Clinicians' experiences of caring for people brought in by police to the emergency department: A qualitative interpretive study

AIM

To explore nurses' and doctors' experiences of providing care to people brought in by police (BIBP) to the emergency department (ED).

DESIGN

A qualitative interpretive study using in-depth individual interviews.

METHODS

Semi-structured interviews were conducted with nurses and doctors who worked in various EDs in one Australian state and were involved in the care of people BIBP. Interviews were undertaken between May and October 2022 and focused on the structures (i.e., what), processes (i.e., how) and outcomes of care for people BIBP. Data were analysed using deductive and then inductive content analysis.

RESULTS

Nine nurses and eight doctors were interviewed. Structures described by participants included human structures (staff) and organizational structures (areas for assessment, involuntary assessment orders, investigations, chemical/physical restraints). For processes, participants described practices including risk/mental health assessments, legal considerations, and increased/decreased levels of care compared to other presentations. Communication processes were largely between police and health care staff. Service outcomes pertained to discharge location (custody, community, hospital admission) and length of stay.

CONCLUSION

The current care delivery for people BIBP to the ED is unique and complex, often occurring in high traffic, resource-intensive areas. There is a need to strengthen structures and processes, to improve service outcomes.

IMPLICATIONS FOR THE PROFESSION

Understanding the care requirements for people brought into ED by police enables the delivery of targeted care alongside appropriate resource allocation.

IMPACT

This study provides a comprehensive understanding of the health care requirements for people BIBP to EDs. Interventions delivered in the ED to support health care delivery for people BIBP and foster clinician and police relationships are required to optimize patient and health service outcomes.

REPORTING METHOD

This study adheres to the COREQ checklist (Table S1) of the EQUATOR guidelines.

PATIENT OR PUBLIC CONTRIBUTION

This study focused on ED staff experiences.

Embracing ChatGPT for Medical Education: Exploring Its Impact on Doctors and Medical Students

ChatGPT (OpenAI), a cutting-edge natural language processing model, holds immense promise for revolutionizing medical education. With its remarkable performance in language-related tasks, ChatGPT offers personalized and efficient learning experiences for medical students and doctors. Through training, it enhances clinical reasoning and decision-making skills, leading to improved case analysis and diagnosis. The model facilitates simulated dialogues, intelligent tutoring, and automated question-answering, enabling the practical application of medical knowledge. However, integrating ChatGPT into medical education raises ethical and legal concerns. Safeguarding patient data and adhering to data protection regulations are critical. Transparent communication with students, physicians, and patients is essential to ensure their understanding of the technology's purpose and implications, as well as the potential risks and benefits. Maintaining a balance between personalized learning and face-to-face interactions is crucial to avoid hindering critical thinking and communication skills. Despite challenges, ChatGPT offers transformative opportunities. Integrating it with problem-based learning, team-based learning, and case-based learning methodologies can further enhance medical education. With proper regulation and supervision, ChatGPT can contribute to a well-rounded learning environment, nurturing skilled and knowledgeable medical professionals ready to tackle health care challenges. By emphasizing ethical considerations and human-centric approaches, ChatGPT's potential can be fully harnessed in medical education, benefiting both students and patients alike.

Experiences of Australian emergency doctors and nurses using advance care directives in the provision of care at the end of life

OBJECTIVE

An advance care directive is a legal document outlining the wishes made by a person about treatment options. However, there is increasing evidence that an advance care directive that has previously been documented may not always benefit the current prognosis of the patient. Therefore, the aim of the present study was to explore the experiences of Australian emergency doctors and nurses concerning the use of previously documented advance care directives at the point of care for patients and their families.

METHODS

A qualitative study guided by a phenomenological interpretive approach was employed. Semi-structured interviews were conducted with ED doctors and nurses across Australia. Data were thematically analysed using a seven-stage data analysis framework.

RESULTS

An analysis of the interview data resulted in four major themes: (i) Benefits of Advance Care Directives; (ii) Knowledge and Awareness; (iii) Communication; and (iv) Availability of Advance Care Directive Information.

CONCLUSIONS

From the findings, advance care directives were believed to be beneficial in decision making when patients, families, and ED staff agreed with the decisions made. Advance care directives were often made a long time ago but were useful to start conversations around goals of care and end-of-life care relevant to the patient's current situation. Findings in the present study further reinforced that an advance care directive was beneficial when used alongside goals of care at the point of care in EDs.

A latent profile analysis of doctors' joy in work at public hospitals

Introduction

When doctors' work stress increases, their joy in work decreases, severely affecting the quality of care and threatening patient safety. Analysis of the latent categories of joy in work of doctors in public hospitals and the differences in the characteristics of each category can help uncover hidden messages that enhance doctors' joy in work.

Methods

Questionnaires were administered to 426 doctors working in public hospitals using the general information questionnaire and the public hospital doctor's joy in work evaluation scale. Upon identifying their potential categories using latent profile analysis, chi-square test, and multinomial logistic regression were performed to analyze the differences in the characteristics of each category.

Results

The 426 public hospital doctors could be divided into three potential categories: "low joy in work" (11.27%), "medium joy in work" (59.86%), and "high joy in work" (28.87%). Most of the doctors did not have much joy in work, with 71.13% of them having "low to medium joy in work." Doctors who work in secondary or tertiary hospitals, have a personnel agency or contract, and are older than 45 years are more likely to belong to the "low joy in work" category. Some of the protective factors are having an average monthly income (RMB) of 10,001-15,000 yuan and having a fair or good self-rated health status.

Conclusion

There are obvious classification characteristics of doctors' level of joy in work. Hospital managers can take commensurate actions to improve their joy in work, thereby improving patient safety and the quality of medical services.

Education and learning: potential methodological and ethical issues in systematic reviews containing a meta-analysis: some critical reading suggestions for junior doctors

Junior doctors make clinical decisions regularly; therefore, they need to adequately interpret the evidence supporting these decisions. Patients can be harmed if clinical treatments are supported by biased or unreliable evidence. Systematic reviews that contain meta-analyses of randomized controlled trials are a relatively low-biased type of evidence to support clinical interventions. Therefore, it is reasonable to think that doctors will likely select this type of study to answer clinical questions. In this article, doctors are informed about potential methodological and ethical issues in systematic reviews that contain a meta-analysis that are sometimes not easily identified or even overlooked by the current tools developed to assess their methodological quality or risk of bias. The article presents a discussion of topics related to data extraction, accuracy in reporting, reproducibility, heterogeneity, quality assessment of primary studies included in the systematic review, sponsorship, and conflict of interest. It is expected that the information reported will be useful for junior doctors when they are reading and interpreting evidence from systematic reviews containing meta-analyses of therapeutic interventions, mainly those doctors unfamiliar with methodological principles.

Knowledge and Attitude Towards the Elderly Among Doctors and Medical Students: A Questionnaire-Based Study

INTRODUCTION

 There is a continuous rise in the total number and percentage of elders globally, and as such, they are expected to utilize healthcare services more often. Therefore, this study aimed to determine doctors' and students' current knowledge and attitudes toward elders and compare those findings with other studies worldwide. The specific objectives of this study were to determine and compare the differences in attitudes between medical students and doctors regarding geriatrics. This comparison will focus on the following four key domains: social values, resource distribution, compassion, and medical care. Another objective was to assess the knowledge of medical students and doctors regarding geriatric topics. This assessment will help determine the necessity for interventions such as educational programs and workshops on geriatrics.

METHODS

This cross-sectional questionnaire-based study was conducted by disseminating a Google Forms survey to medical students and doctors. The survey included the University of California, Los Angeles (UCLA) Geriatrics Attitudes Scale and the UCLA Geriatrics Knowledge Test. Data was analyzed using SPSS version 29.0.2.0 (Armonk, NY: IBM Corp.).

RESULTS

 A total number of 126 medical students and 72 doctors filled out the survey. Both medical students and doctors demonstrated moderate scores on the attitudes scale, with overall average scores of 2.92 out of 5 and 2.93 out of 5, respectively. As for knowledge, medical students achieved an average score of 41%, while doctors attained an average score of 43%.

CONCLUSION

 This study provides significant insights regarding the knowledge and attitudes of students and doctors and attitudes towards geriatrics. The moderate attitudes score and poor knowledge score across both groups indicate the need for medical educators in Oman to further emphasize and teach about geriatrics in medical curricula.

Clinicians' Attitudes Toward Electronic Health Records in Saudi Arabia

AIM

 This study explored physicians' and nurses' attitudes toward an electronic health record (EHR) system and examined the features and factors that clinicians associated with the implementation of EHR systems.

METHODS

 A self-administered anonymous questionnaire with high reliability and validity was adopted from existing research to gather clinicians' attitudes toward the EHR system implemented at King Khalid University Hospital, one of the biggest hospitals in Riyadh, Saudi Arabia.

RESULTS

 A total of 438 questionnaire responses were received from the participants; 240 of them were physicians and 198 were nurses. The participants had a mean age of 43.7 years (standard deviation (SD) 17.1), 213 (52.7%) were female and 207 (47.3%) were male. Most participants (424, 96.8%) had one or more years of experience using computers, and a majority (304, 69.4%) had one or more years of experience using EHR systems. Most physicians and nurses (214, 89.5% vs. 174, 87.9%) were satisfied with their hospital's EHR system and felt that the system was highly usable and had the potential to improve communication between staff, facilitate easy storage of and access to information and lead to improved health outcomes for patients. The study found positive attitudes among clinicians concerning the quality of training and education around the new system (178, 74.2% of physicians vs. 142, 71.7% of nurses; p > 0.05) and toward leadership during the transition to HER (222, 92.5% vs. 183, 92.4%). On the other hand, a majority of nurses reported that the EHR system took longer to use and increased their workload compared with the previous analogue system (115 (47.9%) vs. 133 (67.2%); p ≤ 0.01 and 46.7% vs. 112 (64.1%)). A large majority of physicians and nurses surveyed (214 (89.2%) vs. 167 (84.3%)) stated that clinicians should be consulted in the design of such systems as a way to maximise the potential benefits of EHR and mitigate extra workload demands.

CONCLUSION

 Most clinicians expressed overall satisfaction with the EHR system, but there were some areas of dissatisfaction among the respondents, such as increasing workload and stress among nurses. There is scope for further research to continue to explore physicians' and nurses' attitudes toward EHRs and for future experimental studies that examine the impact of EHRs on clinician workloads, patient health outcomes and quality of care.

Measuring e-Professional Behavior of Doctors of Medicine and Dental Medicine on Social Networking Sites: Indexes Construction With Formative Indicators

BACKGROUND

Previous studies have predominantly measured e-professionalism through perceptions or attitudes, yet there exists no validated measure specifically targeting the actual behaviors of health care professionals (HCPs) in this realm. This study addresses this gap by constructing a normative framework, drawing from 3 primary sources to define e-professional behavior across 6 domains. Four domains pertain to the dangers of social networking sites (SNSs), encompassing confidentiality, privacy, patient interaction, and equitable resource allocation. Meanwhile, 2 domains focus on the opportunities of SNSs, namely, the proactive dissemination of public health information and maintaining scientific integrity.

OBJECTIVE

This study aims to develop and validate 2 new measures assessing the e-professional behavior of doctors of medicine (MDs) and doctors of dental medicine (DMDs), focusing on both the dangers and opportunities associated with SNSs.

METHODS

The study used a purposive sample of MDs and DMDs in Croatia who were users of at least one SNS. Data collection took place in 2021 through an online survey. Validation of both indexes used a formative approach, which involved a 5-step methodology: content specification, indicators definition with instructions for item coding and index construction, indicators collinearity check using the variance inflation factor (VIF), external validity test using multiple indicators multiple causes (MIMIC) model, and external validity test by checking the relationships of the indexes with the scale of attitude toward SNSs using Pearson correlation coefficients.

RESULTS

A total of 753 responses were included in the analysis. The first e-professionalism index, assessing the dangers associated with SNSs, comprises 14 items. During the indicators collinearity check, all indicators displayed acceptable VIF values below 2.5. The MIMIC model showed good fit (χ213=9.4, P=.742; χ2/df=0.723; root-mean-square error of approximation<.001; goodness-of-fit index=0.998; comparative fit index=1.000). The external validity of the index is supported by a statistically significant negative correlation with the scale measuring attitudes toward SNSs (r=-0.225, P<.001). Following the removal of 1 item, the second e-professionalism index, focusing on the opportunities associated with SNSs, comprises 5 items. During the indicators collinearity check, all indicators exhibited acceptable VIF values below 2.5. Additionally, the MIMIC model demonstrated a good fit (χ24=2.5, P=.718; χ2/df=0.637; root-mean-square error of approximation<0.001; goodness-of-fit index=0.999; comparative fit index=1.000). The external validity of the index is supported by a statistically significant positive correlation with the scale of attitude toward SNSs (r=0.338; P<.001).

CONCLUSIONS

Following the validation process, the instrument designed for gauging the e-professional behavior of MDs and DMDs consists of 19 items, which contribute to the formation of 2 distinct indexes: the e-professionalism index, focusing on the dangers associated with SNSs, comprising 14 items, and the e-professionalism index, highlighting the opportunities offered by SNSs, consisting of 5 items. These indexes serve as valid measures of the e-professional behavior of MDs and DMDs, with the potential for further refinement to encompass emerging forms of unprofessional behavior that may arise over time.

Americans do not select their doctors based on race

To what extent do Americans racially discriminate against doctors? While a large literature shows that racial biases pervade the American healthcare system, there has been no systematic examination of these biases in terms of who patients select for medical treatment. We examine this question in the context of the ongoing global COVID-19 pandemic, where a wealth of qualitative evidence suggests that discrimination against some historically marginalized communities, particularly Asians, has increased throughout the United States. Conducting a well-powered conjoint experiment with a national sample of 1,498 Americans, we find that respondents do not, on average, discriminate against Asian or doctors from other systematically minoritized groups. We also find no consistent evidence of treatment effect heterogeneity; Americans of all types appear not to care about the racial identity of their doctor, at least in our study. This finding has important implications for the potential limits of American prejudice.

Patients, Doctors, and Chatbots

Medical advice is key to the relationship between doctor and patient. The question I will address is "how may chatbots affect the interaction between patients and doctors in regards to medical advice?" I describe what lies ahead when using chatbots and identify questions galore for the daily work of doctors. I conclude with a gloomy outlook, expectations for the urgently needed ethical discourse, and a hope in relation to humans and machines.

The psychological impact of COVID-19 on frontline doctors in Tshwane public hospitals

BACKGROUND

 The coronavirus disease 2019 (COVID-19) pandemic placed immense pressure on frontline doctors. Burnout is a psychological syndrome that develops in response to chronic work stress. It consists of emotional exhaustion (EE), depersonalisation (DP) and reduced personal accomplishment (PA). Burnout is associated with personal dysfunction and compromises the work profession and patient safety. International studies suggest burnout is exacerbated during a pandemic.

METHODS

 We conducted a descriptive cross-sectional observational study. Respondents included frontline doctors working in emergency medicine, family medicine and internal medicine during COVID-19 in Tshwane public hospitals. The survey included two validated questionnaires, the Maslach Burnout Inventory and the Depression, Anxiety, Stress Scale-21. The aim was to determine the prevalence and severity of burnout, psychological and somatic symptoms in frontline doctors.

RESULTS

 Of the 163 participants, we found clinical burnout to be present in 58.9% (n = 96) and extreme burnout in 19.6% (n = 32). Moderate to extremely severe levels of stress, anxiety and depression were present in 55.1% (n = 90), 43.6% (n = 71) and 22.1% (n = 36) of participants, respectively. We found significant correlations between burnout and psychological symptoms. Increased levels of burnout, anxiety, depression and stress were found to be meaningfully associated with adverse somatic symptoms.

CONCLUSION

 Our study demonstrated an insufferably high prevalence of burnout and psychosomatic symptoms in frontline doctors during COVID-19. In the event of future pandemics, more measures should be taken to support frontline doctors.Contribution: Pandemic-associated burnout and its psychophysical consequences have not been studied in frontline doctors in South Africa.

Exploring the Information Sources Consulted by Doctors at the Point of Care in Four Selected South African Referral Hospitals

BACKGROUND

To provide an understanding of the clinical information sources consulted by teaching or referral hospital-based doctors in four South African provinces.

METHODS

A quantitative cross-sectional survey design was used. To identify provinces, hospitals, and participants, simple random sampling was adopted. This study targeted a total of 276 doctors from all the four hospitals working across different departments within the hospitals. This study was conducted in four selected South African public referral/teaching hospitals in four different provinces, namely Nelson Mandela Academic Hospital in the Eastern Cape province; Witbank Hospital in Mpumalanga province; Robert Mangaliso Sobukwe Hospital in Northern Cape province and lastly, Pietersburg Hospital in Limpopo province.

RESULTS

Overall, 221 doctors were surveyed. Doctors relied more on colleagues as formal and informal sources of information. They seldomly relied on newspapers, reference, and library books, or used hospital computers to access the internet. They seldomly attended training workshops organised by the district or provincial office. Protocols and clinical guidelines which are kept in the hospitals and easily accessible were often (27.9%) or always (51.1%) used.

CONCLUSIONS

Teaching hospitals need to strengthen information resources to ensure that even when colleagues are used as an information source, they are an accessible means to validate the correctness of the information provided.

"You treat what you have to treat, and you don't care as much if they understand or if they feel good about it": Communication barriers and perceptions of moral distress among doctors in emergency departments

Doctors facing communication barriers when assessing patients in emergency departments (ED) is a frequent phenomenon, as the global prevalence of dementia and migration have increased. This study aims to explore how communication barriers influence moral distress as perceived by medical doctors working at emergency departments. Twelve doctors at 2 different EDs in Stockholm, Sweden, participated. Answers on communication barriers were collected from an interview guide on moral distress. Informants' responses were analyzed using qualitative thematic analysis. The results suggest that doctors experience moral distress when assessing patients with communication barriers due to an inability to mediate calm and safety and understand their patients, and due an increased need of resources and difficulties in obtaining consent before conducting examinations or interventions. In conclusion, communication barriers can be a cause of moral distress, which should be considered when developing tools and methods to mitigate and manage moral distress.

Knowledge, Attitude and Practice of Biomedical Waste Management Among Doctors and Nurses During the COVID-19 Pandemic in Puducherry: A Cross-Sectional Study

Background Biomedical waste (BMW) management is an important practice that has to be followed by all healthcare workers (HCW) in health centres. COVID-19 had become a global threat, and the spread of the infection had increased drastically. Healthcare workers were already involved in managing COVID-19 patients. It is essential to have adequate knowledge, attitude and good practices among healthcare workers during the COVID-19 period. Hence, the present study was conducted to assess the knowledge, attitude and practices of COVID-19 biomedical waste management among doctors and nurses working in a private tertiary care centre in Puducherry. Methods A cross-sectional study was conducted to assess the knowledge, attitude and practice of BMW management among doctors and nurses who were working during the COVID-19 period. A total of 384 samples were recruited, and the study was conducted for a period of four months. Data were collected from a pre-validated, pre-tested questionnaire that assessed the knowledge, attitude and practices of biomedical waste management. Further analysis was done using Microsoft (MS) Excel (Microsoft® Corp., Redmond, WA) and the Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). Results Among the 384 participants, 152 (39.6%) had excellent knowledge, 143 (37.2%) had good knowledge and 89 (23.2%) had poor knowledge. Among the 111 doctors, 55 (49.5%) had excellent knowledge, and 36 (32.4%) had good knowledge. Among the 273 nurses, 107 (39.2%) had good knowledge and 97 (35.5%) had excellent knowledge. Of the study participants, 98.2% had a favourable attitude, and 89.6% had favourable practices towards biomedical waste management. Occupation and training received on BMW management were found to be predictors of knowledge regarding biomedical waste management. Conclusion From the present study, it is found that the knowledge of biomedical waste management needs to be improved among doctors and nurses, especially in situations such as the COVID-19 pandemic. In this study, a positive correlation was found between knowledge score and practice score, which states that increasing knowledge regarding biomedical waste management will improve practice towards biomedical waste management. Also, doctors and nurses who had already received training in biomedical waste management were found to have better knowledge than those who had not. Hence, the college administration should do various health education activities and training sessions to enhance biomedical waste management among doctors and nurses working in the hospital.

The Impact of the COVID-19 Pandemic on Educational and Academic Activities of Healthcare Professionals in Bahrain

INTRODUCTION

Since its emergence, the COVID-19 pandemic has had a radical effect on different aspects of health worldwide. The burden created by the COVID-19 pandemic on healthcare systems has also involved educational and academic activities among healthcare professionals.

OBJECTIVES

This study aimed to explore the effect of the COVID-19 pandemic on the participation of doctors and nurses in educational and academic activities in Bahrain.

METHODS

A cross-sectional survey was conducted through an online questionnaire that was distributed among 204 healthcare providers (HCPs) in the Kingdom of Bahrain.

RESULTS

Out of 204 HCPs, 110 (53.9%) were doctors and 94 (46.1%) were nurses. A total of 154 responses were received (100 (64%) doctors and 54 (35.1%) nurses) with an overall response rate of 75.5%. Seventy-four (74%) doctors and 32 (59.2%) nurses stated that their overall academic activities had decreased since the start of the pandemic, yet this was not statistically significant (P=0.059). Unlike nurses, doctors attended more webinars 54 (54%) and online courses 47 (47%), compared to the time before the pandemic (P=0.022, P=0.014, respectively).

CONCLUSION

The COVID-19 pandemic had a negative impact on educational and academic activities among healthcare workers. However, it created an opportunity to expand the use of electronic and online methods in those activities.

Bridge to Better Care: Investigating Transient Ischemic Attack (TIA) Management Expertise Among Primary Healthcare Providers in Al-Ahsa, Saudi Arabia

Introduction Transient ischemic attacks (TIAs) are brief episodes of neurological impairment caused by reduced blood flow to the brain, spinal cord, or retina, typically lasting under an hour. Recent advances in neuroimaging suggest that some TIAs may actually be small strokes with resolved symptoms. This study focuses on assessing the knowledge and management of TIAs among primary care physicians and nurses in Al-Ahsa, Saudi Arabia. Methodology This is a cross-sectional study, conducted in Al-Ahsa, Saudi Arabia, during the period July to August 2023. Data were collected using an electronic questionnaire and was analyzed using IBM SPSS Statistics for Windows, version 27.0.1 (released 2020, IBM Corp., Armonk, New York, United States). Results Among the participants, 64.0% correctly identified TIA as an ischemic neurological deficit. However, only 20.2% provided correct responses for all TIA symptoms. Regarding diagnostic tests, 47.4% acknowledged the need for neuroimaging immediately after TIA, while 17.5% recognized the importance of ultrasonography of the supra-aortic trunks. In terms of TIA management, 38.6% preferred referral to the emergency service, and 41.2% correctly perceived the risk of TIA recurrence as similar to that of established cerebral ischemic stroke. Significant disparities were observed in the recognition of TIA symptoms, with physicians outperforming nurses, particularly in identifying motor deficits (82.4% vs. 65.2%) and speech alterations (86.8% vs. 76.1%, p = 0.004). However, nurses exhibited better knowledge in recognizing the need for a neuroimaging test (48.5% vs. 45.7%, p = 0.849) and the urgency of conducting a transcranial Doppler (TCD) (19.1% vs. 23.9%, p = 0.641). Conclusion A considerable proportion of healthcare providers demonstrate a good understanding of TIA definition and management. However, the lack of significant predictors for good knowledge and attitude suggests the need for more comprehensive strategies to enhance TIA management expertise across healthcare professionals.

How Much Do We Know about Oral Cancer?-An Online Survey

INTRODUCTION

Oral cancer (OC) is a disease with a high mortality rate due to its late recognition. Since the oral cavity is easily accessible for visual inspection, enabling early diagnosis, the education of healthcare workers about preventive oral examinations is critical. This research aimed to assess the level of participants' OC knowledge, as well as to raise awareness about this diagnosis.

MATERIALS AND METHODS

The research was conducted as an online survey among students of dental medicine, students of medicine, doctors of dental medicine and doctors of medicine. The questionnaire was designed solely for the purpose of this study and consisted of 29 questions. The first part of the questionnaire consisted of general questions about the participants, whereas the questions in the second part addressed their knowledge and attitudes towards OC.

RESULTS

The surveyed population comprised of 140 dental students, 105 medical students, 159 doctors of dental medicine and 100 medical doctors. The level of knowledge about OC among the participants is not yet satisfactory. The group of dental medicine students scored highest, while medical doctors showed the weakest knowledge.

CONCLUSION

Additional education about OC for doctors of dental medicine and medical doctors is needed. This step will improve prevention and increase chances for early detection.

Knowledge, Attitudes, and Willingness of Healthcare Workers in Iraq's Kurdistan Region to Vaccinate against Human Monkeypox: A Nationwide Cross-Sectional Study

Although human monkeypox infections had not been recorded in the Kurdistan region of Iraq as of August 2023, the rapid growth of cases worldwide and the detection of monkeypox in neighboring Middle Eastern nations call for careful planning and timely response measures. Educating and empowering frontline healthcare workers (HCWs) so that they can act to curb the spread of monkeypox infections are core elements of primary prevention and protecting public health. Therefore, this study aimed to assess HCWs' knowledge and attitudes about monkeypox and their willingness to vaccinate against monkeypox. By employing a convenience sampling method, an online survey was disseminated via Google Forms between 1 November 2022 and 15 January 2023. The researchers utilized regression analyses to ascertain the factors associated with the three parameters: knowledge, attitude, and the willingness to vaccinate. A total of 637 HCWs were included in the analysis (ages ranged between 21 and 51 years). The mean overall scores were 8.18 of a max score of 16 (SD 3.37), 3.4 of 5 (SD 1.37), and 2.41 of 5 (SD 1.25) for knowledge, attitude, and willingness to vaccinate, respectively. A multivariate logistic regression analysis demonstrated that HCWs who had heard about monkeypox before 2022 rather than later had a higher level of knowledge (AOR: 4.85; 95% CI: 2.81-8.36; p < 0.001). In addition, those who had newly joined the workforce or had less than 1 year experience in practice had more positive attitudes about curbing monkeypox (AOR: 0.35; 95% CI: 0.20-0.59; p < 0.01) than those who practiced for longer. No significant predictors of willingness to vaccinate against monkeypox were identified. The research revealed that HCWs exhibited a relatively low level of monkeypox knowledge. They also had poor attitudes towards monkeypox vaccination and were therefore reluctant to receive the vaccines. Imparting knowledge about the infectious disease can cultivate better awareness and attitudes among HCWs as to their roles in mitigating the spread of an epidemic in the foreseeable future.

Knowledge and perceptions of physicians and veterinarians about One Health in Türkiye

Background

One Health is a multisectoral and interdisciplinary concept that acknowledges the interconnections between people, animals and their shared environments. Understanding the views of physicians and veterinarians may help promote One Health principles.

Aim

To assess the knowledge and perceptions of physicians and veterinarians about One Health in Türkiye.

Methods

This was a descriptive mixed-methods study among 74 doctors and 221 veterinarians in Türkiye. Quantitative data were collected through a questionnaire sent by email to members of the Ankara Chambers of Medicine and the Ankara Chambers of Veterinary Medicine. Qualitative data were obtained through focus group discussions with boards of directors of both chambers. Recordings were transcribed and the data were categorized in line with the questionnaire. The data were analyzed using SPSS version 23.0.

Results

Few (6.3%) of the veterinarians had not heard about One Health while majority of the physicians (63.5%) had not heard about it (P < 0.001). Most of the physicians (95.9%) and veterinarians (71.5%) had not received training on One Health; significantly more veterinarians had received training (P < 0.001). Most of the veterinarians (73.3%) and a few physicians (35.1%) had applied One Health in their work (P < 0.001). Although participants mentioned other disciplines related to One Health, they had not been involved in any cooperative or collaborative work relating to these disciplines.

Conclusion

The application of One Health principles by the physicians and veterinarians was limited, and few of them had collaborated with other disciplines during their practice. Joint training and further professional and educational integration are needed in Türkiye to support the implementation of One Health.

Exodus of Lebanese doctors in times of crisis: a qualitative study

Introduction

Since 2019, Lebanon is experiencing an unprecedented exodus of doctors, seriously threatening the national health system, which is expected to continue without quick and effective solutions. Therefore, this study aimed to understand the factors that push Lebanese doctors to migrate and the factors that retain others in the country. Additionally, this study aims to propose solutions to preserve an adequate supply of medical care amidst the crisis.

Methods

Qualitative semi-structured interviews and focus group discussions were conducted using pre-developed guides. Purposive and snowball sampling was adopted to recruit physicians who emigrated and physicians staying in Lebanon. Transcripts of interviews and focus groups were coded using Dedoose software and analyzed through a combination of inductive and deductive approaches.

Results

Emigration was found to be the result of numerous interconnected factors. The main drivers for emigration were declining income, career problems, reduced quality of care, unhealthy work environment, and the deteriorated political and socio-economic contexts leading to instability and insecurity. As for the retention factors, they included affective attachment and sense of belonging to the professional environment and the country, followed by recognition and valorization at work. Several recommendations were developed to maintain quality of care delivery, including reforms of the health system, development of focused human resource retention strategies based on resource mapping evidence, negotiations with recruiting institutions to endorse the code ethics ending unethical practices draining countries' human resources, provision of financial incentives to doctors, and the recognition and valorization of physicians. Other rapid interventions were suggested, such as short-term medical missions to mitigate shortages in certain specialties, telemedicine, adaptation of recruitment processes to compensate for resources shortages in certain specialties, and adoption of task-shifting approaches to alleviate the workload on overburdened specialists.

Discussion

The findings of this study shed the light on the different factors influencing migration while framing them in the Lebanese context. These findings and recommendations should inform stakeholders and policy makers about the interventions needed to restore the quality of care. The feasibility and sustainability of most formulated recommendations depend on several factors, with political and socio-economic security and stability being the most crucial ones.

Past the Pandemic: a virtual intervention supporting the well-being of healthcare workers through the COVID-19 pandemic

To decrease burnout and improve mental health and resiliency among doctors, nurses, and hospital staff during the COVID-19 pandemic, the University of Colorado partnered with ECHO Colorado to offer the state's healthcare workforce an interactive, psychoeducational, and online intervention that encouraged connection and support. The series utilized the Stress Continuum Model as its underlying conceptual framework. Between July 2020 and February 2022, 495 healthcare workers in Colorado participated in the series across eight cohorts. One-way repeated measures ANOVAs were performed to test for differences in pretest and posttest scores on series' objectives. Healthcare workers showed significant improvement from pretest to posttest in (1) knowing when and how to obtain mental health resources, F(1, 111) = 46.497, p < 0.001, (2) recognizing of the importance of being socially connected in managing COVID-related stress, F(1, 123) = 111.159, p < 0.001, (3) managing worries, F(1, 123) = 94.941, p < 0.001, (4) feeling prepared to manage stressors related to the pandemic, F(1, 111) = 100.275, p < 0.001, (5) feeling capable in dealing with challenges that occur daily, F(1, 111) = 87.928, p < 0.001, and (6) understanding the Stress Continuum Model F(1, 123) = 271.049, p < 0.001. This virtual series showed efficacy in improving the well-being of healthcare workers during a pandemic and could serve as a model for mental health support for healthcare workers in other emergency response scenarios.

'It breaks my heart': Healthcare practitioners' caring for families with epidermolysis bullosa

Background

Epidermolysis bullosa (EB) is a painful genodermatosis presenting with skin fragility and blisters. There is no cure; the prognosis is guarded and depends on the subtype of the disease. Managing these patients can be emotionally challenging for healthcare practitioners.

Aim

To determine the perceptions, impact, and needs of healthcare practitioners (HCP) caring for patients and their families with EB.

Setting

Nelson Mandela School of Medicine, Durban and Grey's Hospital, Pietermaritzburg, KwaZulu-Natal.

Methods

The study was guided by interpretative phenomenological analysis. Individual in-depth interviews were conducted with 10 healthcare practitioners. Guba's trustworthiness framework was used to ensure rigour.

Results

Six global themes were identified, each related primarily to the perceptions, impact, and needs of healthcare practitioners. The experiences and perceptions of healthcare practitioners were that caring for patients with an incurable disease such as EB could negatively impact healthcare practitioners. There were divergent views among the disciplines of HCPs regarding the extent of care in a resource-limited environment. This resulted in negative emotions, ethical concerns, and a need for continued medical education and the application of coping strategies. Healthcare practitioners observed that patients and their families were vulnerable, requiring comprehensive biopsychosocial care.

Conclusion

Healthcare practitioners should be aware of their emotional challenges, seek support where necessary, and use effective coping strategies and self-care.

Contribution

The concerns and needs of healthcare practitioners are highlighted and interventional strategies to assist healthcare practitioners are suggested which will ultimately improve patient care.

Burnout in emergency department staff: The prevalence and barriers to intervention

Background

Burnout impacts patient care and staff well-being. Emergency department (ED) staff are at an elevated risk for burnout. Despite an acceleration in burnout research due to the coronavirus disease 2019 (COVID-19) pandemic, there is limited data on the nature and prevalence of burnout in the South African emergency medicine setting.

Aim

This study determined the prevalence of burnout in ED staff (doctors, nurses and non-clinical staff) at Tygerberg Hospital and explored staff awareness and utilisation of interventions.

Setting

The study was conducted at Tygerberg Hospital, South Africa.

Methods

This cross-sectional study used the Maslach Burnout Inventory to assess burnout via a self-administered electronic survey in a convenience sample of 109 ED staff. Quantitative data were analysed with descriptive and inferential statistics. Qualitative data were analysed using thematic analysis.

Results

A total of 46 participants (45.10%) experienced burnout, with 73 participants (71.57%) at high risk for emotional exhaustion or depersonalisation. The prevalence of burnout in doctors was 57.89%, non-clinical staff was 25.93%, and nursing staff was 50.00%. Burnout was higher in doctors and nursing staff compared to non-clinical staff, with high emotional exhaustion and depersonalisation found in interns and specialist professional nurses. The level of intervention awareness was 41.8% and the level of intervention utilisation was 8.82%. Thematic analysis identified awareness, accessibility and reactive utilisation as barriers to utilisation with opportunities to reduce burnout and enhance resilience.

Conclusion

Coordinated health system and organisational efforts are required to optimise intervention strategies to reduce burnout.

Contribution

Guidance on the design and planning of intervention strategies considering at risk groups, intervention-related factors, and non-clinical staff.

Knowledge of pharmacovigilance among healthcare professionals and the impact of an educational intervention

Aim

To determine the knowledge regarding various aspects of pharmacovigilance among doctors and nurses of a tertiary care teaching hospital and to evaluate the effect of an educational intervention.

Methods

A cross-sectional study was conducted among doctors and nurses of a tertiary care teaching hospital. The participants attended a one-hour educational session during which the concept of pharmacovigilance, the Pharmacovigilance Program of India, the need for reporting ADRs, and the method of reporting were explained by a subject expert. A 20-item questionnaire was used to assess their knowledge regarding pharmacovigilance before and after an educational session. The pre-post comparisons were done using Wilcoxon's signed-rank test. A p-value less than 0.05 was considered statistically significant.

Results

Forty-two doctors and 115 nurses participated in the study. A significant improvement in the participant scores was seen following the educational intervention in both doctors (Z = -5.344, p < 0.001) and nurses (Z = -8.808, p < 0.001). Lack of knowledge/awareness was perceived as the major barrier for ADR reporting among nurses as well as doctors.

Conclusion

There is need for education and training among doctors and nurses to enhance their knowledge about drug safety and reporting practices. Educational intervention is likely to improve the knowledge regarding pharmacovigilance, and thereby enhance reporting by healthcare professionals.

Anger: an underappreciated destructive force in healthcare

Anger is an emotional state that occurs when unexpected things happen to or around oneself and is "an emotional state that varies in intensity from mild irritation to intense fury and rage." It is defined as "a strong feeling of displeasure and usually of antagonism," an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. "Why is everyone so angry?" the New York Times asked in the article "The Year We Lost It." We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca's writings about anger and implement his wisdom on anger from over 2000 years ago.

Children, Sexual Abuse and the Emotions of the Community Health Practitioner in England and Wales, 1970-2000

A survivor of child sexual abuse felt that doctors missed opportunities to notice her distress when, at fourteen, she had an unexplained illness that lasted for a year. The cause, she wrote, was "explained by Doctors as psychological, but nobody questioned further. WHY??? … If adults don't listen[,] then we have no one to turn to." For decades, community health practitioners have been identified as an important group in protecting children from maltreatment, but survivor testimony and agency statistics demonstrate that they rarely receive verbal disclosures or recognize the physical or behavioural warning signs of sexual abuse. The accounts we have of the 1980s tell of swiftly heightening professional awareness, followed by a visceral backlash in the latter part of the decade that discouraged practitioners from acting on their concerns. This article uses trade and professional journals, training materials, textbooks, and new oral histories to consider why community-based doctors and nurses have struggled to notice and respond to the sexually abused child. It will argue that the conceptual model of child sexual abuse that community health practitioners encountered in the workplace encouraged a mechanical and procedural response to suspicions of abuse. In a highly gendered and contested workplace, practitioners' feelings about how survivors, non-abusing family members, and perpetrators should be understood were rarely debated in training or in practice. The emotional cost to the practitioners of engagement with sexual abuse, and their need for spaces of reflexivity and structures of support, were ignored.

Advice-seeking and advice-giving in Arabic computer-mediated communication in the medical context

The current study aims to examine the discourse patterns and strategies of advice-seeking and advice-giving through Arabic computer-mediated communication (CMC) in the medical context. The contribution of this study lies in examining and analyzing the discourse patterns of CMC between patients and doctors in Arabic, how these patterns help doctors understand the advice sought and inquiries made by their patients, and how they help patients understand the comments made by their doctors on their inquiries. The data consist of 300 messages categorized into 150 advice-seeking (postings) and 150 advice-response (replies) messages. They were manually collected from a public medical website by copying and pasting them into an Excel spreadsheet for coding and statistical analyses. Two models were used to analyze the speech acts of advice. Morrow's model was used for advice-seeking, while Hinkel's taxonomy was used for advice responses, after some modifications were made to both models. The findings revealed that advice-seeking and advice-response messages had three parts: opening, middle, and closing. The study revealed that both patients and doctors used the opening and closing parts occasionally, unlike the middle part, which was used more often. For advice-seeking, describing the medical problem was the most frequent strategy used by patients when they asked for advice, followed by yes/no questions. These types of strategies were used in advice-seeking more frequently than others. Additionally, it was found that asking yes/no questions and describing the medical problem was the most frequent compound strategy used by patients seeking advice. However, for advice responses, the results revealed that giving clarification/information was the most frequent strategy used by doctors, followed by direct advice. When compared with other types, these two types were used frequently in the advice responses. The results also demonstrated that giving clarification/information and direct advice was the most frequent compound strategy used by doctors in advice responses.

Medical ethics and compliance amongst physician groups: a self-assessed survey in a hospital in Southeast Nigeria

Background

Being a doctor remains a moral enterprise as he is expected to make some medical decisions based on ethical principles during encounter with patients.

Objective

The objective of this study was to investigate the knowledge and application of medical ethical principles amongst physician groups in a Hospital in Enugu, Nigeria.

Methods

This was a cross-sectional self-assessed study conducted amongst medical doctors in five specialty groups in a teaching hospital in Enugu, Nigeria.Descriptive and inferential statistics were used to summarize the items and determine whether significant differences on knowledge and application of medical ethics existed amongst the physician groups in the treatment of patients.

Findings

Observance and compliance with medical ethical conduct was highest among doctors that were aged 55 years and above. In sex, male doctors had higher ethical conduct compliance than female doctors. Comparing the doctors by rank, medical officers, consultants and senior registrars respectively had the highest ethical conduct.

Conclusions

Knowledge and practice of medical ethics were mostly deficient among younger Nigerian and female doctors. Remedying the situation will require better curricula both at the undergraduate and post-graduate medical school programmes for doctor trainees. Requiring certification in bioethics for license renewal will also help in resolving and improving the knowledge gap.

Psychiatrists and homicidal threats: a cross-sectional study

OBJECTIVES

To investigate the frequency, characteristics and impact of death threats by patients towards psychiatrists.

METHODS

A cross-sectional survey of psychiatrists (n = 60) was undertaken to investigate the frequency, characteristics and impact of death threats by patients in one Irish healthcare region serving a mixed urban-rural population of 470,000.

RESULTS

Forty-nine responses (82%) were received. Thirty-one per cent of respondents experienced death threats by patients during their careers. Victims were more likely to be male and in a consultant role. Patients making the threats were more likely to be males aged 30-60 with a history of violence and diagnosis of personality disorder and/or substance misuse. A majority of threats occurred in outpatient settings and identified a specific method of killing, usually by stabbing. Prosecution of the perpetrator was uncommon. Of the victimised psychiatrists, 53% reported that such threats affected their personal lives, and 67% believed their professional lives were impacted. In half of the incidents, there were adverse incidents subsequent to the threats, involving either the patient or the clinician.

CONCLUSIONS

Death threats by patients have significant psychological and professional impacts on psychiatrists. Early liaison with employers and police and transferring the care of the patient to another clinician may be useful measures.

Assessing the Well-Being at Work of Nurses and Doctors in Hospitals: Protocol for a Scoping Review of Monitoring Instruments

BACKGROUND

Well-being at work can be defined as "creating an environment to promote a state of contentment which allows an employee to flourish and achieve their full potential for the benefit of themselves and their organisation." In the health care context, well-being at work of nurses and doctors is important for good patient care. Moreover, it is strongly associated with individual- and organization-level consequences. Relevant literature presents models and concepts of physical, mental, and social well-being. This study uses the 6 elements of the job demands-resources (JD-R) model to interpret well-being at work (job demands, job resources, personal resources, leadership, well-being, and outcomes) as part of a Netherlands Federation of University Medical Hospitals program to find ways to improve and monitor health care professionals' well-being in Dutch hospitals. Many instruments exist to measure well-being at work in terms of population, setting, and other aspects. An overview of available and eligible instruments assessing and monitoring the well-being of nurses and doctors is currently missing.

OBJECTIVE

We will perform a scoping review aiming to provide an overview of validated instruments assessing and monitoring the well-being of nurses and doctors at work.

METHODS

We will perform a search of published literature in the following databases: Medline, Embase, and CINAHL. Studies will be eligible if they (1) assess well-being at work of nurses and doctors employed in hospitals; (2) describe an evaluation of an instrument or review an instrument; (3) measure well-being at work or aspects of well-being at work according to the elements of the JD-R model, and (4) were published in English from 2011 onwards. Title/abstract screening according to the eligibility criteria will be followed by full-text screening. Data extraction of included studies will be conducted by 3 reviewers independently. Reviewers will use standardized data extraction forms that include study characteristics, sample characteristics, measurement instrument details, and psychometric properties. The analysis will be descriptive. When synthesizing the data, a distinction will be made between comprehensive instruments and common instruments.

RESULTS

This scoping review identifies instruments that have been developed and validated for monitoring the well-being of nurses and doctors at work. Studies were searched between September and December 2021 and screened between December 2021 and May 2022. A total of 739 studies were included.

CONCLUSIONS

Timely screening of well-being at work may be beneficial for individual health care workers, the organization, and patients. There is often a substantial gap and mismatch between employer perceptions of well-being and well-being interventions. It is important to develop and implement suitable interventions adapted to the needs of nurses and doctors and their health or other problems. Well-being screening should be timely to gain insight into these needs and problems. Moreover, to determine the effectiveness of well-being interventions, measurement is mandatory. The results will be critical for organizations to select a monitoring instrument that best fits the needs of employees and organizations.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/43692.

Attitude of Romanian Medical Students and Doctors toward Business Ethics: Analyzing the Influence of Sex, Age, and Ethics Education

This study investigated the attitude of Romanian medical students and doctors toward business ethics by measuring the preference for a particular ethical philosophy, namely, the preference for Machiavellianism, moral objectivism, social Darwinism, ethical relativism, and legalism. At the same time, this study aimed to explore the influence of sex, age, and ethics education on the attitude toward business ethics. The data collection was performed using a voluntary self-administered online survey including the Attitudes Toward Business Ethics Questionnaire (ATBEQ) instrument. Our findings show that the values based on which Romanian medical students and doctors make business decisions belong predominantly to the moral objectivism philosophy, which is grounded on rational actions based on a set of objective moral standards.

Satisfaction Levels in Doctors About Workplace Environment During the COVID-19 Pandemic: Experiences from Tertiary Hospitals in Dhaka, Bangladesh

BACKGROUND

The satisfaction level of doctors regarding the workplace environment signifies both the psychological and physical environment. One of the many challenges to conquer was the adaptation to a steadily changing working environment and the development of a proper working environment during the COVID-19 pandemic.

OBJECTIVES

The objective of this study was to evaluate the level of satisfaction of doctors regarding the workplace environment.  Methods: A cross-sectional study was conducted from January to December 2020. A total of 217 conveniently selected doctors working at selected tertiary hospitals in Dhaka city were interviewed using a pretested, structured questionnaire. The Minnesota Satisfaction Questionnaire (MSQ) was used to assess the level of job satisfaction on a 5-point Likert scale consisting of 20 items. The percentile score was used to categorize the respondents as highly satisfied (75 and above), averagely satisfied (26 to 74), and dissatisfied (below 25). Bivariate and multivariate analyses were performed.  Result: Among the 217 respondents, the total mean MSQ score was 3.62±0.23 regarding job satisfaction. About two-thirds of the respondents (63.1%) reported an average level of satisfaction. More than two-thirds of respondents (69.6%) expressed high satisfaction regarding the physical work environment, while the majority of respondents (93.1%) expressed high satisfaction with the psychosocial work environment. However, no significant association was found between outcome and input variables (p>0.05).  Conclusion: The study findings showed that satisfaction regarding the psychological environment was higher among the respondents than that of physical working conditions. Evidence-based measures are to be addressed in hospitals to achieve the optimum level of satisfaction among doctors during pandemics.

A Doctor in the House, An Ethical Consideration on Treating Their Family Members: A Mixed-Method Study

BACKGROUND

 The ethical dilemma of doctors treating their own family members has long been a contentious issue in the field of medicine. Despite these dilemmas, doctors may feel compelled to become involved in the care of family members and reluctant to set standards for themselves. Therefore, this study aimed to assess the experience of doctors in the treatment of their families in Perambalur District, Tamil Nadu, India.

METHODOLOGY

 A mixed-method study was conducted among the doctors in Perambalur District, Tamil Nadu, India from December 2021 to October 2022. A semi-structured questionnaire was used to assess the socio-demographic details and the experience of doctors in treating their family members, followed by a focused group discussion (FGD). Data were analyzed using SPSS version 16 (SPSS Inc., Chicago). A scatter plot was created to visualize the relationship between age, experience of doctors, and confidence level with the frequency of treating family members. A chi-square test was performed to find any associations, and a p-value <0.05 was considered significant. For qualitative data, a fish herringbone model was constructed.

RESULTS

 A total of 72 doctors participated in the study. The study found that almost all the doctors (100%) received medical requests from family members, the median number of requests received in a year was 6.5 with an interquartile range of 4-8 and three-quarters (66.6%) of them accepted the requests and treated them. However, concerns about maintaining objectivity, emotional attachment, and loss of confidentiality were cited as primary reasons for not accepting all requests. The study also found a positive relationship between age, years of experience, and the frequency of treating family members. The FGD highlighted challenges related to potential risks in managing complex cases, emotional involvement impacting decision-making, conflicts of interest, and pressures from family members and societal norms.

CONCLUSION

 In the present study, almost all the doctors received requests from their family members in the last year, and more than three-fourths of the doctors treated their family members. One-fourth of the doctors rejected requests from family members due to concerns about the potential loss of objectivity and the risk of misdiagnosing symptoms caused by emotional attachments. This study sheds light on the complexities and ethical considerations doctors face when treating family members. It emphasizes the need for medical ethics education in the curriculum to guide future doctors in making ethical decisions in such situations. Implementing clear-cut medical ethics guidelines in India would be instrumental in addressing these issues and ensuring ethical practices in the medical field.

[Social networks as a space of communication on health issues]

Social media is bringing a new dimension to healthcare as it offers an environment through which the public, patients, and healthcare professionals can report health issues with the possibility of potentially improving health outcomes. Social networks are a powerful tool that ensures cooperation between users and is a mechanism of social interaction for a wide range of people. Although the use of social networks for communication in the field of health has a number of advantages, the exchange of information must be monitored for quality and reliability, as well as to preserve the confidentiality of users.

[Changes of payment of physicians between 1998 and 2021 in Hungary]

INTRODUCTION

The development of the medical career model is a priority issue from the point of view of safe patient care.

OBJECTIVE

In our research, we aimed to examine the average monthly income of doctors employed in Hungary between 1998 and 2021, especially with regard to the significant increase in medical payment in 2021.

DATA AND METHODS

Data were derived from the database of the National Directorate General for Hospitals. Doctors employed full-time in all public health institutions were included in our time-series analysis. In our institutional-level analysis, we considered all employed doctors of all public hospitals. Each healthcare institution was grouped according to the type of institution.

RESULTS

The payment of full-time doctors in Hungary increased by 16.1 times between 1998 and 2021. In 2020, the payment of hospital doctors at the national level was 767 505 Ft (2186 €), while in 2021, as a result of the increase in medical income, it was 1 415 481 Ft (3948 €) (+84%). In 2021, this was 1 435 972 Ft (4005 €) in national institutes, 1 204 258 Ft (3359 €) in clinical centers, 1 397 181 Ft (3897 €) in capital hospitals, 1 520 821 Ft (4242 €) in county hospitals and 1 688 726 Ft (4710 €) in city hospitals. The difference between the highest and the lowest payment was 1.90 times in national institutes, 1.26 times in clinical centers, 1.93 times in capital hospitals, 1.47 times in county hospitals and 1.75 in city hospitals.

CONCLUSION

In 2021, as a result of the increase in medical incomes, the average incomes increased significantly. We observed significant differences between the types of institutions. Orv Hetil. 2023; 164(29): 1146-1154.

The experiences of autistic doctors: a cross-sectional study

Introduction

Medicine may select for autistic characteristics. As awareness and diagnosis of autism are growing, more medical students and doctors may be discovering they are autistic. No studies have explored the experiences of autistic doctors. This study aimed to fill that gap.

Methods

This is a cross-sectional study. A participatory approach was used to identify the need for the project and to modify a pre-existing survey for use exploring the experiences of autistic doctors.

Results

We received 225 responses. 64% had a formal diagnosis of autism. The mean age of receiving a formal diagnosis was 36 (range 3-61). Most were currently working as doctors (82%). The most common specialties were general practice / family medicine (31%), psychiatry (18%), and anesthesia (11%). Almost half of those working had completed specialty training (46%) and 40% were current trainees. 29% had not disclosed being autistic to anyone at work. 46% had requested adjustments in the workplace but of these, only half had them implemented.Three quarters had considered suicide (77%), one quarter had attempted suicide (24%) and half had engaged in self-harm (49%). 80% reported having worked with another doctor they suspected was autistic, but only 22% reported having worked with another doctor they knew was autistic. Having never worked with a potentially autistic colleague was associated with having considered suicide.Most preferred to be called "autistic doctors" (64%). Most considered autism to be a difference (83%). Considering autism to be a disorder was associated with preference for the term "doctors with autism," and with having attempted suicide.

Conclusion

Autistic doctors reported many challenges in the workplace. This may have contributed to a culture of nondisclosure. Mental health was poor with high rates of suicidal ideation, self-harm, and prior suicide attempts. Despite inhospitable environments, most were persevering and working successfully. Viewing autism as a disorder was associated with prior suicide attempts and a preference for person-first language. A neurodiversity-affirmative approach to autism may lead to a more positive self-identity and improved mental health. Furthermore, providing adequate supports and improving awareness of autistic medical professionals may promote inclusion in the medical workforce.

Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave)

Introduction

The COVID-19 pandemic has led to significant challenges for frontline healthcare workers' (FHW), raising many mental health and wellbeing concerns for this cohort. To facilitate identification of risk and protective factors to inform treatment and interventions, this study investigated key predictors of psychological distress and subjective wellbeing in FHWs.

Methods

During the Omicron wave of the COVID-19 pandemic (January 2022), Victorian (Australia) doctors, nurses, allied health and non-medical staff from Emergency Departments, Intensive Care units, Aged Care, Hospital In The Home, and COVID Wards completed a cross-sectional survey consisting of the Kessler 6 item (Psychological Distress), Personal Wellbeing Index (Subjective Wellbeing), Coronavirus Health Impact Survey tool (COVID-19 related factors) and occupational factors. Multivariable linear regressions were used to evaluate unadjusted and adjusted associations. Relative weight analysis was used to compare and identify key predictors.

Results

Out of 167 participants, 18.1% screened positive for a probable mental illness and a further 15.3% screened positive for low wellbeing. Key risk factors for greater psychological distress included COVID infection worries, relationship stress and younger age. For both psychological distress and lower wellbeing, health status and supervisor support were key protective factors, while infection risks were key risk factors. Only positive changes in relationship quality was protective of lower wellbeing.

Conclusion

This study highlights the significance of social determinants and individual level factors alongside work related factors, in influencing FHWs' mental health and wellbeing during public health crises, such as the COVID-19 pandemic. Findings suggest that future interventions and supports should take a more holistic approach that considers work, social and individual level factors when supporting FHWs' mental health and wellbeing.

Unveiling the Prevalence and Factors of Workplace Bullying in Primary Healthcare Settings: A Cross-Sectional Study in Jeddah City, Saudi Arabia

Introduction Bullying in workplaces can lead to serious and deleterious effects on both the health and well-being of individuals. In a healthcare environment, bullying can lead to life-threatening adverse outcomes for patients and healthcare workers. The aim of this study was to evaluate the prevalence and factors of bullying among primary healthcare workers in Jeddah, Saudi Arabia. Methods This cross-sectional study targeted physicians and nurses in Jeddah healthcare centers and used a Negative Acts Questionnaire-Revised (NAQ-R) to evaluate participants' exposure to bullying. The chi-square test was used to examine the relationship between the outcome and other variables. Results The majority of participants (59.8%) had more than 10 years of experience and were nurses (56.6%). The majority of participants (69.4%) scored below 33 on the NAQ-R scale, while 19.9% scored between 33 and 45, and 10.7% scored over 45. Most perpetrators were references/patients (22.4%), supervisors (19.2%), department managers, or general managers (19.2%). Of all participants, 28.8% had experienced workplace bullying (WPB), and 31.7% witnessed it over the past five years. Being subjected to WPB (P < 0.001), being bullied by a manager (P < 0.001), and experiencing and witnessing WPB over the past five years (P < 0.001) correlated with higher NAQ-R scores. Years of experience were significantly associated with NAQ-R scores (P = 0.016). Conclusions This study indicates bullying among a third of healthcare workers, mainly perpetrated by patients and managers. Years of experience and manager offenses, experiencing and witnessing WPB were associated with higher bullying rates. Therefore, there is an urgent need for antibullying policies, awareness campaigns, education programs, effective communication, conflict resolution, leadership training, and transparent culture to address this problem.

The assessment and validation of the depression, anxiety, and stress scale (DASS-21) among frontline doctors in Pakistan during fifth wave of COVID-19

Objective

The study aims to document sociodemographic features, address the symptoms and levels of depression, anxiety, and stress among frontline doctors in Pakistan, and validate the depression, anxiety, stress scale (DASS-21) on the context of Pakistan.

Method

A cross-sectional survey was conducted throughout the regions of Pakistan on frontline doctors to document their sociodemographic patterns and the levels of depression, anxiety, and stress while dealing with the fifth wave (Omicron-variant) of the coronavirus (SARS-CoV-2) pandemic in Pakistan (December 2021-April 2022). Respondents (N = 319) were recruited through a snowball sampling process.

Results

Though previous literature reported declines in psychological symptoms after earlier waves of COVID-19, these DASS-21 findings show that as the pandemic has worn on, frontline doctors in Pakistan are having considerable personal symptoms of depression (72.7%), anxiety (70.2%), and stress (58.3%). Though specifically related to the COVID-19 pandemic, they rated only moderate levels of depression and stress, however they reported severe levels of anxiety. The results also revealed a positive correlation between depression and anxiety (r = 0.696, p < 0.001), depression and stress (r = 0.761, p < 0.001), and anxiety and stress (r = 0.720, p < 0.001).

Conclusion

Through the application of all required statistical procedures, DASS-21 is validated in the cultural context of Pakistan among this group of frontline doctors. The findings of this study can provide new directions for the policy makers (government and hospitals' administration) of Pakistan to focus on the mental wellbeing of the doctors under similar enduring public health crises and to protect them from short- or long-term disorders.

A systematic review of mental health interventions to reduce self-stigma in medical students and doctors

Background

A growing body of literature has revealed that many medical students and doctors do not seek professional help for their mental health due to fear of stigma (both public- and self-stigma) and questioning of their clinical competency. The aim of this systematic review was to identify and evaluate direct and indirect interventions that address mental health stigma in medical students and/or doctors. We focused explicitly on studies that measured the impact on self-stigma outcomes.

Method

A systematic search of the following electronic databases was undertaken from inception to 13 July 2022: PubMed, Embase, PsycINFO, and CINAHL, together with manual searching of reference lists. Screening of titles, abstracts, and full texts of eligible studies, plus quality appraisal using the Mixed Methods Appraisal Tool, were independently conducted by multiple reviewers with disagreements resolved via discussion.

Results

From 4,018 citations, five publications met the inclusion criteria. None of the studies explicitly aimed to reduce self-stigmatisation, with the majority focusing on medical students. Most of the identified interventions focused on reducing professional stigma (i.e., stigma toward patients with mental illness) and measurement of self-stigma was incidentally collected via a subscale of the general stigma measure selected. Three studies found significant reductions in self-stigma following the delivered intervention. These studies were of moderate quality, had medical student samples, employed combined education and contact interventions, and used the same outcome measure.

Discussion

Intentional development and evaluation of interventions specifically designed to decrease self-stigma among doctors and medical students are needed, with further research required on the optimal components, format, length, and delivery of such interventions. Researchers delivering public/professional stigma reduction interventions should strongly consider measuring the impact of such interventions on self-stigma outcomes, using fit-for-purpose, psychometrically sound instruments.

Comparative analysis among doctors working in private and government hospitals in identifying and prioritizing essential stress factors during COVID-19- an AHP-TOPSIS approach

The spread of COVID-19 across the world, triggered multiple stresses among doctors working tirelessly round the clock to attend sick patients. Doctors had to cope with new environment thereby developing anxiety and fear. The current paper identifies and explores the stress intensity developed among doctors with the aid of multi-criteria decision analysis in doctors working in private and government hospitals of India during COVID-19. After identification of numerous stresses through questionnaire, weights are assigned to common most stress factors by employing AHP method. Furthermore, comparative analysis and prioritization of stress factors is performed with the aid of TOPSIS. The current combined system is a quantitative analysis furnished to establish the feasibility of the methods in weighing and MCDM in stress assessment. This study identifies and predicts the foremost stress factor which needs to be addressed by hospital management to keep doctors with a stable and fresh mindset. This research further establishes a proper MCDM technique which need to be applied in all hospital to regulate and distribute doctors work load without overloading them. Psychological stress is the foremost type of stress reported by multiple doctors. Results showed that lack of balance among personal and professional life followed by lack of communication is highly related problem in doctors in such adverse events.

Drug information-seeking behaviours of physicians, nurses and pharmacists: A systematic literature review

BACKGROUND

Medication use typically involves physicians prescribing, pharmacists reviewing, and nurses administering medications to patients. Drug information (DI) is often required during the process, with the various health care professionals (HCPs) seeking information differently according to their needs and familiarity with various resources.

OBJECTIVE

This systematic literature review aims to evaluate studies on drug information-seeking behaviour (ISB) of physicians, nurses and pharmacists to ascertain their DI needs, DI sources used, facilitators and barriers to DI-seeking.

METHODS

A systematic search was conducted on PubMed, Embase.com, Scopus, PsycINFO, CINAHL and Cochrane Library to identify eligible primary research articles published between January 2000 and May 2020.

RESULTS

The reviewed studies (N = 48) revealed that HCPs have a wide range of DI needs, with the top needs being similar across the three HCPs. Information sources used most often by all three groups were tertiary, followed by human and primary sources. Factors relating to the source characteristics were the most reported facilitators and barriers to DI-seeking. Some differences in drug ISB were also identified.

CONCLUSION

Our findings can also guide information providers and educators to optimize information provision. It may also facilitate effective communication amongst HCPs when obtaining DI from or providing DI to one another.

The Prevalence of Violence Against Resident Doctors and Its Subsequent Effects on Patient Management in a Tertiary Care Hospital in Delhi, India

Introduction Workplace violence (WPV) is a significant problem for healthcare professionals across the world, regardless of whether they work in developed or developing countries. Studies have shown that in India, up to 75% of doctors have experienced some form of violence in the workplace. The purpose of the present study was to examine the extent of violence against doctors and its impact on patient management. Methodology This cross-sectional study was conducted in a tertiary care hospital in New Delhi in June 2022. A total of 326 resident doctors from six departments were selected using stratified random sampling. Data were collected using a semi-structured interview schedule and a pre-validated questionnaire. Statistical analysis was done using Stata 17, and ethical clearance was obtained from the Institute Ethical Committee. Result Workplace violence was prevalent among healthcare professionals, with 80.4% (95% confidence interval (CI): 75.6%-84.5%) experiencing verbal abuse and 21.7% (95% CI: 17.4%-84.5%) experiencing physical violence. Perceived delays in treatment and patient deaths were the most common causes of violence. Most participants were hesitant to report WPV due to time-consuming reporting processes and a lack of organisational support. WPV had a negative impact on doctors' mental and personal well-being, with 73.3% reporting its negative impact. WPV has led to a decrease in the provision of surgical and medical interventions. Conclusion The study findings suggest that a significant proportion of doctors in a tertiary care hospital in Delhi encounter some form of workplace violence. Despite the high incidence of WPV, reporting of these events remains low due to inadequate support and deficient reporting procedures within healthcare organisations. The negative impact of WPV is not limited to the physicians' psycho-social well-being but extends to their approach to patient care as well. Therefore, taking appropriate actions to prevent WPV is crucial for ensuring the safety and well-being of healthcare professionals and improving patient outcomes.

Mentalizing, Resilience, and Mental Health Status among Healthcare Workers during the COVID-19 Pandemic: A Cross-Sectional Study

The COVID-19 pandemic has caused unprecedented stress on healthcare professionals worldwide. Since resilience and mentalizing capacity play very important preventive roles when it comes to mental health, the main goal of this study was to determine whether the capacity for mentalizing and resilience could explain the levels of depression, anxiety, and stress among healthcare workers during the COVID-19 pandemic. The study was conducted in Serbia on a sample of 406 healthcare workers (141 doctors and 265 nurses) aged 19 to 65 (M = 40.11, SD = 9.41). The participants' mental health status was evaluated using the Depression, Anxiety, and Stress Scale-DASS-42. The Reflective Functioning Questionnaire was used to evaluate the capacity for mentalizing. Resilience was assessed using the Brief Resilience Scale. The results of the correlation analysis showed that there were negative correlations between resilience and all three dimensions of mental health status: depression, anxiety, and stress. Hypermentalizing was negatively correlated with depression, anxiety, and stress, while hypomentalizing was positively correlated. Hierarchical linear regression analysis showed that both resilience and hypermentalizing were significant negative predictors of depression, anxiety, and stress, and that hypomentalizing was a significant positive predictor of depression, anxiety, and stress. Furthermore, socioeconomic status was a significant negative predictor of depression, anxiety, and stress. Marital status, number of children, and work environment were not statistically significant predictors of any of the three dimensions of mental health status among the healthcare workers in this study. There is an urgent need to establish and implement strategies to foster resilience and enhance the capacity for mentalizing among healthcare workers in order to minimize the devastating effects of the COVID-19 pandemic on mental health.

The comparative mental health of Australian doctors before and during COVID-19: A population-based approach

OBJECTIVE

Occupational surveys of doctors consistently show higher rates of depression and anxiety than reported in general population surveys, findings replicated in all other occupational groups, suggesting potential selection bias. We evaluated the comparative mental health of different occupations in Australia from the same sampling frame over the past 6 years and assessed whether COVID-19 differentially affected different occupational groups.

METHODS

We analysed six annual data waves (2015-2020) from the nationally representative 'Household, Income, and Labour Dynamics in Australia' study. Mental health (Mental Health Inventory-5 from the 36-Item Short Form Survey) and life satisfaction scores of doctors over this period were compared with five other professions and all other employees. Regression models were adjusted for age, gender, income and work hours. Two-way analysis of variance examined the comparative changes in mental health among occupations between 2019 and after exposure to the COVID-19 pandemic in late 2020.

RESULTS

The sample of 15,174 employed respondents included 106 doctors. The 5-year mean mental health score for doctors (M = 78.7; SD = 13.1) was significantly higher than that for teachers (M = 75.6; SD = 14.9), nurses and midwives (M = 76.6; SD = 15.9), lawyers (M = 74.2; SD = 16.1), accountants (M = 74.2; SD = 16.5) and all other employed respondents (M = 73.1, SD = 16.7) (p < 0.001). Cognitive wellbeing comparisons were similar. There were no significant changes in professionals' mental health over this period except for an improvement in engineers and a decline for teachers. From 2019 to 2020, all occupations suffered mental health declines without any significant inter-occupational differences.

CONCLUSION

Australian doctors identified from a population-based sample rather than occupational surveys reported better levels of mental health and greater life satisfaction than most professions prior to COVID-19 without experiencing the worsening seen in the general employed population over the past 5 years. From 2020, there was a mental health decline in all of the employed population, not disproportionately affecting doctors. Although over-representing Australian trained general practitioners, the results from both this sample and other tentative findings challenge the discourse in medical advocacy, but need more formal comparative studies to confirm.

Should a patient's socioeconomic status count in decisions about treatment in medical care? A longitudinal study of Norwegian doctors

AIMS

The major causes of social inequalities in health are found outside of healthcare. However, healthcare can also play a role in maintaining, reducing, or reinforcing inequality. We present and discuss results from a panel study of doctors' views on whether and how socioeconomic factors should play a role in clinical decision making.

METHODS

The panel comprised a representative sample of Norwegian doctors, established in 1994. For the current study, the doctors received postal questionnaires in 2008, 2012 and 2016. Data were analysed using descriptive statistics, correlation analysis, factor analysis and mixed models for repeated measurements.

RESULTS

The sample sizes were 1072 (65%), 1279 (71%) and 1605 (73%), respectively. The doctors were increasingly positive towards considering socioeconomic factors, and reported giving more time and advice and asking for less pay to compensate for unfavorable socioeconomic factors. General practitioners were more likely to consider socioeconomic factors and changed their practice accordingly compared to other clinicians. The percentage of doctors who agreed that different amounts of resources should be used to obtain similar health effects was high and increased over time.

CONCLUSIONS

Increasingly more doctors are willing to consider patients' socioeconomic factors in clinical care. This could be contrary to professional ethics, in which only medical need should count. However, it depends on how 'need' is interpreted. As treatment outcomes partly depend on non-medical factors, socioeconomic factors should be considered because they influence patients' ability to benefit from medical care. Equality requires mitigating factors with negative impacts on health outcomes.

Burnout, mental health, physical symptoms, and coping behaviors in healthcare workers in Belize amidst COVID-19 pandemic: A nationwide cross-sectional study

BACKGROUND

Healthcare workers are vulnerable to burnout, especially during the COVID-19 pandemic in the low resource settings. Belize is a small Central American developing country known for its chronic healthcare worker shortage and this is the first study to assess burnout prevalence and its associated factors among healthcare workers in Belize.

AIM

To evaluate the prevalence of burnout and its associated factors in HCWs in Belize covering multiple domains (mental health, physical symptoms, and coping behaviors) during the COVID-19 pandemic.

METHODS

A cross-sectional survey that was developed and validated by a panel of experts was delivered online to all the healthcare workers in Belize from September to November 2021. Burnout was assessed using Copenhagen Burnout Inventory. Depression and anxiety screening was carried out using the Patient Health Questionnaire - 2 (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2). Burnout associated factors were estimated using logistic regression models.

FINDINGS

Of the total of 263 participants, 27.76% had overall burnout: 56.65% had personal, 54.37% had work-related, and 19.39% had patient-related burnout. Burnout was positively associated with anxiety (OR: 3.14 [1.67, 5.92]), depression (OR: 4.45 [2.30, 8.61]), intentions of quitting their jobs (OR: 2.59 [1.49, 4.51]), health status worsening (OR: 2.21 [1.26, 3.87]), multiple physical symptom presentation (OR: 1.19, [1.10, 1.29]), and use of multiple maladaptive coping behaviors (OR: 1.66, [1.30, 2.12]).

INTERPRETATION

Healthcare workers in Belize showed substantial levels of burnout which were significantly associated with using maladaptive coping behaviors, presenting multiple physical symptoms, quitting their jobs, health status worsening, and other mental health issues. These findings should be used to develop and implement programs such as regular health check-ups, health promotion awareness campaigns, and worker recruitment strategies which would improve the working conditions, quality of life, and psychological well-being of our healthcare workers.

Factors influencing health professionals' use of high-flow nasal cannula therapy for infants with bronchiolitis - A qualitative study

Aim

To explore the factors influencing the use of high-flow nasal cannula (HFNC) therapy for infants with bronchiolitis.

Design

Qualitative approach using semi-structured interviews.

Methods

The semi-structured interviews (face-to-face or virtual) were conducted between September 2020 and February 2021. Deductive content analysis was used to map key influencing factors for use of HFNC therapy to the Theoretical Domains Framework (TDF).

Results

Nineteen interviews were undertaken before reaching thematic saturation (7 nurses, 12 doctors) in emergency departments and paediatric wards from four purposively selected hospitals in Australia and New Zealand. Influencing factors were mapped to eight domains in the TDF with 21 themes identified. Main findings included: (1) Health professionals' expectations of HFNC therapy on patient deterioration, work of breathing and oxygenation; (2) Staff emotions relating to concern and anxiety about deterioration and "need to do something"; (3) Social influences from other health professionals and parents and (4) Environmental factors relating to logistics of care and patient transfer considerations. These factors, combined with the ready availability of HFNC equipment and health professionals having the required skills to administer the therapy, contributed to its initiation.

Conclusion

Individual/personal and contextual/environmental factors contribute to the use of HFNC therapy for infants with bronchiolitis. It is evident these influences contribute substantially to increased use, despite evidence-based guidelines recommending a more nuanced approach to this therapy. These findings will inform a targeted implementation intervention to promote evidence-based use of HFNC therapy in infants with bronchiolitis.

The impact of COVID-19 pandemic on mental burden and quality of life in physicians: Results of an online survey

Background

In previous pan-/epidemics such as the SARS epidemic of 2002/2003, negative effects on the wellbeing and an increase in symptoms of depression and anxiety were observed in doctors due to social isolation and the threat they experienced. Therefore, it is feared that the COVID-19 pandemic will also have a negative impact on the mental health and quality of life of doctors.

Objective

The impact of the COVID-19 pandemic on the mental health of physicians. In particular, on the subjective anxiety and burden, depression and quality of life for the total sample and subsamples (work in COVID-19 units vs. no work in COVID-19 units).

Materials and methods

In an online survey, 107 physicians (23-42 years) were asked about their mental health during the COVID-19 pandemic. In addition to socio-demographic data, pandemic- and work-related data were also included. For example, infection control measures, deployment on COVID-19 wards and the subjective perceived threat posed by the pandemic. The physicians were asked to rate their perceived anxiety and stress, retrospectively, at 7 different points in time during the pandemic. The Hospital Anxiety and Depression Scale (HADS) was used to retrospectively assess symptoms of anxiety and depression before and after the onset of the pandemic. The quality of life of the participants after 2 years of the pandemic was assessed using the WHO Quality of Life (WHOQOL-BREF).

Results

Both subjective anxiety and burden showed wave-like patterns with higher scores in autumn, winter and spring. We observed significant differences between the seven measurement time points for anxiety [Chi²(6) = 197.05, p < 0.001] as well as for burden [Chi²(6) = 106.33, p < 0.001]. Symptoms of depression and anxiety increased significantly during the COVID-19 pandemic (M = 14.16, SD = 7.83) compared to the pre-pandemic time [M = 7.31, SD = 5.14, t ₍₁₀₆₎ = -10.67, p < 0.001]. Physicians who worked at COVID-19 units showed higher scores in quality of life related to social relationships (M = 70.39, SD = 17.69) than physicians not working at COVID-19 units [M = 61.44, SD = 24.55, t _(90.14) = -2.145, p = 0.035]. The multi-factorial ANOVA showed that previous psychiatric illness (p < 0.001), greater difference in depression scores (p = 0.014), higher anxiety scores (p = 0.048) and less work experience (p = 0.032) led to lower quality of life.

Conclusion

Hospitals should offer specific support, such as supervision, to prevent the development of longer-term psychiatric sequelae likely to lead to sick leave and high costs for the healthcare system.

Trial registration

The study has been registered at the German Clinical Trials Registry (DRKS-ID: DRKS00028984).