What is the prevalence of burnout amongst first contact physiotherapists working within primary care?

Background

It has long been known general practitioners suffer with burnout. First contact physiotherapists (FCP's) are a new role to primary care. However, concerns have been raised around the longevity and sustainability of the role and the risk of clinician burnout.

Aims

To assess the prevalence of burnout amongst the FCP workforce.

Method

A self-reporting online questionnaire was developed and captured key demographical data and burnout scores amongst FCP's between February 2022 and March 2022. The burnout assessment tool (BAT12) was used to assess clinician burnout.

Results

A total of 332 responses were collected. Overall, 13% of clinicians were burnt out, and 16% at risk. The BAT12 also found 43% of the clinicians are exhausted and a further 35% are at risk of exhaustion. Non-clinical hours were significantly associated with burnout score. Clinicians who had more non-clinical time per month were the least burnt out. Increased non-clinical hours was significant in reducing burnout score.

Conclusions

This study found 13% of clinicians are suffering from burnout with a further 16% at risk. Worryingly 78% of clinicians are either exhausted or at risk of exhaustion. Non-clinical hours have a direct impact on burnout and every effort is needed by employers to increase non-clinical time. This study supports the release by the Chartered Society of Physiotherapy whereby they recommend sufficient time be allocated within job plans for appropriate supervision, training and continued professional development. Further research is needed to explore the association of non-clinical time and clinician burnout.     

What is the best sequence of treatment for patients with EGFR mutations?

The arrival of tyrosine kinase inhibitors (TKI) in first line of treatment for advanced non-small cell lung cancer with EGFR mutations has changed the strategy of treatment of theses patients. Indeed, response rates in these cases reach around 60 to 70%, with a progression-free survival greatly prolonged, up to 10 months. It seems that these patients with mutated tumor benefit from TKI whatever the treatment line, with the same efficacy. So, the best sequence of treatment (TKI in first line then chemotherapy in second line, or the opposite) needs still to be defined in this sub-group of NSCLC. The choice has to take in account the data of efficacy of TKIs and chemotherapy in the EGFR mutated tumors, with an anticipation of subsequent lines from the first line. Besides, data of toxicity and quality of life have also to be considered.     

What is the ideal study design for evaluation of treatment for heart failure?: Insights from trials assessing the effect of ACE inhibitors on exercise capacity

There is a wealth of evidence that angiotensin converting enzyme(ACE) inhibitors improve symptoms, morbidity and mortality inpatients with heart failure. In this context the use of ACEinhibitors could be considered a tool with which to assess theeffect of trial design and methodology on the ability to detectimprovement in symptoms and exercise performance. Thirty-five published, double-blind, randomized placebocontrolledtrials, involving a total of 3411 patients, which compared theeffect of ACE inhibitors and placebo on exercise capacity inpatients with symptomatic chronic heart failure were identified.Studies were examined in relation to whether they used cross-overor parallel group study design, study size, use of treadmillvs bicycle exercise test, year of publication, patient entrycriteria, duration of follow-up and the particular ACE inhibitorused. Exercise duration improved in 23 of the studies, while symptomsimproved in 25 of the 33 studies which evaluated this. In themajority of the trials (27 of 33) there was concordance betweenthe effect on symptoms and on exercise capacity. There weresix trials which showed discrepant results. Study size, durationof follow-up and method of exercise testing used were foundto be major factors affecting the outcome. Trials using treadmillexercise tests were more likely to be positive than those usingbicycle ergometry. All nine trials with study size more than50, follow-up of 3–6 months and using treadmill exercisetests showed improved exercise capacity as well as symptoms.These findings may be useful in designing future trials forevaluating treatment for heart failure.     

What is the clinical significance of bone loss in primary hyperparathyroidism?

To help determine the clinical significance of the bone loss associated with primary hyperparathyroidism, we studied the prevalence of vertebral fractures in a group of patients with this disorder. From a registry of parathyroidectomies, 206 cases were reviewed, and lateral chest roentgenograms were studied for the presence of fractures. All roentgenograms were interpreted by two of the investigators who were "blinded" to diagnoses. Comparisons of readings were made that assured interrater agreement. A group of patients who underwent cholecystectomy served as controls. Studied in a logistic regression analysis model, controlling for the effects of age, sex, and race, primary hyperparathyroidism was found to be significantly associated with vertebral fractures. Subgroup analyses performed on the patients with hyperparathyroidism failed to identify specific biochemical or clinical markers associated with fractures. Our results suggest that the bone loss of primary hyperparathyroidism is clinically significant, leading not only to decreased bone densities but also to an increased prevalence of fractures.     

What is the optimal approach for using a direct amplification test in the routine diagnosis of pulmonary tuberculosis? A preliminary assessment

OBJECTIVE: The aim of this study was to determine the most appropriate strategy for the rapid diagnosis of pulmonary tuberculosis (PTB) using a nucleic acid amplification (NAA) test. METHODOLOGY: This was a prospective study of 128 adult patients in whom respiratory secretions were tested for Mycobacterium tuberculosis by the AMPLICOR assay. The basis for starting PTB treatment was noted for each patient. The optimal approach was determined by using Bayes' theorem to compare different combinations of pretest probability, smear results with the AMPLICOR test. RESULTS: The incidence of PTB was 15.6%. In only one patient was treatment for PTB commenced because of a positive AMPLICOR result. The rest were managed according to the conventional approach which relied upon clinical judgment and direct smear. The optimal approach was to treat patients with high or intermediate pretest risk for PTB who returned positive AMPLICOR tests. The overall accuracies of the conventional approach, AMPLICOR test and optimal approach were 89.8, 95.3 and 96.1%, respectively. CONCLUSION: This small study suggests that NAA testing be limited to patients with high or intermediate pretest risk of PTB. In this group, positive results demand treatment while the management of those with negative results still relies on clinical judgment.     

What is the best long‐term management strategy for patients with primary adrenal insufficiency?

Primary adrenal insufficiency is treated with glucocorticoid and mineralocorticoid replacement therapy. Recent data revealed that health-related quality of life in adrenal insufficiency is impaired in many patients and that patients with adrenal insufficiency are also threatened by an increased mortality and morbidity. This may be caused by inadequate glucocortiocid therapy and adrenal crisis. Therefore, the optimization of hormone replacement therapy remains one of the most challenging tasks in endocrinology because it is largely based on clinical grounds because of the lack of objective assessment tools. This article provides answers to the important daily clinical questions, such as correct dose finding, dose adaptation in special situations, e g, pregnancy, improvement of quality of life and measures for protection from adrenal crisis. Other important aspects discussed are side effects of glucocortiocid replacement therapy and interactions with other drugs.     

What is the current role of endoscopy in primary sclerosing cholangitis?

Endoscopy has important roles in the management of primary sclerosing cholangitis (PSC), ranging from narrowing down the differential diagnoses, screening for complications, determining prognosis and therapy. While the need for a diagnostic endoscopic retrograde cholangiopancreatography (ERCP) may be obviated by a positive magnetic resonance cholangiopancreatography (MRCP), a negative MRCP does not exclude PSC and may therefore necessitate an ERCP, which is traditionally regarded as the gold standard. In this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveillance and treatment of portal hypertension complicating PSC.     

What is the Value of CT Angiography for Patients with Acute Chest Pain?

Coronary CT angiography (CCTA) is an innovative technique to visualize the coronary arteries in patients with suspected coronary artery disease. CCTA has been validated in patients with non acute symptoms. Because of its high negative predictive value in this population, some have advocated using it in patients admitted to the emergency department with chest pain to determine the presence of coronary artery disease and acute coronary syndrome (ACS). With current CCTA protocols, adequate evaluation of the coronary arteries is feasible using radiation doses similar to, and even lower than, those for single-photon emission CT, which is commonly used to stratify these patients. In addition to its unique capability of visualizing the coronary tree in a noninvasive fashion, CCTA evaluates extracardiac pathologic conditions, which are part of the differential diagnosis in patients with chest pain, such as pulmonary embolism and acute aortic syndrome. These conditions, although less common than ACS, are also life threatening and their timely diagnosis and treatment may have a positive impact on survival. Other less frequent conditions, such as coronary artery anomalies, also are easily detected with CCTA. Overall, CCTA has an excellent negative predictive value and sensitivity for ACS in patients presenting with chest pain and simultaneously can aid in the diagnoses of other relevant intrathoracic abnormalities.     

What is the definition of cure for aplastic anemia?

Treatment with immune suppression and bone marrow transplantation has improved the response rates and survival of patients with aplastic anemia. Measurement of response requires that common endpoints be recorded at specific times. There has been no agreement on such parameters for patients with aplastic anemia. In this paper issues related to measurement of response are reviewed and criteria for response are proposed. Adoption of uniform criteria would facilitate comparisons of treatment efficacy.     

Implantation of a drug delivery system during surgery for patients with primary hepatocarcinoma

BACKGROUND: Postoperative regional chemotherapy is one of the most effective methods to decrease the recurrent rate and improve the prognosis of primary hepatocarcinoma (PHC). This study was undertaken to assess the optimal pathway to implant the drug delivery system (DDS) in the different ways of resecting PHC so as to offer a valuable reference to clinical implantation of the DDS. METHODS: One hundred and ninety cases were divided into two groups according to whether the tumors were resected completely (A) or not (B). Groups A and B were subdivided into three groups a, b and c according to the pathway selected for DDS implantation. The patients in subgroup a received DDS implantation through both the hepatic artery and portal vein (A+P-implanted group), the patients in subgroup b received DDS implantation through the portal vein (P-implanted group), and the patients in subgroup c received DDS implantation through the hepatic artery (A-implanted group). RESULTS: The 1- and 3-year recurrent rates of subgroup c in group A were higher than those of subgroup b, and there was no significant difference between subgroups a and b. Compared with subgroups a and c, the 1- and 3-year survival rates of subgroup b were similar to those of group a but higher than those of group c. The 1- and 3-year survival rates between subgroups a and b in group B were significantly different. The prognosis of subgroup c was lower than that of subgroup a and no significant difference was observed between subgroups b and c. CONCLUSIONS: The DDS should be implanted into the portal vein when PHC is resected completely. It may be better to implant it into both portal vein and hepatic artery if the tumor cannot be completely resected.