The impact of metastatic sites in advanced pancreatic adenocarcinoma, systematic review and meta-analysis of prospective randomized studies.

The real impact of specific sites of metastasis on prognosis of metastatic pancreatic cancer (MPC) is unknown. To evaluate the association of specific metastatic sites and survival outcomes in MPC a systematic literature review was performed including prospective randomized trials of systemic treatments in metastatic pancreatic cancer indexed in PubMed, Embase and Web of Science. Data regarding systemic treatment regimens, progression free survival and overall survival were extracted. The outcomes were compared using a random effects model. The index I2 and the graphs of funnel plot were used for the interpretation of the data. Of 1,052 abstracts, 7 randomized trials were considered eligible with a combined sample size of 2,975 MPC patients. Combining the studies with meta-analysis, we could see that patients with liver metastasis had a HR for death of 1.53 with 95% CI of 1.15 to 2.02 (p-value 0.003) and HR for risk of progression of 1.96 with 95% CI of 1.28 to 2.99 (p-value 0.002), without significant heterogeneity. Having two or more sites of metastasis comparing to one site did not have impact on overall survival; RR of 1.05 with 95% CI 0.91 to 1.23 (p-value 0.493). In conclusion, liver metastasis confers worse outcomes among patients with MPC. Apparently, multiple metastatic sites do not present worse prognosis when compared with only one organ involved, therefore, demonstrating the severity of this disease. Prospective studies evaluating other treatments are necessary to address the impact of local treatments in liver metastasis in MPC.

Association between burnout syndrome and anxiety in residents and anesthesiologists of the Federal District / Associação entre síndrome de burnout e ansiedade em residentes e anestesiologistas do Distrito Federal

Abstract Background and objective There is a shortage of studies addressing the association between burnout syndrome and anxiety among anesthesiologists. Identifying the relationship between these two conditions is of fundamental importance for the prevention, follow-up, and treatment of the professionals. Thus, we evaluated the association between burnout syndrome and anxiety in anesthesiologists and residents of anesthesiology in the Federal District. Method A cross-sectional study using a convenience sample of residents and anesthesiologists from the Federal District. The correlation between State Trait Anxiety Inventory and Burnout Syndrome (Maslach Burnout Inventory) was tested using multiple linear regression analysis, considering a significance level of 5%. Results Of the 78 completed forms, there were predominance of males (57.69%), mean age of 42 ± 9.7 years for anesthesiologists and 30 ± 2.9 years for residents. Burnout syndrome had a prevalence of 2.43% among anesthesiologists and 2.70% among resident physicians, while a high risk for its manifestation was 21.95% in anesthesiologists and 29.72% in resident physicians. There was a correlation between state-anxiety and the variables burnout emotional exhaustion, burnout depersonalization, and trait-anxiety. Regarding trait-anxiety, there was no statistically significant correlation with other variables. Conclusions There is association between state-anxiety and the emotional exhaustion dimensions of burnout, burnout depersonalization, and trait-anxiety. The occurrence of anxiety can negatively influence the way the individual faces daily stressors, which may be related to the use of ineffective strategies to cope with stress.

Resumo Justificativa e objetivo Existe escassez de estudos sobre a associação entre a síndrome de burnout e ansiedade entre anestesiologistas. A identificação da relação entre as duas condições é de fundamental importância para a prevenção, o acompanhamento e tratamento dos profissionais. Assim, foi avaliada a associação entre síndrome de burnout e ansiedade nos anestesiologistas e residentes em anestesiologia do Distrito Federal. Método Estudo de corte transversal que usou amostra por conveniência composta por residentes e anestesiologistas do Distrito Federal. Correlação entre ansiedade (State Trait Anxiety Inventory) e síndrome de burnout (Maslach burnout Inventory) foi testada a partir da análise de regressão linear múltipla, considerou-se nível de significância de 5%. Resultados Dos 78 formulários respondidos, houve predominância de indivíduos do sexo masculino (57,69%), com média de 42 ± 9,7 anos para os anestesiologistas e de 30 ± 2,9 anos para os residentes. A síndrome de burnout apresentou prevalência de 2,43% entre os anestesiologistas e 2,70% entre médicos residentes, enquanto alto risco para sua manifestação nos anestesiologistas foi de 21,95% e para médicos residentes, de 29,72%. Observou-se correlação entre ansiedade-estado e as variáveis exaustão emocional de burnout, despersonalização de burnout e ansiedade-traço. Em relação à ansiedade-traço não houve correlação estatisticamente significante com as demais variáveis. Conclusão Existe associação entre ansiedade-estado e as dimensões exaustão emocional de burnout, despersonalização de burnout e ansiedade-traço. A ocorrência de ansiedade pode influenciar negativamente a maneira como o indivíduo enfrenta os fatores estressores cotidianos, o que pode estar relacionado ao uso de ineficazes estratégias de enfrentamento diante do estresse.

[Association between burnout syndrome and anxiety in residents and anesthesiologists of the Federal District]. / Associação entre síndrome de burnout e ansiedade em residentes e anestesiologistas do Distrito Federal.

BACKGROUND AND OBJECTIVE: There is a shortage of studies addressing the association between burnout syndrome and anxiety among anesthesiologists. Identifying the relationship between these two conditions is of fundamental importance for the prevention, follow-up, and treatment of the professionals. Thus, we evaluated the association between burnout syndrome and anxiety in anesthesiologists and residents of anesthesiology in the Federal District. METHOD: A cross-sectional study using a convenience sample of residents and anesthesiologists from the Federal District. The correlation between State Trait Anxiety Inventory and Burnout Syndrome (Maslach Burnout Inventory) was tested using multiple linear regression analysis, considering a significance level of 5%. RESULTS: Of the 78 completed forms, there were predominance of males (57.69%), mean age of 42 ± 9.7 years for anesthesiologists and 30 ± 2.9 years for residents. Burnout syndrome had a prevalence of 2.43% among anesthesiologists and 2.70% among resident physicians, while a high risk for its manifestation was 21.95% in anesthesiologists and 29.72% in resident physicians. There was a correlation between state-anxiety and the variables burnout emotional exhaustion, burnout depersonalization, and trait-anxiety. Regarding trait-anxiety, there was no statistically significant correlation with other variables. CONCLUSIONS: There is association between state-anxiety and the emotional exhaustion dimensions of burnout, burnout depersonalization, and trait-anxiety. The occurrence of anxiety can negatively influence the way the individual faces daily stressors, which may be related to the use of ineffective strategies to cope with stress.