Pandemic Challenges and Opportunities for Gender Equity in Clinical Research

In the arena of clinical research, gender equity accelerates research excellence: we need multiple perspectives and all the brain power we can muster to maximize research productivity and quality. [...]women physician investigators enhance enrollment of women as participants in clinical trials, which is crucial to our ability to generalize from the data and to maintain the health of women. Women are underrepresented among academic grand rounds speakers,14 speakers at medical conferences15, and award recipients from medical specialty societies.16 Time pressure is especially intense on young women faculty. Besides spending more time on domestic chores, they spend more time at work on teaching, service, and mentoring. Female primary care physicians spend more time with patients.22 Elderly hospitalized patients treated by female internists experience lower mortality and readmission rates.23 Patients undergoing coronary artery bypass grafting had shorter hospital length of stay when treated by an all-female physician team as compared with an all-male team.24 Female patients treated by male physicians following acute myocardial infarction have higher mortality than those treated by female physicians.25 Sex discordance between patient and surgeon is associated with increased likelihood of adverse postoperative outcomes-and that observation that is driven by worse outcomes for female patients treated by male physicians.26 Clinical trials play a fundamental role in bringing new medications and interventions to our patients, yet women have often been excluded from participation. Among 60 randomized controlled trials (RCTs) of lipidlowering therapies reported between 1990 and 2018, there was a modest increase in enrollment of women over time, but women remain underrepresented compared with the relative burden of disease.30 In another study of 317 RCTs of heart failure with reduced ejection fraction published in highimpact journals over the past 20 years, only 25% of participants overall were female, and females were under-enrolled in 72% of these trials.

Risk of exposure to Covid-19 in nursing assistants, nurses, and physicians in a university hospital in the face of pandemic.

Objective: Healthcare professionals were the workers most affected by Covid-19, espe-cially during the first waves of the pandemic. Thus, the aim of this study is to evaluate the perceived risk of exposure to Covid-19, the information received and the work participation between nurses, physicians and nursing assistants. Method(s): A cross-sectional study was conducted using an epidemiological survey among nurses, physicians and nursing assistants in a university hospital. Aspect and content validation, cognitive pretest, and piloting of the epidemiological survey was carried out with thirty subjects. A descriptive analysis was per-formed using mean and standard deviation (SD) for quantitative variables and absolute (n) and relative (%) frequencies for qualitative variables. The chi-square test and the ANOVA test were applied to assess the association of the responses with the variables: sex, type of worker, area of work and activity in Covid-19 Units. Result(s): Nurses, physicians and nursing assistants worked mainly in assistance areas and high risk of exposure units. Nursing assistants and nurses had a higher perception of risk. Nurses were less involved in the organiza-tion, but felt more supported by their colleagues. However, physicians felt more supported by their superiors and better care when they had a health problem. Conclusion(s): Nursing assistants and nurses presented higher risk perception, nurses were less involved in the organization of health care, while physicians felt more supported by their superiors.Copyright © 2023, Fundacion Index. All rights reserved.

Helen Salisbury: Practising in the dark

After careful screening to exclude coronavirus symptoms we invite some patients into the practice to be examined. With longstanding patients I hope that this will be just a brief interruption to our normal relationship, but when I haven't previously met the patient it poses a significant challenge to building a rapport. In the past week the number of new patients reporting coronavirus symptoms has fallen, as has the death rate at our local hospital.

A critique of clinical economy: reassessing value and care during covid-19—an essay by Eric Reinhart and Daniel Brauner

For decades, American medical practice has been organised around billing codes, with severe consequences for patient care and physician morale. The interruption of routine clinic visits owing to covid-19 presents an opportunity to reconsider the guiding principles of clinical care, write Eric Reinhart and Daniel Brauner

Social connection: An exploration of screening methods in primary care

Research has found a correlation between a lack of social links and greater prevalence of mental health issues, indicating that social connection is a key determinant in both physical and mental health outcomes. Social isolation has been related to loneliness, all-cause mortality, cardiovascular disease, and other major health problems. Urban lifestyles, technology advancements, and the COVID-19 pandemic have all contributed to this problem. In order to address related physical and mental health issues, healthcare professionals must have a thorough understanding of the prevalence of social connection impairments as well as how to identify and treat them. This study surveyed primary care physicians on their approach to evaluating social connection in patients and identified potential barriers to gathering this information. The purpose of this study was to explore the attitudes and beliefs of primary care physicians in the United States towards the impact of social connection on the health of their patients and the extent to which they screen and assess for social connection. Surveys were collected from 208 licensed primary care physicians. Results showed the majority of participants agreed that addressing a patient's social connection is as important as addressing their medical needs and that they feel comfortable asking about a patient's current social connection. However, fewer participants reported being well informed about self-report tools or using validated measures to screen for social connection in their practice. These results suggest that there may be a need for more resources to help primary care physicians incorporate screening for social connection into their practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Attitudes among physicians toward vaccine mandates for emerging infectious disease: the case of the COVID-19 vaccine

Objectives: The outbreak of SARS-CoV-2 resulted in a global pandemic. Vaccine mandates were implemented in several countries, including in Taiwan, and often targeted health-care workers in particular. This study investigated attitudes among Taiwanese physicians toward such policies and how ethical beliefs and logic influenced attitudes. Methods: A total of 16 physicians were recruited by using the snowball method from hospitals in northern Taiwan. Data were collected through semi-structured interviews. Results: Physicians tended not to support mandatory vaccination. Five themes emerged: (1) Individual rights, including violation of autonomy and labor rights;(2) vaccine performance, including safety and efficacy;(3) institutional norms, including the degree of relevancy of the policy-issuing unit and the employment relationship between physicians and institutions;(4) social and workplace stigma resulting from coercive policies in different job categories or departments;and (5) professional ethics of physicians. Conclusions: Autonomy and professional ethics among physicians influence attitudes toward vaccine mandates. Vaccine performance, institutional norms, and stigma also influence attitudes toward vaccine mandates and decision-making. Even with high ethical awareness, the study participants tended not to support vaccine mandates. The government should formulate mandatory vaccination policy means for healthcare workers that can be used by hospitals. Each hospital should assess their unique risks and implement policies that best suit their needs. (Taiwan J Public Health. 2023;42(1):75-87)

CHALLENGES FOR PATIENTS WITH RMD'S IN BULGARIA DURING THE COVID-19 PANDEMIC

BackgroundThe Covid-19 pandemic has put patients with rheumatic diseases in front of a number of obstacles that had to be solved together with Bulgarian rheumatologists. The lockdowns and restrictive measures have made it difficult for people with rheumatic diseases to have access to timely hospital and pre-hospital care. A number of digital solutions have been implemented to address these issues.ObjectivesTo highlight the problems that patients with rheumatic diseases had during the Covid-19 pandemic;access to rheumatologists and the effectiveness of hospital and pre-hospital care during the pandemic, access to treatment, changes of treatment;communication between physicians and patients, the impact of the pandemic on work, social contacts, hobbies.MethodsAn anonymous survey was conducted online and by telephone. The survey was developed by Medical university, Plovdiv, University hospital "Kaspela”:, Plovdiv, Bulgarian Association for Musculoskeletal Ultrasound, Bulgarian organization for people with rheumatic diseases;Association for patients with autoimmune diseases.Number of participants: 1205 patients with RMD's.Age range: 18-82ResultsFace to face meetings with doctors have been limited during the pandemic.Visits to the rheumatologist's office are significantly reduced and phone, email, text messaging, online consultations were preferred as communication channels.Before the pandemic, 76% of respondents most often communicated with their physicians by visiting their practice, during the pandemic their relative share decreased to 46%, with a significant difference of 30%Phone consultations: patients using this type of communication increasing from 38% before the pandemic to 56% during the pandemic, a significant difference of 18%The percentage of patients who communicated via text or email rises from 10% to 17 %.It has become apparent that Digital transformation is needed and patients and physicians should work together to achieve it and to be established in Bulgaria.245 patients reported a change in their treatment. Of these: (30%) reduced the dose of their medications, 119 (49%) increased the dose and the remaining 55 (21%) stopped their therapy.From the responses of the respondents, it is clear that 71% have not experienced a change in their work during the COVID-19 pandemic, 17% have worked from home.From the responses of the respondents, it is clear that 71% have not experienced a change in their work during the COVID-19 pandemic, 17% have worked from home, 4% have been fired, 3% have left their jobs due to the risk of their health and 5% left their jobs for other reasons.ConclusionThe Covid-19 pandemic has shown that the digital transformation in rheumatology care can be an efficient alternative to some of the services offered to patients with rheumatic diseases in Bulgaria (especially secondary examinations and therapy monitoring examinations). The results of the conducted survey could be used to support digitization in healthcare in Bulgaria.Very important was the collaboration between the patient organizations and the Bulgarian Association for Musculoskeletal Ultrasound, Medical University, Plovdiv and the rheumatologists from University hospital "Kaspela” Plovdiv.References[1]Gianfrancesco M, Hyrich KL, Al-Adely S, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79: 859–66.[2]Monti S, Balduzzi S, Delvino P, Bellis E, Quadrelli VS, Montecucco C. Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies. Ann Rheum Dis 2020;79: 667–68.[3]Dejaco, C.;Alunno, A.;Bijlsma, J.W.;Boonen, A.;Combe, B.;Finckh, A.;Machado, P.M.;Padjen, I.;Sivera, F.;Stamm, T.A.;et al. Influence of COVID-19 pandemic on decisions for the management of people with inflammatory rheumatic and musculoskeletal diseases: A survey among EULAR countries. Ann. Rheum. Dis. 2020AcknowledgementsBul arian organization for people with rheumatic diseases.Association for patients with autoimmune diseases.Bulgarian Association for Musculoskeletal Ultrasound.Disclosure of InterestsNone Declared.

Improving Healthcare Facilities in Remote Areas Using Cutting-Edge Technologies

Healthcare is a critical field of research and equally important for all nations. Providing secure healthcare facilities to citizens is the primary concern of each nation. However, people living in remote areas do not get timely and sufficient healthcare facilities, even in developed countries. During the recent COVID-19 pandemic, many fatalities occurred due to the inaccessibility of healthcare facilities on time. Therefore, there is a need to propose a solution that may help citizens living in remote areas with proper and secure healthcare facilities without moving to other places. The revolution in ICT technologies, especially IoT, 5G, and cloud computing, has made access to healthcare facilities easy and approachable. There is a need to benefit from these technologies so that everyone can get secure healthcare facilities from anywhere. This research proposes a framework that will ensure 24/7 accessibility of healthcare facilities by anyone from anywhere, especially in rural areas with fewer healthcare facilities. In the proposed approach, the patients will receive doorstep treatment from the remote doctor in rural areas or the nearby local clinic. Healthcare resources (doctor, treatment, patient counseling, diagnosis, etc.) will be shared remotely with people far from these facilities. The proposed approach is tested using mathematical modeling and a case study, and the findings confirm that the proposed approach helps improve healthcare facilities for remote patients.

Features of the mental state of doctors of various specialties during the COVID-19 pandemic.

In the context of the COVID-19 pandemic, the burden on healthcare professionals at all levels has increased significantly, especially those who are at the forefront of the fight for patients' lives. Physicians directly caring for COVID-19 patients are exposed to excessive stress and significant biological and psychosocial risk. Objective. To identify the features of the mental state of doctors of various specialties during the COVID-19 pandemic. Material and methods. The study included 85 doctors of the Arkhangelsk region: 41 anesthesiologists/intensive care physicians (mean age 32.4+/-5.0 years) and 44 general practitioners (mean age 38.9+/-4.2 years). The study was conducted during the third wave of the COVID-19 pandemic (from May to June 2021). We used the following study methods: questionnaire, psychological testing (K. Maslach and S. Jackson Burnout Inventory (MBI), Beck's Depression Inventory, Perceived Stress Scale, World Health Organisation-Five Well-Being Index), mathematical and statistical processing of empirical data. Results and discussion. Analysis of the results showed that about half of the surveyed general practitioners and only 3 (7.3%) of the anesthesiologists/intensive care physicians had a history of COVID-19, having contracted it while performing professional duties. Manifestations of maladaptation, such as low professional competence, lack of soft skills, aggressiveness, introversion, risktaking, recklessness, and family problems, are more pronounced in anesthesiologists/intensive care physicians. They were more likely to have negative emotions and feelings, were less satisfied with themselves and life in general, and had a lower well-being index than general practitioners. General practitioners overestimated their professional burnout severity and more often complained about their state of health. Correlation analysis of the examination results for anesthesiologists/intensive care physicians allowed us to identify direct relationships between the level of perceived stress, overstrain and depression, low mood, difficulties in relationships with relatives and colleagues, dissatisfaction with various aspects of life, inverse relationships between the level of perceived stress and the well-being index. In general practitioners, direct relationships were established between perceived stress and overexertion, and inverse relationships were established between the level of perceived stress, the well-being index, and the reduction of personal achievements. Conclusion. The COVID-19 pandemic negatively impacts anesthesiologists/intensive care physicians more than general practitioners, causing negative emotions and maladaptation. In primary care physicians, the pandemic increases mobilization processes to address emerging professional challenges. Therefore, special attention should be paid to psychological support for anesthesiologists/intensive care physicians.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

Building Research Capacity in Primary Care Practices That Serve Predominantly Racial and Ethnic Minority Populations

In this commentary, we report on lessons learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The process of collaborating on research was mutually beneficial for a network of independent practices and a group of academic researchers. * The process benefited the practices by facilitating more precise thinking about quality improvement, motivating the staff, and enabling readiness for health system change. * The process benefited the researchers by illuminating nuances of clinical and organizational workflow and revealing the practices' in-depth understanding of the communities they serve. * If practices have more federally funded opportunities to consistently participate in research, it could help speed greater adoption of payment reform models to promote health equity at the state and national levels. _____ A 2021 National Academies of Sciences, Engineering, and Medicine report, Implementing High-Quality Primary Care, has called out the persistent "neglect of basic primary care research" in the United States.1 A 2020 study by the RAND Corporation found that primary care research represents only 1% of all federally funded projects (including projects funded by the National Institutes of Health, the Agency for Healthcare Research and Quality [AHRQ], and the Veterans Health Administration).2 However, innovation in primary care is central to advancing health care delivery. Leaders in health care innovation recently called for CMS to test a proposal for primary care payment reform in accountable care organizations (ACOs) composed of independent practices (ie, practices not owned by hospitals).3 By innovating in independent practices, these leaders argued that CMS would provide incentives for those practices to stay independent, thereby potentially decreasing the vertical market consolidation that contributes to rising health care costs.3 Yet these same practices may have less experience with the kind of systematic innovation that leads to generalizable insights, because what little funding is available for primary care research is mostly awarded to large academic medical centers.1 AHRQ's practice-based research networks have not fully addressed this gap, as they have struggled to find infrastructure and maintain funding.1 In this commentary, we report on the lessons we learned over 2 years (2020-2022) from conducting primary care research through a novel alliance of an ACO consisting of independent practices, a health plan, and several academic researchers, with the support of a private foundation. [...]ACPNY found that experience with research facilitates innovation and readiness for health system change (lesson 1C).

Empowering cultural change at North Manchester general hospital

ContextNorth Manchester General Hospital is a large District General Hospital in Greater Manchester, serving a relatively disadvantaged population. The overall culture change project involved practically all facets of a functioning medical organisation, including the Senior Medical Leadership Team (SMLT), Transformation team, Human Resources, Finance, and many more. However, one of the key aims of the change was to improve the experience of Junior Doctors working at NMGH. Therefore, postgraduate doctors in training have been key to all of the development, including the Medical Director's Leadership Fellow (MDLF), Junior Doctors' Leadership Group (JDLG), and every staff member that they represent.Issue/ChallengeHistorically, North Manchester General Hospital (NMGH) has had a reputation as a poor place to work;staff aimed to avoid the site. The hospital was unable to retain highly-skilled employees, and trainee experience was extremely low, impacting on patient safety metrics. The site was stuck in a continuous cycle of having this reputation, leading to an inability to attract permanent staff, causing a deficit in teaching and training opportunities, further diminishing the reputation.Rotational junior doctors are the most transient group of NHS healthcare workers (HCWs). Their experience is reflective of organisational culture and that of other, less vocal groups of HCWs. Prior to 2020, many junior doctors considered NMGH to be a ‘rite of passage' ‘ one to be avoided if possible, but if unavoidable, just get through it. On-call teams were chronically short-staffed, 3 services were in enhanced General Medical Council (GMC) monitoring, and GMC survey results were unsatisfactory. Teams were forced to be tenacious, lateral thinking, and resilient to cope with the stresses of work.2019 saw NMGH receive significant criticism from GMC and Health Education North West (HENW) monitoring visits. The General Surgery (GS) Department remained in ‘enhanced monitoring', and patient safety concerns were raised. These included inadequate ‘prescribing of admission medication', poor use of incident reporting systems, and challenges escalating sick patients. Trainees described ‘fire-fighting, not learning'. Improvement recommendations included addressing departmental culture, reinforcing the importance of incident reporting, and ensuring trainees had easy access to appropriate senior support at all times. Early in 2020, trainee experience further deteriorated in GS, due to a negative culture and deficiencies in support, education and training. This resulted in Foundation Year 1 doctors being removed from GS.The Senior Medical Leadership Team (SMLT) decided that enough was enough;the hospital culture needed a fundamental overhaul. There was a clear and urgent need to address staff experience.Assessment of issue and analysis of its causesThe Senior Medical Leadership Team (SMLT) set themselves an audacious goal: to support NMGH to transform into the best training and working experience for junior doctors in Greater Manchester. This goal was split into primary drivers, with each driver linked to specific future projects, and projects assigned to each leadership team member. These projects, identified through co-production with junior doctors, were aimed to improve employee experience, including facilitating access to breaks, improving supervision and support, and enhancing development opportunities â€' aiming to raise staff wellbeing and patient safety standards. Changes were made to General Surgery, resulting in huge investments in expanding the permanent junior doctor and consultant workforces.Several initiatives were implemented to help assess the scope of work required, including setting up a Junior Doctors' Leadership Group (JDLG), or ‘Shadow Board'. All hospital specialties are represented;some representatives sit on the SMLT, on Educational Board meetings, and the Clinical Leaders Forum. The SMLT join every JDLG meeting. Whilst acting as a conduit for rapid two-way communication between clinician and leadership teams (e.g. reliably informing doctors about last-minute changes to visiting policy during Covid surges, or effectively communicating crucial information to crash-call teams when building work closed part of the hospital), the group debates issues raised by junior doctor colleagues they represent, and feeds that back to the SMLT. Recent examples include raising patient safety concerns related to misinterpretation of the Emergency Department Referrals policy, and working collaboratively with junior doctors to address urgent staffing and patient safety risks related to the last wave of the pandemic.In addition to this, a Medical Director's Leadership Fellow (MDLF) role was established. This was fundamental in progressing projects related to the SMLT goal and ensuring appropriate input from junior doctors, Human Resources, the Communications and Transformation teams, and more. As a key member of the JDLG, the MDLF is a role designed in part to enhance junior doctor experience, foster better relationships between staff groups, and encourage feedback provision. The role has been vital in bridging the gap between doctors and hospital leaders, managers and executives – often a source of discontent amongst clinicians. Bridging this gap is important in developing the hospital's culture. Even though many projects are still ongoing, improvements are already being experienced.Impact2021 GMC Survey results showed improvement in 15/18 metrics compared to 2019. These included improvements in ‘Reporting Systems', ‘Workload', and ‘Clinical Supervision Out Of Hours'. 2020 Care Quality Commission inspection reports showed improvement in 11 individual aspects, including improvement to ‘outstanding' in 3 elements.HENW/GMC monitoring visits in 2021 reported ‘they have more robust teams to support the ward and on call workload', resulting from investment in clinicians. It also notes, ‘prescribing audits have shown improvements in prescribing of time critical medication', and demonstrable improvements in ‘use of incident reporting systems and sharing of lessons learnt'. Further comments note that there have been ‘significant improvements in culture in the [General Surgery] department over the past year';one doctor described the department as ‘the most supportive place he had worked'. The report summary noted, ‘through strong clinical leadership and oversight, and a concerted effort to improve departmental culture there have been significant improvements in General Surgical trainee experience with good support, supervision and education reported'. The department was subsequently removed from enhanced GMC monitoring.Although this rapid and impressive turnaround occurred within one department, benefits were seen elsewhere in the organisation.The efforts of the SMLT and JDLG have resulted in positive cultural changes. Surveys reflected: ‘friendly colleagues, less work-related stress, helpful management', and ‘thank you for your work to improve NMGH. I was worried about working at NMGH having heard ‘horror stories' about working there. However, these have not been reflected in reality at all, and NMGH has offered excellent training opportunities.InterventionThe JDLG helps ensure that important information is shared with the wider junior doctor group. Colleagues now feel that their voices are heard. The positives from the previous culture are still evident – leadership teams across the Trust have repeatedly recognised the ‘can-do attitudes' of NMGH staff, with the negative culture firmly in the past. Staff testimonials include: ‘there has definitely been an improvement over the years I have worked here;‘my supervisor was supportive and encouraged reflection through discussions about experiences;and ‘the senior staff are INCREDIBLE. They offer support, they teach, and they encourage us to learn new skills. I cannot be more thankful'. This is in contrast to historical Freedom To Speak Up (FTSU) submissions, which pointed to a culture of disregarding the opinions of NMGH staff.The ‘can-do' approach has been evident during the waves of Covid-19;members of the JDLG fed into management and governance structures to highlight problems in real time, increasing the organisation's responsiveness to challenges faced, working as a two-way conduit of information.During the 2021 HENW/GMC visit, the team reported that junior doctors knew the Medical Director and Director of Medical Education by first name, and felt able to raise concerns directly to them, evidencing a more flattened hierarchy. The visiting team reported being impressed by this positive change and were not aware of other organisations where this had been achieved to this extent.Having Postgraduate Doctors in Training play such a significant role within the Senior Leadership Team setup is relatively unique. As explained, empowering staff to feel they can raise any issues directly to the Medical Director or SMLT, or via the JDLG, has played a huge role in facilitating palpable cultural change through leadership structure additions. As a point of contact, the MDLF has acted as an extension of the JDLG, but works directly alongside the Medical Director and Associate Director of Medical Education, essentially enabling the SMLT to keep their ear to the ground, their fingers on the pulse of staff atmosphere and wellbeing.Examples of achievements of the MDLF include projects to introduce personalised theatre caps (benefits include enhanced communication, especially in emergencies, improving patient outcomes), formation of a Wellbeing group (representatives from all cohorts of staff across the site discuss wellbeing initiatives and colleagues' wellbeing concerns), and an impressive and rapid response to staffing crises and patient safety risks during the most recent Covid-19 wave. As a result of these outcomes, other Trusts haveapproached the SMLT, requesting further information regarding the JDLG and MDLF model;another MDLF has since been appointed at a different trust site.Involvement of stakeholders, such as patients, carers or family members:The SMLT itself is made up of clinicians from a variety of backgrounds, across medicine and surgery. SMLT members sit in morning medical handovers to actively gather clinician experience feedback. They also work closely alongside colleagues from Nursing, Finance, HR, Transformation teams, and more, which enables the SMLT to work collaboratively with the multidisciplinary team to improve culture at NMGH.The MDLF is in the perfect position to take advantage of this MDT approach. As a result, the MDLF sits on Group-level Patient Safety Panels (acting to highlight patient safety incidents, initiatives, and achievements across the entire Trust). This panel consists of representatives from hospital, community, and medical education staffing groups. The lessons learnt are then communicated to individual hospitals, no matter where the incident or initiative originated. A big part of the meeting is the FTSU aspect, and local FTSU Guardians are active within the panel.Given that the MDLF role is so closely linked to improving communication and feedback, a Freedom To Speak Up Champion role fitted well within the responsibilities of the post. Therefore, over the past year, the MDLF has worked alongside the FTSU team and has completed training as a FTSU Champion. As a consequence of working closely with shop-floor colleagues, the MDLF has received communications from a wide variety of staff roles and levels of seniority throughout the year, asking questions, or raising awareness about issues. The MDLF can then seek appropriate advice, signpost the colleague, and keep them updated on a potential resolution, further propagating the positive feedback loop and support of the wider MDT. As previously mentioned, the JDLG consists of representatives from all medical specialties, and each member is encouraged to raise concerns, suggest improvements, and lead on projects;these include an overhaul of the medical handover process, enabling a safer and more efficient handover, and escalating concerns of a coll ague speaking up about potential patient safety concerns within a department. Furthermore, speakers at JDLG meetings have included the Head of Nursing: Quality & Patient Experience, local FTSU Guardians, the Director of Human Resources, and the local Guardian of Safe Working Hours, enabling group members to share information from a wide range of disciplines with shop-floor colleagues. As a result of the efforts and MDT approach of the above groups, a placement feedback survey performed early in 2022 demonstrated that 93% of respondents felt their working environment supports a multidisciplinary approach.Key MessagesOne of the hallmarks of good medical leadership is putting all staff members, regardless of their role, seniority, or experience, in the best position for them to succeed. Giving Postgraduate doctors early opportunities to play a significant part in, and learn about, an organisation's leadership structure, is not only beneficial to the doctor, but helps the organisation capitalise on a previously relatively untapped market of ideas and solutions. Crucially, this is not limited to postgraduate doctors in training, but also locally-employed doctors, which make up a significant proportion of the workforce in any hospital yet typically remain underrepresented and under-utilised.NMGH has realised the potential that can be unlocked in Junior Doctors, through leadership placements and roles, and the positive benefit this can have on the individual, team and organisation.Lessons learntNorth Manchester General Hospital was fortunate in that the entire SMLT bought into everything: the overall project for culture change, the introduction of the MDLF into the SMLT, and empowering members of the JDLG to contribute to change at the highest level. Having spoken to other organisations looking to replicate our success, they have found that this buy-in is absolutely crucial. Recruiting effectively, to both the MDLF position and JDLG representative roles, is vital, as a huge amount of motivation to fight for change and the betterment of the system is required when overcoming barriers and challenges. Many of the barriers we faced are well-documented in literature, and to a point we expected them;these included resistance from non-medical stakeholders, which was somewhat abetted by further conversations, explanation of goals and objectives, and outlining the overall vision of the SMLT. Of course, resistance to change is important in any project, as it can highlight potential issues not yet visualised.Measurement of improvementFrom the start, we set out our intention to use openly-available, independent metrics of improvement, such as the GMC Nation Training Survey. To compliment this, the MDLF utilised a variety of temperature-check methods, including surveys (dissemination supported by the increasingly-established network of the Postgraduate doctors in training of the JDLG) and departmental visits. Importantly, having a fellow junior doctor asking for feedback, rather than a traditional member of the SMLT, enabled us to garner potentially more honest opinions, criticisms and ideas. As explained elsewhere, GMC survey results have shown improvement, and local surveys have displayed some very positive results. That said, it is recognised that the vision is a long-term project, and continuous improvement will be sought, rather than settling on the progress made thus far.Strategy for improvementThe SMLT sat down and brainstormed an overall vision alongside the individual large-scale projects that would contribute to achieving change. Within this, individual members of the SMLT were assigned roles leading one or more projects, and the MDLF role was created in part to support with the running of these projects where required. This enabled utilisation of the minds of the JDLG and other Postgraduate doctors in training. The MDLF role was instrumental in not only involving this cohort, but also reaching out to other organisations to share learned experiences when they had gone through implementation of similar projects. The team was kep accountable not by having a set timeline for implementation but by having regular away days, reporting back to their colleagues and the transformation team regarding progress.The JLDG, established in 2020, and reappointed every year, have been key to the success of the culture change, through engagement, sense-checking and feedback regarding strategy and relevant projects. Over time the organisation has increasingly engaged this Shadow Board in the development and role out of projects as well as problem solving of significant challenges. Through this team the SMLT has fedback key messages and challenges to the Junior Doctor workforce, which has resulted in increased engagement across the organisation.

The impact of perceived organizational support on professional commitment: a moderation of burnout and mediation of well-being

PurposeIn today's challenging world, achieving professional commitment among healthcare workers is becoming the need of time. Drawing on self-determination theory, the current study examines how and under which boundary conditions perceived organizational support affects professional commitment.Design/methodology/approachData was collected from doctors and nurses employed in public and private sector hospitals by employing a split-questionnaire design.FindingsThe authors' study findings demonstrate that perceived organizational support has a positive and indirect effect on the professional commitment of nurses and doctors via mediating the role of subjective well-being. The authors also found that these findings depend on healthcare workers' burnout levels. The positive relationship between perceived organizational support and subjective well-being is attenuated by burnout syndrome.Practical implicationsThe current study poses implications for policymakers and administrators of healthcare institutions as well as to develop a supportive culture to evoke more professional commitment among healthcare workers. Implications for nursing managers and policymakers are discussed in light of the study findings.Originality/valueHealthcare institutions are increasingly paying attention to raising the professional commitment of their workforce, especially in the wake of a crisis like the COVID-19 outbreak. The current study will add to the body of literature on nursing management, healthcare studies and organizational psychology in the South Asian context by explaining the relationship between POS and professional commitment, drawing on self-determination theory.

The Impact of COVID-19 on Africa: Health and Economic Implications

The novel coronavirus (2019-nCoV) presents a difficult journey ahead for public health sectors and economies of African. This chapter analyses Africa's public service infrastructure deficits while considering the health and macroeconomic implications of coronavirus for the continent. To assess Africa's national and continental disease outbreak preparedness, the available COVID-19 data is analyzed against several risk factors like physician availability, access to basic sanitation, and drinking water services derived from the World Health Organization and World Bank. The macroeconomic impact of the pandemic on the economies of African countries is explored with a focus on sectors such as merchandise trade, agriculture, tourism, and oil with current data. The analysis indicates serious gaps in access to adequate public health and how this has negative implications for economic stability. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

SCALE – critical care: collaborative leadership for improving health

ContextThe SCALE critical care project is a collaborative health workforce capacity and educational development initiative, between the Ministry of Health Uganda, and the NHS in the UK. The clinical leads are consultants in Anaesthesia and Intensive care from Cambridge, UK and Kampala, Uganda.Issue/ChallengeUganda faces a many challenges with the workforce in critical care, for both medical and nursing staff. There is significantly limited critical care training burdened with difficulties in retention of staff. In 2020 there were 1.3 ICU beds per million population, however this has been expanded as a result of the COVID 19 pandemic. There is now a need to ensure that skilled human resources are available to ensure functional critical care capacity and development of the speciality.The SCALE critical care project is structured around 3 co-dependent initiatives:A distance learning programme including online learning and medical grand roundsLong term placements in the UK for medical and nursing staffLong and short term placements for UK volunteers, with a focus on practical support and educational deliveryAssessment of issue and analysis of its causesKey stakeholders include senior intensive care doctors leading the development of critical care in Uganda and Cambridge, the Ugandan Ministry of Health, the Uganda UK Health Alliance (UUKHA) and many other partners including RCOA, Association of Anesthesiologists of Uganda, Health Education England and Cambridge Global Health Partnerships.There have been reciprocal visits on both sides, including the permanent secretary for health visiting Cambridge in April 2022. During the UK team’s visit to Uganda we were able to gain a broad understanding of critical care delivery, meeting nurses, doctors on the unit to senior hospital directors at a range of hospitals in both Kampala and Mbarara.ImpactAnticipated long term benefits include increased critical care staffing experience, capacity and job satisfaction. Improvement in multidisciplinary working (training of doctors and nurses is occurring in parallel, involvement of physiotherapy and biomedical engineering also proposed).Ultimately, we hope that in the future this work will be characterised by improved patient outcomes and reduced mortality as well as development of research capacity alongside the clinical aspects of the project.InterventionThere has been development of leadership and management for both sides of the partnership at many levels. The junior members of the team are able to participate in high level discussions and gain an understanding of how sustainable and reciprocal partnerships are developed and evolve. The more senior leaders are able to learn from healthcare in another culture, and mentorship of the future healthcare leaders in critical care.Involvement of stakeholders, such as patients, carers or family members:Patients are not currently directly involved in the project.Key MessagesSustainable partnerships require investment from senior leaders in order to develop and affect meaningful change.Development of critical care capacity through clinical training, leadership and research will ensure that patients will benefit not just from access to critical care, but from the wider benefits to healthcare that result, in Uganda as well as in the UK through the development of clinical, leadership and teaching skills volunteers will experience.Lessons learntUndertaking such an ambitious programme requires a large time commitment from senior leaders on both sides of the partnership at a time when healthcare resources are stretched. Whilst much time is volunteered, the support of the hospitals and governments has been critical to the success and sustainability of the project.Measurement of improvementOutput measurement will include increase in critical care workforce numbers in Uganda, with a plan 6-10 MTI doctors to be hosted by Cambridge University Hospitals.We collect feedback from the grand rounds and seek to improve content and delivery accordingly.Publication of novel research from Uganda will be a lo ger term measurement once the research strand of the partnership is developed.Strategy for improvementThe first MTI doctor is due to arrive in the UK late in 2022;there will be ongoing training â€' both clinical intensive care medicine, but also in other critical areas such as leadership and management training. The doctors who undergo the MTI training will return to Uganda to be the future leaders and drivers of intensive care medicine training.The SCALE Critical Care project is truly collaborative. Training of doctors alone will not lead to meaningful or sustainable development â€' training of the multidisciplinary team including nurses and physiotherapists is a critical part of the project.

COVID-19 Pandemic Learning: The Uprising of Remote Detailing in Pharmaceutical Sector Using Sales Force Automation and Its Sustainable Impact on Continuing Medical Education

The availability of resources is vital when rapid changes and updated medical information in the provision of care are needed, such as in the fight against COVID-19, which is not a conventional disease. Continuing medical education plays an essential role in preparing for and responding to such emergencies. Workflow has improved based on the virtual meetings, online trainings, and remote detailing conducted by medical representatives in order to deliver educational content instantly through digital tools, such as salesforce automation (SFA), webinars, etc. In terms of its regulatory barriers, the pharmaceutical industry mainly targets healthcare professionals, unlike most businesses that reach end users directly. Medical representatives are equipped with an SFA to enhance customer relationship management (CRM) and closed loop marketing (CLM) capabilities in pharmaceutical companies. This study aimed to fill a gap in the literature by investigating the use of SFA in work patterns, such as health professionals' loyalty and involvement in their medical knowledge in Turkey, and how it allows for differentiating training from marketing. This study intended to compare the data on internists and medical products gathered from a well-known pharmaceutical company's SFA. The data covered the first three months of the year 2020, when medical representatives had a normal daily routine, and that of 2021, when Turkey experienced the most powerful surge of the COVID-19 pandemic. The analysis was based on simple correspondence analysis (SCA) and multiple correspondence analysis (MCA) for 11 variables. Monitoring product, physician's segment, and medical representatives' behaviors with SFA had a significant influence on the pharma-physician relationship strategy, as expected. The findings supported the view that SFA technologies can be deployed to advance the medical knowledge of physicians, in addition to managing and designing superior CRM and CLM capabilities.

Symptoms Predicting SARS-CoV-2 Test Results in Resident Physicians and Fellows in New York City

Accurate prediction of SARS-CoV-2 infection based on symptoms can be a cost-efficient tool for remote screening in healthcare settings with limited SARS-CoV-2 testing capacity. We used a machine learning approach to determine self-reported symptoms that best predict a positive SARS-CoV-2 test result in physician trainees from a large healthcare system in New York. We used survey data on symptoms history and SARS-CoV-2 testing results collected retrospectively from 328 physician trainees in the Mount Sinai Health System, over the period 1 February 2020 to 31 July 2020. Prospective data on symptoms reported prior to SARS-CoV-2 test results were available from the employee health service COVID-19 registry for 186 trainees and analyzed to confirm absence of recall bias. We estimated the associations between symptoms and IgG antibody and/or reverse transcriptase polymerase chain reaction test results using Bayesian generalized linear mixed effect regression models adjusted for confounders. We identified symptoms predicting a positive SARS-CoV-2 test result using extreme gradient boosting (XGBoost). Cough, chills, fever, fatigue, myalgia, headache, shortness of breath, diarrhea, nausea/vomiting, loss of smell, loss of taste, malaise and runny nose were associated with a positive SARS-CoV-2 test result. Loss of taste, myalgia, loss of smell, cough and fever were identified as key predictors for a positive SARS-CoV-2 test result in the XGBoost model. Inclusion of sociodemographic and occupational risk factors in the model improved prediction only slightly (from AUC = 0.822 to AUC = 0.838). Loss of taste, myalgia, loss of smell, cough and fever are key predictors for symptom-based screening of SARS-CoV-2 infection in healthcare settings with remote screening and/or limited testing capacity. [ FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Q&A

In this interview, Jody Casey, vice president, healthcare partnerships at EUigo Health Research, highlights how the pandemic has put the spotlight on diversity in trials, how EUigo is working with physicians to make studies more accessibie, as well as what is in store for the future of appropriate representation in trials. There needs to be a greater breadth of population and diversity in trials. Because a COVID vaccine is so critically important for all Americans, it's been brought to light the fact that trials are generally lacking in diversity. Casey: A unique aspect of Elligo is that we securely access electronic health record (EHR) data from our physician partners.

Bringing Clinical Trials to the Point of Care

Tryon Medical Partners, based in Charlotte, North Carolina, is a fairly new practice, which broke off from a nearby hospital system approximately three years ago. Overall, the patient does enjoy the experience and when integrated with primary care and their own PCPs, I think clinical trial retention rates are higher because of the attention from their provider." Grayson also sees that the patients are excited to participate when asked, and spread the word to friends and family. Because of the practice population, and history of underrepresentation, Grayson believes that the clinical research information and understanding for them is enlightening.

Covid-19: Questions of conscience and duty for scientific advisers

England is abandoning lockdown and possibly hope of containing a second wave of covid-19. From 1 June schools will open to children other than those of key workers. Outdoor markets and car showrooms will reopen. In two weeks, it will be the turn of all non-essential retailers. This is meant to be a moment of optimism, a green recovery, centred on the health of people and the planet (doi:10.1136/bmj.m2077, doi:10.1136/bmj.m2076), backed by an effective system of testing and contact tracing and possibly informed by a public inquiry (doi:10.1136/bmj.m2052).Instead, England arrives here in a state of utter confusion (doi:10.1136/bmj.m1785). The public's confidence in the official lockdown advice is shaken. The covid-19 response is short on testing, uncertain on contact tracing, and reliant on unreliable apps (doi:10.1136/bmj.m2085). Scotland, Wales, and Northern Ireland are not following England's lead. The UK has the second highest number of covid-19 deaths of any nation and, by some calculations, the most deaths per capita.

Will the COVID-19 cloud change pediatric medicine forever?

With the United States still in the throes of a pandemic, nearly 400 pediatric health care providers share their struggles in getting patients back to the office, advocating for a COVID-19 vaccine, and working their way toward optimism in the face of the biggest health care challenge of their lives. [...]although the reasons around the pessimism remained the same in both 2013 and 2019 (insufficient time with patients, inadequate reimbursement, and health care reform), this year-no surprise-the top reason was concerns about adequately treating patients with COVID-19 and multisystem inflammatory syndrome in children (MIS-C). In 2019, when asked what the top 2 challenges to their practice were, 45% of health care providers said transitioning to electronic health records (EHRs) and dealing with insurance (42%) were the greatest obstacles.