Experiences and perceptions of men following breast cancer diagnosis: a mixed method systematic review.

BACKGROUND: Men with breast cancer experience unique physical and emotional challenges. However, a thorough understanding of these experiences including the psychosocial effects and supportive care needs have received less attention. In some settings, men with breast cancer experience stigma within the healthcare system and their care needs are not prioritised. This influences the level of professional support offered, consequently worsening their health and well-being outcomes. This review explored the variabilities in the experiences and treatment modalities of male breast cancer (MBC) across different contexts. METHODS: All primary study designs including qualitative, quantitative, and mixed methods studies that reported on the experiences, treatment approaches and outcomes of MBC were included in this systematic review. Six databases (Embase, Medline, PsycINFO, Global Health, CINAHL and Web of Science) were searched for articles from January 2000 to September 2023. A results-based convergence synthesis was used for data analysis and reported using PRISMA guidelines. RESULTS: Of the studies screened (n = 29,687), forty-four fulfilled the predetermined criteria and were included. Our findings relating to the experiences and treatment approaches of MBC are broadly themed into three parts. Theme 1-Navigating through a threat to masculinity: describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with breast cancer, and disclosure. Theme 2- Navigating through treatment: captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. Theme 3-Coping and support systems: describes how MBC patients coped with the disease, treatment process, aftercare/rehabilitative care, and the available support structures. CONCLUSIONS: Men experience a myriad of issues following a breast cancer diagnosis, especially with their masculinity. Awareness creation efforts of MBC among the public and healthcare practitioners are urgently required, which could change the perception of men in promoting early diagnosis, adherence to treatments, post-treatment monitoring, oncological results and a better quality of life. Considerations for training, education and development of specialised guidelines for healthcare practitioners on MBC would provide the necessary knowledge and skills to enhance their practice through the adoption of person-centred and male-specific care strategies. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare including future research focusing on MBC specific clinical trials. TRIAL REGISTRATION: PROSPERO Registration No. CRD42021228778.

Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review.

INTRODUCTION: The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services. METHOD: An electronic search was performed across the following databases: PUBMED, CINAHL, Medline, SCOPUS, and ScienceDirect for articles published from January 2009 and June 2023. Articles were included if they fulfilled a predefined criteria mainly focused on experiences of PwD and/or other stakeholders when using the radiography services. Data obtained from the included studies were analysed using a result-based convergent synthesis. RESULT: Eleven studies from diverse settings met the inclusion criteria. A mix of both positive and negative experiences of PwD and stakeholders were reported following visits to radiology and radiotherapy departments were highlighted across settings. The findings were themed around the need for: person-centred care, effective communication, attitudinal changes of staff, specialised and improved clinical environment and inclusion of caregivers for the care of PwD. DISCUSSION: This study emphasise the critical importance of adopting holistic approaches to caring for PwD. This involves adopting a person-centred approach, actively involving caregivers, effective communication, and adequate training for radiographers to provide quality services, all in dementia-friendly environments. CONCLUSION: The experiences of various stakeholders highlight the need for a more holistic approach and strategy for the care and management of PwD within the context of the radiography services. This calls for an urgent need for a comprehensive strategy that includes awareness creation of staff to enhance the quality of care and the overall experience for PwD using the radiography services.

Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion : A Systematic Literature Review.

PURPOSE: This systematic review is aimed at synthesising the literature base to date on the frequency and topographical distribution of neuroanatomical changes seen on imaging following COVID-19 invasion with a focus on both the acute and chronic phases of the disease. METHODS: In this study, 8 databases were systematically searched to identify relevant articles published from December 2019 to March 2022 and supplemented with a manual reference search. Data were extracted from the included studies and narrative synthesis was employed to integrate the findings. RESULTS: A total of 110 studies met the inclusion criteria and comprised 119,307 participants (including 31,073 acute and 143 long COVID-19 patients manifesting neurological alterations) and controls. Considerable variability in both the localisation and nature of neuroanatomical abnormalities are noted along the continuum with a wide range of neuropathologies relating to the cerebrovascular/neurovascular system, (sub)cortical structures (including deep grey and white matter structures), brainstem, and predominant regional and/or global alterations in the cerebellum with varying degrees of spinal involvement. CONCLUSION: Structural regional alterations on neuroimaging are frequently demonstrated in both the acute and chronic phases of SARS-CoV­2 infection, particularly prevalent across subcortical, prefrontal/frontal and cortico-limbic brain areas as well as the cerebrovascular/neurovascular system. These findings contribute to our understanding of the acute and chronic effects of the virus on the nervous system and has the potential to provide information on acute and long-term treatment and neurorehabilitation decisions.

Knowledge, perceptions, and expectations of Artificial intelligence in radiography practice: A global radiography workforce survey.

BACKGROUND: Artificial Intelligence (AI) technologies have already started impacting clinical practice across various settings worldwide, including the radiography profession. This study is aimed at exploring a world-wide view on AI technologies in relation to knowledge, perceptions, and expectations of radiography professionals. METHODS: An online survey (hosted on Qualtrics) on key AI concepts was open to radiography professionals worldwide (August 1st to December 31st 2020). The survey sought both quantitative and qualitative data on topical issues relating to knowledge, perceptions, and expectations in relation to AI implementation in radiography practice. Data obtained was analysed using the Statistical Package for Social Sciences (SPSS) (v.26) and the six-phase thematic analysis approach. RESULTS: A total of 314 valid responses were obtained with a fair geographical distribution. Of the respondents, 54.1% (157/290) were from North America and were predominantly clinical practicing radiographers (60.5%, 190/314). Our findings broadly relate to different perceived benefits and misgivings/shortcomings of AI implementation in radiography practice. The benefits relate to enhanced workflows and optimised workstreams while the misgivings/shortcomings revolve around de-skilling and impact on patient-centred care due to over-reliance on advanced technology following AI implementation. DISCUSSION: Artificial intelligence is a tool but to operate optimally it requires human input and validation. Radiographers working at the interface between technology and the patient are key stakeholders in AI implementation. Lack of training and of transparency of AI tools create a mixed response of radiographers when they discuss their perceived benefits and challenges. It is also possible that their responses are nuanced by different regional and geographical contexts when it comes to AI deployment. Irrespective of geography, there is still a lot to be done about formalised AI training for radiographers worldwide. This is a vital step to ensure safe and effective AI implementation, adoption, and faster integration into clinical practice by healthcare workers including radiographers. CONCLUSION: Advancement of AI technologies and implementation should be accompanied by proportional training of end-users in radiography and beyond. There are many benefits of AI-enabled radiography workflows and improvement on efficiencies but equally there will be widespread disruption of traditional roles and patient-centred care, which can be managed by a well-educated and well-informed workforce.

Towards describing the global impact of the COVID-19 pandemic on clinical radiography education: A systematic review.

INTRODUCTION: The sudden onset of the COVID-19 pandemic has brought significant and rapid changes to the traditional ways of providing radiography education, including adaptations to teaching and learning styles as well as disruptions to students' clinical placement. This review explored the impact of the pandemic on clinical radiography education globally. METHODS: A systematic literature search was conducted on relevant databases, including PubMed, Science Direct, CINAHL (Cumulative Index of Nursing and Allied Health Literature, and SCOPUS. All relevant articles were critically appraised for quality and subjected to information extraction and results-based convergent synthesis. RESULTS: A total of 17 articles met the inclusion and exclusion criteria for this review. The key findings are themed around challenges and benefits with the introduction of new teaching and learning approaches and resilience exhibited by students during the pandemic to overcome: inadequate support and mentorship while transitioning to fully qualified professionals, challenges with PPE usage, and impact on personal and academic life. CONCLUSIONS: Globally, radiography students experienced several challenges, especially during the initial acute phase of the pandemic. The pandemic-related challenges identified in this review could negatively influence the radiography student attrition rates, consequently worsening the existing radiography workforce shortage. Thus, urgent institutional level support systems and interventions would be necessary to mitigate the pandemic impact and improve the students' learning experience.

Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems.

Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.

Normalization of impaired emotion inhibition in bipolar disorder mediated by cholinergic neurotransmission in the cingulate cortex.

The muscarinic-cholinergic system is involved in the pathophysiology of bipolar disorder (BD), and contributes to attention and the top-down and bottom-up cognitive and affective mechanisms of emotional processing, functionally altered in BD. Emotion processing can be assessed by the ability to inhibit a response when the content of the image is emotional. Impaired regulatory capacity of cholinergic neurotransmission conferred by reduced M2-autoreceptor availability is hypothesized to play a role in elevated salience of negative emotional distractors in euthymic BD relative to individuals with no history of mood instability. Thirty-three euthymic BD type-I (DSM-V-TR) and 50 psychiatrically-healthy controls underwent functional magnetic resonance imaging (fMRI) and an emotion-inhibition paradigm before and after intravenous cholinergic challenge using the acetylcholinesterase inhibitor, physostigmine (1 mg), or placebo. Mood, accuracy, and reaction time on either recognizing or inhibiting a response associated with an image involving emotion and regional functional activation were examined for effects of cholinergic challenge physostigmine relative to placebo, prioritizing any interaction with the diagnostic group. Analyses revealed that (1) at baseline, impaired behavioral performance was associated with lower activation in the anterior cingulate cortex in BD relative to controls during emotion processing; (2) physostigmine (vs. placebo) affected behavioral performance during the inhibition of negative emotions, without altering mood, and increased activation in the posterior cingulate cortex in BD (vs. controls); (3) In BD, lower accuracy observed during emotion inhibition of negative emotions was remediated by physostigmine and was associated with cingulate cortex overactivation. Our findings implicate abnormal regulation of cholinergic neurotransmission in the cingulate cortices in BD, which may mediate exaggerated emotional salience processing, a core feature of BD.

In vivo hippocampal subfield volumes in bipolar disorder-A mega-analysis from The Enhancing Neuro Imaging Genetics through Meta-Analysis Bipolar Disorder Working Group.

The hippocampus consists of anatomically and functionally distinct subfields that may be differentially involved in the pathophysiology of bipolar disorder (BD). Here we, the Enhancing NeuroImaging Genetics through Meta-Analysis Bipolar Disorder workinggroup, study hippocampal subfield volumetry in BD. T1-weighted magnetic resonance imaging scans from 4,698 individuals (BD = 1,472, healthy controls [HC] = 3,226) from 23 sites worldwide were processed with FreeSurfer. We used linear mixed-effects models and mega-analysis to investigate differences in hippocampal subfield volumes between BD and HC, followed by analyses of clinical characteristics and medication use. BD showed significantly smaller volumes of the whole hippocampus (Cohen's d = -0.20), cornu ammonis (CA)1 (d = -0.18), CA2/3 (d = -0.11), CA4 (d = -0.19), molecular layer (d = -0.21), granule cell layer of dentate gyrus (d = -0.21), hippocampal tail (d = -0.10), subiculum (d = -0.15), presubiculum (d = -0.18), and hippocampal amygdala transition area (d = -0.17) compared to HC. Lithium users did not show volume differences compared to HC, while non-users did. Antipsychotics or antiepileptic use was associated with smaller volumes. In this largest study of hippocampal subfields in BD to date, we show widespread reductions in nine of 12 subfields studied. The associations were modulated by medication use and specifically the lack of differences between lithium users and HC supports a possible protective role of lithium in BD.

Subcortical volumes across the lifespan: Data from 18,605 healthy individuals aged 3-90 years.

Age has a major effect on brain volume. However, the normative studies available are constrained by small sample sizes, restricted age coverage and significant methodological variability. These limitations introduce inconsistencies and may obscure or distort the lifespan trajectories of brain morphometry. In response, we capitalized on the resources of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to examine age-related trajectories inferred from cross-sectional measures of the ventricles, the basal ganglia (caudate, putamen, pallidum, and nucleus accumbens), the thalamus, hippocampus and amygdala using magnetic resonance imaging data obtained from 18,605 individuals aged 3-90 years. All subcortical structure volumes were at their maximum value early in life. The volume of the basal ganglia showed a monotonic negative association with age thereafter; there was no significant association between age and the volumes of the thalamus, amygdala and the hippocampus (with some degree of decline in thalamus) until the sixth decade of life after which they also showed a steep negative association with age. The lateral ventricles showed continuous enlargement throughout the lifespan. Age was positively associated with inter-individual variability in the hippocampus and amygdala and the lateral ventricles. These results were robust to potential confounders and could be used to examine the functional significance of deviations from typical age-related morphometric patterns.

Greater male than female variability in regional brain structure across the lifespan.

For many traits, males show greater variability than females, with possible implications for understanding sex differences in health and disease. Here, the ENIGMA (Enhancing Neuro Imaging Genetics through Meta-Analysis) Consortium presents the largest-ever mega-analysis of sex differences in variability of brain structure, based on international data spanning nine decades of life. Subcortical volumes, cortical surface area and cortical thickness were assessed in MRI data of 16,683 healthy individuals 1-90 years old (47% females). We observed significant patterns of greater male than female between-subject variance for all subcortical volumetric measures, all cortical surface area measures, and 60% of cortical thickness measures. This pattern was stable across the lifespan for 50% of the subcortical structures, 70% of the regional area measures, and nearly all regions for thickness. Our findings that these sex differences are present in childhood implicate early life genetic or gene-environment interaction mechanisms. The findings highlight the importance of individual differences within the sexes, that may underpin sex-specific vulnerability to disorders.

Cortical thickness across the lifespan: Data from 17,075 healthy individuals aged 3-90 years.

Delineating the association of age and cortical thickness in healthy individuals is critical given the association of cortical thickness with cognition and behavior. Previous research has shown that robust estimates of the association between age and brain morphometry require large-scale studies. In response, we used cross-sectional data from 17,075 individuals aged 3-90 years from the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to infer age-related changes in cortical thickness. We used fractional polynomial (FP) regression to quantify the association between age and cortical thickness, and we computed normalized growth centiles using the parametric Lambda, Mu, and Sigma method. Interindividual variability was estimated using meta-analysis and one-way analysis of variance. For most regions, their highest cortical thickness value was observed in childhood. Age and cortical thickness showed a negative association; the slope was steeper up to the third decade of life and more gradual thereafter; notable exceptions to this general pattern were entorhinal, temporopolar, and anterior cingulate cortices. Interindividual variability was largest in temporal and frontal regions across the lifespan. Age and its FP combinations explained up to 59% variance in cortical thickness. These results may form the basis of further investigation on normative deviation in cortical thickness and its significance for behavioral and cognitive outcomes.

Longitudinal Structural Brain Changes in Bipolar Disorder: A Multicenter Neuroimaging Study of 1232 Individuals by the ENIGMA Bipolar Disorder Working Group.

BACKGROUND: Bipolar disorder (BD) is associated with cortical and subcortical structural brain abnormalities. It is unclear whether such alterations progressively change over time, and how this is related to the number of mood episodes. To address this question, we analyzed a large and diverse international sample with longitudinal magnetic resonance imaging (MRI) and clinical data to examine structural brain changes over time in BD. METHODS: Longitudinal structural MRI and clinical data from the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) BD Working Group, including 307 patients with BD and 925 healthy control subjects, were collected from 14 sites worldwide. Male and female participants, aged 40 ± 17 years, underwent MRI at 2 time points. Cortical thickness, surface area, and subcortical volumes were estimated using FreeSurfer. Annualized change rates for each imaging phenotype were compared between patients with BD and healthy control subjects. Within patients, we related brain change rates to the number of mood episodes between time points and tested for effects of demographic and clinical variables. RESULTS: Compared with healthy control subjects, patients with BD showed faster enlargement of ventricular volumes and slower thinning of the fusiform and parahippocampal cortex (0.18

Impact of the COVID-19 pandemic on clinical radiography education: Perspective of students and educators from a low resource setting.

INTRODUCTION: The COVID-19 pandemic has had significant impact on clinical radiography educational activities including teaching, research, and clinical placement. The study aimed to investigate the impact of the COVID-19 pandemic on clinical radiography education in a low-resource setting from the perspectives of students and educators. METHODS: A cross-sectional online survey was conducted between December 2020 and March 2021. Participants included student radiographers and educators from six clinical radiography training institutions in Ghana. Conventional descriptive statistics, frequency, and thematic text analysis were undertaken. RESULTS: 291 valid responses were received involving 277 students and 14 educators. Most of the respondents, predominantly students did not find the online platforms for learning user-friendly. Key challenges to clinical radiography training during the pandemic included poor internet connectivity (73.8%), inadequate time for academic discussions (50.9%), and the reluctance of health facilities to accept students for clinical placement (51%). Challenges with data collection and the provision of supervision were issues associated with research activities. DISCUSSION: The findings suggest the COVID-19 pandemic has had significant impact on clinical radiography education in Ghana and other countries of similar resource availability. CONCLUSION: Clinical radiography training institutions need to customize approaches to education. Adopting blended learning approaches as well as the use of simulation to augment practical placement opportunities are new modes of instruction that will maximize learning experience.

Artificial intelligence in medical imaging practice in Africa: a qualitative content analysis study of radiographers' perspectives.

PURPOSE: Studies have documented the clinical potentials of artificial intelligence (AI) in medical imaging practice to improving patient care. This study aimed to qualitatively explore the perception of radiographers relating to the integration of AI in medical imaging practice in Africa. METHODS: The study employed a qualitative design using an open-ended online instrument administered between March and August 2020. Participants consisted of radiographers working within Africa during the time of the study. Data obtained were analysed using qualitative content analysis. Six themes of concerns were generated: expectant tool; career insecurity; cost of new technology, equipment preservation and data insecurity; service delivery quality; need for expanding AI awareness. RESULTS: A total of 475 valid responses were obtained. Participants demonstrated a positive outlook about AI in relation to clinical quality improvement, competent diagnosis, radiation dose reduction and improvement in research. They however expressed concerns relating to the implementation of this technology, including job security and loss of core professional radiographer skills and roles. In addition, concerns regarding AI equipment maintenance, lack of awareness about AI and education and training opportunities were evident. CONCLUSION: Awareness of the importance of AI in medical imaging practice was acknowledged; however, concerns relating to job security, data protection must be given critical attention for successful implementation of these advanced technologies in medical imaging in Africa. Inclusion of AI modules in the training of future radiographers is highly recommended.

Radiographers' perspectives on the emerging integration of artificial intelligence into diagnostic imaging: The Ghana study.

INTRODUCTION: The integration of artificial intelligence (AI) systems into medical imaging is advancing the practice and patient care. It is thought to further revolutionise the entire field in the near future. This study explored Ghanaian radiographers' perspectives on the integration of AI into medical imaging. METHODS: A cross-sectional online survey of registered Ghanaian radiographers was conducted within a 3-month period (February-April, 2020). The survey sought information relating to demography, general perspectives on AI and implementation issues. Descriptive and inferential statistics were used for data analyses. RESULTS: A response rate of 64.5% (151/234) was achieved. Majority of the respondents (n = 122, 80.8%) agreed that AI technology is the future of medical imaging. A good number of them (n = 131, 87.4%) indicated that AI would have an overall positive impact on medical imaging practice. However, some expressed fears about AI-related errors (n = 126, 83.4%), while others expressed concerns relating to job security (n = 35, 23.2%). High equipment cost, lack of knowledge and fear of cyber threats were identified as some factors hindering AI implementation in Ghana. CONCLUSIONS: The radiographers who responded to this survey demonstrated a positive attitude towards the integration of AI into medical imaging. However, there were concerns about AI-related errors, job displacement and salary reduction which need to be addressed. Lack of knowledge, high equipment cost and cyber threats could impede the implementation of AI in medical imaging in Ghana. These findings are likely comparable to most low resource countries and we suggest more education to promote credibility of AI in practice.

Australian radiographers' and radiation therapists' experiences during the COVID-19 pandemic.

INTRODUCTION: Radiographers and radiation therapists are key patient-facing health practitioners supporting the delivery of optimal patient care during the COVID-19 pandemic. The aim of this research was to investigate the impact of COVID-19 on clinical service delivery and well-being of these healthcare professionals in Australia. METHODS: A cross-sectional online survey of Australian radiographers and radiation therapists was conducted in June-July 2020. The survey collected data on demographic characteristics, and the impact of COVID-19 on professional practice, infection control and workplace-related stress. RESULTS: A total of 218 responses were received. Changes in work hours (P < 0.001) and workload (P = 0.022) were experienced due to COVID-19. Diagnostic radiographers reported increased procedural pressure on mobile radiography, computed tomography and general radiography. For radiation therapists, most pressure included areas of simulation and linear accelerator. PPE was in short supply at the start of the pandemic, and at the time of the study, shortages were identified for all PPE items. There was no difference in PPE supply reported by diagnostic radiographers and radiation therapists except for hand sanitiser (P = 0.003). Respondents experienced increased personal stress (61.4%) and anxiety (58.2%) at work due to COVID-19. In addition, their work caused increased stress to their family, partners or friends (57.4%). CONCLUSIONS: COVID-19 has resulted in changes to clinical working patterns and service delivery. PPE shortages, as well as increased workplace-related stress, were identified. Workplaces should seek to mitigate the pandemic impact through the provision of adequate PPE for safe practice as well as implement strategies to support and enhance staff well-being.

White matter microstructure and structural networks in treatment-resistant schizophrenia patients after commencing clozapine treatment: A longitudinal diffusion imaging study.

This study investigates changes on white matter microstructure and neural networks after 6 months of switching to clozapine in schizophrenia patients compared to controls, and whether any changes are related to clinical variables. T1 and diffusion-weighted MRI images were acquired at baseline before commencing clozapine and after 6 months of treatment for 22 patients with treatment-resistant schizophrenia and 23 controls. The Tract-based spatial statistics approach was used to compare changes over time between groups in fractional anisotropy (FA). Changes in structural network organisation weighted by FA and number of streamlines were assessed using graph theory. Patients displayed a significant reduction of FA over time (p<0.05) compared to controls in the genu and body of the corpus callosum and bilaterally in the anterior and superior corona radiata. There was no correlation between FA change in patients and changes in clinical variables or serum level of clozapine. There was no changes in structural network organisation between groups (F(7,280)=2.80;p = 0.187). This longitudinal study demonstrated progressive focal FA abnormalities in key anterior tracts, but preserved brain structural network organisation in patients. The FA reduction was independent of any clinical measures and may reflect progression of the underlying pathophysiology of this malignant form of schizophrenia illness.

Impact of the COVID-19 pandemic on radiography practice: findings from a UK radiography workforce survey.

OBJECTIVES: Radiographers are key patient-facing healthcare professionals involved in many aspects of patient care. The working patterns and professional practice of the radiography workforce (RW) has been altered during the COVID-19 pandemic. This survey aimed to assess the impact of the pandemic on radiography practice in the United Kingdom (UK). METHODS: An online cross-sectional survey of the UK RW was performed (March 25th to April 26th, 2020). The survey sought information regarding 1. Demographics 2. Impact of the pandemic on professional practice 3. Infection prevention/control and 4. COVID-19 related stress. Data collected was analysed using the Statistical Package for Social Sciences (v.26). RESULTS: A total of 522 responses were received, comprising n = 412 (78.9%) diagnostic and n = 110 (21.1%) therapeutic RW categories from across the UK. 12.5% (65/522) of the respondents were redeployed. Redeployment did not appear to contribute (p = 0.31) to work-related stress. However, fear of contracting the infection and perceived inadequate personal protective equipment (PPE) were identified as key contributors to stress during the study period. Compared to the therapeutic RW, a significantly higher proportion of the diagnostic RW identified fear of being infected as a major stressor (166/412 (40.3%) vs 30/110 (27.3%), p = 0.01). CONCLUSION: This survey has demonstrated changes to clinical practice, in particular to working patterns, service delivery and infection prevention and control were key contributors to workplace-related stress during the pandemic. ADVANCES IN KNOWLEDGE: Timely and adequate staff training and availability of PPE as well as psychosocial support during future pandemics would enhance quality patient and staff safety.