Long hours and other issues in the healthcare workplace are contributing to burnout
During the COVID-19 pandemic, hospital employee turnover increased to 19.5%. Compare that to labor turnover of about 4% in the general U.S. workforce. Burnout is a major factor driving the increased turnover rate and a dire issue affecting physicians more than ever.
Before the pandemic, 27% of U.S. physicians stated that they felt burned out. In 2022, nearly double (45%) the rate of physicians said they have personally experienced burnout in the last 2 years. These percentages are variable depending on location in the country and specialty; however, these trends are headed in the wrong direction. The next frontier must be addressing the organizational and systemic drivers of burnout.
What Is Burnout?
The American Medical Association defines burnout as: "A long-term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement, and a lack of empathy for patients." For someone who goes to school for at least a decade after high school to even qualify to practice medicine independently, this definition seems to be the opposite of what a physician should be and feel.
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They're systemic problems, not individual
Medical mistakes are as old as the practice of medicine itself, but it wasn't until 1999 that the United States started paying more attention to them.
Over 20 years later, we may be reducing medical errors -- a recent study published in JAMA found significant decreases in mistakes in cases of pneumonia, acute myocardial infarction, heart failure, and surgery between 2010 and 2019 -- but the way we're reacting to people who disclose them is worrying. That is, we treat those who report them more harshly than those who cover them up.
Recently, the West Los Angeles VA Medical Center reinstated Dr. Robert Cameron as chief of thoracic surgery; Dr. Cameron reported concerns about anesthesia care in two near-death cases he was involved with. Subsequently, the medical center forced him to retire early. That was back in 2018. It took nearly 4 years to restore him to a position he lost because of his honesty.
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Move signals new urgency as cases rise
The Biden administration declared a public health emergency (PHE) for monkeypox, signaling new urgency as cases rise in the U.S.
Since the first case was identified in the U.S. in May, the total number of cases has risen to 6,617, according to the latest data from the CDC. It's a sharp increase from less than 5,000 last week.
"We're prepared to take our response to the next level in addressing this virus, and we urge every American to take monkeypox seriously and to take responsibility to help us tackle this virus," HHS Secretary Xavier Becerra said in a press briefing Thursday afternoon.
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An international team of scientists identified a new virus that was likely to have been transmitted to humans after it first infected animals, in another potential zoonotic spillover less than three years into the coronavirus pandemic.
A peer-reviewed study published in the New England Journal of Medicine detailed the discovery of the Langya virus after it was observed in 35 patient samples collected in two eastern Chinese provinces. The researchers — based in China, Singapore and Australia — did not find evidence that the virus transmitted between people, citing in part the small sample size available. But they hypothesized that shrews, small mammals that subsist on insects, could have hosted the virus before it infected humans.
The first Langya virus sample was detected in late 2018 from a farmer in Shandong province who sought treatment for a fever. Over a roughly two-year period, 34 other people were found to have been infected in Shandong and neighboring Henan, with the vast majority being farmers.
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NEXT EXAM DATES:
Part I
August 27, September 17,
October 22, November 19 & December 17
Part II
September 23
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Broader representation can help address health disparities and improve patient outcomes
The COVID-19 pandemic sparked rapid innovation and adoption of new methodologies and practices across clinical trials. It also allowed the world to see the difficulty of ensuring diversity and access to those trials -- a challenge we've faced for many years. Innovators in biopharma, life-science technology companies, and clinical research organizations (CROs) partnered with the FDA and health regulators around the world to successfully meet this enormous challenge. But we need to keep our foot on the gas.
It's time to press ahead with meaningful, durable change -- to codify the lessons we've learned during the COVID pandemic, amplify what worked, and harmonize the regulatory environment to promote further progress.
We're at a critical inflection point to continue ensuring that trials are designed for the correct population. Regulators have established stronger guidelines around the importance of clinical trial diversity and access -- including the FDA, whose window for public comments recently closed on draft guidance to this effect. This guidance comes at an important moment. The pandemic illuminated the disparate health outcomes faced by marginalized communities, while also spawning major strides in patient diversity for clinical trials, a development that benefits both patients and research efficacy.
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Misinformation promoted by Texas lawmaker in 2021 pops up again on Twitter
False claims that COVID-19 vaccine trials were halted when animals died in preclinical studies are making the rounds on social media again, according to reports.
The misinformation gained traction in 2021 after Sen. Bob Hall (R-Texas) claimed at a hearing that the "American people are now guinea pigs." A 1-minute clip of his remarks was recently re-upped on Twitter, including the false claim that early-phase studies for COVID vaccines were stopped due to safety issues.
"What I have read, they actually started the animal tests and because the animals were dying, they stopped the tests," Hall claimed in 2021, according to Associated Press (AP). "They didn't do the human testing and they stopped the animal tests because the animals were dying, and then they turned it out for the public," Hall said.
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If the trial succeeds, the vaccine could be the first human vaccine for the tick-borne illness in the U.S. in 2 decades. One other vaccine – LYMErix – was used in the past but was discontinued in 2002.
"With increasing global rates of Lyme disease, providing a new option for people to help protect themselves from the disease is more important than ever," Annaliesa Anderson, PhD, Pfizer's senior vice president and head of vaccine research and development, said in the statement.
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Please plan to join us at the
2023 ASIPP Annual Meeting
March 16-18 National Harbor, Maryland
Register Early
More details will be posted on our website at asipp.org.
Registration begins November 2022.
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For meeting or exhibitor/sponsor information:
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.
Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.
Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.
For more information or to submit your articles, click here.
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| CASE REPORT |
Rudy Lukman, MD, Alif Noeriyanto Rahman, MD, and Herry Herman, MD, PhD
Abstract
BACKGROUND: The elbow is the conduit of upper extremity actions, delivered through the shoulders to the hand. Elbow problems greatly affect daily function and quality of life of the sufferers. Here we report the use of prolotherapy as an adjunct to physiotherapy to provide a speedy range of motion (ROM) recovery in an army officer affected by neglected old unreduced elbow dislocation, which was reduced with an open reduction surgery and internal fixation of his elbow. The patient provided HIPAA compliant consent for the inclusion of their clinical information in this report.
METHODS: We used the Hackett-Hemwall technique as described in the literature. A total of 15 mL solution of 5% dextrose and 0.2% lidocaine is injected in the lateral epicondyle humerus and extensor carpi radialis brevis tendon proximally, also tender areas around the elbow about 0.5 mL to 1 mL per injection.
RESULTS: Eight sessions of prolotherapy were administered; 2 months after the last session, ROM of the elbow was 500 to 1350 and the Visual Analog Scale score decreased from 7 to 1. Patient was satisfied with the result.
CONCLUSIONS: Treating postoperative stiffness is one of the utmost precautions for postsurgical management. Particularly for chronic elbow dislocation, prevention of stiffness needs to be more progressive to treat the condition. Our case presented one alternative management where prolotherapy may provide a satisfactory outcome for pain and assist to speed recovery in a subacute surgical patient.
KEY WORDS: Prolotherapy, post operative elbow stiffness, old unreduced elbow dislocation, case report
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| NARRATIVE REVIEW |
Benjamin Gill, DO, David S. Cheng, MD, Patrick Buchanan, MD, and David W. Lee, MD
Abstract
BACKGROUND: The most common presentation of cluneal neuropathy is ipsilateral low back and gluteal pain. Cluneal neuralgia has been described historically in surgical contexts, with much of the description and treatment related to entrapment and decompression, respectively. Treatment options for addressing axial low back pain have evolved with advancements in the field of interventional pain medicine, though clinical results remain inconsistent. Recent attention has turned toward peripheral nerve stimulation. Nonsurgical interventions targeting the superior and medial cluneal nerve branches have been performed in cases of low back and buttock pain, but there is no known review of the resulting evidence to support these practices.
OBJECTIVES: In this manuscript we provide a robust exploration and analysis of the available literature regarding treatment options for cluneal neuropathy. We provide clinical manifestations and recommendations for future study direction.
STUDY DESIGN: Narrative review.
METHODS: This was a systematic, evidence-based narrative, performed after extensive review of the literature to identify all manuscripts associated with interventional treatment of the superior and medial cluneal nerves.
RESULTS: Eleven manuscripts fulfilled inclusion criteria. Interventional treatment of the superior and middle cluneal nerves includes blockade with corticosteroid, alcohol neurolysis, peripheral nerve stimulation, radiofrequency neurotomy, and surgical decompression.
LIMITATIONS: The supportive evidence for interventions in cluneal neuropathy is largely lacking due to small, uncontrolled, observational studies with multiple confounding factors. There is no standardized definition of cluneal neuropathy.
CONCLUSION: Limited studies promote beneficial effects from interventions intended to target cluneal neuropathy. Despite increased emphasis and treatment options for this condition, there is little consensus on the diagnostic criteria, endpoints, and measures of therapeutics, or procedural techniques for blocks, radiofrequency, and neuromodulation. It is imperative to delineate pathology associated with the cluneal nerves and perform rigorous analysis of associated treatment options.
KEY WORDS: Cluneal neuropathy, superior cluneal nerves, medial cluneal nerves, peripheral nerve stimulation, low back pain
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| RANDOMIZED CONTROLLED TRIAL |
Sameh Abdelhalik Ahmed, MD, Amr Ahmed Magdy, MD, Mohammad Ali Abdullah, MD, and Amr Arafa Albadry, MD
Abstract
BACKGROUND: The best tool for management of postherpetic neuralgia (PHN) is a matter of debate. The use of ultrasound-guided erector spinae plane block (ESPB) in patients with PHN may decrease pain severity and the need for analgesics.
OBJECTIVES: The objective of this clinical study was to test the efficacy of ESPB with and without the addition of magnesium sulphate on pain control and analgesic consumption in patients with PHN.
STUDY DESIGN: Randomized controlled double-blinded trial.
SETTING: A single university center.
METHODS: A total of 75 patients with PHN were included in the study. Patients were randomly divided into 3 equal groups. Group A received sham ESPB (2 mL normal saline), Group B received ESPB with 20 mL of bupivacaine (0.25%), and Group C received ESPB with 20 mL of bupivacaine (0.25%) and 100 mg magnesium sulphate. All patients received standard medical care. The pain score, the consumption of pregabalin and acetaminophen, the incidence of complications, and the patient’s satisfaction were measured and recorded.
RESULTS: In comparison to the control group, the use of real ESPB with or without the addition of magnesium significantly decreased the Numeric Rating Scale score for pain during the first week of follow-up (P < 0.05); decreased the mean daily consumption of pregabalin and acetaminophen from the third to the twelfth week of follow-up (P < 0.05); and increased the level of patients’ satisfaction (P = 0.03). The addition of magnesium sulphate showed an insignificant difference in comparison to the use of bupivacaine alone in ESPB (P < 0.05).
LIMITATIONS: The study was limited by being a singlecenter study, using a single-level injection, and using a single volume of local anesthetic mixture.
CONCLUSION: ESPB with or without adding magnesium sulphate is an effective pain management tool for cases of PHN. It leads to a significant decrease in pain score and analgesic requirements.
KEY WORDS: Post-herpetic neuralgia, erector spinae plane, thoracic, lumbar, magnesium, pain score, pregabalin, paracetamol
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Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Norcal Mutual is A-Rated by AM best and is licensed in all 50 states. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary award-winning risk management CME activities, click here.
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ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.
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ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.
We have received a tremendous amount of interest in the ASIPP® billing and coding program.
Click here to learn more about the negotiated rate for practices and more!
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up-to-date news related to you, your practice, and your patients!
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