Insight into resident burnout, mental wellness, and coping mechanisms early in the COVID-19 pandemic.

BACKGROUND: Acute augmentation of stress and disruption of training, such as during the COVID-19 pandemic, may impact resident wellbeing. OBJECTIVES: We investigated how residents in various specialties in the United States were impacted by COVID-19 on mental wellbeing and resilience levels, and the methodology for coping with the stress incurred. METHODS: In April 2020, the authors electronically surveyed 200 residency programs of all specialties nationally. The survey utilized two validated questionnaires to assess wellbeing and resilience, while investigating demographics and coping mechanisms. The authors used student t-test and ANOVA to quantitatively analyze the data. RESULTS: The sample consisted of 1115 respondents (with an 18% response rate). Male gender & Age >39 years were associated with more favorable average well-being indices (both p<0.01). Regarding resources, institutional support (IS) appeared favorable for resident well-being (IS 2.74, SD1.96 vs NoIS 3.71, SD2.29, p<0.01) & resilience (IS 3.72, SD0.70 vs NoIS 3.53, SD0.73, p = 0.05). The effects of mindfulness practices (MP) were not statistically significant for improvement of wellness (MP 2.87, SD 1.99 vs No MP 2.76, SD 2.15, p = 0.85) or resilience (MP 3.71, SD 0.70 vs No MP 3.72, SD 0.68, p = 0.87). CONCLUSIONS: Findings highlight the critical importance of resident mental status in cases of augmented stress situations. Institutional support may contribute to promotion of resident wellbeing.

Acute management of auricular hematoma: a novel approach and retrospective review.

This retrospective case series is used to describe a refined technique for the aspiration and drainage of auricular hematoma that is simple, cost-effective, and allows for rapid recovery. Patients, all high school males participating in competitive wrestling, were enrolled voluntarily after risks and benefits were discussed, and consent was obtained. Criteria for enrollment included acute auricular hematoma of at least 2 cm in size with occurrence no greater than 3 weeks before presentation, and no overt signs of infection. Patients underwent alcohol cleansing followed by injection of 1% lidocaine, and hematoma aspiration with an 18-gauge catheter. The cannula was left within the hematoma cavity, and a compression dressing was applied. This method is an acceptable alternative to current methods of managing auricular hematoma. It is simple, cost-effective, and provides rapid recovery with a complication rate comparable to other procedures described.

The delivery of a health promotion intervention by a public health promotion specialist improves patient satisfaction in the emergency department.

OBJECTIVES: The objective was to introduce a public health promotion specialist (PHPS) into the hospital emergency department (ED) to provide a brief health promotion intervention to patients and to determine the effect of the initiative on patient satisfaction. METHODS: Patients in the intervention group were offered and received a 5- to 10-minute presentation about exercise, heart health, healthy eating on a budget, or weight control by a trained PHPS. Patients in the control group received usual ED care. Both groups completed the patient satisfaction instrument. Ordinal logistic regression models were used to compare the two groups on patient satisfaction questions and to identify predictors of the likelihood of patients referring others to the ED. RESULTS: Subjects in the intervention group were more likely to rate the services as great in areas of patient satisfaction such as provider listening, staff being friendly and helpful, comfort and safety, and privacy. Those in the intervention group were three times more likely than those in the control group to state that they would refer others to the ED. CONCLUSIONS: Health promotion and disease prevention interventions carried out by PHPS in the ED can improve patient satisfaction.

Fluconazole as a prophylactic measure for tinea gladiatorum in high school wrestlers.

OBJECTIVE: To evaluate the use of prophylactic oral fluconazole in reducing the incidence of tinea gladiatorum in high school wrestlers. DESIGN: A prospective longitudinal study was conducted on high school wrestlers in northwest Ohio between 1997 and 2007. SETTING: Two northwest Ohio high school wrestling teams. PARTICIPANTS: High school wrestlers (373). INTERVENTIONS: Prophylactic fluconazole at a daily oral dosage of 100 mg for a 3-day regimen prior to the onset of the competitive interscholastic wrestling season and 6 weeks into the wrestling season. Guardians of participants signed consent forms outlining the risks associated with fluconazole prior to being enrolled into the study. MAIN OUTCOME MEASURES: Incidence of tinea gladiatorum in participants. RESULTS: Over the course of this 10-year study, out of 373 participants using prophylactic fluconazole, the incidence rate of tinea gladiatorum dropped from 67.4% to 3.5%. It should be noted that more than 50% of these infections occurred within the initial year of this study when the second administration of fluconazole was given at week 8 instead of week 6. No adverse effects were reported over the 10-year study period. CONCLUSIONS: The twice-per-season regimen of 100 mg daily for 3 days was highly effective in dramatically reducing the incidence of these skin lesions. The success of our study is 2-fold: First, fluconazole provided prophylaxis. Second, the overall incidence of fungal disease throughout the entire wrestling team was markedly decreased because most of the wrestlers participated in this study, significantly reducing exposure to these lesions through wrestling practice. No adverse effects in the use of fluconazole over this 10-year study period were reported.