Burnout syndrome among psychiatric trainees in 22 countries: Risk increased by long working hours, lack of supervision, and psychiatry not being first career choice.

BACKGROUND: Postgraduate medical trainees experience high rates of burnout, but evidence regarding psychiatric trainees is missing. We aim to determine burnout rates among psychiatric trainees, and identify individual, educational and work-related factors associated with severe burnout. METHODS: In an online survey psychiatric trainees from 22 countries were asked to complete the Maslach Burnout Inventory (MBI-GS) and provide information on individual, educational and work-related parameters. Linear mixed models were used to predict the MBI-GS scores, and a generalized linear mixed model to predict severe burnout. RESULTS: This is the largest study on burnout and training conditions among psychiatric trainees to date. Complete data were obtained from 1980 out of 7625 approached trainees (26%; range 17.8-65.6%). Participants were 31.9 (SD 5.3) years old with 2.8 (SD 1.9) years of training. Severe burnout was found in 726 (36.7%) trainees. The risk was higher for trainees who were younger (P<0.001), without children (P=0.010), and had not opted for psychiatry as a first career choice (P=0.043). After adjustment for socio-demographic characteristics, years in training and country differences in burnout, severe burnout remained associated with long working hours (P<0.001), lack of supervision (P<0.001), and not having regular time to rest (P=0.001). Main findings were replicated in a sensitivity analysis with countries with response rate above 50%. CONCLUSIONS: Besides previously described risk factors such as working hours and younger age, this is the first evidence of negative influence of lack of supervision and not opting for psychiatry as a first career choice on trainees' burnout.

Towards meaningful medication-related clinical decision support: recommendations for an initial implementation.

SUMMARY: Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either purchase the computable clinical content or develop it themselves. Content provided by vendors does not always meet local expectations. Most organizations lack the resources to customize the clinical content and the expertise to implement it effectively. In this paper, we describe the recommendations of a national expert panel on two basic medication-related CDS areas, specifically, drug-drug interaction (DDI) checking and duplicate therapy checking. The goals of this study were to define a starter set of medication-related alerts that healthcare organizations can implement in their clinical information systems. We also draw on the experiences of diverse institutions to highlight the realities of implementing medication decision support. These findings represent the experiences of institutions with a long history in the domain of medication decision support, and the hope is that this guidance may improve the feasibility and efficiency CDS adoption across healthcare settings.

Enhancing medication use safety: benefits of learning from your peers.

BACKGROUND: Maryland hospitals have been improving the safety of medication use practices since 2000. A retrospective analysis of 35 hospitals was conducted for 2005-2007 to determine the changes in medication use practices, communication methods within hospitals, patient education and changes in medical record management. METHODS: Thirty-five Maryland hospitals completed the Institute for Safe Medication Practices Medication Safety Self-Assessment for Hospitals, a voluntary initiative to improve the safety of medication use. A weighting structure is applied to calculate key element scores, core characteristic scores and overall self-assessment scores that were used in ANOVA and regression analyses. FINDINGS: The state-wide aggregate score significantly increased from 74.2% in 2005 to 81.2% in 2007 (p<0.05). The 35 hospitals scored highest in the following key areas in 2007: drug standardisation, storage and distribution (90.2%); drug labelling, packaging and nomenclature (88.1%); and environmental factors (84.3%). Results indicated that hospitals scored lowest in the key element area related to accessibility of patient information (72.5%) and in the core characteristics pertaining to redundancies and independent double checks (64.2%) in 2007. A substantial number of hospitals had positive and significant (p<0.05) changes in certain key elements and/or core characteristics. Few hospitals showed significant (p<0.05) decreases in their scores. CONCLUSION: MEDSAFE has directly assisted Maryland hospitals in improving medication use safety. The strategies and tools of MEDSAFE have been used in Maryland since 2000 and Singapore and Austria since 2006.

Novel protection strategy for pulmonary transplantation.

BACKGROUND: Ischemia-reperfusion injury continues to represent a significant challenge to successful lung transplantation. Traditional pulmonary ischemic protection is performed using hypothermic hyperkalemic depolarizing solutions to reduce the metabolic demands of the ischemic organ. Measures to further reduce the effects of ischemic injury have focused on the reperfusion period. We tested the hypothesis that novel physiologic hyperpolarizing solutions-using ATP-dependent potassium channel (K(ATP)) openers-given at the induction of ischemia, will reduce cellular injury and provide superior graft function even after prolonged periods of ischemia. METHODS: An isolated blood-perfused ventilated rabbit lung model was used to study lung injury. Airway, left atrial, and pulmonary artery pressures were measured continuously during the 2-h reperfusion period. Oxygenation, as a surrogate of graft function, was measured using intermittent blood gas analysis of paired left atrial and pulmonary artery blood samples. Graft function was measured by oxygen challenge technique (F(i)O(2) = 1.0). Wet-to-dry ratio was measured at the conclusion of the 2-h reperfusion period. Control (Group I) lungs were perfused with modified Euro-Collins solution (depolarizing) and reperfused immediately (no ischemia). Traditional protection lungs were perfused with modified Euro-Collins flush solution and stored for 4 h (Group II) or 18 h (Group III) at 4 degrees C before reperfusion. Novel protection (Group IV) lungs were protected with a hyperpolarizing solution containing 100 nM Aprikalim, a specific K(ATP) channel opener, added to the modified Euro-Collins flush solution and underwent 18 h of ischemic storage at 4 degrees C before reperfusion. RESULTS: Profound graft failure was measured after 18 h of ischemic storage with traditional protection strategies (Group III). Graft function was preserved by protection with hyperpolarizing solutions even for prolonged ischemic periods (Group IV). Wet-to-dry weight ratio, airway, left atrial, and pulmonary artery pressures were not significantly different between the groups. CONCLUSIONS: We have created a model of predictable lung injury. Membrane hyperpolarization with a K(ATP) channel opener (PCO) provides superior prolonged protection from ischemia-reperfusion injury in an in vitro model of pulmonary transplantation.

[A method for the internal drainage of the bile ducts]. / Sposib vnutrishn'oho drenuvannia zhovchnykh protok.

The choledochoduodenostomy conduction method with the functionally active valve formation was proposed for the duodenocholedochal reflux via the anastomosis prophylaxis.

[A pathogenetic validation of a method for correcting portal hypertension]. / Patohenetychne obhruntuvannia sposobu korektsiï portal'noï hypertenziï.

The correction method of portal hypertension, basing on the blood circulation flow reduction in the main abdominal cavity arterial vessels, was elaborated in experiments on dogs. The functional and morphological changes in vascular bed and the abdominal cavity organs after the portal hypertension modelling and its surgical correction were studied up.

[Structural-functional transformations of the ileal lymph nodes in pregnancy complicated by blood loss]. / Strukturno-funktsional'nye preobrazovaniia podvzdoshnykh limfaticheskikh uzlov pri beremennosti, oslozhnennoi krovopoterei.

The microanatomic organization of iliac lymph nodes was studied in 24 pregnant Wistar rats (pregnancy term 21 days) after simulation of acute hemorrhage in them. A considerable decrease of a relative area occupied by a marginal sinus was revealed. This shows transport functional changes of lymph nodes in pregnancy complicated by hemorrhage.

[A new method for cannulation of the common bile duct in an experiment]. / Novyi sposib kaniuliuvannia zahal'noï zhovchnoï protoky v eksperimenti.

The proposed method of common biliary duct cannulation is simple, easily performed and permits studying bile hydrodynamics biligenesis for a necessary time. Tightness of the system is completely preserved after removal a choledochostomical tube. Walls of the invaginated stump of the cystic duct are swiftly abated as a result of hydrostatic pressure and cover its gap. The presence of purse string kapron suture in a stump orifice creates an obstacle to deinvagination. Good reparation properties of serous and subserous membranes, covering the biliary duct, promote rapid closing of stoma. Effectiveness of the proposed method of common biliary duct cannulation by means of the invaginated stump of the cystic duct is confirmed by the smooth postoperative course and absence of a biliary fistula after the tube removal.

Use of an ambulatory infusion pump in a 12-year-old with Salmonella osteomyelitis.

A 12-year-old girl with sickle cell hemoglobinopathy presented with a Salmonella osteomyelitis of her right humerus requiring six weeks of parenteral antibiotic therapy. Home therapy was evaluated. Due to the frequency of the medication administration (every six hours) and the apprehension of the family members, a Pharmacia-Deltec CADD-VT Infusion Pump was chosen for drug administration. Based on the stability of ampicillin, 1.3 g q6h was administered to provide a minimum of 1 g for the last dose of a 24-hour cycle. Ampicillin 6 g contained in 100 mL of sterile water for injection provided a 60 mg/mL solution with an osmolarity of 347 mOsmol. The pump was programmed to deliver 22 mL of solution over one hour, every six hours. A keep-vein-open rate of 0.2 mL/h maintained line patency. A 100 mL cassette of solution prepared daily was replaced on the pump by a home therapy nurse each morning. At the end of six weeks of therapy, the osteomyelitis was eradicated. We found the use of an ambulatory infusion pump an effective, convenient, and cost-saving method of treatment for our patient.

Neurobehavioral and biochemical response to manganese and selenium exposure in rats.

Aiming to extend previous findings, male Wistar rats were treated per os for 13 weeks with manganese chloride in two doses: 300 mg/kg body weight (group I) and 20 mg/kg b.w. (II), the former was associated (III) with a microdose (1 ppm) of natrium selenite. The findings show an impairment of active avoidance learning in group III, a decrease of swimming performance and histological lesions in several brain areas (both especially in group III), changes of the aggressive behavior and decreases in the brain tissue of superoxide dismutase activity (I & II) and of lipid peroxidation (in all groups).

Changes of phagocytic biological rhythm by reduction of circadian times and by influences upon hypothalamus.

The circadian oscillations of central temperature and phagocytic activity of blood polymorphonuclears were studied in guinea pigs after circadian times have been reduced, under the effect of chlorpromazine or in animals with bilaterally lesioned hypothalamus in preoptic or in tuberomammillary area. The phagocytic activity was assayed against staphylococcus epidermidis in heparinized blood. In the animals exposed to artificial light in conditions of space restriction (stressed) the phagocytic activity is depressed in the lighting period, the differences light-dark being higher (300%) as in controls (25%). Chlorpromazine lowers both central temperature and phagocytic activity, without changes of their circadian rhythms. Bilateral symmetrical injuries of the preoptic hypothalamic area determined a rise of the central body temperature in the beginning of the dark period. The phagocytic activity of these animals decreases especially at the end of the dark period. Lesions of the tuberomammillary area reduces the phagocytic activity to very low levels and attenuates to a marked extent its circadian oscillations. Body temperature remain unaffected. The circadian biorhythm of the body temperature and of the phagocytic activity, usually concurrently, are controlled by separate hypothalamic mechanisms. After tuberomammillary lesions the phagocytic response of animals to an endovenous injection of a bacterial suspension is very low. The results are discussed on the basis of present data and of prior researches of this laboratory.

[Structural and functional characteristics of myocardial capillaries after resection of the lungs]. / Strukturno-funktsional'nye osobennosti kapilliarov miokarda posle rezektsii legkikh.

In the experiment performed on 107 dogs, after resection of 33-75% of the pulmonary volume, it has been stated that considerable disturbances take place in the myocardial microcirculatory bed. At early stage after the operation the amount of capillaries per 1 mm2 of the section increases, their lumens become wide. With elapse of time after the operation, as a result of myocardial hypertrophy, density in arrangement of the capillaries decreases, and the transversal section area of the cardiomyocyte per one capillary increases. In the capillary walls destructive changes are also noted; they result in myocardiodistrophy and in development of cardiac failure.

Implementation of standardized forms to increase pharmacist/physician communication.

This article reports on the development and use of carbonized, standard communication forms by pharmacists in a 150-bed osteopathic teaching institution. The use of these communication forms has resulted in increased physician awareness of the clinical services offered by pharmacy and standardized responses to recurring drug therapy recommendations. Communication between physicians and pharmacists has been expanded, and a cost savings in drug therapy has resulted.