Factors associated with sickness absence in a large NHS Trust.

BACKGROUND: Sickness absence rates vary widely across a large acute NHS Trust, with the highest rates in some of the largest directorates. AIMS: This study was aimed to identify factors associated with sickness absence in teams and to inform interventions to improve staff health and well-being. METHODS: Using 2018 data from the electronic staff record and NHS Staff Survey, we examined variables associated with cost centre sickness absence rates, perceived abuse and staff engagement scores using multivariable linear regression. RESULTS: Data were available for 9362/15 423 (61%) of staff. Cost centre sickness absence was significantly positively associated with predominance of nursing and midwifery staff (ß = 0.28 [0.012-0.55]) and significantly inversely associated with predominance of medical and dental staff (ß = -0.94 [-1.2 to -0.65]) and proportion white (ß = -1.11 [-1.9 to -0.37]). Cost centre sickness absence was not significantly associated with staff engagement, reported abuse, age or higher headcount. Cost centre staff engagement was significantly positively associated with proportion white (ß = 0.98 [0.42-1.6]). Reported abuse by managers (ß = -13 [-22 to -4.2]) and by colleagues (ß = -24 [-35 to -12]) was significantly inversely associated with proportion white. Reported abuse by colleagues was significantly associated with predominance of medical and dental (ß = 7.6 [2.3-13]) and nursing and midwifery staff (ß = 9.1 [4.4-14]). CONCLUSIONS: These observed associations of sickness absence, staff engagement and perceived abuse with job mix and ethnicity should be further explored. Individual or team-level data, rather than cost centre-level data, might more meaningfully elucidate why sickness absence rates vary between groups of staff.

Emotion regulation and burnout in doctors: a systematic review.

BACKGROUND: Burnout is a pervasive health condition affecting many doctors at various stages in their careers. Characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment it can result in significant personal and professional consequences putting patient care at risk. Emotion regulation describes a capacity to self-modulate emotions to achieve desirable emotional outcomes. Emotional intelligence theory suggests that emotion regulation skills facilitate the maintenance of appropriate emotions, reducing or adapting undesirable emotions in oneself and others. Emotion regulation is usually automatic but can be controlled through learnt strategies. There is evidence that occupationally stressed individuals are less capable of down-regulating negative emotions. This paper systematically reviews studies of the role of emotion regulation in burnout in doctors. AIMS: To examine the relationship between emotion regulation and burnout among doctors. METHODS: Four online databases (Psych Info 1833-2017, Medline 1928-2017, Scopus 1960-2017 and Embase 1974-2017) were searched in August 2017. Searches returned 15 539 citations, which after de-duplication yielded 12 295 citations. After title and abstracts screening 12 273 citations were excluded. Twenty-two full text articles were read and eight excluded for ineligibility. Following data extraction, bias and methodological quality assessment, findings were synthesized using descriptive analysis and presented according to relevant themes. RESULTS: A correlative relationship was observed between emotion regulation and burnout in doctors. Findings also indicated that-using self-regulatory or taught emotion regulation skills or interventions such as mindfulness were associated with a reduction in burnout. CONCLUSION: Emotion regulation is an important psychological variable associated with burnout.

Randomized controlled trial of computerized cognitive behavioural therapy for depressive symptoms: effectiveness and costs of a workplace intervention.

BACKGROUND: Depression and anxiety are major causes of absence from work and underperformance in the workplace. Cognitive behavioural therapy (CBT) can be effective in treating such problems and online versions offer many practical advantages. The aim of the study was to investigate the effectiveness of a computerized CBT intervention (MoodGYM) in a workplace context. METHOD: The study was a phase III two-arm, parallel randomized controlled trial whose main outcome was total score on the Work and Social Adjustment Scale (WSAS). Depression, anxiety, psychological functioning, costs and acceptability of the online process were also measured. Most data were collected online for 637 participants at baseline, 359 at 6 weeks marking the end of the intervention and 251 participants at 12 weeks post-baseline. RESULTS: In both experimental and control groups depression scores improved over 6 weeks but attrition was high. There was no evidence for a difference in the average treatment effect of MoodGYM on the WSAS, nor for a difference in any of the secondary outcomes. CONCLUSIONS: This study found no evidence that MoodGYM was superior to informational websites in terms of psychological outcomes or service use, although improvement to subthreshold levels of depression was seen in nearly half the patients in both groups.

Occupational transmission of hepatitis C in healthcare workers and factors associated with seroconversion: UK surveillance data.

The study aims were to describe a case series of occupationally acquired hepatitis C (HCV) infections in UK healthcare workers and examine factors associated with transmission using exposure data reported to the Health Protection Agency between July 1997 and December 2007. Fifteen reported cases of documented HCV seroconversion occurred after percutaneous exposure, the majority from hollow-bore needles used in the source patient's vein or artery and contaminated with blood or blood-stained fluid. The seroconversion rate was 2.2% (14/626). In multivariable analysis of healthcare workers with percutaneous exposure to blood or blood-stained fluid, we demonstrate that blood sampling procedures (odds ratio [OR], 5.75; 95% CI, 1.33-24.91; P = 0.01) and depth of injury (OR for deep vs superficial injury, 21.99; 95% CI, 2.02-239.61; P = 0.02) are independently associated with a greater risk of HCV seroconversion. This is the first UK study of occupationally acquired HCV in healthcare workers. It has reinforced our knowledge of risk factors for HCV transmission. Most of these exposures and transmissions were preventable. Healthcare employers should provide regular education on the risks of occupational exposure and prevention through standard infection control procedures. They should ensure the availability of effective prevention measures and facilitate prompt reporting and adequate follow-up of exposures.

Limited value of annual tuberculosis symptom reminders for health care workers.

BACKGROUND: (UK) National Institute for Health and Clinical Excellence tuberculosis (TB) guidance (2006) recommends that occupational health services send annual TB symptom reminders to staff at increased risk of occupational TB exposure. AIMS: To evaluate the effectiveness of annual TB symptom reminders. METHODS: Retrospective analysis of returns from 4 years' annual TB symptom reminders compared with numbers of hospital staff diagnosed with active TB in the same time period. RESULTS: There were 405 responses to symptom reminders received during the period studied that represented a response rate of 16%. None of the respondents declared TB symptoms. Twelve staff were diagnosed with active TB over the same period. From their work location, only two of these would have received TB symptom reminders according to local TB policy. CONCLUSIONS: Annual TB symptom reminders as currently used result in little direct benefit.

Pan-Thames survey of occupational exposure to HIV and the use of post-exposure prophylaxis in 71 NHS trusts.

OBJECTIVES: To review the management of occupational exposure to definite or suspected HIV-infected blood, following the introduction of the 1997 UK Department of Health guidelines on the use of post-exposure prophylaxis. METHODS: Cross-sectional telephone survey of protocols in 71 NHS Trusts in the Pan-Thames region. Retrospective postal survey of the management of each definite or suspected HIV blood exposure between 1 July 1997 and 30 June 1999. RESULTS: Sixty-two (93%) Trusts had a written protocol, with many specialties involved in exposure management. Twenty-four Trusts reported 171 occupational exposures to definite or suspected HIV-infected blood. Of 97 definite HIV exposures, eight (8%) were discovered on post-incident HIV testing of the source patient; to which most source patients agreed when approached. Seventy-two (74%) exposed health care workers started prophylaxis and 49 (68%) completed the recommended 4-week course. Only half of those whose exposures occurred more than 6 months ago were known to have had a follow-up HIV test. CONCLUSIONS: Although most Trusts have implemented the Department of Health's guidance, collecting data on individual exposures proved difficult. We suggest that a designated department in each Trust co-ordinates and records HIV exposure management. Routine HIV testing is acceptable to most source patients and is appropriate in areas with a high prevalence of HIV seropositivity.

A survey of the use of post-exposure prophylaxis for occupational exposure to human immunodeficiency virus.

The objective of this study was to review the appropriateness of the use of post-HIV exposure prophylaxis for incidents involving occupational exposure to body fluids. The design was a retrospective analysis of the 32 incidents for which at least one dose of post-exposure prophylaxis was given, reported to the occupational health department of a London teaching hospital between 20 August 1997 and 20 January 1999. The main outcome measures were the proportion of prescriptions for exposure to a known HIV positive source, and criteria for prescribing when the source patient's HIV status was unknown. Only 31% of prescriptions were for exposure to a known HIV positive source. The reasons for prescribing post-exposure prophylaxis in the other 69% of cases were unclear. Safety data for short courses of anti-retroviral drugs in this setting could help to assess the appropriateness of their use to allay anxiety in healthcare workers, pending clarification of the source patient's HIV status. Closer collaboration between departments and more detailed guidance would improve consistency of practice, and may save some unnecessary prescriptions for expensive and toxic drugs.

A pilot study to determine the potential application of the pressure specified sensory device in the maxillofacial region.

This pilot study was carried out at the Chang-Gung Memorial Hospital in Taiwan. In order to evaluate this instrument, One-point static (IPDS) cutaneous pressure thresholds were estimated in the perioral region utilizing a hand-held pressure specified sensory device (PSSD). Pressure specified two point discrimination (2PDS) could not be estimated due to the extreme sensitivity of the lip. Normative data were collected from 50 adults and a small, further group of 10 persons evaluated on two separate occasions to determine the likely chance of reproducibility and reliability. The normal range for 1PDS as determined using a hand-held technique, lay between 0.01 g/mm2 and 0.08 g/mm2. These results are up to 200 x lower than previously reported by other authors when estimated with Semmes-Weinstein nylon monofilaments. The results obtained suggest that sensitivity may not decline with advancing years, that the upper lip is more sensitive than the lower lip and that there may be a difference in the appreciation of sensation across the mid-line. Re-examination of the smaller group of subjects established values within 0.01 g/mm2 at 82% of points, 0.02 g/mm2 at 90% of points and 0.03 g/mm2 at 100% of points. The results achieved, although highly operator dependent and difficult to reproduce, reflect the exquisite sensitivity of the lip. The instrument, which was designed for assessment of hand sensation, would benefit from modification if its enormous potential as a research tool in the maxillofacial region is to be maximized. Despite a steep operator learning curve the PSSD may well prove itself to be an invaluable clinical tool and this instrument is worthy of further study within individual units.

Pattern assembly--an aid to flap design during oral microsurgical reconstruction.

Surgical ablation of tumors within the oral cavity results in a three-dimensional defect and a potential puzzle for the reconstructive surgeon. Although a myriad of papers discussing the relative advantages and disadvantages of various methods of reconstruction are readily available for consultation, very few publications have provided the surgeon with a guide either to visualization of the defect or to how to reconstruct a three-dimensional defect with an essentially two-dimensional flap. Our intention is not to provide the answer for every oral reconstructive problem--after all, no two patients are alike--but we will demonstrate that an appreciation of the defect in three-dimensions, together with an understanding of oral function, provides a template for flap design and inset. This is achieved by simplifying the complex anatomical shape of the oral cavity into a geometric form from which a series of simple, easily recognisable shapes can be derived and assembled as necessary into a pattern that reproduces the defect, providing a template for flap design and inset.

The trephining of bone from the iliac crest: an anterior approach.

A quick and simple method of trephining moderate amounts of cancellous bone (up to 6 cc) from the iliac crest via an anterior approach is presented. The advantages of this technique are that no muscle or ligamentous attachments are disturbed and postsurgical morbidity is low.

Transfacial access for neurosurgical procedures: an extended role for the maxillofacial surgeon. I. The upper cervical spine and clivus.

A variety of osteoplastic flaps have been devised for transoral or extraoral access to the base of skull and the upper anterior cervical spine. Part I of this two-part review will describe access to the clivus and upper anterior cervical spine. Part II will describe access to the middle cranial fossa, the infratemporal fossa and the pterygoid (retromaxillary) "space".

Transfacial access for neurosurgical procedures: an extended role for the maxillofacial surgeon. II. Middle cranial fossa, infratemporal fossa and pterygoid space.

A variety of osteoplastic flaps have been devised for transoral or extraoral access to the base of skull and the upper anterior cervical spine. Part I of this two-part review describes access to the clivus and upper anterior cervical spine. Part II will describe access to the middle cranial fossa, the infratemporal fossa and the pterygoid (retromaxillary) "space".

Hazard warning. A case of postoperative pulmonary barotrauma.

A case is described in which extensive pulmonary barotrauma occurred due to the application of a face mask to an indwelling cuffed endotracheal tube. The design of the mask is such that a seal was made between the mask and the tube. The design of mask is widely used in theatre recovery areas and clinicians are alerted to this potential hazard.

An obstructed airway: cuff herniation during nasotracheal anaesthesia for a bimaxillary osteotomy.

A case of airway obstruction resulting from lumen occlusion by an inflated endotracheal tube cuff is reported. The possible causes and remedies for this unusual complication are discussed.

Gentamicin impregnated polymethylmethacrylate (PMMA) beads in the treatment of primary chronic osteomyelitis of the mandible.

Primary chronic osteomyelitis (chronic diffuse sclerosing osteomyelitis) of the mandible is an uncommon condition, probably arising as a consequence of infection with bacteria of low virulence, in which bone deposition rather than bone resorption occurs. These bacteria are most likely derived from skin or oral mucosa gaining access to bone from the periodontium or through the circulation. Furthermore, delayed hypersensitivity and ischaemic changes within bone may contribute to the inflammatory response, which once initiated is very difficult to eradicate. When the likely aetiological factors are considered a logical approach to management includes the surgical removal of affected bone and the topical application of a broad spectrum antibiotic to the resultant surgical bed.