The indication of rituximab in acquired TTP at the acute phase is still debated. Rituximab was initially associated with daily TPE in patients with a suboptimal response to standard treatment (refractory patients or patients experiencing an exacerbation of the disease). However, the high response rates reported with this therapy provided confidence in its use and prompted investigators to administrate it earlier in the management of the disease. In this regard, the UK group89 reported in 2011 that frontline treatment with rituximab resulted in a shorter hospitalization and fewer relapses that occurred later in comparison with a historical group not treated with rituximab (Tables 2 and 3). Fewer and later relapses were also observed in rituximab-treated patients by the French TMA Reference Center Network82 and the Oklahoma TTP registry.93,95 As a consequence, frontline treatment with rituximab is a reasonable indication, although it may expose patients to overtreatment, as in up to 50% of cases, acquired TTP recovers with standard treatment.96 Further studies should determine whether rituximab allows for improving the poorer outcome of the more severe forms of the disease (ie, old patients with cerebral and/or cardiac involvement).45,76
Vincristine was used mainly in refractory TTP in the prerituximab era. In a literature review of 56 studies and 105 patients, stable remission was achieved in 73% of patients receiving vincristine as secondary or salvage therapy. Today, however, rituximab is usually preferred in acquired TTP.97 Cyclosporine A has been reported as an effective treatment in refractory TTP98 and as frontline treatment in association with TPE. The clinical response correlates with improvement in ADAMTS13 activity and suppression of anti-ADAMTS13 antibodies.99 However, a recent randomized study showed no significant difference in the exacerbation rate between patients treated in adjunct to TPE with cyclosporine A or with steroids, questioning the role of cyclosporine A.100 Today, however, rituximab is usually preferred in acquired TTP, and use of vincristine and cyclosporine A is reserved for patients refractory to other lines of therapy.
Frontline - 27 May 2016 (True PDF)
Encounters of watchlisted individuals at our borders are very uncommon, underscoring the critical work CBP Agents and Officers carry out every day on the frontlines. DHS works tirelessly to secure our borders through a combination of highly trained personnel, ground and aerial monitoring systems, and robust intelligence and information sharing networks.
Forty seven percent of patients receiving frontline therapy received chlorambucil and obinutuzumab. Sixty-seven patients were treated with obinutuzumab and consisted of 36 males (53.7%) and 31 females (46.3%) with 29 patients (43.3%) over age 75 years. Rates of grade 3 and 4 obinutuzumab IRRs were lower (6%) compared to the CLL11 clinical trial (20%) due to local practices including slower infusion rates and using chlorambucil before starting obinutuzumab treatment. Many patients had difficulty tolerating the full dosage of chlorambucil. Only 26 patients (38.8%) had their dose of chlorambucil escalated to the full dose of 0.5 mg/kg. In addition, only 18 patients (26.9%) received all doses of obinutuzumab and all 12 doses of chlorambucil.
All participants in the study provided written informed consent, and all data was anonymised during analysis. As confidentiality cannot be guaranteed in group-based research, participants were asked to keep information discussed during the sessions confidential. Ethical approval for the study was obtained from the Faculty of Humanities, University of the Free State (Ethics reference number: UFS-HSD2016/0687). Approval for the study was also obtained from the Free State Department of Health.
Ethical approval for the study was obtained from the Faculty of Humanities, University of the Free State (Ethics reference number: UFS-HSD2016/0687). Approval for the study was also obtained from the Free State Department of Health. All participants in the study provided written informed consent, and all data was anonymised during analysis. As confidentiality cannot be guaranteed in group-based research, participants were asked to keep information discussed during the sessions confidential.
This cross-sectional study was performed from February to May 2016 at the Razi Nursing and Midwifery School affiliated with the Kerman University of Medical Sciences (KUMS), in Kerman, Iran. This study is a part of a larger study. The results of the first part was published in previous study [21].
Conclusions and Relevance In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19.
Due to occupational segregation, discrimination, and other impacts of systemic racism, racial pay disparities are one of the persistent, structural features of the U.S. labor market (Wilson and Rodgers 2016). Despite some historical progress, in 2019 Hispanic workers were being paid 10.8% less than white workers with similar ages and education levels, and Black workers were being paid 14.9% less than comparable white workers (Gould 2020).
Minimum wage increases are extremely popular. Moreover, the highest approval of minimum wage increases comes from those groups who critics say are most likely to suffer job losses. An analysis of the 2016 American National Election Survey by Aaron Sojourner estimates that more than seven in 10 unemployed workers approved of raising the minimum wage (Sojourner 2021). Figure H also shows that the unemployed favor raising the minimum wage by an 11 percentage-point margin over those already employed. A stronger preference for minimum wage increases holds for other demographic groups who face greater obstacles in the labor market. Black and Hispanic adults are significantly more likely to approve of minimum wage increases than white adults. Women approve of minimum wage increases significantly more than men, with similar approval margins between those without and with a college degree.
Novel virus outbreaks, such as the COVID-19 pandemic, may increase psychological distress among frontline workers. Psychological distress may lead to reduced performance, reduced employability or even burnout. In the present study, we assessed experienced psychological distress during the COVID-19 pandemic from a self-determination theory perspective.
The COVID-19 pandemic resulted in an increase of psychological distress among frontline workers. Both need frustration and need satisfaction explained unique variance of psychological distress, but seemed to originate from different sources. Challenging times require healthcare organisations to better support their professionals by tailored formal and informal support. We propose to address both indirect (e.g. organisation) and direct (e.g. colleagues) elements of the clinical and social environment in order to reduce need frustration and enhance need satisfaction.
Citation: van der Goot WE, Duvivier RJ, Van Yperen NW, de Carvalho-Filho MA, Noot KE, Ikink R, et al. (2021) Psychological distress among frontline workers during the COVID-19 pandemic: A mixed-methods study. PLoS ONE 16(8): e0255510.
In this study, we quantitatively assessed frustration and satisfaction of basic psychological needs, and psychological distress during COVID-19, and qualitatively explored experiences of frontline workers. Our results provide insights about different elements of the social environment that affected psychological distress among frontline workers. While frontline workers experienced need frustration and increased levels of psychological distress, relatedness support seemed to help them deal with the challenges of the COVID-19 pandemic. In many narratives, we observed an interconnectedness between needs. In the next paragraphs, we discuss both quantitative and qualitative findings, their meaning from a theoretical and empirical perspective, and the implications for practice.
An important contribution of our findings to recent empirical studies is the combination of qualitative and quantitative data assessed multiple times, while many recent studies are cross-sectional and quantitative in nature [3, 5]. Many studies show an increase in psychological distress among healthcare staff during this pandemic [9, 11, 12, 38, 39]. Our findings are in line with literature that healthcare organisations can implement a diverse range of interventions [40] to support their staff during a pandemic, for example, through clear communication, sufficient training, rostering and support networks [5, 6]. Also, social support among colleagues is important to mitigate psychological distress [5]. We have captured the actual experiences of frontline workers, which indicate that both supportive and frustrating elements of the work environment simultaneously affect their perceived psychological distress. Our findings resonate with recent reviews [6, 40] that suggest that an institutional approach seems vital to mitigate psychological distress. 2ff7e9595c
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