Years Of Experience In Healthcare Research Articles

Heart of Care: Embracing Grief and Growth in Oncology and Palliative Medicine

Introduction The emotional impact of patient loss in oncology and palliative care profoundly affects healthcare professionals. This study explores clinicians’ experiences, emotional reactions, and coping mechanisms in these fields, focusing on their professional and personal growth. It aims to provide a comprehensive understanding of how healthcare professionals from different regions and with varying years of experience deal with patient loss, emphasizing cultural, social, and institutional influences on their coping strategies. Methods A mixed-methods approach combined qualitative and quantitative elements. Data were collected using a Microsoft® Forms© survey targeting oncology and palliative care healthcare professionals. The survey included questions on experiences with patient loss, coping strategies, personal and professional growth, and beliefs. Statistical methods and thematic analysis were used to analyse quantitative and qualitative data. Ethical approval was obtained, and the survey ensured participant anonymity and confidentiality. Results The survey received 125 responses from nineteen countries. Emotional reactions to patient loss were significant, with various coping strategies reported, including spiritual practices, self-care, and professional support groups. Personal and professional growth were key outcomes of dealing with patient loss. Themes like Emotional Impact, Coping Mechanisms, and Reflections on Death and Dying were prevalent. Analysis revealed no significant correlation between the time taken by the participants to complete the survey and years of healthcare experience. Conclusion Healthcare professionals in oncology and palliative care face significant emotional challenges due to patient loss. The study emphasizes the importance of diverse and effective coping mechanisms, the supportive role of personal beliefs and workplace environments, and the journey of personal and professional growth amidst these challenges. It highlights the resilience of healthcare workers and underscores the need for supportive systems in managing the emotional aspects of patient care.

Assessment of Knowledge and Attitudes Toward Palliative Care and End-of-Life Decision-Making in Saudi Arabia: A Cross-Sectional Study.

Palliative care in Saudi Arabia has witnessed significant recent progress through the establishment of the Saudi Society for Palliative Care and the National Palliative Care Program. The objective of this study was to assess knowledge and attitudes regarding palliative care and end-of-life decision-making in Saudi Arabia's Eastern and Central provinces among individuals residing in these regions. Utilizing a cross-sectional survey-based research design, we assessed knowledge and attitudes regarding palliative care and end-of-life decision-making in Saudi Arabia's Eastern and Central provinces. Participants were recruited through purposive sampling via social media. Data collection included demographic information, palliative care knowledge, attitudes toward palliative care, and cultural influences on end-of-life decisions. A total of 710 participants completed the survey, resulting in a response rate of 85%, with a balanced gender distribution, predominantly aged 25-54. Over half were healthcare providers, many possessing more than 15 years of healthcare experience. A substantial proportion had received formal palliative care training and had personal involvement in end-of-life decisions. While most participants demonstrated a good understanding of palliative care, knowledge gaps, especially regarding its timing, persisted. Generally, participants felt at ease discussing end-of-life care and believed in palliative care's effectiveness. Cultural influences on end-of-life decisions were perceived both positively and negatively, with some facing cultural challenges in palliative care. This study underscores a promising understanding of palliative care in Saudi Arabia alongside persistent misconceptions. It highlights the necessity for targeted education to rectify misperceptions, particularly concerning the initiation timing of palliative care. Cultural factors strongly impact end-of-life decisions, emphasizing the need for culturally sensitive healthcare discussions and provider training.

Healthcare personnel at non–acute-care facilities are at risk of COVID-19 from workplace and community exposures

Background: Healthcare personnel (HCP) working in non–acute-care facilities are at high risk of COVID-19. We sought to determine SARS-CoV-2 seroprevalence, and analyzed behaviors and activities related to COVID-19 acquisition in this cohort. Methods: Between May and June 2021, HCP were enrolled at a skilled nursing facility and a memory care facility in St. Louis, Missouri. Data regarding demographics, prior SARS-CoV-2 testing, symptoms consistent with COVID-19 in the previous 6 months, COVID-19 vaccination, personal protective equipment (PPE) use, and COVID-19 exposures were collected via survey. Blood specimens were obtained to determine SARS-CoV-2 nucleocapsid IgG antibody seroprevalence (Abbott Laboratories). Study protocol was approved by the Washington University Institutional Review Board. Results: The survey was completed by 74 HCP. 82% of participants were female, and 31% reported >10 years of healthcare experience. The overall SARS-CoV-2 seropositivity rate was 8.9% (5 HCP). Of the surveyed HCP, 50% reported symptoms concerning for COVID-19 in the prior 6 months. Headache (38%), fatigue (35%) and fever (27%) were the most common self-reported symptoms. Among symptomatic HCP, only 35% sought medical care for these symptoms. All HCP reported having taken at least 1 COVID-19 test prior to study enrollment. Of note, 18.9% (14 HCP) had a self-reported prior positive SARS-CoV-2 PCR test, of whom 9 HCP were seronegative. All seronegative HCP with a self-reported history of COVID-19 reported infection >3 months before study participation. Completion of a primary COVID-19 vaccination series was reported by 86% of HCP. Known exposure to COVID-19 at work was reported by 28% of HCP. When asked about PPE at the time of workplace exposure, N95 mask use was reported by 81%, gloves by 57%, gowns by 33%, face shields by 29% and surgical masks by 14%. Known specific exposure to COVID-19 outside work was reported by 31% of HCP. Conclusions: One year after the initial COVID-19 pandemic impacted the St. Louis region, HCP at non–acute-care facilities had a SARS-CoV-2 seroprevalence of 8.9%. Similar frequency of exposures were reported from both the workplace and community, with high rates of PPE use at the workplace. HCP in such settings remain at high risk of COVID-19 exposure from workplace and community exposures. Ongoing efforts are needed to maintain PPE use to prevent SARS-CoV-2 transmission within non–acute-care facilities, and continue access to timely COVID-19 screening for HCP.Disclosure: None

1889. Knowledge, beliefs and practices about COVID-19 infection and vaccination in healthcare personnel at non-acute care facilities

Abstract Background The objective of this study is to characterize the experiences, knowledge, beliefs, and perceptions of risk related to COVID-19, infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at three non-acute care facilities. Methods The study protocol was approved by the Washington University IRB. Between April-May 2021, anonymous surveys were distributed to HCP at three non-acute care facilities in St. Louis, MO. Data was collected on demographics, experience working in healthcare, COVID-19 exposures, knowledge and beliefs about infection prevention policies and procedures, PPE use, perception of risk of acquiring COVID-19, and COVID-19 vaccination status. Results There were 156 respondents; 78% were female, and 53% reported >10 years of healthcare experience. The largest proportion (32%) were in direct patient care as nurses or nurses’ aides. A majority (97%) reported adequate knowledge of how to protect themselves from COVID-19 at work, and most (95%) reported access to adequate PPE supplies. HCP (58.7%) reported that wearing a mask or face shield made communication difficult, 56% stated they had taken on additional responsibilities due to staff shortages, and 53% indicated that their job became more stressful because of COVID-19. More than a quarter (28%) had considered quitting their job due to COVID-19. HCPs were more concerned about acquiring COVID-19 in the community than at work (47 vs 33%). When asked about the COVID-19 vaccine, 78% of respondents reported receiving at least one dose of vaccine and 72% had completed a primary vaccine series. The most common reasons given for deciding to get vaccinated were a desire to protect family and friends (84%) and wanting to help stop the spread of COVID-19 (82%). For unvaccinated respondents (29%), the most common reasons for not receiving vaccination were concern for side effects (53%) and belief that the vaccine was not tested well enough (50%). Conclusion A significant proportion of HCP reported stress and increased responsibilities at work due to COVID-19, and 1 in 4 considered leaving their job. A majority were vaccinated, with concerns about side effects or inadequate vaccine testing cited as the most common concerns by unvaccinated HCPs. Disclosures All Authors: No reported disclosures.

The Impact of Epidemics and Pandemics on the Mental Health of Healthcare Workers: A Systematic Review.

Background: There is increasing evidence that healthcare workers (HCWs) experience significant psychological distress during an epidemic or pandemic. Considering the increase in emerging infectious diseases and the ongoing COVID-19 pandemic, it is timely to review and synthesize the available evidence on the psychological impact of disease outbreaks on HCWs. Thus, we conducted a systematic review to examine the impact of epidemics and pandemics on the mental health of HCWs. Method: PubMed, PsycInfo, and PsycArticles databases were systematically searched from inception to June-end 2020 for studies reporting the impact of a pandemic/epidemic on the mental health of HCWs. Results: Seventy-six studies were included in this review. Of these, 34 (45%) focused on SARS, 28 (37%) on COVID-19, seven (9%) on MERS, four (5%) on Ebola, two (3%) on H1N1, and one (1%) on H7N9. Most studies were cross-sectional (93%) and were conducted in a hospital setting (95%). Common mental health symptoms identified by this review were acute stress disorder, depression, anxiety, insomnia, burnout, and post-traumatic stress disorder. The associated risk factors were working in high-risk environments (frontline), being female, being a nurse, lack of adequate personal protective equipment, longer shifts, lack of knowledge of the virus, inadequate training, less years of experience in healthcare, lack of social support, and a history of quarantine. Conclusion: HCWs working in the frontline during epidemics and pandemics experience a wide range of mental health symptoms. It is imperative that adequate psychological support be provided to HCWs during and after these extraordinary distressful events.

1644. “And the stick to fight TB is IPT”: Perspectives on TPT Implementation Among Senior Nurses in Rural South Africa

BackgroundTuberculosis (TB) disproportionately affects people living with HIV (PLH). The World Health Organization (WHO) has endorsed tuberculosis preventative therapy (TPT) in resource-limited settings with high HIV and TB burdens. South Africa has led global TPT efforts, yet implementation remains sub-optimal.MethodsIn a rural, impoverished region of South Africa with high TB and HIV prevalence, primary care clinic-based senior nurses were asked to participate in anonymous, semi-structured interviews assessing TPT knowledge, beliefs, and attitudes. The currently available regimen is isoniazid preventive therapy (IPT) for 12 months. Through an iterative process, a code list was generated and applied to each transcript. The data were analyzed using thematic analysis and Nvivo 12 software to identify facilitators and barriers to IPT prescribing.ResultsAmong 22 nurses at 14 primary health clinics, 86% were female, median age 39 (IQR 31-54.8) years, with median 10.5 (IQR3-18) years of health care experience. Nurses felt that TPT was effective at preventing TB. Barriers to implementation included limited time to counsel patients due to understaffing in high-volume clinics and lack of documentation of IPT prescription in patients’ charts, which limited effective follow-up. Nurses certified in Nurse-Initiated Management of Antiretroviral Therapy (NIMART) expressed confidence in their IPT knowledge, but those not certified wanted additional training. Nurses identified patient-level factors impeding TPT implementation, including transportation, HIV-related stigma, mobility, particularly among men, and pill burden associated with length of IPT (12 months) with concurrent daily chronic medications. Facilitators included availability of IPT in both hospitals and primary care clinics, and capacity for task-shifting to other healthcare professionals (counselors, staff nurses). The impending rollout of 3HP (12 weeks of isoniazid-rifapentine) was viewed favorably.ConclusionNurses identified limited time to counsel PLH and lack of standardized training programs as the main barriers to implementation of TB preventative therapy. Addressing these barriers will be critical to successful implementation of new TPT regimens.Disclosures All Authors: No reported disclosures

International survey of COVID-19 management strategies.

BackgroundWhile individual countries have gained considerable knowledge and experience in coronavirus disease of 2019 (COVID-19) management, an international, comparative perspective is lacking, particularly regarding the measures taken by different countries to tackle the pandemic. This paper elicits the views of health system staff, tapping into their personal expertise on how the pandemic was initially handled.MethodsFrom May to July 2020, we conducted a cross-sectional, online, purpose-designed survey comprising 70 items. Email lists of contacts provided by the International Society for Quality in Health Care, the Italian Network for Safety in Health Care and the Australian Institute of Health Innovation were used to access healthcare professionals and managers across the world. We snowballed the survey to individuals and groups connected to these organizations. Key outcome measures were attitudes and information about institutional approaches taken; media communication; how acute hospitals were re-organized; primary health organization; personal protective equipment; and staffing and training.ResultsA total of 1131 survey participants from 97 countries across the World Health Organization (WHO) regions responded to the survey. Responses were from all six WHO regions; 57.9% were female and the majority had 10 or more years of experience in healthcare; almost half (46.5%) were physicians; and all other major clinical professional groups participated. As the pandemic progressed, most countries established an emergency task force, developed communication channels to citizens, organized health services to cope and put in place appropriate measures (e.g. pathways for COVID-19 patients, and testing, screening and tracing procedures). Some countries did this better than others. We found several significant differences between the WHO regions in how they are tackling the pandemic. For instance, while overall most respondents (71.4%) believed that there was an effective plan prior to the outbreak, this was only the case for 31.9% of respondents from the Pan American Health Organization compared with 90.7% of respondents from the South-East Asia Region (SEARO). Issues with swab testing (e.g. delay in communicating the swab outcome) were less frequently reported by respondents from SEARO and the Western Pacific Region compared with other regions.ConclusionThe world has progressed in its knowledge and sophistication in tackling the pandemic after early and often substantial obstacles were encountered. Most WHO regions have or are in the process of responding well, although some countries have not yet instituted widespread measures known to support mitigation, for example, effective swab testing and social control measures.

Virtual Standardized Patients vs Academic Training for Learning Motivational Interviewing Skills in the US Department of Veterans Affairs and the US Military

Despite the need for effective and scalable training in motivational interviewing (MI) that includes posttraining coaching and feedback, limited evidence exists regarding the effectiveness of using virtual (computerized) standardized patients (VSPs) in such training. To evaluate the efficacy of training with a VSP on the acquisition and maintenance of MI skills compared with traditional academic study. This study was a 2-group, parallel-training randomized trial of 120 volunteer health care professionals recruited from a Department of Veterans Affairs and Department of Defense medical facility. Motivational interviewing skill was coded by external experts blinded to training group and skill assessment time points. Data were collected from October 17, 2016, to August 12, 2019. After a computer course on MI, participants trained during two 45-minute sessions separated by 3 months. The 2 randomized training conditions included a branching storyline VSP, which provided MI skill rehearsal with immediate and summative feedback, and a control condition, which included academic study of content from the computerized MI course. Measurement of MI skill was based on recorded conversations with human standardized patients, assessed using the Motivational Interviewing Treatment Integrity 4.2.1 coding system, measured at baseline, after training, and after additional training in the randomized condition 3 months later. A total of 120 volunteers (83 [69%] women), with a mean (SD) of 13.6 (10.3) years of health care experience, participated in the study; 61 were randomized to receive the intervention, and 59 were randomized to the control group. Those assigned to VSP training had significantly greater posttraining improvement in technical global scores (0.23; 95% CI, 0.03-0.44; P = .02), relational global scores (0.57; 95% CI, 0.33-0.81; P = .001), and the reflection-to-question ratio (0.23; 95% CI, 0.15-0.31; P = .001). Differences were maintained after the 3-month additional training session, with more improvements achieved after the 3-month training for the VSP trainees on the reflection-to- question ratio (0.15; 95% CI, 0.07-0.24; P = .001). This randomized trial demonstrated a successful transfer of training from a VSP to human standardized patients. The VSP MI skill outcomes were better than those achieved with academic study and were maintained over time. Virtual standardized patients have the potential to facilitate dissemination of MI and may be useful for training in other evidence-based skills and treatments. ClinicalTrials.gov Identifier: NCT04558060.

Abstract 155: Undergraduate Student Nurse ACLS Certification to Improve Practice Transition and Confidence

Abstract Summary: Simulation research is well-established for existing teaching methods in academic settings. The study introduced an in-class simulation method focused on the transformation of a stagnant classroom into an engaging, simulation arena to improve student’s recognition of a deteriorating patient. In addition to the in-class simulation, a leveled code blue curriculum and code blue multi-patient simulation provided a foundation for students to complete an Advanced Cardiac Life Support (ACLS) certification prior to graduation from a traditional Baccalaureate of Science (BSN) nursing program. Purpose: The presentation synthesizes data on the impact of the in-class simulation experience. The specific area of interest is the ability of the nursing student to recognize and assess the deteriorating patient. It is through the swift acknowledgement of such life-threatening situations, that the development of code blue critical thinking can begin. In conjunction with simulation, a leveled code blue curriculum with the inclusion of an ACLS certification will facilitate student confidence for transition into clinical practice. Methods: An exploratory, single group design with a convenience sample of 92 BSN senior nursing students enrolled in the 3-credit, seventh semester medical-surgical, didactic nursing course. Variables: Variables included age, gender, race, exposure to code blue events in the clinical and work settings, and previous years of health care experience. Procedures: The modified 12-item survey, Code Blue Self-Confidence, assessed participant code blue confidence pre/post intervention. A demographic survey was utilized to measure correlative data with code blue skill confidence. Findings: Correlative findings revealed a significant improvement in student confidence with recognizing and intervening with the deteriorating patient to ensure swift implementation of code blue processes. Recommendations: Recommendations are for a multi-site study to replicate the validity of the in-class simulation, leveled code blue curriculum, and ACLS certification to facilitate the undergraduate nursing student’s transition into clinical practice. Practice Implications: Nurse response times greatly impact patient outcomes in critical situations. The safe zone of a simulation environment versus clinical practice creates opportunities for students to transition from novice to beginner to competent, while able to make errors and glean reflective knowledge before managing the direct care of a critically ill patient. One critical skill is the ability of a new nurse to identify and quickly respond to the needs of a deteriorating patient. Patient outcomes are improved when nurses launch proficiently from graduation into the transition of the nursing profession.

Evidence calls for practice change in intramuscular injection techniques

Background and objective: Intramuscular (IM) injections are administered to patients in all health care settings. Even though this procedure is invasive and the evidence supporting the process of administration is extensive, techniques and procedures vary throughout the literature and in practice. The purpose of this descriptive correlational study was to 1) investigate the literature on current evidence-based IM injection procedures pertaining to gender, patient weight, injection site, needle length, and technique, 2) compare surveyed healthcare personnel self-reported IM injection practices, and 3) query respondents on informational resources they access, continuing education they receive, and their years of healthcare experience and higher education.Methods: The Intramuscular Injection Questionnaire (IIQ) was sent via email to various professional healthcare facilities and their respective social media sites. Two hundred and six (206) healthcare personnel of various healthcare backgrounds and educational levels accessed the IIQ via a link to Qualtrics software. SPSS Version 24 was used for data analysis.Results: Most respondents were registered nurses with 4-15+ years of experience. Seventy-eight percent of respondents considered their IM injection knowledge at above average or expert levels. Gender was not considered an important factor when selecting an injection needle among 75% of participants. Of all respondents, 61% use z-track technique, 59% use the ventrogluteal site and 34% always bunch or stretch the skin during injection. IM injection education was not provided in 75% of healthcare facilities.Conclusions: IM injection practices vary among respondents and in the literature; some reported practices are contrary to current evidence-based practice. While the evidence provides some sound recommendations, some procedures are not well-documented or supported including in nursing texts. Nurses and other healthcare personnel must critically analyze the site, depth, needle, volume, medication, vaccine, and whether to bunch or stretch, according to evidence-based practice. Healthcare facilities should provide IM injection education routinely to ensure safe practices. Future studies (Level 1 and 2) are needed to further demonstrate the best evidence leading to safe and effective IM injections.

Epidemiological multicentre study on the education provided to patients with type 2 diabetes mellitus in the Spanish Health Care System. The Forma2 study

PurposeThe purpose of the present study was to characterize the education that patients with type 2 diabetes mellitus receive, and to identify differences as regards the presence of insulin therapy or not. MethodsThis crossover, multicentre and descriptive study involved 1066 Spanish physicians who completed a questionnaire on Internet. ResultsThe physicians that responded had a mean of 26.0 years of experience in healthcare, and mainly worked in a walk-in clinic in an urban area. Physicians rated the level of patient knowledge about their disease on a 5.0 point-scale. Fifty percent of them indicated that they spent between 15 and 30min in educating patients at the time of diagnosis. Previous control with HbA1c>9%, presence of microvascular complications, and a low socio-cultural level, were factors associated with spending more time in education. ConclusionThis is the first study designed to evaluate the education provided to patients with type 2 diabetes mellitus from Spain. The time spent and the individualization of the education are important factors associated with better long-term control of the disease, and thus with the effectiveness of the clinical management.

Abstract 117: Application Of A Delphi Method To Develop A Patient Decision Aid For Implantable Cardioverter Defibrillator Candidates

Background: Development of patient decision aids (PtDA) requires decision making about the facts, risks, and benefits to present to patients. Delphi process methodology has been employed successfully as a consensus-building tool across several disciplines. This work represents the first phase of a Canadian study that is developing a PtDA for prophylactic implantable cardioverter defibrillator (ICD) candidates. Our aim was to engage healthcare providers, ICD stakeholders, and patients in decisions about the content and format of the PtDA, using a modified Delphi process. Method: Twenty healthcare professionals, 1 stakeholder representative, and 16 people living with ICDs were invited to participate. Our Delphi approach utilized electronic and paper based response systems that included 1) anonymity, 2) iteration, 3) controlled feedback and, 4) statistical group response options. The first Delphi round comprised 39 evidence-based survey items including ICD facts, risks, benefits, and values. A review panel of decision aid experts, cardiovascular researchers, and electrophysiologists selected the content items. Participants completed the survey by rating each category item on a 5-point likert scale from “1= not important” to “5 = extremely important”. A predetermined cut-off of > 75%, wherein participants rated an item as “very important” or higher, guided the selection of items during the two Delphi rounds completed. To provide participants with statistical group responses, the second round participants received the anonymous first round item rankings prior to rating the 11 remaining items. Results: Twenty-seven participants completed round one of the Delphi (14 ICD patients). Mean (SD) age of ICD patients was 66.8 (7.1) years. The number of years of experience in healthcare reported by non-ICD respondents ranged from 2 to30 years. Of the 39 items included in round one, 14 items were retained ( > 75% agreement), 14 items were removed (<60% agreement), and 11 items proceeded to the second round (60-74% agreement). During the second Delphi round (n=27), 6 of the 11 items that did not reach agreement in round one were retained ( > 75% agreement). Examples from item categories include: 1) Risk items - i ) Lead problems over the long term, ii ) Possible complications during the surgical procedure to insert the ICD. 2) Benefit items- i ) Prevent cardiac arrest from a dangerous heart rhythm, ii ) Assurance that a dangerous heart rhythm can be corrected. 3) Fact, Value & Preferences - i ) What a standard ICD cannot do, ii ) The wish for a natural death, iii ) Driving restrictions if the ICD delivers a shock. Conclusion: The results from this Delphi survey informed the content that will be incorporated into a PtDA for new ICD candidates. The next phase will include field-testing of the PtDA. Ultimately, the goal is to support quality decision making in ICD candidates.

Reflecting on my career journey, so far

Deborah Easby is a third year student nurse at Sheffield Hallam University, now nearing the end of her studies. With 20 years of experience in healthcare behind her and two children in tow, Deborah decided to become a nurse. In this issue's column, Deborah reflects on her career journey so far, including her achievements and some of the obstacles she has had to overcome

Physician Assistants—One Less Doctor(ate) in the House

IN RECENT YEARS, NUMEROUS ALLIED HEALTH PROFESsions have adopted or are planning to adopt clinical or practice doctorates. Although some have transitioned to an entry-level doctorate (eg, pharmacy and physical therapy) and others (eg, nursing) recognize the doctorate as an advanced practice degree, the professions’ goals are the same—to replace the master’s degree with a professionspecific doctoral degree. Allied health care clinicians with these degrees now practice, or will soon practice, as “doctors” alongside their physician colleagues. These clinicians function as competent and effective members of the health care team and had done so before obtaining doctoral degrees. So why make the move to a doctorate? Those in favor argue that a doctorate improves professional image, promotes more autonomous practice, and serves as an appropriate response to advancing technologies and the increasing complexity of health care. Others argue that doctorates may confuse patients, that they represent “degree creep,” and that doctoral degrees are sought largely for professional status rather than for issues related to clinical competence and market demand. The additional tuition costs associated with doctoral degrees and the perception that doctorates are prestigious and will attract students create incentives for universities to offer the degree. The added cost, however, has the potential to adversely affect recruitment of low-income and minority students. In addition, requirements for doctoral degrees lengthen the time in school, vary from program to program, and have not been proven to enhance students’ clinical abilities. At a time when the country is working to keep up with increasing demands of health care, do the perceived benefits of a doctorate justify the additional expense, time, and delay in getting clinicians into the workforce? The physician assistant (PA) profession has said “no.” In March 2009, PA organizations conducted a PA Clinical Doctorate Summit that involved clinically practicing PAs, PA educators, students, army PAs, representatives of other allied health professions, workforce experts, and allopathic and osteopathic physicians. Summit recommendations, which also reflect the views of a majority of surveyed PAs, express opposition to an entry-level PA clinical doctorate and officially endorse the master’s degree as the entrylevel and terminal degree for the profession. The recommendations include support for PAs who choose to pursue postgraduate training beyond the master’s degree but limit this support to non–PA-specific doctoral degrees. Discussions during the PA Clinical Doctorate Summit revolved around a number of issues, including the effects a PA doctorate could have on the profession’s relationship with physicians (eg, would physicians perceive a doctorate as a move toward independent practice?), the additional cost for students, and the potential for the degree to diminish the profession’s diversity. Final justifications for concluding that a PA-specific doctorate is unnecessary were “the length and cost of the current educational model has resulted in a responsive accessible PA workforce . . . and has adapted over 40 years to provide high quality, cost-effective, patientcentered care,” and that “both physicians and PAs practice in the domain of medicine therefore the entry-level doctorate for the practice of medicine is the MD or DO.” Despite the final recommendations, significant pressure for PAs to transition to a doctoral degree persists, especially as other clinicians work to expand their prestige and scope of practice. Some leaders in the PA profession have suggested that the decision not to endorse a clinical doctorate “ . . . may be tantamount to committing professional suicide.” They argue that physicians’ and the public’s perception that nonphysician clinicians with doctoral degrees are better educated, favors nurse practitioners, and will cause PAs to become marginalized, weakening the profession’s status within the health care community. Physicians practicing today may be unaware that physicians established the PA model of education in the 1960s to train individuals with prior health care experience to rapidly meet the needs of medically underserved areas. Currently, most applicants accepted to PA school have a bachelor’s degree, including required coursework in the basic and behavioral sciences, and 3 years of health care experience. PA education, which is modeled on medical education, averages 27 months in length and typically includes a didactic year of instruction in the sciences and clinical medi-

Admission Variables as Predictors of PANCE Scores in Physician Assistant Programs: A Comparison Study Across Universities

The purpose of this study was to create a model of cognitive and noncognitive measures that could estimate the probability of achieving a given level of performance on the Physician Assistant National Certifying Examination (PANCE). A retrospective records review of admissions information used by six universities was conducted to discover which factor had the most impact on the dependent variable of the PANCE score. Multiple predictors were measured: undergraduate grade point average (uGPA), graduate GPA, prerequisite grades, Graduate Record Exam (GRE)-verbal, GRE-quantitative, GRE combined, interview scores, years of health care experience, age, gender, and first-year scores on the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT). While PACKRAT scores are not applicable to admission selection, they are a strong midpoint predictor of PANCE performance. Multiple regression analysis was used to develop prediction equations. Expectancy tables were developed to provide estimation of PANCE performance, given the various score ranges on each of the predictor variables. Four predictors made a significant contribution to the final regression equation: GPA, GRE-verbal, GRE-quantitative, and PACKRAT scores. The PACKRAT scores were consistently the best predictors of performance on the PANCE. Each of these four predictors can be plugged into predictability tables to estimate the probability of achieving various score intervals on the PANCE. A model of equations and predictors can be used to project how successful a physician assistant (PA) graduate will be on PANCE performance. Years of health care experience, grades on prerequisites, and demographics were not significant predictors across programs but did have significance in certain individual institutions. Future research should examine which specific noncognitive traits measured in interviews can add value to predictability.

Evidence of hepatitis C virus–specific interferon gamma–positive T cells in health care workers in an infectious disease department

Few studies are available on possible hepatitis C virus (HCV)-specific T-cell immune response in health care workers (HCWs) involved in the care of patients with HCV infection. We aimed to investigate whether a HCV-specific interferon (IFN)-gamma T-cell response, known to be involved in infection resolution, was present in those HCWs involved in the management of patients with persistent HCV infection. Our study involved 30 subjects, classified as group A (20 consecutive patients, 16 males and 4 females, with histologically proven chronic hepatitis), or group B (10 HCWs, 7 males and 3 females, with at least 7 years of health care experience and HCV-RNA and anti-HCV negative). As a control group, we used 10 blood samples from healthy donors at a blood donor center (group C). HCV-RNA was measured by real-time polymerase chain reaction. Blood samples (at least 35 mL) were collected from all group A and group B subjects in our hospital. Specific IFN-gamma was stimulated with HCV pool peptides (core, 2 microg/mL), with influenza Mp peptides used as a positive control. Levels of HCV-specific IFN-gamma-positive cells were higher in the HCWs (group B) compared with the infected patients (group A) and healthy blood donors (group C) (Mann-Whitney U test, P < .001). A clinically silent persistent exposure to HCV, through some as-yet undetermined mechanism, may induce a virus-specific IFN-gamma-producing CD8(+) T-cell response in healthy aviremic HCWs. This finding suggests that possible unapparent parenteral routes may stimulate host defenses with no evidence of hepatitis.

Prevalence of Psychiatric Disorders Among Toronto Hospital Workers One to Two Years After the SARS Outbreak

This study aimed to determine the incidence of psychiatric disorders among health care workers in Toronto in the one- to two-year period after the 2003 outbreak of severe acute respiratory syndrome (SARS) and to test predicted risk factors. New-onset episodes of psychiatric disorders were assessed among 139 health care workers by using the Structured Clinical Interview for DSM-IV and the Clinician-Administered PTSD Scale. Past history of psychiatric illness, years of health care experience, and the perception of adequate training and support were tested as predictors of the incidence of new-onset episodes of psychiatric disorders after the SARS outbreak. The lifetime prevalence of any depressive, anxiety, or substance use diagnosis was 30%. Only one health care worker who identified the SARS experience as a traumatic event was diagnosed as having PTSD. New episodes of psychiatric disorders occurred among seven health care workers (5%). New episodes of psychiatric disorders were directly associated with a history of having a psychiatric disorder before the SARS outbreak (p=.02) and inversely associated with years of health care experience (p=.03) and the perceived adequacy of training and support (p=.03). Incidence of new episodes of psychiatric disorders after the SARS outbreak were similar to or lower than community incidence rates, which may indicate the resilience of health care workers who continued to work in hospitals one to two years after the SARS outbreak. In preparation for future events, such as pandemic influenza, training and support may bolster the resilience of health care workers who are at higher risk by virtue of their psychiatric history and fewer years of health care experience.

A SARS postcard--reflections of two healthcare leaders.

Summarizing our reflections on the past eight weeks is a daunting task. The opportunity to provide leadership for a hospital that has met the challenge of caring for clients with SARS (severe acute respiratory syndrome) has been unique. It has given us new understanding of system-wide and organizational processes, crisis management, our staff, the true meaning of organizational culture and teamwork and our own capacity to sustain leadership in the face of uncertainty. The SARS outbreak unleashed an unprecedented demand for leadership, courage and resilience among healthcare providers. The discovery of a new, highly contagious illness, with an almost 20% mortality rate, thrust the Ontario healthcare system into an emergency unparallelled in recent times. Although our experience and that of other healthcare administrators is likely quite different from that of the frontline staff, it is rich with lessons learned that can be applied in the future. Indeed, our own personal involvement included home quarantine when one of our colleagues had been diagnosed as a suspected SARS case. It is difficult to explain the impact of these events to others who have not been as closely involved with the Toronto SARS crisis. When we shared our observation that this would change healthcare forever, we were often asked why. Between us, we have about 54 years of healthcare experience, yet neither of us has ever before witnessed such an enduring test of leadership. Creating an air of calm, competence, trust, transparency and confidence was probably the single most important element of managing this event. We have shared the stress and emotional upset of conveying messages that we knew would raise great anxiety. There is no more difficult task than to share the news that members of your own staff have been A SARS Postcard – Reflections of Two Healthcare Leaders