Burnout in trauma and orthopaedic surgeons: can the UK military stress management model help?

The recent coronavirus disease (COVID-19) pandemic has increased doctors' stresses at work and at home, putting them at increased risk of burnout. Considering this, we recently conducted the British Orthopaedic Association (BOA) Burnout and Wellbeing Survey which showed that, from 1298 respondents (approximately 25% of the membership of the BOA), 40% reported burnout and a further 50% were just below the threshold. The burnout rates were found to be higher in Black, Asian and minority ethnic (BAME), female and LGBTQ+ groups (45.6%) compared to white, heterosexual males (33.6% - p < 0.001) and also higher in trainees (49.1%) and associate specialists (52.1%) compared to consultants (35.7% - p < 0.001). We discuss what can be learned from the experience of the UK Armed Forces in their programme for stress management, their mental resilience training and their campaign to destigmatize mental wellbeing, that may mitigate burnout in our profession. We also put forward the case for appropriate resources to be allocated to tackling burnout in orthopaedic doctors and introduce the BOA's Wellbeing Initiative.

Universal screening for SARS-CoV-2 in pregnant women at term admitted to an East London maternity unit.

OBJECTIVE: To explore the prevalence of asymptomatic SARS-CoV-2 in the maternity population. STUDY DESIGN: Newham University Hospital based in East London serving a population with the highest death rate secondary to SARS-CoV-2 in the UK, commenced universal screening of all admissions to the Maternity Unit from 22nd April to 5th May, 2020. A proforma was created to capture key patient demographics, indication for admission and presence of SARS-CoV-2 related symptoms at the point of presentation. RESULTS: A total of 180 women with a mean age of 29.9 (SD 7.4) years, at a median gestation of 39 (IQR 37 + 1-40 + 3) weeks underwent universal screening with nasopharyngeal PCR swabs during the two-week period of the study. BAME identity or parity was not associated with the likelihood of a positive result. Seven women (3.9 %, 1.6-7.8) were tested positive for SARS-CoV-2, of whom 6 (3.3 %, 1.2-7.1) were asymptomatic; 85.7 % (42.1-99.6) of the SARS-CoV-2 positive women were asymptomatic. The sensitivity of symptom-driven testing was 14.3 % (0.36-57.87) and specificity was 91.86 % (86.72-95.48) with a positive predictive value of 6.67 % (1.08-31.95) and a negative predictive value of 96.34 % (95.10-97.28). CONCLUSION: The prevalence of SARS-CoV-2 in the maternity population served by Newham University Hospital was 3.9 %, four weeks after lockdown. Of the women who were found to be SARS-CoV-2 positive, a high proportion (87.9 %) were asymptomatic. These findings support the need for universal testing to enable targeted isolation and robust infectious control measures to mitigate outbreaks of SARS-CoV-2 in maternity units.