Prevalence of Burnout Among Public Health Professionals: A Systematic Review

CONTEXT

Since the initial outbreak of COVID-19, health professionals-both clinical health care, as well as public health concentrations-have faced tremendous pressures. A growing body of literature indicates the pandemic has magnified already prevalent burnout rates among clinical health professionals and to what extent for public health professionals remains to be determined.

OBJECTIVE

This study purpose is to conduct a systematic review of literature examining burnout prevalence among public health professionals before and during the COVID-19 pandemic-nationally and internationally-with identification of potential risk factors.

DESIGN

We conducted a literature search in PubMed, EMBASE, PsycINFO, SocINDEX, and ClinicalKey since inception through April 4, 2023. Inclusion criteria included peer-reviewed, original research studies (qualitative or quantitative), in English, assessing prevalence of, or risk factors for, burnout in public health professionals. Two authors independently screened abstracts, titles, full report of studies and abstracted data related to burnout. This review was conducted using Joanna Briggs Institute Systematic Reviews guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines with narrative synthesis. Protocol for this review registered on PROSPERO (CRD42023424468).

RESULTS

Of 3327 health-related articles mentioning burnout, 15 met inclusion criteria (11 quantitative and 4 qualitative) with 10 in international settings and 5 in US majority of quantitative studies were from international settings and only 1 in United States. Seventy-eight percent of studies that included prevalence data, exhibited a burnout prevalence greater than 50% (with a range of 19%-81%). The pandemic likely heightened (13% increase) already elevated burnout prevalence. Major risk factors identified included overwork, lack of support, changing roles, and full-time employment status, though many risk factors had not been studied in the United States.

CONCLUSIONS

Burnout is prevalent among public health professionals, nationally and internationally, and likely heightened by the COVID-19 pandemic. More research is warranted assessing burnout among differing public health concentrations and interventions developed. Public health is an essential framework for protecting and promoting health nationally and internationally, and we need to ensure and support solidity of that framework.

Bereavement care immediately after perinatal loss in health care facilities: a scoping review protocol

OBJECTIVE

This scoping review will summarize what is known about formal and informal perinatal bereavement care guidelines used in health care facilities before discharge, and map the mental health outcomes of parents against characteristics of the guidelines.

INTRODUCTION

Conflicting evidence for bereavement care guidelines, the lack of randomized controlled trials and experimental studies, and older synthesized information with a limited focus or population make synthesis complex. A scoping review will facilitate the process of determining the breadth and depth of the literature.

INCLUSION CRITERIA

Sources pertaining to bereavement care guidelines used in health care facilities immediately after perinatal loss (miscarriage, stillbirth, or neonatal death) and measuring parents' mental health outcomes will be included. Sources relating to family members other than parents, perinatal loss occurring outside of a health care facility, and physical care guidelines will be excluded.

METHODS

The proposed review will be conducted using JBI methodology for scoping reviews. The team will consider quantitative and qualitative studies, practice guidelines, case reports, expert opinions, systematic reviews, professional organization websites, and gray literature. Major databases to be searched will include CINAHL (EBSCO), PsycINFO (EBSCO), SocINDEX (EBSCO), Cochrane, Embase, MEDLINE (PubMed), and Web of Science. The earliest empirical study found (1976) will serve as the starting date limit. After pilot testing the two-step screening process (titles and abstracts, then full-text articles), data will be extracted, collated, and presented in narrative form as well as in tables and diagrams. The results will provide facilities with a broad view of bereavement care to support grieving parents' mental health.

Laryngeal Solitary Fibrous Tumor: A Case Report and Systematic Review

OBJECTIVES/HYPOTHESIS

Solitary fibrous tumors are spindle cell neoplasms of mesenchymal origin that rarely occur in the larynx and may be mistaken for other pathologies. This case presentation and systematic review investigates presentation, treatment modalities, and outcomes of this unusual tumor.

STUDY DESIGN

Systematic review of PubMed, CINAHL, Web of Science, and EMBASE including a novel case presentation METHODS: A systematic search according to the PRISMA guidelines was performed to isolate the reports of solitary fibrous tumors arising in the larynx and its subsites. Variables analyzed included patient demographics, presenting symptoms, smoking status, concurrent tumors, imaging studies, biopsy results, treatment, outcomes, and follow-up. Our additional report provides the second such description of this lesion originating within the true vocal fold.

RESULTS

Systematic review revealed 21 previous reports of solitary fibrous tumors originating from laryngeal subsites. The most common presenting symptom was dysphonia. All patients underwent local excision. Two patients had recurrences. Our patient presented with progressive dysphonia over 4 years. Stroboscopic examination revealed a large translucent mass of the left vocal fold. Local excision of the tumor was achieved with transoral resection with KTP laser. Immunohistochemical staining demonstrated a strong positivity for CD34 and HMW CK34BE12. Nine-month follow-up has not revealed any evidence of persistent or recurrent disease.

CONCLUSION

Laryngeal solitary fibrous tumors are rare and are unlikely to recur in the absence of malignant findings. Complete surgical resection is an acceptable treatment for this lesion accompanied by appropriate follow-up.

Adverse Events after Rigid and Flexible Endoscopic Repair of Zenker’s Diverticula: A Systematic Review and Meta-analysis

Objective

To determine adverse events after endoscopic flexible vs endoscopic rigid cricopharyngeal myotomy for treatment of Zenker’s diverticulum (ZD).

Data Sources

Systematic review of MEDLINE, Web of Science, CINAHL, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for all years according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional studies were identified from review citations and a by hand search of manuscripts referencing ZD.

Review Methods

A structured literature search was conducted to identify studies for this systematic review. Methodological Index for Non-randomized Studies (MINORS) criteria were applied to assess study quality. For inclusion, each study had to provide data for at least 10 adult patients who had undergone endoscopic ZD repair reporting clear association with the postprocedure course in each case. Data extracted included all reported adverse events, recurrences, follow-up, and operative times.

Results

In total, 115 studies were included. All but 8 were retrospective case series. Sixty-one reported series of patients after rigid endoscopic stapler repair, 31 after rigid laser repair, and 13 with other rigid endoscopic instruments. Twenty-nine flexible endoscopic studies were included. Mortality, infection, and perforation were not significantly more likely in either the rigid or the flexible group, but bleeding and recurrence were more likely after flexible endoscopic techniques (20% vs <10% and 4% vs 0%, respectively). Dental injury and vocal fold palsy were reported rarely in the rigid endoscopic groups.

Conclusions

Adverse events are rare after endoscopic Zenker’s repair. The flexible approach minimizes exposure limitations and can be completed in some patients without general anesthesia. Transoral rigid approaches result in fewer revision surgeries compared with flexible diverticulotomy.

Assessment and Treatment of Pain during In-Office Otolaryngology Procedures: A Systematic Review

OBJECTIVE

To qualitatively assess practices of periprocedural pain assessment and control and to evaluate the effectiveness of interventions for pain during in-office procedures reported in the otolaryngology literature through a systematic review.

DATA SOURCES

PubMed, CINAHL, and Web of Science searches from inception to 2018.

REVIEW METHODS

English-language studies reporting qualitative or quantitative data for periprocedural pain assessment in adult patients undergoing in-office otolaryngology procedures were included. Risk of bias was assessed via the Cochrane Risk of Bias or Cochrane Risk of Bias in Non-Randomized Studies of Interventions tools as appropriate. Two reviewers screened all articles. Bias was assessed by 3 reviewers.

RESULTS

Eighty-six studies describing 32 types of procedures met inclusion criteria. Study quality and risk of bias ranged from good to serious but did not affect assessed outcomes. Validated methods of pain assessment were used by only 45% of studies. The most commonly used pain assessment was patient tolerance, or ability to simply complete a procedure. Only 5.8% of studies elicited patients' baseline pain levels prior to procedures, and a qualitative assessment of pain was done in merely 3.5%. Eleven unique pain control regimens were described in the literature, with 8% of studies failing to report method of pain control.

CONCLUSION

Many reports of measures and management of pain for in-office procedures exist but few employ validated measures, few are standardized, and current data do not support any specific pain control measures over others. Significant opportunity remains to investigate methods for improving patient pain and tolerance of in-office procedures.