"I have nothing more to give": Disparities in burnout and the protective role of immigrant status during the COVID-19 pandemic.

Burnout is an epidemic, with deleterious effects on individuals, patient care, and healthcare systems. The Coronavirus Disease 2019 (COVID-19) pandemic may be exacerbating this problem. We aimed to explore socio-cultural and gender norms that modulate burnout development in physicians during the pandemic and analyze any disparities associated with gender, marital and immigration status and work-life balance. We conducted an online cross-sectional survey of physicians (August-November, 2021): The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout, combined with a validated survey assessing work-life balance. Demographic data was obtained for each participant. MBI-HSS subscales were measured, along with work and home related changes due to COVID-19. The association between life changes due to COVID-19 and odds of burnout was estimated by logistic regression. Complementary analysis was performed to determine factors most associated with burnout. 352 respondents were analyzed. There was a high prevalence of burnout. Over half of individuals reported a high degree of emotional exhaustion (EE) (56%). 83% of individuals reported at least one life factor changed due to COVID-19. Home-related life changes due to COVID-19 were associated with 143% higher odds of emotional burnout [adjusted odds ratio (aOR) 2.43; 95% confidence interval (CI) 1.49, 3.98] after covariate adjusted analysis. High EE was most evident when there were three or more life changes, suggesting a cumulative effect. First-generation immigrants, older physicians, and trainees were identified as protective factors. Although female gender was identified as a factor related to EE through forward selection, this was not statistically significant (aOR 1.34; 95% CI 0.80, 2.24). Burnout remains pervasive among physicians. We highlight new risk factors for EE (home-life changes due to COVID-19), and protective factors (first-generation immigrants) not previously explored. Understanding burnout and its disparities allows for improved mitigation strategies, decreasing its deleterious effects.

“I have nothing more to give”: Disparities in burnout and the protective role of immigrant status during the COVID-19 pandemic

Burnout is an epidemic, with deleterious effects on individuals, patient care, and healthcare systems. The Coronavirus Disease 2019 (COVID-19) pandemic may be exacerbating this problem. We aimed to explore socio-cultural and gender norms that modulate burnout development in physicians during the pandemic and analyze any disparities associated with gender, marital and immigration status and work-life balance. We conducted an online cross-sectional survey of physicians (August–November, 2021): The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout, combined with a validated survey assessing work-life balance. Demographic data was obtained for each participant. MBI-HSS subscales were measured, along with work and home related changes due to COVID-19. The association between life changes due to COVID-19 and odds of burnout was estimated by logistic regression. Complementary analysis was performed to determine factors most associated with burnout. 352 respondents were analyzed. There was a high prevalence of burnout. Over half of individuals reported a high degree of emotional exhaustion (EE) (56%). 83% of individuals reported at least one life factor changed due to COVID-19. Home-related life changes due to COVID-19 were associated with 143% higher odds of emotional burnout [adjusted odds ratio (aOR) 2.43;95% confidence interval (CI) 1.49, 3.98] after covariate adjusted analysis. High EE was most evident when there were three or more life changes, suggesting a cumulative effect. First-generation immigrants, older physicians, and trainees were identified as protective factors. Although female gender was identified as a factor related to EE through forward selection, this was not statistically significant (aOR 1.34;95% CI 0.80, 2.24). Burnout remains pervasive among physicians. We highlight new risk factors for EE (home-life changes due to COVID-19), and protective factors (first-generation immigrants) not previously explored. Understanding burnout and its disparities allows for improved mitigation strategies, decreasing its deleterious effects.

Heart failure in general and cardiac transplant patients with COVID-19.

Coronavirus disease 2019 (COVID-19) is primarily an infection of the respiratory tract, but it can have multisystem manifestations. Cardiac complications of COVID-19 can range from acute myocardial injury, cardiac arrhythmias, or heart failure, amongst others. Heart failure (HF) in COVID-19 can be a de novo process or due to worsening of pre-existing cardiovascular ailment. HF in a patient with COVID-19 not only poses challenges in clinical presentation and management of COVID-19 but also affect prognosis of the patient. This article aims to succinctly revisit the implications of this pandemic regarding pre-existing HF or new-onset HF based on prevailing data. It also focuses on the management and special recommendations from prior studies and guidelines.

Associations between resources and practices of ILD centers and outcomes in patients with idiopathic pulmonary fibrosis: data from the IPF-PRO Registry.

BACKGROUND: Performance benchmarks for the management of idiopathic pulmonary fibrosis (IPF) have not been established. We used data from the IPF-PRO Registry, an observational registry of patients with IPF managed at sites across the US, to examine associations between the characteristics of the enrolling sites and patient outcomes. METHODS: An online survey was used to collect information on the resources, operations, and self-assessment practices of IPF-PRO Registry sites that enrolled ≥ 10 patients. Site variability in 1-year event rates of clinically relevant outcomes, including death, death or lung transplant, and hospitalization, was assessed. Models were adjusted for differences in patient case mix by adjusting for known predictors of each outcome. We assessed whether site-level heterogeneity existed for each patient-level outcome, and if so, we investigated potential drivers of the heterogeneity. RESULTS: All 27 sites that enrolled ≥ 10 patients returned the questionnaire. Most sites were actively following > 100 patients with IPF (70.4%), had a lung transplant program (66.7%), and had a dedicated ILD nurse leader (77.8%). Substantial heterogeneity was observed in the event rates of clinically relevant outcomes across the sites. After controlling for patient case mix, there were no outcomes for which the site variance component was significantly different from 0, but the p-value for hospitalization was 0.052. Starting/completing an ILD-related quality improvement project in the previous 2 years was associated with a lower risk of hospitalization (HR 0.60 [95% CI 0.44, 0.82]; p = 0.001). CONCLUSIONS: Analyses of data from patients with IPF managed at sites across the US found no site-specific characteristics or practices that were significantly associated with clinically relevant outcomes after adjusting for patient case mix. Trial registration ClinicalTrials.gov, NCT01915511. Registered 5 August 2013, https://clinicaltrials.gov/ct2/show/NCT01915511.

Prone Positioning for Pregnant Women With Hypoxemia Due to Coronavirus Disease 2019 (COVID-19).

The coronavirus disease 2019 (COVID-19) pandemic has prompted expanded use of prone positioning for refractory hypoxemia. Clinical trials have demonstrated beneficial effects of early prone positioning for acute respiratory distress syndrome (ARDS), including decreased mortality. However, pregnant women were excluded from these trials. To address the need for low-cost, low-harm interventions in the face of a widespread viral syndrome wherein hypoxemia predominates, we developed an algorithm for prone positioning of both intubated and nonintubated pregnant women. This algorithm may be appropriate for a wide spectrum of hypoxemia severity among pregnant women. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is responsible for the clinical manifestations of COVID-19. This syndrome can manifest as severe pneumonia complicated by hypoxemia and ARDS. Given the current global COVID-19 pandemic, with a large number of ARDS cases, there is renewed interest in the use of prone positioning to improve oxygenation in moderate or severe hypoxemia. Among the populations who can benefit from prone positioning are pregnant women experiencing severe respiratory distress, as long as the physiologic changes and risks of pregnancy are taken into account.