Physician Burnout

Burnout is pervasive among physicians and is rapidly becoming a pandemic in healthcare. It is characterized by increasing demands without adequate support and hallmarked by depersonalization, emotional exhaustion, and a reduced sense of personal accomplishment. It is essential to address burnout, as it can lead to decreased productivity, increased healthcare costs, medical errors, workforce attrition, depression, and even suicide. Many factors contribute to burnout, and it occurs at all stages of medicine: it can begin during medical school, intensify during the years of graduate medical education (GME) or residency training, and persist as residents become staff physicians. It affects both sexes, but may impact female physicians disproportionately. Impact can also vary among specialties. Recognizing the problem and intervening with unified physician and organization-directed solutions centered on well-being, efficient practice models, and goal prioritization may help to reduce the prevalence and effects of burnout

FACTORS RELATED TO THE USE OF PLAY THERAPY AMONG ELEMENTARY SCHOOL COUNSELORS

The purpose of this study was to examine variables that are related to elementary school counselors’ use of play therapy in the elementary school setting. The specific variables explored were age, years of experience, workshop hours, graduate coursework, supervision in play therapy, school counselor self-efficacy, and perceived effectiveness using play therapy. The use or non-use of play therapy was the dependent variable in the study. A survey was sent to a total of 2,500 American School Counselor Association members that fit the criteria of currently practicing elementary school counselors, and 192 participants were included in this research study. All questions of variables were gathered from the participant’s self-report responses on the survey. Correlations and a logistic regression were conducted to analyze the data. The findings indicated there were statistically significant correlations among the predictor variables of age, years of experience, workshop hours, graduate coursework, self-efficacy as a school counselor, and perceived effectiveness using play therapy. In addition, in the final logistic regression model, perceived effectiveness was a significant predictor of the use of play therapy among elementary school counselors

“Because It Kind of Falls in Between, Doesn’t It? Like an Acute Thing and a Chronic”: the Psychological Experience of Anaphylaxis in Adulthood

Anaphylaxis is a serious, rare condition increasing in prevalence. This study explored the psychological experience of adult-onset anaphylaxis from patient, family and staff perspectives. Semi-structured interviews were conducted with twelve participants. Two global themes emerged from thematic analysis: ‘controllability’ (‘an unknown and distressing experience’, ‘the importance of control over triggers’ and ‘responsibility but no control: the impact on others’) and ‘conflict’ (‘rejecting illness identity’, ‘minimisation of risk’, ‘accessing specialist care: running in slow motion’ and ‘patient-centred versus service-centred care’). Findings highlight the importance of perceived control and emphasise the presence of conflict in the experience of this complex, episodic condition

The role of cognitive control in the positive symptoms of psychosis

BACKGROUND: Positive symptoms of psychosis (e.g., hallucinations) often limit everyday functioning and can persist despite adequate antipsychotic treatment. We investigated whether poor cognitive control is a mechanism underlying these symptoms. METHODS: 97 patients with early psychosis (30 with high positive symptoms (HS) and 67 with low positive symptoms (LS)) and 40 healthy controls (HC) underwent fMRI whilst performing a reward learning task with two conditions; low cognitive demand (choosing between neutral faces) and high cognitive demand (choosing between angry and happy faces - shown to induce an emotional bias). Decision and feedback phases were examined. RESULTS: Both patient groups showed suboptimal learning behaviour compared to HC and altered activity within a core reward network including occipital/lingual gyrus (decision), rostral Anterior Cingulate Cortex, left pre-central gyrus and Supplementary Motor Cortex (feedback). In the low cognitive demand condition, HS group showed significantly reduced activity in Supplementary Motor Area (SMA)/pre-SMA during the decision phase whilst activity was increased in LS group compared to HC. Recruitment of this region suggests a top-down compensatory mechanism important for control of positive symptoms. With additional cognitive demand (emotional vs. neutral contrast), HS patients showed further alterations within a subcortical network (increased left amygdala activity during decisions and reduced left pallidum and thalamus activity during feedback) compared to LS patients. CONCLUSIONS: The findings suggest a core reward system deficit may be present in both patient groups, but persistent positive symptoms are associated with a specific dysfunction within a network needed to integrate social-emotional information with reward feedback

INHALE: the impact of using FilmArray Pneumonia Panel molecular diagnostics for hospital-acquired and ventilator-associated pneumonia on antimicrobial stewardship and patient outcomes in UK Critical Care—study protocol for a multicentre randomised controlled trial

Background: Hospital-acquired and ventilator-associated pneumonias (HAP and VAP) are common in critical care and can be life-threatening. Rapid microbiological diagnostics, linked to an algorithm to translate their results into antibiotic choices, could simultaneously improve patient outcomes and antimicrobial stewardship. Methods: The INHALE Randomised Controlled Trial is a multi-centre, parallel study exploring the potential of the BioFire FilmArray molecular diagnostic to guide antibiotic treatment of HAP/VAP in intensive care units (ICU); it identifies pathogens and key antibiotic resistance in around 90 min. The comparator is standard care whereby the patient receives empirical antibiotics until microbiological culture results become available, typically after 48–72 h. Adult and paediatric ICU patients are eligible if they are about to receive antibiotics for a suspected lower respiratory infection (including HAP/VAP) for the first time or a change in antibiotic because of a deteriorating clinical condition. Breathing spontaneously or intubated, they must have been hospitalised for 48 h or more. Patients are randomised 1:1 to receive either antibiotics guided by the FilmArray molecular diagnostic and its trial-based prescribing algorithm or standard care, meaning empirical antibiotics based on local policy, adapted subsequently based upon local microbiology culture results. Co-primary outcomes are (i) non-inferiority in clinical cure of pneumonia at 14 days post-randomisation and (ii) superiority in antimicrobial stewardship at 24 h post-randomisation (defined as % of patients on active and proportionate antibiotics). Secondary outcomes include further stewardship reviews; length of ICU stay; co-morbidity indicators, including septic shock, change in sequential organ failure assessment scores, and secondary pneumonias; ventilator-free days; adverse events over 21 days; all-cause mortality; and total antibiotic usage. Both cost-effectiveness of the molecular diagnostic-guided therapy and behavioural aspects determining antibiotic prescribing are being explored. A sample size of 552 will be required to detect clinically significant results with 90% power and 5% significance for the co-primary outcomes. Discussion: This trial will test whether the potential merits of rapid molecular diagnostics for pathogen and resistance detection in HAP/VAP are realised in patient outcomes and/or improved antibiotic stewardship. Trial registration: ISRCTN Registry ISRCTN16483855. Retrospectively registered on 15 July 2019