Perceived challenges of working in a fertility clinic: a qualitative analysis of work stressors and difficulties working with patients

STUDY QUESTION What are some of the challenges of working in a fertility clinic? SUMMARY ANSWER The most frequently mentioned challenges were workload (e.g. high time pressure) and patient-related sources (e.g. unrealistic expectations). WHAT IS KNOWN ALREADY One study showed a too high workload, worry about handling human material and low success rates were main stressors in fertility clinics. STUDY DESIGN, SIZE, DURATION An online open-ended survey inviting participants to respond to seven questions was distributed to 5902 members of the European Society for Human Reproduction and Embryology (ESHRE, October 2010). Questions asked participants to describe the top three factors that made (i) their work stressful (hereafter ‘Work stressors’) and (ii) working with patients difficult (hereafter ‘Perceived sources of difficulties’), and (iii) to choose from these factors which top three issues they would be willing to attend a workshop to resolve (hereafter ‘Workshops’). A qualitative content analysis using inductive coding for each question was used to extract meaningful themes from the text replies, at three levels of increasing abstraction (lower and higher categories, general themes). PARTICIPANTS/MATERIALS, SETTING, METHODS The final sample comprised 526 respondents (8.9% participation rate). Respondents were predominantly clinicians (41.3%, n = 216) or embryologists (35.5%, n = 186) from European countries (73.0%, n = 386). MAIN RESULTS AND THE ROLE OF CHANCE The number of text replies generated for each question was 1421, 1208 and 907 for the ‘Work Stressors’, ‘Perceived sources of difficulties’ and ‘Workshop’ questions, respectively. The most often reported higher-order categories of Work Stressors were ‘Time and Workload’ (61.6%, e.g. time pressure), ‘Organisation, Team and management issues’ (60.4%, e.g. team conflicts) and ‘Job content and work environment’ (50.3%, e.g. burdensome administration). For ‘Perceived sources of difficulties’ these were ‘Patient-related sources’ (66.7%, e.g. unrealistic expectations), ‘Communication and Counselling with patients’ (33.7%, e.g. strained information giving) and ‘Misinformation and lack of knowledge’ (27.8%, e.g. Dr Google). Finally, the topics participants would be willing to address in Workshops were ‘Communicating and Counselling with Patients’ (24.9%), ‘Dealing with Patient-related sources’ (19.6%) and ‘Clinical topics’ (19.6%). Three general themes emerged. First, a theme of ‘time and time trade-offs’ expressed the oft-mentioned need to trade-off time spent on one activity (e.g. managing patient demands) against another activity (e.g. clinical workload, administration) with stress level dependent on the efficacy of trading-off. Second, the theme of ‘multifactorial causes’ of challenging patient interactions that embodied the many sources of difficulties working with patients. What staff would be willing to address in workshops was indicated by the final general theme of ‘a little of everything’, which linked to the need for multiple workshops addressing the multifactorial nature of challenges in fertility clinics. LIMITATIONS, REASONS FOR CAUTION Only about 10% of members receiving the survey participated. The work was limited to the stressful and difficult aspects of working in fertility clinics, which may give a more negative impression than if questions about the rewards and benefits had also been included. WIDER IMPLICATIONS OF THE FINDINGS The nature of stressors and difficulties of working in a fertility clinic are consistent with models of occupational stress and patient complexity. Specialized psychologists, management consultants and other occupational experts could assist fertility teams in overcoming many of the challenges. More research is required on the effect of encountered work stressors and perceived sources of difficulties in working with patients on staff and patient outcomes

Understanding binding selectivity toward trypsin and factor Xa the role of aromatic interactions

A congeneric series of four bis benzamidine inhibitors sharing a dianhydrosugar isosorbide scaffold in common has been studied by crystal structure analysis and enzyme kinetics with respect to their binding to trypsin and factor amp; 8197;Xa. Within the series, aromatic interactions are an important determinant for selectivity discrimination among both serine proteases. To study the selectivity determining features in detail, we used trypsin mutants in which the original binding site is gradually substituted to finally resemble the factor amp; 8197;Xa binding pocket. The influence of these mutations has been analyzed on the binding of the closely related inhibitors. We present the crystal structures of the inhibitor complexes obtained by co crystallizing an intermediate trypsin mutant. They could be determined to a resolution of up to 1.2 amp; 8197; , and we measured the inhibitory activity Ki of each ligand against factor amp; 8197;Xa, trypsin, and the various mutants. From these data we were able to derive a detailed structure activity relationship which demonstrates the importance of aromatic interactions in protein ligand recognition and their role in modulating enzyme selectivity. Pronounced preference is experienced to accommodate the benzamidine anchor with meta topology in the S1 specificity pocket. One ligand possessing only para topology deviates strongly from the other members of the series and adopts a distinct binding mode addressing the S1 amp; 8242; site instead of the distal S3 S4 binding pocke

Les déterminants psychosociaux de l'observance thérapeutique chez les personnes infectées par le VIH (représentations et valeurs)

METZ-SCD (574632105) / SudocSudocFranceF

Understanding Substrate Selectivity of Phoslactomycin Polyketide Synthase by Using Reconstituted in Vitro Systems

Polyketide synthases (PKSs) use simple extender units to synthesize complex natural products. A fundamental question is how different extender units are site-specifically incorporated into the growing polyketide. Here we established phoslactomycin (Pn) PKS, which incorporates malonyl- and ethylmalonyl-CoA, as an in vitro model to study substrate specificity. We combined up to six Pn PKS modules with different termination sites for the controlled release of tetra-, penta- and hexaketides, and challenged these systems with up to seven different extender units in competitive assays to test for the specificity of Pn modules. While malonyl-CoA modules of Pn PKS exclusively accept their natural substrate, the ethylmalonyl-CoA module PnC tolerates different alpha-substituted derivatives, but discriminates against malonyl-CoA. We show that the ratio of extender transacylation to hydrolysis controls incorporation in PnC, thus explaining site-specific selectivity and promiscuity in the natural context of Pn PKS