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PURPOSE: The year 2020 was marked by the COVID-19 pandemic, massively disruptive at the general population level and for healthcare systems. We aimed to evaluate the psychological distress associated with work-related experiences among medical professionals and supporting staff during the pandemic outbreak. PATIENTS AND METHODS: A cross-sectional survey was conducted between April and May 2020, employing a self-administered on-line questionnaire that included the collection of socio-demographic and professional status information, Hamilton Anxiety Rating Scale, nine-item Patient Health Questionnaire (PHQ-9), Maslach Burnout Inventory - General Survey, Connor-Davidson Resilience Scale, and a subscale of the International Personality Item Pool (IPIP) for empathy. A total of 364 professionals of the county-coordinated area responded. Descriptive statistics summarized the findings and a mediation model was analyzed, applying the causal step strategy. The specific direct and causal mediation effects were estimated with the bias-corrected and accelerated bootstrap sampling method. RESULTS: Anxiety, burnout, stress, resilience, and empathy proved to be significantly associated with both the professional category (ie, consultant, specialty doctor, trainee doctor, senior nurse, trainee nurse or other) and the perceived professional support (the nonparametric multivariate permutation test resulted in p=0.048 and p<0.001, respectively). When controlling for the marital and professional status, the female gender had an OR=2.26, 95% CI (1.21; 4.22) toward a high level of empathy compared to males. The causal mediation effect of the perceived lack of professional support on empathy through burnout-depersonalization was highly significant (p<0.001) with an average of 0.0599, 95% CI (0.0238; 0.10), while the direct effect was non-significant (p=0.536) with an average of 0.0295, 95% CI (-0.0774; 0.15). CONCLUSION: We highlighted the impact of the lack of professional support on healthcare workers' empathy through burnout-depersonalization in a context of a high workload, time pressure, job stress beyond previous training, and inherently limited organizational support, which are potentially modifiable factors in the mid-term.
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BACKGROUND: Currently applied cognitive tests for assessing the risk of post-operative delirium require time and specialised medical staff, in addition to the patients' mental strain. We investigated the four-point scoring Clock-Drawing Test (CDT-4) as a preoperative independent predictor for post-operative delirium. METHODS: A total of 100 consecutive patients aged over 65 years admitted for accidental hip fracture were assessed for delirium using the Confusion Assessment Method Scale. The cognitive function was rated with mini-mental state examination, Montreal Cognitive Assessment Scale (MoCA), and CDT-4. Descriptive statistics were performed, and a logistic regression model for post-operative delirium was applied. RESULTS: Out of the 100 enrolled patients 98 underwent hip repair surgery and 65 (66%) had post-operative delirium, with 24 (42%) incident cases. The median (IQR) ages were 78 (72-83) and 84 (80-87) years for the non-delirium and post-operative delirium groups, respectively. The logistic regression concluded with age and CDT-4 as independent preoperative predictors, while controlling for gender, pre-surgery delirium, MoCA visual, and MoCA attention: OR 1.32 [95% CI (1.099-1.585); p = 0.003] for age; OR 0.153 [95% CI (0.033-0.719); p = 0.017] for CDT-4. CONCLUSIONS: Employing CDT-4 as a bedside assessment of delirium risk may help to preoperatively stratify and prioritise the patients for preventive perioperative care in a timely manner.
