Are We Really Listening? A Program to Assess and Mitigate Systemic Factors Contributing to Clinician Burnout

Background: Many US physicians are experiencing burnout affecting patient care quality, safety, and experience. Institutions often focus on personal resilience instead of system-level issues. Our leaders developed a novel process to identify and prioritize key system-related stressors and work to mitigate factors that negatively impact clinician wellbeing through a structured Listening Campaign. Methods: The Listening Campaign consists of meeting with each clinician group leader, a group Listening Session, a follow up meeting with the leader, a final report, and a follow-up session. During the Listening Session, clinicians engage in open discussion about what is going well, complete individual reflection worksheets and identify one “wish” to improve their professional satisfaction. Participants rate these wishes to assist with prioritization. Results: As of January 2020, over 200 clinicians participated in 20 listening sessions. One-hundred twenty-two participants completed a survey; 80% stated they benefited from participation and 83% would recommend it to others. Conclusion: Collecting feedback from clinicians on their experience provides guidance for leaders in prioritizing initiatives and opportunities to connect clinicians to organizational resources. A Listening Campaign is a tool recommended for healthcare systems to elicit clinician perspectives and communicate efforts to address systemic factors

Research priorities for mitochondrial disorders: Current landscape and patient and professional views

Primary mitochondrial disorders encompass a wide range of clinical presentations and a spectrum of severity. They currently lack effective disease-modifying therapies and have a high mortality and morbidity rate. It is therefore essential to know that competitively-funded research designed by academics meets core needs of people with mitochondrial disorders and their clinicians. The Priority Setting Partnerships are an established collaborative methodology that brings patients, carers and families, charity representatives and clinicians together to try to establish the most pressing and unanswered research priorities for a particular disease. We developed a web-based questionnaire, requesting all patients affected by primary mitochondrial disease, their carers, and clinicians to pose their research questions. This yielded 709 questions from 147 participants. These were grouped into overarching themes including basic biology, causation, health services, clinical management, social impacts, prognosis, prevention, symptoms, treatment, and psychological impact. Following the removal of 'answered questions' the process resulted in a list of 42 discrete, answerable questions. This was further refined by web-based ranking by the community to 24 questions. These were debated at a face-to-face workshop attended by a diverse range of patients, carers, charity representatives and clinicians to create a definitive 'Top Ten of unanswered research questions for primary mitochondrial disorders'. These Top Ten questions related to understanding biological processes, including triggers of disease onset, mechanisms underlying progression and reasons for differential symptoms between individuals with identical genetic mutations; new treatments; biomarker discovery; psychological support; and optimal management of stroke-like episodes and fatigue

Global database on large magnitude explosive volcanic eruptions (LaMEVE)

© 2012 Crosweller et al. To facilitate the assessment of hazards and risk from volcanoes, we have created a comprehensive global database of Quaternary Large Magnitude Explosive Volcanic Eruptions (LaMEVE). This forms part of the larger Volcanic Global Risk Identification and Analysis Project (VOGRIPA), and also forms part of the Global Volcano Model (GVM) initiative (www.globalvolcanomodel.org). A flexible search tool allows users to select data on a global, regional or local scale; the selected data can be downloaded into a spreadsheet. The database is publically available online at www.bgs.ac. uk/vogripa and currently contains information on nearly 3,000 volcanoes and over 1,800 Quaternary eruption records. Not all volcanoes currently have eruptions associated with them but have been included to allow for easy expansion of the database as more data are found. Data fields include: Magnitude, Volcanic Explosivity Index (VEI), deposit volumes, eruption dates, and rock type. The scientific community is invited to contribute new data and also alert the database manager to potentially incorrect data. Whilst the database currently focuses only on large magnitude eruptions, it will be expanded to include data specifically relating to the principal volcanic hazards (e.g. pyroclastic flows, tephra fall, lahars, debris avalanches, ballistics), as well as vulnerability (e.g. population figures, building type) to facilitate risk assessments of future eruptions

Research priorities for mitochondrial disorders: current landscape and patient and professional views

Primary mitochondrial disorders encompass a wide range of clinical presentations and a spectrum of severity. They currently lack effective disease-modifying therapies and have a high mortality and morbidity rate. It is therefore essential to know that competitively-funded research designed by academics meets core needs of people with mitochondrial disorders and their clinicians. The Priority Setting Partnerships are an established collaborative methodology that brings patients, carers and families, charity representatives and clinicians together to try to establish the most pressing and unanswered research priorities for a particular disease. We developed a web-based questionnaire, requesting all patients affected by primary mitochondrial disease, their carers, and clinicians to pose their research questions. This yielded 709 questions from 147 participants. These were grouped into overarching themes including basic biology, causation, health services, clinical management, social impacts, prognosis, prevention, symptoms, treatment, and psychological impact. Following the removal of ‘answered questions’ the process resulted in a list of 42 discrete, answerable questions. This was further refined by web-based ranking by the community to 24 questions. These were debated at a face-to-face workshop attended by a diverse range of patients, carers, charity representatives and clinicians to create a definitive ‘Top Ten of unanswered research questions for primary mitochondrial disorders’. These Top Ten questions related to understanding biological processes, including triggers of disease onset, mechanisms underlying progression and reasons for differential symptoms between individuals with identical genetic mutations; new treatments; biomarker discovery; psychological support; and optimal management of stroke-like episodes and fatigue

Making science public: challenges and opportunities

This Programme investigated the relationship between science, politics and publics in the aftermath of an influential 2000 UK House of Lords Science and Society report. We conceptualised top-down initiatives promising greater transparency around the use of scientific evidence in policymaking and opportunities for public engagement around research and innovation agendas, as well as bottom-up instances of public mobilisation around science as an effort to make science public. In principle, such a movement seemed to speak directly to wider arguments for ‘opening up’ controversial domains of evidence and research to public scrutiny of framing, tacit assumptions, and alternative forms of expertise. Yet, these promises raised a number of dilemmas that we sought to examine in a range of cases

Mortality Among Adults With Cancer Undergoing Chemotherapy or Immunotherapy and Infected With COVID-19

Importance: Large cohorts of patients with active cancers and COVID-19 infection are needed to provide evidence of the association of recent cancer treatment and cancer type with COVID-19 mortality. // Objective: To evaluate whether systemic anticancer treatments (SACTs), tumor subtypes, patient demographic characteristics (age and sex), and comorbidities are associated with COVID-19 mortality. // Design, Setting, and Participants: The UK Coronavirus Cancer Monitoring Project (UKCCMP) is a prospective cohort study conducted at 69 UK cancer hospitals among adult patients (≥18 years) with an active cancer and a clinical diagnosis of COVID-19. Patients registered from March 18 to August 1, 2020, were included in this analysis. // Exposures: SACT, tumor subtype, patient demographic characteristics (eg, age, sex, body mass index, race and ethnicity, smoking history), and comorbidities were investigated. // Main Outcomes and Measures: The primary end point was all-cause mortality within the primary hospitalization. // Results: Overall, 2515 of 2786 patients registered during the study period were included; 1464 (58%) were men; and the median (IQR) age was 72 (62-80) years. The mortality rate was 38% (966 patients). The data suggest an association between higher mortality in patients with hematological malignant neoplasms irrespective of recent SACT, particularly in those with acute leukemias or myelodysplastic syndrome (OR, 2.16; 95% CI, 1.30-3.60) and myeloma or plasmacytoma (OR, 1.53; 95% CI, 1.04-2.26). Lung cancer was also significantly associated with higher COVID-19–related mortality (OR, 1.58; 95% CI, 1.11-2.25). No association between higher mortality and receiving chemotherapy in the 4 weeks before COVID-19 diagnosis was observed after correcting for the crucial confounders of age, sex, and comorbidities. An association between lower mortality and receiving immunotherapy in the 4 weeks before COVID-19 diagnosis was observed (immunotherapy vs no cancer therapy: OR, 0.52; 95% CI, 0.31-0.86). // Conclusions and Relevance: The findings of this study of patients with active cancer suggest that recent SACT is not associated with inferior outcomes from COVID-19 infection. This has relevance for the care of patients with cancer requiring treatment, particularly in countries experiencing an increase in COVID-19 case numbers. Important differences in outcomes among patients with hematological and lung cancers were observed

A review of the rural-digital policy agenda from a community resilience perspective

© 2016 The Authors This paper utilises a community resilience framework to critically examine the digital-rural policy agenda. Rural areas are sometimes seen as passive and static, set in contrast to the mobility of urban, technological and globalisation processes (Bell et al., 2010). In response to notions of rural decline (McManus et al., 2012) rural resilience literature posits rural communities as ‘active,’ and ‘proactive’ about their future (Skerratt, 2013), developing processes for building capacity and resources. We bring together rural development and digital policy-related literature, using resilience motifs developed from recent academic literature, including community resilience, digital divides, digital inclusion, and rural information and communication technologies (ICTs). Whilst community broadband initiatives have been linked to resilience (Plunkett-Carnegie, 2012; Heesen et al., 2013) digital inclusion, and engagement with new digital technologies more broadly, have not. We explore this through three resilience motifs: resilience as multi-scalar; as entailing normative assumptions; and as integrated and place-sensitive. We point to normative claims about the capacity of digital technology to aid rural development, to offer solutions to rural service provision and the challenges of implementing localism. Taking the UK as a focus, we explore the various scales at which this is evident, from European to UK country-level

Priorities for synthesis research in ecology and environmental science

ACKNOWLEDGMENTS We thank the National Science Foundation grant #1940692 for financial support for this workshop, and the National Center for Ecological Analysis and Synthesis (NCEAS) and its staff for logistical support.Peer reviewedPublisher PD

Priorities for synthesis research in ecology and environmental science

ACKNOWLEDGMENTS We thank the National Science Foundation grant #1940692 for financial support for this workshop, and the National Center for Ecological Analysis and Synthesis (NCEAS) and its staff for logistical support.Peer reviewedPublisher PD

How collaborative are quality improvement collaboratives:A qualitative study in stroke care

BACKGROUND: Quality improvement collaboratives (QICs) continue to be widely used, yet evidence for their effectiveness is equivocal. We sought to explain what happened in Stroke 90:10, a QIC designed to improve stroke care in 24 hospitals in the North West of England. Our study drew in part on the literature on collective action and inter-organizational collaboration. This literature has been relatively neglected in evaluations of QICs, even though they are founded on principles of co-operation and sharing. METHODS: We interviewed 32 professionals in hospitals that participated in Stroke 90:10, conducted a focus group with the QIC faculty team, and reviewed purposively sampled documents including reports and newsletters. Analysis was based on a modified form of Framework Analysis, combining sensitizing constructs derived from the literature and new, empirically derived thematic categories. RESULTS: Improvements in stroke care were attributed to QIC participation by many professionals. They described how the QIC fostered a sense of community and increased attention to stroke care within their organizations. However, participants’ experiences of the QIC varied. Starting positions were different; some organizations were achieving higher levels of performance than others before the QIC began, and some had more pre-existing experience of quality improvement methods. Some participants had more to learn, others more to teach. Some evidence of free-riding was found. Benchmarking improvement was variously experienced as friendly rivalry or as time-consuming and stressful. Participants’ competitive desire to demonstrate success sometimes conflicted with collaborative aims; some experienced competing organizational pressures or saw the QIC as duplication of effort. Experiences of inter-organizational collaboration were influenced by variations in intra-organizational support. CONCLUSIONS: Collaboration is not the only mode of behavior likely to occur within a QIC. Our study revealed a mixed picture of collaboration, free-riding and competition. QICs should learn from work on the challenges of collective action; set realistic goals; account for context; ensure sufficient time and resources are made available; and carefully manage the collaborative to mitigate the risks of collaborative inertia and unhelpful competitive or anti-cooperative behaviors. Individual organizations should assess the costs and benefits of collaboration as a means of attaining quality improvement