Psychological distress among healthcare professionals at the frontlines: anaesthesiologists’ perspective

The COVID-19 pandemic raging in Malaysia has been one of the greatest challenges so far since its formation, and standing at the forefront of this “war” are Malaysian healthcare practitioners. We sought to capture a snapshot of the psychological distress encountered by those in the medical profession standing at the frontlines of the fight against COVID-19, by carrying out a cross-sectional study to investigate the prevalence of burnout and depression risk among anaesthesiology clinicians in a nationally designated exclusive COVID-19 hospital. We utilised validated questionnaires and included all the clinicians (n=88) in the Anaesthesiology and Intensive Care Department. This study was conducted throughout the month of May 2020, which corresponded to the end of the first Malaysian Government Movement Control Order (from 18th March to 3rd May 2020). Results showed that more than half of anaesthesiologists managing COVID-19 patients suffered from burnout, and up to 67% had a high risk of depression. Both burnout and depression are significantly associated with one another. The findings are discussed, followed by recommendations for preventative strategies to increase the mental fortitude of healthcare practitioners in Malaysia

Psychological distress among healthcare professionals at the frontlines: anaesthesiologists’ perspective

The COVID-19 pandemic raging in Malaysia has been one of the greatest challenges so far since its formation, and standing at the forefront of this “war” are Malaysian healthcare practitioners. We sought to capture a snapshot of the psychological distress encountered by those in the medical profession standing at the frontlines of the fight against COVID-19, by carrying out a cross-sectional study to investigate the prevalence of burnout and depression risk among anaesthesiology clinicians in a nationally designated exclusive COVID-19 hospital. We utilised validated questionnaires and included all the clinicians (n=88) in the Anaesthesiology and Intensive Care Department. This study was conducted throughout the month of May 2020, which corresponded to the end of the first Malaysian Government Movement Control Order (from 18th March to 3rd May 2020). Results showed that more than half of anaesthesiologists managing COVID-19 patients suffered from burnout, and up to 67% had a high risk of depression. Both burnout and depression are significantly associated with one another. The findings are discussed, followed by recommendations for preventative strategies to increase the mental fortitude of healthcare practitioners in Malaysia

A survey on burnout and depression risk among anaesthetists during COVID-19: the tip of an iceberg?

The recent article by Heath et al. [1] is a timely one, which addresses the need for solutions to minimise the adverse psychological impact of the COVID-19 pandemic. In the midst of this public health crisis, anaesthetists are at the frontline of the ‘war’ against the virus, and hence at great risk of suffering from mental and emotional harm, akin to a ‘parallel pandemic’ [2]. Due to the nature of the work of anaesthetists in managing patients in acute and critical care, with special emphasis on airway management and ventilatory support, their work-load worldwide has increased during the pandemic, predisposing to burnout. Also, as the clinicians responsible for airway management, anaesthetists are among those at greatest risk of contracting COVID-19 [3], and with this risk comes worry and anxiety, contributing to further psychological distress. In view of the multiple psychological challenges faced by anaesthetists worldwide, we sought to define the problem by investigating the prevalence of burnout and depression risk among anaesthetists in a nationally designated exclusive COVID-19 hospital

Increase in the use of inhaled nitric oxide in neonatal intensive care units in England: a retrospective population study

Objective To describe temporal changes in inhaled nitric oxide (iNO) use in English neonatal units between 2010 and 2015.Design Retrospective analysis using data extracted from the National Neonatal Research Database.Setting All National Health Service neonatal units in England.Patients Infants of all gestational ages born 2010–2015 admitted to a neonatal unit and received intensive care.Main outcome measures Proportion of infants who received iNO; age at initiation and duration of iNO use.Results 4.9% (6346/129 883) of infants received iNO; 31% (1959/6346) were born <29 weeks, 18% (1152/6346) 29–33 weeks and 51% (3235/6346)>34 weeks of gestation. Between epoch 1 (2010–2011) and epoch 3 (2014–2015), there was (1) an increase in the proportion of infants receiving iNO: <29 weeks (4.9% vs 15.9%); 29–33 weeks (1.1% vs 4.8%); >34 weeks (4.5% vs 5.0%), (2) increase in postnatal age at iNO initiation: <29 weeks 10 days vs 18 days; 29–33 weeks 2 days vs 10 days, (iii) reduction in iNO duration: <29 weeks (3 days vs 2 days); 29–33 weeks (2 days vs 1 day).Conclusions Between 2010 and 2015, there was an increase in the use of iNO among infants admitted to English neonatal units. This was most notable among the most premature infants with an almost fourfold increase. Given the cost of iNO therapy, limited evidence of efficacy in preterm infants and potential for harm, we suggest that exposure to iNO should be limited, ideally to infants included in research studies (either observational or randomised placebo-controlled trial) or within a protocolised pathway. Development of consensus guidelines may also help standardise practice

CureGN Study Rationale, Design, and Methods: Establishing a Large Prospective Observational Study of Glomerular Disease

Glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and immunoglobulin A (IgA) nephropathy, share clinical presentations, yet result from multiple biological mechanisms. Challenges to identifying underlying mechanisms, biomarkers, and new therapies include the rarity of each diagnosis and slow progression, often requiring decades to measure the effectiveness of interventions to prevent end-stage kidney disease (ESKD) or death. Multicenter prospective cohort study. Cure Glomerulonephropathy (CureGN) will enroll 2,400 children and adults with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy (including IgA vasculitis) and a first diagnostic kidney biopsy within 5 years. Patients with ESKD and those with secondary causes of glomerular disease are excluded. Clinical data, including medical history, medications, family history, and patient-reported outcomes, are obtained, along with a digital archive of kidney biopsy images and blood and urine specimens at study visits aligned with clinical care 1 to 4 times per year. Patients are followed up for changes in estimated glomerular filtration rate, disease activity, ESKD, and death and for nonrenal complications of disease and treatment, including infection, malignancy, cardiovascular, and thromboembolic events. The study design supports multiple longitudinal analyses leveraging the diverse data domains of CureGN and its ancillary program. At 2,400 patients and an average of 2 years’ initial follow-up, CureGN has 80% power to detect an HR of 1.4 to 1.9 for proteinuria remission and a mean difference of 2.1 to 3.0mL/min/1.73m2 in estimated glomerular filtration rate per year. Current follow-up can only detect large differences in ESKD and death outcomes. Study infrastructure will support a broad range of scientific approaches to identify mechanistically distinct subgroups, identify accurate biomarkers of disease activity and progression, delineate disease-specific treatment targets, and inform future therapeutic trials. CureGN is expected to be among the largest prospective studies of children and adults with glomerular disease, with a broad goal to lessen disease burden and improve outcomes