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PURPOSE Positive psychology shows promise in improving positive affect and happiness. We tested a digital version of a positive psychology intervention called Three Good Things (3GT) among health care workers to assess whether gratitude practice improved well-being. METHODS All members of a large academic medicine department were invited. Participants were randomized to an immediate intervention group or control group (delayed intervention). Participants completed outcome measures surveys (demographics, depression, positive affect, gratitude, and life satisfaction) at baseline, and at 1 month and 3 months post-intervention. Controls completed additional surveys at 4 and 6 months (completion of the delayed intervention). During the intervention, we sent 3 text messages per week asking for 3GT that occurred that day. We used linear mixed models to compare the groups and to look at the effects of department role, sex, age, and time on outcomes. RESULTS Of 468 eligible individuals, 223 (48%) enrolled and were randomized with high retention through the end of the study. Most (87%) identified as female. For the intervention group, positive affect improved slightly at 1 month, then declined slightly but remained significantly improved at 3 months. Depression, gratitude, and life satisfaction scores showed a similar trend but were not statistically different between groups. CONCLUSIONS Our research showed adherence to a positive psychology intervention for health care workers created small positive improvements immediately post-intervention but were not sustained. Further work should evaluate whether utilizing different duration or intensity of the intervention improves benefits. Key words: health care workers; psychology, positive; physicians, primary care; psychological well-being; randomized controlled trial https://doi.org/10.1370/afm.2963, INTRODUCTION There are well-documented global concerns about mental distress among physicians (1) and nurses. (2) The COVID-19 pandemic increased rates of burnout among all members of the health care workforce, [...]

Purpose Detroit experiences the highest preterm birth rate and some of the worst birth outcomes in the country. Women and children have extremely high levels of poverty and face numerous barriers to care including lack of trust and racial disparities in care and concrete barriers such as limited transportation and childcare, work hour conflicts, and lack of insurance. Description We report on a unique model of patient care focused on providing patient-centered care and building trusting relationships. This model is encompassed in a new free, volunteer-run, faith-based clinic which offers prenatal, postpartum, and infant care. Assessment In the first 2 years of operation, demand for services rose rapidly and there were stellar clinical outcomes, despite the fact that Luke patients are among the medically and socially highest risk populations in the nation. Conclusion While marginalized populations have worse birth outcomes and far more infant deaths, making care accessible and responsive to patient needs while focusing on building patient relationships is an important strategy to improve outcomes., Author(s): Katherine J. Gold [sup.1] [sup.2] [sup.3] , Bradley Garrison [sup.3] , Sherie Garrison [sup.2] [sup.3] , Penny Armbruster [sup.3] Author Affiliations: (1) grid.214458.e, 0000000086837370, Department of Family Medicine, University [...]

Purpose: Mental health providers are well-positioned to engage in suicide prevention efforts, yet implementation depends on skill acquisition and providers often report feeling underprepared. This pilot study explored the acceptability, feasibility, and preliminary effectiveness of three suicide prevention-focused simulations with virtual clients. Method: Students (n = 22) were recruited from a Master of Social Work program, completed pre- and post-test surveys, and engaged with three simulated trainings: (1) suicide risk assessment, (2) safety planning, and (3) motivating a client to treatment. Results: Simulations were reported to be acceptable and feasible, with strong student desire and need for greater suicide prevention training. We observed significant improvements over time in clinical skills via simulated training scores and perceptions of clinical preparedness. Discussion: Preliminary findings indicate simulated training with virtual clients is promising and suggest the three suicide prevention simulations may be useful, scalable, and effective in social work training programs and beyond. [ABSTRACT FROM AUTHOR]

Objectives Healthcare providers in low-resource settings confront high rates of perinatal mortality. How providers cope with such challenges can affect their well-being and patient care; we therefore sought to understand how physicians and midwives make sense of and cope with these deaths. Methods We conducted semi-structured interviews with midwives, obstetrician-gynecologists, pediatricians and trainee physicians at a large teaching hospital in Kumasi, Ghana. Interviews focused on participants' coping strategies surrounding perinatal death. We identified themes from interview transcripts using qualitative content analysis. Results Thirty-six participants completed the study. Themes from the transcripts revealed a continuum of control/self-efficacy and engagement with the deaths. Providers demonstrated a commitment to push on with their work and provide the best care possible. In select cases, they described the transformative power of attitude and sought to be agents of change. Conclusions Physicians and midwives in a low-resource country in sub-Saharan Africa showed remarkable resiliency in coping with perinatal death. Still, future work should focus on training clinicians in coping and strengthening their self-efficacy and engagement., Author(s): Alissa D. Petrites[sup.1] , Patricia Mullan[sup.2] , Kathryn Spangenberg[sup.3] , Katherine J. Gold[sup.4] Author Affiliations: (1) Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WAUSA (2) Department [...]

For several years, the medical literature has exploded with headlines decrying an epidemic of physician burnout. Burnout rates are reportedly highest among those on the front lines of patient care, [...]

Fetal deaths account for nearly one percent of all births in the United States. The cost of hospital care associated with fetal deaths may be substantial. However, there is very limited data on the economic burden of fetal death. We conducted a retrospective medical chart review of stillbirths at three large hospitals in Michigan over a tenyear period and identified medical complications, hospital costs, and length of stay for these deliveries. Mothers with stillbirth were matched with mothers of the same age who delivered a live-born infant at the same hospital during the same year. Our final sample was comprised of 533 stillbirths and 1,053 matched live births. Average hospital cost for stillbirth was $7,495 (±7,015) and the average length of stay was 2.8 days (±2.8). Having a serious maternal medical complication was associated with higher costs and longer length of stay among women with stillbirth. Early stillbirths between 20 and 28 weeks gestational age, epidural/spinal/general anesthesia, and cesarean delivery were also associated with longer length of stay. Average hospital costs for women with stillbirth were more than $750 higher than women with live births but length of stay was not significantly different between the two. This study suggests that stillbirths were associated with substantial maternal hospital costs. Future research examining the economic impact of stillbirths beyond labor and delivery such as increased costs associated with additional testing and care in subsequent pregnancies will help better understand the overall economic impact of stillbirths. Keywords Fetal death * Hospital costs * Length of stay * Obstetrics * Stillbirth, Introduction Stillbirths (fetal death at 20 weeks of gestation or more) total about 26,000 per year in the United States, accounting for nearly 1% of all deliveries [1]. While the [...]

Physician suicide and well-being are critical issues but studies use varying methodologies and suicide is frequently underreported. This study sought to update data on physician suicides in the United States. The National Violent Death Reporting System (NVDRS) at the Centers for Disease Control collects details about violent deaths. The study used 2010–2015 data from 27 NVDRS states to identify suicide deaths among physicians or non-physicians and calculate annual standardized mortality rates (SMR). Of 63,780 victims total, there were 357 physicians identified over 6 years, (307 men and 50 women). If results are extrapolated to all 50 states, there would be approximately 119 physician suicides annually. The SMR for physicians overall was not statistically different from that of non-physicians. This is the first study in 16 years to update estimated physician suicide rates in the United States. The research used strict criteria to identify physicians so results likely represent the lower boundary of physician suicides. Findings show that physician suicide is not significantly lower than that of non-physicians and emphasizes the importance of focusing on structural changes to reduce stigma around mental health in the medical community. [ABSTRACT FROM AUTHOR]

Background: Medical assistant (MA) roles have expanded rapidly as primary care has evolved and MAs take on new patient care duties. Research that looks at the MA experience and factors that enhance or reduce efficiency among MAs is limited. Methods: We surveyed all MAs working in 6 clinics run by a large academic family medicine department in Ann Arbor, Michigan. MAs deemed by peers as "most efficient" were selected for follow-up interviews. We evaluated personal strategies for efficiency, barriers to efficient care, impact of physician actions on efficiency, and satisfaction. Results: A total of 75/86 MAs (87%) responded to at least some survey questions and 61/86 (71%) completed the full survey. We interviewed 18 MAs face to face. Most saw their role as essential to clinic functioning and viewed health care as a personal calling. MAs identified common strategies to improve efficiency and described the MA role to orchestrate the flow of the clinic day. Staff recognized differing priorities of patients, staff, and physicians and articulated frustrations with hierarchy and competing priorities as well as behaviors that impeded clinic efficiency. Respondents emphasized the importance of feeling valued by others on their team. Conclusions: With the evolving demands made on MAs' time, it is critical to understand how the most effective staff members manage their role and highlight the strategies they employ to provide efficient clinical care. Understanding factors that increase or decrease MA job satisfaction can help identify highefficiency practices and promote a clinic culture that values and supports all staff. [ABSTRACT FROM AUTHOR]

This cross-sectional study explored the ways that medical assistants and physicians can work together to ensure that patients receive appropriate care. [ABSTRACT FROM AUTHOR]