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Background and aimsMajority of elective orthopaedic operations are postponed to accommodate the reallocation of healthcare resources to combat the pandemic. The aim of this paper is to evaluate the mental state of orthopaedic patients amidst limited orthopaedic management options. The secondary aim of this paper is to identify areas of significant stressors and to provide avenues for improvements.MethodsA survey was administered on patients in outpatient clinics within a tertiary institution from 31 May to 13 June 2021 where government interventions prevented elective orthopaedic surgeries from being performed. Individuals' fatigue level were assessed with Chalder fatigue scale (CFS) and they were surveyed on their areas of stressors.ResultsA total of 160 orthopaedic patients (67 males and 93 females) were surveyed with an average age of 48.3 years old (range 17-88). 65 out of 160 (40.6%) were deemed to be severely fatigued (CFS > 4) with a higher prevalence amongst females than males (47.3% vs 31.3% respectively.) The top three areas identified as stressors included transmitting to family/friends, travel restrictions/quarantine orders and limitation on recreational/social activities (67.5%, 45.6% and 57.5% respectively). 25.6% of the patients indicated that the increased difficulty in accessing healthcare was a stress factor.Discussion and conclusionThere is a high proportion of severe fatigue amongst orthopaedic patients. Combined with postponement of orthopaedic care and treatment, the detrimental effects of a prolong pandemic can be more pronounced on orthopaedic patients. Identified areas of stressors provide avenues for improvements to safeguard the mental health of orthopaedic patients.
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Aim: It was recommended that surgery should be delayed for at least 7 weeks following COVID-19 infection to reduce risk of operation. However, for patients undergoing cancer surgery, a delay of 7-week might not be feasible practically. The aim of this case report was to demonstrate that it would be safe to carry out operation during early post-COVID period in selected cases with proper prophylaxis. Method(s): We prospectively collected data for patients undergoing cancer surgery and emergency operation in the hepatobiliary team from Mar 2022 to May 2022. Informed consent for recording and publication of the data was obtained from patients. COVID-19 related data and peri-operative outcome and measures to prevent postoperative complications were recorded. Patients were followed-up in our clinic after 8 weeks post-operatively. Result(s): 4 patients receiving elective hepatobiliary cancer surgery and 1 patient receiving emergency laparotomy for intestinal obstruction were recruited. The time from positive COVID-19 to operation ranged from 23 to 45 days. All patients were asymptomatic for COVID-19 at the time of operation. Prophylaxis for deep vein thrombosis and pneumonia was employed for all cases. All our patients recovered from surgery without pulmonary complication or unexpected ICU admission. There was no mortality in our case series. The patients' length-of-stay ranged from 4 to 12 days. Conclusion(s): It was safe to perform operation in carefully selected patients within 7 weeks after COVID-19 infection with appropriate peri-operative complication prevention measures.
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Objective: To investigate the psychological strain experienced by orthopaedic healthcare workers and attributing factors during the COVID-19 pandemic. Methods: We surveyed healthcare workers in an outpatient musculoskeletal clinic with a questionnaire based on the validated Caregiver Strain Index1 . We have previously shown the prevalence of psychological strain during the pre-peak phase of the pandemic.2 The same group was followed up 6 months later (post-peak phase) to evaluate the downstream psychological strain. Results: Of the 57 participants who were followed up, 30 (52.6%) experienced a greater level of strain (Group A), similar to the prevalence in our previous study (51.6%). Significantly, participants in Group A work longer hours per day compared to Group B (8.8±1.6 vs. 8.0±1.5;mean difference, 0.8;95%CI, 0.0 to 1.6;p=0.043). “Family adjustments” (84.2%) garnered the most positive responses. Conclusion: Longer working hours contributes to psychological strain and measures should be designed to mitigate this. Potential impact on family life of healthcare workers is an unrecognised toll which should receive more attention. Health ministries should ensure measures to safeguard the mental health of healthcare workers to avoid reactive strategies during a pandemic. (Figure Presented).
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Rapid sequence intubation (RSI) is a procedural skill that house officers (HO) in Malaysia need to learn during their training in emergency department (ED) posting. This study aimed to evaluate the confidence and competency of HO in RSI after completed training in the ED of a university hospital during the COVID-19 pandemic. A prospective cross-sectional study was conducted among 44 HO. When they begin their posting in ED, a pre-test was done with a questionnaire to evaluate their knowledge and confidence level. A post-test was conducted three months later with a similar questionnaire. They underwent an objective structured clinical examination to evaluate their skill. A feedback survey form was filled in by the HO regarding their satisfaction in training in emergency rotation. The mean score for pre-test and post-test were 8.75 ± 3.005 and 14.86 ± 2.258, respectively (P = 0.000). There was an improvement in knowledge level and confidence level between pre-test and post-test (all P = 0.000). 43.2% were competent in knowledge, while 65.9% were competent in skill. 35 house officers filled in the feedback survey form. It showed that 42.9% (n = 15) were very satisfied and 28.6% (n = 10) were satisfied with the training in ED. There was an improvement in knowledge and confidence level in RSI among the HO after ED rotation. The clinical exposure in intubating real patients was limited among HO due to the COVID-19 pandemic. The training of HO for RSI in ED needs to be further improvised to optimize their learning process. © 2021 Penerbit Universiti Kebangsaan Malaysia. All rights reserved.