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Kursumovic E, Cook TM, Lucas DN, Davies MT, Martin S, Kane AD, Armstrong RA, Oglesby FC, Cortes L, Taylor C, Moppett IK, Agarwal S, Beecham E, Cordingley J, Dorey J, Finney SJ, Kunst G, Nickols G, Mouton R, Nolan JP, Patel B, Pappachan VJ, Plaat F, Scholefield BR, Smith JH, Varney L, Wain EC, Soar J. The 7th National Audit Project (NAP7) baseline survey of individual anaesthetists: preparedness for and experiences of peri-operative cardiac arrest. Anaesthesia 2023; 78:1453-1464. [PMID: 37920919 DOI: 10.1111/anae.16154] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/04/2023]
Abstract
The Royal College of Anaesthetists' 7th National Audit Project baseline survey assessed knowledge, attitudes, practices and experiences of peri-operative cardiac arrests among UK anaesthetists and Anaesthesia Associates. We received 10,746 responses, representing a 71% response rate. In-date training in adult and paediatric advanced life support was reported by 9646 (90%) and 7125 (66%) anaesthetists, respectively. There were 8994 (84%) respondents who were confident in leading a peri-operative cardiac arrest, with males more confident than females, but only 5985 (56%) were confident in leading a debrief and 7340 (68%) communicating with next of kin. In the previous two years, 4806 (46%) respondents had managed at least one peri-operative cardiac arrest, of which 321 (7%) and 189 (4%) of these events involved a child or an obstetric patient, respectively. Respondents estimated the most common causes of peri-operative cardiac arrest to be hypovolaemia, hypoxaemia and cardiac ischaemia, with haemorrhage coming fifth. However, the most common reported causes for the most recently attended peri-operative cardiac arrest were haemorrhage; (927, 20%); anaphylaxis (474, 10%); and cardiac ischaemia (397, 9%). Operating lists or shifts were paused or stopped after 1330 (39%) cardiac arrests and 1693 (38%) respondents attended a debrief, with 'hot' debriefs most common. Informal wellbeing support was relatively common (2458, 56%) and formal support was uncommon (472, 11%). An impact on future care delivery was reported by 196 (4%) anaesthetists, most commonly a negative psychological impact. Management of a peri-operative cardiac arrest during their career was reported by 8654 (85%) respondents. The overall impact on professional life was more often judged positive (2630, 30%) than negative (1961, 23%), but impact on personal life was more often negative.
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Sliwinski S, Werneburg E, Faqar-Uz-Zaman SF, Detemble C, Dreilich J, Mohr L, Zmuc D, Beyer K, Bechstein WO, Herrle F, Malkomes P, Reissfelder C, Ritz JP, Vilz T, Fleckenstein J, Schnitzbauer AA. A toolbox for a structured risk-based prehabilitation program in major surgical oncology. Front Surg 2023; 10:1186971. [PMID: 37435472 PMCID: PMC10332323 DOI: 10.3389/fsurg.2023.1186971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/17/2023] [Indexed: 07/13/2023] Open
Abstract
Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients' resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in outcomes and definitions. In this scoping review, class 1 and 2 evidence was included to identify seven main aspects of prehabilitation for the treatment pathway: (i) risk assessment, (ii) FITT (frequency, interventions, time, type of exercise) principles of prehabilitation exercise, (iii) outcome measures, (iv) nutrition, (v) patient blood management, (vi) mental wellbeing, and (vii) economic potential. Recommendations include the risk of tumor progression due to delay of surgery. Patients undergoing prehabilitation should perceive risk assessment by structured, quantifiable, and validated tools like Risk Analysis Index, Charlson Comorbidity Index (CCI), American Society of Anesthesiology Score, or Eastern Co-operative Oncology Group scoring. Assessments should be repeated to quantify its effects. The most common types of exercise include breathing exercises and moderate- to high-intensity interval protocols. The program should have a duration of 3-6 weeks with 3-4 exercises per week that take 30-60 min. The 6-Minute Walking Testing is a valid and resource-saving tool to assess changes in aerobic capacity. Long-term assessment should include standardized outcome measurements (overall survival, 90-day survival, Dindo-Clavien/CCI®) to monitor the potential of up to 50% less morbidity. Finally, individual cost-revenue assessment can help assess health economics, confirming the hypothetic saving of $8 for treatment for $1 spent for prehabilitation. These recommendations should serve as a toolbox to generate hypotheses, discussion, and systematic approaches to develop clinical prehabilitation standards.
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Affiliation(s)
- Svenja Sliwinski
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Elisabeth Werneburg
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Sara Fatima Faqar-Uz-Zaman
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Charlotte Detemble
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Julia Dreilich
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Lisa Mohr
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Dora Zmuc
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Katharina Beyer
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
| | - Wolf O. Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Florian Herrle
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Romed Klinik Prien am Chiemsee, Klinik für Allgemein- und Viszeralchirurgie, Prien am Chiemsee, Germany
| | - Patrizia Malkomes
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Christoph Reissfelder
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joerg P. Ritz
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Helios Clinics Schwerin, Department for General and Visceral Surgery, Schwerin, Germany
| | - Tim Vilz
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Johannes Fleckenstein
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Department of Pain Medicine, Hospital Landsberg am Lech, Landsberg am Lech, Germany
| | - Andreas A. Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
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Jalili M, Rezapour-Mirsaleh Y, Mirhosseini SJ. Investigating Surgeons' Reactions to Patients' Death: A Phenomenological Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231162731. [PMID: 36872588 DOI: 10.1177/00302228231162731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The main purpose of this study was to scrutinize the reaction of surgeons towards patients' death. This study enjoyed a qualitative approach using a phenomenological lived experience. 12 surgeons who had witnessed patients' death were selected through purposive sampling until data saturation was achieved. The data were collected using semi-structured interviews and were analyzed through the Colaizzi's method. The main concepts extracted from the analysis of the participants' experience comprised three main themes, six sub-categories and 19 initial sub-categories. The main themes were (a) emotional-mental reactions including the sub-themes of emotional distress, mood disorder and mental distress, (b) death encounter including the sub-themes of rational encounter and pre-emptive measure and (c) post-traumatic growth covering the concepts of optimism and performance improvement. The obtained findings imply that the patients' death can sometimes make surgeons aware of the post-incident growth although such deaths affect their personal, family, social and professional lives.
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Affiliation(s)
- Maryam Jalili
- Department of Counseling, Faculty of Humanities and Social Sciences, Ardakan University, Ardakan, Iran
| | - Yasser Rezapour-Mirsaleh
- Department of Counseling, Faculty of Humanities and Social Sciences, Ardakan University, Ardakan, Iran
| | - Seyed Jalil Mirhosseini
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Baigrie RJ, Stupart D. Coping with anastomotic leaks: harder as one gets older? Br J Surg 2023; 110:395-396. [PMID: 36637232 PMCID: PMC10364549 DOI: 10.1093/bjs/znac455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Robert J Baigrie
- Gastrointestinal Unit, Life Kingsbury Hospital, Cape Town, South Africa.,Colorectal Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Douglas Stupart
- Department Surgery, University Hospital Geelong, Geelong, Victoria, Australia
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Unexpected operative death from hemorrhage: a review of six cases and recommendations. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Akyol C, Celik SU, Koc MA, Bayindir DS, Gocer MA, Karakurt B, Kaya M, Kekec SN, Simsek FA. The Impact of Patient Deaths on General Surgeons’ Psychosocial Well-Being and Surgical Practices. Front Surg 2022; 9:898274. [PMID: 35574543 PMCID: PMC9096651 DOI: 10.3389/fsurg.2022.898274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patient deaths are an unavoidable occurrence in surgical practice. Although these events have negative effects on patients and their families, they can also have a profound adverse impact on surgeons who are unprepared for these deep emotional experiences. This study aims to investigate the impact of patient deaths on general surgeons’ psychosocial well-being and surgical practices. Methods A national cross-sectional survey of a 30-item questionnaire was conducted. The survey evaluated the surgeons’ demographics, professional and practice characteristics, and the impact of patient deaths on their emotional well-being, professional career, and social life. Results Four hundred eighty participants completed the survey. One-third of the participants reported that patient deaths affected their emotional well-being, 23.3% reported that patient deaths affected their social life, and 34.2% reported that patient deaths affected their professional career. Surgeons who reported suffering from the emotional impact of death exhibited no differences in terms of place of practice, academic title, surgical experience, work hours, or annual surgical volume. Middle-aged surgeons (p = 0.004), females (p = 0.041), and surgeons who reported feeling burned out (p < 0.001) were more likely to be affected by patient loss. Feelings of sadness, worry, and stress were most reported. A total of 18.1% of the participants indicated that they considered taking a break after patient death, and 11.9% thought they would abandon their surgical career. Conclusions The findings of this study suggest that patient death affects surgeons’ psychosocial well-being and surgical practices. Greater awareness and effort are required at the personal, institutional, and organizational level to provide effective support, helping surgeons to cope with the emotional burden of patient deaths.
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Affiliation(s)
- Cihangir Akyol
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
- Correspondence: Cihangir Akyol Suleyman Utku Celik
| | - Suleyman Utku Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
- Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey
- Correspondence: Cihangir Akyol Suleyman Utku Celik
| | - Mehmet Ali Koc
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Duygu Sezen Bayindir
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Ali Gocer
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Buket Karakurt
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kaya
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Sena Nur Kekec
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Furkan Aydin Simsek
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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Stabnick A, Yeboah M, Arthur-Komeh J, Ankobea F, Moyer CA, Lawrence ER. "Once you get one maternal death, it's like the whole world is dropping on you": experiences of managing maternal mortality amongst obstetric care providers in Ghana. BMC Pregnancy Childbirth 2022; 22:206. [PMID: 35287601 PMCID: PMC8919901 DOI: 10.1186/s12884-022-04535-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/11/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Maternal mortality has a significant global impact, especially in low-resource settings. Little prior research has been conducted on the potential effects of poor maternal outcomes on the personal and professional well-being of healthcare providers. This study explores the in-depth experiences and perspectives of obstetric providers in Ghana who work in a setting with frequent maternal mortalities. METHODS This is a qualitative study of semi-structured interviews conducted at the Komfo Anokye Teaching Hospital in Ghana. Participants were obstetric healthcare providers, defined as midwives, house officers currently rotating on the obstetrics/gynecology service, and obstetrician/gynecologists at any training or practice level (residents, fellows, and specialists). Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo for qualitative analysis. Using the Attride-Stirling qualitative model, an incremental and iterative process was used to code interviews with keyword phrases and develop a framework of organizing and global themes. RESULTS Interviews were conducted with 27 participants-15 midwives and 12 physicians (three obstetrician/gynecologist residents, six obstetrician/gynecologist specialists, and three house officers), with sample size determined by data saturation. Obstetric providers' experiences in a setting with frequent maternal mortalities were dependent on their level of preparedness to manage maternal mortalities and the workplace environment. Providers' level of preparedness was dependent on both the training they had received on the medical management of obstetric emergencies, as well as a lack of training on the mental health aspects of coping with maternal mortality. The impact of the workplace environment was dependent on systems failures and limited resources, blame from colleagues and supervisors, and a lack of support in the workplace. In turn, obstetric providers' experiences managing frequent maternal mortalities impacted their clinical care performance and mental health. CONCLUSIONS Maternal deaths have profound personal and professional impacts on the healthcare providers who manage them. A large need exists for additional institutional training and support for obstetric providers who manage maternal mortality, especially in low-resource settings like Ghana.
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Affiliation(s)
- Anna Stabnick
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Michael Yeboah
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | - Johnny Arthur-Komeh
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | - Frank Ankobea
- Department of Obstetrics and Gynecology, KNUST-SMD, Kumasi, Ghana
| | - Cheryl A. Moyer
- Global REACH, Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Emma R. Lawrence
- Global REACH, Department of Obstetrics & Gynecology, University of Michigan Medical School, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
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Ayalew M, Deribe B, Abraham Y, Reta Y, Tadesse F, Defar S. Post-traumatic Stress Disorder Symptoms and Its Predictors Among Healthcare Workers Following COVID-19 Pandemic in Southern Ethiopia: A Cross-Sectional Study. Front Psychiatry 2022; 12:818910. [PMID: 35058824 PMCID: PMC8763794 DOI: 10.3389/fpsyt.2021.818910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/10/2021] [Indexed: 12/13/2022] Open
Abstract
Background: COVID-19 causes immense psychological pressure on communities in addition to physical misery. There is currently a scarcity of data on the psychological impact of the COVID-19 epidemic on Ethiopian healthcare workers (HCWs). Therefore, this study was aimed to assess the post-traumatic stress disorder (PTSD) symptoms and its predictors following COVID-19 pandemic among healthcare workers (HCWs) in southern Ethiopia. Methods: A hospital based cross-sectional study design was used among 387 randomly selected HCWs between September 25 and October 25, 2020 at four selected public hospitals in Sidama National Regional State, southern Ethiopia. Impact of Event Scale-Revised (IES-R) was used to collect data post-traumatic stress disorder (PTSD) symptoms. Logistic regression analyses with 95% CI were used to examine the relationship between independent and outcome variables. Result: The prevalence of PTSD symptoms was found in 56.8% of participants. Significant factors that increase risk of PTSD symptoms were being female (AOR = 1.91, 95% CI = 1.19, 3.05), married (AOR = 1.87, 95% CI = 1.12, 3.14) and nurses (AOR = 3.31, 95% CI = 1.66, 6.63). On the other hand, HCWs working other than emergency unit such as inpatients/wards (AOR = 0.43, 95% CI = 0.24, 0.75), OPD (AOR = 0.48, 95% CI = 0.24, 0.97) and other units (AOR = 0.49, 95% CI = 0.25, 0.96) less likely to be affected by PTSD symptoms. Conclusion: The current study showed high levels of PTSD symptoms as psychological challenges for HCWs. Sex, age, marital status, type of profession and working environment were significant factors for PTSD symptoms in HCWs during the pandemic. HCWs require mental health support during and after the pandemic.
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Affiliation(s)
- Mohammed Ayalew
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Bedilu Deribe
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Yacob Abraham
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Yared Reta
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Fikru Tadesse
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Semira Defar
- Department of Midwifery, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
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Ayalew M, Deribe B, Abraham Y, Reta Y, Tadesse F, Defar S, Hoyiso D, Ashegu T. Prevalence and determinant factors of mental health problems among healthcare professionals during COVID-19 pandemic in southern Ethiopia: multicentre cross-sectional study. BMJ Open 2021; 11:e057708. [PMID: 35119379 PMCID: PMC8718344 DOI: 10.1136/bmjopen-2021-057708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/08/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To assess the prevalence of depression, anxiety and stress and its determinant factors during COVID-19 pandemic among healthcare professionals in southern Ethiopia. DESIGN Multi-centre cross-sectional study. SETTING AND STUDY PERIOD Randomly selected public hospitals in Sidama, southern Ethiopia between 25 September 2020 and 25 October 2020. PARTICIPANTS 387 healthcare professionals were randomly selected. OUTCOME MEASURES Prevalence and determinant factors of depression, anxiety and stress was assessed. RESULT Depression, anxiety and stress prevalence were shown to be 50.1% (95% confidence interval (CI) 45.0% to 55.0%), 55.0% (95% CI 51.1% to 59.9%) and 38.5% (95% CI 33.6% to 43.2%), respectively. Being female (adjusted odd ratio (AOR) 3.71, 95% CI 2.31 to 5.97), married (AOR 2.28, 95% CI 1.34 to 3.86), living alone (AOR 1.87, 95% CI 1.09 to 3.20), nurses (AOR 2.94, 95% CI 1.44 to 5.99) and working in inpatients (AOR 0.53, 95% CI 0.29 to 0.93) were significantly associated with depressive symptoms. Moreover, older age groups (AOR 3.15, 95% CI 1.04 to 6.56), females (AOR 3.25, 95% CI 2.01 to 5.25), married (AOR 1.69, 95% CI 1.01 to 2.87) and nurses (AOR 3.32, 95% CI 1.63 to 6.78) were significantly associated with symptoms of anxiety. Stress symptoms were significantly high among females (AOR 2.47, 95% CI 1.53 to 3.97), married (AOR 2.77, 95% CI 1.60 to 4.78), living alone (AOR 2.01, 95% CI 1.15 to 3.52), nurses (AOR 2.34, 95% CI 1.11 to 4.92) and working in units other than emergency (inpatient (AOR 0.32, 95% CI 0.18 to 0.57) and other units (AOR 0.48, 95% CI 0.25 to 0.95)). CONCLUSION The current study found that healthcare professionals have high levels of depression, anxiety and stress symptoms. Sex, age, marital status, type of profession, living status and working environment were significant factors for mental health problems in healthcare professionals during the pandemic. Healthcare professionals require mental health support at which monitoring and control can be performed during and after the pandemic.
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Affiliation(s)
- Mohammed Ayalew
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia
| | - Bedilu Deribe
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia
| | - Yacob Abraham
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia
| | - Yared Reta
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia
| | - Fikru Tadesse
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia
| | - Semira Defar
- Department of Midwifery, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia
| | - Dawit Hoyiso
- School of Nursing, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia
| | - Tebeje Ashegu
- Department of Midwifery, Hawassa University College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia
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Berry P, Kotha S. The under-recognised effects of serious endoscopic complications on practitioners. Lancet Gastroenterol Hepatol 2021; 6:978-980. [PMID: 34774150 DOI: 10.1016/s2468-1253(21)00341-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/24/2021] [Accepted: 08/31/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Philip Berry
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London SE1 7JD, UK
| | - Sreelakshmi Kotha
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust, London SE1 7JD, UK.
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Siddaiah-Subramanya M, To H, Haigh C. The psychosocial impact of surgical complications on the operating surgeon: A scoping review. Ann Med Surg (Lond) 2021; 67:102530. [PMID: 34276982 PMCID: PMC8267492 DOI: 10.1016/j.amsu.2021.102530] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Aim Surgical complications are common, and their management is an integral part of surgical care. The impact on the surgeon, the “second victim” is significant, particularly in terms of psychological health. The aim of this review is to describe the nature of psychosocial consequences of surgical complications on the surgeons involved. Method Following scoping review protocols, we set out to identify the evidence-base for psychosocial consequences on the operating surgeon, predominantly general surgeons, following surgical complications. Results This scoping review identified 19 articles, mainly survey and interview based (n = 8), with all but one article from first world countries. Seven articles reported on negative emotions or depressive behavioural responses. All original studies reported on difficulty in coping (37.5%), and a range of behaviours. There was little evidence for support structures or active interventions to aid the surgeon post complication. Conclusions The review suggests that the psychosocial impact, following a complication, is variable but affects every surgeon irrespective of the level of impact on the patient. The main variables differentiating impact are severity, and outcome of the complication and seniority of the surgeon. Reported emotions and behaviours were generally negative and persist across the surgeon's journey towards recovery. Surgeons who manage stress well exhibit largely constructive behaviours and actively work to recover. Identification of variables underpinning complications, and affected surgeons is paramount, as is the provision of services to support recovery. Efforts should be made to proactively prevent complications, via education, awareness and to formalise support processes. Surgical complications negatively impact the operating surgeon (the second victim). Negative emotions and behaviours manifested may persist throughout surgeon’s career. Surgeons’ reaction can negatively influence social and professional relationships. Range of factors affect coping and recovery, and the support sought tend not to focus on psychosocial aspects of coping. Need to develop management resources for surgeons to manage the psychosocial impact.
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Affiliation(s)
- Manjunath Siddaiah-Subramanya
- Department of Upper GI Surgery, Queen Elizabeth Hospital, Birmingham, UK.,University of Melbourne, Melbourne, Australia
| | - Henry To
- University of Melbourne, Melbourne, Australia.,Department of General Surgery, Northern Hospital Epping, Melbourne, Australia
| | - Catherine Haigh
- Monash Rural Health Gippsland, Monash University, Traralgon, Australia
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12
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Pellino G, Pellino IM, Pata F. Uncovering the Veils of Maya on defensive medicine, litigation risk and second victims in surgery: care for the carers to protect the patients. Colorectal Dis 2021; 23:548-549. [PMID: 33217079 DOI: 10.1111/codi.15451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Francesco Pata
- General Surgery Unit, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy.,La Sapienza University, Rome, Italy
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13
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Conti C, Fontanesi L, Lanzara R, Rosa I, Porcelli P. Fragile heroes. The psychological impact of the COVID-19 pandemic on health-care workers in Italy. PLoS One 2020; 15:e0242538. [PMID: 33206714 PMCID: PMC7673566 DOI: 10.1371/journal.pone.0242538] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
This survey-based study aimed to explore the mental health status and psychological care needs of 933 health-care workers in Italy during the COVID-19 outbreak. Sociodemographic data, exposure to COVID-19, perception of psychological care needs, depression, anxiety, somatization, and post-traumatic symptoms were concurrently assessed. The majority of the sample (71%) suffered from somatization and 55% of distress. Female care workers experienced higher levels of anxiety (d = 0.50) and somatization symptoms (d = 0.82) and stated they needed psychological care more than men (p < .001). Younger participants (aged <40 years-old) reported higher levels of somatization, depression, anxiety, and post-traumatic symptoms (effects size range from d = 0.22 to d = 0.31). Working in a high infected area (red-zones) and directly with COVID-19 patients (front-line) affected the psychological health of participants to a smaller degree. Health-care workers who lost one of their patients reported higher levels of depression (d = 0.22), anxiety (d = 0.19), post-traumatic symptoms (d = 0.30), and psychological care needs than those who did not have the same experience (p < .01). Health-care workers who perceived the need for psychological support scored above the clinical alarming level (cut-off scores) in all the psychological scales, ranging from 76% to 88%. Psychological distress (p < .01), anxiety (p < .05), depression (p < .05), and being women (p < .01) contribute to explain the need for psychological care and accounted for 32% of the variance in this sample. These findings point out the importance to consider the psychological impact of COVID-19 on Italian health-care workers and strongly suggest establishing psychological support services for providing adequate professional care.
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Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University “G. d'Annunzio” of Chieti‐Pescara, Chieti, Italy
| | - Lilybeth Fontanesi
- Department of Psychological, Health, and Territorial Sciences, University “G. d'Annunzio” of Chieti‐Pescara, Chieti, Italy
| | - Roberta Lanzara
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Ilenia Rosa
- Department of Dynamic and Clinical Psychology, “Sapienza” University of Rome, Rome, Italy
| | - Piero Porcelli
- Department of Psychological, Health, and Territorial Sciences, University “G. d'Annunzio” of Chieti‐Pescara, Chieti, Italy
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14
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Pellino G, Pellino IM. Deaths, errors and second victims in surgery: an underestimated problem. Br J Surg 2020; 107:152. [PMID: 31869471 DOI: 10.1002/bjs.11432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/24/2019] [Indexed: 01/16/2023]
Affiliation(s)
- G Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Colorectal Unit, University Hospital Vall d'Hebron, Barcelona, Spain
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15
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Boyle FM, Allen J, Rey-Conde T, North JB. Learning from regret. Br J Surg 2020; 107:422-431. [PMID: 32077094 DOI: 10.1002/bjs.11452] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Death after surgery is infrequent but can be devastating for the surgeon. Surgeons may experience intense emotional reactions after a patient's death, reflecting on their part in the death and the patient's loss of life. Excessive rumination or feelings of regret may have lasting negative consequences, but these reactions may also facilitate learning for future decision-making. This qualitative study analysed surgeons' reflections on what might have been done differently before a patient's death and explored non-technical (cognitive and interpersonal) aspects of care as potential targets for improvement. METHODS In Australia's Queensland Audit of Surgical Mortality, surgeons reflect on factors surrounding the death of patients in their care and respond to the open-ended question: in retrospect, would you have done anything differently? Framework analysis was applied to surgeons' responses to identify themes relating to non-technical aspects of care. RESULTS Responses from 1214 surgeons were analysed. Two main themes were identified. Dilemmas and difficult decisions confirmed the uncertainty, complexity and situational pressures that often precede a surgical death; regret and empathy for patients featured in some responses. In the second main theme, communication matters, surgeons cited better communication, with patients, families, colleagues and at handover, as a source of reflective change to improve decision-making and reduce regret. CONCLUSION Surgical decision-making involves uncertainty, and regret may occur after a patient's death. Enhancing the quality of communication with patients and peers in comprehensive assessment of the surgical patient may mitigate postdecision regret among surgeons.
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Affiliation(s)
- F M Boyle
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
| | - J Allen
- Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality, Brisbane, Queensland, Australia
| | - T Rey-Conde
- Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality, Brisbane, Queensland, Australia
| | - J B North
- Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality, Brisbane, Queensland, Australia
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16
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Joliat GR, Demartines N, Uldry E. Author response: Defensive medicine and second victims in surgery. Br J Surg 2019; 107:152-153. [PMID: 31869456 DOI: 10.1002/bjs.11431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/08/2022]
Affiliation(s)
- G-R Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - E Uldry
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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17
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Pellino G. Tweets of the month. Br J Surg 2019; 106:1856-1857. [PMID: 31747066 DOI: 10.1002/bjs.11439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- G Pellino
- Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy and Colorectal Unit, University Hospital Vall d'Hebron, Barcelona, Spain (@GianlucaPellino)
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18
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Chamberlain C, Blazeby JM. A good surgical death. Br J Surg 2019; 106:1427-1428. [DOI: 10.1002/bjs.11360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/14/2019] [Indexed: 01/20/2023]
Affiliation(s)
- C Chamberlain
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J M Blazeby
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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19
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This month on Twitter. Br J Surg 2019; 106:1561. [DOI: 10.1002/bjs.11385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 11/06/2022]
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