Ohio Valley Medical Center

About: Ohio Valley Medical Center is a healthcare organization based out in Wheeling, West Virginia, United States. It is known for research contribution in the topics: Emergency department & Vasculitis. The organization has 50 authors who have published 40 publications receiving 646 citations.

Factors Associated With Burnout During Emergency Medicine Residency

Abstract: Objectives While the prevalence of burnout in practicing emergency physicians has been studied, little is known of the prevalence and risk factors in emergency medicine (EM) residents. The aim of this study was to assess the prevalence of burnout among EM residents and the individual-level factors associated with burnout. Methods Eight EM residency programs were surveyed using the Maslach Burnout Inventory (MBI). Demographic data and data on job satisfaction and tolerance of uncertainty in clinical decision-making were collected using validated instruments. Results Of 289 eligible residents, 218 completed the MBI (response rate = 75%). A total of 142 residents (65%) met the criteria for burnout. Complete data sets of the other instruments were obtained from 193 (response rate = 67%), and this group comprised our study population. Subjects having a significant other or spouse had a higher prevalence of burnout compared to single residents (60% vs. 40%, p = 0.002). Poor global job satisfaction (p < 0.0001), lack of administrative autonomy (p = 0.021), and lack of clinical autonomy (p = 0.031) correlated with burnout, as did intolerance of uncertainty (p = 0.015). Conclusions Burnout is highly prevalent in EM residents. Interventions should be targeted at 1) improving resident autonomy in the emergency department where possible, 2) supervision and instruction on medical decision-making that may affect or teach individuals to cope with risk tolerance, and 3) social supports to reduce work–home conflicts during training. Resumen Objetivos La prevalencia del sindrome del desgate profesional (SDP, burnout) en la practica de los urgenciologos ha sido estudiada, pero se conoce poco la prevalencia y los factores de riesgo en los residentes de Medicina de Urgencias y Emergencias (MUE). El objetivo de este estudio fue valorar la prevalencia del SDP entre los residentes de MUE y los factores individuales asociados. Metodologia Se realizo una encuesta a 8 residencias de MUE mediante el Maslach Burnout Inventory (MBI). Se recogieron datos demograficos y de satisfaccion en el trabajo y tolerancia de la incertidumbre en la toma de decisiones clinicas usando instrumentos validados. Resultados De los 289 residentes elegibles, 218 completaron el MBI (porcentaje de respuesta de un 75%). Ciento cuarenta y dos residentes (65%) cumplieron los criterios de SDP. Se obtuvieron datos completos de otros instrumentos en 193 (porcentaje de respuesta de un 67%), y este grupo fue la poblacion a estudio. Los sujetos que tenian esposo, esposa o pareja tuvieron una mayor prevalencia de sindrome de desgaste profesional en comparacion) con los residentes solteros (60% vs 40%, p = 0,002). La satisfaccion global laboral pobre (p < 0,0001), la falta de autonomia administrativa (p = 0,021) y de autonomia clinica (p = 0,031) se correlacionaron con el SDPy asi como la intolerancia con la incertidumbre (p = 0,015). Conclusiones El SDP es muy prevalente en los residentes de MUE. Las intervenciones deberian ser dirigidas a: 1) mejorar la autonomia del residente en el servicio de urgencias donde sea posible, 2) la supervision y la instruccion en la toma de decisiones medicas que puedan impactar o formar a los sujetos para afrontar la tolerancia del riesgo y, 3) el soporte social para reducir los conflictos entre el mundo familiar y laboral durante la formacion.

Candida endophthalmitis: focus on current and future antifungal treatment options.

Abstract: Candida endophthalmitis is a sight-threatening manifestation of disseminated candidiasis. The occurrence of endogenous candida endophthalmitis in patients with candidemia has ranged from 0-45% in the published literature. In critically ill patients, it has even been associated with increased mortality. In recent years, use of newer antifungal therapies for invasive candidiasis has increased given the rise in infections with non-albicans species of Candida. To identify current practices of the management of endogenous candida endophthalmitis and relevant antifungal drug research in this disease state, we conducted a MEDLINE search (1967-2006) and bibliographic search of the English-language literature. Treatments for candida endophthalmitis have not been evaluated through well-designed, well-powered clinical trials. Data have mainly been presented in case reports, case series, animal studies, pharmacokinetic studies, and as small subsets of larger trials. Traditional systemic therapies have been amphotericin B with or without flucytosine or fluconazole. Cure rates with antifungal drugs alone appear to be much higher in patients with chorioretinitis than in endophthalmitis with vitreal involvement. Pars plana vitrectomy with or without intravitreal amphotericin B injections has been advocated particularly for patients with moderate-to-severe vitritis and substantial vision loss. Information on new antifungal agents for endophthalmitis is limited, despite increasing use in patients with candidemia. Voriconazole may be a particularly attractive agent to consider for infections with fluconazole-resistant, voriconazole-susceptible strains. The current patchwork of animal studies and small patient reports provide clinicians with some insight into the role of newer agents in the treatment of candida endophthalmitis. In general, it appears that chorioretinitis infections can be more readily cured with most systemic antifungal agents, whereas more aggressive treatment, often including vitrectomy with or without intra-vitreal antifungal administration, is needed for patients with endophthalmitis with vitritis.