Omitting repetitive clerking does not disadvantage cardiology patients and reduces duplication.

Nottingham University Hospital's cardiology department receives an average of 320 admissions via the emergency department (ED) monthly. The majority are out-of-hours. In ED, admissions are clerked by ED doctors as well as the specialist cardiology advanced nursing team (CATS). Upon transfer to cardiology, they are then re-clerked by an on-call junior doctor (JD). Our aim in this quality improvement project was to investigate the benefit of re-clerking cardiology patients by the JD. The CATS team clerking and plan were directly compared to the JD's plan across 100 patients by two reviewers. Data were also collected on the time spent performing a clerking by nine JDs. An alternative form of reviewing patients, which involved the JD reviewing the CATS clerking, bloods, observations and discussing with nursing staff, was performed in 29 cases. In 5% of cases a JD changed the management plan. Three cases were flagged to doctors by nursing staff, and two cases involved starting oral antibiotics. The average time spent clerking patients previously was 49.5 +/212 minutes (mean+/2SD). In the new method, this was 12.5 +/23 minutes. We conclude that 0mitting repetitive clerking does not disadvantage patients, while saving time for on-call JDs. Patients are also not woken up unnecessarily overnight, which may reduce the risk of delirium. We plan to rationalise our admission system.

The Mental Health of Health Care Workers in the UK During COVID-19: The Prevalence of Anxiety, Depression, and Stress.

Introduction: The COVID-19 pandemic had a significant impact on the mental health of health care workers (HCWs). Aim: This study investigated the mental health of HCWs working in Leicester, UK during COVID-19. Settings: Two hospital trusts in Leicester, UK. Methods: An online survey was sent to HCWs in two trusts in July 2020. The Generalized Anxiety Disorder-7 scale (GAD-7) and the Patient Health Questionnaire-9 scale (PHQ-9) were used to measure the prevalence rates of anxiety and depression. The Perceived Stress Scale-14 (PSS-14) was used to measure levels of perceived stress. Other questions were used to identify the prevalence of increased alcohol intake and possible risk factors. Statistical Analysis Used: Chi-square test, independent sample t-test, ANOVA, and logistic regression. Results: A total of 1009 HCWs completed the survey. Using a cutoff score of 5 (mild symptoms), for both GAD-7 and PHQ-9, 80.2% of participants had at least one condition and 71.5% had both. Using the cutoff score of 10 (moderate/severe symptoms), 27.2% had at least one condition and 27.25% had both conditions. In addition, 37.5% of those who did not report pre-existing mental health conditions now have at least one condition. About 33.6% of participants reported an increase in alcohol consumption. A number of risk factors were identified: having less social support, not feeling supported at work, and poor pre-existing mental health. Conclusions: The pandemic had a significant impact on mental health of HCWs. Health organizations need to monitor and address these emerging effects.

Autofluorescence in Parathyroidectomy: Signal Intensity Correlates with Serum Calcium and Parathyroid Hormone but Routine Clinical Use is Not Justified.

BACKGROUND: The inability to identify the pathological gland at surgery results in failure to cure hyperparathyroidism in 2-5%. The poorly understood characteristic of parathyroid tissue to manifest autofluorescence (AF) under near-infrared (NIR) light has been promoted as an intraoperative adjunct in parathyroid surgery. This study sought to explore potential clinical correlates for AF and assess the clinical utility of AF in parathyroid surgery. METHODS: Consecutive patients undergoing parathyroid surgery for primary and renal disease were included. NIR imaging was used intraoperatively and the degree of AF of parathyroid glands graded by the operating surgeon. Variables assessed for correlation with AF were: pre-operative serum calcium and PTH, SestaMIBI positivity, gland weight and histological composition. RESULTS: Ninety-six patients underwent parathyroidectomy over an 8-month period: 49 bilateral explorations, 41 unilateral and 6 focussed lateral approaches: 284 potentially 'visualisable' glands in total. Two hundred and fifty-seven glands (90.5%) were visualised with NIR. Correlation was found between the degree of fluorescence and pre-operative serum calcium and PTH, but not between gland weight and SestaMIBI positivity. In those with renal hyperparathyroidism, a predominance of oxyphil cells correlated with increased AF. CONCLUSION: Autofluorescence intensity correlates with serum calcium, PTH and gland composition. Further refinements would be required for this information to be of value in a clinical setting. Improvements allowing NIR to visualise the additional 9.5% of parathyroids and overcome the variation in signal intensity due to depth of access are required for the routine adoption of this technology. At present, its routine use in a clinical setting cannot be justified.