Occupational burnout, job satisfaction and anxiety among emergency medicine doctors in Turkey.

OBJECTIVE: The objective of the study was to investigate possible differences in the levels of anxiety, burnout and job satisfaction among emergency medicine doctors based on their age, gender, employment duration, job title and institution. METHODS: General practitioners, residents, specialists and faculty members working in emergency departments (ED) in Turkey were invited to participate in this questionnaire-based study through an e-mail link between September 2018 and January 2019. A total of 141 doctors from different cities of Turkey who completely filled the questionnaire with their own will were recruited for the study. The Maslach Burnout Inventory(MBI) was used to measure occupational burnout levels, the State-Trait Anxiety Inventory(STAI) to measure anxiety levels and the Short Form Minnesota Satisfaction Questionnaire(SFMSQ) to measure job satisfaction levels of doctors working in EDs. In assessing MBI; Emotional Exhaustion score(EE) is considered low for 0-11 points, moderate for 12-17 points and high >17 points; Depersonalization score is considered low for 0-5 points, moderate for 6-9 points and high ≥ 10 points; , Feeling of low personal accomplishment(PA) is considered low for 0-21 points, moderate for 22- 25 points and high ≥ 26 points. In Assessing STAI; 20- 49 points were considered low/ moderate anxiety and 50- 80 points considered high/ very high anxiety. In assessing SFMSQ neutral job satisfaction point was reported 3; so individuals are considered extremely dissatisfied/ not satisfied (low) if job satisfaction point <3 and very/ extremely satisfied (high) if job satisfaction point >3. RESULTS: The mean age of the study group was 33.3 (±7.3) and mean employment duration was 8.37 (±6.89). In the overall study population, the emotional exhaustion(EE) was high while depersonalization(DP) and reduction of personal accomplishment(PA) were detected at medium level in the evaluation of MBI subscales. In evaluating overall study population for STAI, state and trait anxiety scores both showed the presence of mild to moderate anxiety. The overall study population evaluation results for SFMSQ were, high levels of general and intrinsic job satisfaction and low levels of extrinsic job satisfaction was measured. Younger the age and shorter the duration of employment is found to be associated with a significant increase in EE and DP and a significant decrease in PA. CONCLUSION: In this study, scale results showed that doctors working in EDs had high levels of occupational burnout and anxiety, while job satisfaction levels were low. In addition, a significant relationship was found between the decrease in "age and employment duration" and the increase in "depersonalization".

Comparison of intravascular access methods applied by nurses wearing personal protective equipment in simulated COVID-19 resuscitation: A randomized crossover simulation trial.

BACKGROUND: Prehospital emergency care of children is challenging. In the era of the COVID-19 pandemic, when medical personnel should use personal protective equipment against aerosol-generating procedures, the efficiency of medical procedures may decrease. The study objective was to evaluate the effectiveness of different intravascular access methods applied by nurses wearing biosafety Level-2 suits in simulated paediatric COVID-19 resuscitation. METHODS: A prospective, randomized, crossover, single-blinded simulation trial was performed. Nursing staff attending Advanced Cardiovascular Life Support courses accredited by the American Heart Association participated in the study. A total of 65 nurses were recruited and randomly assigned to different study groups. They received standard training on intravascular access methods employing distinct devices. The participants wore biosafety Level-2 suits and performed vascular access with the following intraosseous devices: NIO-P, EZ-IO, and Jamshidi needle; intravenous (IV) access was used as a reference method. Both the order of participants and the access methods were random. Each participant performed intravascular access with each of the four methods tested. The effectiveness of the first attempt to obtain intravascular access and the following time parameters were analysed: the time between grasping the intravascular device out of the original packing until infusion line connection. The ease of the procedure was measured with a visual analogue scale (1 - easy; 10 - difficult). RESULTS: The first attempt success rate of intravascular access by using NIO-P and EZ-IO equalled 100% and was statistically significantly higher than that with the Jamshidi needle (80.0%; p = 0.02) and with the IV method (69.2%; p = 0.005). The time required to connect the infusion line varied and amounted to 33 ± 4 s for NIO-P compared to 37 ± 6.7 s for EZ-IO (p<0.001), 43 ± 7 s for Jamshidi (p<0.001), and 98.5 ± 10 s for IV access (p<0.001). The procedure was easiest in the case of NIO-P and EZ-IO (2 ± 1 points; p=1.0) compared with Jamshidi (5 ± 3 points; p<0.001) and IV access (7 ± 2 points; p<0.001). CONCLUSION: The study provides evidence that nurses wearing biosafety Level-2 suits were able to obtain intraosseous access faster and more effectively as compared with IV access during simulated COVID-19 paediatric resuscitation. The most effective method of intravascular access was the NIO-P intraosseous device. Further clinical trials are necessary to confirm the results.

Is There a Difference Between the Readabilities of Informed Consent Forms Used for Elective and Emergency Procedures in Turkey?

BACKGROUND: Informed consent is an important aspect of ethical medical practice. In legal terms, making an intervention without informed consent may mean negligence or malpractice and may lead to legal action, maltreatment, and even attack against the doctor. This study aims to evaluate the readability of informed consent forms (ICFs) used for elective (urology and general surgery) and emergency procedures (emergency medicine and intensive care) by comparing through readability formulas. METHOD: Elective and emergency ICFs were accessed through the web sites of national health care associations. A total of 387 consent forms were evaluated and the same forms were included only once. A total of 35 consent forms were evaluated for emergency procedures, while a total of 55 consent forms were evaluated for elective procedures. Atesman and Bezirci-Yilmaz formulas defined for determining the readability level of Turkish texts and Gunning fog and Flesch Kincaid formulas measuring the general readability level were used for calculating the readability level of consent forms. RESULTS: Even though elective ICFs are more readable compared to those of emergency procedures according to Bezirci-Yilmaz formulas, this was statistically insignificant ([Formula: see text]). The readability of elective consent forms was found to be at a significantly more difficult level to read compared to Atesman, Gunning fog, and Flesch Kincaid formulas ([Formula: see text], [Formula: see text], [Formula: see text], respectively). CONCLUSION: Even though the procedure is emergency or elective, a difficult readability level may cause problems for the doctor in legal phases. Readable and understandable consent forms should be available to be able to explain morbidity and mortality and improve prognosis. Education level of our country should also be considered while preparing these consent forms.

New treatment modalities with vaccine therapy in renal cell carcinoma.

The aim of implementing vaccine therapy is to activate immune response against malignant cells by overcoming the tolerance triggered by the tumor. These treatments are effective using the immune response against cancer. Not every type of cancer is suitable for vaccine therapies. For a vaccine therapy to be implemented, cancer should be immunogenic and contain tissue-specific proteins, should have a slow progression, and treatments should be feasible. For that reason, studies regarding urological cancers are mostly focused on the kidneys and the prostate. Vaccine therapies used in renal cell carcinoma (RCC) can be categorized under the following titles: autologous tumor cells, dendritic cells, genetically modified tumor cells, and protein/peptide. Although there are old studies on the implementation of vaccine therapies in RCC, researches have only been intensified recently. In addition to their effective potential for lengthening general survival, decreasing tumor burden and cancer development in long term, vaccine treatments are especially effective in metastatic RCC patients. We think that vaccine treatments would be applied more in near future since RCC are immunogenic. In this compilation, we will discuss vaccine therapies used in RCC, which urologists are not so familiar with, in the light of the up-to-date literature.

Ischemic priapism: Can eosinophil count and platelet functions be positive predictive factors in etiopathogenesis.

INTRODUCTION: We evaluated the relation between ischemic priapism (IP) and blood count parameters in IP patients. We especially wanted to examine the contribution of eosinophil count (EC), platelet count (PC), and mean platelet volume (MPV) values, which are suspected predictive parameters for vascular endothelium damage and venoocclusive pathogenesis and etiopathogenesis, particularly in IP. METHODS: A total of 40 IP patients fulfilled the study criteria. Forty healthy volunteers in a similar age group were included as the control group. Complete blood count values were compared between the two groups. Intergroup comparisons were performed using the Mann-Whitney U test, and the chi-square test was used to assess the relationship between categorical variables in the patient groups. The area under the curve was calculated by receiver operating characteristic (ROC) regression analyses. Epidemiological diagnosis percentages were calculated by finding cutoff values. RESULTS: The IP group's high MPV, PC, and EC values compared to those of the control group were detected to be statistically significant (p<0.001, p=0,03, p=0.001, respectively). No statistically significant difference was observed between the two groups for other blood count parameters. Statistically significant values for IP were measured as MPV: positive predictive value: 84%; EC: positive predictive value: 71.4%; and PC: positive predictive value: 61.4%. CONCLUSIONS: High MPV, PC, and EC values are significant positive predictive factors in IP etiopathogenesis. No proof was detected for other blood count parameters playing an active role in IP etiopathogenesis.

Can Eosinophil Count, Platelet Count, and Mean Platelet Volume Be a Positive Predictive Factor in Penile Arteriogenic Erectile Dysfunction Etiopathogenesis?

Blood count parameters of patients referring with erectile dysfunction (ED) were examined in this study and it was investigated whether eosinophil count (EC), platelet count (PC), and mean platelet volume values among the suspected predictive parameters which may play a role in especially penile arteriogenic ED etiopathogenesis had a contribution on pathogenesis. Patients referring with ED complaint were evaluated. Depending on the medical story, ED degree was determined by measuring International Index of Erectile Function. Penile Doppler ultrasonography was taken in patients suspected to have vasculogenic ED. According to penile Doppler ultrasonography result, patients with arterial deficiency were included in the penile arteriogenic ED group and the patients with normal results were included in the nonvasculogenic ED group. A total of 36 patients participated in the study from the penile arteriogenic ED group and 32 patients from the nonvasculogenic ED group. Compared with the nonvasculogenic ED group, the penile arteriogenic ED group's low International Index of Erectile Function score, high EC, mean platelet volume and PC values were detected to be statistically significant ( p < .001, p = .021, p = .018, p = .034, respectively). No statistically significant difference was observed among the two groups when age, white blood cells, red blood cells, and hemoglobin values were considered. Pansystolic volume velocities were detected as statistically significantly low compared with the nonvasculogenic ED group in the measurements made in 5th, 10th, 15th, and 20th minutes on the right and left sides in the penile arteriogenic ED group. High MPV value and PC is a significant predictive factor for penile arteriogenic ED and vasculogenic ED and high EC is specifically predictive of arteriogenic ED.