Introduction:Burnout is a widely known phenomenon. It is defined as a state of prolonged physical and psychological exhaustion and is experienced virtually by every medical student due to the highly demanding nature of medical education. This study probes into the prevalence and psychosocial determinants of burnout in Pakistani medical students.Methods:A descriptive, cross-sectional study design and convenience (non-probability) sampling technique were employed in undergraduate medical students from years 1-5. A total of 777 medical students from two medical colleges were included in the study from May-August, 2014. An English version of the Copenhagen Burnout Inventory (CBI) and a series of demographic questions, intermixed with questions from other topics, were included in the questionnaire. Data was analysed by using SPSS ver.21.Results:The majority of students were females and enrolled in the third year of MBBS. Of the medical students involved, 30.6% were found to have high/very high levels of burnout (Kristenson’s burnout scoring). Although 38.7% of students said that they did not feel burned out after reading the definition of burnout given in the questionnaire, 35.9% out of these students actually had high levels of burnout according to CBI. According to the multiple regression analysis, burnout in medical students was significantly associated with age, gender, doctor parents, no help or no supportive resources (e.g., from colleagues), lack of time off, lack of belief in what you do, fear of big consequences of failure, family responsibilities, and uncertain future. Perception of teachers lacking leadership skills and doing too much study with little balance was associated with low burnout scores.Conclusion:There is a high prevalence of burnout in Pakistani medical students. The present study identifies several factors associated with burnout in Pakistani medical students. Although these factors are a part of daily life of medical students, their identification should prompt the use of effective coping strategies and skills, thus, minimising their burnout levels.
IntroductionBurnout is defined as a prolonged state of physical and psychological exhaustion. Doctors, due to the demanding nature of their job, are susceptible to facing burnout, which has far reaching implications on their productivity and motivation. It affects the quality of care they provide to patients, thus eroding the doctor–patient relationship which embodies patient centeredness and autonomy. The study aims at addressing the stressors leading to burnout and its effect on the doctor–patient relationship.MethodsA descriptive, cross-sectional study design with convenience (non-probability) sampling technique was employed in six major hospitals of Lahore, Pakistan. A total of 600 doctors were approached for the study which included house officers or “HOs” (recent graduates doing their 1 year long internship) and post-graduate trainees or “PGRs” (residents for 4–5 years in their specialties). Burnout was measured using the Copenhagen Burnout Inventor (CBI) while attitudes towards the doctor–patient relationship was measured using the Patient Practitioner Orientation Scale (PPOS), which measures two components of the relationship: power sharing and patient caring. Pearson correlation and linear regression analysis were used to analyze the data via SPSS v.21.ResultsA total of 515 doctors consented to take part in the study (response rate 85.83%). The final sample consisted of 487 doctors. The burnout score was not associated with the total and caring domain scores of PPOS (P > 0.05). However, it was associated with the power sharing sub-scale of PPOS. Multiple linear regression analysis yielded a significant model, by virtue of which CBI scores were positively associated with factors such as female gender, feeling of burn out, scoring high on sharing domain of PPOS and a lack of personal control while CBI scores were negatively associated with private medical college education, having a significant other, accommodation away from home and a sense of never ending competition. Burnout levels varied significantly between house officers and post graduate trainees. Twenty-three percent of the participants (mostly house officers) had high/very high burnout levels on the CBI (Kristenson’s burnout scoring). Both groups showed significant differences with respect to working hours, smoking status and income.ConclusionAlthough burnout showed no significant association with total and caring domain scores of PPOS (scale used to assess doctor–patient relationship), it showed a significant association with the power sharing domain of PPOS suggesting some impact on the overall delivery of patient care. Thus, it necessitates the monitoring of stressors in order to provide an atmosphere where patient autonomy can be practiced.
Patients requiring immunosuppressive therapy after transplantation are susceptible to infection by a variety of common and uncommon pathogens, and infection has been the major cause of death in organ transplant recipients. Here we present one of a kind case where klebsiella pneumonia led to a fatal and life threatening complication i.e. gastro pulmonary fistula in a renal transplant recipient.
Background Radioactive iodine-131 (RAI) therapy is used to treat hyperthyroidism secondary to toxic multinodular goiter (TMNG) and Graves’ Disease (GD). The treatment failure (TF) rate for RAI as reported in previous studies is 8-16% (1). Most patients respond to RAI with normalization of thyroid function tests and improvement of clinical symptoms within 4–8 weeks. Previous studies also report higher TF rates amongst Black patients (2), but due to the low number of Blacks included in the study, identification of factors related to higher TF rates was difficult. Study Purpose Determine treatment failure rates in patients who underwent RAI treatment for hyperthyroidism and characteristics related to Treatment Failure. Methods This is a retrospective study that included patients treated with RAI for either TMNG or GD from 2014-2021 at an urban hospital. Patients with thyroid cancer, less than 18 years, or toxic adenoma were excluded. TF was defined as persistent hyperthyroidism 6 months after RAI. Remission was defined as euthyroid or hypothyroid state off of anti-thyroid hormones 6 months after RAI. Factors evaluated included age at RAI, gender, race, cause of hyperthyroidism, percentage uptake in pretreatment scan, peak Ft4 / Ft3 pre-treatment, RAI dose, and treatment with methimazole post RAI. Comparison of TF to those who achieved remission was performed using two-sample t-test or the Wilcoxon rank-sum test for continuous variables and fisher tests for categorical variables. Results 66 patients were included in the analysis. Mean age was 49 years, majority female (76%), African (21%), African American (45%), GD (68%), TMNG (32%). 19 had TF (28.7%). There was no significant difference in characteristics between TF and remission groups prior to RAI. The RAI dose was not significantly different between the groups (21. 0;21.1mCi). However, patients given methimazole shortly after RAI were at significantly higher risk of TF compared to patients who did not receive methimazole after RAI (64% vs 89%, p=0. 04). Conclusion Previous studies report TF after RAI as high as 16%. Patients at our Hospital with TMNG or GD who underwent RAI had a higher TF rate of 28.7%. The high TF rate was not due to low RAI treatment dose. Randomized Controlled Trials have found 61%-86% (1) success with RAI dose ranging from 5.4 -15.7 mCi (1). In comparison, mean RAI dose at our hospital was high at 21. 0. Patients prescribed methimazole within 4 weeks of RAI were more likely to have TF at 6 months. Based on the results of this study, we will initiate a change in protocol at our institution to hold methimazole for at least 4 weeks after RAI to see if this lowers the TF rates. References 1. Ross, Douglas S., et al. Thyroid 26.10 (2016): 1343–1421. 2. Mohamadien, N. R., & Sayed, M. H. (2020). American Journal of Nuclear Medicine and Molecular Imaging,10(5), 235. Presentation: No date and time listed
Background Radioactive iodine-131 (RAI) therapy is used to treat hyperthyroidism secondary to toxic multinodular goiter (TMNG) and Graves’ Disease (GD). The treatment failure (TF) rate for RAI as reported in previous studies is 8-16% (1). Most patients respond to RAI with normalization of thyroid function tests and improvement of clinical symptoms within 4–8weeks. Previous studies also report higher TF rates amongst Black patients (2), but due to the low number of Blacks included in the study, identification of factors related to higher TF rates was difficult. Study Purpose: Determine treatment failure rates in patients who underwent RAI treatment for hyperthyroidism and characteristics related to Treatment Failure. Methods This is a retrospective study that included patients treated with RAI for either TMNG or GD from 2014-2021 at an urban hospital. Patients with thyroid cancer, less than 18 years, or toxic adenoma were excluded. TF was defined as persistent hyperthyroidism 6 months after RAI. Remission was defined as euthyroid or hypothyroid state off of anti-thyroid hormones 6 months after RAI. Factors evaluated included age at RAI, gender, race, cause of hyperthyroidism, percentage uptake in pretreatment scan, peak Ft4 / Ft3 pre-treatment, RAI dose, and treatment with methimazole post RAI. Comparison of TF to those who achieved remission was performed using two-sample t-test or the Wilcoxon rank-sum test for continuous variables and fisher tests for categorical variables. Results 66 patients were included in the analysis. Mean age was 49 years, majority female (76%), African (21%), African American (45%), GD (68%), TMNG (32%). 19 had TF (28.7%). There was no significant difference in characteristics between TF andremission groups prior to RAI. The RAI dose was not significantly different between the groups (21. 0;21.1mCi). However, patients given methimazole shortly after RAI were at significantly higher risk of TF compared to patients who did not receive methimazole after RAI (64% vs 89%, p=0. 04). Conclusion Previous studies report TF after RAI as high as 16%. Patients at our Hospital with TMNG or GD who underwent RAI had a higher TF rate of 28.7%. The high TF rate was not due to low RAI treatment dose. Randomized Controlled Trials have found 61%-86%(1) success with RAI dose ranging from 5.4 -15.7 mCi (1). In comparison, mean RAI dose at our hospital was high at 21. 0. Patients prescribed methimazole within 4 weeks of RAI were more likely to have TF at 6 months. Based on the results of this study, we will initiate a change in protocol at our institution to hold methimazole for at least 4 weeks after RAI to see if this lowers the TF rates. References: 1. Ross, Douglas S., et al." Thyroid 26.10 (2016): 1343-1421.2. Mohamadien, N. R., & Sayed, M. H. (2020). American Journal of NuclearMedicine and Molecular Imaging,10(5), 235. Presentation: No date and time listed
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