Guiding principles for the conduct of the Violence Study of Healthcare Workers and System (ViSHWaS): Insights from a global survey

Background

Although many studies worldwide have reported on violence against health care workers, there is a lack of homogeneous data for understanding the current state of the issue. Conducting a global survey required a robust team organisation structure, unique dissemination strategies, and continual networking to maintain and propagate the pool of survey collaborators and responders. Here we aimed to describe the strategies that helped us carry out a global survey-based study, the lessons learned, and provide a practical roadmap for future large-scale cross-sectional studies.

Methods

We conducted this cross-sectional survey-based study from 6 June to 9 August 2022, basing it on the 'Hub and Spoke' model, with a single core team and subgroups in different regions managed by country leads. The key steps included team organisation, strategy formulation for survey dissemination and data collection, social media launch, and conducting a post-survey analysis amongst the collaborators. The core team convened weekly via video conference to discuss the modus operandi. The language barrier was managed through audio translation or by shifting to 'an interviewer-administered' questionnaire.

Results

The core team included 11 members from seven countries, followed by 28 country leads from 110 countries. We also gathered 80 regional collaborators who provided feedback and spread the message. The Violence Study of Healthcare Workers and Systems (ViSHWaS) returned 5500 responses globally. Guiding principles garnered through this collaborative project include focusing on effective team organisation, ensuring external validation of survey tool, personalised communication, global networking, timely communication for maintaining momentum, and addressing regional limitations. The post-survey analysis showed that WhatsApp messaging was the most common modality used for survey dissemination, followed by in-person meetings and text messaging. We noted that the successful techniques were direct communication with respondents, regular progress updates, responsiveness to regional and country lead needs, and timely troubleshooting. The most common barriers for the respondents were limitations in language proficiency, technical fallouts, lack of compliance with, and difficulty understanding the questionnaire.

Conclusions

In this global survey-based study of more than 5500 responses from over 110 countries, we noted valuable lessons in team management, survey dissemination, and addressing barriers to collaborative research.

Durvalumab-Induced Myocarditis and Dilated Cardiomyopathy in a Patient With Non-small Cell Lung Cancer: A Diagnostic Conundrum

Immune checkpoint inhibitors have been a therapeutic oncological breakthrough in managing diverse malignancies. We present a 78-year-old male with stage IIIb non-small cell lung cancer (NSCLC) managed by concurrent chemotherapy with carboplatin/pemetrexed and radiotherapy followed by monthly durvalumab injections. He presented to the hospital with shortness of breath and fluid overload after eight months of starting durvalumab. Workup, including laboratory investigations, coronary angiography, and stress myocardial magnetic resonance imaging, increased our suspicion for the diagnosis of durvalumab-induced myocarditis and nonischemic dilated cardiomyopathy. He was managed with aggressive diuresis and pulse dose steroids with an improvement in his symptoms and his cardiac function. This case illustrates an under-reported clinical side effect in the era of advancement in oncological immunotherapy.

An Undifferentiated Primary Mediastinal Carcinoma Compressing the Main Pulmonary Artery: A Rare Cause of Right Ventricular Strain

Undifferentiated carcinoma (or poorly differentiated carcinoma) of the mediastinum is a relatively rare pathological variant of anterior mediastinal tumors. Pathologists usually use the term to describe an epithelial tumor with no histological features that enable the identification of its site of origin. Invasion of adjacent vital cardiopulmonary structures is among the most problematic complications of anterior mediastinal masses. We report a case of a 60-year-old male presenting with easy fatiguability, significant weight loss, and chest pain. A CT scan of the chest revealed a large anterior mediastinal mass, compression of the main pulmonary artery, and a large pericardial effusion. The patient underwent pericardiocentesis, emergent radiotherapy, and platinum-based chemotherapy. His condition dramatically improved, and he was subsequently discharged home for further follow-up.

A historical delve into neurotrauma-focused critical care

Neurocritical care is a multidisciplinary field managing patients with a wide range of aliments. Specifically, neurotrauma is a rapidly growing field with increasing demands. The history of how neurotrauma management came to its current form has not been extensively explored before. Our review delves into the history, timeline, and noteworthy pioneers of neurotrauma-focused neurocritical care. We explore the historical development during early times, the 18th-20th centuries, and modern times, as well as warfare- and sports-related concussions. Research is ever growing in this budding field, with several promising innovations on the horizon.

ViSHWaS: Violence Study of Healthcare Workers and Systems-a global survey

OBJECTIVE

To provide insights into the nature, risk factors, impact and existing measures for reporting and preventing violence in the healthcare system. The under-reporting of violence against healthcare workers (HCWs) globally highlights the need for increased public awareness and education.

METHODS

The Violence Study of Healthcare Workers and Systems study used a survey questionnaire created using Research Electronic Data Capture (REDCap) forms and distributed from 6 June to 9 August 2022. Logistic regression analysis evaluated violence predictors, including gender, age, years of experience, institution type, respondent profession and night shift frequency. A χ2 test was performed to determine the association between gender and different violence forms.

RESULTS

A total of 5405 responses from 79 countries were analysed. India, the USA and Venezuela were the top three contributors. Female respondents comprised 53%. The majority (45%) fell within the 26-35 age group. Medical students (21%), consultants (20%), residents/fellows (15%) and nurses (10%) constituted highest responders. Nearly 55% HCWs reported firsthand violence experience, and 16% reported violence against their colleagues. Perpetrators were identified as patients or family members in over 50% of cases, while supervisor-incited violence accounted for 16%. Around 80% stated that violence incidence either remained constant or increased during the COVID-19 pandemic. Among HCWs who experienced violence, 55% felt less motivated or more dissatisfied with their jobs afterward, and 25% expressed willingness to quit. Univariate analysis revealed that HCWs aged 26-65 years, nurses, physicians, ancillary staff, those working in public settings, with >1 year of experience, and frequent night shift workers were at significantly higher risk of experiencing violence. These results remained significant in multivariate analysis, except for the 55-65 age group, which lost statistical significance.

CONCLUSION

This global cross-sectional study highlights that a majority of HCWs have experienced violence, and the incidence either increased or remained the same during the COVID-19 pandemic. This has resulted in decreased job satisfaction.

Effect of Dapagliflozin in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Background

Heart failure (HF) is a major cause of recurrent hospitalization and death worldwide. Sodium-glucose cotransporter-2 inhibitors including dapagliflozin are anti-diabetic drugs with promising cardiovascular (CV) effects. We performed systematic review and meta-analysis of randomized controlled trials investigating the effects of dapagliflozin in heart failure patients.

Methods

We searched PubMed, Scopus and ScienceDirect databases. A total of 1,567 studies from January 2017 to September 10, 2022, were screened. After applying exclusion criteria, 22 studies were retrieved for full-text screening, and nine of them were eligible for this meta-analysis. Effect estimates for dichotomous variables were expressed as risk ratio (RR) and 95% CI. The primary outcomes were the incidence of all-cause mortality, hospitalization due to HF, and CV death. This review was registered on PROSPERO with ID CRD42022347793.

Results

A total of 14,032 patients were included. The overall risk ratio of all-cause mortality favored the dapagliflozin group over the placebo/standard therapy group (RR = 0.89, 95% CI: 0.82-0.97, P = 0.006) and the pooled studies were not heterogenous (I2 = 0%). Additionally, dapagliflozin significantly reduced the hospitalization due to heart failure (RR = 0.76, 95% CI: 0.70-0.84, P > 0.00001, I2 = 0%), cardiovascular death (RR = 0.87, 95% CI: 0.78-0.97, P = 0.01, I2 = 0%) and their composite outcomes.

Conclusion

Dapagliflozin reduces the risk of all-cause mortality, heart failure hospitalizations and cardiovascular death in a wide range of heart failure patients.

Guiding Principles for the Conduct of Violence Study of Healthcare Workers and System (ViSHWaS): Insights from a Global Survey

Background Globally many studies have reported on violence faced by healthcare workers. However, there is still a lack of homogeneous data to give us a concrete understanding of the present scenario on a global scale. Conducting a global survey required a robust team organization structure, unique dissemination strategies accounting for the regional limitations, and continual networking to maintain and propagate the pool of survey collaborators and responders. This study aims to describe the strategies that helped carry out a global survey- based study, the lessons learned, and recommendations for future studies.   Methods This cross-sectional survey-based study was based on methodology of the “Hub and Spoke” model with the core team and sub-groups about different regions and managing country leads. The study was conducted across eight weeks from 6th June 2022 to 8th August 2022. The key steps included team organization, strategy formulation for survey dissemination and data collection, launching the project on social media, and conducting a post-survey amongst the collaborators. The Core Team convened weekly via video conference platforms to discuss the modus operandi, including the responsibilities of team members in communicating with HCWs from each country; strategies for data extraction and analysis. A standard message was created for the survey in English, which was spread via text, audio and video messages; the message was tailored according to the target region and population. The language barrier was managed by creating an audio translation or shifting to “an interviewer-administered” questionnaire. Call for leads and collaborators was organized through social media platforms and incentivized by proposing collaborative authorship.   Results A core team of 11 members from 7 countries was assembled, which expanded to 40 country leads from around 110 countries. We also amassed more than 75 regional collaborators who worked to provide feedback and spread the message. The “Violence Study of Healthcare Workers and Systems” (VISHWAS) amassed 5500 responses across the world. A weekly alternating trend in the number of survey responses was observed for eight weeks. Guiding principles garnered through this collaborative project include focusing on 1. Effective team organization, 2. Ensuring external validation of survey tool, 3. Personalized communication, 4. Global networking, 5. Timely communication for maintaining momentum, and 6. Addressing regional limitations. The post-survey analysis showed that WhatsApp messaging was the most common modality used for survey dissemination, followed by in-person meetings and text messaging. The successful techniques were noted to be 1. Direct communication with respondents, 2. Regular progress updates, 3. Responsiveness for regional and country lead’s needs  4. Timely troubleshooting. The most common barriers for the respondents were limitations in language proficiency, technical fallouts, lack of compliance with, and difficulty understanding the questionnaire.   Conclusion In this global survey-based study of more than 5500 responses from over 110 countries, valuable lessons in team management, survey dissemination, and addressing barriers to collaborative research. We thereby recommend incorporating the guiding principles from this study to design future surveys on a global scale.

TCL-360 A Case of Angioimmunoblastic T-Cell Lymphoma Presenting as Airway Obstruction

Angioimmunoblastic T-cell lymphoma (AITL) is a rare subset of non-Hodgkin lymphoma (NHL). The incidence in the United States is 0.05 per 100,000 person years. It comprises 15%-20% of the cases of peripheral T-cell lymphoma. The most common presentation is generalized lymphadenopathy. NHL is known to involve Waldeyer's ring as the primary site of disease in 5% to 10% of cases. An 83-year-old woman presented to the outpatient clinic with shortness of breath, noisy breathing, and right groin swelling. Physical examination revealed diffuse lymphadenopathy. A complete blood count revealed moderate anemia, normal white blood cell count, and thrombocytosis. A liver function test revealed increased alkaline phosphatase (ALP) and alanine transaminase (ALT) levels. Serum albumin and haptoglobin were low. A CT scan of the chest revealed mediastinal and axillary adenopathy. Brain CT showed a nasopharyngeal mass 2×2 cm. Multiple hypodense lesions were seen in the liver. A biopsy of the right inguinal mass revealed an angioimmunoblastic variant of T-cell lymphoma. The patient was started on a MiniCHOP with prednisone regimen. AITL is a rare disease of older adults. Our patient presented with asymmetrical right inguinal lymphadenopathy. Waldeyer's ring involvement is rare in NHL and is large enough to cause symptomatic breathing difficulty. The nasopharyngeal mass possibly contributed to the noisy breathing. The patient's lab results revealed thrombocytosis and a normal leukocyte count, which were a deviation from the cytopenias seen in AITL. The patient had an increase in ALP and ALT levels. In the absence of history of alcohol intake, diabetes mellitus, and obesity, these findings are suggestive of metastatic liver involvement. Due to its low incidence, there is a dearth of large-scale studies evaluating the presenting symptoms of AITL. The variations in laboratory abnormalities from routine findings also warrant further studies. The predominant involvement of nasopharyngeal mucosa leading to breathing difficulties in this case highlights the importance of having high suspicion, since AITL can present as various unique clinical scenarios.