This study aimed to investigate the evolution of burnout levels and cardiovascular risk among healthcare professionals during the COVID-19 pandemic, identifying associated risk factors, with a particular focus on the impact of working hours, job roles and working units.

A longitudinal, observational study was conducted.

The study was carried out in a medical centre in central Taiwan, encompassing various healthcare settings.

A total of 1502 healthcare workers participated, including nurses, medical technicians, resident doctors, attending physicians and administrative staff. Participants were selected based on consistent completion of a 4-year questionnaire, with exclusion criteria for those who did not complete.

The primary outcome measured was burnout levels using the Chinese version of the Copenhagen Burnout Inventory. The secondary outcome was cardiovascular risk calculated from employees’ health check-up data using the Framingham Risk Score.

Cardiovascular risk showed an upward trend over 4 years. Personal and work-related burnout significantly decreased from 2019 to 2020 but increased from 2020 to 2022, aligning with changes in weekly working hours. Nurses exhibited the most pronounced fluctuations, likely due to their younger average age, shorter professional tenure and frequent direct patient contact, which may heighten vulnerability to pandemic-related stressors. In contrast, attending physicians demonstrated age as a protective factor against burnout, as greater seniority, clinical experience and professional maturity may buffer stress and foster resilience. Participants who worked in COVID-related units generally had elevated burnout levels and working hours. During the initial outbreak in 2020, employees working in COVID-related units had reduced working hours but stable burnout levels, while employees in non-COVID-related units experienced decreased burnout.

This study highlights the critical impact of long working hours on burnout among healthcare professionals during the COVID-19 pandemic. Nurses emerged as a vulnerable group, sensitive to pandemic-induced changes, while attending physicians exhibited more resilience. COVID-related units face greater stress and are less likely to benefit from reductions in patient numbers and working hours during the pandemic. Our findings underscore the urgent need for tailored interventions, such as regulated work hours, flexible scheduling and enhanced organisational and peer support, to protect healthcare workers’ well-being. These strategies can strengthen workforce resilience and sustainability in future public health crises.

Neutropenic fever (NF) has a crude mortality rate of 3–18%. International guidelines recommend that all patients with NF receive ultrabroad-spectrum antibiotics (UBSAs) within 1 hour of emergency department (ED) registration. However, over 70% patients presenting to hospital with suspected NF (sNF) cannot access absolute neutrophil count (ANC) result within 1 hour, do not have NF and do not require UBSAs. In ED and hospitalised patients with sNF, we hypothesise that the ASTERIC protocol effectively and safely reduces the use of UBSAs compared with standard care alone.

This pragmatic, parallel, multicentre, type 1, hybrid effectiveness-implementation, stepped-wedge, before-and-after, cluster randomised controlled trial aims to evaluate whether antibiotic prescribing can be safely reduced through implementing a multifaceted antibiotic stewardship intervention (ASTERIC) in adult patients with sNF presenting to EDs. The sNF was defined as a fever with a single oral temperature of ≥38.3°C (101°F) within 24 hours before ED registration or a temperature of ≥38.0°C (100.4°F) sustained over a 1-hour period, following last chemotherapy or targeted therapy within 6 weeks for any solid tumour, or in any period following therapies against leucaemia, lymphoma, myelodysplastic syndrome, aplastic anaemia, multiple myeloma or recipient of HSCT. The study will involve eight hospitals in Hong Kong with variable baseline practice. We will include 704 adult patients (352 patients in pre-implementation and post-implementation periods, respectively) with sNF (tympanic temperature ≥38.3°C) and 48 staff participants (6 staff participants in each hospital). Healthcare professionals will receive a multifaceted stewardship intervention consisting of risk assessment tools, fast-track ANCs, a decision tool for patient management and antibiotic use, supported by an educational package and staff interaction programmes (ASTERIC protocol). Patients’ blood ANC, and cancer therapy and chronic illness therapy scores will be measured. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and Proctor conceptual frameworks will be followed for evaluation of implementation. The main outcome measures are the mean total dose of UBSAs prescribed in 7 days and serious adverse events at 30 days. Data analysis will incorporate intention-to-treat, per-protocol and as-treated analyses for service outcomes (effectiveness, safety, quality of life assessments and cost-effectiveness) and mixed methods for implementation outcomes, informed by the Theoretical Domains Framework. We expect that the study results will inform health policy with improvement in hospital services in treating stable sNF, evidenced by improved safe antibiotic stewardship, early antibiotic de-escalation and reduced costs and length of stay.

The institutional review boards of all study sites approved this study. This study will establish the ASTERIC protocol safely improves antibiotic stewardship and clinical management in adult patients with sNF. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. All patients with sNF will be influenced by the new protocol which is agreed at hospital level. Randomisation is at hospital level, not patient level. Patient consent is sought for follow-up and data access, not for treatment. Staff consent is sought for interviewing.

NCT06794320.

Despite the abundant evidence showing the benefits of muscle-strengthening exercise (MSE), no epidemiological tool is available for assessing MSE among Indonesian university students. This study is the first to adapt the Muscle-Strengthening Exercise Questionnaire (MSEQ) from its original English version into another language, specifically Indonesian, incorporating cultural adaptations and to pilot test it to assess its validity and reliability among university students in Indonesia.

Translation and cultural adaptation, content validity studies, concurrent validity studies and reliability studies were conducted following COnsensus-based Standards for the Selection of Health Status Measurement INstruments guidelines. Content validation, conducted with three experts and nine university students, informed the development of the MSEQ Indonesian version. The concurrent validity study compared the results of measuring MSE frequency, intensity, duration and volume with those of the 7-day diary and relative handgrip strength with 22 respondents for concurrent validity against subjective measurement and 70 respondents for concurrent validity against objective measurement. For the reliability study, 39 respondents were asked to fill the MSEQ Indonesian version twice with a time interval of 7 days.

The study involved 143 participants, including experts and university students from three universities across two different islands in Indonesia.

Single administration MSEQ, consecutive administration MSEQ and 7-day diary recording resulted in 0%, 33.8% and 68.5% dropout rate, respectively. Moderate-to-strong correlations were observed between the results for the weekly frequency, duration, intensity and volume of MSE and those of the 7-day diary and hand grip strength. Test–retest reliabilities were good to excellent for machine weight, holistic and overall MSE but poor for bodyweight MSE. In assessing the target muscle group, the MSEQ Indonesian version showed good test–retest reliability for machine-weight MSE but poor-to-very good test–retest reliability for bodyweight, free weight and holistic MSE.

Our study demonstrated the acceptable validity and reliability of the Indonesian version of the MSEQ for assessing MSE among university students in Indonesia, not only by comparing each dimension of MSE with subjective measures but also by comparing MSE volume with objective measures. To enhance the generalisability of these findings, future studies should assess the MSEQ Indonesian version in diverse adult populations by considering dropout rates found by our study, ensuring its broader applicability and sample size adequacy.