Factors affecting the work passion of physicians during the COVID-19 pandemic: a qualitative study in Thailand.

PURPOSE: This qualitative study explores the factors influencing physicians' work passion during the COVID-19 pandemic in the Thai medical context. METHODS: Using an appreciative inquiry (AI) approach, we conducted qualitative interviews with 30 physicians from a public hospital in Thailand to investigate the factors that influence passion for their professional work (work passion). RESULTS: Our analysis revealed 12 codes influencing physician work passion, which were grouped into four themes: job factors (meaningful work, challenging tasks, task accomplishment, autonomy, work-life balance); organizational factors (fairness, positive environment); relationship factors (having a role model, psychological support, collaboration, recognition and respect); and individual factors (spiritual drive). CONCLUSION: These findings contribute to developing knowledge about work passion among physicians and provide information to develop effective strategies to harness and manage work passion, thus improving clinical practice and healthcare outcomes. This qualitative study sheds light on the factors that influence physician work passion during the COVID-19 pandemic in Thailand, providing valuable information for future research and guiding the development of strategies to optimize work passion and its impact on clinical practice.

Immunogenicity of the ChAdOx1 nCoV-19 vaccine in patients with hematologic malignancies.

Purpose: The present study aimed to study the immunogenicity of the ChAdOx1 nCoV-19 vaccine in patients with hematologic malignancies. Materials and Methods: This prospective cohort study of hematology patients aimed to evaluate their antibody levels against the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein and seroconversion rates following two doses of the ChAdOx1 nCoV-19 vaccine. Between June and July 2021, we enrolled 61 patients and included 44 patients in our analysis. Antibody levels were assessed 8 and 4 weeks after the first and second injections, respectively, and compared with those of a healthy group. Results: Eight weeks after the first dose, the geometric mean antibody level was 1.02 binding antibody units (BAU)/mL in the patient group and 37.91 BAU/mL in the healthy volunteer group (p<0.01). Four weeks after the second dose, the geometric mean antibody level was 9.44 BAU/mL in patients and 641.6 BAU/mL in healthy volunteers (p<0.01). The seroconversion rates 8 weeks after the first dose were 27.27% and 98.86% in the patient and healthy volunteer groups, respectively (p<0.001). The seroconversion rate 4 weeks after the second dose was 47.73% in patients and 100% in healthy volunteers. Factors leading to lower seroconversion rates were rituximab therapy (p=0.002), steroid therapy (p<0.001), and ongoing chemotherapy (p=0.048). Factors that decreased antibody levels were hematologic cancer (p<0.001), ongoing chemotherapy (p=0.004), rituximab (p<0.001), steroid use (p<0.001), and absolute lymphocyte count <1,000/mm3 (p=0.009). Conclusion: Immune responses were impaired in individuals with hematologic malignancies, particularly patients undergoing ongoing therapy and B-cell-depleting therapy. Additional vaccinations should be considered for these patients, and further investigated.

An evaluation of the association of leukopenia and severe infection in patients with systemic lupus erythematosus.

BACKGROUND: Leukopenia is a common finding in systemic lupus erythematosus (SLE) and may contribute to severe infections. OBJECTIVES: The objectives of this study were to determine the prevalence of leukopenia in SLE patients and examine the association between these conditions and severe infections noting the risk factor of severe infections. METHODS: This study was a prospective inception lupus cohort of newly diagnosed SLE patients seen between May 2007 and June 2011. Only cases that had been observed for a minimum of 1 year or died during the study were included. RESULTS: There were 89 SLE patients (92% females), with their mean (SD) age and disease duration at the study entry of 31.7 (12.2) years and 2.4 (2.9) months. Leukopenia was found at the diagnosis in 51.6% of the cases. The cumulative prevalence of leukopenia, lymphopenia, and neutropenia was observed in 57.3%, 96.6%, and 60.7%, respectively. Persistent lymphopenia, noted continuously for more than or equal to 75% of the observation period, was found in 41.6%, but there was no persistent neutropenia. The incidence rate of severe infection was 12.4 per 100 patient-years. There was no difference of severe infection-free survival rate between patients who ever and never had leukopenia. In the multivariate analysis, using cyclophosphamide was the independent predictor for severe infection in SLE (hazard ratio, 2.73; 95% confidence interval, 1.10-6.77). CONCLUSIONS: Leukopenia was common in SLE but usually not persistent. In this study, the presence of leukopenia at any time was not the risk factor for severe infection in SLE. Cyclophosphamide was the important predictor for severe infection in SLE.