Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Resident and physician health are increasingly recognized by the Royal College of Physicians and Surgeons of Canada and its CanMEDS framework as integral to residency training in Canada. Resident stress, burnout, and depression also have implications for patient care. Although curricula have been advocated to promote resident wellness and resilience, no such published curricula exist to guide programs in addressing these needs. ⋯ The described ARWP is a novel innovation in Canadian postgraduate medical education. We believe this ARWP is the first comprehensive, formalized, actualized program in Canada. It also provides a guide and a helpful resource for further development of resident wellness programs by other disciplines in Canada and internationally.
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Despite our considerable experience with the problem of addiction in our specialty, most anesthesia care providers don't know how to identify or help an impaired colleague. The purpose of this article to provide sufficient information on substance use disorder (SUD) to aid in its identification amongst colleagues and to assist in its management. ⋯ Due to the considerable morbidity and mortality associated with the abuse of anesthetic agents as well as the continuous increase in the rate of substance abuse by anesthesia providers, it is essential for anesthesia care providers to become familiar with the presenting signs and symptoms of substance abuse and impairment.
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In this narrative review, the neurobiological mechanisms underlying substance abuse and addiction are discussed with a particular emphasis on the mechanisms that promote ongoing use and relapse. Addiction is estimated to affect 10-15% or more of the adult population, including physicians. Genetic predisposition, psychological and environmental risk factors, the timing of exposure to the substance, the type of substance used, and the frequency of use influence the individual's susceptibility to addiction. ⋯ Repetitive exposure to substances leads to persistent, altered genetic expression and accumulation of ΔFos-B and corticotropin-releasing factor. High levels of these substances suppress the reward circuit and activate the endogenous stress response, resulting in a generalized state of discord. These changes are enduring and can trigger substance use relapse even after long periods of abstinence.