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The Western Journal of Emergency... Oct 2022Emergency department (ED) staff are at a high risk for compassion fatigue (CF) due to a work environment that combines high patient acuity, violence, and other workplace...
INTRODUCTION
Emergency department (ED) staff are at a high risk for compassion fatigue (CF) due to a work environment that combines high patient acuity, violence, and other workplace stressors. This multifaceted syndrome has wide-ranging impacts which, if left untreated, can lead to adverse mental health conditions including depression, anxiety, and substance use disorders. However, the majority of studies examining CF look solely at clinicians; as a result, there is little information on the impact of CF across other roles involved in supporting patient care. We conducted this study to establish the prevalence of CF across both clinical and non-clinical roles in the adult ED setting.
METHODS
For this single institution, cross-sectional study, all full- and part-time ED staff members who worked at least 50% of their shifts in the ED or within the adult trauma service line were eligible to participate. Using the Professional Quality of Life Scale, which measures CF via compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS), we assessed for group differences between roles using non-parametric one-way ANOVA.
RESULTS
A total of 152 participants (response rate = 38.0%) completed the survey. This included attending physicians (n = 15, 9.7%), resident/fellow physicians (n = 23, 15.1%), staff nurses (n = 54, 35.5%), emergency technicians (n = 21, 13.8%), supportive clinical staff (n = 28, 18.4%), and supportive ancillary staff (n = 11, 7.2%). Across all roles, the majority of respondents had average levels of BO (median = 25.0, interquartile range [IQR] 20.0-29.0) and STS (median = 23.0, IQR 18.0-27.0) coupled with high levels of CS (median = 38.0, IQR 33.0-43.0). There was a difference in CS by role (P = .01), with nurses reporting lower CS than attending physicians. Secondary traumatic stress also differed by role (P = .01), with attending physicians reporting lower STS than both emergency technicians and nurses. Group differences were not seen in BO.
CONCLUSIONS
Rates of compassion fatigue subcomponents were similar across all ED team members, including non-clinical staff. Programs to identify and mitigate CF should be implemented and extended to all roles within the ED.
Topics: Adult; Humans; Compassion Fatigue; Cross-Sectional Studies; Quality of Life; Burnout, Professional; Emergency Service, Hospital
PubMed: 36409952
DOI: 10.5811/westjem.2022.8.57733 -
Archives of Pathology & Laboratory... Mar 2022Because of new and improved imaging techniques, cystic/intraductal pancreatobiliary tract lesions are increasingly being discovered, and brushings or endoscopic...
CONTEXT.—
Because of new and improved imaging techniques, cystic/intraductal pancreatobiliary tract lesions are increasingly being discovered, and brushings or endoscopic ultrasound/computed tomography/magnetic resonance imaging-guided fine-needle aspiration biopsies from these lesions have become an integral part of pathologists' daily practice. Because patient management has become increasingly conservative, accurate preoperative diagnosis is critical. Cytologic distinction of low-risk (pseudocysts, serous cystadenoma, lymphoepithelial cysts, and squamoid cysts of the pancreatic duct) from high-risk pancreatic cysts (intraductal papillary mucinous neoplasm and mucinous cystic neoplasm) requires incorporation of clinical, radiologic, and cytologic findings, in conjunction with chemical and molecular analysis of cyst fluid. Cytopathologists must ensure appropriate specimen triage, along with cytologic interpretation, cyst classification, and even grading of some (mucinous) cysts. Epithelial atypia in mucinous cysts (intraductal papillary mucinous neoplasm and mucinous cystic neoplasm) has transitioned from a 3-tiered to a 2-tiered classification system, and intraductal oncocytic papillary neoplasms and intraductal tubulopapillary neoplasms have been separately reclassified because of their distinctive clinicopathologic characteristics. Because these lesions may be sampled on brushing or fine-needle aspiration biopsy, knowledge of their cytomorphology is critical.
OBJECTIVE.—
To use an integrated, multidisciplinary approach for the evaluation of cystic/intraductal pancreatobiliary tract lesions (incorporating clinical, radiologic, and cytologic findings with [chemical/molecular] cyst fluid analysis and ancillary stains) for definitive diagnosis and classification.
DATA SOURCES.—
Review of current literature on the cytopathology of cystic/intraductal pancreatobiliary tract lesions.
CONCLUSIONS.—
Our knowledge/understanding of recent updates in cystic/intraductal pancreatobiliary lesions can ensure that cytopathologists appropriately triage specimens, judiciously use and interpret ancillary studies, and incorporate the studies into reporting.
Topics: Cystadenoma, Serous; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Magnetic Resonance Imaging; Pancreatic Cyst; Pancreatic Neoplasms
PubMed: 33836534
DOI: 10.5858/arpa.2020-0553-RA -
Journal of Latina/o Psychology Nov 2019Familism is a central Hispanic/Latino cultural value that emphasizes close, supportive family relationships and prioritizing family over the self. One of its best-known...
Familism is a central Hispanic/Latino cultural value that emphasizes close, supportive family relationships and prioritizing family over the self. One of its best-known measures is Sabogal's Familism Scale (Sabogal, Marin, Otero-Sabogal, VanOss Marin, & Perez-Stable, 1987). Although widely used, this scale's measurement properties are not well understood. This study addressed that gap by examining the factor structure, factorial invariance, convergent and discriminant validity, and internal consistency of Sabogal's Familism Scale using data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. A diverse population-based sample of Hispanics/Latinos ( = 5,313) completed measures that were administered via interview in English or Spanish. Confirmatory factor analyses ( = 5,310) revealed that a three-factor model (, , ; Sabogal's original three factors) fit the data well and did not vary across English and Spanish language groups (i.e., factorial invariance). Convergent and discriminant validities were also established; familism correlated positively with other Hispanic/Latino cultural values (simpatía, fatalism) and correlated negatively with U.S. acculturation. Internal consistency was acceptable. Sabogal's Familism Scale is recommended for continued use in the study of familism in U.S. Hispanics/Latinos.
PubMed: 31853517
DOI: 10.1037/lat0000126 -
BMJ Global Health Oct 2021About 96.3 million children and adolescents aged 0-19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly...
BACKGROUND
About 96.3 million children and adolescents aged 0-19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly treatable diseases, many face disability and increased risk of mortality. Due to this population's unique perioperative needs, increasing access to paediatric surgical care requires a situational evaluation of the distribution of paediatric surgeons and anaesthesiologists. This study's aim is to identify the percentage of Nigerian youth who reside within 2 hours of paediatric surgical care at the state and national level.
METHODS
The Association of Paediatric Surgeons of Nigeria and the Nigeria Society of Anaesthetists provided surgical and anaesthesia workforce data by state. Health facilities with paediatric surgeons were converted to point locations and integrated with ancillary geospatial layers and population estimates from 2016 and 2017. Catchment areas of 2 hours of travel time around a facility were deployed as the benchmark indicator to establish timely access.
RESULTS
Across Nigeria's 36 states and Federal Capital Territory, the percentage of Nigeria's 0-19 population residing within 2 hours of a health facility with a paediatric surgical and anaesthesia workforce ranges from less than 2% to 22.7%-30.5%. In 3 states, only 2.1%-4.8% of the population can access a facility within 2 hours, 12 have 4.9%-13.8%, and 8 have 13.9%-22.6%.
CONCLUSION
There is significant variation across Nigerian states regarding access to surgical care, with 69.5%-98% of Nigeria's 0-19 population lacking access. Developing paediatric surgical services in underserved Nigerian states and investing in the training of paediatric surgical and anaesthesia workforce for those states are key components in improving the health of Nigeria's 0-19 population and reducing Nigeria's burden of surgical disease, in line with Nigeria's National Surgical, Obstetrics, Anaesthesia and Nursing Plan.
Topics: Adolescent; Child; Female; Geography; Humans; Nigeria; Pregnancy
PubMed: 34697085
DOI: 10.1136/bmjgh-2021-006025 -
CytoJournal 2022While most tumors metastatic to the serous membranes are of epithelial origin, cytologists should be aware that non-epithelial neoplasms can also cause malignant... (Review)
Review
While most tumors metastatic to the serous membranes are of epithelial origin, cytologists should be aware that non-epithelial neoplasms can also cause malignant effusions including sarcomas, melanomas, germ cell tumors, and, more rarely, brain tumors. The differential diagnosis of a malignant effusion is accordingly broad, especially for the small round blue cell tumors that includes not only mesenchymal tumors, but also non-mesenchymal tumors, such as neuroblastoma and Wilms tumor. Diagnosing non-epithelial malignancies in effusion specimens based entirely upon their cytomorphologic features is difficult because these neoplasms often exhibit considerable morphological overlap and their cytomorphology can differ from the original tumor. As malignant cells have a tendency to round up in body fluids these non-epithelial neoplasms can therefore mimic reactive mesothelial cells and metastatic adenocarcinoma. The use of ancillary studies including immunostaining, FISH, and molecular studies is thus often critical to reach a definitive diagnosis. This review article will be incorporated finally as one of the chapters in CMAS (CytoJournal Monograph/Atlas Series) #2. It is modified slightly from the chapter by the initial authors in the first edition of Diagnostic Cytopathology of Serous Fluids.
PubMed: 35510115
DOI: 10.25259/CMAS_02_10_2021 -
Journal of Thoracic Disease Jun 2023Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the standard for evaluating mediastinal and hilar lesions. EBUS-TBNA is limited by small...
BACKGROUND
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the standard for evaluating mediastinal and hilar lesions. EBUS-TBNA is limited by small volume of material obtained for immunohistochemistry (IHC) and ancillary studies important for oncological therapies. The Franseen Acquire needle is designed for EBUS-transbronchial needle core biopsy (TBNB) allowing larger core sizes with evidence in gastroenterology literature but little in pulmonology. This study reports the first Asia-Pacific experience of EBUS-TBNB and adequacy of samples for diagnosis and ancillary studies.
METHODS
A retrospective cohort study of EBUS-TBNB at the Royal Adelaide Hospital was conducted between December 2019 and May 2021. Diagnostic rate, adequacy for ancillary studies and complications were evaluated. Samples were flushed into formalin for histological processing with no rapid on-site cytological evaluation (ROSE). For suspected lymphoma, samples were flushed into HANKS for flow cytometry. Cases performed with the Olympus Vizishot during the same 18-month were similarly analysed.
RESULTS
One hundred and eighty-nine patients were sampled with the Acquire needle. Diagnostic rate was 174/189 (92.1%). Where reported [146/189 (77.2%)], average core aggregate sample size was 13.4 mm × 10.7 mm × 1.7 mm. For non-small cell lung cancer (NSCLC) cases, 45/49 (91.8%) had adequate tissue for programmed cell death-ligand 1 (PD-L1). 32/35 (91.4%) adenocarcinoma cases had sufficient tissue for ancillary studies. There was one false negative malignant lymph node at the first Acquire procedure. There were no major complications. One hundred and one patients were sampled with the Vizishot needle. Diagnostic rate was 86/101 (85.1%) with only 25/101 (24.8%) having reported tissue cores (P<0.0001 of Vizishot) with the remaining samples processed via cell block.
CONCLUSIONS
Acquire EBUS-TBNB diagnostic rate is comparable to historical data with >90% of cases having sufficient core material for ancillary studies. There appears to be a role for the Acquire alongside the standard of care for the work up of lymphadenopathy and particularly for lung cancer.
PubMed: 37426168
DOI: 10.21037/jtd-22-1747 -
Academic Emergency Medicine : Official... Jun 2023Since the publication of the American Academy of Pediatrics (AAP) clinical practice guideline for brief resolved unexplained events (BRUEs), a few small, single-center...
BACKGROUND
Since the publication of the American Academy of Pediatrics (AAP) clinical practice guideline for brief resolved unexplained events (BRUEs), a few small, single-center studies have suggested low yield of diagnostic testing in infants presenting with such an event. We conducted this large retrospective multicenter study to determine the role of diagnostic testing in leading to a confirmatory diagnosis in BRUE patients.
METHODS
Secondary analysis from a large multicenter cohort derived from 15 hospitals participating in the BRUE Quality Improvement and Research Collaborative. The study subjects were infants < 1 year of age presenting with a BRUE to the emergency departments (EDs) of these hospitals between October 1, 2015, and September 30, 2018. Potential BRUE cases were identified using a validated algorithm that relies on administrative data. Chart review was conducted to confirm study inclusion/exclusion, AAP risk criteria, final diagnosis, and contribution of test results. Findings were stratified by ED or hospital discharge and AAP risk criteria. For each patient, we identified whether any diagnostic test contributed to the final diagnosis. We distinguished true (contributory) results from false-positive results.
RESULTS
Of 2036 patients meeting study criteria, 63.2% were hospitalized, 87.1% qualified as AAP higher risk, and 45.3% received an explanatory diagnosis. Overall, a laboratory test, imaging, or an ancillary test supported the final diagnosis in 3.2% (65/2036, 95% confidence interval [CI] 2.7%-4.4%) of patients. Out of 5163 diagnostic tests overall, 1.1% (33/2897, 95% CI 0.8%-1.5%) laboratory tests and 1.5% (33/2266, 95% CI 1.0%-1.9%) of imaging and ancillary studies contributed to a diagnosis. Although 861 electrocardiograms were performed, no new cardiac diagnoses were identified during the index visit.
CONCLUSIONS
Diagnostic testing to explain BRUE including for those with AAP higher risk criteria is low yield and rarely contributes to an explanation. Future research is needed to evaluate the role of testing in more specific, at-risk populations.
Topics: Infant; Humans; Child; Patient Discharge; Risk Factors; Diagnostic Techniques and Procedures; Hospitals; Retrospective Studies
PubMed: 36653969
DOI: 10.1111/acem.14666 -
Current Opinion in Cardiology Nov 2022Various definitions of periprocedural myocardial infarction (MI) have been proposed by academic groups and professional societies differing in terms of biomarker... (Review)
Review
PURPOSE OF REVIEW
Various definitions of periprocedural myocardial infarction (MI) have been proposed by academic groups and professional societies differing in terms of biomarker thresholds and ancillary criteria for myocardial ischemia. The incidence and clinical significance of periprocedural MI substantially varies according to the definitions applied. In this review, we summarize available clinical data on the frequency and outcomes of periprocedural MI according to various MI definitions in patients undergoing percutaneous coronary intervention (PCI).
RECENT FINDINGS
Numerous clinical studies and meta-analyses have investigated the incidence and prognostic relevance of periprocedural MI following PCI. The incidence of periprocedural MI was higher when defined by universal definition of myocardial infarction (UDMI), which applies a lower biomarker threshold with broader ancillary criteria compared with the Society for Cardiovascular Angiography and Intervention (SCAI) and academic research consortium (ARC)-2. The prognostic impact of periprocedural MI defined by SCAI and ARC-2 on mortality was consistently greater compared with the UDMI definition.
SUMMARY
Among chronic coronary syndrome patients undergoing PCI, the frequency and prognostic value of periprocedural MI varies considerably based on definitions. Periprocedural MI defined by the ARC-2 and SCAI occurred 3-6 times less frequently and were prognostically more relevant as compared with the UDMI. Clinically relevant definitions should be used in daily practice and clinical trials.
Topics: Biomarkers; Coronary Artery Disease; Humans; Myocardial Infarction; Percutaneous Coronary Intervention; Risk Factors; Syndrome; Treatment Outcome
PubMed: 36094520
DOI: 10.1097/HCO.0000000000000995 -
ACI Open Jan 2024To achieve scientific goals, researchers often require integration of data from a primary electronic health record (EHR) system and one or more ancillary EHR systems...
BACKGROUND
To achieve scientific goals, researchers often require integration of data from a primary electronic health record (EHR) system and one or more ancillary EHR systems used during the same patient care encounter. Although studies have demonstrated approaches for linking patient identity records across different EHR systems, little is known about linking patient encounter records across primary and ancillary EHR systems.
OBJECTIVES
We compared a patients-first approach versus an encounters-first approach for linking patient encounter records across multiple EHR systems.
METHODS
We conducted a retrospective observational study of 348,904 patients with 533,283 encounters from 2010 to 2020 across our institution's primary EHR system and an ancillary EHR system used in perioperative settings. For the patients-first approach and the encounters-first approach, we measured the number of patient and encounter links created as well as runtime.
RESULTS
While the patients-first approach linked 43% of patients and 49% of encounters, the encounters-first approach linked 98% of patients and 100% of encounters. The encounters-first approach was 20 times faster than the patients-first approach for linking patients and 33% slower for linking encounters.
CONCLUSION
Findings suggest that common patient and encounter identifiers shared among EHR systems via automated interfaces may be clinically useful but not "research-ready" and thus require an encounters-first linkage approach to enable secondary use for scientific purposes. Based on our search, this study is among the first to demonstrate approaches for linking patient encounters across multiple EHR systems. Enterprise data warehouse for research efforts elsewhere may benefit from an encounters-first approach.
PubMed: 38765555
DOI: 10.1055/s-0044-1782679 -
Journal of Ethnicity in Substance Abuse 2016The study assessed whether overall perceived ethnic discrimination and four unique discrimination types were associated with binge drinking in participants from the...
Binge drinking and perceived ethnic discrimination among Hispanics/Latinos: Results from the Hispanic community health study/study of Latinos sociocultural ancillary study.
The study assessed whether overall perceived ethnic discrimination and four unique discrimination types were associated with binge drinking in participants from the Hispanic Community Health Study/Study of Latinos who also completed the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study (n = 5,313). In unadjusted analyses that were weighted for sampling strategy and design, each unit increase in discrimination type was associated with a 12-63% increase in odds of binge drinking; however, after adjusting for important demographic variables including age, sex, heritage group, language, and duration of U.S. residence, there was no longer an association between discrimination and binge drinking. Further research still needs to identify the salient factors that contribute to increased risk for binge drinking among Hispanics/Latinos.
Topics: Adult; Aged; Binge Drinking; Female; Hispanic or Latino; Humans; Male; Middle Aged; Prejudice
PubMed: 26643869
DOI: 10.1080/15332640.2015.1024374