Confidence Of Doctors Research Articles

A scoping review of the perceptions of death in the context of organ donation and transplantation

BackgroundSocio-cultural perceptions surrounding death have profoundly changed since the 1950s with development of modern intensive care and progress in solid organ transplantation. Despite broad support for organ transplantation, many fundamental concepts and practices including brain death, organ donation after circulatory death, and some antemortem interventions to prepare for transplantation continue to be challenged. Attitudes toward the ethical issues surrounding death and organ donation may influence support for and participation in organ donation but differences between and among diverse populations have not been studied.ObjectivesIn order to clarify attitudes toward brain death, organ donation after circulatory death and antemortem interventions in the context of organ donation, we conducted a scoping review of international English-language quantitative surveys in various populations.Study appraisalA search of literature up to October 2020 was performed, using multiple databases. After screening, 45 studies were found to meet pre-specified inclusion criteria.Results32 studies examined attitudes to brain death, predominantly in healthcare professionals. In most, around 75% of respondents accepted brain death as equivalent to death of the person. Less common perspectives included equating death with irreversible coma and willingness to undertake organ donation even if it caused death. 14 studies examined attitudes to organ donation following circulatory death. Around half of respondents in most studies accepted that death could be confidently diagnosed after only 5 min of cardiorespiratory arrest. The predominant reason was lack of confidence in doctors or diagnostic procedures. Only 6 studies examined attitudes towards antemortem interventions in prospective organ donors. Most respondents supported minimally invasive procedures and only where specific consent was obtained.ConclusionsOur review suggests a considerable proportion of people, including healthcare professionals, have doubts about the medical and ethical validity of modern determinations of death. The prognosis of brain injury was a more common concern in the context of organ donation decision-making than certainty of death.

Current state of legislative regulation of insurance liability of medical workers

The development of medicine in Russia is facing problems associated with risks in the activities of medical professionals, primarily with “medical errors” and responsibility for their commission. In addition, the number of conflict situations between doctors and patients has significantly increased. Medical activity is currently insufficiently protected, the confidence of doctors in the correctness and expediency of providing medical care has significantly decreased. There are many cases when doctors, fearing possible criminal prosecution, leave the profession. One of the solutions to these problems is the real consolidation at the legislative level of the right of each individual doctor (as an individual, and not a medical organization) to insure their professional liability. In the article, with the statistics of the investigation of iatrogenic crimes, an attempt is made to analyze the current normative acts regulating the issue under consideration, as well as existing initiatives to improve legislation in this area.

TP8.2.26 A new simulation-based course to improve trauma management by junior doctors

Abstract Aims Trauma calls at small hospitals are often attended by small and/or junior teams, especially overnight. The quality of primary surveys was subjectively observed to be extremely variable, sufficient to cause concern about patient safety. In addition, the introduction of the ‘ward trauma call’ for falls was generating anxiety amongst juniors. I recognised an unmet need and gained permission from the Director of Medical Education to create a half-day ‘Introduction to Trauma’ simulation-based course. Method A sample group of Foundation doctors attended a pilot course. Confidence in aspects of trauma management was assessed using Likert scales. Results Pre-course results indicated doctors were reasonably confident with their A-E assessments (63% moderately or very confident) but lacked confidence in trauma skills such as using a scoop. After the course 100% reported increased confidence about what will happen in a trauma call, and 63% reported increased confidence in their A-E assessments. Increased confidence was also widely reported in trauma skills (e.g. log roll 88%), how to manage a ward trauma call (100%), and where to find further guidance (100%). Conclusions This pilot demonstrated that a small group simulation-based teaching intervention can significantly increase the confidence of foundation doctors in all aspects of their role in trauma management. The most notable increases were in trauma equipment use and in managing ward trauma, suggesting these are areas where foundation doctors lack guidance or experience. The course is now part of trust induction for new foundation doctors.

Support Asylum and Vulnerabilities through e-health: SAVe as a healthcare continuity tool

Abstract Issue Migrants and refugees (M&Rs) could present different vulnerabilities and health conditions. The high geographical and setting mobility of migrants within the reception system as well as the legal and administrative variability can impact negatively the continuity of care of eventual vulnerabilities and diseases. Description of the practice The Italian National Institute for Health Migration and Poverty developed an IC platform to take care of migrant's health over its migration pathway in the hosting country. SAVe guarantees both the health assessment at the border and the following steps of clinical care. It offers specialized tools guiding health professionals to evaluate M&Rs' vulnerabilities as well as infectious and chronic diseases. The electronic system is compliant with the EU-GDPR and includes validated tools such as the WHO (Five) WBI, the EASO tool for special needs identification, the Italian guidelines on Border health checks and the Italian protocol for the unaccompanied minors' age assessment. Results The system is being implemented in 4 Italian Regions, where over 28,000 migrants are hosted in reception structures and is expected to be used in the whole Italian reception system. The migrant person is also given the opportunity to save, store and use his health records even in case of relocation to another country. Lessons SAVe is turning out as an innovative tool to evaluate vulnerabilities and health of M&Rs who are present in Italy. The use of validated and evidence-based tools improves the confidence of doctors in detecting vulnerabilities and social determinants of health. Its spread at National level is expected to guarantee the continuity of care. Further, the interoperation between SAVe and the National Health File would allow health data collection from the first arrival of migrant until its full integration in the country. Key messages SAVe is designed to evaluate comprehensively the health of M&Rs, increase the continuity of care and optimize the healthcare resources. Its socio-health and evidence based approach encourages the use as a benchmark for health data collection and health information sharing.

453 Introduction of A Novel Online Learning Platform Increases Junior Doctors Confidence Prior To Starting Trauma & Orthopaedic On-Calls

Abstract Aim Trauma and Orthopaedic (T&O) junior doctors are expected to manage on-calls involving a high volume of patients presenting with a wide variety of complex conditions. Despite this, many junior doctors feel poorly prepared at the start of their placements with individual hospitals providing variable levels of induction. We therefore aimed to provide a free ‘Introduction to T&O on-calls’ course for junior doctors. Method The online platform ‘Zoom’ was used to provide 13 interactive lectures by T&O trainees and consultants over a single day in July 2020. In total, 280 UK junior doctors attended with 91.1% completing feedback. Pre- and post-course questionnaires were used to establish improved knowledge. Results Only 7.4% of participants either had or were aware of a local trust induction covering T&O on-calls. The course had an overall satisfaction rating of 90%, with participants showing a 15.3% improvement in on-call knowledge from pre-course to post-course (p<0.05). Prior to the course only 35% of participants felt prepared to perform an on-call which increased to 77% after the course. Almost all participants (90%) agreed that similar courses in other surgical specialties (General surgery (79%), Urology (60%), Vascular surgery (60%), ENT 55%)) which are commonly cross covered by junior doctors would be hugely beneficial. Conclusions Our principal focus moving forward is to establish a formal national induction programme for T&O junior doctors that is recognised by the relevant T&O organisations. This will instil confidence in the junior doctors whilst achieving patient safety and excellence during busy T&O on-calls.

COVID-19 Pandemic: Effect on Confidence Levels of Portuguese Towards People of Different Professions.

BackgroundThe COVID-19 pandemic is emerging in a world where science is highly developed. Nevertheless, science is not the only resource that people resort to when they have difficulties. In this pandemic context, some professions became more relevant, including front-line professionals, such as medical doctors and nurses, and those who may have an indirect role. The aim of this study is to understand whether there is a strengthening of people’s confidence, in politicians, journalists, science-based activities, and in more mystical dimensions.MethodsA cross-sectional study was carried out to understand the levels of confidence of the Portuguese population in several professional groups, measured in two pandemic moments. Participants were recruited to participate in the study through online platforms. The sample was randomly collected from the Portuguese population. The sample was composed of 1455 Portuguese people with a mean age of 44 years, and 1080 were female.ResultsWe found high levels of confidence in medical doctors and nurses, as well as in other health professions, science, and education. We detected the opposite trend for politicians and journalists. Measured in two pandemic moments, we found confidence levels in these professionals were lower in September than in July with statistical significance differences [(politicians (t = 3.15, p = 0.00); journalists (t = 2.49, p = 0.01)].ConclusionIt is important to improve a joint action between politicians, journalists, health and science professionals to communicate measures to increase confidence from people. There is a need for the engagement of the population in the adoption of protective measures and contribute to easier control in pandemic situations.

Does a smartphone application improve medical students and new ENT junior doctors confidence when dealing with ENT clinical scenarios?

Introduction: The development of an electronic ENT application may improve medical students’ and junior doctors’ confidence in approaching common ENT scenarios if they have had little prior experience in this surgical subspeciality. Methods: A cohort of medical students and junior doctors based at Blackpool Victoria Hospital were asked to rate their confidence in approaching five common ENT scenarios before and after being granted access to a locally-developed ENT application. Results: Every participant showed an increase in their confidence score in dealing with each ENT scenario following access to the application. Junior doctors’ confidence scores showed an overall average confidence increase of 148% and medical students demonstrated an increase of 124%. Discussion: ENT smartphone applications have been shown to be successful in increasing medical students’ and junior doctors’ confidence in approaching common ENT clinical scenarios. The provision of such a resource for surgical subspecialties promotes a further step towards a paperless NHS as well as a standardised way of approaching patient care.

Advancing neurosurgery education in junior doctors and medical students – A neurosurgery virtual lecture series

BackgroundExposure to neurosciences, especially neurosurgery, in UK medical schools is limited and variable. This combined with the fact that neurology and neurosurgery have been perceived as notoriously difficult subjects could negatively affect confidence and efficiency in junior doctors when assessing and managing patients with neurosurgical conditions. This study aims to assess the impact of a neurosurgery virtual lecture series on foundation doctors' and medical students’ confidence and knowledge in the assessment and management of neurosurgical patients. MethodsSix virtual lectures were delivered via Zoom weekly between October and November 2020 covering lesion localisation, neuroradiology, neurosurgical emergencies, trauma assessment, and neuro-ICU. Data was collected relating to participants’ pre- and post-lecture self-perceived confidence levels and performance of five SBA questions, lecture series satisfaction, and feedback. Results31 participants in a district general hospital attended the virtual lecture series (17 foundation doctors and 14 medical students). Pre-lecture, foundation doctors felt significantly more confident than medical students in trauma assessment, spinal emergencies and neurointensive care medicine. In all lectures, participants' median confidence levels improved significantly post-lecture (p < 0.05). There was no significant difference in the performance of pre-lecture SBA questions between foundation doctors and medical students in all but one lecture, which was the neuro-ICU lecture where foundation doctors scored better (3.0 vs 1.0, p = 0.012). In both cohorts, the participants’ median scores in SBA questions (objective marker of knowledge improvement) increased significantly post-lecture in all lectures. ConclusionThis study has shown that this neurosurgery virtual lecture series that was focused and low-cost was well received, improved knowledge and confidence of junior doctors and medical students in assessing and managing neurosurgical patients. Future expansion of this lecture series into regional or national initiative can further increase exposure to neurosurgery, ultimately improving the care of neurosurgical patients.

Improving knowledge and confidence in the acute management of eating disorders and resulting complications

AimsThis project aimed to improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call.BackgroundA recent survey found just 1% of doctors have the opportunity for clinical experience on eating disorders. Anecdotally, a number of junior doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts.MethodThis project aimed to ascertain levels of confidence with managing patients with eating disorders, and to collect suggestions to improve this. This was achieved using a survey sent out to 97 doctors working in a Mental Health Trust.We then utilised two of the suggestions to improve the identified areas of concern. The first method involved direct lectures. This was followed up with the creation of a poster highlighting the pertinent information which was displayed in key clinical areas. The second avenue was the creation of an information booklet covering key clinical information that is available to all on call doctors.ResultThe response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Refeeding syndrome was identified as the greatest area of concern by responding doctors.To assess the impact of the lectures, MCQs were given out before and after the presentation. The results were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%.ConclusionBy using multiple methods to improve doctors confidence, (lectures, written information and visual posters), this quality improvement project achieved its aims in improving doctors knowledge, and through having easy access to important information, will have long term positive effects on patient care.

Improving the confidence and competence of junior doctors in conducting seclusion reviews

Aims•To improve the quality and consistency of medical seclusion reviews at St Charles Hospital and across the Trust.•To ensure at least 80% compliance with minimum standards for seclusion review documentation by the end of December 2020.•To increase doctors' mean perceived competence and confidence scores to 4.5/5 by the end of December 2020MethodSeclusion is commonly used to manage patients at high risk of aggression or violence, but is a high risk and very restrictive intervention. As such, it requires regular nursing and medical reviews. Work has been done recently at St Charles to improve the timeliness and effectiveness of nursing reviews including detailed guidance. Medical reviews are usually performed by junior doctors, many with limited experience in psychiatry. There is •A lack of consistent local or national guidance for junior doctors undertaking seclusion reviews•The quality and scope of these reviews is not consistent•There may be a need to ensure that there is more standardization and to improve junior doctors' confidence – and therefore patient safety and experience – overall.•The following interventions were used to improve the quality of seclusion reviews at the hospital:•Minimum standard guidelines•Presenting in Restrictive interventions meeting.•Feedback from PICU consultants for guidelines•Changing guidelinesFuture plans: •Guidelines teaching (Early November)•Re-audit and new survey (Early November)•Simulation training (Mid November)•Seclusion teaching video (Early December- to be ready for Induction)•Re-audit and new survey (Beginning of April)ResultSurveys were conducted before and after quality improvement interventions were put in place. The average confidence levels of junior doctors increased from 38.5% to 87% following these interventions.ConclusionRevision of seclusion guidelines, junior doctor teaching and simulation training are effective interventions to improve junior doctor confidence levels in conducting seclusion reviews.

Quality improvement project: improving the confidence of junior doctors to manage emergencies; Drs abc in an acute psychiatric setting

AimsTo improve the confidence and preparedness of junior doctors in managing medical or psychiatric emergencies when on call at an inpatient psychiatric unit.BackgroundFacilities for emergency care differ between acute medical and psychiatric units. Protocols for managing acutely deteriorating patients and those requiring immediate resuscitation differ across these organisations.Managing medical emergencies can be stressful for all involved. Junior doctors rotate between services where the level of support varies depending on specialty and setting. For doctors who have worked in a setting where the minimum emergency response includes a Resuscitation team, moving to an environment with less support available is a challenge.In our unit, the protocol following an urgent call is for the on-call doctor (who has access to basic resuscitation equipment) to attend and assess the need for paramedics and transfer to local hospital. Stress can be worsened by change of environment, change of expectation and concern about best management in new settings.MethodA cohort of junior doctors were recruited. Baseline assessment included rating their confidence level (scale 1- 10), listing common medical and psychiatric scenarios they had experienced and those they felt least confident managing. Over a period of 10 weeks, follow-up data was obtained. Interventions to improve confidence were assessed during this period, including a handbook and a teaching session on emergency medications. At the end of the project a wordcloud was created in response to the request to “choose 5 words to describe your feelings when called to an emergency”. Identified themes have been fed back to relevant senior staff and will form the basis of future projects.ResultThe initial average confidence score improved from 4.9 to 9.2 and was sustained out to 14 weeks. According the word cloud the most commonly used words were “morale” and “education”.ConclusionPrior to the study, confidence levels amongst the Junior Doctors was low. Introduction of the handbook and teaching session led to an improvement which was sustained. Key themes identified using a word cloud were “morale” and “education”.For junior doctors moving from between services, different expectations and protocol for management of emergencies can influence confidence levels. Psychiatric units should be cognisant of these concerns and implement evidence-based intervention to support junior doctor confidence and improve quality of working experience.

Creating a virtual, clinical scenario based teaching programme for foundation doctors in Leeds

AimsThrough consultation with foundation doctors on their psychiatry placements in Leeds, we established that they didn't feel the trustwide teaching programme met their needs, with them rating the relevance as 5.8 on a 1-10 Likert scale. They also reported their access to formal and informal teaching had been limited by COVID-19 restrictions. We aimed to create an accessible teaching programme that met their developmental needs as set out by the Foundation curriculum, as well as their confidence and skill set in dealing with common mental health presentations. Our supplementary aims were to promote psychiatry as a career and to provide supervised teaching opportunities to core trainees.MethodHaving assessed the foundation doctors confidence in dealing with different scenarios, we created a 9 week teaching programme covering common mental health presentations they're likely to encounter during their training. The virtual sessions focus on what assessment and management skills would be expected for a foundation doctor, as well as when and how to access support and refer on. The programme was designed to be trainee led with the teaching being facilitated by core trainees as it was felt that they would best relate to the experiences and developmental needs of foundation doctors. This also provided the CTs with an opportunity to develop their teaching skills, something that has become more difficult during COVID.ResultThrough weekly feedback of the sessions we were able to demonstrate that for 8 of the 9 sessions the foundation doctors rated them as being ‘useful’ or ‘very useful’ and we're currently reviewing the topic and materials for the outlying session.Through self-assessed ratings before and after the programme, we demonstrated significant increases in confidence in dealing with all 9 of the scenarios. All of the foundation doctors indicated that they had found the programme beneficial.ConclusionAs shown in the results, the programme has been well received by the foundation doctors who's confidence in dealing with a range of scenarios has improved. The programme has also been well received by the trust who have asked us to repeat the it for future foundation rotations and by core trainees who were grateful of the development opportunities that this provided. Further developments will include extending the programme for the duration of the placement to enable us to cover an enhanced range of presentations and to consolidate core skills.

P98 Quality Improvement Project: Improving documentation and junior doctor confidence on COVID-19 ward rounds using a ward round pro forma

Introduction.Templates and checklists have improved patient outcomes in multiple settings.1,2 There are barriers in junior doctors scribing complete entries using blank sheets; patient care might suffer due to incomplete records. This project implemented a ward round pro-forma across three wards of a tertiary hospital containing high risk COVID-19 patients, aiming to improve both documentation rates and subsequent ease in finding pertinent information.Methods.Respiratory consultants determined 11 key parameters that should be documented daily for COVID-19 patients.Baseline objective data collection analysed all high-care ward round entries (n = 15), recording parameters as present or absent. Multidisciplinary team (MDT) opinions were collected via questionnaire. The pro-forma was trialled for two-weeks; repeated subjective and objective analysis was performed. All (n = 12) inpatient notes on the COVID-19 high-care ward were analysed.Results/Discussion.Pro-forma compliance was 100%. The mean number of key parameters documented per ward round entry increased by 80%, from 5 to 9. Eleven (100%) of the key parameters showed increased completion rates (fig.1). Junior doctor confidence increased 1-Likert point: ‘average’ to ‘confident’ (fig.2). 97% of respondents (n = 31) reported the pro forma saved time. Information finding and swab tracking both increased by 1-Likert point: ‘average’ to ‘easy’ (fig.2). From a medico-legal perspective, documentation of basic information (date, time) improved by 13%. This project shows not only a 60% increase in ceiling of care documentation, but also improved ease in accessing such information.Conclusion.This pro-forma is a simple and acceptable intervention to improve documentation rates and information accessibility, giving junior doctors more confidence.

Monitoring COVID-19 Vaccine Acceptance in Kuwait During the Pandemic: Results from a National Serial Study.

BackgroundWith COVD-19 cases on the rise globally and two approved vaccines, determining vaccine acceptance is imperative to avoid low inoculation rates. The aim of this study was to evaluate the changes and determinants of vaccine acceptance among citizens and non-citizens, over time during the pandemic in Kuwait.MethodsData were obtained from the COVID-19 Snapshot Monitoring (COSMO Kuwait) study that was implemented according to the WHO tool for behavioral insights on COVID-19. Data was collected online, every two weeks throughout the pandemic. Individuals living in Kuwait during the pandemic were surveyed, representing an independent sample of the population during each data collection wave.ResultsA total of 7241 adults living in Kuwait participated. Sixty-seven percent of those participating agreed to take a vaccine if it was available and recommended. However, the proportion of vaccine acceptance drastically dropped overtime as COVID-19 related restrictions were eased, among citizens (73 to 47%) and noncitizens (80 to 60%). Some factors associated with increased odds of agreeing to take the COVID-19 vaccine, among citizens and non-citizens, included increased frequency of informing oneself about the virus (OR, 1.34–1.83; 95% confidence interval 1.16–2.55), having high versus low confidence in doctors (OR, 1.79–2.11; CI 1.17–3.80), increased agreement with containment policies (OR, 1.11–1.27; CI 1.05–1.41), expressing more fears and worries (OR, 1.05–1.12; 1.01–1.24), and the increased perceived likelihood of getting infected with influenza (OR, 1.3–1.4; CI 1.03–1.84). Decreased odds of agreement were associated with increased age (OR, 0.37–0.61; CI 0.26–0.95), being female (OR, 0.56–0.62; CI 0.43–0.73), and not taking the influenza vaccine in 2019 (OR, 0.61; CI 0.43–0.87).ConclusionVaccine acceptance was multifactorial, heterogenous among citizens and non-citizens, and changed over time. While acceptance was relatively high, it decreased throughout the pandemic and as restrictions in the country loosened. This increase in vaccine hesitancy reveals a challenge in achieving high inoculation levels, and the need for effective vaccine-promotion campaigns and increased health education in the country.

Exploring the Career Engagement, Interests, and Goals of Pharmacy Students Identifying as Underrepresented Racial Minorities

Objective. To examine pharmacy career engagement, interest, and confidence in Doctor of Pharmacy (PharmD) students identifying as underrepresented racial minorities (URMs).Methods. A 15-item survey about career engagement, confidence, and goals was administered at a business session of a national conference. The survey included demographic items and items about career exposure prior to and during school, career aspirations after graduation, frequency of engagement in various settings, career factors, and career confidence. Cronbach alpha was used to examine survey reliability. Descriptive statistics and nonparametric statistical tests were used to analyze survey responses.Results. Sixty-nine URM students completed the survey. Most indicated frequent engagement with community pharmacy prior to and during school; no engagement with hospital pharmacy prior to school, yet occasional or frequent engagement during school; and no engagement with the pharmaceutical industry prior to and during school. Most selected hospital pharmacy as their career aspiration, followed by community pharmacy and industry. Approximately half indicated an interest in completing a postgraduate fellowship. Items selected as important to career choice included patient care, job security, and level of stress. Group differences were found by gender and year in school.Conclusion. Despite calls for diversity in pharmacy, there is a paucity of research in this area. This study provides a first glimpse into the career engagement, confidence, and goals of students identifying as URMs, raising a number of critical issues for pharmacy education. Moving forward, schools, employers, and researchers must work to better understand the career development of URM students, including barriers and facilitators to access and success.

AB175. SOH21AS185. Peer-led basic surgical skills training for interns: bridging the surgical-medical skills gap during internship

Background: Core surgical skills are both advantageous and necessary in the pursuit of several post-graduate specialities, beyond formal surgical training. Early opportunity to practice and obtain these skills can only serve to improve doctor competency and confidence levels, thus progressing safe patient care. Despite this, basic surgical skills are not listed as a required clinical competency by the National Intern Training Programme. This study sought to evaluate the impact, if any, of peer-led basic surgical skills and suturing workshops on interns’ confidence in undertaking these skills.

Advances in infectious disease treatment promise to expand the pool of donor organs

More than 109,000 people in the United States were awaiting organ transplants in November 2020, and approximately 17 die each day before receiving one (1). Seeking to expand the pool of organs available to these patients, clinicians are beginning to look to sources once considered off-limits: organs from deceased donors with infections such as HIV and hepatitis C. Making more organs viable for transplant requires not only an effective treatment and reliable tests to detect infections, but also building the confidence of patients and doctors. Image credit: Shutterstock/David Tadevosian. At first, the notion of knowingly giving an organ from an infected donor to an immunosuppressed transplant recipient seems unthinkable. But a better understanding of the diseases caused by certain pathogens, as well as the availability of new drugs to treat or even prevent infections, mean that donor organs once discarded can now be used successfully. In recent years, this principle has been demonstrated dramatically via a series of hepatitis clinical trials: Organ recipients treated prophylactically with new, highly effective hepatitis C (HCV) medications were protected from infection after receiving organs from HCV-infected donors. This proof of concept was made possible in 2013, with advances in a curative new class of HCV drugs known as direct-acting antivirals. And it comes at a time when the opioid epidemic has, for tragic reasons, increased the potential supply of deceased organ donors—many of them infected with HCV. But researchers are also exploring ways to safely use organs from donors infected with other viruses, including HIV, as well as other pathogens. In all cases, making more organs viable requires not only an effective treatment and reliable tests to detect infections but also building the confidence of patients and doctors. Organ recipients and their physicians have always had to carefully weigh the benefits and risks of …

The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia.

The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale–Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and depression scores whereas Vietnam had all the lowest scores. The risk factors for adverse mental health during the COVID-19 pandemic include age <30 years, high education background, single and separated status, discrimination by other countries and contact with people with COVID-19 (p<0.05). The protective factors for mental health include male gender, staying with children or more than 6 people in the same household, employment, confidence in doctors, high perceived likelihood of survival, and spending less time on health information (p<0.05). This comparative study among 7 MICs enhanced the understanding of metal health in the general population during the COVID-19 pandemic.

Impact of the COVID-19 Pandemic on Physical and Mental Health in Lower and Upper Middle-Income Asian Countries: A Comparison Between the Philippines and China

Objective: The differences between the physical and mental health of people living in a lower-middle-income country (LMIC) and upper-middle-income country (UMIC) during the COVID-19 pandemic was unknown. This study aimed to compare the levels of psychological impact and mental health between people from the Philippines (LMIC) and China (UMIC) and correlate mental health parameters with variables relating to physical symptoms and knowledge about COVID-19.Methods: The survey collected information on demographic data, physical symptoms, contact history, and knowledge about COVID-19. The psychological impact was assessed using the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21).Findings: The study population included 849 participants from 71 cities in the Philippines and 861 participants from 159 cities in China. Filipino (LMIC) respondents reported significantly higher levels of depression, anxiety, and stress than Chinese (UMIC) during the COVID-19 (p < 0.01) while only Chinese respondents' IES-R scores were above the cut-off for PTSD symptoms. Filipino respondents were more likely to report physical symptoms resembling COVID-19 infection (p < 0.05), recent use of but with lower confidence on medical services (p < 0.01), recent direct and indirect contact with COVID (p < 0.01), concerns about family members contracting COVID-19 (p < 0.001), dissatisfaction with health information (p < 0.001). In contrast, Chinese respondents requested more health information about COVID-19. For the Philippines, student status, low confidence in doctors, dissatisfaction with health information, long daily duration spent on health information, worries about family members contracting COVID-19, ostracization, and unnecessary worries about COVID-19 were associated with adverse mental health. Physical symptoms and poor self-rated health were associated with adverse mental health in both countries (p < 0.05).Conclusion: The findings of this study suggest the need for widely available COVID-19 testing in MIC to alleviate the adverse mental health in people who present with symptoms. A health education and literacy campaign is required in the Philippines to enhance the satisfaction of health information.

Factors affecting confidence and competence of doctors in performing operative vaginal births: A qualitative study

ObjectivesOperative vaginal birth (OVB) is an important skill for obstetricians. It is the most common emergency intervention in obstetrics and requires a high degree of skill. While there is a lot of data available on technical and non-technical factors affecting the outcome of OVBs little work has been done to investigate the factors that make obstetricians feel confident and competent when performing such a procedure. The objective of this study was therefore to identify the common factors that affect confidence and competence of obstetricians in operative vaginal births (OVB). Our hypothesis was that a qualitative research method would provide a rich approach where themes would be developed that the participants themselves identify as important. Study DesignQualitative research within two University Hospitals and one District Hospital in Ireland. Participants interviewed ranged from first year trainees to consultant obstetricians. Interviews using open ended questions. Interviews were recorded on audio and later transcribed. Thematic analysis was performed until saturation. Results35 obstetricians were interviewed. The median number of years of experience was 5 years (range 3–20 years). The median number of OVB was 200 (range 20−1000+). Vacuum was the preferred choice amongst junior trainees. Preference shifted to forceps with increasing clinical experience.Seven clear themes emerged. Three themes were common to all participants: firstly, that all clinicians reported respect for the primiparous OVB in anticipation of possible complications, secondly the wish for senior midwifery support and finally the importance of clinical experience and exposure. Four themes were common to trainees only. Female clinicians in training reported significant self-doubt in their ability to perform an OVB and had concerns about causing harm. Clinicians in training wished to be trained by consultants during their first year on the labour ward. Experience was important. The final theme was a wish for more training in forceps OVB by clinicians in training. ConclusionThis qualitative study identified factors that can be used to design education and training in OVB in order to support trainees and ultimately improve care for the woman and baby.