Search Results (89)

Background/Objectives: Ecological momentary assessment (EMA) is a methodology that offers a real-time approach to monitoring clinician well-being, but its utility during high-intensity operational periods remains underexplored. This study examines the feasibility and performance of an EMA-based system for tracking clinical responsibilities and burnout among healthcare workers during the first year of the COVID-19 pandemic. Methods: Utilizing an intensive longitudinal design, 398 healthcare workers, including physicians, physician assistants, nurses, and trainees, completed brief EMA surveys every five days from April 2020 to March 2021. Burnout was assessed with a validated single-item measure and analyzed in relation to redeployment status and hospital caseloads. Results: The EMA approach successfully captured meaningful temporal fluctuations in burnout. Redeployment was associated with higher burnout levels (b = 0.125; p = 0.01), and rising caseloads amplified this effect (interaction b = 0.169; p = 0.001). Nurses showed the strongest caseload-related increases in burnout (b = 0.359; p < 0.001). These patterns persisted even after individuals returned to their usual roles. Conclusions: This study demonstrates that EMA is a scalable and sensitive approach for continuous burnout surveillance, capable of detecting role-specific and context-dependent stress responses in real time. EMA-based monitoring can support early identification of at-risk groups, guide staffing and redeployment decisions, and inform timely organizational interventions during crises and other periods of operational strain. Full article

Background/Objectives: The Commission d’examen des troubles mentaux (CETM), under Quebec’s Tribunal Administratif du Québec, reviews individuals found not criminally responsible on account of mental disorder (NCRMD). These hearings seek to balance public safety with reintegration, guided largely by treatment team recommendations. Despite the CETM’s central role in forensic psychiatry, limited empirical data exist on how its decisions align with clinical advice and which dynamic risk factors influence outcomes. This study aimed to (1) profile the CETM’s 2023 caseload, (2) evaluate concordance between CETM dispositions and treatment team recommendations, and (3) examine clinical, social, and legal factors associated with decision-making. Methods: We conducted a retrospective review of 1721 judgments issued by the CETM in 2023, retrieved from the publicly accessible Société Québécoise d’information juridique (SOQUIJ) database. Eligible cases included annual NCRMD review hearings, excluding trial fitness assessments and repeated hearings within the same year. A structured coding grid documented sociodemographic, administrative, legal, and clinical information, with emphasis on dynamic risk factors such as treatment adherence, substance use, and recent aggression. Descriptive analyses summarized population characteristics and concordance between clinical recommendations and CETM decisions. Results: The cohort was predominantly male (85%) with a mean age of 41 years. Psychotic disorders were the most frequent primary diagnoses (76%), frequently accompanied by substance use and antisocial traits. Most patients (79.6%) had prior psychiatric hospitalizations, while 25.5% had prior incarcerations. Nearly half displayed recent aggression or non-compliance. Treatment teams most often recommended conditional discharge (55%), followed by detention with conditions (21%) and unconditional release (19%). CETM decisions aligned with recommendations in 83.6% of cases; when divergent, rulings were more restrictive (8.6%) than permissive (4.6%). Conclusions: This study provides the first large-scale profile of Quebec’s CETM. High concordance with clinical teams was observed, but restrictive decisions were more frequent in cases of disagreement. The findings underscore the importance of incorporating standardized risk assessment tools to enhance transparency, consistency, and balance in forensic decision-making. Full article

The purpose of this cross-sectional study was to examine burnout profiles and organizational variables that impact burnout in school mental health providers, such as school counselors, school psychologists, social workers, and interventionists. We disseminated a survey to a large sample of school personnel across a Midwestern state. From the larger sample, we analyzed responses from school mental health providers (n = 120), as there are severe shortages of these professionals within the state and across the country. When shortages occur, caseloads are higher, thus increasing the work demands and the propensity for burnout. With burnout leading to attrition from the field, this creates a vicious cycle that could be prevented through the awareness and implementation of strategies to counteract the factors contributing to burnout. Results indicate school mental health providers (n = 120) in this state endure high levels of emotional exhaustion, while still maintaining a sense of personal accomplishment. Further, higher levels of perceived organizational support and job satisfaction appeared to lower burnout, whereas respondents who worked in schools implementing a multi-tiered system of support experienced higher burnout. Key findings, implications for practice, limitations, and future directions are discussed. Full article

This study presents the first nationwide, system-level investigation of occupational stress and professional burnout among probation counselors in Romania, in the context of increasing caseloads, complex job demands and limited institutional support. Building on a comprehensive theoretical analysis, we employ a sociological research design involving a representative sample of 247 probation counselors from all 42 national probation services. Using the Maslach Burnout Inventory—Human Services Questionnaire, along with stress-related factors, we examine the prevalence, most important factors and typologies of burnout. Advanced quantitative techniques—including multiple linear regression, principal component analysis and K-means clustering—allow for a robust identification of key predictors of emotional exhaustion and three distinct psychosocial profiles: stress-resistant seniors, under involved younger staff and overworked, frustrated employees. We also conducted a confirmatory factor analysis (CFA) to check the validity of the MBI-HSS. This typology offers a novel conceptual framework for understanding professional burnout in probation, highlighting systemic vulnerabilities and distinct risk categories. Nevertheless, limitations exist: self-reported data may underestimate stress, and omitting variables like resilience or work meaning constrains explanatory depth. Despite these constraints, this study addresses a significant gap in Romanian probation research and lays the foundation for future longitudinal and qualitative studies. These should incorporate psychological and organizational factors to improve targeted interventions and human resources strategies. Full article

Mental health professionals are often confronted with clients’ traumatic narratives, which may lead to increased levels of vicarious trauma and burnout, especially when work-related risk factors are present. This study aims to investigate the relationship between vicarious trauma and burnout among mental health professionals in Greece while taking into account work-related and intrapersonal factors using a sample of 266 mental health professionals, who completed the Core Self-Evaluations Scale, Self-Compassion Scale, Vicarious Trauma Scale, and Counselor Burnout Inventory, and provided information about work-related variables, such as caseload, clinical supervision, clinical training, and therapeutic experience. The findings showed that Greek mental health professionals’ burnout positively associated with vicarious trauma and caseload, while negatively associated with intrapersonal factors and work-related factors, namely, years of clinical supervision, clinical training and therapeutic experience. Vicarious trauma negatively correlated with core self-evaluations, self-compassion, and clinical experience. Finally, low core self-evaluations and self-compassion were found to explain greater burnout levels together with higher vicarious trauma and work overload per week, while core self-evaluations were the only variable that moderated the relationship between vicarious trauma and burnout of Greek mental health professionals. These findings indicate that in order to address the interplay between vicarious trauma and burnout, targeted interventions that focus on personal attributes, coping strategies, and systemic organizational support are needed. Full article

The Draw-A-Person Intellectual Ability test for children, adolescents, and adults is a widely used tool in psychology for assessing intellectual ability. This test relies on human drawings for initial raw scoring, with the subsequent conversion of data into IQ ranges through manual procedures. However, this manual scoring and IQ assessment process can be time-consuming, particularly for busy psychologists dealing with a high caseload of children and adolescents. Presently, DAP-IQ screening continues to be a manual endeavor conducted by psychologists. The primary objective of our research is to streamline the IQ screening process for psychologists by leveraging deep learning algorithms. In this study, we utilized the DAP-IQ manual to derive IQ measurements and categorized the entire dataset into seven distinct classes: Very Superior, Superior, High Average, Average, Below Average, Significantly Impaired, and Mildly Impaired. The dataset for IQ screening was sourced from primary to high school students aged from 8 to 17, comprising over 1100 sketches, which were subsequently manually classified under the DAP-IQ manual. Subsequently, the manual classified dataset was converted into digital images. To develop the artificial intelligence-based models, various deep learning algorithms were employed, including Convolutional Neural Network (CNN) and state-of-the-art CNN (Transfer Learning) models such as Mobile-Net, Xception, InceptionResNetV2, and InceptionV3. The Mobile-Net model demonstrated remarkable performance, achieving a classification accuracy of 98.68%, surpassing the capabilities of existing methodologies. This research represents a significant step towards expediting and enhancing the IQ screening for psychologists working with diverse age groups. Full article

Background and Objectives: Mitral valve transcatheter edge-to-edge repair (TEER) is a widely adopted therapeutic approach for managing significant mitral regurgitation (MR) in high-risk surgical candidates. While procedural safety and efficacy have been demonstrated, the impact of institutional expertise on outcomes remains unclear. We aimed at evaluating whether the institutional monthly volume of TEER influences short- and long-term clinical results. Materials and Methods: This analysis from the multicenter, prospective GIOTTO trial study evaluated the impact of institutional monthly volume on outcomes of TEER to remedy significant mitral regurgitation. Centers were stratified into tertiles based on monthly volumes (≤2.0 cases/month, 2.1–3.5 cases/month, >3.5 cases/month), and key clinical, echocardiographic, and procedural outcomes were analyzed. Statistical analysis was based on standard bivariate tests as well as unadjusted and multivariable adjusted Cox models. Results: A total of 2213 patients were included, stratified into tertiles based on institutional procedural volume: 645 (29.1%) patients in the first tertile, 947 (42.8%) patients in the second tertile, and 621 (28.1%) patients in the third tertile. Several baseline differences were found, with some features disfavoring less busy centers (e.g., functional class and surgical risk, both p < 0.05), and others suggesting a worse risk profile in those treated in busier institutions (e.g., frailty and history of prior mitral valve intervention, both p < 0.05). Procedural success rates were higher in busier centers (p < 0.001), and hospital stay was also shorter there (p < 0.001). Long-term follow-up (median 14 months) suggested worse outcomes in patients treated in less busy centers at unadjusted analysis (e.g., p = 0.018 for death, p = 0.015 for cardiac death, p = 0.014 for death or hospitalization for heart failure, p < 0.001 for cardiac death or hospitalization for heart failure), even if these associations proved no longer significant after multivariable adjustment, except for cardiac death or hospitalization for heart failure, which appeared significantly less common in the busiest centers (p < 0.05). Similar trends were observed when focusing on tertiles of overall center volume and when comparing for each center the first 50 cases with the following ones. Conclusions: High institutional monthly volume of TEER mitral valve repair appears to correlate with an improved procedural success rate and shorter hospitalizations. Similarly favorable results were found for long-term rates of cardiac death or hospitalization for heart failure. These findings inform on the importance of operator experience and center expertise in achieving state-of-the-art results with TEER, while confirming the usefulness of the proctoring approach when naïve centers begin a TEER program. Full article

Behaviors of concern (BoC) may be defined as persistent behaviors that impact the daily functioning and learning of children. They are behaviors that could pose a risk to their own safety or the safety of others. Supporting children with BoC is vital for student learning, success, and inclusion in both mainstream and special settings. Traditionally, the onus has been on the teacher to support and manage a classroom and all behaviors within that classroom. However, with an increase in BoC impacting school and class activities, targeted support in schools has become more common. Many factors have accelerated this shift, particularly the rise of burnout, lack of confidence, and aggressive behavior in schools, particularly in special school settings. The current study, through a Foucauldian power/knowledge and disciplinary theory paradigm, investigated whether having one specialist in the school aids the children and staff. A focused case study was conducted via seven semi-structured interviews with staff at one special school in the Republic of Ireland (RoI) with a full-time behavior specialist (BS) on site. The findings revealed that (1) the role of the BS is based on identifying BoC and implementing support, (2) having a behavior specialist is key for supporting children and staff in schools, (3) support and interventions are more sustainable once there is the presence of a specialist, and (4) challenges such as a lack of space, inadequate funding, large caseloads, staff shortages, and lack of time are a reality in the school setting. The main conclusion derived from this study is that having a BS in the school has a positive impact on the children, staff, and attitudes, providing both practical and pastoral power, which are essential for effective inclusive practices. Full article

Background and Objective: We aimed to evaluate current trends and complications after radical nephrectomy with inferior vena cava (IVC) thrombectomy and to provide evidence on the role of the annual hospital caseload on perioperative outcomes. Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the German Bureau of Statistics (2005–2022). All hospitals performing radical nephrectomy with IVC thrombectomy were subclassified based on their annual caseload to low- (<3 cases/year), intermediate- (3–9 cases/year), and high-volume centers (≥10 cases/year). We included 3608 patients. Key Findings and Limitations: Overall, 1880 (52%) patients underwent surgery in low-, 1466 (40%) in intermediate-, and 848 (8%) in high-volume centers. Most patients (3574, 99%) underwent open surgery. The number of patients undergoing radical nephrectomy with IVC thrombectomy has decreased in the last years. Patients undergoing surgery in low-, intermediate- and high-volume centers had similar baseline characteristics. Operation in high-volume centers, compared to low-volume centers, was associated with lower odds of intensive care unit admission (29% versus 45%, OR: 0.5, 95% CI: 0.4–0.7, p < 0.001) and a shorter hospital stay by 3.9 days (95% CI: 2.2–5.6, p < 0.001). Importantly, for every additional case performed annually, hospitals improve their perioperative outcomes in terms of mortality (p = 0.032), intensive care unit admissions (p = 0.002), acute kidney disease (p = 0.029), and length of hospital stay (p < 0.001). Conclusions and Clinical Implications: The present real-world data demonstrate that, for every additional case performed annually, hospitals improve their perioperative outcomes in terms of major perioperative complications. Full article

Aim: The management of low-grade gliomas (LGGs) is evolving with new insights into disease biology. Furthermore, recently, the phase III INDIGO¹ study highlighted the benefits of an IDH inhibitor, vorasidenib, in treating residual or recurrent grade 2 IDH-mutant gliomas following surgery alone. We aimed to characterise the current patterns of care for patients with LGGs in Australia and New Zealand, including the role of vorasidenib. Methods: An online survey examining respondents’ practice setting, caseload, and preferred treatment approach to three clinical scenarios was distributed through the Cooperative Trials Group for Neuro-Oncology, New Zealand Aotearoa Neuro-Oncology Society, and the Australian and New Zealand Society for Neuropathology in December 2023 with three reminders in April, June, and September of 2024. Results: The survey response rate was 19.6% (57/291), 87.7% from Australia, and 12.3% from New Zealand, spanning medical oncology (45.7%), pathology (22.8%), radiation oncology (17.5%), and neurosurgery (14.0%). Case 1 examined an IDH-mutant grade 2 astrocytoma following gross total resection. Observation alone was recommended by 93%. Case 2 examined an incompletely resected IDH-mutant grade 2 astrocytoma. If feasible, 38% recommended further surgery and 83% adjuvant chemotherapy and radiotherapy. After 12 months of disease stability, 53% of the respondents preferred vorasidenib over the existing therapies. Case 3 examined an incompletely resected IDH-mutant grade 3 oligodendroglioma. No respondents recommended observation alone, with 26% recommending salvage surgery and 97% recommending further chemotherapy and radiotherapy. Conclusions: This study describes current management practices for LGGs in Australia and New Zealand, showing ongoing variation and a cautious approach to integrating IDH inhibitors. This highlights the critical role of multidisciplinary team-based decision-making in increasingly complex clinical situations. Full article

The Clay N. Hixson Student Success Center within the College of Engineering at Tennessee Tech University has undergone a transformative upgrade by integrating the Define, Measure, Analyze, Improve, and Control (DMAIC) framework with select Kaizen principles for continuous improvement to enhance student support services. Key performance indicators (KPIs) have been employed to assess the achievement of core goals, significantly advancing recruitment, retention, and overall student success. Implementing the DMAIC framework has streamlined processes such as a unified degree map and a math bridge program, resulting in a 53% increase in incoming first-year students and broadening the College of Engineering’s outreach. These efforts have also contributed to a 10% increase in first-to-second-year retention rates. Through the utilization of DMAIC, the regular redistribution of advisor caseloads and cross-training has been facilitated, ensuring timely student support without overburdening advisors. Additionally, targeted academic support initiatives have reduced the at-risk student population from 19% to 11%. These management techniques extend to multiple initiatives, including enhancements to high school summer camps, advisor listening sessions, and student surveys designed to meet evolving student needs. Creating specialized areas for academic advisors has also supported their professional growth, contributing to better student outcomes. This paper comprehensively analyzes these strategies and provides valuable insights for institutions seeking to apply DMAIC and continuous improvement models to strengthen student support systems. Full article

Background/Objectives: The 2023 World Health Organization (WHO) guideline on infants aged under six months (u6m) wasting now includes mid-upper arm circumference (MUAC) and weight for age Z score (WAZ) as malnutrition treatment programme enrolment criteria. Evidence for the new criteria and optimal cut-offs is, however, sparse. We aimed to explore the potential caseload implications of the new criteria and explore how different cut-offs might affect them. Methods: We conducted a secondary analysis of data from 1048 Ethiopian infants u6m using STATA software version 17. Frequency tables and percentages were used to present malnutrition across various characteristics. The chi-square test with 95% confidence intervals (CIs) at a p value of <0.05 was used to compare infant caseload identified by the WHO-2023 versus WHO-2013 criteria. Results: We found substantial overlaps among anthropometric indicators of malnutrition in infants defined by the WHO-2023 programme enrolment criteria. New WHO criteria result in a larger potential caseload (19.2% for 6 weeks to 6 months and 15.1% for infants under 6 weeks) compared with WHO-2013 criteria (2.4%). Whilst there are marked overlaps between low WAZ, low WLZ, and low MUAC, they capture different infants. An MUAC of <110 mm alone would capture only a third of all cases identified by WAZ and/or WLZ < −2. Conclusions: In Ethiopia, the WHO-2023 criteria markedly increase malnutrition caseloads compared with WHO-2013 criteria. There might be a case for increasing MUAC thresholds in MUAC-focused programs where WLZ or WAZ measurements are difficult. Future longitudinal data are needed to know which criteria best identify infants at highest risk of mortality/morbidity/poor development. Full article

Background: Secondary mitral regurgitation (SMR) is characterized by a pathological process impacting the left ventricle (LV) as opposed to the mitral valve (MV). In the absence of structural alterations to the MV, the expansion of the LV or impairment of the papillary muscles (PMs) may ensue. A number of technical procedures are accessible for the purpose of determining the optimal resolution for MR. Nevertheless, there is a dearth of rigorous data to facilitate a comparative analysis of MV replacement, MV repair (including subvalvular repair), and transcatheter mitral valve interventions (TMV-Is). The objective of this investigation is to evaluate and compare the efficacy and clinical outcomes of transcatheter mitral valve repair (TMV-r) utilizing the edge-to-edge mitral valve repair (TEER) procedure in comparison to conventional surgical mitral valve interventions (S-SMVis) in patients with secondary mitral regurgitation. Methods and analysis: A consortium of five cardiac surgery institutions from four European states and Japan have joined forces to establish a multicenter observational registry, designated TEERMISO. Patients who underwent technical procedures for SMR between January 2007 and December 2023 will be enrolled consecutively into the TEERMISO registry. The investigation team evaluated the comparative efficacy of replacement and repair techniques, utilizing both the standard surgical methodology and the transcatheter intervention. The primary clinical outcome will be the degree of left ventricular remodeling, as assessed by the left ventricular end-diastolic volume index, at 10 years. The forthcoming research will assess a variety of secondary endpoints, among which all-cause mortality will be the primary endpoint. Subsequent assessments will be made in the following order: functional status, hospitalization, neurocognition, physiological measures (echocardiographic assessment), occurrence of adverse clinical incidents, and reoperation. Ethics and dissemination: The multicenter design of the database is anticipated to reduce the potential for bias associated with institutional caseload and surgical experience. All participating centers possess an established mitral valve protocol that facilitates comprehensive follow-up and management of any delayed mitral complications following replacement surgery or surgical repair of the secondary mitral regurgitation. The data collected will provide insights into the impact of diverse surgical approaches on standard mitral valve surgery and TEER. This will facilitate the evaluation of LV remodeling over the course of long-term post-procedural follow-up. Trial Registration: ClinicalTrials.gov ID: NCT05090540; IRB ID: 202201143 Full article

Extracorporeal cardiopulmonary resuscitation (ECPR) is a complex, life-saving procedure that uses mechanical support for patients with refractory cardiac arrest, representing the pinnacle of extracorporeal membrane oxygenation (ECMO) applications. Effective ECPR requires precise patient selection, rapid mobilization of a multidisciplinary team, and skilled cannulation techniques. Establishing a program necessitates a cohesive ECMO system that promotes interdisciplinary collaboration, which is essential for managing acute cardiogenic shock and severe pulmonary failure. ECPR is suited for selected patients, emphasizing the need to optimize every step of cardiac arrest management—from public education to advanced post-resuscitation care. The flexibility of ECMO teams allows them to manage various emergencies such as cardiogenic shock, massive pulmonary embolism, and severe asthma, showcasing the program’s adaptability. Launching an ECPR program involves addressing logistical, financial, and organizational challenges. This includes gaining administrative approval, assembling a diverse team, and crafting detailed protocols and training regimens. The development process entails organizing teams, refining protocols, and training extensively to ensure operational readiness. A systematic approach to building an ECPR program involves establishing a team, defining patient selection criteria, and evaluating caseloads. Critical elements like patient transport protocols and anticoagulation management are vital for the program’s success. In conclusion, initiating an ECPR program demands thorough planning, collaborative effort across specialties, and ongoing evaluation to improve outcomes in critical cardiac emergencies. This guide offers practical insights to support institutions in navigating the complexities of ECPR program development and maintenance. Full article

Background/Objectives: Microsurgical clipping has traditionally been considered a standard treatment for middle cerebral artery (MCA) aneurysms. Recently, a caseload reduction related to improved endovascular treatment options has occurred in cerebrovascular neurosurgery. Therefore, studies that report the clinical and radiological outcomes after clipping are highly warranted. Methods: Patients with an unruptured MCA bifurcation aneurysm, who were surgically treated at the Department of Neurosurgery in Linz between 2002 and 2019, were included in this study. Clinical and radiological outcome parameters were evaluated for each patient. Results: Overall, 272 patients were eligible for inclusion. Complete aneurysm occlusion was demonstrated in 266 (99.3%) of the 268 (98.5%) patients who underwent postoperative digital subtraction angiography. In six (2.2%) patients, a permanent new neurological deficit (pNND) persisted after treatment. Intraoperative aneurysm rupture was a significant factor (p = 0.0049) in the logistic regression. At the last follow-up, only two patients (0.7%) had an unfavorable outcome (mRS > 2). More recent surgeries were associated with fewer cases of pNND (p = 0.009). A transient new neurological deficit occurred in 13 patients (4.8%), with aneurysm size being a significant risk factor (p = 0.009). Surgical site infections were reported in four patients (1.5%), with patient age (p = 0.039) and time (p = 0.001) being significant factors. Two patients died (0.7%) perioperatively and two patients (0.7%) needed a retreatment in the long-term follow-up. Conclusions: The findings indicate that microsurgical clipping is a safe procedure with minimal need for retreatment. It achieves a high occlusion rate while maintaining a very low rate of adverse outcomes. Continuous intraoperative enhancements over time have contributed to a progressive improvement in clinical outcomes in recent years. This trend is exemplified by the absence of detectable pNND in the era of ICG angiography. Consequently, these data support the conclusion that microsurgical clipping should still be considered an appropriate treatment option for unruptured MCA bifurcation aneurysms. Full article