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The end of burnout : why work drains us and how to build better lives
\"Burnout has become our go-to term for talking about the pressure and dissatisfaction we experience at work. But because we don't really understand what burnout means, the discourse does little to help workers who are suffering from exhaustion and despair. Jonathan Malesic was one of those workers, and to escape he quit his job as a tenured professor. In The End of Burnout, he dives into the history and psychology of burnout, traces the origin of the high ideals we bring to our dismal jobs, and profiles the individuals and communities who are already resisting our cultural commitment to constant work. In The End of Burnout, Malesic traces his own history as someone who burned out of a tenured job to frame this rigorous investigation of how and why so many of us feel worn out, alienated, and useless in our work. Through research on the science, culture, and philosophy of burnout, Malesic explores the gap between our vocation and our jobs, between the ideals we have for work and the reality of what we have to do. He eschews the usual prevailing wisdom in confronting burnout (\"Learn to say no!\" \"Practice mindfulness!\") to examine how our jobs have been constructed as a symbol of our value and our total identity. And beyond looking at what drives burnout-unfairness, a lack of autonomy, a breakdown of community, mismatches of values-this book highlights groups that are addressing these failures of ethics. We can look to communities of monks, employees of a Dallas nonprofit, intense hobbyists, and artists with disabilities to see the possibilities for resisting a \"total work\" environment and the paths to recognizing the dignity of workers and nonworkers alike. In this critical yet deeply humane book, Malesic offers the vocabulary we need to recognize burnout, overcome burnout culture, and find moral significance in our lives beyond work\"-- Provided by publisher.
Book
Comparison of prognostic value of Roper Hall and Dua classification systems in acute ocular burns
AimTo compare the predictive outcome of ocular burns using two different prognostic classification systems, that is, Dua and Roper Hall classification.Patients and methodsIn a prospective, randomised, controlled clinical trial, the extent of acute ocular burns in 100 patients was graded by Roper Hall and Dua classifications. Patients were randomised in two groups of 50 each to receive conventional medical therapy alone or additional amniotic membrane transplantation (AMT). Moderate burns were graded similarly (grade II and III) under both systems, while severe burns were classified differently and compared further. Baseline parameters (size of epithelial defect, corneal haze, limbal ischaemia, conjunctival involvement and visual acuity) and outcome variables (healing of epithelial defect, corneal clarity, corneal vascularisation, visual outcome and symblepharon) after 1 year were noted and compared.ResultsThere was no difference in terms of time taken and rate of healing of epithelial defect, but there was a significant difference in extent of corneal vascularisation between grades IV, V and VI (p<0.05). In patients who received AMT in addition to medical therapy, the degree of corneal clarity achieved was significantly better in patients with grade IV burns than either grade V (p=0.045) or grade VI (p=0.024) burns, and final visual acuity was significantly better in these patients (p=0.043). On comparison of patients with grade IV burns (with and without AMT), the outcome in terms of extent of corneal vascularisation was significantly better (p=0.0124) in patients who received AMT.ConclusionsDua classification by providing further subclassification of grade IV ocular burns by Roper Hall into three separate grades has a superior prognostic predictive value in severe ocular burns.
Journal Article
Efficacy and safety of platelet-rich plasma as an adjunct therapy to split thickness skin graft in burn patients with granulating raw wounds: a prospective, randomized, double-blind study—study protocol
Background
Burn wounds are commonly encountered in clinical settings and the management aims at the prevention of mortality and morbidity due to disability. The platelet-rich plasma (PRP) is blood-derived biomaterial that is enriched with growth factors and cytokines that facilitate wound healing. The PRP has proven its efficacy in various other wounds, but its role in post-burn raw areas and graft take has not been validated. This proposed multicentre randomized controlled trial aims to evaluate the efficacy and safety of platelet-rich plasma as an adjunct therapy to split-thickness skin graft in burn patients with granulating raw wounds.
Method/design
This trial is an investigator-initiated, double-blind multicentre, randomized controlled parallel arm trial alongside trial cost-effectiveness analysis. Granulating deep second-degree and third-degree burns affecting 3–20% of total body surface area (TBSA) at 10–14th post-burn day will be included in the study. A total of 550 patients (275 in each group) will be randomized to receive either standard skin graft or allogenic PRP with skin graft treatment. The primary endpoint will be the mean percentage of graft-take on the 14th postoperative day. The result will be analyzed by two independent assessors who are blinded to the study. Secondary endpoints include (a) time taken for complete wound healing; (b) frequency of adverse events; (c) follow-up with scar index at 3 months, 6 months, and 1 year using the Patient and Observer Scar Assessment Scale (POSAS) score; (d) cost-effectiveness analysis of the intervention compared to the comparator; and (e) to estimate in a subset of participants the association between growth factor levels (PDGF BB and TGF ß-1) of activated PRP and clinical response.
Discussion
The proposed trial will be expected to verify the efficacy and safety of PRP for split-thickness skin graft (STSG) in deep second-degree or third-degree granulating wounds of burn patients based on the outcome of the study.
Journal Article
Bacterial Infections After Burn Injuries
Patients who are admitted to the hospital after sustaining a large burn injury are at high risk for developing hospital-associated infections. If patients survive the initial 72 hours after a burn injury, infections are the most common cause of death. Ventilator-associated pneumonia is the most important infection in this patient population. The risk of infections caused by multidrug-resistant bacterial pathogens increases with hospital length of stay in burn patients. In the first days of the postburn hospitalization, more susceptible, Gram-positive organisms predominate, whereas later more resistant Gram-negative organisms are found. These findings impact the choice of empiric antibiotics in critically ill burn patients. A proactive infection control approach is essential in burn units. Furthermore, a multidisciplinary approach to burn patients with a team that includes an infectious disease specialist and a pharmacist in addition to the burn surgeon is highly recommended.
Journal Article
Effortless : make it easier to do what matters most
\"Do you ever feel like : You're teetering right on the edge of burnout? You want to make a higher contribution, but lack the energy ? You're running faster but not moving closer to your goals? Everything is so much harder than it used to be ? As high achievers, we've been conditioned to believe that the path to success is paved with relentless work. That if we want to overachieve, we have to overexert, overthink, and overdo. That if we aren't perpetually exhausted, we're not doing enough. But lately, working hard is more exhausting than ever. And the more depleted we get, the more effort it takes to make progress. Stuck in an endless loop of \"Zoom, eat, sleep, repeat,\" we're often working twice as hard to achieve half as much. Getting ahead doesn't have to be as hard as we make it. No matter what challenges or obstacles we face, there is a better way: instead of pushing ourselves harder, we can find an easier path. Effortless offers actionable advice for making the most essential activities the easiest ones, so you can achieve the results you want, without burning out. Effortless teaches you how to: Turn tedious tasks into enjoyable rituals Prevent frustration by solving problems before they arise Set a sustainable pace instead of powering through Make one-time choices that eliminate many future decisions Simplify your processes by removing unnecessary steps Make relationships easier to maintain and manage And much more The effortless way isn't the lazy way. It's the smart way. It may even be the only way. Not every hard thing in life can be made easy. But we can make it easier to do more of what matters most\"-- Provided by publisher.
Superficial partial burns and donor sites are unique wounds: case series of extended wear Cutimed ® Sorbact
Background: Superficial partial burns and donor site wounds are unique and do not behave like other wounds, warranting a unique approach. A dressing with an antimicrobial effect to prevent infection and minimise trauma at the wound by extending wear time promotes spontaneous healing by epithelialisation. The properties of Cutimed® Sorbact® achieve this goal in its temporary skin-like substitute action. This audit aims to illustrate that our management of superficial partial burns and donor sites is successful.Methods: A prospective audit was done from January to June 2019 at the Harry Gwala Regional Hospital, where Cutimed® Sorbact®was used at the burn surgeon’s discretion. Sorbact® was typically chosen for acute superficial partial-thickness burns at presentation and donor sites.Results: A total of 27 patients were included. There were 14 superficial partial-thickness burns (nine children and five adults) treated with a mean wear time of 14 days to healing, with two patients having a wear time of 17 and 22 days, respectively. There were 13 donor sites treated (eight children and five adults), with 12 cases healed by day 17 and one complication of depth conversion.Conclusion: Frequent removal of the primary Cutimed® Sorbact® dressing in the epithelialising wound causes trauma to the wound, leading to delayed healing despite the absence of infection. Leaving the primary Cutimed® Sorbact® in situ while monitoring for complications leads to successful outcomes. This has been adopted as standard management in our service for superficial partial burns and donor sites.
Journal Article
Virtual Reality Single-Port Sleeve Gastrectomy Training Decreases Physical and Mental Workload in Novice Surgeons: An Exploratory Study
BackgroundNovice surgeons experience high levels of physical and mental workload during the early stages of their curriculum and clinical practice. Laparoscopic sleeve gastrectomy is the first bariatric procedure worldwide. Feasibility and safety of single-port sleeve gastrectomy (SPSG) has been demonstrated. An immersive virtual reality (VR) simulation was developed to provide a repetitive exercise to learn this novel technique. The primary objective of this study was to evaluate the impact of the VR training tool on mental and physical workload in novice surgeons. The secondary objective included an evaluation of the VR simulator.MethodsA monocentric-controlled trial was conducted. Ten participants were divided into two groups, the VR group and the control group (without VR training). Surgery residents participated in a first real case of SPSG and a second case 1 month later. The VR group underwent a VR training between the two surgeries. Mental and physical loads were assessed with self-assessment questionnaires: NASA-TLX, Borg scale, and manikin discomfort test. The VR simulator was evaluated through presence, cybersickness, and usability questionnaires.ResultsThis study showed a decrease of the mental demand and effort dimensions of NASA-TLX between the first and the second surgery in the VR group (P < .05). During the second surgery, a marginally significant difference was shown concerning the mental demand between the two groups. Postural discomfort of the VR group decreased with practice (P < .01), mainly between the first and the second surgery (P < .05). Furthermore, participants characterized the VR simulator as realistic, usable, and very useful to learned surgery.ConclusionThis exploratory study showed an improvement in mental and physical workload when novice surgeons trained with VR (repetitive practice, gesture improvement, reduction of stress, etc.). Virtual reality appears to be a promising perspective for surgical training.
Journal Article