BackgroundNumerous studies around the world has already suggested that burnout among doctors is a global phenomenon. However, studies for burnout in doctors are relatively limited in Chinese communities when compared to the West. As risk factors, barriers to intervention and strategies combatting burnout in different parts of the world can vary a lot due to different social culture and healthcare system, study with a focus at doctors in China from a cultural perspective is a worthful endeavor.MethodsSystematic searches of databases were conducted for papers published in peer-reviewed journals from 2006 to 2016. Selection criteria included practicing doctors in Mainland China and publications written in English or Chinese. Keywords searched including “burnout”, “doctors” and “China” in 3 electronic databases has been undergone. Traditional understanding of “work attitude” and “doctors’ humanity” from ancient Chinese literature has also been retrieved.ResultsEleven full papers, including 9302 participants, were included in this review. The overall prevalence of burnout symptoms among doctors in China ranged from 66.5 to 87.8%. The review suggested that negative impact of burnout include association with anxiety symptoms and low job satisfaction at the individual doctors’ level, and prone to committing medical mistakes affecting patient safety and higher turnover intention at the society/organizational level. Burnout was higher among doctors who worked over 40 h/week, working in tertiary hospitals, on younger age group within the profession (at age 30-40), and with negative individual perception to work and life.Conclusions and implicationsThe overall prevalence and adverse impact of burnout among doctors in China echo with the findings from Western studies. Young doctors and doctors working in tertiary hospitals are more at risk of burnout, probably related to shift of social culture related to the loss of medical humanities and a weak primary healthcare system. Potential strategies of managing burnout in Chinese doctors should therefore take consideration from the Chinese cultural perspective, with renaissance of medical humanities and strengthening the primary healthcare system in China.
SummaryWe report a case of upper airway obstruction as a result of delayed massive lingual swelling following routine cleft palate repair in an otherwise healthy 12-month-old girl. We believe that ischaemia and venous congestion were the causes of macroglossia, after prolonged use of the Digman Dott tongue retractor. In any dificult and lengthy repair, we recommend the prophylactic insertion of a nasopharyngeal airway under direct vision by the surgeons after surgery to prevent potential upper airway obstruction. Key wordsAnaesthesia; paediatric. Complication; macroglossia. Airway; obstruction. Surgery; cleft palate.Palatoplasty is a relatively common procedure and the overall incidence of postoperative morbidity varies from 15 to 26% [I, 21. Haemorrhage and airway obstruction are the most frequent major complications [2]. Upper airway obstruction after cleft palate repair is most commonly associated with laryngospasm, but it is also a well recognised complication in patients with pre-existing craniofacial anomalies such as Pierre-Robin syndrome [3] and following primary pharyngeal flap reconstruction [4, 51. Life-threatening airway obstruction as a result of lingual swelling is unusual. Re-establishment of an adequate airway can be extremely difficult, if not impossible. In this report, we describe a case of massive lingual swelling shortly after routine palatoplasty in an otherwise normal child and we review the potential risk factors, pathogenesis, clinical course, preventive measures and the management of this complication. Case historyA 12-month-old, 8.6 kg girl presented for elective cleft palate repair. She had been delivered vaginally at term following an uncomplicated pregnancy. Her birth weight was 2.58 kg and she had a complete bilateral cleft palate. Apart from recurrent middle ear infections and delayed phonologic development, her perinatal history was uneventful. Pre-operatively, physical examination revealed a healthy girl with a central, wide soft palate cleft, but an otherwise normal airway. She was given premedication of trimeprazine 24 mg orally, 30 min before surgery.Following inhalational induction with isoflurane in oxygen and nitrous oxide, an intravenous infusion of 0.18% saline in 4.3% dextrose was started at 40ml.h-'. After administration of atracurium 5 mg and fentanyl 10 pg intravenously, the trachea was intubated easily with a 4.0-mm uncuffed oral-RAE tube (Mallinckrodt Lab. Ltd. Athlone, Ireland).The child was placed in the Trendelenberg position, with the neck hyperextended. A Digman Dott self retaining tongue retractor was inserted to optimise surgical exposure. The cleft edge was infiltrated with lignocaine 0.5% 5ml with 1 : 200 000 adrenaline. A V-Y pushback palatoplasty was performed. The operation was technically difficult because of the large cleft and relatively small mouth. The entire procedure lasted 3 h and 45 min, with the tongue retractor in place during most of the operation. Total blood loss was approximately 60 ml and was replaced with 70 ml of stable plasma protein ...
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