Hospital Medical Staff Research Articles

Raymond A Dieter, Jr. MD MS

Raymond A Dieter, Jr. MD MS

Differences in Coping Strategies and Help-Seeking Behaviours among Australian Junior and Senior Doctors during the COVID-19 Pandemic.

Background: Throughout the COVID-19 pandemic, hospital medical staff (HMS) have faced significant personal, workplace, and financial disruption. Many have experienced psychosocial burden, exceeding already concerning baseline levels. This study examines the types and predictors of coping strategies and help-seeking behaviours utilised by Australian junior and senior HMS during the first year of the pandemic. Methods: A cross-sectional online survey of Australian frontline healthcare workers was conducted between 27 August and 23 October 2020. Data collected included demographics, personal and workplace disruptions, self-reported and validated mental health symptoms, coping strategies, and help-seeking. Results: The 9518 participants included 1966 hospital medical staff (62.1% senior, 37.9% junior). Both groups experienced a high burden of anxiety, depression, post-traumatic stress disorder, and burnout. Coping strategies varied by seniority, with maintaining exercise the most common strategy for both groups. Adverse mental health was associated with increased alcohol consumption. Engagement with professional support, although more frequent among junior staff, was uncommon in both groups. Conclusions: Junior and senior staff utilised different coping and help-seeking behaviours. Despite recognition of symptoms, very few HMS engaged formal support. The varied predictors of coping and help-seeking identified may inform targeted interventions to support these cohorts in current and future crises.

Perception, knowledge and attitudes on advance medical directives among hospital staff: Using mixed methodology.

It is necessary to examine the level of perception, knowledge and attitudes of the medical staff for advance medical directives, which are practical alternatives to good practice for end-of-life care in the actual medical field. This study was conducted to determine the degree of perception, knowledge and attitude of cancer hospital medical staff about advance medical directives, and to confirm the relationship between them. It also explored their experiences with advance medical directives. This study used a convergent design to collect quantitative and qualitative data separately in the mixed methodology. This design adheres to the STROBE guidelines. Participants were a total of 140 subjects (70 doctors and 70 nurses) with more than 3years and considered to have sufficient experience related to the study purpose. Focus group participants were a total 19 persons (9 doctors and 10 nurses). Mean score for perception was 35.40, which indicates lower perception when compared to the median value (37.50 points). Perception of advance medical directives had significant, positive relations with attitude of advance medical directives (p=.032). The perception on attitude of advance medical directives factor was significantly influencing (p=.021). As a result of the analysis based on qualitative research questions, six subjects and 11 categories were created by deriving meaningful sentences from the statements. This study suggests that the perception of medical professionals about advance medical directives has a positive correlation with attitudes, as well as a causal relationship. Based on the finding from this study, concrete strategies and interventions to improve the perception of advance medical directives among cancer hospital medical staff are needed.

Editorial introductions.

Editorial introductions.

Adverse reactions following Pfizer-BioNTech COVID-19 vaccine among ”Prof. Dr. Alexandru Obregia” Clinical Psychiatry Hospital medical staff

From the beginning of the COVID-19 pandemic, health organizations and medical scientists worked hard to develop a vaccine that can protect against COVID-19. Given the increased interest of the general population in the side effects occurring after being vaccinated, the aim of this study is to illustrate their frequency and their sub­jec­tive intensity. The ”Prof. Dr. Alexandru Obregia” Cli­ni­cal Psy­chia­try Hospital medical staff members who re­ceived the Pfizer-BioNTech COVID-19 vaccine between January 2021 and March 2021 were questioned about the ad­verse reactions after the first and the second dose. The ques­tion­naires were anonymous. A total of 201 persons answered the ques­tion­naire after the first vaccine dose, and 150 persons answered after the second shot. 91% of the respondents experienced at least one local reaction at the injection site after the first dose, compared to 87.33% after the second dose. The most frequent local reactions were represented by pain at the site of injection and difficulty moving the arm. Systemic reactions were more frequently reported after booster shot, compared to the first dose (p=0.002): 49.8% of the subjects had systemic reactions after the first dose, while 66.7% experienced them after the second one. The most frequently reported systemic reactions were drowsiness, fatigue, myalgia, headache, low-grade fever and chills. The intensity of adverse effects was mild to moderate, with 72% of the subjects considering the intensity of adverse reactions after the second shot as being greater than after the first shot. No anaphylactic reactions or other complications or severe side effects were mentioned in the analyzed group.

A narrative review of research on healthcare staff’s burnout during the COVID-19 pandemic

BackgroundDuring the 2019 coronavirus disease (COVID-19) pandemic, burnout emerges as a critical health problem that might involve workers in many occupations, particularly healthcare personnel. Although burnout syndrome is not necessarily proved to be nosologic, it yields serious physical, mental, and social outcomes. However, it is essential to provide practical strategies and effective instruments for people so that they can adapt to such highly stressful conditions.ObjectivesThe present review was conducted to explore preliminary evidence for nature, treatment, and prevention of burnout among healthcare workers during the COVID-19 pandemic.MethodsRelated English literatures published from the beginning of January 2020 to the end of September 2020 were searched in PubMed, Web of Science, Scopus, and Google scholar databases. “Burnout,” “COVID-19,” “healthcare workers,” “medical staff,” and “pandemic” constituted the search terms. A narrative technique was implemented for material synthesis and creating a compelling and cohesive story.ResultsFinal results provided the burnout history and its major effects, causes, and prevalence among healthcare workers. Also, some strategies were listed to be employed by hospital medical staff and organizations to deal with the COVID-19 pandemic.ConclusionsRecent evidence demonstrated that healthcare staff could gain significant benefits from interventions to modify burnout syndrome, especially from organization-directed interventions. So, health policymakers and practitioners should adopt such interventions and develop context-specific approaches promoting a healthy workplace and averting burnout during the COVID-19 crisis.

When COVID-19 delays the management of an urgent heart condition: A rare case of a spontaneous dissection of two coronary arteries.

Some severe life‐threatening conditions could be misdiagnosed during the current COVID‐19 pandemic.

Who is willing to participate in and provide Family Doctor Contract Service?: A cross-sectional study based on the medical staff's perspective in China.

China encourages medical staff from non-primary hospitals (higher-level hospitals) to participate in and provide Family Doctor Contract Service (FDCS) due to a lack of primary medical resources in community health service centers. This study aims to explore the factors affecting the willingness of family doctor contracting from the tertiary hospital medical staff's perspective.An anonymous self-administered survey was conducted among the medical staff from tertiary hospitals in Hangzhou, Zhejiang Province. Information of the socio-demographic characteristics, the willingness of participating in FDCS and its related reasons, and factors that might affect willingness were investigated. A multivariate logistic regression was used to identify the statistically significant variables associated with willingness.A total of 346 medical staff were recruited in the survey, and 37.86% of them were willing to participate in and provide FDCS. Medical staff with the following characteristics had stronger will: (1)with higher education level;(2)having better knowledge with family doctor;(3)being more attracted by the national policy of FDCS;(4)thinking it help for income increase.The majority of willing doctors (25.95%) believed that participating in FDCS could help them achieve their personal value, and the reason chosen most for unwilling reason was “low income and unrealized personal value (32.21%).”It is necessary for the government to establish the essential matching mechanisms to guarantee the development of the family doctor, including increasing the final financial support for primary health facilities, and developing the national incentive mechanism for family doctors.

The Relationship Between Workload and Burnout Among The Medical Staff In Hospital


 Prolonged occupational stress can lead to the syndrome of job burnout. Workload was one of the factors that can cause the burnout. The main objective of this study was to determine the levels of job burnout and their relationships with workload among the medical staff. The key roles of medical staff in a hospital can be broadly separated into four areas which were the doctors, nurses, allied health professionals and support staff. Eighty medical staff from hospital volunteered to participate in this research. Different data were gathered using the Maslach Burnout Inventory (MBI), NASA-Task Load Index and Demographic questionnaire. The significance of the study was to investigate the relationship between the job burnout and workload among the medical staff in hospitals. The overall level of workload and job burnout was moderate. The results indicated that workload and job burnout among medical staff in hospitals was at moderate level. There was a significant relationship between workload and job burnout in this research.

This Great Catastrophe: Bungling Pandemics from 1918 to Today

In examining how badly the United States bungled its COVID-19 pandemic response, it is worth going back to the commemorations of the 100th anniversary of the 1918 flu pandemic. Author after author cautioned that the next pandemic would overwhelm the United States health system and that the demand for hospital beds, treatments, and medical staff would quickly outstrip supply. These prescient predictions from just two years ago. Why, when the risks were so obvious and so clearly understood, were they ignored? In answering that question there is blame enough to go around. The American public increasingly refused vaccines for communicable diseases, resisted spending for health research, and elected anti-science candidates. Those elected officials in turn failed to take obvious steps to ward off an entirely foreseeable disaster. Some of these developments are new(ish), relating to the specifics of the current political climate. Yet what is most striking is how readily official responses fell into virtually the same patterns that stymied effective pandemic response in 1918, and how structural racism predicted which communities would be hardest hit and least served by government responses. Instead of learning from the mistakes of the 1918 pandemic we have largely repeated them. This paper traces some of the threads of complacency, hubris, isolationism, and distrust that got in the way both times, and draws some broader lessons we must learn about American political culture before the pandemic next time.

Quality assessment of a consultation-liaison psychiatry service

BackgroundConsultation-Liaison Psychiatry (CLP) provides services for patients with medical-psychiatric comorbidity at the general hospital. Referral satisfaction is considered as one of the most important outcome measures of CLP interventions. Our aim was to assess the levels of satisfaction with the CLP service amongst medical staff at a university hospital in Denmark.MethodsMedical staff answered an online survey regarding their experience with different aspects of inpatient and outpatient CLP services.ResultsThere were 152 responses from 16 medical units, with a survey return rate above 85%. Measured on a 5-point Likert scale, there was a median rating of 4 in response to questions regarding communication and organizational aspects, a median rating of 5 in response to questions regarding overall evaluation of the CLP service on both inpatient and outpatient questionnaire. The questions regarding treatment quality were rated with a median of 4 on the inpatient questionnaire and 2 of the outpatient questionnaire items, and with a median of 5 on 2 outpatient items. Physicians´ evaluations were statistically more positive than nurses´. As a group, respondents already employed before the CLP unit was established and those who used the CLP services more were statistically significantly more satisfied then respondents employed after the establishment of the CLP unit and those who used the CLP service less.ConclusionThe CLP services were positively appreciated and considered to be valuable among medical hospital staff. We believe that Consultation-Liaison Psychiatry deserves further help to implement and expand its services in general hospital settings. In addition, our results underline the feasibility of surveys as quality measures of clinical care.

PDG8 Economic Burden of Patients Treated with Dalbavancin in a Spanish Hospital: ECODAL Analysis

The pharmacokinetic profile of dalbavancin (long half-life) allows an early discharge of hospitalized patients requiring intravenous antibiotic therapy ensuring therapeutic compliance. A hypothesis would be that outpatient's treatment helps offset the hospitalization cost associated with the use of standard IV treatment. Objective was to assess the economic burden of dalbavancin treated patients in a Spanish hospital setting. Single center observational retrospective post-hoc analysis based on electronic medical records of dalbavancin treated patients in 2018. Variables: baseline patient characteristics, hospitalization characteristics, drug treatment and concomitant therapy, treatment related adverse events, and direct costs (hospital care, specialized care, medical staff, nursing staff, drugs, tests, and equipment), and costs associated with re-admission; all these costs were obtained from the hospital (Hospital Pharmacy and Analytical Accounting departments). Robustness of results was validated by individual bootstrap analysis. Thirty-four dalbavancin treated patients in 2018 were included; mean age 57.88 and 70.6% men. Main indications were: outpatient management 68% (n=23), and 32% for predicted poor adherence, such as parenteral drug users (n=5). The main syndromes included: infective endocarditis (29%) and 47% of the infections were bacteremic; 50% of the infections were caused by Staphylococcus aureus (23.5% SARM). Direct costs are statistically significant for prolonged outpatient treatment, patients with baseline respiratory morbidity, and the use of dalbavancin as a second or more line treatment. The mean accumulative cost was 23,340,28€/patient, being the greatest expenditure in hospital stay, mean 28.56 days and 7,983.46€, and interventions, 8,407.98€. Without dalbavancin, this cost would have been increased in 9,745.56€ due to longer hospital stays, 47.41 additional days. There were no costs associated to the management of dalbavancin’s adverse events. Dalbavancin cost is compensated by a decrease in the length of hospital stay, and 30% total costs reduction. In 2018, dalbavancin could have avoided 1.612 hospital stay days.

2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report

2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report

Daily multidisciplinary COVID-19 meeting: Experiences from a French university hospital

ObjectivesIn March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. In absence of official recommendations, implementing daily multidisciplinary team (MDT) COVID-19 meetings was urgently needed. Our aim was to describe our initial institutional standard operating procedures for implementing these meetings, and their impact on daily practice. MethodsAll consecutive patients who were hospitalized in our institution due to COVID 19, from March 31 to April 15, 2020, were included. Criteria to be presented at MDT meetings were defined as a proven COVID-19 by PCR or strongly suspected on CT scan, requiring hospitalization and treatment not included in the standard of care. Three investigators identified the patients who met the predefined criteria and compared the treatment and outcomes of patients with predefined criteria that were presented during MDT meeting with those not presented during MDT meeting. COVID-19 MDT meeting implementation and adhesion were also assessed by a hospital medical staff survey. ResultsIn all, 318 patients with confirmed or suspected COVID-19 were examined in our hospital. Of these, 230 (87%) were hospitalized in a COVID-19 unit, 91 (40%) of whom met predefined MDT meeting criteria. Fifty (55%) patients were presented at a MDT meeting versus 41 (45%) were not. Complementary exploration and inclusion in the CorImmuno cohort were higher in MDT meeting group (respectively 35 vs. 15%, P=0.03 and 80 versus 49%, P=0.0007). Prescription of hydrocortisone hemisuccinate was higher in group of patients not presented during MDT meeting (24 vs. 51%, P=0.007). Almost half of the patients fulfilling the inclusion criteria were not presented at MDT meeting, which can be partly explained by technical software issues. ConclusionsMultidisciplinary COVID-19 meetings helped implementing a single standard of care, avoided using treatments that were untested or currently being tested, and facilitated the inclusion of patients in prospective cohorts and therapeutic trials.

Estimating the effectiveness of routine asymptomatic PCR testing at different frequencies for the detection of SARS-CoV-2 infections

BackgroundRoutine asymptomatic testing using RT-PCR of people who interact with vulnerable populations, such as medical staff in hospitals or care workers in care homes, has been employed to help prevent outbreaks among vulnerable populations. Although the peak sensitivity of RT-PCR can be high, the probability of detecting an infection will vary throughout the course of an infection. The effectiveness of routine asymptomatic testing will therefore depend on testing frequency and how PCR detection varies over time.MethodsWe fitted a Bayesian statistical model to a dataset of twice weekly PCR tests of UK healthcare workers performed by self-administered nasopharyngeal swab, regardless of symptoms. We jointly estimated times of infection and the probability of a positive PCR test over time following infection; we then compared asymptomatic testing strategies by calculating the probability that a symptomatic infection is detected before symptom onset and the probability that an asymptomatic infection is detected within 7 days of infection.ResultsWe estimated that the probability that the PCR test detected infection peaked at 77% (54–88%) 4 days after infection, decreasing to 50% (38–65%) by 10 days after infection. Our results suggest a substantially higher probability of detecting infections 1–3 days after infection than previously published estimates. We estimated that testing every other day would detect 57% (33–76%) of symptomatic cases prior to onset and 94% (75–99%) of asymptomatic cases within 7 days if test results were returned within a day.ConclusionsOur results suggest that routine asymptomatic testing can enable detection of a high proportion of infected individuals early in their infection, provided that the testing is frequent and the time from testing to notification of results is sufficiently fast.

Prediction of personal protective equipment use in hospitals during COVID-19.

Demand for Personal Protective Equipment (PPE) such as surgical masks, gloves, and gowns has increased significantly since the onset of the COVID-19 pandemic. In hospital settings, both medical staff and patients are required to wear PPE. As these facilities resume regular operations, staff will be required to wear PPE at all times while additional PPE will be mandated during medical procedures. This will put increased pressure on hospitals which have had problems predicting PPE usage and sourcing its supply. To meet this challenge, we propose an approach to predict demand for PPE. Specifically, we model the admission of patients to a medical department using multiple independent M_{t}/G/infty queues. Each queue represents a class of patients with similar treatment plans and hospital length-of-stay. By estimating the total workload of each class, we derive closed-form estimates for the expected amount of PPE required over a specified time horizon using current PPE guidelines. We apply our approach to a data set of 22,039 patients admitted to the general internal medicine department at St. Michael’s hospital in Toronto, Canada from April 2010 to November 2019. We find that gloves and surgical masks represent approximately 90% of predicted PPE usage. We also find that while demand for gloves is driven entirely by patient-practitioner interactions, 86% of the predicted demand for surgical masks can be attributed to the requirement that medical practitioners will need to wear them when not interacting with patients.

The powerlessness of a psychiatrist against the administrative system on the example of a patient with organic hallucinosis – a case report

Psychiatry is a unique area of medicine where the doctor, holistically caring for the patient, often comes across many administrative, juridical or social difficulties. They seem to be less common among other specializations of medicine, but still knowledge in the field of law is an indispensable part of the specialization training of young psychiatry entrants. The ability to apply it properly is particularly important and often necessary while dealing with a psychiatric patient. The purpose of this work is to illustrate such a juridical casus of the patient, previously hospitalized in various hospital wards as a result of being a victim of criminal battery, as well as to present the authentic juridical and social barriers, which a psychiatrist caring for chronically ill patients is obliged to break through. This case description also shows a review and depiction of legal acts and laws that have been applied. It calls attention to doctors’ helplessness in relation to the current administrative system, as well as raises the problem and powerlessness of hospital medical staff caring for chronically mentally ill patients, who must be provided care regardless of inefficiency of social care system. Moreover, this work also points to the importance of the appropriate

Gender Differences in Anger Among Hospital Medical Staff Exposed to Patients with COVID-19.

Purpose: Occupational exposure to patients with COVID-19 is a stress factor. The aim of this study was to assess gender differences in anger among medical hospital staff.Methods: N=78 hospital employees with direct or indirect contact to patients with COVID-19 completed State-Trait Inventory-2.Results: Female personnel showed higher scores in the main “trait anger” scale and its subscale “anger temperament,” whereas “anger control-out” was significant lower. Direct patient contact had no influence.Conclusion: More specific training for female hospital staff could achieve health-related equity. Focusing on anger as a leading indicator could lead to better prevention and self-monitoring. Registered at Clinicaltrials.gov (NCT04368312).

Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study.

BackgroundInformation in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff.ObjectiveThe aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia.MethodsAn institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (α=.78)ResultsIn this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use.ConclusionsMost respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians.

Integrated health intervention on polypharmacy and inappropriate prescribing in elderly people with multimorbidity: Results at the end of the intervention and at 6 months after the intervention

Background and objectiveTo analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity. Material and methodsPatients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months. ResultsOne hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was > 10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p< .001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention. ConclusionsAn integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention.