Experiences of nurses studying towards post-basic qualifications during COVID-19 in KwaZulu-Natal.

Background: The COVID-19 pandemic caused abrupt closure of schools including higher education institutions. The transition from in-person to virtual teaching platforms caused challenges for frontline nurses in post-basic programmes. Nurses were forced to divide their efforts between responding to the pandemic and their studies. Aim: The study aims to describe the experiences of nurses studying post-basic qualifications during COVID-19 in KwaZulu-Natal. Setting: The setting comprised virtual platforms such as closed social media groups (nursing colleagues and South African Society of Occupational Health Nurses Facebook) and Microsoft Teams or WhatsApp calls. Methods: A qualitative descriptive design using individual virtual interviews with eight nurses working in healthcare settings while studying post-basic qualifications. The framework was Fullan's Change Theory in educational settings. Data were analysed using applied thematic analysis. Results: Four themes were identified; transitioning from in-person to online teaching and learning, challenges in clinical placements, support to achieve educational goals, and unique aspects of studying and caring for infected patients and 10 sub-themes emerged. Conclusion: Participants found benefits of online learning despite challenges with the Internet network. There was a shortage of mentors, and personal protective equipment in clinical settings; however, participants were cognisant of the duty to care for infected patients notwithstanding personal risk of infection. Contribution: Nurses were at the frontline of the pandemic yet facing challenges in clinical facilities and their studies. The study could contribute to understanding participants' experiences, which might help with response planning in future pandemics.

Sleep disorders among frontline nurses after the COVID-19 outbreak: a large-scale cross-sectional study.

This large-scale cross-sectional multicenter study aims to investigate the prevalence of sleep disorders among frontline nurses in China after the COVID-19 pandemic and to identify potential influencing factors contributing to these sleep disturbances. A total of 2065 frontline nurses from 27 provinces in China participated in an online survey conducted through the Wenjuan Xing platform. Data on demographic characteristics, work-related factors, and mental health assessments, including the Pittsburgh Sleep Quality Index (PSQI), Zung Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), were collected. Statistical analyses, including chi-square tests, t-tests, binary logistic regression, and ROC analysis, were conducted to explore the relationships between various factors and sleep disorders. Over half (52.7%) of the surveyed nurses exhibited sleep disorders, reflecting a considerable post-pandemic impact on sleep quality. Factors such as nursing titles, personality traits, COVID-19 infection status, and exercise frequency showed statistically significant associations with sleep disorders. Extraverted nurses and those who had recovered from COVID-19 displayed a lower risk of sleep disorders, while anxiety was identified as an independent risk factor. The study also identified a nuanced relationship between exercise frequency and sleep quality. The study highlights a high prevalence of sleep disorders among frontline nurses post-COVID-19, emphasizing the need for targeted interventions. Factors such as nursing titles, personality traits, COVID-19 infection status, exercise habits, and anxiety levels were found to influence sleep quality. Comprehensive support strategies addressing these factors are essential for improving the overall well-being of frontline nurses and, subsequently, sustaining a resilient healthcare workforce. Further research is recommended to explore additional influencing factors and consider diverse nurse populations.

Impact of COVID-19 Pandemic on Reusable Device Pre-Cleaning Training for Front-line Staff.

High-level disinfection and sterilization are complex processes, requiring initial and ongoing training of frontline staff.1 A key component of appropriate disinfection and sterilization is point-of-use pre-cleaning performed by front-line staff. Our facility implemented an annual hospital-wide education and competency program for staff that perform pre-cleaning of reusable medical devices.

Trajectories and Predictors of Client Violence Among Child Protection Services Workers.

Objective: This study used social dominance theory and the Jobs Demands-Resources (JD-R) model to: (1) examine child protective services (CPS) workers' trajectories of client violence, including yelling, threats, and physical violence over job tenure; and (2) assess how demographic characteristics and job attributes contributed to the trajectories. Method: Using data from a longitudinal study of newly-hired CPS workers (n = 837-859 depending on outcome), we examined trajectories of client violence from 6 months to 3.5 years. Multi-level mixed effect logistic regression was used to examine how demographic variables and time-lagged job attribute predictors (e.g., caseload characteristics, time pressure, role demands) contributed to the occurrence of client violence over time. Results: Over the study period, the experience of being yelled at declined from 80% to 64%. Being threatened declined from nearly 48% to nearly 39%, while physical violence did not change. Younger and White workers as well as women generally experienced higher rates of non-physical violence. Caseload difficulty, role demands, and time pressure related to higher rates of non-physical violence, while organizational supports were not significant. Physical violence occurred sporadically; time pressure was the only significant variable. The influence of job attributes on each form of violence did not change over time. Conclusion: The high rates of non-physical violence, particularly during early tenure, suggest the need for providing vulnerable workers the skills to assess for and manage client violence. When violence occurs, developing responsive protocols for CPS workers at all levels can nourish a culture of safety thereby reducing future incidents.

Designing an Intervention to Improve Medication Safety for Nursing Home Residents Based on Experiential Knowledge Related to Patient Safety Culture at the Nursing Home Front Line: Cocreative Process Study.

BACKGROUND: Despite years of attention, avoiding medication-related harm remains a global challenge. Nursing homes provide essential health care for frail older individuals, who often experience multiple chronic diseases and polypharmacy, increasing their risk of medication errors. Evidence of effective interventions to improve medication safety in these settings is inconclusive. Focusing on patient safety culture is a potential key to intervention development as it forms the foundation for overall patient safety and is associated with medication errors. OBJECTIVE: This study aims to develop an intervention to improve medication safety for nursing home residents through a cocreative process guided by integrated knowledge translation and experience-based codesign. METHODS: This study used a cocreative process guided by integrated knowledge translation and experience-based co-design principles. Evidence on patient safety culture was used as an inspirational source for exploration of medication safety. Data collection involved semistructured focus groups to generate experiential knowledge (stage 1) to inform intervention design in a multidisciplinary workshop (stage 2). Research validation engaging different types of research expertise and municipal managerial representatives in finalizing the intervention design was essential. Acceptance of the final intervention for evaluation was aimed for through contextualization focused on partnership with a municipal advisory board. An abductive, rapid qualitative analytical approach to data analysis was chosen using elements from analyzing in the present, addressing the time-dependent, context-bound aspects of the cocreative process. RESULTS: Experiential knowledge was represented by three main themes: (1) closed systems and gaps between functions, (2) resource interpretation and untapped potential, and (3) community of medication safety and surveillance. The main themes informed the design of preliminary intervention components in a multidisciplinary workshop. An intervention design process focused on research validation in addition to contextualization resulted in the Safe Medication in Nursing Home Residents (SAME) intervention covering (1) campaign material visualizing key roles and responsibilities regarding medication for nursing home residents and (2) "Medication safety reflexive spaces" focused on social and health care assistants. CONCLUSIONS: The cocreative process successfully resulted in the multifaceted SAME intervention, grounded in lived experiences shared by some of the most important (but often underrepresented in research) stakeholders: frontline health care professionals and representatives of nursing home residents. This study brought attention toward closed systems related to functions in medication management and surveillance, not only informing the SAME intervention design but as opportunities for further exploration in future research. Evaluation of the intervention is an important next step. Overall, this study represents an important contribution to the complex field of medication safety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/43538.

Influence of social support and coping strategies on psychological stress among frontline medical personnel during the Yangbi Earthquake: a cross-sectional analysis.

Objectives: This study aimed to investigate the psychological stress experienced by frontline medical staff during the Yangbi Earthquake and to understand how coping strategies and social support influence stress responses. Methods: From days 3 to 14 post-earthquake, online questionnaires were administered to frontline medical staff to assess perceived social support, coping strategies, and psychological stress responses using the Perceived Social Support Scale (PSSS), Trait Coping Strategies Questionnaire (TCSQ), and Stress Response Questionnaire (SRQ). Data analysis included correlation analysis to explore relationships between variables, multiple linear regression to identify key predictors of stress, and path analysis to determine direct and indirect effects. Results: A total of 253 valid questionnaires were analyzed, with a participant composition of 81.82% females and 18.18% males, and the majority being nurses (62.06%). Psychological stress responses varied by gender and age, with females and older age groups showing higher physical stress responses (P < 0.05). Correlation and regression analyses indicated that negative coping and lower levels of social support were associated with increased stress responses (P < 0.05). Path analysis revealed that intra-family and extra-family support influenced stress responses directly and indirectly through coping strategies (P < 0.05). Conclusion: This study suggests that perceived social support directly influences stress responses in frontline medical personnel during disasters, with coping strategies mediating this effect. Future research should explore these dynamics over time through longitudinal studies.

Factors Associated with Psychological Distress, Fear, and Coping Strategies during the COVID-19 Pandemic in Thailand: A Cross-Sectional Study.

Introduction: Despite being initially perceived as a local infectious disease, COVID-19 has emerged as one of the most perilous global health threats, significantly impacting the psychological well-being of individuals worldwide. Objective: This cross-sectional descriptive study investigates the psychological distress, fear, and coping mechanisms among Thai people residing in Thailand during the COVID-19 pandemic. Methods: This online cross-sectional survey targeted Thai individuals during the first and third waves of the COVID-19 pandemic. Participants aged 18 and above who provided consent self-reported their responses to the Kessler Psychological Distress Scale, Fear of COVID-19 Scale, and Brief Resilient Coping Scale. Data collection occurred between November 2020 and January 2021 across four regions of Thailand. Univariate and multivariate logistic regression analyses explored associations between contextual factors and the variables of interest. Results: Out of 498 survey respondents, with an average age of 43.07 (SD = 13.69) years, 81.9% were female, and 61.6% self-identified as healthcare workers, with 47.59% identified as frontline healthcare workers. Findings revealed that 46% of participants experienced moderate-to-very high levels of psychological distress, 14.3% reported high levels of fear of COVID-19, and 35.1% exhibited low resilient coping. Factors such as changes in employment status or financial situations, comorbidities, contact with known or suspected COVID-19 cases, recent healthcare utilization for COVID-19-related stress, and elevated fear of COVID-19 were associated with higher levels of psychological distress. Conversely, being nurses and perceived better mental health status were linked to more effective coping strategies. Conclusion: These results emphasize the critical importance of government interventions to safeguard the psychological well-being of healthcare workers and the broader Thai population. Urgent measures to bolster resilience among these groups during and after the pandemic are imperative.

Efficacy and Safety of Frontline Single-Agent Rituximab in Extranodal Marginal Zone Lymphoma.

First-line therapy for patients with extranodal marginal zone lymphoma (EMZL) is not well established, except for eradication therapy for Helicobacter pylori in early gastric MZL. Various regimens, for example, locoregional treatment and systemic chemo-immunotherapy, can be used depending on the site and stage of disease. Single-agent rituximab is a useful approach in the setting of localized, low-intermediate risk EMZL. The aim our research was to analyze the effectiveness and safety of single-agent rituximab (375 mg/m2 once weekly for 4 weeks) in naïve EMZL in a real-life setting. The primary endpoint was the overall response rate (ORR), secondary endpoints were progression-free (PFS), overall (OS) and disease-free survivals (DFS), and drug tolerability. Fifty-nine patients were analyzed. Median time between diagnosis and rituximab was 3.6 months. The ORR was 89.9%, with 67.8% complete response (CR). Median DFS and PFS were reached at 6.3 and 5.3 years, respectively. After a median follow-up of 5 years, median OS was not reached. The most common adverse event was infusion reaction, reported in 28 cases, mainly during the first infusion and easily manageable. Single-agent rituximab may represent a valid therapeutic option in the first-line treatment of EMZL, at least for localized disease, with a favorable toxicity profile.

Efficacy and Safety of Bendamustine-Rituximab as Frontline Therapy for Indolent Non-Hodgkin Lymphoma: A Real-World, Single-Center, Retrospective Study.

Background The use of bendamustine with an anti-CD20 monoclonal antibody as frontline therapy for indolent non-Hodgkin lymphoma (NHL) has become a standard of care. We aimed to evaluate the real-world efficacy and safety of bendamustine-rituximab (BR) frontline therapy for indolent NHL. Patients and methods Patients with indolent NHL treated with frontline BR therapy in Hôpital du Sacré-Coeur de Montréal, from January 2015 to August 2018 were included in this retrospective study. Results Our cohort included 42 adults with a median age of 63 years. Follicular lymphoma was the most common histology (n = 31, 74%). Most patients had advanced disease (Lugano stage III or IV, 88%). The overall response rate was 84% (complete response = 62% and partial response = 22%). Median progression-free survival (PFS) was not reached. At 30 months, PFS was 74.8% and overall survival was 90%. Grade 3-4 neutropenia occurred in 21% of patients. Infection-related adverse events were observed in 17 patients (40%). Most were grade 1 and 2 events (84%). One case of grade 5 progressive multifocal leukoencephalopathy related to John Cunningham (JC) virus reactivation was observed. The most common non-infectious-related adverse events were mild nausea and fatigue. Conclusions The efficacy and safety of BR treatment for indolent NHL were comparable in our real-life cohort compared to prior studies. This supports BR as a standard of care for indolent NHL. Future studies should assess whether the use of granulocyte-colony stimulating factors as primary prophylaxis effectively mitigates the hematological and infection-related adverse events related to BR therapy.

CARs Moving Forward: The Development of CAR T-Cell Therapy in the Earlier Treatment Course of Hematologic Malignancies.

Chimeric antigen receptor T-cell (CAR-T) has revolutionized the treatment of hematologic malignancies. There are several approvals in lymphomas, leukemias and myeloma. Randomized clinical trials have shown that CAR-T cell therapy improves survival over standard of care in diffuse large B-cell lymphoma (DLBCL) and multiple myeloma (MM), changing dramatically the current treatment paradigm. Current efforts are directed in improving outcomes in the frontline setting and confirmatory randomized trials are ongoing.

Long-term efficacy and safety of dose-dense and dose-intense ABVD without consolidation radiotherapy in patients with advanced Hodgkin lymphoma: A 15-year follow-up of the ABVDDD-DI phase II study.

We demonstrated that dose-densified and dose-intensified ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine; ABVDDD-DI) was safe and effective. Here, we present a post hoc long-term analysis of the 82 patients enrolled in the original study. The median observation time was 175 months (IQR 159-197). At 15 years, progression-free and overall survival rates were 81.2% (95% CI, 69.9%-88.7%) and 92.7% (95% CI, 82.6%-97.0%), respectively. Four patients with multiple cardiovascular risk factors experienced delayed G3 cardiac events. The cumulative incidence of second malignancies at 20 years was 6.1%. Fertility and childbearing potential were unaffected. Data support an ongoing benefit for ABVDDD-DI without uneven late toxicities.

Workplace support for physicians during the COVID-19 Pandemic: Did it affect burnout?

BACKGROUND: A concern before 2020, physician burnout worsened during the COVID-19 pandemic. Little empirical data are available on pandemic workplace support interventions or their influence on burnout. We surveyed a national sample of frontline physicians on burnout and workplace support during the pandemic. METHODS: We surveyed a stratified random sample of 12,833 US physicians most likely to care for adult COVID-19 patients from the comprehensive AMA Physician Professional Data ™ file. The sample included 6722 primary care physicians (3331 family physicians, 3391 internists), 880 hospitalists, 1783 critical care physicians (894 critical care physicians, 889 pulmonary intensivists), 2548 emergency medicine physicians, and 900 infectious disease physicians. The emailed survey elicited physicians' perceptions of organizational interventions to provide workplace support and/or to address burnout. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Proportional specialty representation and response bias were addressed by survey weighting. Logistic regression assessed the association of physician characteristics and workplace interventions with burnout. RESULTS: After weighting, respondents were representative of the total sample. Overall physician burnout was 45.4%, significantly higher than in our previous survey. Open-ended responses mentioned that staffing shortages (physician, nursing, and other staff) combined with the increased volume, complexity, and acuity of patients during the pandemic increased job demands. The most frequent workplace support interventions were direct pandemic control measures (increased access to personal protective equipment, 70.0%); improved telehealth functionality (43.4%); and individual resiliency tools (yoga, meditation, 30.7%). Respondents placed highest priority on workplace interventions to increase financial support and increase nursing and clinician staffing. Factors significantly associated with lower odds of burnout were practicing critical care (compared with emergency medicine) OR 0.33 (95% CI 0.12 - 0.93), improved telehealth functionality OR 0.47 (95% CI 0.23 - 0.97) and being in practice for 11 years or longer OR 0.44 (95% CI 0.19-0.99). CONCLUSIONS: Burnout across frontline specialties increased during the pandemic. Physician respondents focused on inadequate staffing in the context of caring for more and sicker patients, combined with the lack of administrative efforts to mitigate problems. Burnout mitigation requires system-level interventions beyond individual-focused stress reduction programs to improve staffing, increase compensation, and build effective teams.

Evaluating Safety and Clinical Activity of Front-line Treatment with Cadonilimab plus Chemotherapy in Advanced/Metastatic Nonsmall Cell Lung Cancer Harboring STK11 Genetic Aberration: A Protocol of Phase II Study.

BACKGROUND: Cadonilimab is a first-in-class bispecific PD-1/CTLA-4 antibody. Serine/threonine kinase (STK11) mutation was shown to be related to low PD-L1 expression and objective response rate (ORR) in nonsmall cell lung cancer (NSCLC), resulting in poor progression-free survival (PFS) and overall survival (OS). Herein, we hypothesized that combining cadonilimab with chemotherapy could enhance antitumor immunity and extend survival in these patients. Consequently, we designed this study to explore the clinical activity and safety of cadonilimab combined with chemotherapy in patients with advanced/metastatic NSCLC harboring STK11 alteration. TRIAL DESIGN: This single-center, open-label, single-arm phase II trial is conducted at the first affiliated hospital of Guangzhou Medical University. Treatment-naïve advanced/metastatic NSCLC patients harboring STK11 mutation will be enrolled in this study. Eligible patients will receive either cadonilimab (10mg/kg on Day 1) plus pemetrexed (500 mg/m2) and carboplatin (AUC = 5) for nonsquamous NSCLC or abraxane (100 mg/m2) and carboplatin (AUC = 5) for squamous NSCLC for 4 cycles, followed by maintenance therapy (cadonilimab plus pemetrexed or abraxane). The treatment will be discontinued when disease progression, intolerability to cadonilimab, and/or chemotherapy occurs. Measurable lesions were assessed according to the Response Evaluation Criteria in Solid Tumors (1.1). The main endpoint is ORR and safety. Subordinate endpoints include PFS, disease control rate, and duration of response. RESULTS: The study commenced enrolment in September 2023, with preliminary findings regarding the primary endpoint anticipated by January 2025.

Lived experiences of radiology caregivers during a health crisis: A COVID-19 case analysis.

Background: Health crises have been linked with the exacerbation of pre-existing difficulties and the emergence of unique challenges, as evidenced by the impact of coronavirus disease 2019 (COVID-19) on health caregivers worldwide. Baseline data allow for reflection and preparation for any future health emergencies therefore giving impetus to phenomenological enquiries among the experiencers. Aim: This study aimed to explore the lived experiences of the eThekwini district frontline radiology caregivers during the COVID-19 pandemic. Setting: The study was conducted in public and private radiology departments in the eThekwini district of KwaZulu-Natal, South Africa. Methods: A qualitative, interpretative phenomenological analysis methodology was adopted in a multi-method data-collection context comprising semi-structured interviews and focus group discussions (FGDs) among 24 radiologists, radiographers, and radiology nurses obtained by non-probability sampling. Data were transcribed verbatim and analysed using an interpretative phenomenological approach. Results: Three superordinate themes emerged, namely: (1) duties and roles during the COVID-19 pandemic, (2) work-related challenges, (3) personal challenges. Conclusion: Frontline radiology caregivers experienced increased workload, staff shortages, salary cuts, personal protective equipment (PPE) shortages, non-recognition, poor managerial support, disrupted social relations, and poor work-life balance. This necessitates the need for the radiology departments to address staffing, infection prevention and control deficits, and invest in support interventions to assist frontline radiology caregivers during health crises. Contribution: The findings comprise baseline information that can be used for reflection and guiding radiology departments in preparing for any future health crises.

Development and evaluation of portable NIR technology for the identification and quantification of Australian illicit drugs.

The efficient and accurate analysis of illicit drugs remains a constant challenge in Australia given the high volume of drugs trafficked into and around the country. Portable drug testing technologies facilitate the decentralisation of the forensic laboratory and enable analytical data to be acted upon more efficiently. Near-infrared (NIR) spectroscopy combined with chemometric modelling (machine learning algorithms) has been highlighted as a portable drug testing technology that is rapid and accurate. However, its effectiveness depends upon a database of chemically relevant specimens that are representative of the market. There are chemical differences between drugs in different countries that need to be incorporated into the database to ensure accurate chemometric model prediction. This study aimed to optimise and assess the implementation of NIR spectroscopy combined with machine learning models to rapidly identify and quantify illicit drugs within an Australian context. The MicroNIR (Viavi Solutions Inc.) was used to scan 608 illicit drug specimens seized by the Australian Federal Police comprising of mainly crystalline methamphetamine hydrochloride (HCl), cocaine HCl, and heroin HCl. A number of other traditional drugs, new psychoactive substances and adulterants were also scanned to assess selectivity. The 3673 NIR scans were compared to the identity and quantification values obtained from a reference laboratory in order to assess the proficiency of the chemometric models. The identification of crystalline methamphetamine HCl, cocaine HCl, and heroin HCl specimens was highly accurate, with accuracy rates of 98.4 %, 97.5 %, and 99.2 %, respectively. The sensitivity of these three drugs was more varied with heroin HCl identification being the least sensitive (methamphetamine = 96.6 %, cocaine = 93.5 % and heroin = 91.3 %). For these three drugs, the NIR technology provided accurate quantification, with 99 % of values falling within the relative uncertainty of ±15 %. The MicroNIR with NIRLAB infrastructure has demonstrated to provide accurate results in real-time with clear operational applications. There is potential to improve informed decision-making, safety, efficiency and effectiveness of frontline and proactive policing within Australia.

Awareness of personal safety among frontline healthcare workers working in COVID ward of BPKIHS during COVID-19 pandemic: a cross-sectional study authors.

Background: Frontline healthcare workers are at higher risk for COVID-19 infection and due to lack of availability of adequate personal protective equipment (PPE), lack of knowledge and good practices results in more deaths each year due to occupational accidents and diseases. Objective: The aim of the study was to assess the awareness of personal safety, the association between the level of awareness with selected socio-demographic variables and to identify the correlation between knowledge and practice of personal safety. Materials and methods: A descriptive cross-sectional study design was conducted among 106 Frontline Healthcare workers who have worked in the COVID ward. The study was conducted between 7 August 2022 and June 2023. A convenient sampling technique was used for sample selection. A validated self-administered questionnaire was used to assess the awareness of personal safety. Descriptive statistics (mean, SD frequency and percentage) and inferential statistics (χ2 and Spearman's correlation rank) were used for the data analysis. Results: Among the respondents, there were 38 doctors and 68 nurses. The majority of the respondents had a moderate level of knowledge (79.2%) and practice (52.8%) with a mean score of 13.52±2.10 and 14.51± 2.35, respectively. Doctors have slightly higher levels of knowledge (14.01±1.62) and practice (14.57±2.07) as compared to Nurses (13.19±2.27, 14.48±2.5), respectively. Knowledge was found to be associated with the education level and age of the respondents, and practice has a significant association with training/demonstration with a P value of less than 0.05. Knowledge and practice were found to have a partial positive correlation (r value of 0.27). Conclusion: This study concluded that those having higher levels of education had good levels of knowledge and those who have attended formal or informal training or demonstrations regarding personal safety had good practices regarding personal safety.

Differences in Physician Burnout by Specialty: A Cross-Sectional Survey.

BACKGROUND: The prevalence of physician burnout increased notably during the COVID-19 pandemic, but whether measures of burnout differed based on physician specialty is unknown. The authors sought to determine the prevalence of burnout, worklife conflict, and intention to quit among physicians from different specialties. METHODS: This is a cross-sectional online survey of physicians working at 2 urban hospitals in Vancouver, Canada, from August to October 2021. Responses were categorized by specialty (including surgical and nonsurgical), and data about whether physicians provided frontline patient care during COVID-19 were also included. Physician burnout was measured using the Maslach Burnout Inventory. RESULTS: The survey response rate was 42% (209/498). The overall prevalence of burnout was 69%. Burnout was not significantly different by specialty or between frontline COVID-19 specialties compared with other specialties. Physicians in surgical specialties were more likely to report work-life conflict than those in nonsurgical specialties (p = 0.012). Differences in intention to quit among specialties were not statistically significant. CONCLUSION: During the COVID-19 pandemic, physician burnout was high across physicians, without significant differences between specialties, highlighting the need to support all physicians.

The Effect of Age and Other Patient Characteristics on Outcomes Among Nontransplanted Patients Who Were Treated With First-Line Lenalidomide, Bortezomib, and Dexamethasone: Results From the ConnectⓇ MM Registry.

BACKGROUND: Lenalidomide (R), bortezomib (V), and dexamethasone (d) is a standard-of-care regimen in newly diagnosed multiple myeloma (NDMM); however, characteristics and outcomes for nontransplanted patients receiving frontline RVd are not well understood. PATIENTS: The ConnectⓇ MM Registry is a large, US, multicenter, prospective observational cohort study of NDMM patients. METHODS: This analysis investigated characteristics and outcomes of patients who received RVd alone or followed by Rd or R (RVd ± Rd/R) who did not undergo frontline autologous stem cell transplantation. RESULTS: As of August 2021, 314 of 1979 nontransplanted patients received RVd ± Rd/R as initial therapy. Of these, 135 were aged ≤ 65 years and 179 were > 65 years. 108 patients had time to relapse (TTR) of ≤ 12 months and 182 had TTR > 12 months. Baseline characteristics were comparable regardless of TTR and age group except renal function, which was more commonly impaired in older patients. Among patients aged ≤ 65 and > 65 years, median duration of first-line treatment was 6.3 and 9.0 months, median time to next line for those who received second-line therapy was 15.5 and 15.2 months, median progression-free survival (PFS) was 19.3 and 23.0 months, and median overall survival was 60.0 and 59.1 months, respectively. High-risk disease (per IMWG criteria) and high serum calcium were associated with higher hazard of progression or death; the adjusted PFS hazard ratio with respect to age (≤ 65 vs. > 65 years) based on multivariable analysis was 1.18 (0.89-1.57; P = .25). CONCLUSION: These results indicate RVd is active across age groups and provide a better understanding of outcomes with RVd in NDMM.

Evaluation of the blended public health empowerment program-basic field epidemiology in the Eastern Mediterranean Region.

Introduction: The COVID-19 pandemic encouraged the shift toward technology-based learning globally, impacting education systems profoundly. In response to this emerging need, the Eastern Mediterranean Public Health Network (EMPHNET) adapted its Public Health Empowerment Program-Basic Field Epidemiology (PHEP-BFE) to a Blended Learning Model. This study evaluates the Blended PHEP-BFE program in Iraq, Egypt, and Lebanon, focusing on participant reactions and learning outcomes. Methods: A descriptive evaluation was conducted, aligned with the first two levels of Kirkpatrick's model. Online questionnaires were administered to participants and facilitators through EMPHNET's Learning Management System (LMS). Qualitative and quantitative data were analyzed to assess program effectiveness, satisfaction, and challenges. Results: A total of 138 PHEP-BFE participants (119 (86.2%) males and 19 (13.8%) females) from Iraq (n = 61), Egypt (n = 66), and Lebanon (n = 11) responded to the questionnaire. The majority of the participants (96.4%) reported that they were satisfied with PHEP-BFE. Notably, 77.5% of participants rated the blended learning program as very good or excellent, 18.1% rated it good, and 3.6% found it average, with a minimal 0.7% expressing dissatisfaction. The majority of participants agreed that the blended PHEP-BFE enhanced their capacity to conduct, review and monitor surveillance data (95.7%), perform descriptive data analysis (94.2%), effectively communicate information with agency staff and the local community (95.7%), write summaries of surveillance findings or outbreak investigations (95.7%), use MS Excel to enter, analyze, and display public health surveillance data (91.3%), prepare and administer an oral presentation for fieldwork (94.9%), and increase their knowledge of fundamental field epidemiology (94.9%). The participants responded positively to the program's content, training duration, learning platform, facilitators and mentors, and fieldwork. Conclusion: The study showcases the success of the blended PHEP-BFE in diverse contexts, emphasizing positive participant reactions and improved competencies. The evaluation underscores the program's success in advancing public health training in the EMR. Blended learning models prove promising for future FETP initiatives, contributing valuable insights to public health workforce development. Positive outcomes and identified challenges, provide a roadmap for continuous improvement.

Unspoken expectations and situational participation: a qualitative study exploring the instantiation of next of kin involvement within the trust model.

BACKGROUND: Demographic changes, such as an increase in older adults, present a challenge to the healthcare service's current capacity. Moreover, the need for healthcare personnel is rising, while the availability of labour is dwindling, leading to a potential workforce shortage. To address some of these challenges, enhanced collaboration between home-based healthcare frontline workers, service users, and next of kin is a necessity. The trust model is an organisational model where home-based healthcare services are organised into smaller interdisciplinary teams aiming to tailor the services in collaboration with service-users and their next of kin'. This study explores how the next of kin and frontline workers perceive and perform involvement in making decisions regarding tailoring the services for the users of home-based healthcare services organised after the trust model. METHODS: Four in-depth interviews and 32 observations were conducted, and thematic analysis was employed to identify meaningful patterns across the datasets. RESULTS: The results are presented as two themes: (i) unspoken expectations and (ii) situational participation. The results highlight the complex nature of next-of-kin involvement and shared decision making, raising questions about meeting expectations, evaluating available resources, and developing sustainable involvement processes. CONCLUSION: This study indicates that despite of an interdisciplinary organisational model aiming for shared decision making as the trust model, the involvement of next of kin continues to be a challenge for frontline workers in home-based healthcare services. It also points to the importance of transparent communication and how it is deemed essential for clarifying implicit expectations.