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BACKGROUND: We investigated the impacts of workload, resources, organizational satisfaction, and psychological safety on changes in physician burnout and moral distress among physicians during the early pandemic. METHODS: We obtained national administrative and survey data on burnout, moral distress, organizational satisfaction, psychological safety, COVID-19 burden, and state-level restrictions for 11,877-14,246 Veterans Health Administration (VA) physicians from 2019 and 2020. We regressed the changes in burnout and moral distress on the changes in reasonable workload, appropriate job resources, organizational satisfaction, and psychological safety, controlling for COVID-19 burden and restrictions, and individual and medical center characteristics. RESULTS: Burnout and moral distress were not related to COVID-19 cases or restrictions but were reduced by improvements in workload, organizational satisfaction, and psychological safety. CONCLUSIONS: Health systems should be conscious of factors that can harm or improve physician well-being, especially in the context of external stressors.

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Rationale: Telemedicine consults, including video consults, telephone consults, electronic consults, and virtual conferences, may be particularly valuable in the management of chronic pulmonary diseases, but there is limited guidance on best practices for pulmonary telemedicine consults. Objectives: This scoping review aims to identify, characterize, and analyze gaps in the published literature on telemedicine consults health providers use to manage patients with chronic pulmonary diseases. Methods: We searched PubMed, Embase, Web of Science, and Cochrane Library from database origin through July 10, 2021. We included manuscripts describing applications of telemedicine consults for patients with chronic pulmonary diseases (asthma, chronic obstructive pulmonary disease, lung cancer, pulmonary hypertension, and interstitial lung disease). We restricted our review to full-length articles published in English about provider-led (as opposed to nurse-led) telemedicine consults. Results: Our search yielded 3,118 unique articles; 27 articles met the inclusion criteria. All telemedicine consult modalities and chronic pulmonary conditions were well represented in the review except for pulmonary hypertension and interstitial lung disease, which were represented by one and no articles, respectively. Most articles described a small, single-center, observational study that focused on the acceptability, feasibility, use, and/or clinical effectiveness of the telemedicine consult. Few studies had objectively measured clinical outcomes or included a comparator group, and none compared telemedicine consult modalities against one another. Conclusions: Our scoping review identified limited literature describing pulmonary telemedicine consults and highlighted several gaps in the literature that warrant increased attention. Providers treating chronic pulmonary diseases are left with limited guidance on best practices for telemedicine consults.

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Clostridium difficile is a major cause of nosocomial antibiotic-associated infectious diarrhea and pseudomembranous colitis. Detection of C. difficile by anaerobic bacterial culture and/or cytotoxicity assays has been largely replaced by rapid enzyme immunoassays (EIA). However, due to the lack of sensitivity of stool EIA, we developed a multiplex real-time PCR assay targeting the C. difficile toxin genes tcdB. stool samples from hospitalized pediatric patients suspected of having C. difficile-associated disease were prospectively collected. Three testing modalities were evaluated, including enriched culture, cepheid Xpert and real-time Pcr (tcdB) on stool samples performed with tcdB gene-specific primers and hydrolysis probes. A total of 150 de-identified clinical specimen were analyzed. The sensitivities of stool real-time Pcr were 95% against cepheid Xpert C. difficile and 93% against enriched culture respectively, with a specificity of 97% and 94%. The lower limit of detection of the stool real-time PCR was 0.5 cFU/ml of per reaction for tcdB. Direct detection of C. difficile toxin genes in stool samples by real-time Pcr showed performance comparable to enriched culture. Real-time PCR of DNA from stool samples is a rapid and cost-effective diagnostic modality for patients that should facilitate appropriate patient management.

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The objective of the study was to describe HIV/AIDS knowledge, attitudes, risk behaviors, and sources of information among construction workers in China. A cross-sectional survey of 458 construction workers was conducted among 4 construction sites in Shenyang city in 2006. All 458 participants were individually interviewed in a private setting by a trained team of medical researchers using a structured questionnaire, which included questions on general personal information and the knowledge, attitudes, practice questions and the favorable mode of health education. A total of 428 valid questionnaires were collected. Data entry and statistical analyses were performed using the SPSS 13.0. Our results indicated that the majority of construction workers in China are sexually active youths and adults with limited education and poor knowledge of HIV/AIDS. The proportions of correct answers to questions about HIV/AIDS ranged from 4.9% to 70.7%. The score was significantly different by education level (χ(2)=47.51, p<0.01), and marrital status (χ(2)=16.48, p<0.01). More than 60% of the construction workers had a negative attitude toward HIV/AIDS-infected individuals. The source of workers' knowledge toward HIV/AIDS mainly came from TV (35.8%), newspaper (14.3%), family and friend (13.1%) and others (28.2%). Chinese migrant workers in general lack knowledge about HIV/AIDS. Our study suggests prevention programs should be encouraged and these may have the potential role to limit the emergence of China's HIV/AIDS epidemic.