Objective Malignant melanoma of the female genital tract is a rare disease with poor prognosis, with controversies remaining in its staging and management. In this study, we investigate clinical, pathological, and outcome data for patients referred to a tertiary cancer center with female genital tract melanoma over a decade. Methods Patients were retrospectively identified using a search of pathology reports to identify all cases of female genital tract melanoma from 2007 to 2019. Electronic patient records were used to record clinical information. Histopathology specimens were reviewed by a gynecological and dermatological pathology specialist. Results We identified 30 cases of genital tract melanoma, of which 19 were vulvar, 10 were vaginal, and 1 cervical. Overall survival at 1, 3, and 5 years was found to be 80%, 60%, and 57%. Patients who died were not significantly older at presentation than patients who survived (62 y vs 69 y, p = .215). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, resection margins, or radical versus local surgery. Nonvulvar lesions were significantly associated with mortality compared with vulvar lesions (p = .0018), despite similar age and Breslow thickness. Five patients were diagnosed at in situ stage, all of these were vulvar. Even after excluding these melanomas in situ, nonvulvar melanomas still had a significantly worse mortality rate (p = .048). A higher proportion of nonvulvar lesions than vulvar lesions displayed loss of pigmentation (p = .026). Conclusions Nonvulvar genital tract melanomas carry a significantly worse prognosis. Survival was not related to resection margins, supporting the use of more conservative surgical margins.
Introduction The impact of the COVID-19 pandemic has been particularly significant for surgical trainees. The aim of this study was to systematically review the prevalence of burnout in surgical trainees during the pandemic, to compare rates of burnout between different specialties and to identify factors that may modify the risk of burnout. Methods A systematic review was undertaken following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to identify articles related to the keywords “surgeons burnout COVID-19” and “surgical trainees burnout COVID-19”. A search was carried out on the PubMed/MEDLINE® and ScienceDirect® databases for articles published from January 2020 to August 2022. Results A total of 19 articles met the inclusion criteria, with 3,866 surgical trainees included across all the studies. The overall prevalence of burnout in surgical trainees across the globe during the pandemic was between 9.1% and 95.2%. Burnout rates were higher in general surgery (33.1–95.2%) than in urology (17.6–54.6%), neurosurgery (16.2–44.1%) and orthopaedic surgery (9.1–44.1%). Otolaryngology trainees had the lowest burnout rate (10.9%). Factors associated with an increased risk of burnout included being a female trainee, being a more junior trainee and increased working hours. Conclusions There has been a high level of burnout among surgical trainees across the globe during the pandemic. In light of the devastating effect of COVID-19 on surgical training and the serious consequences of surgeon burnout (both for the individual and for the patients), targetted interventions for the prevention and treatment of burnout in surgical trainees are urgently needed, and must be prioritised by healthcare institutions and training programmes.
Introduction The impact of the COVID-19 pandemic has been particularly significant for surgical trainees. We aimed to systematically review the prevalence of burnout in surgical trainees during the pandemic, to compare rates of burnout between different specialities, and to identify factors that may modify the risk of burnout. Methods A systematic review was performed in compliance with the PRISMA guidelines to identify articles related to the keywords “surgeons’ burnout and Covid-19’’ and “surgical trainees’ burnout and Covid-19”. A search was performed on PubMed/Medline and ScienceDirect for articles published from January 2020 to August 2022. Results A total of 19 articles met the inclusion criteria, 3866 surgical trainees included across all the studies. The overall prevalence of burnout in surgical trainees during the pandemic was between 9.0%-95.2% across the globe. Burnout rates were higher in general surgery (33.1%-95.2%) than in urology (17.6%-55%), neurosurgery (16.2%-44.1%), and orthopaedic surgery (9% - 44.1%). Otorhinolaryngology trainees had the lowest burnout rate (10.9%). Factors associated with an increased risk of burnout included female gender, being a more junior trainee, and increased working hours. Conclusion There has been a high level of burnout amongst surgical trainees across the globe during the pandemic. In light of the devastating effect of COVID-19 on surgical training, and the serious consequences of surgeons’ burnout both for the individual, and for patients, targeted interventions for the prevention and treatment of burnout in surgical trainees are urgently needed and must be prioritised by healthcare institutions and training programmes.
Introduction Restrictions in working hours for trainee doctors across the globe have led to an increased number of patient handovers. Little is known about the educational value of handover meetings in general surgery. This international study aims to evaluate surgeon and trainee perceptions regarding the educational value of handover meetings in general surgery, and to identify factors that influence the educational value of handover meetings. Methods A 19 item online survey was distributed to surgeons and surgical trainees internationally. The survey questions consisted of demographic information, questions requiring a Likert scale response, and free text responses. Free text responses were analysed using thematic analysis. Results There were 79 initial responses to the survey, however there were 44 eligible respondents who completed the full survey. 90.1% of respondents stated that the handover meeting was valuable to them in learning about post-operative complications. 93.2% of respondents stated that the handover meeting was valuable to them in learning about surgical decision making. Key themes included time pressures as a barrier to the educational potential of handover, and the importance of feedback during handover. Conclusion This study suggests that there is substantial educational value to the general surgery handover meeting for surgeons across the world. It appears to be particularly useful to surgeons in learning how to make management decisions, learning about post-operative complications, utilising case-based education techniques, and engaging in effective and meaningful feedback around patient management. We recommend that these findings should be used to prioritise education in surgical handover meetings.
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