Work expectations, their fulfillment, and exhaustion among radiologists of all career levels: what can be learned from the example of Germany.

OBJECTIVES: To evaluate work expectations of radiologists at different career levels, their fulfillment, prevalence of exhaustion, and exhaustion-associated factors. METHODS: A standardized digital questionnaire was distributed internationally to radiologists of all career levels in the hospital and in ambulatory care via radiological societies and sent manually to 4500 radiologists of the largest German hospitals between December 2020 and April 2021. Statistics were based on age- and gender-adjusted regression analyses of respondents working in Germany (510 out of 594 total respondents). RESULTS: The most frequent expectations were "joy at work" (97%) and a "good working atmosphere" (97%), which were considered fulfilled by at least 78%. The expectation of a "structured residency within the regular time interval" (79%) was more frequently judged fulfilled by senior physicians (83%, odds ratio (OR) 4.31 [95% confidence interval (95% CI) 1.95-9.52]), chief physicians (85%, 6.81 [95% CI 1.91-24.29]), and radiologists outside the hospital (88%, 7.59 [95% CI 2.40-24.03]) than by residents (68%). Exhaustion was most common among residents (physical exhaustion: 38%; emotional exhaustion: 36%), in-hospital specialists (29%; 38%), and senior physicians (30%; 29%). In contrast to paid extra hours, unpaid extra hours were associated with physical exhaustion (5-10 extra hours: OR 2.54 [95% CI 1.54-4.19]). Fewer opportunities to shape the work environment were related to a higher probability of physical (2.03 [95% CI 1.32-3.13]) and emotional (2.15 [95% CI 1.39-3.33]) exhaustion. CONCLUSIONS: While most radiologists enjoy their work, residents wish for more training structure. Ensuring payment of extra hours and employee empowerment may help preventing burnout in high-risk groups. KEY POINTS: • Most important work expectations of radiologists who work in Germany are "joy at work," a "good working atmosphere," "support for further qualification," and a "structured residency within the regular time interval," with the latter containing potential for improvement according to residents. • Physical and emotional exhaustion are common at all career levels except for chief physicians and for radiologists who work outside the hospital in ambulatory care. • Exhaustion as a major burnout criterion is associated with unpaid extra hours and reduced opportunities to shape the work environment.

Communication of radiation risk from imaging studies: an IAEA-coordinated international survey.

The purpose of this IAEA-coordinated international study was to understand aspects related to the communication of radiation risk from imaging studies, such as how often imaging department personnel and referring physicians are asked about radiation risks in diagnostic imaging, who asks about these risks, how often professionals are able to provide satisfactory answers using qualitative metrics and how often quantitative risk estimates are needed. A web-based questionnaire with ten questions was completed by 386 healthcare professionals from 63 countries from all four continents, including clinicians/referring physicians (42.5%), radiologists or nuclear medicine physicians (26.7%), medical physicists (23.1%), radiographers/radiological technologists (6.2%) and others (1.6%). The results indicate that radiation risk-related questions are largely asked by patients (73.1%) and parents of child patients (38.6%), and 78% of the professionals believe they are able to answer those questions using qualitative metrics such as very small/minimal, small, medium rather than number of cancers likely occurring. The vast majority, with over three times higher frequency, indicated the purpose of knowing previous radiological exams as 'both clinical information and radiation exposure history' rather than 'only clinical information'. Nearly two-thirds of the clinicians/referring physicians indicated that knowing the radiation exposure history of the patient will affect their decision-making for the next exam, as against only about one-fifth who said 'no, it will not affect their decision-making'. The same question, when addressed to radiologists, resulted in a slightly larger fraction of about three-quarters who said 'yes', as opposed to a smaller fraction of about 12% who said 'no, it will not affect their decision-making'. Mapping the present situation of communication of benefits and risks for patients is important and may be the basis of further analysis, regular monitoring and possibly a target for clinical audits. Further studies focused on specific professional groups might help in obtaining á deeper understanding of the need for practical communication tools.

Changing the composition of buffered eye-drops prevents undesired side effects.

PURPOSE: The Ex Vivo Eye Irritation Test (EVEIT) is used to analyse the clinical observations of corneal calcification attributed to the presence of phosphate within applied eye-drops used in treating glaucoma, Still-Chauffard syndrome, ocular burns and dry eyes. METHOD: Live corneas from abattoir rabbit eyes were cultured in order to study epithelial healing following mechanical abrasion of the corneal surface combined with repeated exposure to various eye-drops. RESULTS: Obvious corneal calcification of the wound area along with a complete epithelial healing covering the calcified area was observed following exposure to phosphate hyaluronate eye-drops. Epithelial healing without calcification was achieved using citrate hyaluronate eye-drops. CONCLUSION: Clinical observations show that topical use of artificial tears containing phosphate on injured eyes may lead to sight-threatening corneal complications. Simulation of such treatment conditions by the EVEIT convincingly demonstrates that changes in the composition of the pharmaceutically used treatments can prevent this undesired side effect. Although considerable healing was achieved during the repeated application of eye-drops, using either a phosphate or citrate buffer, only the drops containing citrate did not develop corneal calcification on the eye. The authors therefore recommend discontinuing the use of phosphate-buffered eye-drops, or other topically applied solutions, to avoid further injury to the patient.

Rinsing with isotonic saline solution for eye burns should be avoided.

BACKGROUND: Recent approaches to emergency treatment of eye burns have given rise to many questions on the effectiveness of traditional rinsing solutions. This led us to study the use of isotonic saline solution and a recently introduced, highly effective solution, Cederroth Eye Wash, in the initial treatment of eye burns. METHODS: A central area (Ø 10mm) of the cornea of isolated ex vivo rabbit eyes was burnt for 20s with 25+/-1.4 micro L of 2N NaOH. The anterior chamber pH was measured continuously via microelectrode. The corneas were immediately rinsed for 15 min with flow rates of 50, 100, 200, 300, 400, and 500 mL/min. RESULTS: After 20 min measurement, no significant differences in intraocular pH were found between unrinsed eyes and eyes rinsed with isotonic saline solution at any flow rate. At all flow rates, Cederroth Eye Wash brought about a significant decrease (p<0.001; Tukey t-test). CONCLUSIONS: Isotonic saline solution was ineffective in the emergency treatment of severe alkali eye burns in this ex vivo rabbit eye model. Cederroth Eye Wash, even at the lowest flow rate, significantly reduced intracameral pH. Thus a small amount of buffer solution effectively decontaminated the eye, whilst large amounts of saline solution did not.

Repeated exposure to benzalkonium chloride in the Ex Vivo Eye Irritation Test (EVEIT): observation of isolated corneal damage and healing.

The prediction of side-effects is a key issue in the REACH initiative on chemicals, in the production of cosmetics and in the preclinical testing of drugs. A new ex vivo test for repeated substance application is presented, that is able to identify corrosive and irritant effects on the eye by using crucial endpoints, such as cellular and morphological damage, and healing characteristics. The test is intended to replace the Draize eye test and to improve the preclinical testing of drugs and chemicals that are likely to come into direct contact with the cornea. The Ex Vivo Eye Irritation Test (EVEIT) is a self-healing system, involving living corneas obtained from abattoir rabbit eyes. The corneas are cultured in a similar way to the method used during the transplantation of corneal grafts. The corneas are exposed to multiple small, mechanical abrasions, and then test substances are repeatedly dropped onto the centres of the corneas. The test substances applied in this study were citrate-buffered hyaluronate eye drops and an artificial tear replacement, with increasing concentrations of up to 0.1% benzalkonium chloride. A dose-dependent inhibition of recovery and impairment of the lactate production mechanism in the cornea was observed with benzalkonium chloride treatment.

The consequences of delayed intervention when treating chemical eye burns.

BACKGROUND: Immediate rescue intervention for chemical and thermal eye burns can save the victim's sight. We studied the anterior chamber pH changes immediately after ex vivo eye burn to investigate the effects of immediate and delayed intervention. METHODS: Twenty three enucleated pigs eyes were burnt with 500 microl 2 mol NaOH for 20 s using a cylinder with a diameter of 10 mm. The corneas were rinsed in groups with 1015 ml ordinary tap water at a flow rate of 1.125 ml/s for 15 minutes immediately after burning (n = 6), and after a delay of 20, 40, and 60 s (n = 5, 3 and 4 respectively). One group of eyes was not rinsed (n = 5). The intraocular pH was defined at the start as 'min pH' and the end as 'max pH'(DeltapH = max pH-min pH). RESULTS: The intraocular pH increased sharply in the untreated eyes from a min pH of 6.76 +/- 0.55 to a max pH of 11.85 +/- 0.24, yielding a DeltapH of 5.08. The difference between the timepoint at which the pH began to increase and the speed of change was significantly different between the unrinsed and rinsed eyes, and there was an inverse correlation between this and the time at which rinsing started (p < 0.001). The best results were achieved in eyes rinsed immediately after burning (p < 0.001). The pH in the eyes not rinsed immediately increased rapidly, and in all groups in which rinsing was delayed the max pH was markedly higher (p = 0.093). CONCLUSIONS: Immediate emergency rinsing is essential in eye burn victims. Appropriate rinsing solutions and treatment facilities in the form of rinsing stations where chemical burns may occur must be available at the workplace. Tap water is also effective as a rinsing solution.

Relationship of eye burns with calcifications of the cornea?

INTRODUCTION: The clinical pattern of corneal calcification has been considered to be a part of chronic eye diseases, such as uveitis, severe glaucoma, keratitis and eye burns. Since, in some cases of eye burns, we have found corneal calcifications to be related to the initial calciferous caustic agents and to the use of phosphate-buffer-containing fluids, we have reviewed our files of clinical eye burns for the incidence and appearance of corneal calcification. METHODS: A total of 176 burnt eyes of 98 patients suffering from severe eye burns were retrospectively reviewed. The following data set was acquired: the type of caustic agent, the time of the burns, the delay and type of immediate treatment and the time and type of first aid, the subsequent medication, the clinical grading and the later results. RESULTS: Calciferous burning agents and corneal calcification are correlated (P<0.01). Initial single rinsing with phosphate does not produce corneal calcification (P=0.134). There is evidence that corneal calcifications are correlated with chronically administered phosphate-buffered eye drops (P<0.005). DISCUSSION: Eye burns followed by calcifications follow two different major patterns: the corrosive substance contained calcium or the continued therapy was applied with phosphate-buffered eye drops. We present case reports of three different types of eye burns and later therapy resulting in corneal calcification. Corneal calcifications are presumably related to longer-lasting phosphate application. One suspicious mechanism is the low content of calcium ion stabilizing proteins such as hyaluronate or fetuin in treatments for severe eye burns. The exceeding of the solubility product of Ca(2+) and PO(4) (-) results in the precipitation of calcium phosphates. In cases of chronic corneal disturbance, we recommend the elimination of phosphate-buffered medications to prevent corneal calcification.