Feasibility of implementing the 'Screening for Distress and Referral Need' process in 23 Dutch hospitals.

PURPOSE: In the Netherlands, the three-step process 'Screening for Distress and Referral Need' (SDRN) was developed for helping identifying, and referring cancer patients suffering from clinically relevant distress or needing a referral. This process includes (1) instrument completion, (2) patient-care provider discussion of the responses, and (3) referral based on 1 and 2. The Netherlands Comprehensive Cancer Organisation, location Groningen (IKNL-G), initiated the implementation of SDRN and developed an implementation roadmap, including procedure and materials. This exploratory study examines the feasibility of SDRN implementation in hospitals, seen from healthcare providers' perspective, responsible for implementation, and those executing SDRN. METHODS: Healthcare providers, from 22 hospitals and from 5 oncology departments of the University Medical Center Groningen (=25 % of Dutch hospitals), evaluated their experiences by responding to a 26-item internet survey. RESULTS: Twenty-five participants (response = 93 %) completed the survey. SDRN was implemented in 21 hospitals (implementation = 91 %), in two thirds of these hospitals in more than one patient group. Adoption of IKNL-G's roadmap elements varied between 84 and 100 %. Participants' average satisfaction score with SDRN was 6.5 (possible range = 0-10, range found = 5-8). Significant positive relationships were found between this satisfaction and participants' satisfaction with frequency of SDRN (p = 0.02), and keeping logistical agreements (p = 0.04). Participants were dissatisfied with SDRN's limited current availability to only select patient groups and only certain disease phases. CONCLUSIONS: The implementation of SDRN in daily practice, supported by a pre-developed implementation roadmap, is highly feasible. Continuous attention to SDRN execution, broadening implementation to all forms of cancer, and during the total disease trajectory seems vital to improve healthcare providers' satisfaction.

Burnout, engagement and resident physicians' self-reported errors.

Burnout is a work-related syndrome that may negatively affect more than just the resident physician. On the other hand, engagement has been shown to protect employees; it may also positively affect the patient care that the residents provide. Little is known about the relationship between residents' self-reported errors and burnout and engagement. In our national study that included all residents and physicians in The Netherlands, 2115 questionnaires were returned (response rate 41.1%). The residents reported on burnout (Maslach Burnout Inventory-Health and Social Services), engagement (Utrecht Work Engagement Scale) and self-assessed patient care practices (six items, two factors: errors in action/judgment, errors due to lack of time). Ninety-four percent of the residents reported making one or more mistake without negative consequences for the patient during their training. Seventy-one percent reported performing procedures for which they did not feel properly trained. More than half (56%) of the residents stated they had made a mistake with a negative consequence. Seventy-six percent felt they had fallen short in the quality of care they provided on at least one occasion. Men reported more errors in action/judgment than women. Significant effects of specialty and clinical setting were found on both types of errors. Residents with burnout reported significantly more errors (p < 0.001). Highly engaged residents reported fewer errors (p

Burnout among Dutch medical residents.

We examined levels of burnout and relationships between burnout, gender, age, years in training, and medical specialty in 158 medical residents working at the University Medical Center Groningen, the Netherlands. Thirteen percent of the residents met the criteria for burnout, with the highest percentage of burnout cases among medical residents in Psychiatry. Significantly more male residents than female residents suffered from severe burnout. Medical residents reported significantly lower mean scores on personal accomplishment than medical specialists and other health care workers; they also reported lower mean scores on emotional exhaustion than medical specialists. Male residents had significantly higher depersonalization scores than female residents. Positive significant relationships were found between personal accomplishment and age and years in training. Obstetrics & Gynecology residents reported significantly more personal accomplishment than residents in Psychiatry, Internal Medicine, Pediatrics, and Anesthesiology. Residents in Psychiatry had significantly lower scores on personal accomplishment than residents in Internal Medicine. Our findings show that burnout is present in a small but significant number of medical residents.

Family functioning and adolescents' emotional and behavioral problems: when a parent has cancer.

BACKGROUND: This article focuses on possible relationships between functioning of adolescents with a parent diagnosed with cancer 1-5 years earlier and family environment. PATIENTS AND METHODS: In all, 138 patients, 114 spouses and 221 adolescents completed the Family Environment Scale. Additionally, adolescents filled in the Impact of Event Scale and Youth Self-report and parents reported on the adolescents' functioning using the Child Behavior Checklist. RESULTS: Patients and spouses reported that their families differ from the norm; they are more expressive and social, better organized, less controlling and have less conflict. Adolescents reported the same and additionally find their family. Family environment was weakly to moderately strongly negatively related to the adolescents' functioning; family relationships related more strongly to the adolescents' functioning than family structure did. No significant relationship was found between family environment and the adolescents' cancer-related distress. Discrepancy in reports of family environment between parents and between parents and adolescents, in general, did not relate to the adolescents' functioning or distress. Parent-adolescent discrepancy only correlated with adolescent self-reports of their functioning. CONCLUSION: Families with parental cancer functioned positively. Despite this, family functioning seems to be a risk factor for behavioral and emotional problems in adolescents.

The role of social support in burnout among Dutch medical residents.

Burnout levels among medical residents are considered high. A lack of social support has shown to have a direct effect on emotional exhaustion, and depersonalization, two of the three burnout indicators. In this study, we examined the satisfaction of medical residents with social support (emotional, appreciative and informative) received from supervisors, fellow medical residents, nurses and patients. In addition, the correlation between social support and burnout was studied. Medical residents were significantly more dissatisfied with the emotional, appreciative and informative support received from their supervisors compared with fellow residents and nurses (respectively, 13.4+/-4.0 vs. 9.9+/-2.8 and 10.0+/-2.4; 10.0+/-2.9 vs. 7.4+/-2.0 and 7.3+/-1.8; and 7.2+/-2.3 vs. 5.4+/-1.6 and 5.3+/-1.5; p<.001). Significant independent effects were found on emotional exhaustion: from dissatisfaction with emotional support [Beta=.44, p<.001, total R2=.25] and dissatisfaction with appreciative support from supervisors [Beta=.30, p<.01, total R2=.11]. Moreover, dissatisfaction with emotional support from supervisors had an independent significant effect on depersonalization [Beta=.33, p=.001, total R2=.14]. The best predictor of burnout appeared to be dissatisfaction with emotional support received from supervisors. Our results suggest that intervention programs should not only focus on the medical residents, but also on the supervisors to improve their supportive skills.

Tratamiento ambulatorio de infecciones severas (TAIS). Una nueva modalidad de atención infectológica / Out patient treatment of severe infections. A new modality of patient care

En los últimos años se han desarrollado nuevas modalidades en atención de los pacientes con infecciones severas. Dentro de éstas se encuentran el tratamiento domiciliario y los centros de atención ambulatoria. Desde diciembre de 1995 se ha creado en el Hospital Garrahan un programa denomiando Tratamiento Ambulatorio de Infecciones Severas (TAIS) bajo la segunda modalidad de atención. Durante los primeros 6 meses de trabajo hemos atendido 99 pacientes con infecciones severas. La media de edad fue de 68 meses. La procedencia fue: Gran Buenos Aires 47 pacientes, Capital Federal: 26 e interior: 26 (24 con residencia transitoria en Capital Federal y 2 en Gran Buenos). La media en Km. de distancia al hospital de los pacientes del Gran Buenos Aires fue de 20 Km. El medio de transporte fue el 54,5 por ciento de los pacientes el colectivo, taxi o remise en el 7,1 por ciento, transporte propio en el 24,2 por ciento, transporte de la obra social en 5.1 por ciento y no requirieron transporte 5.1 por ciento. Los diagnósticos más frecuentes fueron: neutropénicos febriles (29 pacientes),infecciones asociadas a catéteres implantables (11), celulitis periorbitarias (8) bacteriemias (8) meningitis bacteriana (6). En el 47 por ciento de las infecciones se documentó el microorganismo responsable. Tenían enfermedad de base el 64.6 por ciento de los pacientes, siendo las leucemias y los tumores sólidos las más comunes. Se obtuvo éxito terapéutico en todos los niños; sólo en 3 se interrumpió el tratamiento ambulatorio por causa no relacionada con la infección tratada. Se ahorraron 374 días/camas, lo que significa una media de liberación de 3.86 camas/días. La implementación de programas como el TAIS es posible y brind amúlples beneficios para el paciente, el hospital y la sociedad.

Tumor-associated antigen is expressed on lymphocytes from patients with acquired immunodeficiency syndrome.

Monoclonal antibody BE2 recognizes an antigen found on malignant T4+ lymphocytes from cutaneous T-cell lymphoma patients (CTCL). Normal peripheral blood lymphocytes do not express detectable levels of BE2 antigen. Forty-eight percent of patients with the acquired immunodeficiency syndrome (AIDS) had lymphocyte populations that were reactive with monoclonal antibody BE2. Peripheral blood lymphocytes from healthy homosexuals, patients with classical Kaposi's sarcoma or viral syndromes, and healthy normal controls were BE2-. Double-labeling studies demonstrated that BE2+ cells were T lymphocytes. This observation demonstrates that some AIDS patients as well as CTCL patients have circulating cells that express a common lymphocyte abnormality.