Effects of Persistent Exposure to COVID-19 on Mental Health and Burnout Outcomes Among Trainees: A Longitudinal Study (Preprint)

2021 ◽  
Author(s):  
Charles W. Goss ◽  
Jennifer Duncan ◽  
Sunny S. Lou ◽  
Katherine J. Holzer ◽  
Bradley A. Evanoff ◽  
...  
Keyword(s):  
Mental Health ◽  
Medical Center ◽  
Academic Medical Center ◽  
Baseline Survey ◽  
Care Providers ◽  
Physical And Mental Health ◽  
Longitudinal Effects ◽  
Physician Trainee ◽  
Anxiety Depression ◽  
Additional Exposure

BACKGROUND The rapid spread of the Coronavirus disease 2019 (COVID-19) has created considerable strain on the physical and mental health of healthcare workers around the world. The effects have been acute for physician trainees—a unique group functioning simultaneously as learners and care providers with limited autonomy. OBJECTIVE To investigate the longitudinal effects of physician trainee exposure to patients being tested for COVID-19 on stress, anxiety, depression and burnout using three surveys conducted during the early phase of the pandemic. METHODS All physician trainees (N=1375) at an academic medical center were invited to participate in a web-based survey. Multivariable models were used to assess the relationship between repeated exposure to patients being tested for COVID-19 and stress, anxiety, depression and burnout. RESULTS 389 trainees completed the baseline survey (28.3%). Of these, 191 and 136 responded to the ensuing surveys. Mean stress, anxiety and burnout decreased by 21% (95% Confidence Interval (CI): -28% to -12%; P < 0.001), 25% (95% CI: -36% to -11%; P < 0.001) and 13% (95% CI: -18% to -7%; P < 0.001), respectively per survey. However, for each survey time point, there was mean increase in stress, anxiety and burnout per additional exposure: stress [24% (95% CI: +12% to +38%; P < 0.001)], anxiety [22%, (95% CI: +2% to +46%; P = 0.026)], burnout [18%, (95% CI: +10% to +28%; P < 0.001)]. For depression, the association between exposure was strongest for the third survey, where mean depression scores increased by 33% per additional exposure (95% CI: +18% to +50%; P = <0.001). CONCLUSIONS Training programs should adapt to address the detrimental effects of the “pile up” of distress associated with persistent exposure through adaptive programs that allow flexibility for time off and recovery.

scholarly journals Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sunny S. Lou ◽  
Charles W. Goss ◽  
Bradley A. Evanoff ◽  
Jennifer G. Duncan ◽  
Thomas Kannampallil
Keyword(s):  
Risk Factors ◽  
Clinical Education ◽  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Clinical Work ◽  
Educational Opportunities ◽  
Missed Opportunities ◽  
Physician Trainee ◽  
At Home

Abstract Background The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns. Methods All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables. Results 22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33–6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47–1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16–5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038). Conclusions Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

Addressing the mental health needs of learners and nonlearners in an academic medical center during COVID-19

2021 ◽  
pp. 1-15
Author(s):  
Zina V. Peters ◽  
Lynn N. Norwood ◽  
Hetal P. Modi ◽  
Heather Goodman ◽  
Peggy H. Yang ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Well Being ◽  
Behavioral Health Care ◽  
Psychological Needs ◽  
Individual Therapy ◽  
Biomedical Sciences ◽  
Therapy Services

The Coronavirus Disease (COVID-19) has impacted life for people throughout the world, especially for those in health care who experience unique stressors. To support the psychological needs of staff, faculty, and learners at a biomedical sciences university, faculty at Baylor College of Medicine created a mental health and wellness support program consisting of multiple behavioral health care pathways, including phone support, a self-guided mental health app, a coping skills group, and individual therapy services. The authors present this program as a model for academic institutions to support the well-being of faculty, staff, and learners.

scholarly journals Pharmacists’ Perceptions on Their Role, Activities, Facilitators, and Barriers to Practicing in a Post-Intensive Care Recovery Clinic

2019 ◽  
Vol 55 (2) ◽  
pp. 119-125
Author(s):  
Antoinette B. Coe ◽  
Rebecca E. Bookstaver ◽  
Andrew C. Fritschle ◽  
Michael T. Kenes ◽  
Pamela MacTavish ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Care Providers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Direct Patient Care ◽  
Care Providers ◽  
Medication Regimen ◽  
Medication Reviews ◽  
Facilitators And Barriers

Background: Complex medication regimen changes burden intensive care unit (ICU) survivors and their caregivers during the transition to home. Intensive care unit recovery clinics are a prime setting for pharmacists to address patients’ and their caregivers’ medication-related needs. The purpose of this study was to describe ICU recovery clinic pharmacists’ activities, roles, and perceived barriers and facilitators to practicing in ICU recovery clinics across different institutions. Methods: An expert panel of ICU recovery clinic pharmacists completed a 15-item survey. Survey items addressed the pharmacists’ years in practice, education and training, activities performed, their perceptions of facilitators and barriers to practicing in an ICU recovery clinic setting, and general ICU recovery clinic characteristics. Descriptive statistics were used. Results: Nine ICU recovery clinic pharmacists participated. The average number of years in practice was 16.5 years (SD = 13.5, range = 2-38). All pharmacists practiced in an interprofessional ICU recovery clinic affiliated with an academic medical center. Seven (78%) pharmacists always performed medication reconciliation and a comprehensive medication review in each patient visit. Need for medication education was the most prevalent item found in patient comprehensive medication reviews. The main facilitators for pharmacists’ successful participation in an ICU recovery clinic were incorporation into clinic workflow, support from other health care providers, and adequate space to see patients. The ICU recovery clinic pharmacists perceived the top barriers to be lack of dedicated time and inadequate billing for services. Conclusions: The ICU recovery clinic pharmacists address ICU survivors’ medication needs by providing direct patient care in the clinic. Strategies to mitigate pharmacists’ barriers to practicing in ICU recovery clinics, such as lack of dedicated time and adequate billing for pharmacist services, warrant a multifaceted solution, potentially including advocacy and policy work by national pharmacy professional organizations.

scholarly journals Pre- and Postoperative Health Status of Patients with Nonfunctioning and Secretory Pituitary Adenomas and an Analysis of Related Factors

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yi Zhang ◽  
Xiaopeng Guo ◽  
Lijun Wang ◽  
Jinzhu Guo ◽  
Haiyan Zhao ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Physical Function ◽  
Pituitary Adenomas ◽  
Tumor Recurrence ◽  
Health Problems ◽  
The Self ◽  
Physical And Mental Health ◽  
Self Rating ◽  
Anxiety Depression

Purpose. To identify the characteristics of the physical and mental health status of patients with pituitary adenomas, explore the postoperative reversibility of impaired health status, and assess the impact of clinical characteristics, hormone levels, anxiety, depression, and disease stigma on health status. Methods. We prospectively enrolled 147 and 138 patients with nonfunctioning and secretory pituitary adenomas, respectively. Health status was evaluated in 8 domains using the 36-item Short-Form Health Survey before and 3 months after transsphenoidal surgery. The Self-Rating Anxiety Scale, the Self-Rating Depression Scale, and the Stigma Scale for Chronic Illness were used to assess the psychological status. Results. Compared with the healthy population reference values, general physical and mental health, social functioning, and role limitations due to physical and psychological health problems were all found to be significantly impaired in the adenoma patients. Health status was worse in patients with adrenocorticotropic hormone- (ACTH-) secreting and growth hormone- (GH-) secreting adenomas than in patients with nonfunctioning adenomas. Among the patients, 11.6% had anxiety and 30.9% had depression. Higher scores for anxiety, depression, and disease stigma; older age; higher body mass index; and tumor recurrence were independent risk factors for health status impairment in at least one domain. Physical function impairment and role limitations caused by physical health problems became worse after surgery, whereas the mental component of health status remained the same. Conclusion. Health status was impaired in patients with pituitary adenomas, especially secretory adenomas. Physical function and role limitations were worse 3 months after surgery than before surgery. Mental problems, old age, obesity, and tumor recurrence reduced health status.

Behavioral Health Resource Utilization of Emergency Department Patients Presenting from Mass Gathering Events

2019 ◽  
Vol 34 (s1) ◽  
pp. s105-s106
Author(s):  
Charles Hebert ◽  
Gary Peksa ◽  
Joshua DeMott
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Behavioral Health ◽  
Resource Utilization ◽  
Medical Center ◽  
Academic Medical Center ◽  
Mood Stabilizers ◽  
Health Staff ◽  
Mass Gathering ◽  
Physical Restraints

Introduction:Behavioral health needs of attendees at mass gathering events who require emergency department (ED) evaluation are poorly understood. Appropriate resource allocation of mental health staff and other behavioral interventions necessary to support this patient population are also unclear.Aim:To describe behavioral characteristics and psychiatric resource utilization of patients presenting to a tertiary academic medical center emergency department from mass gathering events.Methods:Single-center retrospective study evaluating attendees at mass gathering events who presented to a Chicago ED. Electronic medical records for patients presenting between October 13, 2013, and December 31, 2015, were reviewed and descriptive analyses performed.Results:209 distinct records were reviewed. Most patients presented from large outdoor concerts (n = 186, 89%). Forty-two (20.1%) reported a mental health complaint at presentation, including concerns related to pre-existing psychiatric disturbances or onset of new symptoms. Twenty-seven of the total cohort (12.9%) endorsed a prior psychiatric history. Thirty-five (16.7%) reported use of prescribed psychotropic medications, including antidepressants, stimulants, mood stabilizers, and others. Diagnostic testing among the total sample included serum ethanol measurement (31.1%), urinary toxicology (25.4%), acetaminophen (6.2%), aspirin (5.3%), and creatine kinase measurements (11%). Computed brain tomography was ordered for 20 patients (9.6%). Twelve patients (5.7%) received an anxiolytic (lorazepam) and 113 (54.1%) received intravenous fluids. An antipsychotic (olanzapine) was administered to one patient (0.5%). There were no reports of suicidal ideation, but physical restraints for agitation were employed in 13 patients (6.2%). Police consultation occurred in 10 cases (4.8%). No formal psychiatric consultations were requested by ED providers.Discussion:Patients presenting to the emergency department from mass gathering events frequently endorse behavioral complaints requiring directed use of diagnostic and other emergency department resources for their ailments. The need for physical restraints and limited use of anxiolytics and antipsychotics in our sample suggest that psychiatric consultation is underutilized.

scholarly journals Flourishing Despite Migraines: A Nationally Representative Portrait of Resilience and Mental Health among Canadians

2021 ◽  
Author(s):  
Esme Fuller-Thomson
Keyword(s):  
Mental Health ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Secondary Analysis ◽  
Well Being ◽  
Care Providers ◽  
Physical And Mental Health ◽  
History Of ◽  
Nationally Representative ◽  
The Relationship

Objective 1) To examine the relationship between migraine status and complete mental health (CMH) among a nationally representative sample of Canadians; 2) To identify significant correlates of CMH among those with migraine. Methods Secondary analysis of the nationally representative Canadian Community Health Survey – Mental Health (CCHS-MH) (N=21,108). Bivariate analyses and a series of logistic regression models were performed to identify the association between migraine status and CMH. Significant correlates of CMH were identified in the sample of those with migraine (N=2,186). Results Individuals without a history of migraine had 72% higher odds of being in CMH (OR=1.72; 95% CI=1.57, 1.89) when compared with those with a history of migraine. After accounting for physical health and mental health problems, the relationship between migraine status and CMH was reduced to non-significance, with both groups having an approximately equal likelihood of achieving CMH (OR=1.03; 05% CI=(0.92, 1.15). Among those with migraine, factors that were strongly associated with CMH were a lack of a history of depression, having a confidant, and having an income of $80,000 or more. Conclusion Clinicians and health care providers should also address co-occurring physical and mental health issues to support the overall well-being of migraineurs.

scholarly journals Patients’ Perceptions of Portal Use Across Care Settings: Qualitative Study (Preprint)

2018 ◽  
Author(s):  
Ann Scheck McAlearney ◽  
Cynthia J Sieck ◽  
Alice Gaughan ◽  
Naleef Fareed ◽  
Jaclyn Volney ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Centered Care ◽  
Theory Approach ◽  
Access To Information ◽  
Engagement In Care ◽  
Care Providers ◽  
Patient Centered ◽  
Centered Care

BACKGROUND Patient portals are a promising instrument to improve patient-centered care, as they provide patients information and tools that can help them better manage their health. The implementation of portals in both the inpatient and outpatient setting gives health care providers an opportunity to support patients both during hospitalization and after discharge. Thus, there is a need to better understand how inpatient and outpatient portals are used across care contexts. OBJECTIVE This study aimed to examine patients’ perceptions of using inpatient and outpatient portals across the care settings, including how they used the portals and the benefits and concerns associated with portal use. METHODS This study was conducted in a large Midwestern academic medical center consisting of seven hospitals. We interviewed 120 patients who had used an inpatient portal during their hospitalization, at 15 days and 6 months postdischarge, to determine their perspectives of portal use in both hospital and outpatient settings. Interview transcripts were analyzed inductively and deductively by using team coding processes consistent with a grounded theory approach. RESULTS Interviews focused on three main areas of portal use: experience with the portal features, perceived benefits, and concerns. Responses at 15 days (n=60) and 6 months (n=60) postdischarge were consistent with respect to perceptions about portal use. Patients identified viewing their health information, managing their schedule, and communicating with providers as notable activities. Convenience, access to information, and better engagement in care were indicated as benefits. Concerns were related to technology issues and privacy/security risks. CONCLUSIONS Implementation of inpatient portals as a complement to outpatient portals is increasing and can enable patients to better manage aspects of their care. Although care processes vary substantively across settings, the benefits of convenience, improved access to information, and better engagement in care provide opportunities for portal use across care settings to support patient-centered care.

scholarly journals ABC framework of fear of COVID-19 for psychotherapeutic intervention in Nepal: a review

2020 ◽  
Author(s):  
Dhirendra Paudel
Keyword(s):  
Mental Health ◽  
Stress Disorders ◽  
Physical And Mental Health ◽  
Primary Health Care Centers ◽  
Attending Physician ◽  
Anxiety Depression ◽  
The Impact ◽  
The Relationship ◽  
Health Care Centers ◽  
Different Levels

The COVID-19 pandemic is having an impact on physical and mental health. Most studies report the impact on mental health and mental distress during the pandemic. As a result of various stressors (such as lockdown, quarantines, and misinformation) there is heightened fear of a pandemic. The sufferer may experience a variety of symptoms of anxiety, depression, and even psychosis. In predisposed vulnerable individuals, fear of COVID-19 is perpetuating pain and dysfunction. This study discussed the ABC framework of fear and influencer to better understand the different levels of symptoms and interventions. There is an urgent need to integrate mental health into primary health-care centers. The attending physician should be aware of the stress disorders associated with the pandemic. This article introduces a handy and practical portrayal of the ABC framework that can be taught to individuals in distress during clinical visits to primary care centers providing awareness of the relationship between thinking, emotional and behavioral responses.

scholarly journals 864. Adolescent Primary Care Provider Knowledge of HIV Pre-Exposure Prophylaxis (PrEP) and Universal Screening at a Midwest Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S523-S524
Author(s):  
Genevieve Allen ◽  
Jamie Riddell
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Family Medicine ◽  
Hiv Testing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Care Providers ◽  
Academic Medical ◽  
Exposure Prophylaxis

Abstract Background HIV remains a problem for adolescents with 21% of new infections in the United States in 2018 occurring in youth. In this study we attempted to assess the knowledge of and comfort with pre-exposure prophylaxis and universal HIV testing among adolescent primary care providers affiliated with one academic medical center. Methods We conducted a survey of internal medicine/pediatrics, pediatrics, and family medicine residents and attending physicians affiliated with an academic medical center. Data collected included provider prescribing and referring habits for PrEP and information on their universal HIV testing habits. A “test your knowledge” section followed the survey which asked participants to name PrEP medications and to correctly select laboratory monitoring required for PrEP. Correct answers and prescribing resources were provided on completion of the survey. Results 138 (76%) respondents were aware that PrEP is approved for adolescents. There was no significant difference across specialties or between residents and attendings. 44.8% of respondents felt uncomfortable prescribing PrEP and two thirds had never prescribed PrEP. Reasons for not prescribing PrEP included: not seeing adolescents who qualify (n=80), not having enough training (66), confidentiality concerns (22), forgetting to address PrEP (19), and concern incidence of HIV is too low to recommend PrEP (15). Pediatricians were the least likely to test for HIV with 11% of pediatrician, 32% of internal medicine/pediatric, and 38% of family medicine respondents reported universal HIV testing for patients 15 years and older (p &lt; 0.05). Residents were more likely to test for HIV than attendings (33.3% versus 16%, p &lt; 0.05). 111 participants completed the “test your knowledge” section. 31.5% correctly named two approved PrEP medications. There were 183 responses to the survey (49% response rate). Conclusion Adolescent primary care providers are aware that PrEP is FDA approved for adolescents but a gap in PrEP prescribing and HIV testing persists. There remain perceptions that HIV incidence is too low to discuss PrEP and that providers are not seeing patients who qualify. Next steps include developing an institutional PrEP guideline and creating an electronic medical record order set to facilitate PrEP prescribing. Disclosures All Authors: No reported disclosures

scholarly journals Loneliness and Mental Health: The Mediating Effect of Perceived Social Support

2021 ◽  
Vol 18 (22) ◽  
pp. 11963
Author(s):  
Elody Hutten ◽  
Ellen M. M. Jongen ◽  
Anique E. C. C. Vos ◽  
Anja J. H. C. van den Hout ◽  
Jacques J. D. M. van Lankveld
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Social Connectedness ◽  
Somatic Symptom ◽  
Somatic Symptoms ◽  
Mediating Effect ◽  
Somatic Symptom Disorder ◽  
Physical And Mental Health ◽  
Anxiety Depression ◽  
The Relationship

Social connectedness is a fundamental human need. The Evolutionary Theory of Loneliness (ETL) predicts that a lack of social connectedness has long-term mental and physical health consequences. Social support is a potential mechanism through which loneliness influences health. The present cross-sectional study examined the relationship between loneliness and mental health, and the mediating effects of social support in a Dutch adult sample (N = 187, age 20 to 70). The health variables included in the study are anxiety, depression, somatic symptoms as measured by the SCL-90, and the DSM-5 diagnosis somatic symptom disorder. The results indicated that social support partially mediated the relationship between loneliness and anxiety, depression, and somatic symptoms. These results indicate that social support partially explains the relationship between loneliness and physical and mental health issues. The relationship between loneliness and being diagnosed with somatic symptom disorder was not mediated by social support. This suggests that the mechanisms through which loneliness relates to either somatic symptoms or somatic symptom disorder are different.

Sign in / Sign up

Export Citation Format

Share Document