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Surg Clin North Am ; 99(5): 1029-1035, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446908


Burnout is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. All physicians, and especially surgeons, are at risk for developing burnout. The best strategies for mitigating burnout mimic a modern approach to medicine: the development of preventive practices to protect, promote, and maintain health and well-being. Job satisfaction, job engagement, and compassion satisfaction help protect from burnout. Individual commitment to self-care in conjunction with support from within health care organizations create the optimal framework in which burnout can be mitigated.

Esgotamento Profissional/prevenção & controle , Fadiga por Compaixão/prevenção & controle , Esgotamento Profissional/psicologia , Estilo de Vida Saudável , Humanos , Satisfação no Emprego , Fatores de Risco , Autocuidado
Nutrition ; 30(3): 313-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24355437


OBJECTIVES: Total hepatic blood flow (HBF) via the hepatic artery and portal vein is highly dependent on gastrointestinal perfusion. During postprandial hyperemia, intestinal blood flow depends on nutrient composition, gastrointestinal location, and time. Immune-enhancing diets (IEDs) containing n-3 polyunsaturated fatty acids (PUFAs) selectively augment blood flow in the ileum at 60-120 min via a bile-dependent mechanism. My colleagues and I hypothesized that liver blood flow would be similarly affected by IEDs containing n-3 PUFAs. METHODS: Mean arterial blood pressure, heart rate, and effective HBF (galactose clearance) were measured in anesthetized male Sprague-Dawley rats after gastric gavage of either a control diet (CD, Boost, Novartis) or an IED (Impact, Nestle Nutrition), with or without bile-duct ligation (BDL), and with or without supplemental bile (bovine, dried, unfractionated). Significance was assessed by 2-way ANOVA for repeated measures with the Tukey-Kramer honestly significant difference test. RESULTS: Compared with baseline levels, a CD increased HBF (peak at 40 min , *P < 0.05) whereas an IED increased HBF in two distinct peaks at 40 min (*P < 0.05) and 120 min (*P < 0.05), but BDL prevented both the early (CD and IED, †P < 0.05) and late peaks (IED, †P < 0.05). Bile supplementation in the CD + BDL or IED + BDL groups restored neither the CD peak nor the early or late IED peaks. CONCLUSIONS: HBF during absorptive intestinal hyperemia is modulated by a mechanism that requires an intact enterohepatic circulation. The early peaks at 40 min (CD or IED) were prevented by BDL, even though fat absorption in the proximal gut occurs by bile-independent direct absorption. Bile supplementation with the diet (CD + BDL or IED + BDL) was insufficient to restore HBF hyperemia, which implies that a relationship exists between intestinal and hepatic blood flow that is not solely dependent on bile-mediated intestinal fat absorption and bile recirculation.

Bile/metabolismo , Nutrição Enteral , Ácidos Graxos Ômega-3/administração & dosagem , Fígado/irrigação sanguínea , Fluxo Sanguíneo Regional/fisiologia , Animais , Dieta , Suplementos Nutricionais , Mucosa Intestinal/metabolismo , Fígado/metabolismo , Masculino , Período Pós-Prandial , Ratos , Ratos Sprague-Dawley