[Correlation between compassion fatigue and workplace violence in emergency department nurses]

Objective: To investigate the workplace violence and compassion fatigue of nurses in emergency department and to explore the relationship between the two. Methods: The general information questionnaire, workplace violence scale and professional quality of life scale were used to investigate 957 emergency department nurses of 28 Level II hospitals and above. Results: The scores of each dimension of the professional quality of life scale for nurses in the emergency department were: compassion satisfaction score was 29.91±7.82, the burnout score was 26.63±5.66, and the second trauma score was 23.17±5.94. The total score of compassion fatigue is 49.80±10.42. The incidence of workplace violence was 77.6%. Workplace violence was negatively correlated with compassion satisfaction (r=-0.250, P<0.01) , and positively correlated with burnout, secondary trauma, and total compassion fatigue (r=0.349、0.340、0.384, P<0.01) . Whether there is only non-physical violence in the compassion satisfaction, burnout, secondary trauma, compassion fatigue total score is not statistically significant. Conclusion: Compassion fatigue is more serious in emergency department nurses, and the incidence of workplace violence is higher. Workplace violence has a positive effect on compassion fatigue. Nursing managers should actively prevent workplace violence and improve the working environment, thus reducing empathy fatigue.

Effect of miR-101 on proliferation and oxidative stress-induced apoptosis of breast cancer cells via Nrf2 signaling pathway

OBJECTIVE

To explore the influence of micro ribonucleic acid (miR)-101 on breast cancer cell proliferation and apoptosis via nuclear factor (erythroid-derived 2)-like 2 (Nrf2) signaling pathway.

MATERIALS AND METHODS

All MCF-7 cells were divided into 3 groups, namely control group, miR-101 mimic group (the cells were treated with 50 nmol/L miR-101 mimic), and miR-101 inhibitor group (the cells were treated with 50 nmol/L miR-101 inhibitor). The impact of miR-101 expression level on MCF-7 cell proliferation was evaluated via cell counting kit-8 (CCK-8) and colony formation assays. After the MCF-7 cells in the three groups were treated with 100 nM H2O2 for 12 h, the change in the apoptosis rate was detected via flow cytometry. Moreover, the influence of miR-101 expression level on the Nrf2 signaling pathway was detected via reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting.

RESULTS

According to the CCK-8 assay results, compared with that in control group, the proliferation rate of cells notably declined at 48, 72, and 96 h in miR-101 mimic group, and the difference was statistically significant (p<0.01), while it was substantially raised in miR-101 inhibitor group, showing a statistically significant difference (p<0.01). Compared that in control group, the cell colony formation rate was remarkably lowered in miR-101 mimic group, and the difference was statistically significant (p<0.01), while it was substantially raised in miR-101 inhibitor group (p<0.01). According to the flow cytometry assay results, compared with that in control group, the apoptosis of MCF-7 cells was markedly enhanced in miR-101 mimic group, showing a statistically significant difference (p<0.01), while it was weakened in miR-101 inhibitor group, with a statistically significant difference (p<0.01). The influence of miR-101 on the expression level of Nrf2 was detected via RT-PCR, and it was found that the messenger RNA (mRNA) expression level of Nrf2 was notably lower in miR-101 mimic group than that in control group (p<0.01), while it was raised in miR-101 inhibitor group. Western blotting results showed that compared with control group, miR-101 mimic group had a substantially lowered protein expression level of Nrf2 in the cell nucleus, with a statistically significant difference (p<0.01), while it was notably raised in miR-101 inhibitor group and the difference was statistically significant (p<0.01), indicating that miR-101 can remarkably lower the nucleoprotein expression level of Nrf2.

CONCLUSIONS

The results of this study imply that miR-101 can inhibit the expression of Nrf2 to suppress the proliferation of breast cancer cells and enhance their sensitivity to oxidative stress, which provides a theoretical basis for reversal of tumor resistance.

Barriers to Referral to Fellowship-trained Minimally Invasive Gynecologic Surgery Subspecialists

STUDY OBJECTIVE

To determine patterns and barriers for referral to fellowship-trained minimally invasive gynecologic surgeons.

DESIGN

Questionnaire.

SETTING

United States and its territories and Canada.

PARTICIPANTS

Actively practicing general obstetrician/gynecologists (OB/GYNs).

INTERVENTIONS

Internet-based survey.

MEASUREMENTS AND MAIN RESULTS

Of 157 respondents, 144 (91.7%) general OB/GYNs were included. Subspecialty fellowship training resulted in the exclusion of 13 (8.3%) respondents. A total of 86 respondents (59.7%) considered referral to fellowship-trained minimally invasive gynecologic surgery (MIGS) subspecialists. The top 3 cited reasons for nonreferral were adequate residency training (n = 84, 58.3%), preference for continuity of care (n = 48, 33.3%), and preference for referral to other subspecialists (n = 46, 31.9%). The top 3 cited reasons for referral to MIGS subspecialists were complex pathology (n = 92, 63.9%), complex medical and/or surgical history (n = 76, 52.8%), and out of scope of practice (n = 53, 36.8%). If providers required intraoperative assistance, respondents consulted an OB/GYN colleague with comparable training (n = 50, 34.7%), gynecologic oncologist (n = 48, 33.3%), or non-OB/GYN surgical subspecialist (n = 33, 22.9%). Factors that were not associated with the decision to refer to MIGS subspecialists included years in practice (p = .13), additional training experiences beyond residency (p = .45), and number of hysterectomies performed by laparotomy (p = .69). Self-reported high-volume surgeons (p <.01) were less likely to refer. In contrast, providers who self-reported as low-volume surgeons (p = .02) and were aware of MIGS subspecialists in the community (p <.01) were more likely to consider referral. Respondents reported using a laparoscopic approach to hysterectomy most frequently (n = 79, 54.9%). In contrast, 36.8% preferred the laparoscopic route for themselves or their partner, whereas 48.6% preferred the vaginal approach.

CONCLUSION

Most of the general OB/GYNs would consider referral to fellowship-trained MIGS subspecialists. Providers who reported adequate residency training and those who preferred continuity of care or referral to other surgical subspecialists were less likely to refer to MIGS subspecialists.

Nerve-sparing in Gynecologic Surgery: A Perspective

OBJECTIVE

To provide a perspective on nerve-sparing (NS) surgery in gynecology.

DATA SOURCES

Literature review, English language.

METHODS OF STUDY SELECTION

Systematic reviews and meta-analyses studies were selected for review for oncology; comparative studies were selected for endometriosis, and 1 comparative and 1 prospective study were chosen for sacrocolpopexy.

TABULATION, INTEGRATION, AND RESULTS

Two tables summarize the results of systematic reviews and meta-analyses in oncology. Oncology, endometriosis, and urogynecology sections. Primary benefit of NS technique is decreased bladder dysfunction, and, to a lesser degree, vaginal and rectal dysfunc.

CONCLUSION

NS is preferable to conventional surgery for benign and malignant conditions to reduce postoperative bladder, rectal, and vaginal dysfunction.

A Case Series of Robot-assisted Rectus Abdominis Flap Harvest for Pelvic Reconstruction: A Single Institution Experience

STUDY OBJECTIVE

To analyze outcomes and postoperative complications in patients undergoing robot-assisted rectus abdominis flap harvest for pelvic floor reconstruction.

DESIGN

Case series.

SETTING

Academic setting.

PATIENTS

Pelvic reconstruction surgery patients.

INTERVENTIONS

The rectus abdominis muscle flap can be used as a flap for pelvic reconstruction, providing a large volume of soft tissue that can be used in the treatment of many comorbid conditions, including genital fistulas, postradiation pelvic exenteration, and abdominoperineal resection defects. Intraperitoneal harvest of the rectus muscle using a robotic approach allows avoidance of laparotomy and subsequent disruption of the anterior rectus sheath, thus preserving the integrity of the abdominal wall.

MEASUREMENTS AND MAIN RESULTS

A retrospective analysis of patient demographic and clinical characteristics was performed for all patients who underwent robot-assisted rectus abdominis flap harvest for pelvic floor reconstruction at our institution from October 1, 2016, to October 31, 2018. The postoperative complications analyzed included bowel obstructions, surgical site infections, emergency room visits, and need for readmission. Six patients (4 women and 2 men), with a mean age of 69.2 years (range = 57-79 years) and median follow-up time of 9.2 months (range = 5-12 months), were included. Muscle flap harvest was performed on the right side in 4 patients and on the left in 2 patients. The indications for reconstructive surgery included vesicovaginal fistula, complex pelvic organ prolapse, anterior and posterior exenteration, partial and total vaginectomy, partial vulvectomy, and abdominoperineal resection. Two patients received neoadjuvant chemoradiation. One of the 6 cases was converted to laparotomy; however, this was not owing to the rectus harvest. Three patients experienced no complications after reconstruction; 1 patient reported occasional abdominal pain; 1 patient had intermittent bowel obstruction; and 1 patient developed a pelvic abscess, requiring readmission. All 6 patients achieved satisfactory healing of the pelvic wound after robot-assisted rectus abdominis flap inset.

CONCLUSION

Robot-assisted rectus abdominis flap harvest for pelvic floor reconstruction is a reliable means of defect closure, despite the presence of substantial comorbidities and risk factors in this patient cohort. Patient selection and counseling are crucial to optimize surgical outcomes in this complex population.