Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study

INTRODUCTION@#The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety.@*METHODS@#A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR).@*RESULTS@#We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR.@*CONCLUSION@#Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.

Approaching the Boundaries of Endovascular Treatment in Acute Ischemic Stroke : Multicenter Experience with Mechanical Thrombectomy in Vertebrobasilar Artery Branch Occlusions.

PURPOSE: Little is known about catheter-based endovascular treatment of vertebrobasilar artery branch occlusion (VEBABO) in acute ischemic stroke (AIS). Nonetheless, the experience of mechanical thrombectomy (MT) in distal small sized arteries of the anterior circulation seems promising in AIS. In this multicenter study, we report the feasibility, efficacy and safety of MT in VEBABO. METHODS: Retrospective analysis of consecutive AIS patients treated with MT due to VEBABO including posterior and anterior inferior cerebellar artery (PICA, AICA) and superior cerebellar artery (SCA) occlusions at seven tertiary care centers between January 2013 and May 2020. Baseline demographics and angiographic outcomes including recanalization success of the affected cerebellar arteries and procedural complications were recorded. Clinical outcomes were evaluated by the modified Rankin scale (mRS) at discharge and 90 days. RESULTS: Out of 668 endovascularly treated posterior circulation strokes we identified 16 (0.02%) cases with MT for VEBABO. Most frequently, MT of the SCA was done (13/16, 81%). Most VEBABOs occurred after MT of initial basilar/posterior cerebral artery occlusion (9/16, 56%). In 10/16 (63%) procedures, the affected VEBABO was successfully recanalized. Out of four patients three (75%) with isolated VEBABO had benefited from endovascular therapy. Subarachnoid hemorrhage was observed in 3/16 (19%) procedures. The rate of favorable outcome (mRS ≤2) was 40% at discharge and 47% at 90-day follow-up. Mortality was 13% (2/15). CONCLUSION: The use of MT for VEBABO is rare but appears to be feasible and effective; however, the comparatively high rate of procedure-related hemorrhage highlights that the indications for MT in these occlusion sites should be carefully weighed up.

Perceptions of a night float system for intern doctors in an internal medicine program: an Asian perspective / 한국의학교육

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.

Perceptions of a night float system for intern doctors in an internal medicine program: an Asian perspective / 한국의학교육

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.

VTK-based free multi-planar reformation / 中国医疗器械杂志

This paper introduces the development of the Free-MPR module, based on VC++6.0 environment and VTK5.0, and on Windows XP platform. The Free-MPR module can adjust freely the display plane according to the change of the visual angle, and implement the free multi-planar reformation.

Differential diagnosis of benign and malignant solitary pulmonary nodule with computer-aided detection / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the morphological features of benign and malignant solitary pulmonary nodules (SPNs) and explore the radiological evidences for the differentiation of SPNs.</p><p><b>METHODS</b>With SPN Dicom View software, we analyzed and compared images obtained from 23 patients with malignant SPNs and 22 patients with benign SPNs who received CT scanning with or without contrast medium injection.</p><p><b>RESULTS</b>The enhancement in malignant SPNs group was significantly higher than in the benign SPNs group (P < 0.0001). The irregular enhancement in malignant SPNs group was significantly higher than in the benign SPNs group (P = 0. 0084). The mean range of enhancement was (45.04 +/- 26.76) HU in malignant SPNs group, which was significantly higher than that in the benign SPNs group [(15.70 +/- 17.84) HU, P = 0.033]. The mean peak enhancement value was (136.09 +/- 41.72) HU in malignant SPNs group, which was significantly higher than in benign SPNs group [ (60.60 +/- 60.27) HU, P = 0.007]. The mean enhancement area was (21.69 +/- 21.01)% in malignant SPNs group and (8.61 +/- 10.83)% in benign SPNs group (P = 0.203).</p><p><b>CONCLUSION</b>The enhancement range and peak enhancement value as well as the morphologically irregular enhancement of SPNs may provide useful information in the clinical radiological diagnosis of SPNs.</p>

Analysis of Characteristics of Allergens Skin Prick Tests in Children in Chongming Island / 实用儿科临床杂志

3 years old than those in ≤3 years old group.The incidence rate of the adverse reaction after SPT was 1.6%(6/384),there were 4 temporary fieber,1 asthma and 1 anaphylactic shock.Conclusions The common allergens are inhalant allergens of dermatophagoides pteronyssinus and dermatophagoides farina in Chongming island.The SPT is more suitable for over 3 years old children with typical anaphylaxis of respiratory symptom and maybe have the potential danger.