Medicine Community Research Articles

A qualitative investigation of the impact of coronavirus disease 2019 (COVID-19) on emergency physicians' emotional experiences and coping strategies.

Study objectiveThroughout the coronavirus disease 2019 (COVID‐19) pandemic, emergency physicians in the United States have faced unprecedented challenges, risks, and uncertainty while caring for patients in an already vulnerable healthcare system. As such, the pandemic has exacerbated high levels of negative emotions and burnout among emergency physicians, but little systematic qualitative work has documented these phenomena. The purpose of this qualitative investigation was to study emergency physicians’ emotional experiences in response to COVID‐19 and the coping strategies that they employed to navigate the pandemic.MethodsFrom September 2020 to February 2021, we conducted semistructured interviews with 26 emergency physicians recruited from 2 early COVID‐19 epicenters: New York City and the Metro Boston region. Interviews, coding, and analyses were conducted using a grounded theory approach.ResultsEmergency physicians reported heightened anxiety, empathy, sadness, frustration, and anger during the pandemic. Physicians frequently attributed feelings of anxiety to medical uncertainty around the COVID‐19 virus, personal risk of contracting the virus and transmitting it to family members, the emergency environment, and resource availability. Emergency physicians also discussed the emotional effects of policies prohibiting patients’ family members from entering the emergency department (ED), both on themselves and patients. Sources of physician anger and frustration included changing policies and rules, hospital leadership and administration, and pay cuts. Some physicians described an evolving, ongoing coping process in response to the pandemic, and most identified collective discussion and processing within the emergency medicine community as an effective coping strategy.ConclusionsOur findings underscore the need to investigate the effects of physicians’ pandemic‐related emotional stress and burnout on patient care. Evidence‐based interventions to support emergency physicians in coping with pandemic‐related trauma are needed.

Lack of Methodological Rigor for Task-Based Functional Magnetic Resonance Imaging: Injury-Related Fear or Failure to Correct?

Lack of Methodological Rigor for Task-Based Functional Magnetic Resonance Imaging: Injury-Related Fear or Failure to Correct?

Promoting equity and inclusion with student-driven initiatives

Representation is crucial in building more inclusive communities in science, technology, engineering, mathematics, and medicine (STEMM) fields. STEMM Diversity is a student-driven initiative that was founded to promote equity, diversity, and inclusion (EDI) at McGill University. Here, we discuss the lessons learned while developing STEMM Diversity that can help guide others to develop their own student-driven initiatives.

Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine.

Gender inequity is pervasive in medicine, including emergency medicine (EM), and is well documented in workforce representation, leadership, financial compensation, and resource allocation. The reasons for gender inequities in medicine, including academic EM, are multifactorial and include disadvantageous institutional parental, family, and promotion policies; workplace environment and culture; implicit biases; and a paucity of women physician leader role models, mentors, and sponsors. To address some of the challenges of gender inequities and career advancement for women in academic EM, we established an innovative, peer-driven, multi-institutional consortium of women EM faculty employed at four distinct hospitals affiliated with one medical school. The consortium combined financial and faculty resources to execute gender-specific programs not feasible at an individual institution due to limited funding and faculty availability. The programs included leadership skill-building and negotiation seminars for consortium members. The consortium created a collaborative community designed specifically to enrich career development for women in academic EM, with a formal organizational structure to connect faculty from four hospitals under one academic institution. The objective of this report is to describe the creation of this cross-institutional consortium focused on career development, academic productivity, and networking and sharing best practices for work-life integration for academic EM women faculty. This consortium-building model could be used to enhance existing institutional career development structures for women and other physician communities in academic medicine with unique career advancement challenges.

Primary care professionals\u2019 experiences during the first wave of the COVID-19 pandemic in Greece: a qualitative study

BackgroundThe coronavirus outbreak (COVID-19) tested health care systems worldwide. This qualitative study aimed to explore and understand the experiences, beliefs and concerns of Primary Care Professionals (PCPs) regarding the preparedness and response of primary care to the first wave of the pandemic in Greece, a country where a public structured primary care system has been developing.MethodsWe conducted semi-structured telephone interviews with 33 PCPs (General Practitioners, community General Internal Medicine Specialists, community Paediatricians and nurses) recruited from all regions of Greece after the first wave of the pandemic (June 2020). Interviews were transcribed verbatim, data were anonymised and analysed. Thematic analysis was applied developing a conceptual framework.ResultsFour main themes were identified: a) Primary care unit adaptation and issues faced during the pandemic; b) Management of suspected COVID-19 cases; c) Management of non-suspected cases; d) Consequences of the pandemic. In the first phase of the pandemic, remote management of suspected cases and their referral to the hospital were preferred as a result of a shortage of personal protective equipment and inaccessibility to coronavirus testing in primary care. Due to the discontinuation of regular medical services and the limited in-person contact between doctors and patients, chronic disease management and prevention programmes were left behind. Social and emotional consequences of the pandemic, such as workplace stigma, isolation and social seclusion, deriving from fear of viral transmission, as well as burnout symptoms and exhaustion were commonly experienced among PCPs. Positive consequences of the pandemic were considered to be the recognition of the importance of an empowered public healthcare system by citizens and the valuable insight, knowledge and experience professionals gained in times of crisis.ConclusionsPrimary care has a key role to play during and after the pandemic by using its information infrastructure to identify at-risk groups, detect new cases of COVID-19, provide care according to needs, and carry out vaccination programmes. Central coordination and empowerment of primary care will increase its effectiveness, via public awareness, holistic patient management, and unburdening of hospitals.

Exploring Valued Personality Traits in Practicing Veterinarians.

We examined differences in valued Big Five personality traits of small animal veterinarians between members and nonmembers of the veterinary medicine community. Between fall 2019 and spring 2020, data were collected from an online survey sent to eligible persons across a US midwestern state. Eligible persons included veterinary office clients (i.e., pet owners) and persons practicing/training in veterinary medicine. Participants completed demographic questions and 10 Likert scale items about which Big Five personality characteristics they prefer in a veterinarian. Descriptive data were determined and checked for assumptions of linearity and normality. Data for the primary analyses were analyzed using Spearman's correlations and Kruskal-Wallis H tests. Participants who were members of the veterinary community of practice valued the characteristic openness more than clients but valued emotional stability less than clients. Moreover, tests revealed that young adults (aged 18-24) valued extraversion more than all other age groups but least valued agreeableness. Last, participants aged 55 and older valued agreeableness and emotional stability more than the 18-44 age groups. Findings indicate individuals from different membership and age groups have varying preferences in what personality traits they expect in a veterinarian. Clients care more about their veterinarian being able to handle adversity. Older adults want their veterinarian to be trusting and creative. These findings encourage veterinary medical education to spotlight the development of skills congruent with these desired personality traits. Gaining such skills will be useful for veterinarians who seek to grow or build lasting relationships with clientele and colleagues.

Strategies and interventions for improving safety culture in Australian Emergency Departments: A modified Delphi study.

Patient safety and safety culture are critical for quality healthcare delivery in general and in Emergency Departments (EDs) in particular. The aim of this study is to identify strategies that may contribute to the improvement and maintenance of patient safety culture and which are considered most feasible in the ED environment. A two-step modified Delphi method with 11 experts' panel was performed to establish consensus. A list of potential expert participants with a background in patient safety culture in EDs was compiled through the professional networks of the supervisory team. Snowball sampling was used to identify additional possible participants. The expert panel included key leaders in the emergency medicine community in Queensland, Australia: patient safety experts and researchers, patient safety directors, and healthcare providers in an Australian ED The study ran from September 2018 to December 2018. The tool used in Round 1 in this study was developed through triangulating the outcomes of a review of literature, results from a survey of ED staff and findings from semi-structured interviews with key stakeholders in ED. The results from Round 1 informed the development of the Round 2 tool. The responses from the Delphi Round 1 tool were analysed as both qualitative data and quantitative data. The responses from the Delphi Round 2 tool were treated as quantitative data and analysed with the SPSS software. Consensus was calculated based on more than 80% agreement in collapsed categories 1 and 2 (or 4 and 5) of the five-point Likert scale. Only six strategies out of 17 (35%) achieved consensus for both importance and feasibility. These strategies may therefore be considered the most important and feasible key strategies for improving safety culture in EDs. Seven strategies (41.1%) achieved consensus for importance, but not for feasibility and four strategies (23.55%) did not achieve consensus for either importance or feasibility. This study offers practical solutions for safety culture improvement in the ED context. Six key strategies were seen as both important and feasible and these grouped into three main themes; leadership through agenda setting, operational management approaches to reinforce the agenda and commitment, and systems and structures to reinforce the agenda and monitor progress.

The Legacy of the Wright State University Aerospace Medicine Residency Program.

INTRODUCTION: In the mid-1970s, NASA required a robust training program for physicians responsible for the medical needs of the Shuttle astronauts. Personnel at NASA worked closely with academicians and subject matter experts at Wright State University (WSU) to develop and establish a residency program in aerospace medicine. This academic training program was initiated in 1978 and closed in 2018. The objective of this historical piece is to catalog, for posterity, the impact this training program has had on national and international human spaceflight and aviation. METHODS: A thorough review of all available historical documents and oral histories provided by contemporaries were reviewed in detail, including a search of every available residents thesis and all available historical documents and reports at WSU and NASA Headquarters. RESULTS: Over the past 40 yr, WSU has graduated 172 individuals with an M.S. degree focused on aerospace medicine, of which 84 were residents. Nearly 50 of these residents have worked closely with NASA. Many others became integrated into academia, the aviation industry, or international space programs. DISCUSSION: With the growth in interest for government and commercial spaceflight, the field of aerospace medicine is poised to grow. Although it is not well known outside of the Aerospace Medicine community, the legacy of this pioneering, 40-yr civilian-based program is of significant value. If not recorded in an easily locatable and accessible manner, many of the challenges and outcomes from this residency could be lost until future generations have to spend the money, time, and effort to relearn them. Doarn CR, Shimada K, Shepanek M. The legacy of the Wright State University Aerospace Medicine Residency program. Aerosp Med Hum Perform. 2021; 92(9):744750.

EXPLORING ETHNOMEDICINE PLANTS USED BY THE INDIGENOUS COMMUNITIES IN TERENGGANU, MALAYSIA: HUMAN HEALTH AND THE ENVIRONMENT

Indigenous communities in Malaysia practice traditional medicine, particularly from the surrounding plants to cure different diseases and illnesses. This traditional way of life has been practised for centuries and passed down through generations. This study aims to document medicinal plants that have been used by the Orang Asli to treat illness. A qualitative ethnomedical study was done to document the species that were believed to have medicinal value. This study was carried at all three resettlement villages in Terengganu. Eleven informants who were the head of household with the age of over 30 years old were interviewed. Fieldwork surveys, observation and face-to-face communication were methods used in this study. The finding shows that most of the Orang Asli community in Terengganu are still dependent on plants and herbs to cure ailments. A total of 106 species that belong to 55 plant families were used by them. This study will encourage researchers in various fields such as ethnobotanical, ethno-zoological, ethnomedicinal and pharmaceutical and toxicological accomplishment of flora and fauna from these areas. As such, these medicinal plants need some more extensive efforts to validate scientifically and clinically were to prove the ethnomedical claims toward them.

"Coronasomnia"-promoting resilience through insomnia treatment

HintergrundDer Begriff „Coronasomnia“ beschreibt populärwissenschaftlich Schlafstörungen, die im Zusammenhang mit der COVID-19-Pandemie in Erscheinung treten. Diese können auch im Anschluss der Pandemie einen Teil der Bevölkerung betreffen. Erste wissenschaftliche Hinweise deuten darauf hin, dass durch die Pandemie entstandene Insomniebeschwerden sich nach dem Ende der Pandemie chronifizieren und somit die schlafmedizinische Gemeinschaft weiterhin beschäftigen werden.MethodenEs wurde eine orientierende Literaturrecherche in Medline und Google Scholar mit folgender Kombination an Keywords durchgeführt: „Insomnia and COVID-19“; „Insomnia and Long-COVID“; „Insomnia, PTSD and COVID-19“; „Fatigue and Insomnia in Long-COVID“. Darüber hinaus lagen den Autoren mehrere kürzlich erschienene Artikel vor, welche durch Mitglieder des „European Insomnia Network“ veröffentlicht wurden.ErgebnisseStudien zu dem Thema Insomnie und COVID-19 zeigen signifikante Assoziationen zwischen akuter Infektion und Insomnie bei betroffenen Personen. Die Prävalenz von Insomniesymptomen bei Personen mit COVID-19 lag bei 36–88 % und somit deutlich über die Prävalenz in der Bevölkerung mit 10–40 %.FazitDigitale Therapieangebote als aktuelle Behandlungsmöglichkeit von Insomnie können Patienten unabhängig von der räumlichen Entfernung angeboten werden. Demnach wäre nicht nur eine baldige Zulassung von mobilen Therapieapplikationen, sondern auch von personengeleiteten, digitale Therapieangeboten für Insomnie zu empfehlen. Die Aufnahme personalisierter und schlafedukativer Maßnahmen im Bereich des betrieblichen Gesundheitsmanagements wird nahegelegt.

Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia.

To assess the impact of coronavirus disease 2019 (COVID-19)-related restrictions on narcolepsy type 1 (NT2), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH). Participants with NT1, NT2, and IH followed in a university hospital completed an online 78-question survey assessing demographic, clinical, and occupational features of the population during the first COVID-19-related lockdown. A total of 219 of 851 (25.7%) respondents of the survey reported a mean increase of 1.2 ± 1.9 hours (P < .001) in night sleep time and a mean decrease of 1.0 ± 3.4 points (P < .001) on the Epworth Sleepiness Scale during lockdown. Bedtime was delayed by 46.1% of participants and wakeup time was delayed by 59.6%, driven primarily by participants with IH. Teleworkers (but not in-person workers) reported a mean increase of 0.9 ± 1.2 hours in night sleep (P < .001) and a mean decrease in sleepiness score of 1.6 ± 3.1 (P < .001). Cataplexy improved in 54.1% of participants with NT1. Sleepiness correlated with psychological wellness (r = .3, P < .001). As many as 42.5% enjoyed the lockdown, thanks to reallocation of time usually spent commuting toward longer sleep time, hobbies, and family time, and appreciated a freer napping schedule. Conversely, 13.2% disliked the lockdown, feeling isolation and psychological distress. Extended sleep time, circadian delay (in patients with IH), and teleworking resulted in decreased symptoms of central hypersomnias. These findings suggest that people with IH, NT1, and NT2 may benefit from a decrease in social and professional constraints on sleep-wake habits, and support advocacy efforts aimed at facilitating workplace and schedule accommodations for this population. Nigam M, Hippolyte A, Dodet P, etal. Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia. J Clin Sleep Med. 2022;18(1):255-263.

Altered Mental Status in the Emergency Department - When to Consider Anti-LGI-1 Encephalitis: Case Report.

IntroductionAnti-leucine-rich glioma inactivated-1 (LGI-1) is one of few antibodies implicated in limbic encephalitis, a syndrome that can result in permanent neurological symptoms if left untreated.Case ReportWe present a patient with dystonic seizures, progressive cognitive decline, psychiatric symptoms and short-term memory loss, and mild hyponatremia diagnosed with anti-LGI-1 antibody limbic encephalitis.ConclusionThere are few reports in the emergency medicine community describing anti-LGI-1 antibody limbic encephalitis. Delay in diagnosis can risk irreversible limbic damage. Therefore, it is important for the emergency physician to be aware of anti-LGI-1 antibody limbic encephalitis when presented with adult-onset seizures and altered mental status of unknown etiology.

Cannabis constituents interact at the drug efflux pump BCRP to markedly increase plasma cannabidiolic acid concentrations

Cannabis is a complex mixture of hundreds of bioactive molecules. This provides the potential for pharmacological interactions between cannabis constituents, a phenomenon referred to as “the entourage effect” by the medicinal cannabis community. We hypothesize that pharmacokinetic interactions between cannabis constituents could substantially alter systemic cannabinoid concentrations. To address this hypothesis we compared pharmacokinetic parameters of cannabinoids administered orally in a cannabis extract to those administered as individual cannabinoids at equivalent doses in mice. Astonishingly, plasma cannabidiolic acid (CBDA) concentrations were 14-times higher following administration in the cannabis extract than when administered as a single molecule. In vitro transwell assays identified CBDA as a substrate of the drug efflux transporter breast cancer resistance protein (BCRP), and that cannabigerol and Δ9-tetrahydrocannabinol inhibited the BCRP-mediated transport of CBDA. Such a cannabinoid-cannabinoid interaction at BCRP transporters located in the intestine would inhibit efflux of CBDA, thus resulting in increased plasma concentrations. Our results suggest that cannabis extracts provide a natural vehicle to substantially enhance plasma CBDA concentrations. Moreover, CBDA might have a more significant contribution to the pharmacological effects of orally administered cannabis extracts than previously thought.

Use of evidence in acute stroke decision-making: Implications for evidence-based medicine.

Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which 'best evidence' is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. In this paper, we explore how physicians from the neurology and emergency medicine communities have responded to an evolving body of evidence surrounding the acute treatment of patients with ischemic stroke. Through analysis of this case study, we argue that EBM's vision of evidence-based medical decision-making fails to appreciate a process that we have termed epistemic evaluation. Physicians are required to interpret and apply any knowledge-even what EBM would term 'best evidence'-in light of their own knowledge, background and experience. This is consequential for EBM as understanding what physicians do and why they do it would appear to be essential to achieving optimal practice in accordance with best evidence.

Thoughts on the First Decade of Hospital Pediatrics.

Thoughts on the First Decade of Hospital Pediatrics.

The Scientific and Clinical Case for Reviewing Diagnostic Radiopharmaceutical Extravasation Long-Standing Assumptions.

Background: The patient benefit from a diagnostic nuclear medicine procedure far outweighs the associated radiation risk. This benefit/risk ratio assumes a properly administered radiopharmaceutical. However, a significant diagnostic radiopharmaceutical extravasation can confound the procedure in many ways. We identified three current extravasation hypotheses espoused by medical societies, advisory committees, and hundreds of individual members of the nuclear medicine community: diagnostic extravasations do not cause harm, do not result in high absorbed dose to tissue, and require complex dosimetry methods that are not readily available in nuclear medicine centers. We tested these hypotheses against a framework of current knowledge, recent developments, and original research. We conducted a literature review, searched regulatory databases, examined five clinical cases of extravasated patients, and performed dosimetry on those extravasations to test these globally accepted hypotheses.Results: A literature review found 58 peer-reviewed documents suggesting patient harm. Adverse event/vigilance report database reviews for extravasations were conducted and revealed 38 adverse events which listed diagnostic radiopharmaceutical extravasation as a factor, despite a regulatory exemption for required reporting. In our own case material, assessment of care was evaluated for five extravasated patients who underwent repeat imaging. Findings reflected results of literature review and included mis- or non-identification of lesions, underestimation of Standardized Uptake Values (SUVs) by 19–73%, classification of scans as non-diagnostic, and the need to repeat imaging with the associated additional radiation exposure, inconvenience, or delays in care. Dosimetry was performed for the same five cases of diagnostic radiopharmaceutical extravasation. Absorbed doses to 5 cm3 of tissue were between 1.1 and 8.7 Gy, and shallow dose equivalent for 10 cm2 of skin was as high as 4.2 Sv.Conclusions: Our findings suggest that significant extravasations can or have caused patient harm and can irradiate patients' tissue with doses that exceed medical event reporting limits and deterministic effect thresholds. Therefore, diagnostic radiopharmaceutical injections should be monitored, and dosimetry of extravasated tissue should be performed in certain cases where thresholds are thought to have been exceeded. Process improvement efforts should be implemented to reduce the frequency of extravasation in nuclear medicine.

Time to remember: Vaccines don't cause autism

It was with great concern that the pediatric medicine community heard only 4 years ago of the recurring myth that that vaccines cause autism. So, getting that myth out of the minds of some parents is a constant call to battle. Here are some of the facts.

Women's Health Information Survey: Common Health Concerns and Trusted Sources of Health Information Among Different Populations of Female Patients.

Background: Women are more likely to search for information on behalf of both themselves and others, thus making them a valuable target for health information research. The purpose of this project was to identify and compare the most important medical concerns and sources of health information trusted by women in relationship to demographic differences in two different clinical settings within the same geographic area (Mayo Clinic Department of Family Medicine and Beaches Community Health care—a Sulzbacher Center Clinic).Methods: A novel survey tool was developed to obtain information regarding the age, race, and socioeconomic demographics of patients as well as the patients' personal significant medical concerns and trusted sources of health information.Results: Despite the huge development of health care information delivery through online resources, in our study, the majority of patients from both clinics still used and viewed their primary care provider as the most trusted source of health information. The health concerns most reported by both populations included cardiac health, breast and other cancers, and obesity; meanwhile, mental health was significantly more reported by patients from the free clinic.Conclusions: Education level may be an important factor of the awareness and ultimate treatment and prevention of these prevalent diseases. Furthermore, our study results may help improve patient satisfaction, knowledge, and health outcomes.

Prolonged Effects of the COVID-19 Pandemic on Sleep Medicine Services-Longitudinal Data from the Swedish Sleep Apnea Registry.

The worldwide COVID-19 pandemic has affected the operation of health care systems. The direct impact of obstructive sleep apnea (OSA) on COVID-19 infection outcome remains to be elucidated. However, the coincidence of common risk factors for OSA and severe COVID-19 suggests that patients with OSA receiving positive airway pressure therapy may have an advantage relative to those untreated when confronted with a COVID-19 infection. The ongoing COVID-19 pandemic has led to a substantial reduction of sleep medicine services, and the long-term consequences may be considerable. New strategies for the management of sleep disorders are needed to overcome the current underdiagnosis and delay of treatment.

Racism in Pain Medicine: We Can and Should Do More

Racism in Pain Medicine: We Can and Should Do More