Association Between Physician Burnout and Self-reported Errors: Meta-analysis.

OBJECTIVES: Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians. METHODS: This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studies were hand searched. Data were extracted from published reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I2), publication bias (Begg-Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval. RESULTS: Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19-3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I2 = 67% (36%-83%). CONCLUSIONS: The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.

Burnout, well­being, and self­reported medical errors among physicians.

INTRODUCTION: In recent years, healthcare systems around the world have been subject to profound changes driven by advances in technology, new regulations as well as demographic and societal trends. This volatile and stressful environment has had its consequences for healthcare organizations and their employees. The resulting phenomena of burnout or lowered well­being may affect key aspects of healthcare delivery on individual, organizational, and financial levels. OBJECTIVES: The objective of this paper was to investigate the level of burnout and well­being in a group of Polish physicians, its impact on errors, and associations with other factors. PATIENTS AND METHODS: This was a cross­sectional survey using a self­administered questionnaire with 65 questions and validated tools such as the Maslach Burnout Inventory and the World Health Organization-5 Well­being Index (WHO­5). Correlations between variables were investigated using Spearman rank correlation analysis. Univariable and multivariable logistic regression models were used to evaluate predictors of burnout and errors. The study included residents and physicians of various specialties. RESULTS: A total of 125 residents and physicians, mostly internists and cardiologists, participated in the study, out of which 84 (67%) were found to be burned out. The median WHO­5 score was 40 points. Two­thirds of all physicians admitted to making an error in the last 3 months, which was strongly  associated with burnout. CONCLUSIONS: The level of burnout among respondents was high and had numerous negative consequences that may affect the entire healthcare system. The results suggest there is an urgent need to address the problem of burnout among physicians.

Assessment of 3-T MRI using susceptibility-weighted imaging to detect and evaluate intra- or periarticular blood metabolites and meniscal tears of the knee.

PURPOSE: The purpose of this study was to assess the suitability of susceptibility-weighted imaging (SWI) sequences using the 3T MRI-unit for assessment of potential intraarticular pathologies in patients with acute and chronic torsion trauma of the knee joint. MATERIAL AND METHODS: Sixty-three patients with subacute and chronic rotary knee joint trauma of either the left or right knee were studied using an Achieva MRI 3T device (Philips, Amsterdam, Netherlands). Ground truth was set by two expert radiologists with seven and 10 years of experience in musculoskeletal imaging. Readings were performed separately for meniscus and joint space including synovia, ligaments, and periarticular soft tissue. Haemorrhage was defined as any lesion that was either T1 or SWI positive, without proton density (PD)-hypointensity (calcification). A lesion was defined as any pathology/variant with any signal positivity of either T1, PD, or SWI. RESULTS: A total of 63 patients were included (F : M = 22 : 41). The median age of the cohort was 29 years (range 13 to 71 years). Thirty-nine patients showed a meniscal tear, and only three of them (7.7%) demonstrated a meniscal haemorrhage. A total of 18 patients suffered from a periarticular injury, and 16 patients (88.9%) demonstrated a concomitant periarticular haemorrhage. CONCLUSIONS: These data suggest that SWI can be used for the diagnosis of intra- or periarticular blood metabolites because their potential have an impact on mechanical conflict with the surface of the knee joints, in particular the cartilage and their effect on malacic lesions, but it performs poorly in the detection of meniscal pathologies.

[Rocuronium vs atracurium vs suxamethonium for double-lumen endobronchial tube intubation]. / Ocena warunków intubacji dooskrzelowej przy uzyciu róznych srodków zwiotczajacych.

BACKGROUND: Intubation with a double lumen tube requires excellent and stable relaxation, necessary for accurate positioning of the device using a fibre optic scope. METHODS: We have compared conditions for endobronchial intubation after administration of 1 mg kg(-1) rocuronium (group E), 0.1 mg kg(-1) cis-atracurium (group N) and 1.5 mg kg(-1) suxamethonium (group P) in 70 randomly allocated adult patients, scheduled for elective lung surgery. Conditions for intubation were assessed using Mallampati, Cromack-Lehan and Krieg scores. RESULTS: The duration and conditions for intubation, and the onset of relaxation were comparable in all groups. Patients paralysed with suxamethonium required more frequent repositioning of double lumen tubes, compared to those paralysed with rocuronium and cis-atracurium. DISCUSSION: Although all drugs given in equipotent doses proved to be suitable for the planned procedure, we conclude that suxamethonium could easily be abandoned in routine anaesthesia for elective lung surgery.