Two-stage mental health survey of first-line medical staff after ending COVID-19 epidemic assistance and isolation.

Facing with COVID-19 epidemic such a catastrophic health emergency, the mental health status of medical staff deserves attention. We conducted a two-stage of psychological status monitoring after the end of the assistance and 14 days of isolation, further targeted the vulnerable groups in need of intervention. The study is a cross-sectional survey on 1156 Yunnan medical staff aid to Hubei. Used Cluster sampling method to collect data at 2 time points (at the end of returning from Wuhan and the 14th day of isolation), from March 18, 2020 to April 6, 2020. Female and nurse had higher rates of depressive symptoms than male and doctors and other occupations. The proportion of female with mild and above moderate anxiety levels (22.91%, 2.61%) was higher than male (17.35%, 1.03%) (p < 0.05). Female had a better impaired sleep quality (45.06%, 17.49%) more than male (28.57%, 7.94%). Medical staff supported in Wuhan and with junior professional titles reported a higher proportion of sleep quality impairment. At the 14th isolation day stage, the proportion of nurses changed from depression to health (9.15%) and from health to depression (6.1%) better than doctors. The front-line medical staffs had suffered greater psychological pressure in the treatment process of major public health emergency. Researches on the dynamic monitor for the change of psychological status after aiding epidemic areas were still in relatively blank stage. Targeting the vulnerable characteristics of aiding medical staff is significant for effective psychological intervention and sustainable operation of health system.

An Investigation of Mental Health Status Among Medical Staff Following COVID-19 Outbreaks: A Cross-Sectional Study.

BACKGROUND COVID-19 (coronavirus disease 2019) broke out in China. This study was to investigate the situation of mental health status among medical staff following COVID-19. MATERIAL AND METHODS A cross-sectional study was conducted through structured questionnaires to collect the demographical information of the participating medical staff via WeChat following COVID-19 crisis. The Center for Epidemiologic Studies-Depression Scale (CES-D), impact of events scale revised (IES-R), and Pittsburgh Sleep Quality Index (PSQI) scale were used to evaluate depression, post-traumatic stress disorder (PTSD) symptoms, and sleep quality, respectively. 95% confidence intervals (CI) were calculated. RESULTS A total of 597 medical staff's information was included for the statistical analysis, and found 45.23% of subjects had PTSD symptoms, the mean PSQI score was 6.320±3.587. The results of multivariable analysis implied that medical workers who did not participate in the Hubei aid program (ß=4.128; 95% CI, 0.983-7.272; P=0.010) and PTSD symptoms (ß=7.212; 95% CI, 4.807-9.616; P<0.001) were associated with a higher tendency to depression. The PSQI score was linearly related to the CES-D score (ß=1.125; 95% CI, 0.804-1.445; P<0.001). Subgroup analysis showed that medical workers who did not participate in the Hubei aid program, no traumatic experience before COVID-19 outbreaks, and PTSD symptoms may affect the tendency to depression in females, but not in males. PSQI score was linearly related to the CES-D score both in males and females. CONCLUSIONS The medical staff with PTSD symptoms and higher PSQI score may have a higher tendency to depression following COVID-19 outbreaks.

Protocol for percutaneous tracheostomy and prevention of COVID-19 transmission.

INTRODUCTION: Currently we are faced with countless patients with prolonged invasive mechanical ventilation as a result of the COVID-19 pandemic, with the consequent increase in the need for tracheostomies and the risks that this includes for both patients and staff. OBJECTIVE: It is necessary to establish a safety protocol for the performance of percutaneous tracheostomies in order to reduce the associated infections. MATERIAL AND METHODS: 77 patients underwent tracheostomies between March 2020 and March 2021, evaluating the safety of the protocol and the rate of contagion among the staff. RESULTS: Percutaneous tracheostomy was performed according to the protocol in 72 patients, 5 were excluded due to unfavorable anatomy or other reasons. There were no cases of SARS COVID-19 contagion among health personnel attributable to the procedure during the three-week follow-up period. There were no surgical complications in this series. CONCLUSION: The authors recommend implementing security protocols such as the one discussed in this work, given its low contagion rate and ease of implementation.

Prevalence and influencing factors of anxiety and depression symptoms among the first-line medical staff in Wuhan mobile cabin hospital during the COVID-19 epidemic: A cross-sectional survey.

ABSTRACT: To investigate the prevalence of anxiety and depressive symptoms and the associated risk factors among first-line medical staff in Wuhan during the coronavirus disease 2019 (COVID-19) epidemic.From March 5 to 15, 2020, the Hamilton Anxiety Scale and Hamilton Depression scale were used to investigate the anxiety and depression status of medical staff in Wuhan Cabin Hospital (a Hospital). Two hundred seventy-six questionnaires were received from 96 doctors and 180 nurses, including 79 males and 197 females.During the COVID-19 epidemic, the prevalence rate of anxiety and depression was 27.9% and 18.1%, respectively, among 276 front-line medical staff in Wuhan. The prevalence rate of anxiety and depression among doctors was 19.8% and 11.5%, respectively, and the prevalence rate of anxiety and depression among nurses was 32.2% and 21.7%, respectively. Females recorded higher total scores for anxiety and depression than males, and nurses recorded higher scores for anxiety and depression than doctors.During the COVID-19 epidemic, some first-line medical staff experienced mental health problems such as depression and anxiety. Nurses were more prone to anxiety and depression than doctors. Effective strategies toward to improving the mental health should be provided to first-line medical staff, especially female medical staff and nurses.

Síntomas de ansiedad y depresión en personal de salud que trabaja con enfermos de COVID-19 / Anxiety and depression symptoms in health personnel who work with COVID-19 patients

El personal de salud pública que se enfrenta a la COVID-19, está expuesto a múltiples riesgos entre ellos los trastornos psicológicos. El objetivo de este estudio fue determinar la presencia de síntomas asociados a ansiedad y depresión en personal de salud que trabaja con enfermos de la COVID-19. Se realizó un estudio descriptivo de corte transversal en el que participaron 61 profesionales y técnicos de atención sanitaria, que trabajaban directamente con pacientes con COVID-19, a los cuales se les consultó acerca de la presencia de síntomas asociados a la depresión y ansiedad, sus principales preocupaciones y el tiempo de trabajo continuo para evitar la aparición de síntomas psicológicos. El 64,1% de los participantes relató nerviosismo y 59,2% cansancio, para el 90,16% la principal preocupación fue el fallecimiento del paciente y el 60,66% de los participantes indicó que el período ideal, de atención continua de pacientes COVID-19, para evitar la aparición de síntomas psicológicos era de 7 días. Nuestros resultados sugieren que es necesario elaborar estrategias de trabajo para disminuir la aparición de síntomas asociados al deterioro de la salud mental de los profesionales de la salud que atienden pacientes COVID-19

Public health personnel facing COVID-19 are exposed to multiple risks including psychological disorders. The goal of this study was to determine the presence of symptoms associated with anxiety and depression in health personnel working with COVID-19 patients. A descriptive cross-sectional study involving 61 health care professionals and technicians was conducted, working directly with COVID-19 patients, who were consulted about the presence of symptoms associated with depression and anxiety, their main concerns and ongoing working time to avoid the onset of psychological symptoms. 64.1% of participants reported nervousness and 59.2% tiredness, for 90.16% the main concern was the patient's death and 60.66% of participants indicated that the ideal period, of continuous care of COVID-19 patients, to prevent the onset of psychological symptoms was 7 days. Our results suggest that work strategies need to be developed to decrease the onset of symptoms associated with deteriorating mental health of health professionals caring for COVID-19 patients

Epidemiological, Clinical, Radiological Characteristics and Outcomes of Medical Staff with COVID-19 in Wuhan, China: Analysis of 101 Cases.

Objectives: As of 11 Feb 2020, a total of 1,716 medical staff infected with laboratory-confirmed the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) in China had been reported. The predominant cause of the infection among medical staff remains unclear. We sought to explore the epidemiological, clinical characteristics and prognosis of infected medical staff. Methods: Medical staff who infected with SARS-Cov-2 and admitted to Union Hospital, Wuhan between 16 Jan to 25 Feb, 2020 were included in this single-centered, retrospective study. Data were compared by occupation and analyzed with the Kaplan-Meier and Cox regression methods. Results: A total of 101 medical staff (32 males and 69 females; median age: 33) were included in this study and 74.3% were nurses. A small proportion of the cohort had contact with specimens (3%) as well as patients infected with SARS-Cov-2 in fever clinics (15%) and isolation wards (3%). 80% of medical staff showed abnormal IL-6 levels and 33% had lymphocytopenia. Chest CT mainly manifested as bilateral (62%), septal/subpleural (77%) and groundglass opacities (48%). The major differences between doctors and nurses manifested in laboratory indicators. As of the last observed date, no patient was transferred to intensive care unit or died. Fever (HR=0.57; 95% CI 0.36-0.90) and IL-6 levels greater than 2.9 pg/ml (HR=0.50; 95% CI 0.30-0.86) were unfavorable factors for discharge. Conclusions: Our findings suggested that the infection of medical staff mainly occurred at the early stages of SARS-CoV-2 epidemic in Wuhan, and only a small proportion of infection had an exact mode. Meanwhile, medical staff infected with COVID-19 have relatively milder symptoms and favorable clinical course than ordinary patients, which may be partly due to their medical expertise, younger age and less underlying diseases. The potential risk factors of fever and IL-6 levels greater than 2.9 pg/ml could help to identify medical staff with poor prognosis at an early stage.

Lacking Communication Would Increase General Symptom Index Scores of Medical Team Members During COVID-19 Pandemic in China: A Retrospective Cohort Study.

There are few studies on the psychological status of medical staff during the COVID-19 outbreak. Our study addresses whether lack of communication affects the psychological status of medical team members supporting Wuhan during the COVID-19 pandemic in China. We used general symptom index (GSI) scores of the Symptom Checklist-90 (SCL-90) to evaluate participants' psychological status. We adopted a stratified sampling method and selected the fourth team, with a total of 137 members, as participants. In total 76.6% and 69.7% of female and male participants, respectively, had bachelor's degrees; 41.6% and 21.2% of female and male participants, respectively, were unmarried. Regarding communication, 14.29% and 6.06% of female and male participants, respectively, reported a lack of communication with the team (LCWT). Additionally, 13.0% and 6.1% of female and male participants, respectively, experienced fear of being infected (FoBI). LCWT and FoBI were positively correlated with GSI score (estimated change = 0.2, 95% CI [0.1-0.3]). When adjusted for gender, age, and FoBI, LCWT was positively correlated with GSI score (P < .05). Increasing communication among medical team members can reduce GSI scores.

Are We Speaking the Same Language? Communicating Diagnostic Probability in the Radiology Report.

OBJECTIVE. The purpose of this study was to evaluate the level of agreement in diagnostic probability for selected phrases among radiologists and emergency medicine (EM) physicians. MATERIALS AND METHODS. A survey was distributed to the radiologists and EM physicians at our academic institution. Respondents selected the degree of diagnostic probability they believe was conveyed by 18 commonly used phrases chosen from studies in the radiology literature. Potential responses for the degree of diagnostic probability were < 10%, ≈ 25%, ≈ 50%, ≈ 75%, and > 90%. RESULTS. Seventy-eight percent (28/36) of EM residents and 56% (14/25) of EM attending physicians (combined fellows and attending physicians) completed the survey; 83% (15/18) of radiology residents and 81% (17/21) of radiology attending physicians completed the survey. There was a high degree of shared understanding for most phrases between the departments except for the phrase "compatible with," which was associated with a higher degree of diagnostic probability by radiologists than by EM physicians (p = .02). Although no term was significantly more specific than any other within the ≈ 50% category or below, "most likely" and "diagnostic of" were significantly more specific than other terms in the ≈ 75% and > 90% categories, respectively. CONCLUSION. The results of this study show a high degree of shared understanding between radiologists and EM physicians for most of the phrases (17/18) in the survey. The only phrase that showed a significant difference was "compatible with." These results can be used to generate diagnostic probability groups with suggested phrases that can be used when creating radiology reports, thereby improving communication with the emergency department.

Mentorship Initiatives in Radiation Oncology: A Scoping Review of the Literature.

PURPOSE: Although mentorship is described extensively in academic medical literature, there are few descriptions of mentorship specific to radiation oncology. The goal of the current study was to investigate the state of mentorship in radiation oncology through a scoping review of the literature. METHODS AND MATERIALS: A search protocol was defined according to Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Predefined search terms and medical subject headings were used to search PubMed for English language articles published after January 1, 1990, on mentorship in radiation oncology. Additionally, in-press articles from major radiation oncology and medical education journals were searched. Three reviewers determined article eligibility. Included articles were classified based on predefined evaluation criteria. RESULTS: Fourteen publications from 2008 to 2019 met inclusion criteria. The most commonly described form of mentorship was the dyad (64.3%), followed by team (14.3%) and peer (7.1%); 2 articles did not specify mentorship type (14.3%). The most commonly mentored participants were residents (35.7%), followed by medical students (35.7%) and attendings (21.4%); 1 study included participants of all levels (7.1%). Thirteen studies (92.9%) identified an experimental study design, most of which were cross-sectional (42.9%), followed by cohort studies (28.6%) and before/after (21.4%). Median sample size, reported in 12 of 13 experimental studies, was 132 (coefficient of variation, 1.06). Although outcomes varied widely, the majority described successful implementation of mentorship initiatives with high levels of participant satisfaction. CONCLUSIONS: Although few initiatives are currently reported, the present study suggests that these initiatives are successful in promoting career development and increasing professional satisfaction. The interventions overwhelmingly described mentorship dyads; other forms of mentorship are either less common or understudied. Limitations included interventions not being evaluated in a controlled setting, and many were assessed using surveys with low response rates. This review highlights rich opportunities for future scholarship to develop, evaluate, and disseminate radiation oncology mentorship initiatives.

Anxiety and depression symptoms of medical staff under COVID-19 epidemic in China.

BACKGROUND: It is well known that unexpected pandemic has led to an increase in mental health problems among a variety of populations. METHODS: In this study, an online non-probability sample survey was used to anonymously investigate the anxiety and depression symptoms among medical staff under the COVID-19 outbreak. The questionnaire included Perceived Stress Scale-10 (PSS-10), Generalized Anxiety Disorder 7-Item Scale (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Factors associated with anxiety and depression symptoms were estimated by logistic regression analysis. RESULTS: A total of 1090 medical staff were investigated in this study. The estimated self-reported rates of anxiety symptoms, depression symptoms and both of the two were 13.3%, 18.4% and 23.9% respectively. Factors associated with self-reported anxiety symptoms include married status (OR=2.3, 95%CI: 1.2, 4.4), not living alone (OR=0.4, 95%CI: 0.2, 0.7), never confiding their troubles to others (OR=2.2, 95%CI: 1.4, 3.5) and higher stress (OR=14.4, 95%CI: 7.8, 26.4). Factors associated with self-reported depression symptoms include not living alone (OR=0.4, 95%CI: 0.3, 0.7), sometimes/often getting care from neighbours (OR=0.6, 95%CI: 0.4, 0.9), never confiding their troubles to others (OR=2.0, 95%CI: 1.3, 3.0) and higher stress (OR=9.7, 95%CI: 6.2, 15.2). LIMITATIONS: The study was a non-probability sample survey. Besides, scales used in this study can only identify mental health states. CONCLUSIONS: Under outbreak of COVID-19, self-reported rates of anxiety symptoms and depression symptoms were high in investigated medical staff. Psychological interventions for those at high risk with common mental problems should be integrated into the work plan to fight against the epidemic.

Pressure injury related to the use of personal protective equipment in COVID-19 pandemic.

OBJECTIVE: To describe the prevalence and factors associated with pressure injuries related to the use of personal protective equipment during the COVID-19 pandemic. METHODS: Cross-sectional study conducted using an instrument made available in social networks with 1,106 health professionals. The data were analyzed using descriptive statistics and compared, considering pvalue < 0.05. RESULTS: There was a prevalence of 69.4% for pressure injuries related to the use of personal protective equipment, with an average of 2.4 injuries per professional. The significant factors were: under 35 years of age, working and wearing personal protective equipment for more than six hours a day, in hospital units, and without the use of inputs for protection. CONCLUSION: Pressure injuries related to the use of medical devices showed a high prevalence in this population. The recognition of the damage in these professionals makes it possible to advance in prevention strategies.

The mediation effects of coping style on the relationship between social support and anxiety in Chinese medical staff during COVID-19.

BACKGROUND: The COVID-19 has been a pandemic around the world, which affirmatively brought mental health problems to medical staff. We aimed to investigate the prevalence of anxiety in Chinese medical staff and examine the mediation effects of coping styles on the relationship between social support and anxiety. METHODS: A cross-sectional study via internet survey was conducted from 15 March to 30 March, 2020. The social demographic data, Self-rated Anxiety Scale, Social Support Rate Scale and Trait Coping Style Scale were collected. Pearson correlation and a structural equation model were performed to examine the relationships of these variables. The bootstrap analysis was conducted to evaluate the mediation effects. RESULTS: A total of 453 medical staff participated in this study. The mean score of SAS was 46.1 (SD = 10.4). Up to 40.8% of the participants had anxiety symptoms. The participants lived with family members had lower SAS score (45.1 ± 9.8 vs 49.6 ± 11.8). Social support was negatively associated with anxiety, mediated by positive coping and negative coping partially significantly with an effect size of - 0.183. CONCLUSIONS: Chinese medical staff had a high level of anxiety during the COVID-19 pandemic. Coping styles had effects on the association between social support and anxiety. Sufficient social support and training on positive coping skills may reduce anxiety in medical staff.

[Psychological and behavior status of minor children of medical staff during the COVID-19 epidemic in Hubei province].

OBJECTIVE: To investigate the psychological and behavior status of minor children of medical staff in Hubei province during the coronavirus disease 2019 (COVID-19) epidemic. METHODS: A cross-sectional questionnaire survey was conducted through WeChat from March 13 to 15, 2020, which included a general data questionnaire and Conners parental assessment questionnaire (PSQ). The questionnaires received from outside of Hubei province were excluded through IP address, and the questionnaires with answer time <150 s were also excluded. The influence of parental work status on the psychological behavior was analyzed in children of different age groups. RESULTS: A total of 391 valid questionnaires were collected, there were 207 males (52.9%) and 184 females (47.1%); 91 (23.3%) aged 3 to 6, 183 (46.8%) aged 6 to 10, and 117 (29.9%) aged 10 to 16. Both parents were medical staff in 87 participants(22.3%), one parent was medical staff in 139(35.5%) participants, and no parents were medical staff in 165 (42.2%) participants. In 3-<6 years group, there was no significant difference in the PSQ scores of the children in each factor level (all P>0.05) between children with parents as medical staff and those without. In 6-<10 years group, children with both parents as medical staff had higher hyperactivity-impulse factor score, learning problem factor score and total score than those without parents as medical staff (all P<0.05), while they had higher learning problem factor score than those with one parent as medical staff (P<0.05); the anxiety score of children with one or both parents as medical staff was higher than that of those without parents as medical staff (all P<0.05). In 10 to 16 years group, the behavior problems, learning problems, hyperactivity-impulse, more dynamic index and the total score in children with one parent as medical staff were lower than those with both parents as medical staff or without parents as medical staff (P<0.05 or P<0.01); while there were no significant differences in psychosomatic problems, anxiety factor scores between children with one parent as medical staff and other two groups (all P>0.05). CONCLUSIONS: s During COVID-19 epidemic period, the psychological and behavior status of minor children of Hubei medical staff with different ages shows differences with those without parents as medical staff, particularly in 6-<10 years and 10 to 16 year groups. It is necessary to pay attention to the psychological and behavioral status of children of medical staff in these age groups.

Description of COVID-19 hospitalized health worker cases in the first nine weeks of the pandemic, Brazil, 2020. / Descrição dos casos hospitalizados pela COVID-19 em profissionais de saúde nas primeiras nove semanas da pandemia, Brasil, 2020.

OBJECTIVE: To describe COVID-19 hospitalized health worker cases in Brazil. METHODS: This was a descriptive case series study; it included cases that became ill between February 21st and April 15th, 2020 registered on the Influenza Surveillance Information System (SIVEP-Gripe, acronym in Portuguese). RESULTS: Of the 184 cases, 110 (59.8%) were female and median age was 44 years (min-max: 23-85); 89 (48.4%) were nursing professionals and 50 (27.2%) were doctors. Ninety-two (50.0%) presented comorbidity, with heart disease predominating (n=37; 40.2%). Of the 112 professionals with a record of case progression, 85 (75.9%) were cured and 27 (24.1%) died, 18 of whom were male. CONCLUSION: The profile of COVID-19 hospitalized health workers is similar to that of the general population with regard to age and comorbidities, but different in relation to sex. The most affected areas were nursing and medicine.

Efficiency of microvascular free flap reconstructive surgery: An observational study.

OBJECTIVE: We aimed to assess operative workflow and efficiency in microvascular free flaps via a direct observational study based on Lean principles of quality improvement (QI). METHODS: Observers monitored the workflow of twenty-three free flaps. Pre-operative preparation and surgical duration was recorded with supplemental data provided from our institution's surgical tracking database. Traffic patterns of operating room (OR) staff were documented as "entries" and "exits" from the OR and classified by role and the reason that the entry or exit was required. Patient data was obtained via chart review. RESULTS: The mean surgical time was 9.0 h. Approximately 20% of OR time was dedicated to the pre-incision process, averaging 1.6 h per case. One third of entries and exits occurred during this period. In total, 180.2 surgical hours were observed during which 6215 "entries" and "exits" occurred. The mean number of entries and exits per case was 270; the most common reasons were supplies and communication. No association was observed between elapsed surgical time or total number of entries and exits with post-operative infection rates. CONCLUSION: Comprehensive observational workflow studies of free flaps are challenging to execute due to lengthy procedure times. At our high-volume institution, a significant portion of OR time is devoted to the pre-incision period, largely due to inadequate supply availability and pre-operative communication. These findings will serve as a foundation for QI interventions at our institution, while our observational model provides a broadly applicable framework for assessing surgical efficiency.

Determinants of improved data consistency across routine immunization data tools for health facilities in Kano State, Nigeria.

INTRODUCTION: in this study, determinants of improved data consistency for routine immunization information at health facilities was measured to identify associated factors. METHODS: between June and August 2015, 1055 HFs were visited across 44 Local Government Areas in Kano state. We assessed data consistency, frequency of supportive supervision visits, availability of trained staff and attendance to monthly LGA RI review meetings. We compared RI monthly summary forms (MSF) versus national health management information system summary form (NHMIS) and vaccine management form 1a (VM1a) versus HF vaccine utilization summary monthly summary (HFVUM) for consistency. Data consistency at HF was determined at <+10% between number of children reportedly immunized, and doses of vaccine opened using 3 antigens (BCG, Penta and Measles). Levels of discrepancy <10% were considered as good data consistency. Bivariate and multivariate analysis used to determine association. RESULTS: data Consistency was observed in 195 (18.5%) HFs between (MSF vs NHMIS) and 90 (8.5%) HFs between (VM1a vs HFVUM). Consistency between MSF vs NHMIS was associated with receiving one or more SS visits in the previous month (p=0.001), data collection tools availability (p=0.001), recent attendance to monthly LGA RI review meeting and availability of trained staff. Data consistency between VM1a form and the HF VU summary was associated with a recent documented SS visit (p=0.05) and availability of trained staff (p=0.05). CONCLUSION: low level of data consistency was observed in Kano. Enhanced SS visits and availability of trained staff are associated with improved data quality.

Increased risk of SARS-CoV-2 infection in staff working across different care homes: enhanced CoVID-19 outbreak investigations in London care Homes.

BACKGROUND: Care homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England. METHODS: Care home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. RESULTS: In total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9-4.8; P<0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes. CONCLUSIONS: SARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.

Seasonal variations in pancreatic surgery outcome A retrospective time-trend analysis of 2748 Whipple procedures.

BACKGROUND: Observing cyclic patterns in surgical outcome is a common experience. We aimed to measure this phenomenon and to hypothesize possible causes using the experience of a high-volume pancreatic surgery department. METHODS: Outcomes of 2748 patients who underwent a Whipple procedure at a single high-volume center from January 2000 to December 2018 were retrospectively analyzed. Three different hypotheses were tested: the effect of climate changes, the "July effect" and the effect of vacations. RESULTS: Clavien-Dindo ≥ 3 morbidity was similar during warm vs. cold months (22.5% vs. 19.8%, p = 0.104) and at the beginning of activity of new trainees vs. the rest of the year (23.5 vs. 22.5%, p = 0.757). Patients operated when a high percentage of staff is on vacation showed an increased Clavien-Dindo ≥ 3 morbidity (22.3 vs. 18.5%, p = 0.022), but similar mortality (2.3 vs. 1.8%, p = 0.553). The surgical waiting list was also significantly longer during these periods (37 vs. 27 days, p = 0.037). Being operated in such a period of the year was an independent predictor of severe morbidity (OR 1.271, CI 95% 1.086-1.638, p = 0.031). CONCLUSION: Being operated when more staff is on vacation significantly affects severe morbidity rate. Future healthcare system policies should prevent the relative shortage of resources during these periods.