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For an individual, a sustainable career is a sequence of events in one's professional life that both brings professional satisfaction to the career actor, but also allows them to stay healthy, fit, satisfied with their non-work life, feel stable and secure, and free to decide their professional future. It is challenging to pursue a career as a performing artist in such a way that the artist can say of their career that it is sustainable. Indeed, research shows that artists struggle with job instability, being paid below expectations, high competition for lucrative career opportunities and the loss of psycho-physical fitness, which is important in the profession. Dual career is one of the paths for artists to build a conscious sustainable career. Inspired by research on dual careers for athletes, we found many similarities between the sport and artistic settings, mainly related to the short-term nature of these professions. The idea of an artist pursuing a dual career in such a way that they start preparing for an alternative career path already during their artistic training seems to be a potentially attractive career management strategy to facilitate career reorientation. This study investigates the opinions of performing artists regarding the opportunities to pursue a sustainable career through conscious preparation for career reorientation. A total of 111 performers from Poland participated in the survey. Assessments of the situation of artists in the labour market during the pandemic crisis, their attitudes towards the end/descent of their artistic careers, their opinions on alternatives to practising as a performing artist, and their assessments of the potential for pursuing a dual career strategy were investigated. The survey revealed that the opinions of artists are diverse and ambiguous, probably due to the internal diversity of this professional community. Importantly, a significant group of respondents in our survey said that it was the pandemic that made them aware of the instability of a career as a performing artist (56.7%). The analysis of the research results shows what career self-management strategies the respondents use. Remarkably, for a group of respondents, the pandemic crisis has become a determinant for taking steps towards sustainable career management. [ABSTRACT FROM AUTHOR]

Non-physician clinicians (NPCs) in low and middle-income countries (LMICs) often have little physical proximity to the resources–equipment, supplies or skills–needed to deliver effective care, forcing them to refer patients to distant sites. Unlike equipment or supplies, which require dedicated supply chains, physician/specialist skills needed to support NPCs can be sourced and delivered through telecommunication technologies. In LMICs however, these skills are scarce and sparsely distributed, making it difficult to implement commonly used real-time (synchronous), hub-and-spoke telemedicine paradigms. An asynchronous teleconsultations service was implemented in Turkana County, Kenya, connecting NPCs with a volunteer network of remote physicians and specialists. In 2017–18, the service supported over 100 teleconsultations and referrals across 20 primary healthcare clinics and two hospitals. This qualitative study aimed to explore the impact of the telemedicine intervention on health system stakeholders, and perceived health-related benefits to patients. Data were collected using Appreciative Inquiry, a strengths-based, positive approach to assessing interventions and informing systems change. We highlight the impact of provider-to-provider asynchronous teleconsultations on multiple stakeholders and healthcare processes. Provider benefits include improved communication and team work, increased confidence and capacity to deliver services in remote sites, and professional satisfaction for both NPCs and remote physicians. Health system benefits include efficiency improvements through improved care coordination and avoiding unnecessary referrals, and increased equity and access to physician/specialist care by reducing geographical, financial and social barriers. Providers and health system managers recognised several non-health benefits to patients including increased trust and care seeking from NPCs, and social benefits of avoiding unnecessary referrals (reduced social disruption, displacement and costs). The findings reveal the wider impact that modern teleconsultation services enabled by mobile technologies and algorithms can have on LMIC communities and health systems. The study highlights the importance of viewing provider-to-provider teleconsultations as complex health service delivery interventions with multiple pathways and processes that can ultimately improve health outcomes. [ABSTRACT FROM AUTHOR]

Assessing vocabulary skills is a crucial aspect of educational interventions for students with disabilities, as it directly influences their academic progress, overall communication abilities, and quality of life. This study aims to explore professionals' perceptions regarding the vocabulary assessments used with students with disabilities. By gaining insights into their perspectives and experiences, we can improve the assessment process and enhance instructional practices, ultimately contributing to a better Quality of Life (QoL) for these students. Data were collected through a survey questionnaire completed by 375 professionals working in the field of special education. The findings indicate that professionals in the private sector express higher satisfaction levels and demonstrate better proficiency in applying vocabulary assessment tools compared to those in the public sector. Furthermore, the results reveal that professionals specializing in speech and language disorders report higher satisfaction levels compared to professionals in other specialized areas. [ABSTRACT FROM AUTHOR]

Background: The intention to more effectively mobilise and integrate the capabilities of the community pharmacy workforce within primary care is clearly stated within National Health Service (NHS) England policy. The Pharmacy Integration Fund (PhIF) was established in 2016 to support the development of clinical pharmacy practice in a range of primary care settings, including community pharmacy. Objective: This study sought to determine how PhIF funded learning pathways for post-registration pharmacists and accuracy checking pharmacy technicians enabled community pharmacy workforce transformation, in what circumstances, and why. Methods: Realist evaluation. We identified two main programme theories underpinning the PhIF programme and tested these theories against data collected through 41 semi-structured qualitative interviews with community pharmacist and pharmacy technician learners, educational supervisors, and community pharmacy employers. Results: The data supported the initial programme theories and indicated that the learning pathway for post-registration pharmacists had also provided opportunity for pharmacists to develop and consolidate their clinical skills before pursuing an independent prescribing qualification. Employer support was a key factor influencing learner participation, whilst employer engagement was mediated by perceptions of value expectancy and clarity of purpose. The study also highlights the influence of contextual factors within the community pharmacy setting on opportunities for the application of learning in practice. Conclusions: When designing and implementing workforce transformation plans and funded service opportunities that require the engagement of a diverse range of private, for-profit businesses within a mixed economy setting, policymakers should consider the contextual factors and mechanisms influencing participation of all stakeholder groups. [ABSTRACT FROM AUTHOR]

Background: The use of evidence-based practice among healthcare professionals directly correlates to better outcomes for patients and higher professional satisfaction. Translating knowledge in practice and mobilizing evidence-based clinical care remains a continuing challenge in healthcare systems across the world. Purpose: To describe experiences from the implementation of an Early Detection and Treatment Program for Children (EDT-C) among health care professionals at a pediatric hospital in Sweden. Design and methods: Sixteen individual interviews were conducted with physicians, nurses and nurse assistants, which of five were instructors. Data were analyzed with qualitative content analysis. Results: An overarching theme was created: From uncertainty and skepticism towards assurance and control. The theme was based on the content of eight categories: An innovation suitable for clinical practice, Differing conditions for change, Lack of organizational slack, Complex situations, A pragmatic implementation strategy, Delegated responsibility, Experiences of control and Successful implementation. Conclusions: Successful implementation was achieved when initial skepticism among staff was changed into acceptance and using EDT-C had become routine in their daily work. Inter-professional education including material from authentic patient cases promotes knowledge about different professions and can strengthen teamwork. EDT-C with evidenced-based material adapted to the context can give healthcare professionals a structured and objective tool with which to assess and treat patients, giving them a sense of control and assurance. [ABSTRACT FROM AUTHOR]

Career exploration, a critical antecedent to college students' career choices and employment, offers essential guidance for their career development. However, existing research has not explored how changes in family economic stress impact career exploration. Drawing on social cognitive career theory, this study aims to deepen our understanding of the complex interplay between family economic stress and career exploration among vocational school students. We tested our hypotheses using three-time lagged data collected from 600 vocational school students studying in mainland China. As expected, family economic stress positively predicts career exploration via love of money. Additionally, both students' effective part-time behavior and teacher support were found to positively moderate the indirect relationship between family economic stress and career exploration through love of money. We attempt to highlight the broader implications of understanding the nuanced ways in which economic background shapes career exploration. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

Background: Unexpected, sudden, and tragic losses can prompt us to reflect on the concept of a "good death." The earthquake disaster that struck our country in 2023 vividly demonstrated the challenging impact of such events, which can turn lives upside down and compel us to question the notion of a "good death." This study aims to determine the perceptions of a "good death" and the levels of trauma experienced by physicians and nurses who directly witnessed the earthquake disaster, and to understand the relationship between these factors. Methods: This cross-sectional study was conducted between October 1 and December 31, 2023, using phone interviews facilitated by a web-based Google form. Data were collected from 560 healthcare professionals (280 nurses and 280 doctors) working in hospitals located in Kahramanmaraş, Hatay, Malatya, and Adıyaman provinces in Türkiye, which were directly impacted by the earthquake of February 6, 2023, and who consented to participate in the study. Trauma levels were assessed using the "Post-Earthquake Trauma Level Determination Scale," and perceptions of a good death were evaluated using the "Good Death Scale (GDS)." Data were analyzed using SPSS 25 and AMOS 24 software. Normal distribution was checked with the Kolmogorov-Smirnov Test. Independent t-tests were used to compare independent binary groups, Pearson correlation analysis was used to examine the relationship between scale scores, and Cronbach's α coefficient was used to evaluate the reliability of the scales (Good Death Scale: 0.931; Trauma Scale: 0.957). Structural equation modeling and multi-group analysis were conducted to examine the relationship between scale scores according to the profession variable. Findings: The mean score for the perception of a good death was found to be 52.76 ± 8.77 for physicians and 55.84 ± 9.63 for nurses. A statistically significant difference was detected between physicians and nurses in the "psychosocial spirituality," "personal control," and "clinical" sub-dimensions of the scale (p<0.05). The mean trauma scores were 56.81 ± 17.58 for physicians and 64.82 ± 18.56 for nurses. A significant difference was found in the trauma scale and its sub-dimensions ("excitement limitation," "emotional," "cognitive restructuring," "sleep problems") (p<0.05). It was observed that higher trauma levels positively influenced good death perception scores. Conclusion: This study reveals that healthcare workers are deeply affected psychologically by major disasters, with high levels of trauma. A significant relationship was found between trauma levels and perceptions of a good death. These findings provide an important basis for future research to understand how trauma shapes the lives and job performance of healthcare workers in the long term. [ABSTRACT FROM AUTHOR]

Introduction: To verify whether the COVID-19 pandemic has had an impact on the safety climate based on the perception of the multiprofessional team in the operating room and to analyze the domains of the safety climate during the pre-pandemic and pandemic period of COVID-19, demonstrating the intersections of quantitative and qualitative approaches. Methods: Mixed-method research using a convergent approach strategy, carried out in the operating room of a university hospital, located in Rio de Janeiro, Brazil. The nature of the quantitative phase was cross-sectional, and the nature of the qualitative phase was descriptive. We used the Pillar Integration Process to integrate the data. This research considered the pre-pandemic period was defined as before March 2020 and for the pandemic period, the 2nd and 3rd global waves. Research was approved by the institution's board management and ethics committee. Results: 145 health professionals participated in the quantitative approach, and 20 in the qualitative approach. The impact of the COVID-19 pandemic was highlighted in the domains 'Perceived stress' (p-value = 0.017); 'Working conditions' (p-value = 0.040). Six categories emerged from the qualitative analysis, namely: Stress and professional performance due to COVID-19; Patient safety protocols in the operating room; Responsibility for patient safety, lack of effective communication and performance feedback; Biosafety of the professional staff in the operating room; Security culture maturity; Fair culture, organizational learning, and reporting mistakes. As a result of the data integration, 6 pillars were identified: Perception of communication in the operating room; Evolution of safety culture; Overview of protocol management and implementation; Fair organizational culture; Perception of stress due to COVID-19; Perception of professional performance due to COVID-19. Conclusions: The impact that COVID-19 had on the safety climate in the operating room is evident. It underlines the need to implement strategies that support the solidification of attitudes aimed at patient safety, even in emergencies. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether Heartfulness meditation practice, compared to Gratitude practice, leads to measurable changes in mental wellbeing among healthcare providers across the US. Method: Participants were randomly assigned to one of the following 6-week interventions: the trainer-guided virtual Heartfulness meditation program or the podcast-based self-guided gratitude practice group. The Professional Quality of Life Scale-5 (ProQOL-5) was used to determine Compassion Satisfaction (CS) and risk for Burnout (BO) and secondary traumatic stress (STS). The Utrecht Work Engagement Scale (UWES) was used to assess vigor, dedication, and absorption at work. Outcomes were collected at baseline and the end of the study period. Qualitative questions regarding the experience of learning and practicing were also offered at the end of the six weeks. Results: The majority of participants were nurses (50%), followed by allied healthcare professionals (37%) and physicians (13%) (N = 83). There was a general trend towards increases in CS in the Heartfulness group compared to the gratitude group. However, this was not statistically significant. Strong evidence suggests there was a significant improvement in BO for the Heartfulness group between Week 0 and Week 6 (p = 0.002), as well as STS (p = 0.0004) and vigor (p = 0.0392). Qualitative data analysis revealed that the subjects in the Heartfulness arm reported improved sleep and decreased reactivity to stress. Subjects in the gratitude arm reported improved mood and favorable results using gratitude practices at home with family members. Conclusion: In our study, Heartfulness meditation practice was associated with a significant improvement in burnout and vigor at work, with a trend towards compassion satisfaction after six weeks compared with gratitude practices. Qualitative analysis indicates the benefits of both Heartfulness and Gratitude practices. Further randomized trials with a larger sample size are needed to explore these science-based practices for the wellbeing of healthcare workers. [ABSTRACT FROM AUTHOR]

The logistics management information system (LMIS) plays a crucial role in effective record-keeping and reporting, ensuring efficient management of stock status and consumption data. A proficient LMIS improves accountability and supports informed logistic decisions in healthcare. Conversely, a subpar LMIS negatively affects essential medicine availability, compromising overall healthcare service efficiency. This study aimed to evaluate the status of the logistics management information system and the availability of non-program tracer drugs (NPTDs) in public health facilities within Bahir Dar City. This study employed an institutional-based cross-sectional study. Data were collected from February 20 to April 30, 2022 in 12 public health facilities located in Bahir Dar City. Structured questionnaire and data abstraction formats were used to gather pertinent data. After checking for completeness, the data were analyzed using Microsoft Excel and SPSS version 23. The primary analytical outcomes involved descriptive statistics, encompassing frequencies, averages, and percentages, which were subsequently presented in tables and figures. Bin card and Internal Facility Report and Resupply Form were the only blank LMIS tools available in all health facilities, while stock-record card was the least available, present in only 2(16.7%) facilities. Nine health facilities (75%) used self-prepared forms to request NPTDs from the Ethiopian Pharmaceutical Supply Agency (EPSA) at the end of the review period, whereas 7(58.3%) used official letters for emergency orders. Additionally, seven health facilities (58.3%) used the Health Commodities Management Information System On the day of the visit, 78.68% of NPTDs were available. Tetracycline eye ointment 1% had the longest stock-out duration, lasting for a mean 69.64 days. Rather than using the RRF, most of facilities opted for their own forms to request NPTDs from EPSA. While it is advisable for all health facilities to maintain continuous availability of tracer drugs, this study revealed that the current state of non-program tracer drug availability falls short of meeting this expectation. [ABSTRACT FROM AUTHOR]

Modern veterinary medicine offers a level of care to cats and dogs similar to that available to their owners, including blood transfusions, chemotherapy and MRI scans. The potential benefits to the animals of owners who can afford such care are obvious, but there can also be negative consequences if owners with strong emotional attachments to their pets pursue treatments that significantly reduce the quality of the animal's life while attempting to prolong it. Moreover, caring for a chronically or seriously ill animal can lead to emotional distress and financial and practical challenges for the pet owner. A questionnaire was used to survey cat and dog owners from representative samples of citizens in the UK, Austria and Denmark, to investigate owners' expectations and attitudes towards advanced veterinary care, and the factors that might influence those views. Overall, 58.4% of the pet owners surveyed believed that their pets should have access to the same treatment options as humans, while 51.5% believed that they should have access to the same diagnostic tests as humans. Owners were most likely to be neutral on the question of whether advanced veterinary care has 'gone too far' (45.3%), and to disagree with the statement that advanced care is 'unnecessary' (40.1%). In all three countries, the level of attachment owners had to their pets was most strongly associated with attitudes towards advanced care, with owners scoring higher on Lexington Attachment to Pets Scale (LAPS) being more likely to expect advanced care to be available. Other factors such as owner age, living situation (alone or not), income or possession of pet insurance were less consistently with owner attitudes. Our findings will help inform veterinarians and other health care providers about pet owner expectations and attitudes towards advanced veterinary care, and contribute to the debate on increasing specialisation within the profession. [ABSTRACT FROM AUTHOR]

Technological advancements have long played crucial roles in rice productivity and food security in Bangladesh. Seasonal variation over time and regional differences in rice production, however, pose a threat to agricultural sustainability but remain unexplored. We performed a spatial-temporal mapping of rice cultivation area, production, and yield from 2006–2007 to 2019–2020 using secondary data for disaggregating 64 districts in Bangladesh. Growth and multivariate approaches were employed to analyze time-series data. Results showed that Mymensingh had the highest rice cultivated area and production, while Bandarban had the lowest. The 14 years highest average rice yield was found in Gopalganj and Dhaka (3.63 tons/ha), while Patuakhali (1.73 tons/ha) had the lowest. For the Aus, Aman, and Boro, the rice cultivation area in 19 districts, 11 districts, and 13 districts declined significantly. The overall rice production increased significantly in most districts. For the Aus, Aman, and Boro seasons, the rice yield in 54, 50, and 37 districts demonstrated a significant upward trend, respectively. The adoption rate of modern varieties has risen dramatically. However, there are notable variances between regions and seasons. A significant increasing trend in Aus (0.007% to 0.521%), Aman (0.004% to 0.039%), and Boro (0.013% to 0.584%) were observed in 28, 34, and 36 districts, respectively, with an increase of 1% adaptation of HYV. Predictions revealed that rice cultivation area and production of Aus, Aman, and Boro seasons will be increased in most of the regions of Bangladesh by 2030. Based on spatiotemporal cluster analysis, the five identified cluster groupings illustrated that clusters lack spatial cohesion and vary greatly seasonally. This suggests increasing rice production by expanding cultivable land, adopting high-yielding varieties, and integrating faster technological advancement in research and extension. The findings will assist scientists in developing region-specific production technologies and policymakers in designing decentral region-specific policies to ensure the future sustainability of rice production. [ABSTRACT FROM AUTHOR]

Primary care physicians (PCPs) suffered from heavy workloads and health problems during COVID-19 pandemics, and building their confidence in pandemic response has great potential to improve their well-being and work performance. We identified the organizational factors associated with their confidence in pandemic response and proposed potential management levers to guide primary care response for the pandemic. We conducted a cross-sectional survey with 224 PCPs working in 38 community health centers in China. Guided by self-efficacy theory, organization-level factors (organizational structure and organizational culture) and physician-level factors (job skill variety, perceived organizational support, work-family conflict, and professional fulfillment) were selected, and two-level ordinal logit models were built to examine their association with PCPs' confidence in pandemic response. We found that hierarchical culture (OR = 3.51, P<0.05), perceived organizational support (OR = 2.36, P<0.05), job skill variety (OR = 1.86, P<0.05), and professional fulfillment (OR = 2.26, P<0.05) were positively associated with PCPs' confidence in pandemic response. However, the influence of organization structure and work-family conflict seemed limited. The study not only increases our understanding of the influence of organizational context on PCPs' pandemic response confidence, but also points out potential management levers for front-line primary care managers to enhance primary care pandemic response capacity. [ABSTRACT FROM AUTHOR]

Background: Evidence is available on the potential efficacy of interprofessional education (IPE) to foster interprofessional cooperation, improve professional satisfaction, and improve patient care. While the intention of the World Health Organization (WHO) is to implement IPE in all countries, evidence comes from developed countries about its efficiency, challenges, and barriers to planning and implementing IPE. We therefore conducted this review to examine challenges of implementing IPE to suggest possible pathways to overcome the anticipated challenges in developing countries. Methods: We searched for literatures on IPE in PubMed/MEDLINE, CINAHL, PsycINFO, and ERIC databases. We examined challenges or barriers and initiatives to overcome them so as to suggest methods to solve the anticipated challenges in developing countries. We could not conduct a meta-analysis because of the qualitative nature of the research question and the data; instead we conducted a meta-narrative of evidence. Results: A total of 40 out of 2,146 articles were eligible for analyses in the current review. Only two articles were available from developing countries. Despite the known benefits of IPE, a total of ten challenges or barriers were common based on the retrieved evidence. They included curriculum, leadership, resources, stereotypes and attitudes, variety of students, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Out of ten, three had already been reported in developing countries: IPE curriculum, resource limitations, and stereotypes. Conclusion: This study found ten important challenges on implementing IPE. They are curriculum, leadership, resources, stereotypes, students' diversity, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Although only three of them are already experienced in developing countries, the remaining seven are potentially important for developing countries, too. By knowing these challenges and barriers in advance, those who implement IPE programs in developing countries will be much more prepared, and can enhance the program's potential success. [ABSTRACT FROM AUTHOR]

Background: Few data are available evaluating the associations of formal public health education with long-term career choice and professional outcomes among medical school graduates. The objective of this study was to determine if formal public health education via completion of a masters of public health (MPH) degree among US medical school graduates was associated with early and long-term career choice, professional satisfaction, or research productivity. Methods: We conducted a retrospective cohort study in 1108 physicians (17.1% completed a MPH degree) who had 10-20 years of follow-up post medical school graduation. Multivariable logistic regression analyses were conducted. Results: Compared to their counterparts with no MPH, medical school graduates with a MPH were more likely to have completed a generalist primary care residency only [relative risk (RR) 1.79, 95% confidence interval (CI) 1.35-2.29], obtain employment in an academic institution (RR 1.81; 95% CI 1.33-2.37) or government agency (RR 3.26; 95% CI 1.89-5.38), and practice public health (RR 39.84; 95% CI 12.13-107.38) or primary care (RR 1.59; 95% CI 1.18-2.05). Furthermore, medical school graduates with a MPH were more likely to conduct public health research (RR 8.79; 95% CI: 5.20-13.82), receive NIH or other federal funding (RR 3.11, 95% CI 1.74-5.33), have four or more peer-reviewed publications (RR 2.07; 95% CI 1.56- 2.60), and have five or more scientific presentations (RR 2.31, 95% CI 1.70-2.98). Conclusion: Formal public health education via a MPH was associated with career choice and professional outcomes among physicians. [ABSTRACT FROM AUTHOR]

In this study, the emotional states of the instructors who teach by distance education and the effect of the environment in which they give the lesson on their emotions were examined. Computer-aided "Facial Action Coding System" method was used to measure emotion values from facial images. Through the software developed by the researchers using the Microsoft Face Recognition API, 43292 facial images taken from five trainers during their training were analysed and seven basic emotions representing facial expressions were obtained numerically. As a result of the analysis, it was found that the emotions of the instructors that can be described as negative in the lessons held in the e-studio environment generally increased at the beginning of the lesson, decreased in the following minutes and increased again at the end of the lesson; On the other hand, it was determined that positive emotions decreased at the beginning of the lesson and increased later. In the home environment, while the emotions that can be described as negative at the beginning decreased, positive emotions increased. A significant difference was determined between home and e-studio environment in all emotions except anger. One of the emotions with a difference in value between the two environments is happiness, and it has been determined that happiness has higher values in the home environment. It has been determined that other emotions are experienced more in the e-studio environment. It is thought that the results of the study will contribute to the mental states of the instructors who teach through distance education and to the efficiency of distance education. [ABSTRACT FROM AUTHOR]

Background: Morale and burnout were concerns for hospitalists prior to the COVID-19 pandemic; these concerns were amplified as COVID-19 spread and hospitals experienced unprecedented stress. In contrast to prior literature, our study assesses both satisfaction and the importance of various factors. This study examines morale of hospitalists early in the COVID-19 pandemic in two settings: conventional hospitals and a COVID-19 Alternate Care site (ACS) in the same geographic region in Maryland. Multiple studies published early in the pandemic show low morale in COVID-19 hospitals. Methods: In a cross-sectional survey study, we analyze data from the Hospitalist Morale Index (HMI) administered between September 2020 and March 2021 to determine the pandemic's impact on hospitalist morale. Results: Surprisingly, our study found morale in the ACS was better than morale at the conventional hospitals. ACS hospitalists and conventional hospitalists were demographically similar. Our results show that a significantly higher proportion of conventional hospitalists reported burnout compared to the ACS hospitalists. General quality of life was rated significantly higher in the ACS group than the conventional group. Significantly more ACS hospitalists were invested in making their group outstanding. Five main HMI domains were examined with questions on a 5-point rating scale: Clinical Factors, Workload, Material Rewards, Leadership, and Appreciation/Acknowledgement. ACS hospitalists rated most measures higher than conventional hospitalists; largest differences were observed in Clinical Factors and Appreciation/Acknowledgement domains. Narrative comments from ACS hospitalists revealed strong identification with the mission of the ACS and pride in contributing during a crisis. One key difference between the two groups explains these findings: provider autonomy. The ACS staff chose the position and the assignment, while conventional hospitalists caring for COVID-19 patients could not readily opt out of this work. Conclusion: Our data suggest that autonomy in assignments with risk has implications for morale and burnout. [ABSTRACT FROM AUTHOR]

Background: Professional fulfillment is crucial for physicians' well-being and optimal patient care. Highly demanding work environments, perfectionism and self-critical attitudes jeopardize physicians' professional fulfillment. Objective: To explore to what extent a kinder attitude towards the self, i.e. self-kindness, was associated with physicians' professional fulfillment and whether this relationship was mediated by personal resilience and work-home interference. Methods: In 2020, cardiologists (n = 374) in the Netherlands participated in a web-based survey. Self-kindness was measured by the self-kindness subscale of the Self-Compassion Scale, personal resilience by the Brief Resilience Scale, work-home interference by the negative Work-Home Interference subscale of the Survey Work-Home Interaction–Nijmegen, and professional fulfillment by the corresponding subscale of the Professional Fulfillment Index. Using Hayes' SPSS macro PROCESS v3.5, the authors tested the parallel mediation model. Results: Self-kindness was not directly associated with professional fulfillment (direct effect =.042, p =.36, 95% CI: -0.048, 0.132). Self-kindness was indirectly related to professional fulfillment through individual resilience (indirect effect =.049, 95% CI:.020, 0.086) and work-home interference (indirect effect =.057, 95% CI:.023, 096). Conclusions: This study suggests that improving physicians' self-kindness may enhance professional fulfillment through personal resilience and work-home interference. Our findings may stimulate and remind physicians to be kind towards themselves as it may benefit them and their patients. [ABSTRACT FROM AUTHOR]

Background: Problems with health-related quality of life can affect physicians' ability to work effectively. This study compared the health-related quality of life of Hong Kong physicians to the general population and explored the factors associated with mental and physical health-related quality of life. Methods: This cross-sectional study was conducted from January to April 2016. Medical graduates from the University of Hong Kong participated in a survey containing the Short Form-12 Item Health survey version 2, Patient Health Questionnaire-9, Copenhagen Burnout Inventory, and items on lifestyle behaviors, career satisfaction, and socio-demographics. Results: 496 responses were received. The mean physical component summary score was 53.2 (SD = 7.6), similar to the general population. The mean mental component summary score was 43.6 (SD = 11.8), significantly worse than the general population (P<0.01). Compared to the general population, all Short-Form 12 Health Survey version 2 domains were worse in doctors, aside from bodily pain and general health. Regular exercise was positively associated with physical component summary scores (Coeff 2.024; P = 0.047); but having children and higher personal burnout scores were negatively associated with it (Coeff -1.890; P = 0.036; and Coeff -0.045; P = 0.027, respectively). Poorer mental component summary scores correlated with worse personal (Coeff -0.284; P< 0.001), work-related (Coeff -0.135; P = 0.040), and patient-related burnout (Coeff -0.060; P = 0.041), and higher Patient Health Questionnaire-9 scores (Coeff -9.170; P<0.001). There were significant differences in mental health (P = 0.042) and mental component summary scores (P = 0.012) across age groups, but not with gender. Conclusion: Hong Kong physicians are less impacted by physical health than mental health. Compared to the general population, doctors' mental health has a more significant impact on their lives. Interventions aimed to improve burnout and depression rates in physicians may improve physicians' mental health-related quality of life. [ABSTRACT FROM AUTHOR]

Physician turnover places a heavy burden on the healthcare industry, patients, physicians, and their families. Having a mechanism in place to identify physicians at risk for departure could help target appropriate interventions that prevent departure. We have collected physician characteristics, electronic health record (EHR) use patterns, and clinical productivity data from a large ambulatory based practice of non-teaching physicians to build a predictive model. We use several techniques to identify possible intervenable variables. Specifically, we used gradient boosted trees to predict the probability of a physician departing within an interval of 6 months. Several variables significantly contributed to predicting physician departure including tenure (time since hiring date), panel complexity, physician demand, physician age, inbox, and documentation time. These variables were identified by training, validating, and testing the model followed by computing SHAP (SHapley Additive exPlanation) values to investigate which variables influence the model's prediction the most. We found these top variables to have large interactions with other variables indicating their importance. Since these variables may be predictive of physician departure, they could prove useful to identify at risk physicians such who would benefit from targeted interventions. [ABSTRACT FROM AUTHOR]

Increasing and changing demands for academic teachers worldwide are leading to different consequences, some of which are negative, such as physical and mental health impairment. With the job demands-resources model and the transactional model of occupational stress adopted as a theoretical framework, a cross-sectional study among Polish academic teachers was conducted. The aim of the study is to identify the role of vital personal resources understood as selected health-promoting behaviours, such as (1) stress-coping strategies, (2) sleep hygiene, and (3) using annual vacation leave, in the process of the regeneration. In a cross-sectional survey, the following variables have been assessed: 1) work-related stress using the Psychosocial Risk Scale, 2) occupational burnout using the Oldenburg Burnout Inventory (OLBI), 3) chronic fatigue using the Polish adaptation of the Checklist Individual Strength (CIS), and selected health behaviours of academic teachers 4) stress-coping strategies with the help of the Polish version of Mini-COPE and 5) rest: the amount of sleep and vacation days devoted to rest using a short questionnaire designed by the authors. The sample (N = 340) was comprised of academic teachers employed at Polish higher education institutions who have experienced changes in the work environment in recent years. We conducted a multiple regression analysis to determine the relationships among stress, burnout, and chronic fatigue, looking at coping strategies and rest as a moderator. The results indicate that there is a strong relationship between stress resulting from an excessively demanding work environment on the one hand and occupational burnout and chronic fatigue on the other. At the same time, selected health behaviours of academic teachers only slightly moderate the analyzed relationship. Avoidance strategies strengthen the relationship between stress and its negative consequences, while rest and—to a limited extent—the amount of sleep only slightly contribute to weakening the analyzed relationship. [ABSTRACT FROM AUTHOR]

The disruption caused by the Covid-19 pandemic generated an unprecedented situation, in which digital learning, in the form of Emergency Remote Teaching, was the only possible form of schooling. Italy soon decided to close schools as a measure to counter the spread of the virus. Although the Ministry of Education suggested general guidelines, school principals and teachers were autonomous in deciding how to best organise their educational activities. The first objective of our study is to identify subgroups of teachers, based on the use of digital tools during the Covid-19 emergency. Secondly, we explore how subgroups differ in terms of teachers' satisfaction and students' performance. To this end, we integrate information from an ad hoc survey completed by 1,407 primary and lower secondary teachers in Italy, with the students' standardised test scores provided by INVALSI. Data have been analysed through a 3-step latent class analysis. The findings reveal that one third of the teachers showed resistance to the use of digital technologies and focused mainly on asynchronous teaching. Teachers that used a broader set of digital instruments, instead, were more satisfied with their teaching practices. A more articulated use of technology for teaching activities was also positively associated with higher students' performance in 2021. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, which enforced social distancing and isolation, teachers were required to handle multiple challenges related to their work, including dealing with remote teaching, in addition to personal, medical and financial challenges. The goal of the current research was to examine factors that contributed to professional burnout and commitment to work among teachers during the first and second waves of the COVID-19 pandemic. Methods: A total of 344 elementary school teachers in Israel completed online self-report questionnaires, including assessments of stressors, anxiety, resilience, self-efficacy beliefs, and coping strategies. Structured Equation Modeling [SEM] was used to examine the contribution of these factors to professional burnout and commitment. Results: The gaps between needed and received support had a direct effect on teachers' burnout and commitment, and an indirect effect through anxiety and self-efficacy beliefs. Stress relating to remote teaching and support-gaps regarding remote teaching were the most significant of all the stressors and sources of support. Conclusions: Collectively, these findings highlight the significance of remote teaching as the main cause of stress and professional burnout and suggest that proper preparation of teachers—before and during times of crisis, may have a significant impact on their mental and professional well-being. [ABSTRACT FROM AUTHOR]

Patients with heart failure (HF) often suffer from multimorbidity. Rapid assessment of multimorbidity is important for minimizing the risk of harmful drug-disease and drug-drug interactions. We assessed the accuracy of using the electronic health record (EHR) problem list to identify comorbid conditions among patients with chronic HF in the emergency department (ED). A retrospective chart review study was performed on a random sample of 200 patients age ≥65 years with a diagnosis of HF presenting to an academic ED in 2019. We assessed participant chronic conditions using: (1) structured chart review (gold standard) and (2) an EHR-based algorithm using the problem list. Chronic conditions were classified into 37 disease domains using the Agency for Healthcare Research Quality's Elixhauser Comorbidity Software. For each disease domain, we report the sensitivity, specificity, positive predictive value, and negative predictive of using an EHR-based algorithm. We calculated the intra-class correlation coefficient (ICC) to assess overall agreement on Elixhauser domain count between chart review and problem list. Patients with HF had a mean of 5.4 chronic conditions (SD 2.1) in the chart review and a mean of 4.1 chronic conditions (SD 2.1) in the EHR-based problem list. The five most prevalent domains were uncomplicated hypertension (90%), obesity (42%), chronic pulmonary disease (38%), deficiency anemias (33%), and diabetes with chronic complications (30.5%). The positive predictive value and negative predictive value of using the EHR-based problem list was greater than 90% for 24/37 and 32/37 disease domains, respectively. The EHR-based problem list correctly identified 3.7 domains per patient and misclassified 2.0 domains per patient. Overall, the ICC in comparing Elixhauser domain count was 0.77 (95% CI: 0.71-0.82). The EHR-based problem list captures multimorbidity with moderate-to-good accuracy in patient with HF in the ED. [ABSTRACT FROM AUTHOR]

Using a unique survey of more than 7,000 respondents conducted immediately after the first wave of the COVID-19 pandemic in Italy, we investigate potential drivers of the job satisfaction of healthcare workers. Relying on a representative sample of Italian physicians and nurses, we show that, in addition to personal characteristics (e.g., age, gender, health status), contextual factors (i.e., working conditions) play the leading role in explaining variation in the level of satisfaction (58%). In particular, working in a high-quality facility increases worker satisfaction and willingness to remain in the profession, and in the current medical specialization, while working in a province with a perceived shortage of medical personnel yields the opposite result. Direct experience with COVID-19 (e.g., having tested positive) is not significantly correlated with the level of job satisfaction, which is instead significantly reduced by changes in the working conditions caused by the health emergency. [ABSTRACT FROM AUTHOR]

Objectives: This time-motion study explored the amount of time clinicians spent on wound assessments in a real-world environment using wound assessment digital application utilizing Artificial Intelligence (AI) vs. manual methods. The study also aimed at comparing the proportion of captured quality wound images on the first attempt by the assessment method. Methods: Clinicians practicing at Valley Wound Center who agreed to join the study were asked to record the time needed to complete wound assessment activities for patients with active wounds referred for a routine evaluation on the follow-up days at the clinic. Assessment activities included: labelling wounds, capturing images, measuring wounds, calculating surface areas, and transferring data into the patient's record. Results: A total of 91 patients with 115 wounds were assessed. The average time to capture and access wound image with the AI digital tool was significantly faster than a standard digital camera with an average of 62 seconds (P<0.001). The digital application was significantly faster by 77% at accurately measuring and calculating the wound surface area with an average of 45.05 seconds (P<0.001). Overall, the average time to complete a wound assessment using Swift was significantly faster by 79%. Using the AI application, the staff completed all steps in about half of the time (54%) normally spent on manual wound evaluation activities. Moreover, acquiring acceptable wound image was significantly more likely to be achieved the first time using the digital tool than the manual methods (92.2% vs. 75.7%, P<0.004). Conclusions: Using the digital assessment tool saved significant time for clinicians in assessing wounds. It also successfully captured quality wound images at the first attempt. [ABSTRACT FROM AUTHOR]

Background: Despite broad awareness of the opioid epidemic and the understanding that patients require much fewer opioids than traditionally prescribed, improvement efforts to decrease prescribing have only produced modest advances in recent years. Methods and findings: By using a collaborative model for shared expertise and accountability, nine diverse health care systems completed quality improvement projects together over the course of one year to reduce opioid prescriptions for acute pain. The collaborative approach was flexible to each individual system's goals, and seven of the nine participant institutions definitively achieved their desired results. Conclusions: This report demonstrates the utility of a collaborative model of improvement to bring about real change in opioid prescribing practices and may inform quality improvement efforts at other institutions. [ABSTRACT FROM AUTHOR]

This study aims to investigate the association of organizational and patient behaviors (reflecting the internal and external environment of hospital, respectively) with physician well-being. A national cross-sectional survey was conducted in 77 hospitals across seven provinces in China between July 2014 and April 2015. Physician well-being was assessed with job satisfaction, career regret and happiness. Organizational behaviors were assessed with organizational fairness, leadership attention and team interaction; patient behaviors were assessed with patient trust and unreasonable requests from patients. Of a study sample of 3,159 physicians, 1,788 were men (56.6%) and 1,371 were women (43.4%). Overall, positive organizational and patient behaviors reported by physicians were relatively low. Negative organizational behaviors and patient behaviors including lower organizational fairness, lower leadership attention, lower team interaction and lower patient trust were associated with lower job satisfaction and lower life satisfaction, and higher career regret. The association between organizational behaviors and physician well-being exhibited some gender differences, while no clear gender difference was found for the relationship between patient behaviors and physician well-being. Given the importance of physician well-being for the healthcare system, interventions for improving internal and external hospital environments (e.g., organizational fairness, leadership attention, team interaction and patient trust) may benefit physician well-being. [ABSTRACT FROM AUTHOR]

Aims: To analyse the global process by which Spanish nurses have acquired a differentiated role in primary health care and to develop a theory that explains the evolution of this role. Design: Grounded Theory was selected, as proposed by Glaser and Strauss, following the theoretical framework of Bourdieu's habitus. Methods: Thirteen in-depth interviews were conducted between 2012 and 2015, using theoretical sampling and seeking maximum variability. The analysis of the data included progressive coding and categorization, constant comparative analysis and memo writing. Results: A core category emerged, "Autonomy", composed of three categories: "Between illusion and ignorance. Genesis of a habitus", "The recognisable and recognised habitus" and "Habitus called into question", showing the genesis of the nursing role in primary health care and the elements that influence the autonomy of the role: the ability to decide their training, assume their own leadership, configure teams and acquire independent skills. "Seeking autonomy" was the substantive theory that emerged from the data. Conclusion: The results reveal the elements that strengthen the autonomous professional role and that this role is legitimated when two elements are identified: the acquisition of a habitus, based on practices carried out regularly and the recognition of this habitus by the population and others professionals. Impact: The results of this study identify the elements that guide and strengthen the professional role and redefine the concept of autonomy. These are operational findings and could potentially be used to define new strategies for advancing the role of nursing in primary health care. [ABSTRACT FROM AUTHOR]

Background: This study investigated different patterns of emotional labor among community nurses in China and analyzed the relationships between the sense of career success and emotional labor. Methods: A total of 385 community nurses from Beijing participated in this investigation. Latent class analysis was used to identify meaningful subgroups of participants, and analysis of variance was used to analyze relationships between emotional labor classes and the sense of career success. Results: Emotional labor among community nursing staff in China was divided into three latent classes: active (n = 90, 25.6%), apathetic (n = 65, 18.5%), and moderate (n = 197, 55.9%). The active emotional labor classes had significantly higher career success (p<0.05). The "gaining recognition" dimension showed significant differences across the three classes. Conclusion: Our findings suggested managers to implement a variety of measures to strengthen interventions for employees' emotional labor that are targeted to incentive mechanisms, which will improve nurses' sense of career success. [ABSTRACT FROM AUTHOR]

At a time when vocational education is seen as critical for national development, concern grows regarding how weak organizational culture and occupational commitment may threaten the production of quality graduates and teachers within the field. The failure of vocational institutions to effectively create human capital likely threatens the connections between Chinese industry and its educational institutions. This study thus explores how these connections are influenced by organizational and occupational factors. A multi-layer linear model is employed on data collected from 406 teachers from 69 Chinese vocational colleges and universities. Results suggest that organizational cultural positively influences industry-university cooperative behavior through the construction of strong occupational commitment and job involvement. This study not only enriches and expands new knowledge and academic perspectives, but also provides feasible policy suggestions to help guide educational administrators toward the improvement of vocational education. [ABSTRACT FROM AUTHOR]

This study investigates the satisfaction and adequacy of citizens through the expected quality and perceived quality in the areas of planning and territorial viability, experience in the provision of municipal services and citizen experience in environmental issues, in order to provide tools for territorial decision making for the citizens' well-being. In our research PLS software is used for the analysis of hypotheses. A questionnaire was delivered to a sample of 521 citizens, representing the spectrum of the population, and the statistical study of the responses yielded results on citizen satisfaction and loyalty. Our research includes the study of moderating effects on the causal ratio of perceived value and satisfaction in territorial planning and viability, the perceived quality in the provision of municipal services and the perceived quality in the citizen experience in the environmental management of the territory on the value relationship perceived by the citizen and general satisfaction. A second objective of the study is to see if there are significant differences in the hypotheses raised by gender by performing a multigroup analysis. This difference has been appreciated in two of the hypotheses. The study shows that the policies exercised by the territorial managers of the different areas have a significant influence on the value perceived by citizens, satisfaction and loyalty, which shape their general well-being. Areas for improvement in territorial policies and municipal services such as citizen security, air quality, public lighting and sports services have been identified. Knowing these shortcomings allows politicians to focus their efforts on improving the quality of life in cities. [ABSTRACT FROM AUTHOR]

Background: Assessment of parental satisfaction with child nursing is the key issue in evaluation of the care quality, enabling the adjustment of the services provided to the needs and expectations of recipients, and thus ensuring safety and achieving better long-term health effects. Aim: Assessment of parental satisfaction with child nursing in paediatric wards including its determinants. Material and methods: The study covered 1030 parents of children hospitalised in paediatric and surgical wards of seven hospitals of different levels of health security in Poland. The Polish adaptation of the Empathic standardised questionnaire for assessment of the level of parents' satisfaction with nursing care, developed by Latour et al. and the self-constructed summary of socio-demographic data were applied in the study. Results: More than 90% of respondents expressed high level of satisfaction with nurses' Availability, the lowest, but still high score of respondents' satisfaction was observed for Parental Participation. The highest satisfaction was observed among the parents of children at the preschool, early school and puberty stage, admitted to the hospital on the elective basis, referred for diagnostic assessment and with the length of hospital stay less than 7 and longer than 28 days. Achieving preschool age was the strongest factor which increased assessment of satisfaction in most domains. Conclusions: There is a need for optimising nursing care especially in the area of parental participation. The nursing care' quality improvement plan in paediatric departments should focus particularly on early childhood patients and their parents who are the most critical in satisfaction' assessment. [ABSTRACT FROM AUTHOR]

Communicating Brazilian science still seems to be a challenge for journalists and researchers of public institutions of education and science. In this sense, this research aims to identify and analyze scientists' perceptions regarding the work of journalists, the relationship between these groups, the expectations, and the challenges of science communication in two Federal Institutes of Education in Brazil. We conducted a mixed study in the qualitative stage with the participation of 30 interviewees, and in the quantitative stage, journalists and researchers answered a questionnaire (n = 242). Our results indicated that the work of science communication is not carried out properly in both Institutes and that there is a lack of articulated work among both journalists, communicators, and researchers. The relationship between these groups needs to be built jointly. In this respect, the biggest challenges are to institutionalize science communication, establish a science communication plan, and overcome internal relationship barriers. Our results may underpin science communication policies and policies for scientific dissemination both institutional or even national levels. [ABSTRACT FROM AUTHOR]

Background: Though Midwife-led care remains a key to improving the health status of pregnant mothers, in Ethiopia, maternity care has traditionally been based on a model in which responsibility for care is shared by hospital-based midwives, nurses, general practitioners, and obstetricians. This type of care has been seen as representing a fragmented approach. Objective: The aim of this study was to explore health care providers' perceptions and experiences related to Midwife-led continuity of care at primary hospitals in the north Shoa zone Ethiopia Methods: A qualitative approach was selected as the methodology for this study. Data were collected from 25 midwives and 8 integrated emergency surgical officers (IESO) and medical doctors working in maternal health care units in four primary hospitals in the north Shoa zone, Amhara Regional State. Four focus group discussions and eight individual interviews were conducted. The facilitator utilized a set of open-ended questions for the focus group discussion. Semi-structured interview questions were used for the interviews and thematic data analysis was done. Finding: The main theme extracted was "Midwives welcome consideration of a Midwife-led model that would provide greater continuity of care, but they expressed concerns about organisation and workload". The midwives said that they would welcome working with the midwife-led care model, as they believed using it could lead to improving the quality of maternal health care, provide greater continuity, and improve coverage, birth outcomes, and maternal satisfaction. The midwives could become more autonomous and be able to take more responsibility for maternity care. The group of 25 midwives and the group of 8 IESO and medical doctors perceived that working procedures and changes in the organization of care in the health facility would have to be studied carefully before any changes can be considered. Conclusion: In this study, we found that replacing the existing system of maternal care with a Midwife-led model would require careful analysis of how this model of care might be implemented in Ethiopia. Further investigation will be of great importance in providing insights that will help in developing a final model. [ABSTRACT FROM AUTHOR]

Background: Teaching work is stressful, moreover during the pandemic teachers' stress might have been intensified by distance education as well as by limited access to social support, which functions as a buffer in experiencing stress. The aim of the research was to investigate the relation between distance education and teachers' well-being, and their close relations and other social relations during the first two waves of the COVID-19 pandemic. Methods: The research was conducted in two stages on 285 Polish primary and secondary school teachers who were recruited by means of the chain referral method. The following measures were used: The Depression Anxiety & Stress Scales-21, Berlin Social Support Scales, The Relationship Satisfaction Scale and The Injustice Experience Questionnaire. Results: The teachers experienced at least mild levels of stress, anxiety and depression, both during the first as well as the second waves of the COVID-19 pandemic in Poland. It has been confirmed that there is a negative relation between relationship quality change and social relations quality change, and stress, anxiety and depression. The variables taken into consideration in the research have provided the explanation for the variation of stress—from 6% in the first stage of the research to 47% in the second stage; for the variation of anxiety—from 21% to 31%; and for the variation of depression—from 12% to 46%, respectively. Conclusions: The research results show that due to distance work the distinction between professional work and family life might have been blurred, and as a consequence teachers' well-being could have been worsened. The isolation put on to stop the spreading of the virus might have contributed to changes in social relations, in close relations in particular, and at the same time negatively influenced teachers' abilities to effectively cope with the crisis situations. [ABSTRACT FROM AUTHOR]

There has been increasing interest in examining physician well-being and its predictive factors. However, few studies have revealed the characteristics associated with physician well-being and work-life integration using a machine learning approach. To investigate predictive factors of well-being and obtain insights into work-life integration, the survey was conducted by letter mail in a sample of Japanese physicians. A total of 422 responses were collected from 846 physicians. The mean age was 47.9 years, males constituted 83.3% of the physicians, and 88.6% were considered to be well. The most accurate machine learning model showed a mean area under the curve of 0.72. The mean permutation importance of career satisfaction, work hours per week, existence of family support, gender, and existence of power harassment were 0.057, 0.022, 0.009, 0.01, and 0.006, respectively. Using a machine learning model, physician well-being could be predicted. It seems to be influenced by multiple factors, such as career satisfaction, work hours per week, family support, gender, and power harassment. Career satisfaction has the highest impact, while long work hours have a negative effect on well-being. These findings support the need for organizational interventions to promote physician well-being and improve the quality of medical care. [ABSTRACT FROM AUTHOR]

Physician wellness is vital to career satisfaction, provision of high quality patient care, and the successful education of the next generation of physicians. Despite this, the number of physicians experience symptoms of burnout is rising. To assess the impact of organizational culture on physicians' professional fulfillment and burnout, we surveyed full-time Department of Medicine members at the University of Toronto. A cross-sectional survey assessed: physician factors (age, gender, minority status, disability, desire to reduce clinical workload); workplace culture (efforts to create a collegial environment, respectful/civil interactions, confidence to address unprofessionalism without reprisal, witnessed and/or personally experienced unprofessionalism); professional fulfillment and burnout using the Stanford Professional Fulfillment Index. We used multivariable linear regression to examine the relationship of measures of workplace culture on professional fulfillment and burnout (scores 0–10), controlling for physician factors. Of 419 respondents (52.0% response rate), we included 400 with complete professional fulfillment and burnout data in analyses (60% ≤ age 50, 45% female). Mean scores for professional fulfillment and burnout were 6.7±1.9 and 2.8±1.9, respectively. Controlling for physician factors, professional fulfillment was associated with satisfaction with efforts to create a collegial environment (adjusted beta 0.45, 95% CI 0.21 to 0.70) and agreement that colleagues were respectful/civil (adjusted beta 0.85, 95% CI 0.53 to 1.17). Lower professional fulfillment was associated with higher burnout scores. Controlling for professional fulfillment and physician factors, lower confidence in taking action to address unprofessionalism (adjusted beta -0.22, 95% CI -0.40 to -0.03) was associated with burnout. Organizational culture and physician factors had an impact on professional fulfillment and burnout. Professional fulfillment partially mediated the relationship between organizational culture and burnout. Strategies that promote inclusion, respect and civility, and safe ways to report workplace unprofessionalism are needed in academic medicine. [ABSTRACT FROM AUTHOR]

Background and purpose: During a period of 6 months, we provided our entire neuroradiological staff including physicians, radiographers, and researchers with systematic feedback via email on the further clinical course of stroke patients who underwent mechanical thrombectomy. We analyzed the effects of this feedback on work satisfaction, work meaningfulness and valuation of the therapy among our staff. Methods: Our staff completed two self-reported questionnaires before and after the period of six months with systematic feedback. Results: Employees with higher work meaningfulness and higher work satisfaction valuated endovascular stroke therapy as more useful (p<0.001). A good clinical outcome was regarded more motivating than a good interventional outcome (p<0.001). Receiving systematic feedback did not increase work satisfaction (p = 0.318) or work meaningfulness (p = 0.178). Radiographers valuated the usefulness of interventional therapy the worst of all employees (p≤ 0.017). After the feedback period, 75% of radiographers estimated stroke as a more severe disease than before. Also, their desire for feedback decreased significantly (p = 0.007). Primarily patient cases with unfavorable outcomes were remembered by the staff. Conclusions: Systematic email feedback does not per se enhance work satisfaction or work meaningfulness among employees. However, receiving feedback is educative for the staff. Evaluating work satisfaction and the perception of treatment may help to identify unexpected issues and may therefore help to find specific measures that increase work satisfaction and motivation. [ABSTRACT FROM AUTHOR]

Objectives: To characterize psychological distress and factors associated with distress in healthcare practitioners working during a stringent lockdown in a country (Jordan) that had exhibited one of the lowest incidence rates of Covid-19 globally at the time of the survey. Methods: A cross-sectional online survey sent to healthcare practitioners working in various hospitals and community pharmacies. Demographic, professional and psychological characteristics (distress using Kessler-6 questionnaire, anxiety, depression, burnout, sleep issues, exhaustion) were measured as were sources of fear. Descriptive and multivariable statistics were performed using level of distress as the outcome. Results: We surveyed 937 practitioners (56.1% females). Approximately 68%, 14%, and 18% were nurses/technicians, physicians, and pharmacists (respectively). 32% suffered from high distress while 20% suffered from severe distress. Exhaustion, anxiety, depression, and sleep disturbances were reported (in past seven days) by approximately 34%, 34%, 19%, and 29% of subjects (respectively). Being older or male, a positive perception of communications with peers, and being satisfied at work, were significantly associated with lower distress. Conversely, suffering burnout; reporting sleep-related functional problems; exhaustion; being a pharmacist (relative to a physician); working in a cancer center; harboring fear about virus spreading; fear that the virus threatened life; fear of alienation from family/friends; and fear of workload increases, were significantly associated with higher distress. Conclusion: Despite low caseloads, Jordanian practitioners still experienced high levels of distress. Identified demographic, professional and psychological factors influencing distress should inform interventions to improve medical professionals' resilience and distress likelihood, regardless of the variable Covid-19 situation. [ABSTRACT FROM AUTHOR]

Background: Healthcare provider wellness have been reported to correlate with patient care outcomes. It is not understood whether synergistic effects may exist between them. Objective: We aim to investigate three provider wellness markers and determine their associations with provider self-reported medical errors and intent-to-leave outcomes among Emergency Department (ED) providers. Design: This is a multi-center retrospective study. Method: Three wellness domains include professional fulfillment (PF), burnout (BO), and personal resilience (PR). Two outcomes measured as provider self-reported medical errors and provider intent-to-leave. Correlations between wellness markers and outcomes were analyzed. When adjusted for other confounders (provider demographics, provider experience, and operational environment), a multivariate logistic regression analysis was performed to further determine the interactions among these three domains on provider wellness affecting patient and provider related outcomes. Results: Total 242 surveys were collected from providers at 16 different EDs. The median score of PF were 2.83 among physicians and 2.67 among APPs, BO were 1.00 (physicians) and 0.95 (APPs), and PR were 0.88 (physicians) and 0.81 (APPs). The median scores of self-reported medical errors were 1.50 (physicians) and 0.95 (APPs), and intent-to-leave were 1.00 (physicians and APPs). High correlations occurred among PF, BO, and PR. When analyzed together, high PF, low BO, and high PR functioned as a protective effect on provider intent-to-leave (adjusted odds ratios = 0.09, 95% CI 0.03–0.30). Conclusion: High correlations occurred among three provider wellness markers with no significant difference between physicians and APPs. Providers with high PR, low BO, and high PR tended to be more stable in their jobs. [ABSTRACT FROM AUTHOR]

Introduction: The incidents of violence against doctors, leading to grievous injury and even death, seem to be on an increasing trend in recent years. There is a paucity of studies on workplace violence against doctors and its effect, in India. The present study was conducted to assess workplace violence faced by doctors, its effect on the psycho-social wellbeing of the treating doctor and, subsequently, on patient management. Methods: The present nationwide cross-sectional study was conducted from November 2019 –April 2020. The sample size was calculated assuming the prevalence of workplace violence as 50%, with 20% non-response. Doctors, working in private and/or public set-up, with ≥1 year clinical experience, were included. A pre-tested study tool- Google form—was sent to study participants via social media platforms. The Microsoft Excel spreadsheet was downloaded from google drive and data was analysed using STATA-12 statistical software. Results: A total of 617 responses were received from doctors all over India; out of which 477 (77.3%) doctors had ever faced workplace violence. "Actual or perceived non-improvement or deterioration of patient's condition" (40.0%), followed by "perception of wrong treatment given" (37.3%) were the main causes of workplace violence; and the family members/relatives were the major perpetrators (82.2%). More than half of the participants reported "loss of self-esteem", "feeling of shame" and "stress/depression/anxiety/ideas of persecution" after the incident. Management by surgical interventions (p-value<0.001) and handling of emergency/complicated cases (p-value<0.001) decreased significantly with an increase in severity of workplace violence; while the suggestion of investigations and referrals increased (p-value<0.001). Conclusions: Workplace violence has a significant effect on the psycho-social well-being of doctors, as well as on patient management; which may escalate discontent and distrust among the general public, thereby increasing incidents of workplace violence—in a self-propagating vicious cycle. [ABSTRACT FROM AUTHOR]

The aim of the study is to compare sociodemographic characteristics, psychosocial factors, HIV knowledge and risk behaviors of people living with HIV (PLH) and their social network members (NMs) to inform HIV prevention programs that engage PLH as prevention educators in their communities. We compared baseline characteristics of PLH enrolled in an intervention to become HIV prevention Change Agents (CAs) (n = 458) and 602 NMs they recruited. CAs and NMs responded to questionnaires through a computer-driven interface with Audio Computer-Assisted Self Interview (ACASI) software. Although NMs scored higher on socio-economic status, self-esteem and general self-efficacy, they had lower HIV knowledge (AOR 1.5; 95% CI: 1.1–2.1), greater inconsistent condom use (AOR 3.2; 95% CI: 2.4–4.9), and recent experience as perpetrators of physical (AOR 2.5; 95% CI: 1.2–5.1) or sexual (AOR 4.1; 95% CI: 1.4–12.7) intimate partner violence; and as victims of physical (AOR 1.5; 95% CI: 1.0–2.3) or sexual (AOR 2.2; 95% CI: 1.3–3.8) forms of violence than CAs. Higher HIV knowledge and lower sexual risk behaviors among CAs suggest PLH's potential as communicators of HIV prevention information to NMs. CAs' training should also focus on improving self-esteem, general self-efficacy and social support to increase their potential effectiveness as HIV prevention educators and enhance their own overall health and well-being. [ABSTRACT FROM AUTHOR]

Background: Successive health system reforms have steadily eroded physician autonomy. Escalating accountability demands placed on physicians concurrent with diminishing autonomy plus widespread "cost cutting" endanger clinical work-life quality and, in turn, threaten patient-care quality, safety, and continuity. This has engendered a renewed emphasis on bettering physician work-life to safeguard patient care. Research indicates that autonomy support could be an effective intervention point in this dynamic, and that improving healthcare practitioners' experience of autonomy can promote better patient outcomes. New measures of autonomy support towards physicians during systemic/organizational transformation are thus needed. Objective: We investigated the validity and reliability of two versions of a brief measure of physicians' perceptions of autonomy support. Design: Psychometric evaluation of practitioners' responses to a theory-based, pilot-tested, multi-center, cross-sectional survey-questionnaire. Participants: Physicians serving in California, Massachusetts, or upstate New York clinical practices implementing pay-for-performance incentives were eligible. We obtained responses from 1,534 (35.14%) of 4,365 physicians surveyed. Analysis: We randomly partitioned the study sample equitably into derivation and validation subsamples. We conducted parallel analysis, inter-item/point-biserial correlations, and item-response-theory-based graded response modeling on six autonomy support items. Three items with the highest (a) point-biserial correlations, (b) item-level discrimination and (c) information capture were used to construct a short-form (3-item) version of the full (6-item) autonomy scale. We utilized exploratory structural equation modeling and confirmatory factor analysis to establish the factor structure and construct validity of the full-length and short-form scales before comparing their factor invariance, reliability and interrater agreement across physician subgroups. Findings: All six autonomy support items loaded highly onto one factor accounting for the majority of variance and demonstrating good data fit. The three most discriminating and informative items loaded equally well onto a single factor with similar goodness-of-fit to the data. The three-item scale correlated highly with its six-item parent, showing equally high sensitivity and specificity in discriminating high autonomy support. Variability in scores nested predominantly at within- rather than between-subgroup levels. Conclusions and implications: Our data supported the factor structure, construct validity, internal consistency, and reliability of six- and three-item autonomy support scales. These brief tools are easily incorporated into multi-dimensional questionnaires at relatively low cost. [ABSTRACT FROM AUTHOR]

Part of the oral health care in the care network encompasses users in emergency cases. This study proposed mapping the determinants of the use of dental care services within the health care network to address dental emergencies within the Brazilian Unified Health System (UHS) and to verify the main gaps in the research in this area. This is a scoping review that took place in 2018 using Andersen's behavioral model as a reference. A total of 16 studies, out of 3786 original articles identified, were included and reviewed. Two reviewers independently conducted the selection process and the decision was consensually made. The mapping of the determinants revealed a greater number of enabling factors and a larger gap in the results. Greater use of the emergency service was registered by people in pain, women, adults, those from an urban area, people with a lower income, and those with less education. In future studies, primary surveys are recommended, which include all ages, and analyze different groups of needs and users that take into account the country's northern region and the different subjects pointed out by this review. [ABSTRACT FROM AUTHOR]

Non-physician clinicians (NPCs) in low and middle-income countries (LMICs) often have little physical proximity to the resources–equipment, supplies or skills–needed to deliver effective care, forcing them to refer patients to distant sites. Unlike equipment or supplies, which require dedicated supply chains, physician/specialist skills needed to support NPCs can be sourced and delivered through telecommunication technologies. In LMICs however, these skills are scarce and sparsely distributed, making it difficult to implement commonly used real-time (synchronous), hub-and-spoke telemedicine paradigms. An asynchronous teleconsultations service was implemented in Turkana County, Kenya, connecting NPCs with a volunteer network of remote physicians and specialists. In 2017–18, the service supported over 100 teleconsultations and referrals across 20 primary healthcare clinics and two hospitals. This qualitative study aimed to explore the impact of the telemedicine intervention on health system stakeholders, and perceived health-related benefits to patients. Data were collected using Appreciative Inquiry, a strengths-based, positive approach to assessing interventions and informing systems change. We highlight the impact of provider-to-provider asynchronous teleconsultations on multiple stakeholders and healthcare processes. Provider benefits include improved communication and team work, increased confidence and capacity to deliver services in remote sites, and professional satisfaction for both NPCs and remote physicians. Health system benefits include efficiency improvements through improved care coordination and avoiding unnecessary referrals, and increased equity and access to physician/specialist care by reducing geographical, financial and social barriers. Providers and health system managers recognised several non-health benefits to patients including increased trust and care seeking from NPCs, and social benefits of avoiding unnecessary referrals (reduced social disruption, displacement and costs). The findings reveal the wider impact that modern teleconsultation services enabled by mobile technologies and algorithms can have on LMIC communities and health systems. The study highlights the importance of viewing provider-to-provider teleconsultations as complex health service delivery interventions with multiple pathways and processes that can ultimately improve health outcomes.

Background: Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers. Method: The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet). Results: The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I2 = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers. Conclusion: Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations. [ABSTRACT FROM AUTHOR]

Introduction: Preventable adverse effects of medicines often pass unnoticed, but lead to real harm. Intervention: Nurse-led monitoring using the structured Adverse Drug Reaction (ADRe) Profile identifies and addresses adverse effects of mental health medicines. Objectives: This study investigated the implementation and clinical impact of ADRe, and barriers to and facilitators of sustained utilisation in routine practice. Methods: Administration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales. Results: Residents were aged 60–95, and prescribed 1–17 (median 9 [interquartile range (IQR) 7–13]) medicines. ADRe identified a median of 18 [IQR 11.5–23] problems per resident and nurses made 2 [–] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors’ non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses’ concerns regarding residents’ welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation. Implications: To our knowledge, ADRe is the only instrument that brings a full account of patients’ problems to medication reviews. This juxtaposition of signs and symptoms against prescriptions facilitates dose adjustments and de-prescribing and leads to: reduced pain and sedation; early identification of problems linked to ADRs, such as falls; and timely medication reviews e.g. for dyspnoea. [ABSTRACT FROM AUTHOR]

Physicians currently spend as much as half of their day in front of the computer. The Electronic Health Record (EHR) has been associated with declining bedside skills and physician burnout. Medical student EHR use has not been well studied or characterized. However, student responsibilities for EHR documentation will likely increase as the Centers for Medicare and Medicaid Services (CMS) most recent provisions now allow student notes for billing which will likely increase the role of medical student use of the EHR over time. To gain a better understanding of how medical students use the EHR at our institution, we retrospectively analyzed 6,692,994 EHR interactions from 49 third-year clerkship medical students and their supervising physicians assigned to the inpatient medicine ward rotation between June 25 2015 and June 24 2016 at a tertiary academic medical center. Medical students spent 4.42 hours (37%) of each day at the on the EHR and 35 minutes logging in from home. Improved understanding of student EHR-use and the effects on well-being warrants further attention, especially as EHR use increases with early trainees. [ABSTRACT FROM AUTHOR]