The impaired radiologist

Nursing professionals' mental well-being and workplace impairment during the COVID-19 crisis: A Network analysis

Aim

To investigate the effects of years of nursing experience and mental health on work impairment among nurses during the COVID‐19 crisis.

Background

During the COVID‐19 crisis, nurses experience a greater psychological burden than other health care workers. Studies have not yet investigated the effects of years in nursing and mental health on potential work impairment during the COVID‐19 crisis in nurses.

Methods

A survey was administered to 83 nurses on active duty during the COVID‐19 crisis. The graphical LASSO and the DAG helped estimate the associations between years of nursing experience, mental health and work impairment.

Results

A moderate negative correlation emerged between years of nursing experience, avoidance and work impairment. A direct effect was observed between anxiety and work impairment. A moderate positive correlation emerged between anxiety, depression and work impairment. An indirect effect was observed between depression, burnout, insomnia, years of nursing experience and work impairment.

Conclusions

In the present sample, nurses' work impairment decreased with greater years of nursing experience and increased with higher anxiety, depression, burnout and avoidance levels.

Implications for Nursing Management

These findings can help design effective infectious disease management programmes for students and professionals in nursing to prevent breakdowns and avoid work impairment.

Barriers to seeking help for physicians with substance use disorder: A review

BACKGROUND

Substance use disorders (SUD) might concern as many as 8-15% of physicians. Previous studies suggest that self-diagnosis and self-medication are common practices among physicians. The aim of this review was to identify if barriers to seeking help and medical care for impaired physicians exist. We also aimed at characterizing the nature of these barriers.

METHODS

The review included scientific papers published on the MEDLINE and PsychINFO databases between January 2000 and September 2018. The inclusion criteria were: (i) articles that focused on SUD in physicians. The exclusion criteria were: (i) no mention of SUD; (ii) no mention of barriers to seeking help; (iii) articles focused on burn-out and work-related stress; (iv) articles focused on risk factors or treatments for SUD; (v) articles focused on psychiatric comorbidities and (vi) those focused on other professionals.

RESULTS

Potential barriers to seeking help that were identified for impaired physicians with SUD included denial of the disease and of loss of performance, fear of stigma, psychiatric comorbidities, fear of familial/social/professional and economic consequences and a lack of knowledge.

CONCLUSIONS

Different barriers to seeking help could be identified. Priority should be given to educating medical students to ameliorate this. Increased awareness should reduce the stigma, which, even nowadays, still prevents some physicians from seeking help.

Malpractice claims related to musculoskeletal imaging. Incidence and anatomical location of lesions

PURPOSE

Failure to detect lesions of the musculoskeletal system is a frequent cause of malpractice claims against radiologists.

MATERIALS AND METHODS

We examined all the malpractice claims related to alleged errors in musculoskeletal imaging filed against Italian radiologists over a period of 14 years (1993-2006).

RESULTS

During the period considered, a total of 416 claims for alleged diagnostic errors relating to the musculoskeletal system were filed against radiologists; of these, 389 (93.5%) concerned failure to report fractures, and 15 (3.6%) failure to diagnose a tumour.

CONCLUSIONS

Incorrect interpretation of bone pathology is among the most common causes of litigation against radiologists; alone, it accounts for 36.4% of all malpractice claims filed during the observation period. Awareness of this risk should encourage extreme caution and diligence.

Malpractice claims in interventional radiology: frequency, characteristics and protective measures

PURPOSE

The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process.

MATERIALS AND METHODS

The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006.

RESULTS

In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient's death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity.

DISCUSSION

Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status.

CONCLUSIONS

Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient's right to autonomy also implies adopting clear and rigorous processes for obtaining the patient's informed consent to the medical procedure.