Day: September 19, 2022

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Patient Safety Incidents Doubled for Docs Suffering from Burnout

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Photo by Mulyadi on Unsplash

Doctors experiencing burnout are twice as likely to be involved in patient safety incidents and four times more likely to be dissatisfied with their job, suggests research published today in The BMJ.

The scale of burnout amongst clinicians and the serious impact it can have on patient safety and staff turnover has been revealed in the largest and most comprehensive systematic review and analysis of studies on the subject to date.

Evidence is showing that burnout is is reaching global epidemic levels among physicians. Representatives have warned that spare capacity in the field of medicine is nearing what they call crisis point.

Burnout is defined as emotional exhaustion, cynicism and detachment from the job, and a feeling of reduced personal accomplishment. In the UK, a third of trainee doctors report that they experience burnout to a high or very high degree, while in the US, four in 10 physicians report at least one symptom of burnout. And in a recent review of low and middle income countries the overall single-point prevalence of burnout ranged from 2.5% to 87.9% among 43 studies.

Yet there is a lack of evidence about the association of burnout with a physician’s career engagement and how that potentially impacts on the quality of patient care.

To address this, a team of researchers based in the UK and Greece set out to examine the association of burnout with the career engagement of physicians and the quality of patient care globally.

To do this, they selected and analysed the results of 170 observational studies on the subject involving nearly 240 000 physicians.

Their analysis showed that physicians with burnout were up to four times more likely to be dissatisfied with their job and more than three times as likely to have thoughts or intentions to leave their job (turnover) or to regret their career choice.

Equally worrying was the finding that physicians with burnout were twice as likely to be involved in patient safety incidents and show low professionalism, and over twice as likely to receive low satisfaction ratings from patients.

The analysis also found that burnout and poorer job satisfaction was greatest in hospital settings, physicians aged 31–50 years, and those working in emergency medicine and intensive care, while burnout was lowest in general practitioners.

The association with burnout and patient safety incidents was strongest among physicians aged 20–30 years and emergency medicine workers.

The study authors acknowledge some limitations in their research including the fact that precise definitions of terms, such as patient safety, professionalism, and job satisfaction, varied between the studies analysed so may have led to some overestimation of their association with burnout.

The assessment methods varied widely between the 170 studies, and the design of the original studies imposed limits on their ability to establish causal links between physician burnout and patient care or career engagement.

Nevertheless, the authors concluded: “Burnout is a strong predictor for career disengagement in physicians as well as for patient care. Moving forward, investment strategies to monitor and improve physician burnout are needed as a means of retaining the healthcare workforce and improving the quality of patient care.”

“Healthcare organisations should invest more time and effort in implementing evidence-based strategies to mitigate physician burnout across specialties, and particularly in emergency medicine and for physicians in training or residency,” they added.

This research adds to growing evidence that the poor mental health of healthcare providers jeopardises the quality and the safety of patient care, says Matthias Weigl, Professor of Patient Safety at Bonn University, in a linked editorial.

“The pervasive nature of physician burnout indicates a defective work system caused by deep societal problems and structural problems across the sector,” Prof Weigl warned. 

“Urgent action is imperative for the safety of physicians, patients, and health systems, including interventions that are evidence based and system oriented, to design working environments that promote staff engagement and prevent burnout,” he concluded.

Source: The British Medical Journal

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New Way to Improve Outcomes in Kids with Eosinophilic Oesophagitis

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Children
Photo by Ben Wicks on Unsplash

Researchers have determined the threshold for a new measure of early scarring in the oesophagus of children with eosinophilic oesophagitis (EoE), which allows immediate intervention during endoscopy to halt further damage and prevent food from getting stuck. Their findings were published in the journal Clinical Gastroenterology and Hepatology.

EoE is a chronic immune-mediated disorder of the oesophagus that affects adults and children with a prevalence of 0.5 to 1 per 1000. Left untreated, chronic inflammation promotes scarring of the oesophagus, and the development of oesophageal rings and stricture, which interferes with passage of solid food and can cause impaction (when food is stuck in the oesophagus and cannot dislodge).

The researchers used the Endoscopic Functional Luminal Impedance Probe (EndoFLIP) in the study to measure the “distensibility index,” which is a functional measure of how much force is required to stretch open the oesophagus. Previously, the extent of scar tissue in the oesophagus could only be evaluated visually during endoscopy, making it challenging to detect the early changes and intervene before the damage becomes more extensive.

“This is a gamechanger in how we care for kids with EoE,” said senior author Joshua Wechsler, MD, MSCI. “Now, if distensibility is low, we can dilate the oesophagus during the same procedure, and because we can pinpoint exactly where the scarring is, our intervention is more targeted and takes much less time. We are seeing improvements in symptoms, which is incredibly exciting.”

Source: Ann & Robert H. Lurie Children’s Hospital of Chicago

Categories : Mental Health NeurologyTags : Leave a comment

Unlocking the Complex Neurological Puzzle of Depression

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Source: Pixabay

By studying the brains of fruit flies, which share similar mechanisms to human ones, scientists at Johannes Gutenberg University Mainz (JGU) are attempting to gain a better understanding of depression-like states and thus improve means of treating them. Their findings include the effect of Asian traditional medicine and its mode of preparation, and the effect of timing, such as getting a reward in the evening as opposed to other times of the day. The results were published recently in the journal Current Biology.

One aspect of their research “We have been looking at the effects of natural substances used in traditional Asian medicine, such as in Ayurveda, in our Drosophila fly model,” explained Professor Roland Strauss at JGU. “Some of these could have an anti-depressive potential or prophylactically strengthen resilience to chronic stress, so that a depression-like state might not even develop.”

The researchers intend to demonstrate efficacy, find optimal formulations, and isolate the active substances from the plant, which could lead to new drugs.

“In the Drosophila model we can pinpoint exactly where these substances are active because we are able to analyse the entire signalling chain,” Strauss pointed out. “Furthermore, every stage in the signalling pathway can also be proven.” The researchers subject the flies to a mild form of recurrent stress, such as irregular phases of vibration of the substrate. This treatment results in the development of a depression-like state (DLS) in the flies, ie, they move more slowly, do not stop to examine unexpectedly encountered sugar, and, unlike their more relaxed counterparts, are less willing to climb wide gaps. Whether or not the natural substances have an effect depends on the preparation of each natural substance, eg, whether it has been extracted with water or alcohol.

The research team has also discovered that if they reward the flies for 30 minutes on the evening of a stressful day, by offering them food with a higher sugar content than usual, or by activating the reward signalling pathway, this can prevent DLS developing. Flies have sugar receptors on their tarsi (the lower part of their legs) and their proboscis, while the end of the signalling pathway at which serotonin is released onto the mushroom body (equivalent to the human hippocampus) have also been located.

The researchers’ investigations showed that the pathway was considerably more complex than anticipated. Three different neurotransmitter systems have to be activated until the serotonin deficiency at the mushroom body, which is present in flies in a DLS, is compensated for by reward. One of these three systems is the dopaminergic system, which also signals reward in humans. Humans might obtain a reward through something other than sugar.

Boosting resilience by preventing depression

In addition, the researchers decided to look for resilience factors in the fly genome. The team intends to find out whether and how the genomes of flies that are able to better cope with stress differ from those that develop a DLS in response to exposure to recurrent mild stress. The hope is that in the future it will be possible to diagnose genetic susceptibility to depression in humans – and then treat this with the natural substances that are also being investigated during the project.

Source: Johannes Gutenberg Universitaet Mainz

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Third of Unvaccinated People Lose SARS-CoV-2 Antibodies A Year after Infection

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Findings from a prospective seroprevalence study in Spain reveal falling SARS-CoV-2 antibody levels in unvaccinated but infected individuals a year after their infection. This reinforces the necessity of vaccination even after infection, and confirms that hybrid immunity – gained from both infection and vaccination – is the most robust. The study findings appears in BMC Medicine.

Both infection and vaccination against SARS-CoV-2 contribute to population immunity, an important factor for deciding when and to whom booster shots should be offered. Although immunity against a pathogen is more than antibodies, the easiest strategy for assessing population immunity is to perform seroepidemiological studies.

“Most of the serological studies performed after COVID vaccination focused on specific groups such as healthcare workers, did not distinguish between people with or without previous infection, or did not have clinical and immunological data of the infection,” explained senior co-author Manolis Kogevinas, ISGlobal researcher.

In this study, the research team performed a second measurement in a population-based cohort from Catalonia six months after the start of the vaccination campaign (the first one was just after the first confinement), to monitor the level and type of antibodies against five viral antigens (the whole Spike (S) protein, the RBD receptor binding domain, the S2 fragment, the full nucleocaspid (N) protein, or the N-terminal fragment). They also used information from a questionnaire and health records to identify potential factors that determine the magnitude and duration of the antibody response in unvaccinated, vaccinated, or vaccinated and infected persons. A total of 1076 people, aged 43 to 72 years, were included in the analysis.

The results yielded three main conclusions: First, that in 36% of infected but unvaccinated persons, antibodies were no longer detectable almost a year after the infection, particularly in those older than 60 years and smokers.

The second conclusion was that vaccination induced significantly higher antibody levels in people who had a prior infection, as compared to those without prior infection; and that these levels were strongly associated with the magnitude of the response during the infection. “Our data underscore the importance of vaccinating people even if they have been previously infected, and confirm that hybrid immunity is superior and more durable. This means that people who have been vaccinated but have not been infected would need a booster earlier than those who have,” pointed out Marianna Karachaliou, first author of the study together with Gemma Moncunill.

The third was that the factor most strongly associated with the level of antibodies is the type of vaccine, with Moderna’s Spikevax generating the highest levels of antibodies. Other factors also appear to play a role: people older than 60 or with mental illness had lower antibody levels post-vaccination. “The association between mental health and antibody responses requires further investigation, but it is known that people with disorders such as depression, chronic stress or schizophrenia have a lower response to vaccination in general,” explained co-author Carlota Dobaño.

Among those vaccinated, only 2.1% had no antibodies at the time of testing and approximately 1% had a breakthrough infection. “However, it should be noted that this study was done before the Omicron variant became dominant,” warned Kogevinas.

Source: Barcelona Institute for Global Health (ISGlobal)

Categories : NeurologyTags : Leave a comment

Algorithm Rapidly Assesses Level of Consciousness in ICU Patients

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Source: Pixabay CC0

Neurological assessment of an ICU patient’s level of consciousness is an important but time-consuming task that may take up to an hour. Now, researchers have developed an algorithm that can accurately track patients’ level of consciousness based on simple physiological markers that are already routinely monitored in hospital settings.

The work, published in Neurocritical Care, may eventually yield a way to reduce the strain on medical staff, and could also provide vital new data to guide clinical decisions and enable the development of new treatments.

“Consciousness isn’t a light switch that’s either on or off – it’s more like a dimmer switch, with degrees of consciousness that change over the course of the day,” said Associate Prof Samantha Kleinberg at Stevens Institute of Technology. “If you only check patients once per day, you just get one data point. With our algorithm, you could track consciousness continuously, giving you a far clearer picture.”

To develop their algorithm, A/Prof Kleiberg’s team gathered a variety of data, simple heart rate monitors up to sophisticated devices that measure brain temperature, and used them to forecast the results of a clinician’s assessment of a patient’s level of consciousness. Yet, even using just the simplest physiological data, the algorithm proved as accurate as a trained clinical examiner, and only slightly less accurate than more sophisticated tests such as MRI.

“That’s hugely important, because it means this tool could potentially be deployed in virtually any hospital setting – not just neurological ICUs where they have more sophisticated technology,” A/Prof Kleinberg explained. The algorithm could be installed as a simple software module on existing bedside patient-monitoring systems, she noted, making it relatively cheap and easy to roll out at scale.

Besides giving doctors better clinical information, and patients’ families a clearer idea of their loved ones’ prognosis, continuous monitoring could help to drive new research and ultimately improve patient outcomes.

“Consciousness is incredibly hard to study, and part of the reason is that there simply isn’t much data to work with,” said A/Prof Kleinberg. “Having round-the-clock data showing how patients’ consciousness changes could one day make it possible to treat these patients far more effectively.”

More work will be needed before the team’s algorithm can be rolled out in clinical settings. The team’s algorithm was trained based on data collected immediately prior to a clinician’s assessment, and further development will be needed to show that it can accurately track consciousness around the clock. Additional data will also be required to train the algorithm for use in other clinical settings such as paediatric ICUs.

A/Prof Kleinberg also hopes to improve the algorithm’s accuracy by cross-referencing different kinds of physiological data, and studying the way they coincide or lag one another over time. Some such relationships are known to correlate with consciousness, potentially making it possible to validate the algorithm’s consciousness ratings during periods when assessments by human clinicians aren’t available.

Source: Stevens Institute of Technology