Evaluation of physician burnout at a major trauma centre using the Copenhagen burnout inventory: cross-sectional observational study.

BACKGROUND: Healthcare workers are susceptible to burnout owing to the demanding nature of their profession. The sequela of this is an increased incidence of medical errors and decreased job satisfaction. AIMS: This study aimed to assess the degree of burnout among physicians of different grades and specialties in a major trauma centre. METHODS: This study was performed in a UK tertiary trauma centre (Brighton and Sussex University Hospitals) in which 165 doctors from four medical specialties working with acute admissions were given the Copenhagen burnout inventory questionnaire via email and responses were received anonymously. Mean scores were calculated, and a two-tailed P test was performed to assess for statistically significant difference between patient- and work-related factors. RESULTS: The response rate was 77.57% (n = 165). General surgeons had the highest total burnout mean score of 50.00 with an SD of 12.78 followed by emergency medicine, acute medicine and finally orthopaedics. Junior doctors had an overall score of 53.42 with a standard deviation of 5.21, followed by consultants and registrars. The total burnout scores showed that 7.0% (n = 9) had low burnout scores while 56.3% (n = 72) had moderate burnout and 36.7% (n = 47) had high burnout scores. A two-tailed P test revealed a statistically significant difference between the work-related and patient-related subscales (P < 0.0001). CONCLUSIONS: Ninety-three percent of responders demonstrated either moderate or high levels of burnout in this study. Work-related factors appeared to contribute more to occurrence of burnout rather than the patient-related or doctor-patient interactions.

Increased Doses Lead to Higher Drug Exposures of Levofloxacin for Treatment of Tuberculosis.

Patients with multidrug-resistant tuberculosis in Peru and South Africa were randomized to a weight-banded nominal dose of 11, 14, 17, or 20 mg/kg/day levofloxacin (minimum, 750 mg) in combination with other second-line agents. A total of 101 patients were included in noncompartmental pharmacokinetic analyses. Respective median areas under the concentration-time curve from 0 to 24 h (AUC0-24) were 109.49, 97.86, 145.33, and 207.04 µg · h/ml. Median maximum plasma concentration (Cmax) were 11.90, 12.02, 14.86, and 19.17 µg/ml, respectively. Higher levofloxacin doses, up to 1,500 mg daily, resulted in higher exposures. (This study has been registered at ClinicalTrials.gov under identifier NCT01918397.).

An optimized background regimen design to evaluate the contribution of levofloxacin to multidrug-resistant tuberculosis treatment regimens: study protocol for a randomized controlled trial.

BACKGROUND: Current guidelines for treatment of multidrug-resistant tuberculosis (MDR-TB) are largely based on expert opinion and observational data. Fluoroquinolones remain an essential part of MDR-TB treatment, but the optimal dose of fluoroquinolones as part of the regimen has not been defined. METHODS/DESIGN: We designed a randomized, blinded, phase II trial in MDR-TB patients comparing across levofloxacin doses of 11, 14, 17 and 20 mg/kg/day, all within an optimized background regimen. We assess pharmacokinetics, efficacy, safety and tolerability of regimens containing each of these doses. The primary efficacy outcome is time to culture conversion over the first 6 months of treatment. The study aims to determine the area under the curve (AUC) of the levofloxacin serum concentration in the 24 hours after dosing divided by the minimal inhibitory concentration of the patient's Mycobacterium tuberculosis isolate that inhibits > 90% of organisms (AUC/MIC) that maximizes efficacy and the AUC that maximizes safety and tolerability in the context of an MDR-TB treatment regimen. DISCUSSION: Fluoroquinolones are an integral part of recommended MDR-TB regimens. Little is known about how to optimize dosing for efficacy while maintaining acceptable toxicity. This study will provide evidence to support revised dosing guidelines for the use of levofloxacin as part of combination regimens for treatment of MDR-TB. The novel methodology can be adapted to elucidate the effect of other single agents in multidrug antibiotic treatment regimens. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01918397 . Registered on 5 August 2013.

Motivational messages: lead a Baby Friendly Initiative community project.

2011 saw Baby Friendly Initiative (BFI) success in the towns of Blackburn with Darwen. The towns serve around 2,500 new babies a year, have significant social deprivation and mixed ethnicity. Commitment was made by the Trust and Local Authority, to progress to meeting full BFI standards by commissioning the Acute Trusts Infant Feeding Coordinator (midwife) to lead on the project and the change needed. Numerous challenges were met along the way, such as capacity to lead and deliver (leading to the recruitment of Donna), swine flu, GP training, organisational changes and loss of ante- and postnatal interventions. This was the first Community Trust in England to achieve full accreditation without follow up visits. This article hopes to inspire other Trusts to get started, keep going and don't let go until you get there--because it's worth it.

Medicaid waiver personal care services: results of a statewide survey.

Through a statewide telephone survey of 819 beneficiaries (or their proxies), we collected data regarding client and aide demographics, as well as clients' satisfaction, outcomes, perspectives on staff performance, and complaints associated with home-based personal care services provided under the Virginia Medicaid Elderly and Disabled (E&D) waiver. Most respondents indicated that services improved their lives, and they were generally satisfied. Opportunities for improvement exist, however, especially related to the amount of time spent with the client, the need for training, and communication issues. Ongoing use of client/family caregiver surveys is warranted to allow continued monitoring of service provision.

The effect of random voice hand hygiene messages delivered by medical, nursing, and infection control staff on hand hygiene compliance in intensive care.

Hand hygiene (HH) compliance in the intensive care unit has been studied extensively, with short-term, nonsustained compliance often because of lack of ongoing reinforcement. HH messages delivered by health care workers responsible for overseeing staff in the intensive care unit provided continuous reinforcement of HH. Compliance measured through product usage and reported as HH/bed-days increased by 60% for soap and sanitizer combined and 25% for sanitizer usage (P < 001).

Access to communication technologies in a sample of cancer patients: an urban and rural survey.

BACKGROUND: There is a growing awareness among providers of the symptom burden experienced by cancer patients. Systematic symptom screening is difficult. Our plan was to evaluate a technology-based symptom screening process using touch-tone telephone and Internet in our rural outreach cancer program in Indiana. Would rural patients have adequate access to technologies for home-based symptom reporting? OBJECTIVES: 1) To determine access to touch-tone telephone service and Internet for patients in urban and rural clinics; 2) to determine barriers to access; 3) to determine willingness to use technology for home-based symptom reporting. METHODS: Patients from representative clinics (seven rural and three urban) in our network were surveyed. Inclusion criteria were age greater than 18, able to read, and diagnosis of malignancy. RESULTS: The response rate was 97%. Of 416 patients completing the survey (230 rural, 186 urban), 95% had access to touch-tone telephone service, while 46% had Internet access (56% of urban patients, 38% of rural patients). Higher rates of Internet access were related to younger patient age, current employment, and higher education and income. The primary barrier to Internet access was lack of interest. Use of the Internet for health related activities was less than 50%. The preferred means of symptom reporting in patients with internet access were the touch-tone telephone (70%), compared to reporting by the Internet (28%). CONCLUSION: Access to communication technologies appears adequate for home-based symptom reporting. The use of touch-tone telephone and Internet reporting, based upon patient preference, has the potential of enhancing symptom detection among cancer patients that is not dependent solely upon clinic visits and clinician inquiry.