Conflict in the EMS Workforce: An Analysis of an Open-Ended Survey Question Reveals a Complex Assemblage of Stress, Burnout, and Pandemic-Related Factors Influencing Well-Being.

Emergency Medical Services (EMS) clinicians provide patient care within a high-stakes, unpredictable, and complex work environment in which conflict is inevitable. Our objective was to explore the extent to which added stressors of the pandemic exacerbated EMS workplace conflict. We administered our survey to a sample of U.S. nationally certified EMS clinicians during the COVID-19 pandemic in April 2022. Out of 1881 respondents, 46% (n = 857) experienced conflict and 79% (n = 674) provided free-text descriptions of their experience. The responses were analyzed for themes using qualitative content analysis, and they were then sorted into codes using word unit sets. Code counts, frequencies, and rankings were tabulated, enabling quantitative comparisons of the codes. Of the fifteen codes to emerge, stress (a precursor of burnout) and burnout-related fatigue were the key factors contributing to EMS workplace conflict. We mapped our codes to a conceptual model guided by the National Academies of Sciences, Engineering, and Medicine (NASEM) report on using a systems approach to address clinician burnout and professional well-being to explore implications for addressing conflict within that framework. Factors attributed to conflict mapped to all levels of the NASEM model, lending empirical legitimacy to a broad systems approach to fostering worker well-being. Our findings lead us to propose that active surveillance (enhanced management information and feedback systems) of frontline clinicians' experiences during public health emergencies could increase the effectiveness of regulations and policies across the healthcare system. Ideally, the contributions of the occupational health discipline would become a mainstay of a sustained response to promote ongoing worker well-being. The maintenance of a robust EMS workforce, and by extension the health professionals in its operational sphere, is unquestionably essential to our preparedness for the likelihood that pandemic threats may become more commonplace.

Cognitive bias in the context of epidemic

In connection with the scope and duration of the COVID-19 pandemic, the clinical judgement of clinicians and medical practitioners could be influenced such that diagnostic errors (delays and inaccuracies) may ensue. We hereby recall through two clinical scenarios the constant need for practitioners to take a step back in reflecting of the diagnostic process to avoid the <<tunnel effect>> which may result in delaying common and frequent infectious diseases. The flu-like symptoms presented by these patients (fever, myalgia and asthenia...) quickly prompted our emergency room colleagues to suspect SARS-CoV-2 infection. However, further investigations including imagery and blood cultures revealed completely different but common infectious disease conditions, which are potentially fatal.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Low Adoption of Video Consultations in Post-COVID-19 General Practice in Northern Europe: Barriers to Use and Potential Action Points.

In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.

Patient Experiences with and Preferences for Telemedicine Relative to In-Person Care During the COVID-19 Pandemic.

Introduction: Although telemedicine emerged during the COVID-19 pandemic as a critical mode of health care delivery, there may be differences in the perceived ease of patient-clinician communication and quality of care for telemedicine versus in-person visits, as well as variation in perceptions across patient subgroups. We examined patients' experiences with and preferences for telemedicine relative to in-person care, based on their most recent visit. Methods: We conducted a survey of 2,668 adults in a large academic health care system in November 2021. The survey captured patients' reasons for their most recent visit, perceptions on patient-clinician communication and quality of care, and attitudes toward telemedicine versus in-person care. Results: Among respondents, 552 (21%) had a telemedicine visit. Patients with telemedicine and in-person visits had similar agreement on ease of patient-clinician communication and perceived quality of the visit on average. However, for individuals 65 years of age or older, men, and those not needing urgent care, telemedicine was associated with worse perceptions of patient-clinician communication (65 years of age or older: adjusted odds ratio [aOR], 0.51; 95% confidence interval [CI], 0.31-0.85; men: aOR, 0.50; 95% CI, 0.31-0.81; urgent care: aOR 0.67; 95% CI, 0.49-0.91) and lower perceived quality (65 years of age or older, aOR 0.51; 95% CI, 0.30-0.86; men: 0.51; 95% CI, 0.32-0.83; urgent care: aOR 0.68; 95% CI, 0.49-0.93). Conclusion: Patient-perceived quality of care and patient-clinician communication were similar for telemedicine and in-person visits overall. However, among men, older adults, and those not seeking urgent care, patients using telemedicine had lower perceptions of patient-clinician communication and quality.

Dying in isolation

Palliative care is a nursing and medical specialty focused on providing comfort to those with chronic, life-limiting illness from diagnosis to the end of life through symptom management, aligning goals of care, and providing psychosocial/spiritual support. During the COVID-19 pandemic, millions experienced new, rapid symptoms and many faced untimely deaths. As experts in end-of-life care, palliative care clinicians played a vital role in pandemic care. Yet, the delivery of palliative care required significant adjustments due to visitor restrictions and isolation precautions. These changes included, but are not limited to, communication styles, involvement of family in symptom management, and adoption of telehealth. Throughout pandemic care, palliative care clinicians were also helping patients, families, and clinicians navigate a multitude of ethical decisions, including supporting frontline healthcare workers. This chapter focuses on palliative and end-of-life issues during the COVID-19 pandemic. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

I am surprised that it works so well”: clinicians' views on delivering psychological assessments and therapy to young people in a fully-digital mental health service

Purpose: Many mental health clinicians have delivered services digitally in response to the COVID-19 pandemic. Emerging research suggests that, despite some initial discomfort, therapists appear to adjust to remote working. The purpose of this study is to explore the views of clinicians working within a fully digital organisation towards digital service provision. Design/methodology/approach: Clinicians (N = 52) providing digital mental health assessments and treatments at Healios anonymously completed a mixed-methods questionnaire. Findings: In all, 85% of participants enjoyed working remotely and 71% thought they would continue to work online over the next 5–10 years. Of the participants, 40% reported low confidence in online work's efficacy before working remotely, but 96% reported confidence at the time of questionnaire completion: suggesting confidence increased with experience. An exploratory "inverted” factor analysis generated a two-factor solution, grouping clinicians into two factors based on key views. Factor 1 was predominantly characterised by satisfaction with training received and factor 2 by quality of technical experiences (encountering problems less often and greater personal confidence in resolving them). Qualitative feedback described some benefits of, and barriers to, digital service provision. Clinicians reflected on a perceived change in cultural norms, with more openness to digital services following the COVID-19 pandemic. On a personal level, teletherapy was viewed more favourably with increased personal experience. Originality/value: Clinicians' confidence in providing services digitally is discussed, with reference to how this may be affected by extent of remote working experience and availability of technical support. Staff well-being within the digital workspace is also discussed. © 2023, Emerald Publishing Limited.

clinical-laboratory interaction in the diagnosis of autoimmune neurological conditions: focus on the coVid-19 pandemic.

The interaction between clinic and laboratory is crucial for the diagnostic process of neurological disorders, in particular in patients with autoimmune/inflammatory conditions. In these conditions, different diagnostic assays with specific sensitivity and specificity are available. Many laboratories use commercial assays based on line-blot techniques (for the detection of antibodies to intracellular antigens, such as Hu and Yo) or fixed cell-based-assays (for the detection of antibodies to surface antigens such as NMDAR or LGI1 or to oligodendrocytes-MOG- or astrocytes-AQP4). However, assays with higher sensitivity, such as live CBA or immunohistochemistry on rat brain/cerebellum are available and allow the detection of additional antibodies, also to unknown antigens, by evaluating specific patterns of positivity. In this context, the continuous interaction between clinicians and laboratory physicians is necessary to guide antibody testing and select those cases which need additional advanced investigations. This concept was even more relevant during the COVID-19 pandemic, which led to an increase of samples referred to reference laboratories, in particular from patients with encephalitis or myelitis, for whom the differential diagnosis between an infectious vs. postinfectious vs. inflammatory vs. autoimmune process was challenging. The interaction between clinicians and laboratory physicians in this area focused on solving some important questions, and in particular: 1) to understand whether SARS-CoV-2 infection could cause autoimmune neurological diseases;2) to clarify the course of SARS-CoV-2 infection in patients with autoimmune neurological diseases;3) to understand if vaccines could induce autoimmune neurological diseases;and 4) to understand the effect of vaccination in patients with autoimmune neurological diseases. The constant scientific exchange between the various professional figures led to an improvement of the diagnostic process of these neurological disorders, with a significant impact on patients' prognosis and quality of life.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Tele-Balint under the microscope: What really happens in Tele-Balint groups?

OBJECTIVE: Balint groups provide a safe space for clinicians to discuss difficult cases, with the aim of deepening the clinician-patient relationship and providing space for self-introspection and personal development. During this COVID-19 period, mental health clinicians need a platform to undergo professional supervision and peer learning sessions, which can be provided for by Tele-Balint sessions. This study aims to understand the workings of Balint groups in a multi-disciplinary team, through exploring the experience and perceptions of mental health clinicians in a tertiary obstetrics- and paediatrics-focused hospital in Singapore towards Tele-Balint groups, and examining if these groups can address their professional needs. METHOD: A mixed-methods study was conducted. 26 mental health clinicians who had participated in Tele-Balint groups since March 2020 completed a semi-structured questionnaire, and 12 of them were interviewed. Qualitative analysis of interview transcripts was performed. RESULTS: Qualitative analysis revealed 5 themes. The first 4: professional and personal growth of clinicians, providing emotional support to clinicians, burnout in clinicians: what contributes and what helps, and psychological safety, address whether Tele-Balint groups meet clinicians' needs. The last theme, evolution of nature of Balint groups, addresses whether Tele-Balint groups meet clinicians' needs during the time of a pandemic. CONCLUSIONS: Tele-Balint group participation was found to be beneficial in facilitating personal and professional growth, providing emotional support and preventing burnout, despite some limitations. Members should maintain flexibility towards the Balint process, in order to accommodate others who have differing needs, especially in a multi-disciplinary group.

Telemedicine or In-Person: Referral Letter Content Influencing How a Patient Receives Treatment.

Objective: This study investigated hospital-based specialist services that provide both traditional hospital outpatient appointments (in-person) or through a live videoconferencing session (telehealth) to referred patients. Referral letters submitted to these clinics were assessed against an inclusion criterion and grouped according to which of delivery method the patient received for their appointment (in-person or telehealth). These groups were then compared for differences to see what factors, if any, influence the likelihood of a patient being offered a telehealth appointment. Methods: An extract of all referral letters meeting inclusion criteria between July 01, 2019 and June 30, 2020 were collected (n = 441). Letters were grouped according to delivery modality (in-person or telehealth) and differences between the groups, including variables such as patient demographics, clinical condition, and urgency and the reviewing clinician were assessed for associations. Results: This study observed that where the referring clinician suggested a telehealth appointment for their patient, this was more likely to be offered (38.25%) compared with referrals that did not (7.36%) (x 2 1 = 28.33, p = 0.1857, odds ratio = 2.77). Patients were more likely to be offered a telehealth appointment the further they lived from the treating facility (T = -4.51 on 106.59 df, p = 1.622 e-05). Variation in the selection of delivery modality among reviewing clinicians was also observed (x 2 1 = 42.334, p < 1.42e-08). Discussion: Existing research indicates there is a strong link between the perceptions clinicians as individuals have of telehealth and a willingness to offer this modality to patients. Despite this, specific information about a patient contained within a referral letter may influence the delivery modality that the patient will be offered for their initial appointment. It is important that this information is more routinely included in letters sent by referring clinicians to hospital-based specialist services. It is equally important that when included, this information is identified and actioned by reviewing clinicians in a consistent way. Doing so will benefit patients by increasing the likelihood that they will receive specialist outpatient care in a manner that suits them best.

Routine disclosure statements about ultrasound examinations during Covid-19 pandemic are unhelpful and should be avoided

Various routine disclosure statements relating to the performance of ultrasound (US) during the COVID-19 pandemic are finding their way into radiology reports. These statements usually suggest that US examinations during the pandemic, or on a COVID-19 positive patient, are somehow limited and urge the clinicians to reflect on these considerations when accepting radiology reports. However, such disclosure statements are generally unhelpful to clinicians and are not consistent with the realities of current clinical US practice. This article provides a critique of these disclosure statements and concludes by discouraging sonographers and radiologists from making such statements as a routine part of their clinical ultrasound reports. © 2021 Australasian Sonographers Association

High-performance association rule mining: Mortality prediction model for cardiovascular patients with COVID-19 patterns

On a global scale, 213 countries and territories have been affected by the coronavirus outbreak. According to researchers, underlying co-morbidity, which includes conditions like diabetes, hypertension, cancer, cardiovascular disease, and chronic respiratory disease, impacts mortality. The current situation requires for immediate delivery of solutions. The diagnosis should therefore be more accurate. Therefore, it's essential to determine each person's level of risk in order to prioritise testing for those who are subject to greater risk. The COVID-19 pandemic's onset and the cases of COVID-19 patients who have cardiovascular illness require specific handling. The paper focuses on defining the symptom rule for COVID-19 sickness in cardiovascular patients. The patient's chronic condition was taken into account while classifying the symptoms and determining the likelihood of fatality. The study found that a large proportion of people with fever, sore throats, and coughs have a history of stroke, high cholesterol, diabetes, and obesity. Patients with stroke were more likely to experience chest discomfort, hypertension, diabetes, and obesity. Additionally, the strategy scales well for large datasets and the computing time required for the entire rule extraction procedure is faster than the existing state-of-the-art method. © 2023 Faculty of Engineering, Alexandria University

Post-COVID-19 condition in children.

Post - COVID - 19 condition in children refers to the presence of physical symptoms or syndromes lasting more than 12 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which can be manifested as a combination of various signs and symptoms. Girls,school - aged,adolescents,and children with severe illness in the acute phase of COVID - 19 ,with underlying allergic diseases and poor baseline physical and mental health are high - risk factors for post - COVID - 19 condition in children. Pathogenesis may be related to viral persistence, autoimmunity, chronic inflammatory responses, chronic inflammation of vascular endothelial cells, and microthrom-bosis. A comprehensive treatment scheme including symptoms relieving treatment, rehabilitation, and psychological support. This article reviews the epidemiology, clinical manifestations, pathogenesis, diagnosis, treatment, and management of the post - COVID - 19 condition in children to improve clinicians' comprehension of the disease.Copyright © 2022 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.

A living WHO guideline on drugs for covid-19

Clinical question What is the role of drug interventions in the treatment and prevention of covid-19? Recommendations The first version on this living guidance focuses on corticosteroids. It contains a strong recommendation for systemic corticosteroids in patients with severe and critical covid-19, and a weak or conditional recommendation against systemic corticosteroids in patients with non-severe covid-19. Corticosteroids are inexpensive and are on the World Health Organisation list of essential medicines. How this guideline was created This guideline reflects an innovative collaboration between the WHO and the MAGIC Evidence Ecosystem Foundation, driven by an urgent need for global collaboration to provide trustworthy and living covid-19 guidance. A standing international panel of content experts, patients, clinicians, and methodologists, free from relevant conflicts of interest, produce recommendations for clinical practice. The panel follows standards, methods, processes, and platforms for trustworthy guideline development using the GRADE approach. We apply an individual patient perspective while considering contextual factors (that is, resources, feasibility, acceptability, equity) for countries and healthcare systems. The evidence A living systematic review and network meta-analysis, supported by a prospective meta-analysis, with data from eight randomised trials (7184 participants) found that systemic corticosteroids probably reduce 28 day mortality in patients with critical covid-19 (moderate certainty evidence;87 fewer deaths per 1000 patients (95% confidence interval 124 fewer to 41 fewer)), and also in those with severe disease (moderate certainty evidence;67 fewer deaths per 1000 patients (100 fewer to 27 fewer)). In contrast, systemic corticosteroids may increase the risk of death in patients without severe covid-19 (low certainty evidence;absolute effect estimate 39 more per 1000 patients, (12 fewer to 107 more)). Systemic corticosteroids probably reduce the need for invasive mechanical ventilation, and harms are likely to be minor (indirect evidence). Understanding the recommendations The panel made a strong recommendation for use of corticosteroids in severe and critical covid-19 because there is a lower risk of death among people treated with systemic corticosteroids (moderate certainty evidence), and they believe that all or almost all fully informed patients with severe and critical covid-19 would choose this treatment. In contrast, the panel concluded that patients with non-severe covid-19 would decline this treatment because they would be unlikely to benefit and may be harmed. Moreover, taking both a public health and a patient perspective, the panel warned that indiscriminate use of any therapy for covid-19 would potentially rapidly deplete global resources and deprive patients who may benefit from it most as potentially lifesaving therapy. Updates This is a living guideline. Work is under way to evaluate other interventions. New recommendations will be published as updates to this guideline. Readers note This is version 1 of the living guideline, published on 4 September (BMJ 2020;370:m3379) version 1. Updates will be labelled as version 2, 3 etc. When citing this article, please cite the version number. Submitted August 28 Accepted August 31Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to.

Exploring Clinician Attitudes Towards Treating Eating Disorders: Bridging Counselor Training Gaps

Eating disorder (ED) clinicians may face various challenges in practice, including burnout and feelings of incompetence. Several deficits may contribute to these challenges, such as graduate education and treatment gaps. In this study, 109 interdisciplinary clinicians were surveyed regarding their personal attitudes, experiences, and challenges in treating EDs. Among the various results, quantitative and qualitative findings highlighted the lack of graduate education as the primary challenge to effectively treating EDs, as well as the need for more ED research and culturally responsive care. Recommendations to enhance ED education and counselor training are provided, including managing countertransference and advocating for specialized coursework. Lastly, critical directions for future research are discussed.

Use of a webinar series to improve exposure to oral & maxillofacial surgery during a global pandemic

Exposure to OMFS at undergraduate level is rare. Students seeking such exposure often struggle to access important information that would help them decide about a future career in OMFS. The COVID-19 pandemic has made access to such information, for example career workshops and specialty conferences, more difficult. This paper discusses our experiences of setting up an online webinar series aimed at providing practical advice for undergraduates and early trainees interested in the field of OMFS. Clinicians were approached via email and/or social media to deliver a structured programme of key advice and guidance about OMFS. Individual undergraduate and surgical societies were emailed in order to advertise the series which included talks such as 'Week in the Life', 'Subspecialties' and 'Portfolio Building'. An interactive poster containing a Quick Response code was circulated to allow a streamlined registration process. The seminars were held via Zoom videoconferencing software and feedback collated via Typeform using a Likert-scale questionnaire. On average, the webinars were 60 minutes long and each attracted 53 attendees. The series attracted 183 unique participants. The majority of attendees were dental students and 85% were based in the UK. Overall, 94% felt their knowledge of the specialty had improved and 86% were more likely to consider pursuing OMFS as a career as result of the series. This paper shows that videoconferencing is a useful modality to engage with junior trainees and has a wide reach. These benefits must be harnessed going forward to improve access and exposure to OMFS in early trainees.Copyright © 2022 The Authors

A case study of the well-being of clinicians who counsel family suicide survivors

Counseling suicide survivors can result in occupational hazards for clinicians involved with this population. This dissertation aimed to investigate how clinicians who work with familial survivors of suicide experience well-being outside of the treatment room. The purpose of this study was to investigate how these particular clinicians experience and practice well-being in their own time, outside of the treatment context. The research question sought to answer was how clinicians who counsel familial suicide survivors experience well-being. The case study focused on psychologists, marriage and family therapists, licensed professional counselors, and clinical social workers. The methodology applied in this study was qualitative case study. The study was conducted amidst the COVID-19 pandemic, thus prohibiting the interview process from being conducted in the clinicians' natural setting. The researcher modified the design to allow video interviews. The sample consisted of nine clinicians who met the inclusion criteria participated in the exploration process. The results of this study were the emergence of patterns in the within-case analysis of the data collected constituted efforts for well-being. Inductive reasoning discussed in the clinicians' responses described their understanding of well-being related to self-efficacy and prevention of work-related vicarious exposures. The cross-case analysis provided five major themes: (a) competence in the clinician role, (b) developing protective factors and strategies to avoid secondary trauma, (c) grounded in a spiritual foundation, (d) using peer support, and (e) intentional self-care. The themes concluded findings consistent with the PERMA well-being theory and that the practice for well-being impacts how clinicians provide effective treatment, balance work and home life, and maintain career longevity. (PsycInfo Database Record (c) 2023 APA, all rights reserved)