Required Time Off Research Articles

Measuring Pectus Excavatum Severity, External Caliper, or Cross-Sectional Imaging: Family Perceptions

IntroductionPatients with pectus excavatum (PE) often undergo cross-sectional imaging (CSI) to quantify severity for insurance authorization before surgical repair. The modified percent depth (MPD), an external caliper-based metric, was previously validated to be similar to the pectus index and correction index. This study explored family perceptions of CSI and MPD with respect to value and costs. MethodsThis is a cross-sectional survey study including families of patients enrolled in an ongoing prospective multicenter study evaluating the use of MPD as an alternative to CSI for quantifying PE severity. Families of PE patients who underwent both MPD and CSI completed a survey to determine their perceptions of MPD and costs of CSI. Responses were described and associations were evaluated using chi squared, Wilcoxon rank-sum test and logistic regression as appropriate. Statistical significance was set to 0.05. ResultsThere were 136 surveys completed for a response rate of 88%. Respondents were confident in MPD (86%) and confident in its similarity to CSI (76%). Families of females were less confident in the measurements than males (55% versus 80%, P = 0.02; odds ratio 0.30 (0.11, 0.83). Obtaining CSI required time off work/school in 90% and a copay in 60%. Nearly half (49%) of respondents reported CSI was a time/financial hardship. Increasing copay led to decreased reassurance in CSI (55%: copay > $100 versus 77%: lower copay/75%: no copay; P = 0.04). ConclusionsFrom the family perspective, MPD is valuable in assessing the severity of PE. Obtaining CSI was financially burdensome, particularly for those with higher copays. MPD measurements provide high value at low cost in assessing the severity of PE.

Prevalence, characteristics and clinical impact of work-related musculoskeletal pain in echocardiography

BackgroundWork-related musculoskeletal pain (WRMSP) is increasingly recognised in cardiac ultrasound practice. WRMSP can impact workforce health, productivity and sustainability. We sought to investigate the prevalence, characteristics and clinical impact of WRMSP.MethodsProspective electronic survey of 157 echocardiographers in 10 institutions. Data acquired on demographics, experience, working environment/pattern, WRMSP location, severity and pattern, the impact on professional, personal life and career.Results129/157 (82%) echocardiographers completed the survey, of whom 109 (85%) reported WRMSP and 55 (43%) reported work taking longer due to WRMSP. 40/129 (31%) required time off work. 78/109 (60%) reported sleep disturbance with 26/78 (33%) of moderate or severe severity. 56/129 (45%) required medical evaluation of their WRMSP and 25/129 (19%) received a formal diagnosis of musculoskeletal injury. Those with 11+ years of experience were significantly more likely to receive a formal diagnosis of WRMSP (p = 0.002) and require medication (p = 0.006) compared to those with 10 years or less experience.ConclusionWRMSP is very common amongst echocardiographers, with a fifth having a related musculoskeletal injury. WRMSP has considerable on impact on personal, social and work-related activities. Strategies to reduce the burden of WRMSP are urgently required to ensure sustainability of the workforce and patient access to imaging.

Return-to-Work Experiences in Ontario Policing: Injured But Not Broken.

Police officers and others working in police services are exposed to challenging and traumatic situations that can result in physical and/or psychological injuries requiring time off work. Safely returning to work post-injury is critical, yet little is known about current return-to-work (RTW) practices in police services. This study examines RTW practices and experiences in police services from the perspective of RTW personnel and workers with physical and/or psychological health conditions. We used a purposive sampling approach to recruit sworn and civilian members from several police services in Ontario, Canada. The recruited members had experienced RTW either as a person in a RTW support role or as a worker with a work-related injury/illness. We conducted and transcribed interviews for analysis and used qualitative research methods to identify themes in the data. Five overarching themes emerged. Two pointed to the context and culture of police services and included matters related to RTW processes, injury/illness complexity, the hierarchical nature of police organizations, and a culture of stoicism and stigma. The remaining three themes pointed to the RTW processes of accommodation, communication and trust-building. They included issues related to recovery from injury/illness, meaningful accommodation, timely and clear communication, malingering and trust. Our findings point to potential areas for improving RTW practices in police services: greater flexibility, more clarity, stricter confidentiality and reduced stigma. More research is needed on RTW practices for managing psychological injuries to help inform policy and practice.

Vaccination, time lost from work, and COVID-19 infections: a Canadian healthcare worker retrospective cohort study.

The COVID-19 pandemic highlighted hurdles for healthcare delivery and personnel globally. Vaccination has been an important tool for preventing severe illness and death in healthcare workers (HCWs) as well as the public at large. However, vaccination has resulted in some HCWs requiring time off work post-vaccination to recover from adverse events. We aimed to understand which HCWs needed to take time off work post-vaccination, for which vaccine types and sequence, and how post-vaccination absence impacted uptake of booster doses in a cohort of 26,267 Canadian HCWs. By March 31, 2022, more than 98% had received at least two doses of the approved COVID-19 vaccines, following a two-dose mandate. We found that recent vaccination and longer intervals between doses were associated with significantly higher odds of time-loss, whereas being a medical resident and receiving the BNT162b2 vaccine were associated with lower odds. A history of lab-confirmed SARS-CoV-2 infection was associated with lower odds of receiving a booster dose compared with no documented infection, aOR 0.61 (95% CI: 0.55, 0.68). Similarly, taking sick time following the first or second dose was associated with lower odds of receiving a booster dose, aOR 0.83 (95% CI: 0.75, 0.90). As SARS-CoV-2 becomes endemic, the number and timing of additional doses for HCWs requires consideration of prevention of illness as well as service disruption from post-vaccination time-loss. Care should be taken to ensure adequate staffing if many HCWs are being vaccinated, especially for coverage for those who are more likely to need time off to recover.

MP57-14 REPRODUCTIVE EXPERIENCES OF WOMEN IN UROLOGY: ANALYSIS FROM THE 2022 SOCIETY OF WOMEN IN UROLOGY CENSUS TASK FORCE

You have accessJournal of UrologyCME1 Apr 2023MP57-14 REPRODUCTIVE EXPERIENCES OF WOMEN IN UROLOGY: ANALYSIS FROM THE 2022 SOCIETY OF WOMEN IN UROLOGY CENSUS TASK FORCE Tiffany Damm, Arshia Sandozi, Smita DE, Akanksha Mehta, Jessica Dai, Kelly Harris, Lourdes Guerrios-Rivera, and M Francesca Monn Tiffany DammTiffany Damm More articles by this author , Arshia SandoziArshia Sandozi More articles by this author , Smita DESmita DE More articles by this author , Akanksha MehtaAkanksha Mehta More articles by this author , Jessica DaiJessica Dai More articles by this author , Kelly HarrisKelly Harris More articles by this author , Lourdes Guerrios-RiveraLourdes Guerrios-Rivera More articles by this author , and M Francesca MonnM Francesca Monn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The percentage of female urologists in practice in the U.S. surpassed 10% in 2020 according to the American Urological Association (AUA) census. Women are motivated to succeed in their career but face disproportionate challenges surrounding reproduction, childrearing, and other family responsibilities. It is unknown the number of women in urology who had children or how their employer or training program accommodated them. We aim to establish childbearing practices of women in urology and to determine specific challenges that women who choose to have children experience. METHODS: An electronic survey was sent to members of the Society of Women in Urology including residents, fellows, and female urologists practicing in the United States and U.S. territories via email and social media. The survey was distributed from February to May 2022 and included demographics, practice type, workplace, personal, and reproductive barriers to practice. Descriptive statistics were applied. RESULTS: There were 379 responses received. The average age was 42.9 years (SD 18.6 years), and 71.0% self-reported white, 16.4% Asian or Asian American, and 6.3 % African American. Most women urologists practiced in an urban location (63.5%), at an academic setting (55.7%) and followed by private practice or hospital-employed settings. 67.2% felt that being female put them at a disadvantage for career advancement. Of the respondents, 68.7% have had children. Most respondents (78.0%) took 6 weeks or less for maternity leave. During pregnancy, women were offered redistribution of call, partner coverage of cases, coverage of overhead, decrease in productivity requirements or other accommodations (Figure 1). A significant number of women faced complications associated with pregnancy (29.4%), and 19.6% utilized reproductive assistance. CONCLUSIONS: Knowing how to best support women in urology who choose to build a family is imperative as more women enter the field. Urologists who experience pregnancy require time off, access to healthcare during pregnancy, and reproductive assistance. The results of this survey show the current accommodations offered, none of which are codified. It is unknown what strategies to improve work-life balance are preferred or if these accommodations had an impact on career progression. Source of Funding: N/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e790 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tiffany Damm More articles by this author Arshia Sandozi More articles by this author Smita DE More articles by this author Akanksha Mehta More articles by this author Jessica Dai More articles by this author Kelly Harris More articles by this author Lourdes Guerrios-Rivera More articles by this author M Francesca Monn More articles by this author Expand All Advertisement PDF downloadLoading ...

Shouldering the load: musculoskeletal hazards in shoulder arthroplasty

HypothesisOrthopedic reconstructive surgery can be physically demanding. The musculoskeletal related demands related to performing shoulder arthroplasty are unknown. This study investigates the prevalence of musculoskeletal injuries associated with performing shoulder arthroplasty. MethodsAn anonymous online survey based on the validated Nordic Musculoskeletal Questionnaire (NMQ) was distributed to society members of the American Shoulder and Elbow Surgeons. The REDCap based branching chain logic survey consisted of four main sections including: 1) personal demographics, 2) practice demographics, 3) NMQ questionnaire, and 4) effects of injury. A novel addition to the nine-region NMQ survey evaluated these areas for bothersome subclinical symptoms with no formal treatment requirement. ResultsOverall, 71% of 87 responding surgeons reported musculoskeletal symptoms related to performing shoulder arthroplasty. Within this group, 72% reported primary subclinical pain and 9% reported secondary exacerbation of a previous injury. Symptomatic regions and diagnoses were most often wrist/hand discomfort (20.7%) due to carpal tunnel syndrome and basilar thumb arthritis. Other associated symptoms included spine discomfort due to degenerative disc disease in the cervical (9.4%) or lumbar (18.4%) regions and elbow pain (6.7%) due to lateral epicondylitis or posterior interosseus nerve entrapment. The most common factors related to symptoms were case volume (24%), patient beach-chair operative positioning (17%), and table height (17%). Twenty-five surgeons required time off for work-related symptoms: 23 required <1 week and two required >1 week. Nine surgeons pursued nonoperative treatment and four surgeons underwent surgical intervention. Among all factors assessed, private practice surgeons reported symptoms significantly less frequently than those at tertiary referral (academic) centers. DiscussionA high percentage of orthopedic surgeon’s experience musculoskeletal symptoms related to shoulder arthroplasty. The three most commons areas of work-related pain in shoulder arthroplasty are wrist/hand discomfort, degenerative changes in the cervical and lumbar areas, and elbow pain.

Moral distress and injury in the public health professional workforce during the COVID-19 pandemic.

There is growing concern about moral distress and injury associated with the COVID-19 pandemic in healthcare professions. This study aimed to quantify the nature, frequency, severity and duration of the problem in the public health professional workforce. Between 14 December 2021 and 23 February 2022, Faculty of Public Health (FPH) members were surveyed about their experiences of moral distress before and during the pandemic. In total, 629 FPH members responded, of which, 405 (64%; 95% confidence interval [95%CI]=61-68%) reported one or more experience of moral distress associated with their own action (or inaction), and 163 (26%; 95%CI=23-29%) reported experiencing moral distress associated with a colleague's or organization's action (or inaction) since the start of the pandemic. The majority reported moral distress being more frequent during the pandemic and that the effects endured for over a week. In total, 56 respondents (9% of total sample, 14% of those with moral distress), reported moral injury severe enough to require time off work and/or therapeutic help. Moral distress and injury are significant problems in the UK public health professional workforce, exacerbated by the COVID-19 pandemic. There is urgent need to understand the causes and potential options for its prevention, amelioration and care.

Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players.

To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players. Retrospective case series. Professional domestic and international cricket teams over 13 seasons. Elite Australian cricket players. Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging. Incidence, presentation, history, healing, and management. 211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis. LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI.

Occupational injuries and burn out among orthopedic oncology surgeons.

Orthopedic oncology surgeons commonly engage in prolonged and complex surgical procedures. These types of surgeries increase the risk of physical and psychological stressors, which may in turn make these physicians prone to work-related occupational injuries. The aim of this study was to explore in orthopedic oncologists, the prevalence of work-related physical injuries and psychological disturbances. A modified version of the physical discomfort survey was developed to assess occupational injuries among orthopedic oncology surgeon members of the Musculoskeletal Tumor Society, the Canadian Orthopedic Oncology Society and European Musculoskeletal Oncology Societies. The survey was sent by email, and it explored musculoskeletal complaints, psychological disturbances, treatment required for these complaints and the requirement of time off work. A total of 67 surgeon responses were collected. A high number of orthopedic oncologists (84%) reported an occupational injury. Low back pain (39%) was the most prevalent musculoskeletal condition, followed by lumbar disk herniation (16%), shoulder tendinitis (15%) and lateral epicondylitis (13%). Of the cohort, 46% required surgery and 31% required time off work due to their injury. Thirty-three respondents reported a psychological disorder. Burnout (27%), anxiety (20%) and insomnia (20%) were the most commonly reported. Time required off work due to injury was associated with old age and years in practice. Orthopedic oncology surgeons report a high prevalence of work-related disorders. Lower back related injury and burnout were the most reported disorders. Improving operative room ergonomics and prevention of stress related to the work environment should be areas to explore in upcoming research.

Efficiency, Effectiveness and Wellness in the post-COVID Workplace

In 1840, organized labor compelled factory owners to limit their workdays to eight hours. Subsequent to this action, management discovered that output actually increased, while mistakes and accidents decreased. In 1916, the Adamson Act established an eight-hour day for railroad workers. This was the first federal law that regulated the hours of workers in private companies. The eight-hour day became a standard for most workers in 1937, when the Fair Labor Standards Act was first proposed under the New Deal (Samuel, 2000). &#x0D; Before COVID changed perceptions about how people could accomplish their tasks, leaders expected employees to put in long days at the office, and then respond to emails at all hours. They were expected to willingly donate nights, weekends, and vacation time; all without complaining (Carmichael, 2015). The organizational charts of many companies have work cascading from the top of the organizational pyramid down to the bottom. In that version, we work long hours because authority figures (our bosses) tell us to. Managers want their employees to be “Humble, Hungry, and Smart” (Lecioni, 2016). The problem with “hungry” is that a work ethic equating with excess work hours (or the perception of busyness) is an old-school management philosophy that is not sustainable. It leads to overwork, diminished effectiveness, and burnout. That’s not to say we can’t work very hard or for very long hours. We can. We just can’t do it routinely. A week of 60 hours to resolve a crisis is very different from chronic overwork. Predictable, required time off makes teams more productive (Perlow, 2009).

Scalds and the hazards of hair braiding – The first UK series from a paediatric tertiary burns centre

IntroductionHair braiding is a popular method of hair styling thought to date as far back as 500BC. One of the techniques involves the use of hot water to ‘set the braids’ which carries the risk of significant scald injury. This study presents the first UK based case series of hair braiding associated scald burns referred to a paediatric tertiary burns centre. Our aim is to increase awareness of this novel mechanism of injury, highlight trends and develop targeted prevention strategies. MethodsRetrospective data collection of patients presenting to a regional paediatric burn centre with hair-braiding associated scald burns was collected over a 13 year period (2007–2020). Patient demographics, mechanism of injury, total body surface area (TBSA), location, depth and distribution were evaluated. The presence of additional family, quality, duration and delay of first aid were also collected. The need for admission and length of hospital stay and long-term outcomes were also appraised. ResultsFourteen patients with scald injuries secondary to hair braiding were identified. The mean age was 6.5 years (5–9) and all patients were female. The most prevalent ethnicity affected were patients with African heritage. The mean TBSA was 3% (1–7 %). First aid was performed in only 50% of cases, of which none was adequate. The distribution of burns was as follows: the back (43%), posterior nape of the neck (36%), posterior shoulder (14%), scalp and face (21.5%) chest (7%) and legs (7%).Nine patients required admission to hospital with the mean length of stay of 2.85 days (range 1–12). No patients required surgery. The mean time to healing was 14 days (range 9–26). Longterm complications included hypopigmentation and hypertrophic scarring requiring scar management strategies. DiscussionThis well recognized technique of hair styling carries significant risks of scald injury. Patients often require hospital admission, endure emotional distress and require time off school. Patients can develop significant hypopigmented and hypertrophic scarring at a young age leading to considerable psychosocial morbidity. We recommend spreading awareness of the dangers of hair braiding through education, safety device development, prevention campaigns and targeted outreach work to minimise the hazards of this hair styling technique.

Kinematic and kinetic analyses of professional pitchers with history of core or groin injuries: A propensity-score matched analysis

BackgroundCore injuries in professional baseball pitchers have been linked to both diminished performance and time missed during the season injury was sustained. It is currently unclear how a history of a core injury may affect the future pitching performance and mechanics of professional baseball pitchers. PurposeTo compare kinetic and kinematic variables between professional baseball pitchers with prior core/groin injuries and those without prior injury. Study designDescriptive laboratory study. MethodsProfessional baseball pitchers with a history of core injury pitched 8–12 fastball pitches while evaluated with 3D-motion capture (480 Hz). Inclusion criteria necessitated that the core injury occurred within one to four-years prior to biomechanical evaluation and that the core injury required time off from professional play for a minimum of 2 weeks and maximum of 3 months. These pitchers were 4:1 propensity-scored matched by age, height, weight, and handedness to pitchers with no prior injury history (control). Twenty kinematic and eleven normalized and non-normalized kinetic parameters were compared between groups using appropriate parametric testing. Sub-analysis of pitchers with distinct core muscle and spinal injuries were also analyzed. ResultsThe No Prior Injury (NPI) subgroup (n = 76) had significantly less elbow flexion at ball release (31 ± 5° vs. 35 ± 6° respectfully, p = 0.044) compared to the Core Musculature/Soft Tissue subgroup (CM/ST, n = 10), with no significant difference in kinematics for other injury groups (p > 0.05). The General Core/Groin injury group (GCG, n = 19) had significantly greater normalized elbow anterior force (43.9 ± 4.7 vs. 40.0 ± 5.2 %BodyWeight[BW], p = 0.006) and elbow flexion torque (4.3 ± 0.5 vs. 3.8 ± 0.5 %BWxBodyHeight[BH], p = 0.001) than the NPI pitchers. CM/ST had significantly greater normalized elbow anterior force (p = 0.031), elbow flexion torque (p = 0.002), and shoulder adduction torque (p = 0.007) than NPI pitchers. ConclusionProfessional baseball pitchers with prior core/groin injuries demonstrated increased elbow anterior force and elbow flexion torque compared to pitchers with no prior core injuries. One possible explanation for this finding includes inadequate recruitment and utilization of the lower extremities as a component of the kinetic chain leading to compensation at the level of the throwing arm. Whether these kinetic differences arise as a consequence of injury or present a risk for such warrants additional investigation.

Repetitive Musculoskeletal Injuries: A Survey of Female Adult Reconstruction Surgeons

BackgroundOccupational injuries are a prevalent and costly problem for orthopedic surgeons, especially arthroplasty surgeons performing physically demanding and repetitive tasks. The purpose of this study was to characterize occupational musculoskeletal injuries in female adult reconstruction surgeons. MethodsA prospective survey about workplace musculoskeletal injuries was distributed to female attending adult reconstruction surgeons in May 2020. Participants were identified using subspecialty membership data, social media, and personal contacts. Results were analyzed using descriptive statistics. ResultsOf the total 63 female arthroplasty surgeons who responded, 65.1% were 30-45 year old, and 42.9% were within 5 years of practice, 68.3% sustained an occupational musculoskeletal injury, most commonly forearm/wrist/hand (79.1%), shoulder (48.8%), and low back (44.2%); 10.0% of reported occupational injuries not related to pregnancy resulted in the surgeon requiring time off work, while 48.2% required temporary modifications of job performance, and 10.9% required surgical treatment. Of the injured surgeons who reported having been pregnant, 65.4% reported a workplace exacerbation of a pregnancy-related musculoskeletal condition, including low back pain (52.9%), pubic symphysis pain (35.3%), and carpal tunnel syndrome (29.4%). ConclusionA total of 68.3% of female arthroplasty surgeons reported occupational musculoskeletal injuries, predominately forearm/wrist/hand, with a portion of those requiring modifications of job performance. Musculoskeletal injuries may be mitigated by performing repetitive tasks ergonomically, correcting posture, using appropriately sized instrumentation, and using automated or lighter instruments, to potentially avoid modifications to job performance, time off work, or even surgical procedures. Further studies should investigate factors that contribute to injuries in arthroplasty surgeons and how they can be prevented.

Work-related musculoskeletal injuries among upper extremity surgeons: A web-based survey.

BACKGROUNDWork-related injuries have gained recent attention, especially in the orthopaedic literature. As upper extremity orthopaedic surgical tasks require repetitive and constant maneuvers, these surgeons can be at increased risk of acquiring work-related musculoskeletal (MSK) disorders during their years in practice. AIMTo assess the prevalence, characteristics and impact of MSK disorders among upper extremity orthopaedic surgeons.METHODSA modified version of the physical discomfort survey was sent to surgeons who were members of the American Shoulder and Elbow Surgeons and the Canadian shoulder and elbow society via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant. RESULTSOf the 142 respondents, 90.8% were males and the majority were younger than 55 years old (65.5%). A work-related MSK injury was reported by 89.4% of respondents, of which the most common diagnoses were low back pain (26.1%) and lateral elbow epicondylitis (18.3%). Among those that reported an injury, 82.7% required treatment and 26% required time off work as a direct result of their injury. The need to undergo treatment due to the injury was associated with increased number of injuries (P < 0.01). Moreover, surgeons were more likely to require time off work when they had been in practice for > 21 years (P < 0.05). CONCLUSIONA high proportion of surgeons in our survey reported MSK injuries, with more than one quarter of surgeons reported requiring time off work due to an MSK injury. The high incidence of these disorders may place a financial and psychological burden on surgeons and affect their ability to provide patient care. Awareness of operative ergonomics, irrespective of surgical specialty may help to decrease or possibly prevent the occurrence of these disorders.

The Effect of Travel Burden on Depression and Anxiety in African American Women Living with Systemic Lupus.

The United States has a deficit of rheumatology specialists. This leads to an increased burden in accessing care for patients requiring specialized care. Given that most rheumatologists are located in urban centers at large hospitals, many lupus patients must travel long distances for routine appointments. The present work aims to determine whether travel burden is associated with increased levels of depression and anxiety among these patients. Data for this study were collected from baseline visits of patients participating in a lupus study at MUSC. A travel/economic burden survey was assessed as well as the 8-item Patient Health Questionnaire (PHQ-8) and the 7-item Generalized Anxiety Disorder (GAD-7) survey as measures of depression and anxiety, respectively. Linear regression models were used to assess the relationship between travel burden and depression and anxiety. Frequency of healthcare visits was significantly associated with increased depression (β = 1.3, p = 0.02). Significant relationships were identified between anxiety and requiring time off from work for healthcare appointments (β = 4, p = 0.02), and anxiety and perceived difficulty in traveling to primary care providers (β = 3.1, p = 0.04). Results from this study provide evidence that travel burden can have an effect on lupus patients’ anxiety and depression levels.

The Impact of Adverse Employment and Working Conditions on the Risk of Workplace Injury in Canada.

BackgroundEmployment standards (ES) include having a regular payday, regular breaks, the right to paid sick or vacation time, and paid wages. Inadequate ES contribute to the labour market vulnerability of workers; however, they are not typically considered to be risk factors for workplace injury. In a sample of Canadian workers, we examine the risk of injury associated with inadequate ES, independent of, and combined with inadequate workplace protections from workplace hazards.MethodsData from 2,803 adults working 15 hours or more/week in workplaces with at least five employees were analysed. We explored associations between exposure to workplace hazards with inadequate protections [termed occupational health and safety (OHS) vulnerability] and inadequate ES on workplace injury (physical or mental injury; injury requiring time off). Additive interaction models were used to examine the independent and combined effects of these exposures.ResultsOccupational health and safety vulnerability and inadequate ES were independently associated with increased injury outcomes. Adjusted models showed an additive relationship for all injury outcomes between OHS vulnerability and inadequate ES. Statistically significant superadditive relationships were observed for physical injury risk with policy and procedure vulnerability plus inadequate ES [synergy index (S) 1.50, 95% CI: 1.13–2.00] and for overall OHS vulnerability plus inadequate ES (S 1.53, 95% CI: 1.16–2.02), suggesting a combined effect greater than independent effects.ConclusionOccupational health and safety vulnerability and inadequate ES are independently associated with workplace injury. For certain injury outcomes, the combined effect of OHS vulnerability and inadequate ES is greater than the independent effects of each individual exposure.

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

PHARMACISTS FORGE AHEAD WITH POINT-OF-CARE TESTING, DESPITE BARRIERS

Missed work due to occupational accidents among personnel at a hospital in Paraná.

IntroductionHospital workers are exposed to several occupational hazards, which can lead to work accidents. Objectives: To conduct a survey of the main impacts and causes of missed work resulting from occupational accidents occurred among hospital personnel.MethodsQuantitative, descriptive, exploratory chart review carried out at a not-for-profit hospital in a medium-sized municipality in the state of Paraná, Brazil. For data collection, the medical records of 73 hospital workers who sustained occupational accidents from January 2017 to July 2019 were assessed.ResultsOf the 73 occupational accidents, 63 (86.3%) occurred in female workers; the age of the victims ranged from 20 to 57 years. Twenty-one workers (28.76%) required time off work; of these, 17 (80.9%) were nurses. The average number of days off work was 8.71, and only two workers were on leave for 15 days or more.ConclusionsOccupational accidents occurred predominantly in female workers, with nursing staff being most affected. Only one worker was away for more than 15 days, and only one accident occurred on the way to work rather than in the workplace. The findings of the present study demonstrate that the hospital work environment is complex and potentially hazardous to the health of workers, many of whom are constantly exposed to a risk of occupational accidents.

P213 Can we attend anywhere? Evaluation of multidisciplinary team (MDT) remote consultations

Objectives: To assess the value of remote consultation (RC) for people with cystic fibrosis (pwCF). A pilot of physiotherapy/dietitian-specific clinics found RC to be an acceptable alternative to standard clinics. Due to COVID19, RC was introduced to replace MDT face-to-face (F2F) clinics. Methods: RC's were run 2x weekly. 117 pwCF were surveyed to evaluate previous experience of RC, usefulness of this consultation and preference in continuing. We asked 9 MDT members about their perception and opinion of RC. Results: 55% pwCF and 100% MDT responded.100% found RC useful and 90% stating time efficiency despite 62% having no previous experience. 80% of pwCF preferred video over telephone calls. 72% of respondents had concerns re: lack of lung function measurement, 56% were concerned re: lack of physical examination which was also raised by the MDT. Confidentiality was identified as a concern but 72% of pwCF felt they had no problem discussing sensitive issues but these would be preferable F2F. Benefits included reduced clinic time (80%), convenience of not travelling/parking at hospital (90%) and ease of clinic allocation irrespective of microbiology infection control concerns (70%). Flexibility of access, not requiring time off work, a relaxed discussion of more relevant issues and improvements in clinical flow were noted. F2F consultations remain valuable as these build relationships and allow thorough examination. Conclusion: 64% pwCF and all MDT agreed that alternating RC would be a preferable format, with frequency depending on clinical need. This would minimise travel and cross infection risks whilst continuing optimal clinical care. RC were well received and a viable option to increase review when clinical space is limited. Concern over lack of objective measurement is important as these are clinically required and should be obtained. Technical issues e.g. poor connection, lack of equipment and training should be considered when planning this type of consultation.

Revolution in UK General Practice Due to COVID-19 Pandemic: A Cross-Sectional Survey.

ObjectivesTo assess how UK General Practitioners (GPs) and Practice Managers (PMs) have coped with the challenges posed by the coronavirus disease-19 (COVID-19) pandemic and whether they felt adequately supported by the wider National Health Service (NHS).MethodsThis is a cross-sectional survey. All GPs and PMs (total 1,354) in Leicester, Leicestershire, and Rutland (LLR) were invited to participate in an online questionnaire.ResultsA total of 95 invitees completed the survey. Over a quarter had required time off work due to COVID symptoms or contact. All respondents described either introducing or increasing the use of remote patient consultations. Most striking was the rise in video consultations from just 3% to 95% during the pandemic. Almost half of the feedback on the usefulness of remote consultations were positive, 16% were negative and 17% were mixed. The most commonly cited benefit was time efficiency. Drawbacks of remote consultations included technical difficulties and poor patient communication. Practice premises, systems and processes also required significant modifications during the pandemic to ensure the provision of safe clinical care, including reception screens, one-way patient flow, greater infection prevention measures. However, despite their ability to introduce such widescale change virtually overnight, over 10% of respondents reported that the strain had placed their practice at risk of closure. Over half of respondents felt they were not provided with adequate personal protective equipment (PPE) for the safety of their staff. Perception of the support provided by NHS England and the Clinical Commissioning Groups (CCGs) was rather mixed, although additional guidelines were broadly welcomed. The most requested enduring changes related to remote patient consultations (59%) and remote triage (19%). However, in order to support such largescale permanent change, study respondents felt that a different funding and financial structure is required together with improved IT infrastructure, greater patient education and a more supportive regulatory environment.ConclusionsCOVID-19 has substantially accelerated the pace of change within NHS primary care. The long-term fear is that there may be insufficient financial and clinical backing from regulatory bodies to support such rapid and far-reaching changes.