Community Options (United States)

This systematic review aimed to establish the effectiveness of different interventions to combat burnout among surgeons. Burnout is prevalent among surgeons and can have profound effects on their physical and mental health. Previous literature has discussed the causes of burnout and suggested interventions, although it has been limited in establishing their effectiveness. Medline, Embase and Cochrane databases were searched in accordance with the PRISMA guidelines from January 2000 to February 2025. Studies with primary data regarding measurable outcomes for burnout were included, while studies that did not focus on interventions, abstracts or non-English language texts were excluded. The articles were reviewed by two independent reviewers to ensure they met the inclusion criteria. Bias was assessed using the Joanna Briggs institute critical appraisal tools. 44 studies were included. Interventions were classified as organisational, including changes to working conditions and well-being initiatives, and individual, including mentorship, mindfulness and cognitive skills. Many studies identified improvements in their population's burnout scores although often statistical significance was not achieved. Multiple studies were single-centre with small sample sizes and suffered attrition from the programs provided. Studies were limited using volunteers, which could limit generalisability to the rest of the surgical workforce. This study demonstrated a growing awareness of burnout in the surgical community. While some interventions show potential, the mixed results highlight the need for ongoing research. The stigma associated with burnout prevents uptake and the attrition rate described in the literature needs consideration when developing any future interventions.

Abstract Background Endoscopic activity indices for ulcerative colitis (UC) demonstrate limited accuracy, particularly in acute severe UC (ASUC). Artificial intelligence-based scoring (AI) may enhance this. We investigated whether the DovaVision UC AI tool could detect differences in endoscopic response rates between personalised and standard infliximab (IFX) dosing in ASUC patients enrolled in the prospective randomised TITRATE trial, that were previously not detected with human assessment. Methods In TITRATE, adult IFX-naive steroid-refractory ASUC patients were randomised 1:1 to standard dosing (SD) or personalised dosing (PD) with IFX. After an initial 5 mg/kg IFX infusion, patients in the SD group received 5 mg/kg IFX at week 2 and 6. In the PD arm, additional 5 mg/kg IFX infusions were administered guided by a Bayesian pharmacokinetic algorithm (iDose™) aiming to achieve prospectively defined target IFX serum concentrations until day 42. Endoscopies were recorded at baseline and at week 6. Definitions of endoscopic response were ≥2-point improvement in UC endoscopic index of severity (UCEIS) and ≥1-point improvement in Mayo endoscopic subscore (MES) at week 6 compared to baseline. Patients with missing endoscopic data were classified as non-responders. Endoscopic activity was previously scored on blinded videos by 2 independent human experts, with a third for adjudication (1). Here, we applied the DovaVision UC AI tool to the blinded videos. This scored the UCEIS and MES on individual frames and aggregated results to yield final procedure-level scores. Results In total, 48 patients were randomised to PD (n = 23) or SD (n = 25) (Table 1). Human UCEIS or MES assessments could not distinguish differences in response rates (UCEIS: 13 (56.5%) in the PD and 11 (44.0%) in the SD group (p = 0.540); MES: 14 (60.8%) in PD and 10 (40.0%) in SD group (p = 0.250)) (1).Using AI-assessed UCEIS, 27/48 (56.2%) patients achieved endoscopic response, comprising 18/23 (78.3%) in the PD and 9/25 (36.0%) in the SD group (p = 0.004). Using AI-assessed MES, 24/48 patients (50.0%) responded (16/23 (69.6%) in PD and 8/25 (32.0%) in SD group (p = 0.020)) (Figure 1). Conclusion In ASUC patients treated with IFX, the AI tool was able to detect endoscopic response at 6 weeks of IFX treatment, regardless of the endoscopic activity index that was used. The AI tool could also distinguish response rate differences between personalised and standard dosing of IFX. In the original study, human UCEIS or MES assessments could not distinguish such differences. This is the first IBD study in which AI was able to distinguish treatment effects between different treatment strategies, demonstrating its potential to fundamentally improve clinical trial methodology.

Shareable tabular data is of high importance in industry and research. While generating synthetic records is well-studied, research has only recently extended to relational data synthesis. In the tabular generation setting, diffusion and transformer models exhibit superior performance over prior art. However, in the relational setting, diffusion models outperform transformers. This work focuses on the performance gap between tabular transformers and diffusion models in single (tabular) and multi-table (relational) settings, using REaLTabformer and ClavaDDPM as representative state-of-the-art models. We evaluate these architectures on a set of single- and multi-table datasets, highlighting the gap's root causes between the methods. In our experiments, we attribute this difference to the influence of contextual information and data representation. To bridge the gap in the relational setting, we propose two seemingly simple strategies: layer sharing and contextual cues. This work1 offers insights into key design considerations for single- and multitable generative models, including the incorporation of contextual information and the reuse of existing knowledge. With the proposed methods, we achieve improvements of 1.52× and 1.94× for the Logistic Detection and Discriminator Measure metrics, respectively.

Rotator cuff tears represent a unique modifiable disease entity where muscle quality dictates outcomes of surgical repair, thus making it an appealing target for muscle stem cell-based treatments. Cuff tears are extremely common, with a rising incidence in an aging population. Several studies have shown that muscle quality governs outcomes after rotator cuff repair. Even after successful repair, muscle atrophy and fatty infiltration remain, and continued muscle atrophy with increased fatty infiltration result in higher retear rates and decreased patient function. We have endeavored in this review to capture our body of work and tell the story of our research progression through the past 15 years, from building a preclinical model, to determining the cellular source of fatty infiltration, to returning to refinements of mouse models. During this time, we continually have sought to leverage advances in science and technology to improve our understanding of muscle physiology as it pertains to musculoskeletal and orthopaedic research.

Precision oncology using biomarkers and genomic testing facilitates individualised diagnosis and consequently treatment for cancer patients. Standard of Care is conducted through assays of biomarkers for treatment selection. However, Whole Genome Sequencing (WGS) provides excessively more information about actionable mutations and complex interventions. Despite its potentials in cancer management, WGS is restricted by its high cost and limited capacity. Implementing WGS is complex because it influences several elements of the care delivery and deals with the dynamic changes in supply, demand, technology, and cost. In this study, we use a System Dynamics (SD) model to evaluate WGS implementation. We also use the developed SD model to conduct sensitivity analysis to derive insights for decision-making on genomic testing scenarios. Various scenarios have been compared by the number of diagnosed patients and total cost. These scenarios have been created through alterations in WGS referral system, capacity, price, and willingness rate as well as testing time across different hospitals. The results showed that referring more patients for WGS will increase the number of diagnosed patients (by 30%), however it will impose more cost on the system (by 20%) due to higher cost of WGS. Therefore, investment strategies toward reducing cost of WGS as well as reimbursement policies can be beneficial to make WGS more economic and accessible. This study shows how the developed SD model can contribute to providing insights for policy makers in finding the optimal way for implementing WGS.

Rotator cuff tear (RCT) management continues to represent a notable area of research given its widespread prevalence. Although current strategies of care focus on pain reduction and functional restoration, there has been an increasing amount of focus on the orthobiologics of RCTs in hopes of delivering more efficient, targeted therapies. Understanding these cellular mechanisms of rotator cuff injury outcomes is thus crucial in advancing biologic treatments; as such, this article first aims to summarize the orthobiologic mechanisms that underpin post-RCT tendon-bone healing and muscle degeneration. Next, we review the current strategies of biologic augmentation, including bone marrow stimulation, platelet-rich plasma, and mesenchymal stromal and stem cell therapy. Finally, we offer insights into the future of cell-based treatments, from harnessing extracellular vesicles to deliver biologic therapies to inducing promyogenic cellular differentiation at the site of injury.

Fiber optic sensors (FOS) have already proven their importance in monitoring applications in the fields of applied engineering where it is important to achieve high levels of safety. The main properties of FBG fiber optic sensors are the basis of this success. This contribution, which partly takes up the contents of three review works on the subject written by the disciplinary group where we have been working for more than 20 years [1]–[3], aims to give a personal point of view on the use of photonics for industrial applications with implications for safety. In this work, the main advances in the use of FBG sensors in the field of transportation and industrial applications, and protection in the environment will be described. Briefly, in the first paragraph, I will recall the basic properties of fiber optic sensors based on Fiber Bragg Gratings (FBG), then some specific examples will be described where these technologies have been used in recent years by our design and development group. A new monitoring system in the railway sector is described that allows to measure the weight of a train during circulation, and to verify the integrity and absence of damage to the wheels. A fiber optic system will then be shown that applied to tunnels or galleries (in this case railway tunnels but nothing prevents it from being applied to other large, closed environments, such as underground mines) allows to monitor the presence of dangerous gases to guarantee the safety of the personnel present in such structures.