Background
The growing “process” of burnout impair performance and quality of professional services, with consequences for physicians, healthcare care organization, and patient’s outcomes.
Aims
We ...aim to evaluate which strategy of intervention, individual or organization directed, is more effective to reduce physician burnout and to provide management suggestions in terms of actual organizational strategies and intensity leading to reductions in physician burnout.
Methods
The meta analysis was conducted according to the PRISMA guidelines. We included physicians of any specialty in the primary, secondary, or intensive care setting, including residents and fellows. Eligible interventions were any intervention designed to relieve stress and/or improve the performance of physicians and reported burnout outcomes, including physician-directed interventions and organization-directed interventions. The electronic search strategy applied standard filters for identification of the different studies. Databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (from inception to September 2018), and EMBASE (from beginning to September 2018). Meta analysis was performed with mixed random effect using DerSimonian and Laird method. The standardized mean difference (SMD) and 95% CI for each outcome were separately calculated for each trial pooling data when needed, according to an intention-to-treat principle.
Results
Pooled interventions were associated with small significant reductions in burnout (SMD = − 0.289; 95% CI, − 0.419 to − 0.159; I2 = 29%) (Fig.
2
). Organization-directed interventions were associated with a medium reduction in burnout score (SMD = − 0.446; 95% CI, − 0.619 to − 0.274; I2 = 8%) while physician-directed interventions were associated with a moderate reduction in burnout score (SMD = − 0.178; 95% CI, − 0.322 to − 0.035; I2 = 11%).
Discussion
This systematic review and meta-analysis showed that (1) organization-directed interventions were associated with moderate reduction in burnout score, (2) physician-directed interventions were associated with small reduction in burnout score, (3) organization-directed interventions reduced more the depersonalization than physician-directed interventions, (4) organization-directed interventions were related to a more improvement of the personal accomplishment than physician-directed interventions.
Conclusions
This meta analysis found that physicians could gain important benefits from interventions to reduce burnout, especially from organizational strategies, by viewing burnout rooted in issues related to the working environment and organizational culture.
(2014) 20 Cardiac arrest 5/9 4/8 NS 0 (1) NS not significant The authors stated that their data may have potential implications in clinical practice of acutely ill patients. According to our results, ...critical care clinicians should be wary of basing decisions about conservative or liberal oxygen therapy on the available information from this meta-analysis 1 including trials with a low FI. The effects of oxygen therapy on myocardial salvage in ST elevation myocardial infarction treated with acute percutaneous coronary intervention: the Supplemental Oxygen in Catheterized Coronary Emergency Reperfusion (SOCCER) study.
The use of tracheostomy can facilitate weaning from ventilation and potentially increase the availability of intensive care unit (ICU) beds 2. Key points of this three-step checklist are proper ...wearing of personal protective equipment and actions to reduce the risk of viral aerosolization like pushed down the endotracheal tube and keep it cuffed during the procedure. The three-step checklist for tracheostomy in critically ill COVID-19 patients is tailor-made to improve the safety and efficiency of a high-risk procedure for healthcare works.
Nonverbal communication is established by eye contact, posture, tone of voice, head nods, gesture, and the postural position. Communication between intensive care unit (ICU) staff and patients’ ...families is essential in critical care medicine: relatives rate communication skills as just as valuable as clinical skills, or even more so (Fig. 1). Communication must be unequivocal, truthful, reasoned, and appropriate to the recipient’s ability to understand their emotional state and life situation, with particular attention to frailty, suggesting hope by not creating or encouraging unrealistic expectations, reconstruct the patient’s preferences and values so as to respect their autonomy 5.
Respiratory failure is the most worrisome problem of COVID-19. Patients may develop severe pneumonia requiring invasive mechanical ventilation and a significant proportion of them dies. It has been ...suggested that brainstem might play a role in severe respiratory failure of COVID-19 patients. We described three COVID-19 patients in ICU at Federico II Hospital in Naples that, although had recovered from pneumonia, could not be weaned from invasive mechanical ventilation. Our clinical evaluation was consistent with an involvement of the brainstem and especially of respiratory centre thus possibly explaining the weaning failure in patients that were awake and had recovered from lung involvement. Our data, though limited, indicate that brainstem involvement may play a role in respiratory failure and perhaps in the high death rate of COVID-19 patients. Moreover, the weaning failure from mechanical ventilation due to central respiratory drive depression might underlie the unusual long stay in ICU reported for COVID-19 patients.
To investigate the prevalence and prognostic impact of right heart failure and right ventricular-arterial uncoupling in Corona Virus Infectious Disease 2019 (COVID-19) complicated by an Acute ...Respiratory Distress Syndrome (ARDS).
Ninety-four consecutive patients (mean age 64 years) admitted for acute respiratory failure on COVID-19 were enrolled. Coupling of right ventricular function to the pulmonary circulation was evaluated by a comprehensive trans-thoracic echocardiography with focus on the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio RESULTS: The majority of patients needed ventilatory support, which was noninvasive in 22 and invasive in 37. There were 25 deaths, all in the invasively ventilated patients. Survivors were younger (62 ± 13 vs. 68 ± 12 years, p = 0.033), less often overweight or usual smokers, had lower NT-proBNP and interleukin-6, and higher arterial partial pressure of oxygen (PaO
)/fraction of inspired O
(FIO
) ratio (270 ± 104 vs. 117 ± 57 mmHg, p < 0.001). In the non-survivors, PASP was increased (42 ± 12 vs. 30 ± 7 mmHg, p < 0.001), while TAPSE was decreased (19 ± 4 vs. 25 ± 4 mm, p < 0.001). Accordingly, the TAPSE/PASP ratio was lower than in the survivors (0.51 ± 0.22 vs. 0.89 ± 0.29 mm/mmHg, p < 0.001). At univariate/multivariable analysis, the TAPSE/PASP (HR: 0.026; 95%CI 0.01-0.579; p: 0.019) and PaO
/FIO
(HR: 0.988; 95%CI 0.988-0.998; p: 0.018) ratios were the only independent predictors of mortality, with ROC-determined cutoff values of 159 mmHg and 0.635 mm/mmHg, respectively.
COVID-19 ARDS is associated with clinically relevant uncoupling of right ventricular function from the pulmonary circulation; bedside echocardiography of TAPSE/PASP adds to the prognostic relevance of PaO
/FIO
in ARDS on COVID-19.
No clear consensus on the need to perform an intracorporeal anastomosis (IA) after laparoscopic right colectomy is currently available. One of the potential benefits of intracorporeal anastomosis may ...be a reduction in surgical stress. Herein, we evaluated the surgical stress response and the metabolic response in patients who underwent right colonic resection for colon cancer. Fifty-nine patients who underwent laparoscopic resection for right colon cancer were randomized to receive an intracorporeal or an extracorporeal anastomosis (EA). Data including demographics (age, sex, BMI and ASA score), pathological (AJCC tumour stage and tumour localization) and surgical results were recorded. Moreover, to determine the levels of the inflammatory response, mediators, such as C-reactive protein (CRP), tumour necrosis factor (TNF), interleukin 1β (IL-1β), IL-6, IL-10, and IL-13, were evaluated. Similarly, cortisol and insulin levels were evaluated as hormonal responses to surgical stress. We found that the proinflammatory mediator IL-6, CRP, TNF and IL-1β levels, were significantly reduced in IA compared to EA. Concurrently, an improved profile of the anti-inflammatory cytokines IL-10 and IL-13 was observed in the IA group. Relative to the hormone response to surgical stress, cortisol was increased in patients who underwent EA, while insulin was reduced in the EA group. Based on these results, surgical stress and metabolic response to IA justify advocating the adoption of a totally laparoscopic approach when performing a right colectomy for cancer.This trial is registered on ClinicalTrials.gov (ID: NCT03422588).
To evaluate the effectiveness of epinephrine, compared with control treatments, on survival at admission, ROSC, survival at discharge, and a favorable neurologic outcome in adult patients during ...OHCA.
MEDLINE and PubMed from inception to August 2018.
Randomized controlled trials (RCTs) on adult patients after OHCA treated with epinephrine versus controls.
Independent, double-data extraction; risk of bias assessment with Cochrane Collaboration's criteria.
15 RCTs representing 20 716 OHCA adult patients. Epinephrine, compared with all pooled treatments, was associated with a better survival rate to hospital discharge (RR: 1.16, 95% CI: 1.00-1.35) and a favorable neurologic outcome (RR: 1.24, 95% CI: 1.04-1.48). No difference was found in survival to hospital admission (RR: 1.02, 95% CI: 0.75-1.38) and ROSC when comparing epinephrine with all pooled treatments (RR: 1.13, 95% CI: 0.84-1.53). When epinephrine was compared with a placebo/no drugs, survival to hospital discharge (RR: 1.34, 95% CI: 1.08-1.67), ROSC (RR: 2.03, 95% CI: 1.18-3.51) and survival to hospital admission (RR: 2.04, 95% CI: 1.22-3.43) were increased, but there was not a favorable neurologic outcome (RR: 1.22, 95% CI: 0.99-1.51).
In OHCA, standard or high doses of epinephrine should be used because they improved survival to hospital discharge and resulted in a meaningful clinical outcome. There was also a clear advantage of using epinephrine over a placebo or no drugs in the considered outcomes.
Abstract
Background
Telehealth is an effective option to fight the outbreak of COVID-19. This review aims to systematically characterize the utilization and applications of telehealth during the ...COVID-19 pandemic focusing mainly on technology implementations.
Methods
This study was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The literature search was conducted in Science Direct, IEEE XPLORE, Scopus, and Web of Science databases from January 2020 until July 2021, with an English language restriction. A quality assessment was based on the Critical Appraisal Skills Programs checklist.
Results
The included studies focused on the implementation of technology for telehealth, multidisciplinary approach, service satisfaction, guidelines, and medical training. They provided illustrative insight into the strategy of telehealth in different medical specialties, such as pediatric gastroenterology, oncology, ophthalmology, and laryngology. Nonsurgical specialties had the greatest number of telehealth visits. Clinicians showed positive attitudes toward the implementation of video telehealth visits; patients report high levels of satisfaction with this care and strong interest in continuing this modality as a significant portion of clinical practice.
Conclusions
This systematic review provided an illustrative insight into the strategy of telehealth for different purposes. According to our findings, telehealth may be used in different medical area with a clear strategy of intervention according to patients’ and doctors’ needs.
According to this heterogenous and unpredictable geographic distribution of COVID-19, several countries are increasing their ICU capacity response by converting general ICU in dedicated COVID-19 ...facilities 5. The nursing and medical staff performed the first entry in the ICU boxes and stay inside for 4 h. After that, only two nurses and one medical doctor continue to stay inside for an additional 2 h while the other personnel rest themselves and fulfill the medical records. 5. According to our experience, a simple logistic project and clear organizational plan may be the keys to the success of surging the ICU capacity with dedicated facilities during the COVID-19 outbreak.
PDF
