Feasibility of Prehabilitation Prior to Breast Cancer Surgery: A Mixed-Methods Study.

BACKGROUND: Breast cancer surgery results in numerous acute and long-term adverse outcomes; the degree to which these can be mitigated or prevented through prehabilitation is unknown. METHODS: We conducted a longitudinal, single-arm, mixed-methods study to examine the feasibility of prehabilitation in 22 women undergoing breast cancer surgery. All participants received an individualized exercise prescription including upper quadrant-specific resistance and mobility training and aerobic exercise for the duration of their surgical wait time. Feasibility was assessed by recruitment, adherence, attrition, and intervention-related adverse event rates. An exploratory investigation of intervention efficacy was conducted via a 6-min walk test, upper-quadrant strength and range of motion, volumetric chances associated with lymphedema, and participant-reported quality of life, fatigue, pain, and disability. Outcome assessments were conducted at baseline, prior to surgery, and at six and 12 weeks after surgery. Semi-structured interviews with a subset of participants (n = 5) and health-care providers (H; n = 2) were conducted to provide further insights about intervention feasibility. Qualitative data were analyzed using a hybrid inductive and deductive thematic analysis approach. RESULTS: Recruitment and attrition rates were 62 and 36%, respectively. Average prehabilitation duration was 31 days (range = 7-69 days). Seventy six percent of participants complied with at least 70% of their prehabilitation prescription. There was a clinically significant increase in the 6-min walk distance from baseline to the preoperative assessment (57 m, 95% CI = -7.52, 121.7). The interviews revealed that the intervention was favorably received by participants and HCPs and included suggestions that prehabilitation (i) should be offered to all surgical candidates, (ii) is an avenue to regain control in the preoperative period, (iii) is a facilitator of postoperative recovery, and (iv) is an opportunity to provide education regarding postoperative rehabilitation protocols. A preference for multimodal prehabilitation (including dietetic and psychological counseling) was also highlighted. CONCLUSION: Our findings suggest that surgical prehabilitation in women with breast cancer is feasible. Data are hampered by study sample size and lack of a control group. Thus, randomized controlled trials to examine prehabilitation efficacy in people with breast cancer, especially interventions employing a multimodal strategy, are warranted.

Australian Junior Doctors' Perspectives on Psychiatry Teaching in Medical School.

OBJECTIVE: This research aimed to investigate the perspectives of junior doctors regarding the psychiatry teaching they received in medical school and to ascertain which areas of psychiatry are relevant to practicing junior doctors. METHODS: In 2017 an online survey was sent to junior doctors affiliated with an Australian public health service. Respondents were asked to rate the degree of preparation their medical school education had provided, in regard to the application of psychiatry knowledge/skills in their practice. Respondents were also asked to specify which psychiatry knowledge/skills were relevant to their practice and how psychiatry teaching in medical school could be improved. Authors generated descriptive statistics for the quantitative data and reviewed the open-ended question data to form themes, guided by the general inductive approach. RESULTS: The responses of 82 junior doctors were included in the analysis. Over half of the respondents believed that their psychiatry teaching in medical school had prepared them well for their current clinical practice. Responses to open-ended questions noted the following areas of psychiatry as most relevant to practice: delirium, mood disorders, risk assessment, and de-escalation. Respondents emphasized the importance of teaching psychiatry knowledge/skills relevant to the management of patients seen outside of psychiatric units. CONCLUSIONS: Psychiatry teaching in medical school appears to be providing adequate preparation for most junior doctors. However, there is still significant room for improvement. Changes to the curriculum should be considered, with a greater emphasis on clinically relevant psychiatry knowledge/skills, increased active learning sessions, and a broader range of clinical placements.

Psychiatrist burnout: a meta-analysis of Maslach Burnout Inventory means.

BACKGROUND: Doctors are known to have poor mental health compared with the general population. Psychiatrists are exposed to a number of unique stressors that may increase the risk of poor mental health. The aim of this study was to undertake a meta-analysis of burnout rates in psychiatrists. METHODS: Electronic databases (including MEDLINE, PsycINFO and Embase) were searched. Only studies published since 1999 and using the 22-item Maslach Burnout Inventory were included in the analysis. A meta-analysis was conducted using the Comprehensive Meta-Analysis software. RESULTS: A total of 11 studies, across nine publications, were included in the final analysis. Studies were significantly heterogenous but there was no indication of publication bias. The pooled mean for emotional exhaustion was 22.03 (95% confidence interval (CI): 19.71-24.34, tau = 3.74). For depersonalisation, the pooled mean was 7.41 (95% CI: 5.91-8.90, tau = 2.45). The pooled mean for personal accomplishment was 30.00 (95% CI: 24.75-35.27, tau = 8.87). CONCLUSIONS: The high level of psychiatrist emotional exhaustion is a significant concern. Further research is needed to consider the role of modifiable risk factors in the aetiology of psychiatrist burnout.

Hamlet and psychiatry intertwined.

OBJECTIVES:: This article considers selected landmarks in the history of psychiatry and their impact on Hamlet productions, including Burton's Anatomy of Melancholia, Emil Kraepelin's manic-depression, Freud's oedipal complex and R.D. Laing's 'divided self'. Additionally, this article considers the way Shakespeare's Hamlet has influenced the course of psychiatry. CONCLUSION:: The linkages between psychiatry and Hamlet have existed since the 17th century, and perhaps Shakespeare's Hamlet should have a place on every psychiatrist's shelf.

Career satisfaction and work stressors in psychiatrists and psychiatry trainees in Australia and New Zealand.

OBJECTIVE: To assess the level of career satisfaction and factors associated with work stress in members of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). METHODS: In 2014 an online survey was distributed to members of the RANZCP (including psychiatrists and psychiatry trainees). RESULTS: A total of 1051 members responded to the survey. Almost 85% of respondents indicated that they were satisfied with the work they were doing at the current stage of their career. 'Too much work to do in too little time' emerged as a key stressor and was ranked as the number one stressor in last 12 months by over one third of respondents. Where applicable, examinations, prospect of revalidation and training hurdles were all noted to be moderately/extremely stressful by over 50% of respondents. CONCLUSIONS: The majority of psychiatrists and trainees appear to be satisfied with their current work. However, there are many factors creating increased work stress and affecting welfare. The role of the college in protecting the welfare of its members should be further considered.