Race to the Summit: Impact of a Social Media-based Exercise Competition on Physician Physical, Psychological, and Emotional Well-being

Background In the wake of the COVID-19 pandemic and with increasing non-clinical demands on physician time and effort, the health care community is experiencing disproportionate rates of burnout. Oncologists, specifically, frequently endure challenging situations of caring for terminally ill patients who require emotional support along with intricate medical care. In response, various well-being initiatives for physicians have emerged, predominantly focusing on education or wellness opportunities. However, most these programs are institution-based and not accessible to the physician community as a whole. The effect of physical exercise, particularly team-based activity, on physician well-being and burnout has been postulated but not rigorously studied. We therefore seek to formally investigate whether team-based exercise programs can facilitate collective well-being by enabling physicians to address burnout collectively rather than individually. Methods This prospective study will involve the two-month voluntary team-based multi-sport competition, ACRO Race to the Summit, which will track total exercise minutes logged across various forms of physical activities during the racing period of January 1st, 2023- February 28th, 2023. A pre/post survey design will be used to investigate the potential impact of such collective activity on radiation oncology physician well-being. Included in both surveys, a set of 25 multiple-choice questions based on the validated Stanford Medicine well-being survey and the IPAQ (International Physical Activity Questionnaire) will focus on physical activity level and psychological and emotional well-being in the work place. The post-race survey will include additional questions meant to evaluate participants' perceived impact of the competition on these categories. Results Primary endpoints will assess change in pre- and post-survey metrics related to level of physical activity, and psychological and emotional well-being at work. Secondary endpoints will examine perceived value of team-based exercise in cultivating well-being. Discussion We anticipate that the results from this survey may inform commentary on the role of collective, inclusive exercise as a tool to combat physician burnout. Moreover, the study may provide insight into existing trends in physical activity, and psychological and emotional well-being in the radiation oncology community. Formation of and investment in non-institution, non-work related teams may prove to be a unique means of addressing burnout by strengthening a sense of community within the field as a whole.

Metformin reduces SARS-CoV-2 in a Phase 3 Randomized Placebo Controlled Clinical Trial (preprint)

Current antiviral treatment options for SARS-CoV-2 infections are not available globally, cannot be used with many medications, and are limited to virus-specific targets.1-3 Biophysical modeling of SARS-CoV-2 replication predicted that protein translation is an especially attractive target for antiviral therapy.4 Literature review identified metformin, widely known as a treatment for diabetes, as a potential suppressor of protein translation via targeting of the host mTor pathway.5 In vitro, metformin has antiviral activity against RNA viruses including SARS-CoV-2.6,7 In the COVID-OUT phase 3, randomized, placebo-controlled trial of outpatient treatment of COVID-19, metformin had a 42% reduction in ER visits/hospitalizations/death through 14 days; a 58% reduction in hospitalizations/death through 28 days, and a 42% reduction in Long COVID through 10 months.8,9 Here we show viral load analysis of specimens collected in the COVID-OUT trial that the mean SARS-CoV-2 viral load was reduced 3.6-fold with metformin relative to placebo (-0.56 log10 copies/mL; 95%CI, -1.05 to -0.06, p=0.027) while there was no virologic effect for ivermectin or fluvoxamine vs placebo. The metformin effect was consistent across subgroups and with emerging data.10,11 Our results demonstrate, consistent with model predictions, that a safe, widely available,12 well-tolerated, and inexpensive oral medication, metformin, can be repurposed to significantly reduce SARS-CoV-2 viral load.

Multitasking as Consumer Compensatory Control

Consumer multitasking (i.e. working on multiple tasks simultaneously) is a widespread modern phenomenon, yet the literature lacks an understanding of when and why consumers multitask. We experimentally show that consumers engage in multitasking behavior as a way to compensate for feelings of low control. Specifically, across five main studies and seven web appendix studies using two different multitasking paradigms, we find that consumers feeling low (vs. high) control volitionally choose to multitask more on subsequent tasks, rather than do the tasks sequentially (i.e. one task at a time). Mediation and moderation evidence demonstrate that this effect is driven by increased motivations to use time resources efficiently for those feeling low (vs. high) control. We also find that multitasking generally results in suboptimal consumer decision-making and decreased task performance. An intervention that altered consumer lay beliefs regarding multitasking and time efficiency was effective in lowering multitasking behavior for consumers experiencing low control during the COVID-19 pandemic. By investigating a cause of consumer multitasking and the underlying mechanism, our studies contribute to research on consumer multitasking, perceptions of control, and resource allocation with important implications for advertisers and marketing managers. [ABSTRACT FROM AUTHOR] Copyright of Journal of Consumer Research is the property of Oxford University Press / USA 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

Use of robotic process automation (RPA) for rapid analysis and interpretation of multidrug resistant organisms and COVID-19 results

Introduction: The IPC (Infection Prevention & Control) nurses workload had trebled in the last 5 years due to increased number of patients diagnosed with known Multi Drug Resistant Organisms (MRDOs). IPC nurse resources were saturated with downloading and processing essential microbiology results from an old laboratory system. The potential for human error whilst collating the microbiology results from the laboratory system was moderate as some parts of the process required items to be transcribed. Objectives: 1. To employ Robotic Process Automation (RPA) to lift the burden of repetitive tasks from IPC team and reduce the significant amount of time spent on daily processing of lab results and administrative work. 2. Redirect the specialist nurses' time saved by using RPA towards quality improvement initiatives and patient care. 3. Improve job satisfaction and reduce turnover of staff in the IPC team. 4. Eliminate human error. Methods: IPC team identified RPA as the best solution to lift the administrative burden. A process check was undertaken by UiPath Software Team to identify tasks which could be automated. The RPA was developed to navigate through electronic medical records and lab systems. Buy-in was sought from all relevant stakeholders including Hospital management, Data protection, Information Technology, Procurement, Laboratory, Infection Prevention & Control and UiPath. A solution design document was developed and agreed along with controls and risk assessment. Three key processes were assigned to RPA: Microbiology Results for MDROs, COVID-19 & MDROs Surveillance and Nurse Task Admin Handover. Results: At present, Uipath robot works 24/7, 365 days a year with no break requirements and eliminates human error. RPA reduced administration time by 3 h a day, which equates to 18 h per week or 936 h a year. In addition, RPA saved substantial amount of time required for processing COVID-19 results and surveillance. In fact, RPA facilitated more efficient work flow. RPA liberated resources to deliver essential IPC services such as surgical site infection surveillance, PPE training and education, guideline development, COVID-19 and CPE contact tracing. Conclusion: RPA could be implemented across the wider healthcare environment to optimise use of Infection Prevention and Control Nurses time. (Figure Presented).

Inadequate preparedness for response to COVID-19 is associated with stress and burnout among healthcare workers in Ghana.

INTRODUCTION: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers. But few studies have empirically examined the factors driving these outcomes in Africa. Our study examined associations between perceived preparedness to respond to the COVID-19 pandemic and healthcare worker stress and burnout and identified potential mediating factors among healthcare workers in Ghana. METHODS: Healthcare workers in Ghana completed a cross-sectional self-administered online survey from April to May 2020; 414 and 409 completed stress and burnout questions, respectively. Perceived preparedness, stress, and burnout were measured using validated psychosocial scales. We assessed associations using linear regressions with robust standard errors. RESULTS: The average score for preparedness was 24 (SD = 8.8), 16.3 (SD = 5.9) for stress, and 37.4 (SD = 15.5) for burnout. In multivariate analysis, healthcare workers who felt somewhat prepared and prepared had lower stress (ß = -1.89, 95% CI: -3.49 to -0.30 and ß = -2.66, 95% CI: -4.48 to -0.84) and burnout (ß = -7.74, 95% CI: -11.8 to -3.64 and ß = -9.25, 95% CI: -14.1 to -4.41) scores than those who did not feel prepared. Appreciation from management and family support were associated with lower stress and burnout, while fear of infection was associated with higher stress and burnout. Fear of infection partially mediated the relationship between perceived preparedness and stress/burnout, accounting for about 16 to 17% of the effect. CONCLUSIONS: Low perceived preparedness to respond to COVID-19 increases stress and burnout, and this is partly through fear of infection. Interventions, incentives, and health systemic changes to increase healthcare workers' morale and capacity to respond to the pandemic are needed.

Neuropathology of COVID-19 (neuro-COVID): clinicopathological update.

Coronavirus disease 2019 (COVID-19) is emerging as the greatest public health crisis in the early 21stcentury. Its causative agent, Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), is an enveloped single stranded positive-sense ribonucleic acid virus that enters cells via the angiotensin converting enzyme 2 receptor or several other receptors. While COVID-19 primarily affects the respiratory system, other organs including the brain can be involved. In Western clinical studies, relatively mild neurological dysfunction such as anosmia and dysgeusia is frequent (~70-84%) while severe neurologic disorders such as stroke (~1-6%) and meningoencephalitis are less common. It is unclear how much SARS-CoV-2 infection contributes to the incidence of stroke given co-morbidities in the affected patient population. Rarely, clinically-defined cases of acute disseminated encephalomyelitis, Guillain-Barré syndrome and acute necrotizing encephalopathy have been reported in COVID-19 patients. Common neuropathological findings in the 184 patients reviewed include microglial activation (42.9%) with microglial nodules in a subset (33.3%), lymphoid inflammation (37.5%), acute hypoxic-ischemic changes (29.9%), astrogliosis (27.7%), acute/subacute brain infarcts (21.2%), spontaneous hemorrhage (15.8%), and microthrombi (15.2%). In our institutional cases, we also note occasional anterior pituitary infarcts. COVID-19 coagulopathy, sepsis, and acute respiratory distress likely contribute to a number of these findings. When present, central nervous system lymphoid inflammation is often minimal to mild, is detected best by immunohistochemistry and, in one study, indistinguishable from control sepsis cases. Some cases evince microglial nodules or neuronophagy, strongly supporting viral meningoencephalitis, with a proclivity for involvement of the medulla oblongata. The virus is detectable by reverse transcriptase polymerase chain reaction, immunohistochemistry, or electron microscopy in human cerebrum, cerebellum, cranial nerves, olfactory bulb, as well as in the olfactory epithelium; neurons and endothelium can also be infected. Review of the extant cases has limitations including selection bias and limited clinical information in some cases. Much remains to be learned about the effects of direct viral infection of brain cells and whether SARS-CoV-2 persists long-term contributing to chronic symptomatology.

AI4CoV: Matching COVID-19 Patients to Treatment Options Using Artificial Intelligence (preprint)

We developed AI4CoV, a novel AI system to match thousands of COVID-19 clinical trials to patients based on each patient's eligibility to clinical trials in order to help physicians select treatment options for patients. AI4CoV leveraged Natural Language Processing (NLP) and Machine Learning to parse through eligibility criteria of trials and patients' clinical manifestations in their clinical notes, both presented in English text, to accomplish 92.76% AUROC on a cross-validation test with 3,156 patient-trial pairs labeled with ground truth of suitability. Our retrospective multiple-site review shows that according to AI4CoV, severe patients of COVID-19 generally have less treatment options suitable for them than mild and moderate patients and that suitable and unsuitable treatment options are different for each patient. Our results show that the general approach of AI4CoV is useful during the early stage of a pandemic when the best treatments are still unknown.

Implementation of a digital chatbot to screen health system employees during the COVID-19 pandemic.

The screening of healthcare workers for COVID-19 (coronavirus disease 2019) symptoms and exposures prior to every clinical shift is important for preventing nosocomial spread of infection but creates a major logistical challenge. To make the screening process simple and efficient, University of California, San Francisco Health designed and implemented a digital chatbot-based workflow. Within 1 week of forming a team, we conducted a product development sprint and deployed the digital screening process. In the first 2 months of use, over 270 000 digital screens have been conducted. This process has reduced wait times for employees entering our hospitals during shift changes, allowed for physical distancing at hospital entrances, prevented higher-risk individuals from coming to work, and provided our healthcare leaders with robust, real-time data for make staffing decisions.

Do established infection prevention and control measures prevent spread of SARS-CoV-2 to the hospital environment beyond the patient room?

The role of the hospital environment in the transmission of infection is well described. With an emerging infection whose mode of transmission is under investigation, strict infection prevention and control measures, including patient isolation, hand hygiene, personal protective equipment that is doffed on exiting the patient room, and environmental cleaning should be implemented to prevent spread. Environmental testing demonstrated that COVID-19 patients contaminated the patient area (11/26, 42.3% of tests) but contamination of general ward areas was minimal (1/30, 3%) and the virus was detected after cleaning on one item only (1/25, 4%) which was noted to be in disrepair.