A Burnout Reduction and Wellness Strategy: Personal Financial Health for the Medical Trainee and Early Career Radiation Oncologist

PurposePhysician burnout is reported in more than one out of every 2 practicing clinicians and is just as prevalent in training physicians. Burnout severity is also associated with increasing levels of financial debt. Medical professionals are notable for their high and increasing levels of debt; despite this, financial literacy is poor among physicians, and financial education is largely absent from medical education. Radiation oncologists (ROs) are no different in this regard, with 33% of residents reporting high levels of burnout symptoms, 33% carrying >$200,000 of educational debt, and 75% reporting being unprepared to handle future financial decisions. To fill this gap, we reviewed the basic tenets of personal financial health for the early career RO.Methods and materialsThe core concept of financial independence (FI) is introduced, and we review 4 basic tenets of personal financial health for the young medical professional: debt, behavior, investment, and asset protection strategies.ResultsFI is achieved by saving until the desired quality of life can be maintained, independent of employment income. Debt strategy involves minimizing debt accrual, understanding student loans, and having a debt management plan. Behavioral strategy involves setting financial goals, calculating worth and a savings rate, budgeting, and frugal living. The basics of investing include asset allocation, diversification, rebalancing, and minimizing expenses. Finally, asset protection includes insuring against catastrophic events with disability, life, health, liability, and property insurance.ConclusionsHealthy financial practices can lead to FI and may facilitate professional and personal freedoms with the goal of mitigating burnout-associated stressors. The tenets of strong financial health for ROs in the early stages of their career include sound debt, behavioral, investment, and asset protection strategies. Furthermore, initial and continuing financial education is an overlooked but important curriculum component. ROs with their financial houses in order can devote more resources to learning and practicing good medicine while living healthy, rewarding lives.     

Orally administered isosorbide dinitrate in patients with and without left ventricular failure due to acute myocardial infarction.

The oral effectiveness of 10 mg followed by 20 mg of isosorbide dinitrate in 21 patients with acute mycardial infarction was studied over a period of 13 hours. The patients were grouped according to initial left ventricular filling pressure: group I, pressure less than 20 mm Hg, and group II, pressure more than 20 mm Hg. Patients in group II had left ventricular failure. In both groups isosorbide dinitrate resulted in a significant decrease in pulmonary arterial pressure. The left ventricular filling pressure decreased in group I from 13.6 +/- 4.0 to 7.1 +/- 2.6 mm Hg (mean +/- 1 standard deviation) and in group II from 26.9 +/- 4.6 to 19.0 +/- 3.6 mm Hg (P less than 0.001). Cardiac output decreased in group I from 5.1 +/- 1.0 to 4.5 +/- 0.9 liters/min, whereas in group II it increased significantly from 3.5 +/- 0.8 to 4.1 to 0.9 liters/min (P less than 0.001). In both groups, peripheral arterial blood pressure decreased (P less than 0.60). Heart rate remained constant. Whether cardiac output increased or decreased was found to be dependent on the initial left ventricular filling pressure. In patients with an initially high value (above 20 mm Hg), the increase in cardiac output is probably due to the reduction of afterload. An additional factor may be the decrease in left ventricular filling pressure, which leads to an improved blood supply in the affected mural segments as a result of the decrease in the extravascular component of the coronary resistance. Significant changes in cardiac output and left ventricular filling pressure were achieved 3 to 5 hours after oral administration of isosorbide dinitrate. Clinical signs of failure were less pronounced. Isosorbide dinitrate is, therefore, a therapeutic agent in the treatment of left ventricular failure due to acute myocardial infarction.     

Detection and quantitation of coronary artery stenoses from digital subtraction angiograms compared with 35-millimeter film cineangiograms

To assess the ability to detect coronary artery narrowings from computer-acquired angiograms, a panel of 4 observers independently identified and measured focal coronary narrowings from digital subtraction angiograms and compared the results to those obtained from standard 35-mm cine film angiograms. Both cine and digital angiograms were obtained sequentially using selective intracoronary artery injection of standard amounts of iodinated contrast media. Digital images were obtained at 8 frames/s with a 512 × 512 × 8-bit pixel matrix. Modifications in the imaging chain for computer acquisition included a slower pulsed radiographic mode, a progressive scan camera, and initial storage of the images on an 80-megabyte digital hard disk. Postprocessing computer algorithms were used to enhance the unsubtracted digital images; these included single-frame, mask-mode subtraction, vessel boundary edge enhancement, and 4-fold pixel magnification. In 19 patient studies, 32 arteries were reduced more than 25 % in diameter according to at least 1 of 4 observers on either the digital or cine film angiograms. There was no significant difference in the mean percent diameter narrowing for all the narrowings between the digital angiograms (53 ± 31 %) and the cineangiograms (52 ± 31 %). In addition, a 2-way analysis of variance yielded no significant difference between the amount of variability in the measurements between the cine film and the digital technique. This similar variability persisted when subsets of patients based on the degrees of stenosis were considered (e.g., only narrowings from 50 to 90% diameter reduction). Because digital acquisition permits immediate playback with image enhancement and greater ease of coronary artery quantification, digital angiography may have widespread clinical use for the detection and quantitation of coronary artery disease.     

大孔吸附树脂纯化断血流总皂苷工艺研究

目的:研究大孔吸附树脂纯化断血流总皂苷的工艺条件及参数.方法:以洗脱率、精制度等为指标,考察大孔吸附树脂对断血流总皂苷的吸附性能和洗脱参数.结果:11.4ml断血流总皂苷样品液(生药0.2g/ml)上大孔吸附树脂(φ15mm×H90mm,干重2.5g),用蒸馏水,30%、70%乙醇各3BV依次洗脱,断血流总皂苷富集于70%乙醇洗脱液部位.结论:采用大孔吸附树脂技术富集、纯化断血流总皂苷,其洗脱率为86.8%,精制度为153.2%,该法可较好地纯化断血流总皂苷.     

大孔吸附树脂纯化楤木总皂苷的工艺研究

目的筛选分离楤木总皂苷的最佳树脂,并对影响分离的各种因素进行系统研究,使分离工艺达到最优化。方法采用静态与动态的吸附-解吸两种方法,以高效液相色谱法测定楤木皂苷A的量为评价指标,进行工艺筛选。结果 AB-8分离效果最好,其最佳工艺为药液质量浓度0.1 g/mL(相当于原生药)、上样量为6 BV(树脂床体积),以2.5 BV/h的吸附速率进行吸附,50%乙醇4 BV、2 BV/h进行洗脱效果最佳。经AB-8处理后的楤木皂苷A收率达30%,楤木总皂苷可达80%以上。结论该方法简单可行,分离效果好,能满足于大生产的要求。     

AB-8大孔树脂并聚酰胺柱层析纯化瘤果黑种草子总黄酮

研究AB-8大孔树脂并聚酰胺柱层析纯化瘤果黑种草子总黄酮工艺。方法：用紫外分光光度法测定瘤果黑种草子总黄酮含量,以总黄酮洗脱量为指标,筛选AB-8大孔树脂纯化工艺。结果：合适的上样条件：pH值为3,上样液浓度为4．90mg·mL^-1,吸附流速为1BV／h,洗脱剂为30％乙醇。结论：AB-8大孔树脂并聚酰胺树脂适合于瘤果黑种草子总黄酮的分离纯化。     

大孔吸附树脂对莲子心中有效成分的分离纯化研究

目的研究大孔吸附树脂吸附分离莲子心中莲心碱、异莲心碱及甲基莲心碱的工艺条件及参数。方法考察了AKS-W、AB-8和H214树脂对莲心碱、异莲心碱及甲基莲心碱的静态及动态吸附性能,并采用HPLC定量分析莲心碱、异莲心碱及甲基莲心碱。结果AKS-W树脂对莲子心中有效成分有较好的吸附分离效果,提取物中莲心碱、异莲心碱及甲基莲心碱的质量分数分别提高到10.2%、6.7%和11.9%。结论大孔型非极性吸附树脂AKS-W对莲子心中有效成分是一种较为理想的分离介质。     

大孔树脂对金银花中绿原酸提取纯化效果的研究

目的：考察不同型号的大孔吸附树脂对金银花中绿原酸的提取纯化效果，为在中药纯化研究中应用树脂吸附纯化法，进一步开发金银花的相关产品提供参考。方法：用HPLC法测定绿原酸含量；采用动态吸附法，考察大孔树脂的吸附、解吸附性能和纯化效果。结果：LS-303树脂综合性能最佳，提取液在酸性条件下吸附量佳。结论：LS-303大孔树脂对绿原酸的提取纯化效果较好，可用于工业化生产。     

酚醛树脂对高软化点沥青的发泡行为及生物挂膜性能的影响

以高软化点沥青为原料,采用自发泡法制备泡沫炭,将其用作生物污水处理固菌载体材料,并通过添加适量的酚醛树脂以提高泡沫炭的开孔率,进而提高其生物挂膜量。研究结果表明：当在高软化点沥青中添加酚醛树脂的质量分数为30%时,所制泡沫炭的开孔率高达100%,生物挂膜量（质量分数）达5.4%;当酚醛树脂的添加质量分数为40%时,所制泡沫炭的压缩强度达5.2 MPa,但其开孔率较低,孔结构的均一性较差。     

仙鹤草总黄酮纯化工艺研究

目的 优选仙鹤草总黄酮纯化工艺条件.方法 采用大孔吸附树脂法,以总黄酮含量为评价指标,分别对树脂型号、树脂径高比、上样药液浓度、上样药液速度、洗脱液浓度、洗脱剂用量进行考察.结果 优选的纯化工艺条件为选用D101型大孔树脂,上样药液浓度为0.15g/ml,上样速度为1BV/h,树脂径高比为1∶10,洗脱液为3BV 50％乙醇洗脱.固形物中总黄酮含量为31.05％.结论 该纯化工艺条件合理、稳定,可用于工业化生产.