Working conditions during pregnancy: a survey of 3590 European anaesthesiologists and intensivists.

BACKGROUND: Pregnancy adds challenges for healthcare professionals, regardless of gender. We investigated experiences during pregnancy, attitudes towards pregnant colleagues, family planning decisions, and awareness of regulations among European anaesthesiologists and intensivists. METHODS: A cross-sectional online survey was conducted among 3590 anaesthesiologists and intensivists from 47 European countries. The survey, available for 12 weeks, collected data on demographics, working conditions, safety perceptions, and the impact of clinical practice and training demands on family planning. Quantitative data were analysed using descriptive statistics, whereas qualitative data underwent thematic content analysis. RESULTS: Only 41.4% (n=678) of women were satisfied with their working conditions during pregnancy, and only 38.5% (n=602) considered their working environment safe. The proportion of women who changed their clinical practice during pregnancy and who took sick leave to avoid potentially harmful working conditions increased over time (P<0.001 for both). Men had children more often during residency than women (P<0.001). Pregnant colleagues' safety concerns influenced clinical practice, with women and men who had experience with their own and partner's pregnancy being more likely to modify their practices. Work and training demands discouraged plans to have children, particularly among women, leading to consideration of leaving training. Awareness of national regulations was limited, and respondents highlighted a need for better support and flexible working conditions. CONCLUSIONS: Improved support and working environments for pregnant colleagues and ability to express preferred clinical areas for work are needed. Department heads should commit to safety and family friendliness, and men transitioning to parenthood should not be neglected.

Influence of pairing in examiner leniency and stringency ('hawk-dove effect') in part II of the European Diploma of Anaesthesiology and Intensive Care: A cohort study.

BACKGROUND: The European Diploma of Anaesthesiology and Intensive Care (EDAIC) Part II examination is a supranational examination for anaesthesiologists. OBJECTIVES: We explore the impact of examiner pairing on leniency and stringency, commonly referred to as the 'hawk-dove effect'. We investigate the potential variations in grading approaches, resulting from different examiner pairs and their implications for candidate performance. DESIGN: Retrospective cohort, observational design. SETTING: EDAIC Part II examination data from 2021 to 2023. PARTICIPANTS: Three hundred and twenty-five examiners across 122 EDAIC Part II examination sessions. INTERVENTIONS: We analysed the influence of examiner leniency and examiner pairing on candidate performance in the EDAIC Part II using many-facet Rasch modelling. MAIN OUTCOME MEASURES: The study's main outcome measure was determining a leniency score among the examiner population. The study also aimed to assess how examiner pairing influenced candidate performance, as measured by their scores in the examination. RESULTS: During the study period, the number of examiners who participated in 2021, 2022 and 2023 were 253, 242 and 247, respectively. The median sessions attended were 7.0 (3 to 10). The examination data revealed a mean leniency score of 0 [95% confidence interval (CI) -0.046 to 0.046], with the standard deviation being one-third that of the candidates' ability scores. There were 1424 different pairs of examiners, with most pairs (97%) having only a one-point difference in marking. The mean leniency score for the pair of examiners was -0.053 (95% CI -0.069 to -0.037). CONCLUSION: The variations in grading approaches associated with different pairings emphasise the potential for the 'hawk-dove effect' to influence candidate performance and outcomes. Understanding these variations can guide curriculum development, examiner training and coupling, ensuring a balanced and equitable assessment process. TRIAL REGISTRATION: None.

Effectiveness of a home-based pulmonary rehabilitation maintenance programme: the Rehab2Life study protocol.

Pulmonary rehabilitation (PR) is the bedrock of non-pharmacological treatment for people with COPD. Nonetheless, it is well described in the literature that unless the patient changes his behaviour, the benefits of PR programmes will decline in six to twelve months after finishing the programme. Therefore, maintenance programmes can address the problem of PR programmes' effect loss over time.Community care units can provide multidisciplinary care in the current Portuguese primary health care context. These units have an interdisciplinary team that aims to develop competencies in COPD patients to self-manage the disease.This study aims to test the effectiveness of a 12-month home-based PR programme (Rehab2Life) compared to usual care through a single-blind randomised controlled trial with two parallel groups. The Rehab2Life programme includes two distinct phases. The first is an 8-week PR programme delivered to both groups, and the second is a PR maintenance programme delivered to the intervention group after the initial eight weeks. The control group receive the usual care and regular appointments. The primary outcome is functional capacity, and secondary outcomes are dyspnea, Health-Related Quality of Life (HRQoL), number of exacerbations, symptoms burden, anxiety and depression symptoms, and physical activity.We expect to observe that the home-based PR programme brings clinically relevant benefits to the participants at the end of the first eight weeks and that, at 12 months after the maintenance phase of the programme, benefits are less dissipated than in the control group. We expect to identify the characteristics of the patients who benefit the most from home-based programmes.The trial was registered on 7 April 2022 at ClinicalTrials.gov (NCT05315505).

Patient-centered precision care in anaesthesia - the PC-square (PC) 2 approach.

PURPOSE OF REVIEW: This review navigates the landscape of precision anaesthesia, emphasising tailored and individualized approaches to anaesthetic administration. The aim is to elucidate precision medicine principles, applications, and potential advancements in anaesthesia. The review focuses on the current state, challenges, and transformative opportunities in precision anaesthesia. RECENT FINDINGS: The review explores evidence supporting precision anaesthesia, drawing insights from neuroscientific fields. It probes the correlation between high-dose intraoperative opioids and increased postoperative consumption, highlighting how precision anaesthesia, especially through initiatives like Safe Brain Initiative (SBI), could address these issues. The SBI represents multidisciplinary collaboration in perioperative care. SBI fosters effective communication among surgical teams, anaesthesiologists, and other medical professionals. SUMMARY: Precision anaesthesia tailors care to individual patients, incorporating genomic insights, personalised drug regimens, and advanced monitoring techniques. From EEG to cerebral/somatic oximetry, these methods enhance precision. Standardised reporting, patient-reported outcomes, and continuous quality improvement, alongside initiatives like SBI, contribute to improved patient outcomes. Precision anaesthesia, underpinned by collaborative programs, emerges as a promising avenue for enhancing perioperative care.

The way towards ethical anesthesia care: no aim - no game - no fame or blame?

PURPOSE OF REVIEW: This review explores the intricacies of ethical anesthesia, exploring the necessity for precision anesthesia and its impact on patient-reported outcomes. The primary objective is to advocate for a defined aim, promoting the implementation of rules and feedback systems. The ultimate goal is to enhance precision anesthesia care, ensuring patient safety through the implementation of a teamwork and the integration of feedback mechanisms. RECENT FINDINGS: Recent strategies in the field of anesthesia have evolved from intraoperative monitorization to a wider perioperative patient-centered precision care. Nonetheless, implementing this approach encounters significant obstacles. The article explores the evidence supporting the need for a defined aim and applicable rules for precision anesthesia's effectiveness. The implementation of the safety culture is underlined. The review delves into the teamwork description with structured feedback systems. SUMMARY: Anesthesia is a multifaceted discipline that involves various stakeholders. The primary focus is delivering personalized precision care. This review underscores the importance of establishing clear aims, defined rules, and fostering effective and well tolerated teamwork with accurate feedback for improving patient-reported outcomes. The Safe Brain Initiative approach, emphasizing algorithmic monitoring and systematic follow-up, is crucial in implementing a fundamental and standardized reporting approach within patient-centered anesthesia care practice.

Welfare practices for anaesthesiology trainees in Europe: A descriptive cross-sectional survey study.

BACKGROUND: Current regulations of anaesthesiology training programmes may affect gender equity, female representation and leadership. OBJECTIVE: To describe the work regulations of anaesthesiology training programs and working conditions during the early period of child-rearing in European countries. DESIGN: Cross-sectional survey. SETTING: National Anesthesiologists Societies Committee (NASC) representatives of the European Society of Anesthesiology and Intensive Care. PARTICIPANTS: Thirty-eight NASC representatives. MAIN OUTCOME MEASURES: Basic specialist training working conditions, gender-related data, return to work after childbirth and workplace policies against discrimination during anaesthesiology specialist training. INTERVENTIONS: A 48-item questionnaire to explore the work patterns and conditions for trainees especially for new parents, professional development opportunities and work discrimination regulations in each representative country was distributed to NASC representatives of 44 European countries. RESULTS: We collected the replies of each representative (38 representatives from 44 invited countries' representatives, 86% response rate). The median [IQR] proportion of female trainees was 60% [50 to 68]. There were no reported pay differences between sexes. In eight European countries, pregnant trainees worked fewer hours and were excused from night shifts. Women could not be laid off during pregnancy in all 38 countries (100%). The countries offered a median of 18 weeks of paid (total or partial) maternity leave (range, 13 to 60 weeks). Most countries (89%) accommodate paid paternity leaves. A significant proportion of parental leave was unpaid ( n =18, 42%). Twenty-one (55%) countries allowed part-time work after delivery. The UK was the only country with clear recommendations to formally complain after harassment. CONCLUSION: European countries have a wide variety of regulations. On paper, numerous countries have various paid maternal, paternal and parental leave; however, it remains to be determined if such leave takes place in practice. The practical consequences of these regulations on female trainees during the child-rearing period need to be explored further. TRIAL REGISTRATION: None.

The nuts and bolts of multimodal anaesthesia in the 21st century: a primer for clinicians.

PURPOSE OF REVIEW: This review article explores the application of multimodal anaesthesia in general anaesthesia, particularly in conjunction with locoregional anaesthesia, specifically focusing on the importance of EEG monitoring. We provide an evidence-based guide for implementing multimodal anaesthesia, encompassing drug combinations, dosages, and EEG monitoring techniques, to ensure reliable intraoperative anaesthesia while minimizing adverse effects and improving patient outcomes. RECENT FINDINGS: Opioid-free and multimodal general anaesthesia have significantly reduced opioid addiction and chronic postoperative pain. However, the evidence supporting the effectiveness of these approaches is limited. This review attempts to integrate research from broader neuroscientific fields to generate new clinical hypotheses. It discusses the correlation between high-dose intraoperative opioids and increased postoperative opioid consumption and their impact on pain indices and readmission rates. Additionally, it explores the relationship between multimodal anaesthesia and pain processing models and investigates the potential effects of nonpharmacological interventions on preoperative anxiety and postoperative pain. SUMMARY: The integration of EEG monitoring is crucial for guiding adequate multimodal anaesthesia and preventing excessive anaesthesia dosing. Furthermore, the review investigates the impact of combining regional and opioid-sparing general anaesthesia on perioperative EEG readings and anaesthetic depth. The findings have significant implications for clinical practice in optimizing multimodal anaesthesia techniques (Supplementary Digital Content 1: Video Abstract, http://links.lww.com/COAN/A96 ).

Accuracy of the end-expiratory lung volume measured by the modified nitrogen washout/washin technique: a bench study.

BACKGROUND: The functional residual capacity (FRC) determines the oxygenating capacity of the lung and is heavily affected in the clinical context of the acute respiratory distress syndrome. Nitrogen-wash-in/wash-out methods have been used to measure FRC. These methods have rarely been validated against exactly known volumes. The aim of the study was to assess the accuracy and precision of the N2 washout/washin method in measuring FRC, by comparing it with set volumes in a lung simulator. METHODS: We conducted a diagnostic bench study in the Intensive Care Unit and Radiology Department of a tertiary hospital in Switzerland. Using a fully controllable high fidelity lung simulator (TestChest®), we set the functional residual capacity at 1500 ml, 2000 ml and 2500 ml and connected to the GE Carestation respirator, which includes the nitrogen washout/washin technique (INview™ tool). FRC was then set to vary by different levels of PEEP (5, 8, 12 and 15 cmH2O). The main outcome measures were bias and precision of the TestChest® when compared to the results from the washout/washin technique, according to the results of a Bland Altman Analysis. We verified our findings with volumetric computed tomography. RESULTS: One hundred and thirty-five nitrogen-wash-in/wash-out measurements were taken at three levels of FIO2 (0.4, 0.5, 0.6). The CT volumetry reproduced the set end-expiratory volumes at the Simulator with a bias of 4 ml. The nitrogen-wash-in/wash-out method had a bias of 603 ml with acceptable limits of agreement (95% CI 252 to - 953 ml). Changes were detected with a concordance rate of 97%. CONCLUSIONS: We conclude that the TestChest® simulator is an accurate simulation tool, concerning the simulation of lung volumes. The nitrogen wash-in/wash out method correlated positively with FRC changes, despite a relatively large bias in absolute measurements. The reference volumes in the lung simulator verified with CT volumetry were very close to their expected values. The reason for the bias could not be determined.

Communication content during debriefing in simulation-based medical education: An analytic framework and mixed-methods analysis.

BACKGROUND: Debriefing is an indispensable component of simulation-based medical education, and it has great potential for contributions to reflective learning. Little is known about the relevance of communication during debriefings. We developed a category framework to assess the communication content of debriefings, which we used to analyze possible relationships to participant learning outcomes. METHOD: We deductively and inductively developed a category framework for qualitative content analysis of debriefings. We coded 20 debriefings using this framework, and correlated debriefing frequency with learning outcomes (i.e. engagement, satisfaction, individual and team learning success). RESULTS: The category framework comprised 9 main and 81 subcategories (48 debriefers, 27 participants, 6 simulated patients), which yielded good intercoder agreement. Debriefers and participants communicated equally using mostly advocacy, inquiry, illustration, and confirmation. Debriefer questions and participant inputs were positively related to learning outcomes. In contrast, guess-what-I-am-thinking, apologies, observations, use of materials, participant descriptions, simple repetition of statements, and evaluation by other participants were not positively associated with learning outcomes. CONCLUSION: This study provides important new information about communication content during debriefings. The association between communication content and learning outcomes appears particularly relevant to further enhance efficacy of debriefings and simulation-based medical education.

Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey.

BACKGROUND: Antibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection. OBJECTIVES: To investigate antibiotic prescribing practices in patients with COVID-19. METHODS: We performed an international web-based survey and investigated the pattern of antibiotic use as reported by physicians involved in treatment of COVID-19. SPSS Statistics version 25 was used for data analysis. RESULTS: The survey was completed by 166 participants from 23 countries and 82 different hospitals. Local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% (n = 102) of participants and for 82.9% (n = 136) they did not differ from local community-acquired pneumonia guidelines. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and SD = 1.095 on grading scale from 1 to 5). When antibiotics were started, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05 on bi-modal scale, with values 1 and 2 for disagreement and values 3 and 4 for agreement). In the patients on the ward, 29.1% of respondents chose not to prescribe any antibiotic. Combination of ß-lactams and macrolides or fluoroquinolones was reported by 52.4% (n = 87) of respondents. In patients in the ICU, piperacillin/tazobactam was the most commonly prescribed antibiotic. The mean reported duration of antibiotic treatment was 7.12 (SD = 2.44) days. CONCLUSIONS: The study revealed widespread broad-spectrum antibiotic use in patients with COVID-19. Implementation of antimicrobial stewardship principles is warranted to mitigate the negative consequences of antibiotic therapy.

Perceptions of gender equity in departmental leadership, research opportunities, and clinical work attitudes: an international survey of 11 781 anaesthesiologists.

BACKGROUND: Women make up an increasing proportion of the physician workforce in anaesthesia, but they are consistently under-represented in leadership and governance. METHODS: We performed an internet-based survey to investigate career opportunities in leadership and research amongst anaesthesiologists. We also explored gender bias attributable to workplace attitudes and economic factors. The survey instrument was piloted, translated into seven languages, and uploaded to the SurveyMonkey® platform. We aimed to collect between 7800 and 13 700 responses from at least 100 countries. Participant consent and ethical approval were obtained. A quantitative analysis was done with χ2 and Cramer's V as a measure of strength of associations. We used an inductive approach and a thematic content analysis for qualitative data on current barriers to leadership and research. RESULTS: The 11 746 respondents, 51.3% women and 48.7% men, represented 148 countries; 35 respondents identified their gender as non-binary. Women were less driven to achieve leadership positions (P<0.001; Cramer's V: 0.11). Being a woman was reported as a disadvantage for leadership and research (P<0.001 for both; Cramer's V: 0.47 and 0.34, respectively). Women were also more likely to be mistreated in the workplace (odds ratio: 10.6; 95% confidence interval: 9.4-11.9; P<0.001), most commonly by surgeons. Several personal, departmental, institutional, and societal barriers in leadership and research were identified, and strategies to overcome them were suggested. Lower-income countries were associated with a significantly smaller gender gap (P<0.001). CONCLUSIONS: Whilst certain trends suggest improvements in the workplace, barriers to promotion of women in key leadership and research positions continue within anaesthesiology internationally.

Simulated patient-based teaching of medical students improves pre-anaesthetic assessment: A rater-blinded randomised controlled trial.

BACKGROUND: Pre-anaesthetic assessment of patients is a complex competency that needs to be taught during anaesthesia clerkships. OBJECTIVES: We aimed to improve student teaching and investigated the effectiveness of trained 'simulated patients' (lay persons or actors trained to portray specific roles or symptoms) in the teaching of medical students to perform routine pre-anaesthetic assessments. We hypothesised that the intervention of one 30-min teaching sequence with a simulated patient will improve the performance of year 4 medical students in pre-anaesthesia assessment of elective surgical patients, compared with the control of standard apprentice-based teaching. DESIGN: Randomised controlled trial. SETTING/PARTICIPANTS: One hundred and forty-four year 4 medical students at the University of Bern. INTERVENTION: These students were randomised to either the standard clinician-supervised learning in the operating theatre (n=71; control group) or a single teaching session with a simulated patient (nonhealthcare provider, as a trained layperson) (n=73; intervention group). Both groups of students then performed pre-anaesthetic patient visits. The student performances during these visits were assessed according to the mini-Clinical Evaluation Exercise tool by trained anaesthesiologists blinded to randomisation. The 71 students in the standard clinical supervision group also underwent the simulated patient teaching session on the day following the assessments. RESULTS: The students in the intervention group of simulated patient teaching scored significantly higher in both their mini-Clinical Evaluation Exercise overall impression scores (8.8 ±â€Š0.8 vs. 8.3 ±â€Š0.9; P = 0.004) and mean domain scores (8.7 ±â€Š0.8 vs. 8.3 ±â€Š0.9; P = 0.01), compared with those of the control group with the standard clinical supervision. CONCLUSION: The current single teaching encounter with a trained layperson acting as a simulated patient improved medical student performances in their pre-anaesthetic clinical assessment of surgical patients. This might be a suitable alternative to reduce the teaching burden for busy and costly clinicians.

Attitudes towards Interprofessional education in the medical curriculum: a systematic review of the literature.

BACKGROUND: There is agreement among educators and professional bodies that interprofessional education needs to be implemented at the pre-registration level. We performed a systematic review assessing interprofessional learning interventions, measuring attitudes towards interprofessional education and involving pre-registration medical students across all years of medical education. METHODS: A systematic literature review was performed using PubMed, PsycINFO, EThOS, EMBASE, PEDro and SCOPUS. Search terms were composed of interprofession*, interprofessional education, inter professional, inter professionally, IPE, and medical student. Inclusion criteria were 1) the use of a validated scale for assessment of attitudes towards IPE, and results for more than 35 medical students; 2) peer-reviewed articles in English and German, including medical students; and 3) results for IPE interventions published after the 2011 Interprofessional Education Collaborative (IPEC) report. We identified and screened 3995 articles. After elimination of duplicates or non-relevant topics, 278 articles remained as potentially relevant for full text assessment. We used a data extraction form including study designs, training methods, participant data, assessment measures, results, and medical year of participants for each study. A planned comprehensive meta-analysis was not possible. RESULTS: This systematic review included 23 articles with a pre-test-post-test design. Interventions varied in their type and topic. Duration of interventions varied from 25 min to 6 months, and interprofessional groups ranged from 2 to 25 students. Nine studies (39%) reported data from first-year medical students, five (22%) from second-year students, six (26%) from third-year students, two (9%) from fourth-year students and one (4%) from sixth-year students. There were no studies including fifth-year students. The most frequently used assessment method was the Readiness for Interprofessional Learning Scale (RIPLS) (n = 6, 26%). About half of study outcomes showed a significant increase in positive attitudes towards interprofessional education after interventions across all medical years. CONCLUSIONS: This systematic review showed some evidence of a post-intervention change of attitudes towards IPE across different medical years studied. IPE was successfully introduced both in pre-clinical and clinical years of the medical curriculum. With respect to changes in attitudes to IPE, we could not demonstrate a difference between interventions delivered in early and later years of the curriculum. TRIAL REGISTRATION: PROSPERO registration number:  CRD42020160964 .

A new global health outcome score after trauma (GHOST) for disability, cognitive impairment, and health-related quality of life: data from a prospective cross-sectional observational study.

Background:Trauma patients experience morbidity related to disability and cognitive impairment that negatively impact their health-related quality of life (HRQoL). We assessed the impact of trauma on disability, cognitive impairment and HRQoL after intensive care in patients with and without traumatic brain injury (TBI) and created a predictive score to identify patients with worse outcome. Methods:We identified 262 patients with severe trauma (ISS>15) admitted to the emergency room of a level 1 trauma center. Patients above 13 years were included. After 6 months, patients were assessed for disability, cognitive impairment, and HRQoL. A global health outcome score after trauma (GHOST) was obtained through the combination of these domains. Logistic regression analysis was considered for the effect of demographic, trauma and hospital factors on global outcome. p > 0.05. Statistics performed with SPSS 23.0. Results:Patients with the worst outcomes were older and had a longer length of Intensive Care Unit (ICU) stay. The effect of gender was found in all "GHOST dimensions". TBI was not significantly associated with worse outcome. Conclusions:No significant differences were seen on disability, cognitive impairment and decreased HRQoL in patients with or without TBI. Our GHOST score showed that female gender, older age, and longer ICU stay were significantly associated with the worst outcome. Abbreviations: AIS: Abbreviated Injury Scale; EQ-5D: EuroQol 5-dimensions; EQ-5D-3L: EuroQol 5-dimensions 3-levels; GCS: Glasgow Coma Scale; GOSE: Glasgow Outcome Scale Extended; HRQoL: Health-Related Quality of Life; ICU: Intensive Care Unit; ISS: Injury Severity Score; MMS: Mini Mental State; NICE: National Institute for Health and Care Excellence; RTS: Revised Trauma Score; TBI: Traumatic brain injury; TRISS: Trauma Injury Severity Score; VAS: Visual Analogue Scale.

Coma After Droperidol Administration: A Case Report.

In Switzerland, approximately 32,000 patients are hospitalized annually due to adverse drug reactions (ADRs), representing 2.3% of all hospitalizations. During the perioperative period, the administration of a variety of drugs from different classes over a relatively short period of time increases the risk of ADR. Here, we describe the case of a 32-year-old woman who was administered droperidol to treat nausea in the recovery room after a myomectomy and who subsequently became comatose. Correctable metabolic, respiratory, and cerebrovascular disorders were ruled out. Six hours after the event, she was extubated without residual effects. We discuss potential ADR for droperidol.

Impact of Burnout on Anaesthesiologists.

Professional burnout syndrome (PBS) is an issue affecting individuals and organizations alike, characterized by emotional exhaustion and reduced effectiveness resulting from overwhelming work demands. Root causes include excessive workload, unrealistic expectations, and blurred work-life boundaries, which are often intensified by organizational culture and inadequate support systems. The consequences range from decreased productivity and creativity to high turnover rates and financial strain on organizations. Mitigating PBS requires a comprehensive approach that addresses both individual and organizational levels. Individually, stress management techniques and self-care practices are crucial for building resilience and coping with work-related stressors. Organizations play a vital role in promoting employee well-being by fostering a supportive work environment, promoting work-life balance and providing access to support systems such as counseling and mentorship programs. Leadership is key in creating a culture that values employee health and prioritizes open communication and empathy. Policy interventions can further support efforts to combat PBS by enforcing labor laws that protect employee rights, such as setting limits on working hours and ensuring access to mental health services. Additionally, incentivise organizations to prioritize employee well-being through tax incentives or certification programs can encourage proactive measures against burnout. The aim of this review is to provide a comprehensive exploration of PBS, examining its causes, consequences, and potential mitigation strategies in individuals and organizations, with a focus on anaesthesiology.

European anesthesiologists' experiences with gender-based mistreatment in the workplace: a secondary multilevel regression analysis.

BACKGROUND: Workplace gender-based mistreatment (GBM) refers to negative or harmful behaviors directed towards employees. In healthcare settings, this can lead to job dissatisfaction and underperformance and potentially compromise patient outcomes. The aim of this study was to examine workplace GBM among European anesthesiologists and produce the first European Gender-based Mistreatment Rank in Anesthesiology. METHODS: We conducted a secondary analysis from a worldwide cross-sectional survey database consisting of a 46-item questionnaire exploring, among other outcomes, gender bias attributable to workplace attitudes. The survey completion rate was 80.8%. All respondents were selected from European countries. Associations between mistreatment and the remaining variables were analyzed using univariate and multivariate logistic regression analyses. A generalized linear mixed model was then used to quantify the impact of mistreatment in each European country. Statistical significance was set at P < 0.05. RESULTS: This study included 5,795 respondents from 43 European countries. The independent predictors of GBM were as follows: female gender, younger age, perceiving gender as a disadvantage for leadership, and perceiving gender as a disadvantage for research. The full model was statistically significant, indicating an ability to distinguish between those who experienced GBM and those who did not (P < 0.001). Thus, 26 European countries were ranked based on the prevalence of mistreatment, with Italy showing the best performance (lowest prevalence). CONCLUSIONS: The aim of our study was to provide preliminary insight into GBM in anesthesiology in Europe, function as a key benchmark for gender equity, and chart the evolution of disparities over time.

Fatigue and Mental Illness Symptoms in Long COVID: Protocol for a Prospective Cohort Multicenter Observational Study.

BACKGROUND: The aftermath of the COVID-19 pandemic continues to affect millions worldwide, resulting in persisting postvirus complaints and impacting peoples' quality of life. Long COVID, characterized by lingering symptoms like fatigue and mental illness, can extend beyond a few months, necessitating further research to understand its implications. OBJECTIVE: This study aims to quantify the degree of physical and psychological fatigue in patients following COVID-19 infection and examine its correlation with mental health disorders. METHODS: Using a consecutive nonrandom sampling technique, we will conduct a prospective cohort multicenter observational study in 5 Portuguese hospitals. Symptomatic adult patients with previous COVID-19 attending follow-up consultations will be enrolled. We will include patients who had mild, moderate, and severe acute disease. We will assess clinical outcomes related to COVID-19, including the type of respiratory support such as high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation. The exclusion criteria will include previous severe psychiatric disorders confirmed by a psychiatrist; refusal or inability to respond to the questionnaire; concomitant neurological disorder; persistent fatigue symptoms during the 6 months before infection; and the need for invasive mechanical ventilation during COVID-19 infection due to a high prevalence of postintensive care syndrome. Our primary outcome is the prevalence of fatigue in patients with post-COVID-19 depression and/or anxiety, as measured by the Chalder Fatigue Scale (CFQ-11) and the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes will include an assessment of health-related quality of life via the EQ-5D questionnaire and an exploration of the prevalence of symptoms of posttraumatic stress disorder (PTSD) using the 14-item Posttraumatic Stress Scale (PTSS-14). We will also examine the association between mental health symptoms and the severity of acute COVID-19. The post-COVID-19 data will be collected at least 6 months after the positive test and no longer than 9 months during the clinical appointment. RESULTS: We expect our multicenter study on patients post COVID-19 to reveal a significant link between mental illness symptoms and both physical and psychological fatigue. Patients with heightened depression and anxiety may report increased levels of fatigue. Additionally, we expect to find persistent PTSD symptoms in a subset of participants, indicating the enduring psychological impact of the virus. CONCLUSIONS: This study may underscore the need for integrated care addressing physical and mental health in patients post COVID-19. The observed connections emphasize the importance of considering mental well-being for long-term health outcomes. Despite study limitations, our findings contribute valuable insights for future treatment strategies and highlight the necessity for comprehensive mental health support in post-COVID-19 care. This research provides valuable insights into the mental health implications of COVID-19 and its impact on post-COVID-19 fatigue and the overall well-being of affected individuals. TRIAL REGISTRATION: ClinicalTrials.gov NCT05323318; https://clinicaltrials.gov/study/NCT05323318. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51820.