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Burnout in COVID-19 Residency

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Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 18-24 | Sachin Kale, Pratik Dhabalia, Ajit Chalak, Abhiraj Patel, Abhineet Chand, Sonali Das

DOI: :10.13107/jcorth.2023.v08i01.551

Author: Sachin Kale [1], Pratik Dhabalia [1], Ajit Chalak [1], Abhiraj Patel [1], Abhineet Chand [1], Sonali Das [1]

[1] Department of Orthopaedics, DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Abhiraj Patel,

Department of Orthopaedics, DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India.

E-mail: abhirajpatel15@gmail.com

Abstract

Introduction: Burnout is a syndrome denoting the outcome of chronic work stress which has not been managed successfully. Burnout has only sometimes been at the forefront of studies in healthcare, where patient care and management have received more attention. This study focuses particularly on burnout of residents and healthcare workers during the COVID-19 pandemic that has changed the working environment.

Material and Methods: Questionnaires in the form of surveys have been used to receive feedback regarding work experience within the bubble of isolation and high patient load unique to COVID-19 pandemic. A full and complete analysis of the research is provided after the definition, description, and measurement of burnout are given.

Results: According to a review of the burnout literature, burnout affects medical students, residents, and practicing doctors, with prevalence rates ranging from 28% to 45% for each group. First-year residency during the COVID-19 pandemic, in particular, is plagued with unmanageable burnout symptoms and a depleted support system. Burnout among residents is said to be caused by time demands, a lack of control, poor work organization, naturally challenging employment settings, and interpersonal connections. Workplace solutions might take the form of burnout education, workload adjustments, diversifying job roles, stress management training, mentorship, emotional intelligence seminars, and training in emotional intelligence. In addition, developing interpersonal and professional relationships, meditation, therapy, and exercise are examples of self-directed behavioral, social, and physical activities..

Conclusion: Educators should consider including pertinent instructions and interventions during the process of instructing resident doctors. In addition, they should actively become aware of burnout. Early detection aids in better management of burnout.

Keywords: burnout, COVID-19, residency, work-life balance.

References

  1. Freudenberger HJ. Staff burnout. J Soc Issues 1974;30:159-65.
  2. Melamed S, Shirom A, Toker S, Berliner S, Shapira I. Burnout and risk of cardiovascular disease: Evidence, possible causal paths, and promising research directions. Psychol Bull 2006;132:327-53.
  3. Cohen JS, Patten S. Well-being in residency training: A survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ 2005;22:21.
  4. Sherman MD. Distress and professional impairment due to mental health problems among psychotherapists. Clin Psychol Rev 1996;16:299-315.
  5. Solomon M. Therapeutic depletion and burnout in countertransference. In: Siegel J, editor. Couples Therapy. New York: WW Norton; 1997.
  6. Halbesleben JR, Rathert C. Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Manage Rev 2008;33:29-39.
  7. Kottler JA. On Being a Therapist. San Francisco, CA: Jossey-Bass; 1986.
  8. Ahola K, Honkonen T, Pirkola S, Isometsä E, Kalimo R, Nykyri E, et al. Alcohol dependence in relation to burnout among the Finnish working population. Addiction 2006;101:1438-43.
  9. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd Palo Alto, CA: Consulting Psychologists Press; 1996.
  10. Maslach C, Jackson SE, Leiter M. The Maslach burnout inventory. In: Zalaquett CP, Wood RJ, editor. Evaluating Stress: A Book of Resources. 3rd Lanham, MD: Scarecrow Press; 1997.
  11. Purdy RR, Lemkau JP, Rafferty JP, Rudisill JR. Resident physicians in family practice: Who’s burned out and who knows? Fam Med 1987;19:203-8.
  12. Dupree P, Day HD. Psychotherapists’ Job Satisfaction and Job Burnout as a Function of Work Setting and Percentage of Managed Care Clients. New York: Haworth Press; 1995.
  13. Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V. Occupational stress and burnout in anaesthesia. Br J Anaesth 2003;90:333-7.
  14. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358-67.
  15. Woodside JR, Miller MN, Floyd MR, McGowen KR, Pfortmiller DT. Observations on burnout in family medicine and psychiatry residents. Acad Psych 2008;32:13-9.
  16. Lemkau JP, Purdy RR, Rafferty JP, Rudisill JR. Correlates of burnout among family practice residents. J Med Educ 1988;63:682-91.
  17. West CP, Huschka MM, Novotny PJ. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA 2006;296:1071-8.
  18. Eckleberry-Hunt J, Lick D, Boura J, Hunt R, Balasubramaniam M, Mulhem E, et al. An exploratory study of resident burnout and wellness. Acad Med 2009;84:269-77.
  19. Ramanan RA, Taylor WC, Davis RB, Phillips RS. Mentoring matters: mentoring and career preparation in internal medicine residency training. J Gen Intern Med 2006;21:340-5.
  20. Vuori I. Does physical activity enhance healthy? Patient Educ Couns 1998;33:S95-103.
  21. Sherman MD, Thelen MH. Distress and professional impairment among psychologists in clinical practice. Prof Psychol Res Pract 1998;29:79-85.
  22. Macaskill N, Macaskill A. Psychotherapists-in-training evaluate their personal therapy: Results of a UK study. Br J Psychother 1992;9:133-8.

 

How to Cite this article: Kale S, Dhabalia P, Chalak A, Patel A, Chand A, Das S. Burnout in COVID-19 Residency. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):18-24.

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Moving toward Regional Anaesthesia for Spine Surgery – Need of the Hour

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Journal of Clinical Orthopaedics | Vol 7 | Issue 2 |  Jul-Dec 2022 | page: 38-42 | Samidha Waradkar , Aaliya Mehmood , Saijyot Raut , Vishal Kundnani

DOI: 10.13107/jcorth.2022.v07i02.527

Author: Samidha Waradkar [1], Aaliya Mehmood [2], Saijyot Raut [3], Vishal Kundnani [4]

[1] Consultant Anesthesiology, at Lilavati Hospital and Research Centre, Mumbai, India,
[2] Senior Resident Anesthesiology at Lilavati Hospital and Research Centre, Mumbai, India,
[3] MS Ortho, Consultant Spine Surgeon at Spine Centre, Andheri and SL Raheja Hospital, Mahim, Mumbai, India,
[4] MS Ortho, Consultant Spine Surgeon at Lilavati Hospital and Research Centre, Mumbai, India.

Address of Correspondence
Dr. Aaliya Mehmood,
Flat 701, A-8, Al-Quba CHS, Millat Nagar, Andheri West, Mumbai 400053, India.
E-mail: aaliyamehmood@hotmail.com

Abstract

Background: In the last few decades, many studies have been conducted on comparison between general anaesthesia (GA) versus spinal anaesthesia (SA) for lumbar spine surgeries and each have reported discrepancies between the two methods of induction with equivalent pros and cons; ultimately failing to state a final conclusive method. With the ongoing COVID pandemic, and the fear of aerosol generation associated with GA; our focus has shifted on regional anesthesia completely, as it is been proven safer and more hassle-free to conduct during these challenging times.

Materials and Methods: A similar case study was conducted with 178 patients posted for lumbar spine procedures under the same surgeon. Wherein, 86 received GA and 92 SA. Appropriate statistical analysis was applied to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, paraplegia, paraesthesia, post-Dural puncture headache, signs of meningism, urinary retention, and other perioperative complications among the SA patients.

Results: SA was associated with significantly lower operative time, blood loss, total anaesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR. SA was also associated with shorter stay in the PACU, and overall lesser total duration of hospital stay. None of the 92 patients in SA group needed conversion to GA or had an episode of high/complete sympathetic blockade. No incidences of paraparesis or paraplegia, or episodes of persistent post-operative paraesthesia or weakness, Bagai (vasovagal) syncope, PONV, post-op meningism, post-dural puncture headache, spinal hematoma, intraoperative dural Cerebrospinal Fluid leak or post-op fistula, were noted. There were two incidences of failed spinal which were easily managed with a lower dose repeat SA. Overall better post-op analgesia and higher patient and surgeon satisfaction compared to GA was observed.

Conclusion: SA is effective for use in patients undergoing elective lumbar spine surgeries and very efficient alternative technique to GA. SA offers efficient OR functioning with decreasing overall operation theatre time and shown to be the more convenient anesthetic choice in the perioperative setting.

Keywords: Spinal Anaesthesia, Regional Anaesthesia, Covid-19, Spine Surgery, Lumbar Discectomy, Fast Track Anaesthesia, Aerosol Generation

References

1. Demirel CB, Kalayci M, Ozkocak I, Altunkaya H, Ozer Y, Acikgoz B. A prospective randomized study comparing perioperative outcome variables after epidural or general anesthesia for lumbar disc surgery. J Neurosurg Anesthesiol. 2003;15:185–192.
2. De Rojas JO, Syre P, Welch WC. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clin Neurol Neurosurg. 2014;119:39–43.
3. Pflug AE, Halter JB. Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans. Anesthesiology. 1981;55:120–126
4. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.
5. McLain RF, Bell GR, Kalfas I, Tetzlaff JE, Yoon HJ. Complications associated with lumbar laminectomy: a comparison of spinal versus general anesthesia. Spine (Phila Pa 1976). 2004;29:2542–2547.
6. McLain RF, Tetzlaff JE, Bell GR, Uwe-Lewandrowski K, Yoon HJ, Rana M. Microdiscectomy: spinal anesthesia offers optimal results in general patient population. J Surg Orthop Adv. 2007;16:5–11.
7. Available at: https://www.nysora.com/techniques/neuraxial-and-perineuraxial-techniques/spinal-anesthesia/
8. Scott NB, Kehlet H. Regional anaesthesia and surgical morbidity. Br J Surg. 1988;75(4):299–304.
9. Attari MA, Mirhosseini SA, Honarmand A, Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: a randomized clinical trial. J Res Med Sci. 2011;16:524–529.
10. Brown MJ. Anesthesia for elective spine surgery in adults. 2015. Available from: https://www.uptodate.com/contents/anesthesia-forelective-spine-surgery-in-adults. Accessed July 26, 2017.
11. Modig J, Karlstrom G. Intra- and post-operative blood loss and haemodynamics in total hip replacement when performed under lumbar epidural versus general anaesthesia. Eur J Anaesthesiol. 1987;4(5):345–55.
12. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000;84(4):450–5.
13. Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005;441:250–5.
14. Sakura S. Epidural anesthesia and spinal anesthesia in the elderly. Masui. 2007;56(2):130–8. [In Japanese].
15. Kao FC, Tsai TT, Chen LH, et al. Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine
J. 2015;24:348–357.

 

How to Cite this article: Waradkar S, Mehmood A, Raut S, Kundnani V. Moving toward Regional
Anesthesia for Spine Surgery – Need of the Hour. Journal of Clinical Orthopaedics Jul-Dec 2022;7(2):38-42.

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Financial Ignorance among Orthopedic Surgeons: A Survey In COVID-19 Era

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Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  Jul-Dec 2021 | page: 8-11 | Sachin Kale, Ajit Chalak, Sanjay Dhar, Prasad Chaudhari, Sushmit Singh, Aditya Gunjotikar

Author: Sachin Kale [1], Ajit Chalak [1], Sanjay Dhar [1], Prasad Chaudhari [1], Sushmit Singh [1], Aditya Gunjotikar [1]

[1] Department of Orthopaedics, Dr. D. Y. Patil Medical College and Hospital, Nerul, Navi Mumbai, India

Address of Correspondence
Dr. Sushmit Singh,
Department of Orthopaedics, Dr. D Y Patil Medical College and Hospital, Nerul, Navi Mumbai, India.
E-mail: drsushmits@gmail.com

Abstract

Background: COVID-19 pandemic has severely affected the finances of orthopedic surgeons around the globe due to recurring lockdowns and fewer elective surgeries. It has forced surgeons to reflect on their wealth management status and look for a second source of income as well.
Objectives: The objectives of the study were to determine the effect of the COVID-19 pandemic on the personal finances of orthopedic surgeons and gauge their knowledge regarding the stock market as a second source of income.

Methods: An online survey was conducted among the orthopedic surgeons practicing in Maharashtra, India. The survey included assessment of demographic data, financial knowledge, knowledge of the stock market, and wealth management status.

Results: Most respondents (75.6%) were forced to think about the second source of income after the COVID-19 pandemic. Seventy-nine percent of surgeons felt the need for training for investment in stock markets.
Conclusion: Most of the respondents lack proper knowledge about funds management and retirement planning. This study indicates a strong need for formal education of orthopedic surgeons in the field of personal finance, stock markets, and retirement planning.

Keywords: COVID-19, orthopedic surgeons, personal finance

References

1. West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA 2011;306:952-60.
2. Finney B, Mattu G. National family medicine resident survey. Part 1: Learning environment, debt, and practice location. Can Fam Physician 2001;47:117, 120, 126-8.
3. Jennings JD, Quinn C, Ly JA, Rehman S. Orthopaedic surgery resident financial literacy: An assessment of knowledge in debt, investment, and retirement savings. Am Surg 2019;85:353-8.
4. McKillip R, Ernst M, Ahn J, Tekian A, Shappell E. Toward a resident personal finance curriculum: Quantifying resident financial circumstances, needs, and interests. Cureus 2018;10:e2540.
5. Ramme AJ, Patel M, Patel KA, Montag WH, Schau AJ, Sabo SI, et al. Personal finance primer for the future orthopaedic surgeon: A starting point. JB JS Open Access 2021;6:e20.00006.
6. Cull WL, Katakam SK, Starmer AJ, Gottschlich EA, Miller AA, Frintner MP. A study of pediatricians’ debt repayment a decade after completing residency. Acad Med 2017;92:1595-600.
7. Connelly P, List C. The effect of understanding issues of personal finance on the well-being of physicians in training. WMJ 2018;117:164-6.

How to Cite this article: Kale S, Chalak A, Dhar S, Chaudhari P, Singh S, Gunjotikar A. Financial Ignorance among Orthopedic Surgeons: A Survey in COVID-19 Era. Journal of Clinical Orthopaedics July-Dec 2021;6(2):8-11.

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Challenges and Difficulties faced by Orthopedic Surgeons during the COVID-19 Pandemic: A Review of Modified Surgical Protocols

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Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 20-24 | Sajeev Shekhar, Vivek Shetty, Yash Wagh

Author: Sajeev Shekhar [1], Vivek Shetty [1], Yash Wagh [1]

[1] Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016

Address of Correspondence
Dr. Vivek Shetty,
Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016
E-mail: vivshetty7777@gmail.com

Abstract

Introduction: Since the major outbreak of COVID-19 in March 2020, all hospitals and surgeons opted to postpone elective scheduled surgeries for personal and patient safety
Aim of this study: In this study of 45 consecutive patients, we changed the surgical protocols during this pandemic, our study highlights difficulties faced and how they were tackled.
Materials and Methods: 45 patients were included in this study operated by a single Senior Surgeon at a tertiary centre and their results were compared to similar surgeries performed in the pre-Covid era, in terms of length of hospital stay, duration of surgery, complications/mortality post operatively and overall risk of infection to the patients and hospital staff.
Results: It was found that the, mortality and morbidity in both times were same in Covid-19 negative patients, overall time taken for the surgery was increased, the hospital stay was increased, usage of resources was increased, difficulties faced were not only by the patients but also the health workers.
Keywords: COVID-19, protocols, donning in, doffing off, operation time, aerosol,.

References

1. Raghavan R, Middleton PR, Mehdi A. Minimising aerosol generation during orthopaedic surgical procedures- Current practice to protect theatre staff during Covid-19 pandemic. J Clin Orthop Trauma. 2020;11(3):506-507. doi:10.1016/j.jcot.2020.04.024
2. Iyengar KP, Jain VK, Vaish A, Vaishya R, Maini L, Lal H. Post COVID-19: Planning strategies to resume orthopaedic surgery –challenges and considerations. J Clin Orthop Trauma. 2020;11:S291-S295. doi:10.1016/j.jcot.2020.04.028
3. Jain AK. Current state of orthopedic education in India. Indian J Orthop. 2016;50(4):341-344. doi:10.4103/0019-5413.185586
4. Jain AK. Teaching-learning: an integral component of sound patient care. Indian J Orthop. 2008;42(3):239-240. doi:10.4103/0019-5413.41846
5. Coronavirus Disease 2019 (COVID-19) | CDC. ” [Online]. Available: https://www.cdc.gov/coronavirus/2019-ncov/index.html.
6. Coronavirus disease (COVID-19). ” [Online]. Available: https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
7. Vaishya R, Hospitals IA, Vaish A, Hospitals IA, Jain VK. Resuming elective surgery during the COVID-19 pandemic Resuming elective surgery during the COVID-19 pandemic. 2020;(June):1205-1212.
8. Sobti A, Memon K, Bhaskar RRP, Unnithan A, Khaleel A. Outcome of trauma and orthopaedic surgery at a UK District General Hospital during the Covid-19 pandemic. J Clin Orthop Trauma. 2020;(xxxx). doi:10.1016/j.jcot.2020.06.042
9. Lei S, Jiang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020;21:100331. doi:10.1016/j.eclinm.2020.100331
10. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809-815. doi:10.1016/S0140-6736(20)30360-3
11. Rodrigues-Pinto R, Sousa R, Oliveira A. Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19. J Bone Joint Surg Am. 2020;102(11):946-950. doi:10.2106/JBJS.20.00454
12. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020;67(5):568-576. doi:10.1007/s12630-020-01591-x
13. The Lancet T. COVID-19: protecting health-care workers. Lancet (London, England). 2020;395(10228):922. doi:10.1016/S0140-6736(20)30644-9
14. Placella G, Salvato D, Delmastro E, Bettinelli G, Salini V. CoViD-19 and ortho and trauma surgery: The Italian experience. Injury. 2020;51(6):1403-1405. doi:10.1016/j.injury.2020.04.012.

How to Cite this article: Shekhar S, Shetty V, Wagh Y. Challenges and Difficulties faced by Orthopedic Surgeons during the COVID-19 Pandemic: A Review of Modified Surgical Protocols. Journal of Clinical Orthopaedics July-Dec 2020;5(2):20-24.

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