The future role of the Scandinavian anaesthesiologist: a web-based survey

Background: The Board of the Scandinavian Society for Anaesthesiology and Intensive Care Medicine (SSAI) decided in 2008 to undertake a survey among members of the SSAI aiming at exploring some key points of training, professional activities and definitions of the specialty. Methods: A web‐based questionnaire was used to capture core data on workforce demographics and working patterns together with opinions on definitions for practice/practitioners in the four areas of anaesthesia, intensive care medicine, emergency medicine and pain medicine. Results: One thousand seven hundred and four responses were lodged, representing close to half of the total SSAI membership. The majority of participants reported in excess of 10 years of professional experience in general anaesthesia and intensive care medicine as well as emergency and pain medicine. While no support for separate or secondary specialities in the four areas was reported, a majority of respondents favoured sub‐specialisation or recognition of particular medical competencies, notably so for intensive care medicine. Seventy‐five percent or more of the respondents supported a common framework of employment within all four areas irrespective of further specialisation. Conclusions: The future of Scandinavian anaesthesiology is likely to involve further specialisation towards particular medical competencies. With such diversification of the workforce, the majority of the respondents still acknowledge the importance of belonging to one organisational body.     

Part-time training in general surgery: results of a web-based survey

HYPOTHESIS: The recent increase in female medical school enrollment and emphasis on lifestyle considerations for both men and women pose challenges for residency recruitment and retention. This study was designed to assess interest in part-time surgical training. We hypothesized that more women than men would be interested in this option. DESIGN: A Web-based survey soliciting demographic information and opinions about training priorities was distributed to medical students, surgery residents, fellows, and trained surgeons. Respondents were asked to express on a 5-point Likert scale interest in (and deterrents to) substituting 1 or more years of standard residency with a shorter workweek (< 80 hours but > 40 hours) in exchange for a proportionately overall longer length of training. SETTING: The survey was located on the American College of Surgeons Web site. PARTICIPANTS: Medical students (482), surgical residents (789), fellows (179), and fully trained surgeons (2858) affiliated with at least 1 of 4 major surgical societies. RESULTS: There were 4308 respondents (76% male). Of physician respondents, 9.1% had taken time out of residency for nonresearch reasons. Thirty-six percent of female and 24% of male students agreed to increased interest in surgical careers if part-time training were an option (P = .005). Twenty-five percent of female and 13% of male residents (P<.001) expressed interest in this option. Prolonged training was cited as the primary deterrent. CONCLUSIONS: Eleven percent to 36% of total male and female respondents expressed interest in pursuing part-time training. Significantly more women than men favored a part-time option.     

Pain management in a rheumatology department: a satisfaction survey

OBJECTIVES: To evaluate the quality of pain management in a teaching hospital rheumatology department. METHODS: We conducted a satisfaction survey among all the patients admitted to the conventional rheumatology department of our teaching hospital over a 1-month period (88 patients with a mean length of stay of 5 d). The patients were asked to complete a questionnaire on the day of discharge. The professional staff was not informed of the survey. RESULTS: The mean pain severity score at admission (visual analog scale, VAS) was 7.76 +/- 1.76 and the mean score decrease with treatment was 7.27 +/- 2.81. Expected pain relief and actual pain relief were correlated (R = 0.39; P = 0.001). Nearly all the patients (96.1%) reported have been encouraged to communicate about their pain. Information on the treatment was given to 89.3% of the patients; no significant differences in pain severity or pain relief were found between the patients who did and did not receive this information. The patients were satisfied with their management by the physicians (VAS: 8.83 +/- 2.07) and nurses (VAS: 8.68 +/- 1.72). CONCLUSION: Satisfaction with pain management (a subjective criterion) was good in our patients. However, no validated tools for measuring satisfaction are available, and measurements should be repeated to look for improvements over time. Limitations to these results include the placebo effect, the influence of memory, and the effects of the behavior of hospitalized patients. A repeat survey is needed.     

Pain research in Africa: a ten-year bibliometric survey

Purpose

Over the years, a trend for very low numbers of scientific publications from Africa has emerged. There has been no evaluation of pain research publications from this region. This study was conducted to determine the African pain research spectrum over the last 10 years, to identify trends in the number of publications from different countries, to identify currently underexplored areas of pain research, and to stimulate renewed interest in quality pain research in Nigeria and Africa.

Methods

The English- and non-English-language medical literature on pain from July 2002 to May 2012 was studied using Medline, the Ovid database, and by performing hand searches of relevant references using Google. Publications on pain by Africans and/or non-Africans conducted in Africa on Africans living in Africa within the study period were included. The total number of articles per country, publication types, and impact factors of the respective journals were tabulated to determine the quantity and quality of research in this field.

Results

Two hundred twenty-eight (228) articles from 25 African countries that were published in 129 different journals were identified. The majority were epidemiological studies (43.9 %), experimental studies (20.2 %), randomized controlled trials (2.2 %), and systematic reviews (1.8 %). Nigeria, South Africa, and Uganda topped the list of the most-published articles, with 76 (33.3 %), 71 (31.1 %), and 12 (5.3 %), respectively. The total number of journals with impact factors was 81, of which 29 were high-impact-factor journals.

Conclusion

Pain research publications from Africa should be encouraged. Given the underexplored frontiers of pain research, there is a need to engage in rigorous research in this field to enhance the contribution of the African continent (“the African Voice”) to worldwide advances in this respect.     

Perception of gender discrimination among spine surgeons across Latin America: a web-based survey

BACKGROUND CONTEXTFemale physicians rarely choose spine surgery as their specialty. Although the specialty's nature and its associated lifestyle are potential barriers, gender-related issues may play an important part.PURPOSETo evaluate the gender discrimination among spine surgeons across Latin America.STUDY DESIGNCross-sectional survey.PATIENT SAMPLEThe participants in this study were 223 AO Spine Latin America (AOSLA) registered members who answered the web-based survey.OUTCOME MEASURESPersonal and professional demographics; gender-related objective and subjective experiences regarding career and personal life.METHODSA survey link containing a 24-item questionnaire was sent to the members’ e-mails in September 2019. The survey was designed to evaluate the perception of gender discrimination by spine surgeons during their academic and professional lives.RESULTSOut of 223 members who answered the survey, 196 (87.96%) were male and 27 (12.11%) female. Most were orthopedic surgeons (64.13%), ≥40 years of age (55.16%), and had <20 years of experience (69.95%). Gender discrimination was more frequent among women than among men (66.67% vs. 1.02%), as did discouragement from becoming a spine surgeon, orthopedic surgeon, or neurosurgeon (81.48% vs. 0.51%). Females reported higher rates of sexual harassment (44.44% vs. 7.65%) and more often felt disadvantaged because of gender (55.56% vs. 2.55%). Working harder than men to achieve the same prestige and lack of female mentorship were the most common obstacles reported by women (55.56%). Residency/fellowship influenced the decision to postpone/avoid having children for 66.67% of women but only 37.75% of men. Creation of a Women's Committee in AO Spine was supported by 74.07% of women and 38.78% of men.CONCLUSIONSGender-based discrimination affects women more frequently than men in spine surgery. These experiences likely contribute to the low prevalence of female spine surgeons. Efforts to mitigate bias and support the professional development of women in neurosurgery, orthopedics and spine communities are encouraged.     

Pain control after surgery: a survey of current practice.

A questionnaire was sent to 302 qualified nurses in an attempt to elicit their current practice of administering postoperative analgesics, knowledge of the drugs, opinions regarding prescribing habits and comments on how pain control could be improved; 211 nurses replied (70% response). Knowledge was good but practice poor in that 56% give less than six doses postoperatively and the majority of nurses do not give analgesics until the patient is in pain; 66% thought the amount of analgesic given was a poor indication of pain experienced; 62% felt that prescribing by doctors was inconsistent and 90% thought it could be improved. Deficiencies in communication between anaesthetists, nurses and patients were highlighted. The nurses wished for more involvement in pain management and for more education of patients preoperatively. A selection of comments is included and possible simple methods for improving pain control are discussed.     

A survey of hospital management practices for vulvar melanoma

Background: Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma.

Study Design: The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma.

Results: Five hundred sixty-nine patients with vulvar melanoma were identified. A substantial number of patients were older; during the latter period of this study (1990 to 1994), 50% were 70 years old or older. Surgery was used in more than 90% of patients with stages 0 to III. Local excision was used mainly in early-stage (0 and I) disease. Adjuvant therapy was used infrequently. Lymph node evaluation was performed in more than half of the patients, with greater frequency for patients who had advanced disease. The overall 5-year relative survival rate was 62%. If the lymph nodes contained metastases, survival was poor. Patients with recurrent disease also had poor survival.

Conclusions: Surgery remains the mainstay of therapy for vulvar melanoma. The use of excision and radical operations remained constant during the 10 years of the study.     

Pain management in the neonatal intensive care unit: a national survey in Italy

BACKGROUND: This study assessed current medical practice in preventative analgesia and sedation for invasive procedures in neonatal intensive care units (NICU) in Italy. METHODS: A questionnaire was sent to level II and III Italian NICUs to investigate pain management, pharmacological treatment and the use of pain scores during invasive procedures. Main outcome measures were the extent to which analgesia and sedation are currently used for invasive procedures in Italian neonatal units. RESULTS: The rate of response to the questionnaire was 88%. Written guidelines were available on acute pain control in 25% of the NICUs, and on prolonged pain control in 50%. Routine use of preventative pharmacological and nonpharmacological measures for painful procedures ranged from 13% for elective tracheal intubation to 68% for chest tube insertion. Thirty-six percent of NICUs routinely use sedation with opioids for mechanical ventilation; 14% prevent distress and pain for tracheal suctioning, 44% for heel lancing, 50% for venepuncture and percutaneous venous catheter insertion; 58% use analgesia before lumbar puncture. Validated pain assessment scores were used by 19% of NICUs. CONCLUSIONS: The need for adequate analgesia is still underestimated. Further information on the safety of analgesics in neonatology is imperative, as is an adequate education of physicians and nurses on the use of pain control guidelines as part of the standard of care in the NICU.     

Pain management in subarachnoid haemorrhage: a survey of French analgesic practices

OBJECTIVE: Pain management in patients having a subarachnoid haemorrhage was assessed in French intensive care unit of neurosurgical centres. STUDY DESIGN: Nationwide survey. METHODS: A standardized postal questionnaire was sent to senior doctor of every neurosurgical centres in France inquiring pain scores assessment, analgesics used and their routes of administration, centre's opinion about efficacy of pain management. RESULTS: Of the 34 centres, 24 returned completed questionnaires. Fifty four per cent of the centres evaluated pain intensity with a non valid pain score. In the case of patients in the comatose, pain was not evaluated in fifty four per cent of the centres. Paracetamol and morphine were the most currently used analgesics drugs. Morphine was administered subcutaneously by 75% of the centres. Six centres used also PCA. Thirty-seven percent of the centres were reluctant to use opioids and 75% to use NSAIDS. CONCLUSION: The majority of the centres considered pain management in patient suffering from subarachnoid haemorrhage (SAH) was not optimal and stressed the need to establish a well validated pain rating scale dedicated to SAH patients.     

Japanese clinical practice patterns of primary nephrotic syndrome 2021: a web-based questionnaire survey of certified nephrologists

Clinical and Experimental Nephrology - With the publication of the “Evidence-Based Clinical Practice Guideline for Nephrotic Syndrome 2020,” we examined nephrologists’ adherence...     

Pain profiles in a community dwelling population following spinal cord injury: a national survey

Context: While as many as 60% of patients with spinal cord injury (SCI) develop chronic pain, limited data currently exists on the prevalence and profile of pain post-SCI in community dwelling populations.

Study Design: A cross-sectional population survey.

Setting: Primary care.

Participants: Community dwelling adults with SCI.

Methods: Following ethical approval members registered to a national SCI database (n=1,574) were surveyed. The survey included demographic and SCI characteristics items, the International Spinal Cord Injury Pain Basic Data Set (version 1) the Douleur Neuropathique 4 questionnaire (interview) and questions relating to health care utilisation. Data were entered into the Statistical Package for the Social Sciences (version 20) Significance was set P < 0.05 for between group comparisons.

Results: In total 643 (41%) surveys were returned with 458 (71%) respondents experiencing pain in the previous week. Neuropathic pain (NP) was indicated in 236 (37%) of responses and nociceptive pain in 206 (32%) Common treatments for pain included medications n=347 (76%) massage n=133 (29%) and heat n=115 (25%). Respondents with NP reported higher pain intensities and increased healthcare service utilisation (P= < 0.001) when compared to those with nociceptive pain presentations. A higher proportion of females than males reported pain (P?=?0.003) and NP (P?=?0.001) and those unemployed presented with greater NP profiles compared with those in education or employment (P?=?0.006).

Conclusion: Pain, in particular NP post SCI interferes with daily life, increases health service utilisation and remains refractory to current management strategies. Increased availability of multi-disciplinary pain management and further research into management strategies is warranted.     

Thymoma: a continuing survey at the Massachusetts General Hospital.

An analysis is presented of the treatment of 103 patients with thymoma, 56 with myasthenia gravis and 47 without. In a 1966 report on the first 63 patients, it was stated that the presence of myasthenia and the finding of local tumor invasion at operation were ominous prognostic indicators. The augmented series suggests that myasthenia no longer carries this stigma, possibly because of improved methods in its management in patients who have undergone operation.