Self-referrals to a doctors’ mental health service over 10 years

Background: The adverse impact on doctors’ health of constant organizational change in healthcare is well established. Aims: To investigate the change in self-referral rates to a doctors’ mental health service, and associated morbidity over a decade. Methods: All doctors attending a doctors’ mental health service between 1 January 2002 and 31 December 2011 were asked to complete the Clinical Outcomes in Routine Evaluation questionnaire and Maslach burnout inventory as part of routine assessment before treatment. Univariate analysis of variance was used to test for statistically significant differences between severity scores in different years. Results: Between 1 January 2002 and 31 December 2011, 1062 doctors attended the service; 852 (80%) completed both questionnaires and 64 (6%) completed one of them. The overall response rate was 86% (916/1062). Referrals increased >4-fold, from 44 in 2002 to 185 in 2011. Sixty-one per cent scored above the threshold for psychological distress and 59% for burnout. There were no significant changes in morbidity over time. Conclusions: Increasing numbers of doctors sought help from the doctors’ mental health support service. More than half scored above the thresholds for burnout and psychological distress and these proportions were consistent over 10 years. Doctors may be more willing to seek help than a decade ago. Further research is needed to confirm the underlying reasons for this. More resource is needed to meet the increase in demand

Irinotecan-Induced Toxicity:A Pharmacogenetic Study Beyond UGT1A1

Background and objective: Side effects of irinotecan treatment can be dose limiting and may impair quality of life. In this study, we investigated the correlation between single nucleotide polymorphisms (SNPs) in genes encoding enzymes involved in the irinotecan metabolism and transport, outside UGT1A1, and irinotecan-related toxicity. We focused on carboxylesterases, which are involved in formation of the active metabolite SN-38 and on drug transporters. Methods: Patients who provided written informed consent at the Erasmus Medical Center Cancer Institute to the Code Geno study (local protocol: MEC02-1002) or the IRI28-study (NTR-6612) were enrolled in the study and were genotyped for 15 SNPs in the genes CES1, CES2, SLCO1B1, ABCB1, ABCC2, and ABCG2. Results: From 299 evaluable patients, 86 patients (28.8%) developed severe irinotecan-related toxicity. A significantly higher risk of toxicity was seen in ABCG2 c.421C&gt;A variant allele carriers (P = 0.030, OR 1.88, 95% CI 1.06–3.34). Higher age was associated with all grade diarrhea (P = 0.041, OR 1.03, 95% CI 1.00–1.06). In addition, CES1 c.1165-41C&gt;T and CES1 n.95346T&gt;C variant allele carriers had a lower risk of all-grade thrombocytopenia (P = 0.024, OR 0.42, 95% CI 0.20–0.90 and P = 0.018, OR 0.23, 95% CI 0.08–0.79, respectively). Conclusion: Our study indicates that ABCG2 and CES1 SNPs might be used as predictive markers for irinotecan-induced toxicity.</p

A sea change for sick doctors - how do doctors fare after presenting to a specialist psychotherapy service?

Background: Little is known about doctors who present to services following an episode of psychological distress. MedNet is a psycho-dynamically informed confidential self-referral service for doctors. Aims: To examine the health and work trajectory of MedNet clients between 2002 and 2007 followed up in 2010. Method: We report and compare service-monitoring data for 124 doctors on engagement with health services, whether in work or not, sick leave utilised, and reported distress measured by CORE-OM at intake and at one follow-up time point. Results: 95.6% of doctors continue to work and progress in their careers. 58.3% remained engaged with services. Sick leave had reduced significantly at follow-up. Distress was significantly reduced, but no differences were found with respect to social functioning and well-being. An interesting shift was observed in doctors' use of medication from treating somatic complaints towards treating mood symptoms. Conclusions: Doctors show improvements and continue to progress in their careers after a psychotherapeutically orientated intervention. A shift in doctors' perception of their difficulties is indicated from more somatic to psychological concerns. Many doctor-patients continue with ongoing professional support