Workplace factors associated with mental health of healthcare workers during the COVID-19 pandemic: an international cross-sectional study.

BACKGROUND: The association of workplace factors on mental health of healthcare workers (HCWs) during the COVID-19 pandemic needs to be urgently established. This will enable governments and policy-makers to make evidence-based decisions. This international study reports the association between workplace factors and the mental health of HCWs during the pandemic. METHODS: An international, cross-sectional study was conducted in 41 countries. The primary outcome was depressive symptoms, derived from the validated Patient Health Questionnaire-2 (PHQ-2). Multivariable logistic regression identified factors associated with mental health outcomes. Inter-country differences were also evaluated. RESULTS: A total of 2527 responses were received, from 41 countries, including China (n = 1213; 48.0%), UK (n = 891; 35.3%), and USA (n = 252; 10.0%). Of all participants, 1343 (57.1%) were aged 26 to 40 years, and 2021 (80.0%) were female; 874 (34.6%) were doctors, and 1367 (54.1%) were nurses. Factors associated with an increased likelihood of depressive symptoms were: working in the UK (OR = 3.63; CI = [2.90-4.54]; p < 0.001) and USA (OR = 4.10; CI = [3.03-5.54]), p < 0.001); being female (OR = 1.74; CI = [1.42-2.13]; p < 0.001); being a nurse (OR = 1.64; CI = [1.34-2.01]; p < 0.001); and caring for a COVID-19 positive patient who subsequently died (OR = 1.20; CI = [1.01-1.43]; p = 0.040). Workplace factors associated with depressive symptoms were: redeployment to Intensive Care Unit (ICU) (OR = 1.67; CI = [1.14-2.46]; p = 0.009); redeployment with perceived unsatisfactory training (OR = 1.67; CI = [1.32-2.11]; p < 0.001); not being issued with appropriate personal protective equipment (PPE) (OR = 2.49; CI = [2.03-3.04]; p < 0.001); perceived poor workplace support within area/specialty (OR = 2.49; CI = [2.03-3.04]; p < 0.001); and perceived poor mental health support (OR = 1.63; CI = [1.38-1.92]; p < 0.001). CONCLUSION: This is the first international study, demonstrating that workplace factors, including PPE availability, staff training pre-redeployment, and provision of mental health support, are significantly associated with mental health during COVID-19. Governments, policy-makers and other stakeholders need to ensure provision of these to safeguard HCWs' mental health, for future waves and other pandemics.

Theatre etiquette course: students' experiences.

BACKGROUND: Prior to 2008 medical students at the University of Dundee had no formal teaching in scrubbing, gloving and gowning for theatre. The students had reported high levels of stress, and a lack of knowledge and confidence, when asked to scrub, glove and gown for theatre. We present a cohort study of the effect on students' experiences in theatre following the implementation of a new theatre etiquette course to the undergraduate curriculum. DESIGN: We implemented a new theatre etiquette course for medical students, in which they learned scrubbing, gowning and gloving for theatre. We then identified two cohorts of students: the year group who attended the new course and the year above who did not. At the end of year 4, both cohorts completed a questionnaire about their confidence and experiences in theatre. The results from the year below were compared with the year above, who had no such formal teaching. RESULTS: Questionnaire responses from over 70 per cent of each cohort demonstrated that students attending the new formal course felt significantly more confident in theatre etiquette skills and had an improved experience in the operating theatre, compared with the previous year group. CONCLUSION: The implementation of a theatre etiquette course improved students' preparation and experience in theatre. It also outlines the need for consistent teaching at an undergraduate level. This formal teaching method is recommended for any curriculum in which students attend theatre.

The intercalated BSc in sports and exercise medicine at Barts and The London School of Medicine and Dentistry.

OBJECT: To report about the intercalated Bsc(Hons) in Sports and Exercise Medicine at Barts and The London School of Medicine and Dentistry (BLSMD), Queen Mary University of London. DESIGN: Educational study. SETTING: The course is currently in its tenth year, providing medical students with the opportunity to develop knowledge in the field of Sports and Exercise Medicine (SEM) during one academic year of full time study. PARTICIPANTS: There have been more than 150 graduates, and 22 students are enrolled for the 2012-13 academic year on what has been the most popular and largest intercalated degree at BLSMD in recent years. External applicants typically make up 30-40% of entrants. RESULTS: Equal weighting on taught modules and a portfolio of research activity provides a strong foundation in Sports and Exercise Medicine, and equips successful students with evidence based translational skills, and the opportunity to perform publishable research. CONCLUSION: This article outlines the increasing demand for Sports and Exercise Medicine education, and how the course prepares graduates for practising SEM as a sub-specialist interest or to compete for entry into the Specialist Trainee training route.

Severe pelvic bone loss treated using a coned acetabular prosthesis with a stem extension inside the ilium.

We describe a modified surgical technique for the reconstruction of major acetabular defects using a coned acetabular component (the Stanmore 'ice-cream' cone prosthesis) and report its early clinical outcomes. A single surgeon performed 28 acetabular reconstructions using a stemmed-cone acetabular prosthesis (mean age 70.9 years; 61% female) in 15 oncology patients with periacetabular metastases and 13 patients requiring complex arthroplasty procedures. Defects were graded using the Paprosky classification (10 = 3A; 8 = 3B; 10 = pelvic discontinuity). All procedures were performed without fluoroscopy using an extended posterior hip approach. Mean operative time (including anaesthesia) was 133 minutes; there were no intraoperative complications. Postoperative complications had occurred in 14% (n = 4), at a mean follow-up of 12.5 months (range: 2-33 months). There were no failures in patients with pelvic discontinuity. The stemmed-cone acetabular prosthesis was found to provide a useful method for acetabular reconstruction (including pelvic discontinuity) in both complex oncological and hip arthroplasty cases.

Cadaveric surgery: a novel approach to teaching clinical anatomy.

INTRODUCTION: Anatomy is an essential basic science for safe and effective medical practice. In 2006 the UK Anatomy Act was changed to allow the use of surgical procedures on cadavers. This has unlocked opportunities for new methods of teaching clinically relevant anatomy. This study explores how surgical procedures may provide a purposeful and memorable way for undergraduates to learn anatomy, compared with conventional teaching methods. METHODS: Under supervision, a group of third-year medical students prepared for and then performed a shoulder hemi-arthroplasty after identifying key anatomical structures and surgical objectives. The procedure was performed in a simulated theatre environment. A focus group was used to collect qualitative data based on the learning experience. RESULTS: The surgical approach and implant insertion were successfully completed, and the educational objectives of identifying and learning surrounding structures were met. The focus group found that the exercise presented a relaxed introduction to surgery, enabled learning by association, and provided a learning experience that was both purposeful and complete. DISCUSSION: The preparation and completion of the procedure enabled the students to focus on the anatomy of the shoulder, by identifying and forming associations with surrounding structures. Uniquely, the surgical nature of this project also allowed undergraduate students to practice key surgical skills and principles. CONCLUSION: The authors believe that learning anatomy via a surgical approach provides a relevant, in-depth, purposeful and enjoyable learning experience. This technique also provided a valuable insight into surgery.

Intradiscal electrothermal therapy, percutaneous discectomy, and nucleoplasty: what is the current evidence?

Over the past decade, there has been a surge of minimally invasive techniques aimed at treating both discogenic low back pain (LBP) and radicular pain. This article assesses the current evidence for three such treatments: intradiscal electrothermal therapy (IDET), percutaneous discectomy, and nucleoplasty. An electronic search of the literature carried out using the Cochrane Library database (2007) and Medline (1966-2007) identified 77 references relating to IDET, 363 to percutaneous discectomy, and 36 to nucleoplasty. Two randomized controlled trials (RCTs) assessed the effectiveness of IDET; one demonstrated a positive effect on pain severity only, whereas the other demonstrated no substantial benefit. Other RCTs show that percutaneous intradiscal radiofrequency thermocoagulation is ineffective for the treatment of discogenic LBP. Trials of automated percutaneous discectomy suggest that clinical outcomes after treatment are at best fair and often worse when compared with microdiscectomy. There are no published RCTs assessing Coblation (ArthroCare Spine, Stockholm, Sweden) technology.