 percent and associated to female gender...

Sevofluorano comparado con halotano en cirugía otorrinológica pediátrica / Sevoflurane compared with halothane in pediatric otorhinolaryngology surgery

Se estudiaron 123 niños ASAI y II entre 3 y 12 años en forma prospectiva randomizada sometidos a cirugía otorrinolaringológica electiva, comparando los efectos del Halotano (grupo H) versus el Sevofluorano (grupo S) durante la inducción, y recuperación anestésica. Se predeterminaron cuatro tiempos, siendo TI la pérdida del reflejo palpebral que se obtuvo a 1,14 min, en el grupo S versus 2,9 min, en el grupo H(p<0,001). T2 fue obtención de vía venosa que fue posible luego de 3,26 min. del inicio de la inducción en el grupo S versus el grupo H que fue de 4,37 min (p<0.001). T3 definido como el momento de la intubación de los pacientes fue 6.1 min, en el grupo S y de 7,6 min, en el grupo H(p>0,002) y T4 fue la recuperación de la anestesia que demoró 13,7 min. en el grupo S, mientras que en el grupo H fue de 21,9 min (p>0,001). No hubo diferencias significativas en la hemodinamia, parámetros ventilatorios ni en la incidencia de eventos con la administración de uno u otro agente utilizado. Se concluye que con el uso de Sevofluorano en niños permite acortar los tiempos de inducción y recuperación, siendo además bien tolerado, constituyéndose de esta forma en una alternativa al uso de Halotano en la Anestesia Pediátrica.