STOPTHEBURN: A Randomized Controlled Trial of Death Cafés for Burnout Prevention in ICU Employees.

RATIONALE: Effective interventions to prevent burnout among intensive care unit (ICU) clinicians are urgently needed. Death Cafés, group discussions about death, build a sense of community and create a space for reflection on distressing events. OBJECTIVE: To assess whether participation in regular Death Cafés can prevent burnout in ICU clinicians (physicians, nurses, pharmacists, therapists). METHODS: A randomized clinical trial was conducted from July 2020-December 2022 in ten ICUs in Louisiana. Subjects were randomized to attend four psychotherapist-facilitated, virtual Death Cafés or to a control arm. MEASUREMENTS AND MAIN RESULTS: The primary outcome was burnout defined by the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) at 6 months. Depression and anxiety scores were measured as well as qualitative data on stressors, coping, and Death Café experience. Among 340 clinicians screened and consented (171 physicians; 169 non-physicians), 251 participated (mean age 31.06.8 years, 63% female, 72% white, 37% nurses, 27% residents, 25% interns, 11% other). Burnout prevalence was 19% at baseline. Of 136 participants who completed 6-month follow-up, no significant differences were found between intervention and control for the primary outcome (18% versus 25%, unadjusted OR 0.64 [95% CI 0.26-1.57], p=0.33). There were no differences in anxiety or depression. Notably, the study was limited by an inability to achieve target enrollment and high attrition rate (46%). CONCLUSIONS: Virtual Death Cafés were unable to reduce burnout, although the study was underpowered to detect differences between groups. Clinical trial registered with Clinicaltrials.gov (NCT04347811).

The utility of hyperbaric oxygen therapy in post-transplant cyclophosphamide-induced hemorrhagic cystitis: a case report and review of the literature.

BACKGROUND: To date, there are only a few case reports of cyclophosphamide (Cy)-induced hemorrhagic cystitis (HC) in adult or pediatric allogeneic stem cell transplant (SCT) patients treated successfully with hyperbaric oxygen (HBO). In all the reported cases, Cy was used as a part of the conditioning regimen, rather than post-transplant for graft-versus-host-disease (GVHD) prophylaxis. More recently, the risk of HC in allogeneic SCT is further increased by the widespread use of post-transplantation cyclophosphamide (PTCy) as a highly effective strategy for GVHD prophylaxis. This is the first case reported of PTCy-induced HC successfully treated with HBO to the best of our knowledge. CASE PRESENTATION: In this article, we present a 58-year-old Caucasian male case of allogeneic SCT complicated by severe HC following PTCy, which was successfully treated with HBO, eliminating the need for cystectomy. CONCLUSION: HBO can be a safe, noninvasive, alternative treatment modality for PTCy-induced HC developing in allogeneic SCT patients.

Candida dubliniensis abscess: A clinical case and a review of the literature.

Candida dubliniensis infections are rare in the absence of prolonged immunocompromised status or intravenous drug abuse. We present a case of a C. dubliniensis soft tissue abscess in a patient with uncontrolled diabetes as his only immunocompromising risk factor, treated with surgical drainage and medical management.