Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada.

Purpose: Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada.

From Burnout to Well-Being: A Focus on Resilience.

Burnout is a widespread problem in health care. Factors that contribute to enhancing engagement and building resiliency are widely discussed, but the data supporting these practices are not well understood. Interventions aimed at increasing engagement and promoting resiliency are targeted toward individual practitioners, health care institutions, and national organizations.

Physician Burnout and Well-Being: A Systematic Review and Framework for Action.

Background: Physician burnout in the United States has reached epidemic proportions and is rising rapidly, although burnout in other occupations is stable. Its negative impact is far reaching and includes harm to the burned-out physician, as well as patients, coworkers, family members, close friends, and healthcare organizations.

Objective: The purpose of this review is to provide an accurate, current summary of what is known about physician burnout and to develop a framework to reverse its current negative impact, decrease its prevalence, and implement effective organizational and personal interventions.

Colorectal Surgery Outcomes in Chronic Dialysis Patients: An American College of Surgeons National Surgical Quality Improvement Program Study.

Background: More than 450,000 US patients with end-stage renal disease currently dialyze. The risk of morbidity and mortality for these patients after colorectal surgery has been incompletely described.

Objective: We analyzed the 30-day morbidity and mortality rates of chronic dialysis patients who underwent colorectal surgery.

Analyzing Operative Note Structure in Development of a Section Header Resource.

Operative notes contain essential details of surgical procedures and are an important form of clinical documentation. Sections within operative notes segment provide high level note structure. We evaluated the HL7 Implementation Guide for Clinical Document Architecture Release 2.

Adenocarcinoma of the rectum in patients under age 40 is increasing: impact of signet-ring cell histology.

Background: Overall, the incidence of colorectal cancer appears to be stable or diminishing. However, based on our practice pattern, we observed that the incidence of rectal cancer in patients under 40 is increasing and may be associated with a prominence of signet-ring cell histology.

Objective: The aim of this study was to verify the rising trend in rectal cancer in patients under 40 and describe the histology prominent in that cohort.

Does patient rurality predict quality colon cancer care?: A population-based study.

Background: More than 50 million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized, despite its known impact on screening.

Objective: Our study sought to examine the impact of patient rurality on quality and comprehensive colon cancer care.

Early removal of urinary catheters after rectal surgery is associated with increased urinary retention.

Background: Urinary retention after rectal resection is common and managed prophylactically by prolonging urinary catheterization. However, because indwelling urinary catheterization is a well-established risk factor for urinary tract infection, the ideal timing for urinary catheter removal following a rectal resection is unknown.

Objective: We hypothesized that early urinary catheter removal (on or before postoperative day 2) would be associated with urinary retention.

Pursestring closure of the stoma site leads to fewer wound infections: results from a multicenter randomized controlled trial.

Background: Surgical site infection after stoma reversal is common. The optimal skin closure technique after stoma reversal has been widely debated in the literature.

Objective: We hypothesized that pursestring near-complete closure of the stoma site would lead to fewer surgical site infections compared with conventional primary closure.

Operative report teaching and synoptic operative reports: a national survey of surgical program directors.

Background: Although operative report documentation (ORD) is an essential skill for surgeons and is evolving with electronic health records (EHRs), little is known about current ORD teaching in surgical training.

Study Design: An electronic survey was sent out in January 2012 to all 1,096 ACGME surgical program directors that assessed characteristics of training programs, EHR adoption, ORD education, synoptic or templated report usage for ORD, and attitudes and opinions about ORD education and electronic tools for ORD. Content thematic analysis of qualitative responses was performed iteratively until reaching saturation.

Colorectal surgeons teaching general surgery residents: current challenges and opportunities.

Effective teaching for general surgery residents requires that faculty members with colorectal expertise actively engage in the education process and fully understand the current context for residency training. In this article, we review important national developments with respect to graduate medical education that impact resident supervision, curriculum implementation, resident assessment, and program evaluation. We argue that establishing a culture of respect and professionalism in today's teaching environment is one of the most important legacies that surgical educators can leave for the coming generation.

Continuous intraoperative temperature measurement and surgical site infection risk: analysis of anesthesia information system data in 1008 colorectal procedures.

Objectives: To investigate the association between intraoperative temperature and surgical site infection (SSI) in colorectal surgery with anesthesia information system data.

Methods: Continuously measured intraoperative anesthesia information system temperature data for adult abdominal colorectal surgery procedures at a large tertiary center for 1 year were linked to 30-day American College of Surgeons National Surgical Quality Improvement Program SSI outcomes. Univariable and multivariable analyses of SSI to descriptive temperature statistics, absolute and relative temperature threshold times, and other clinically relevant variables were performed.

Readmission after colorectal surgery is related to preoperative clinical conditions and major complications.

Background: Hospital readmission is increasingly perceived as a marker of quality and is poorly investigated in patients receiving colorectal surgery.

Objective: The objective of this study was to describe patterns and etiology of readmission, to determine the rate of readmission, and to identify risk factors for readmission after colorectal surgery.

Design: This study is a retrospective medical chart review.

Are right-sided colectomy outcomes different from left-sided colectomy outcomes?: study of patients with colon cancer in the ACS NSQIP database.

Importance: Optimization of surgical outcomes after colectomy continues to be actively studied, but most studies group right-sided and left-sided colectomies together.

Objective: To determine whether the complication rate differs between right-sided and left-sided colectomies for cancer. As a secondary analysis, we investigated hospital length of stay.

CEA - a predictor for pathologic complete response after neoadjuvant therapy for rectal cancer.

Background: Preoperative chemoradiation therapy in patients with rectal cancer results in pathologic complete response in approximately 10% to 30% of patients. Accurate predictive factors for obtaining pathologic complete response would likely influence the selection of patients best treated by chemoradiation therapy as the primary treatment without radical surgery.

Objective: The aim of this study was to evaluate the impact of tumor size, stage, location, circumferential extent, patient characteristics, and pretreatment CEA levels on the development of pathologic complete response after chemoradiation therapy.

Abdominal wall thickness: is it associated with superficial and deep incisional surgical site infection after colorectal surgery?

Background: Colorectal surgical procedures have a high rate of surgical site infection (SSI), and obesity has been implicated as a predictor of such infection. We hypothesized that abdominal wall thickness (AWT), as a metric of obesity, would predict postoperative superficial and deep incisional SSI after colorectal surgery, and conducted a study to assess superficial and deep incisional SSI and its relationship to abdominal wall thickness.

Methods: To measure pre-operative AWT through cross-sectional imaging, and to analyze its relationship to SSI, we conducted a retrospective study at a single academic medical center of patients who had had colorectal resection for any indication in 2008 and 2009.

Percutaneous drainage of colonic diverticular abscess: is colon resection necessary?

Background: Recurrent diverticulitis has been reported in up to 30% to 40% of patients who recover from an episode of colonic diverticular abscess, so elective interval resection is traditionally recommended.

Objective: The aim of this study was to review the outcomes of patients who underwent percutaneous drainage of colonic diverticular abscess without subsequent operative intervention.

Design: This was an observational study.

Does enrollment in cancer trials improve survival?

Background: Stakeholders derive many benefits from cancer clinical trials, including guidance for future oncologic treatment decisions. However, whether enrollment in cancer trials also improves patient survival independently of trial outcomes remains underinvestigated. We hypothesized that cancer trial enrollment is not associated with patient survival outcomes.

The evolving role of laparoscopy in colonic diverticular disease: a systematic review.

Background: A PubMed search of the biomedical literature was carried out to systematically review the role of laparoscopy in colonic diverticular disease. All original reports comparing elective laparoscopic, hand-assisted, and open colon resection for diverticular disease of the colon, as well as original reports evaluating outcomes after laparoscopic lavage for acute diverticulitis, were considered. Of the 21 articles chosen for final review, nine evaluated laparoscopic versus open elective resection, six compared hand-assisted colon resection versus conventional laparoscopic resection, and six considered laparoscopic lavage.

Adjuvant chemotherapy for stage III colon cancer in the oldest old: results beyond clinical guidelines.

Background: Randomized trials demonstrating the benefits of chemotherapy in patients with American Joint Committee on Cancer stage III colon cancer underrepresent persons aged ≥ 75 years. The generalizability of these studies to a growing elderly population remains unknown.

Methods: Using the California Cancer Registry for 1994 through 2008, the authors conducted a population-based study of postcolectomy patients aged 50 years to 94 years with stage III (N1M0) colon adenocarcinoma.

Career options in colon and rectal surgery.

As Colon and Rectal Surgery has grown and diversified, the practice opportunities available have greatly expanded. The wealth of choices, may be daunting and even paralyzing for the new graduate or practitioner looking for a career change. Prior to making a decision, candidates must first make an honest assessment of their goals, abilities, and priorities.