Causes of stress and poor wellbeing among paramedic students in Saudi Arabia and the United Kingdom: a cross-cultural qualitative study.

BACKGROUND: Paramedicine presents students with numerous challenges, including factors threatening their wellbeing. Over the last two decades studies have illustrated that paramedics and paramedic students are more likely to have mental disorders than the general population. These findings suggest that course-related factors could be important in contributing to poorer mental health. However, few studies have examined factors related to stress in paramedic students, and none of these have included paramedic students from cross-culture. To address this, the present study (1) explored paramedicine students' training experiences and other education-related factors that could affect their wellbeing, and (2) illustrated the possible differences and similarities between two cultures (Saudi Arabia and the UK) to determine whether the students' cultural environment influenced factors related to their wellbeing. METHODS: A qualitative exploratory research design was used. Twenty semi-structured interviews were conducted with paramedicine students from the United Kingdom and Kingdom of Saudi Arabia (ten participants from each country). Reflexive thematic analysis was employed as the analytical approach in this study. RESULTS: Four major themes were identified which captured the contributors to paramedic students' stress levels: (1) exposure to potentially traumatic events, (2) relationships and communication, illustrating the student's personal and professional experiences with others, (3) programme atmosphere, demonstrating the challenges and support students encounter during their coursework and training, and (4) career, elucidating the pressure of future career expectations and predictions. CONCLUSION: The study revealed contributors to stress were similar in both countries. Better preparation can help to reduce the negative impacts of the possible traumatic events encountered on placements and supportive relationships, especially with proctors, can boost student wellbeing. Universities are able to address both these factors and help foster a positive environment for paramedicine students. As such, these results should help educators and policymakers when identifying and delivering interventions to support paramedic students.

Barriers and enablers to accessing support services offered by staff wellbeing hubs: A qualitative study.

Background: International efforts have been made to develop appropriate interventions to support the mental health needs of healthcare professionals in response to COVID-19. However, fewer staff have accessed these than expected, despite experiencing elevated levels of mental distress since the onset of the pandemic. Consequently, we aimed to examine the barriers and enablers for healthcare professionals in accessing interventions offered by a Staff Mental Health and Wellbeing Hub. Methods: Twenty-five semi-structured interviews were conducted with healthcare, social care and voluntary, community and social enterprise (VCSE) sector staff. Data were analysed using thematic analysis. Results: Four key themes were identified: (1) Environment and Atmosphere in the Workplace; (2) The Impacts of COVID-19; (3) Confidentiality; and (4) Awareness and Communication of Resources. Organisational environments were perceived as an important enabler of accessing the hub services for mental health and wellbeing support. This included the importance of recognising and responding to the ongoing pressures of COVID-19- specific challenges. Ensuring and communicating aspects of confidentiality, and ensuring clear and consistent communication of the benefits of the Hub may encourage help-seeking for mental health challenges among healthcare professionals. Discussion: Our findings highlight important considerations to increase uptake and engagement with services to support the mental health and wellbeing of healthcare professionals and associated staff and volunteers. Organisations aiming to increase employee uptake of these services should regularly circulate consistent and clear emails about what these services offer, provide training and information for managers so they can support staff to access these services and ensure access is confidential.

Percutaneous versus open epiphysiodesis.

OBJECTIVE: Epiphysiodesis is used for the treatment of leg-length discrepancy in skeletally immature patients. Phemister described an open technique that requires surgical dissection with potential morbidity. Recently, minimally invasive approaches that utilize intraoperative fluoroscopy have been introduced. The aim of this study is to compare our experience using the open and the minimally invasive percutaneous techniques. METHODS: A prospective follow-up of 87 consecutive patients undergoing epiphysiodesis for correction of post traumatic leg-length discrepancy using either the open or the percutaneous technique at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1993 and December 2000. RESULTS: Out of the 87 patients, 52 were carried out using the open technique and 35 were utilized by this percutaneous technique. There was no statistically significant difference between the 2 groups in terms of demographic date, operative time, perioperative complications or time required to achieve the growth arrest. However, there was a significant difference in the hospital stay and postoperative need for physiotherapy. The percutaneous group had a shorter hospitalization (average 2.5 days) compared to the open technique group (average 4 days). CONCLUSION: Our experience is similar to what is reported in the literature and confirms that the percutaneous technique has an advantage over the open technique with shorter hospitalization and less duration of physiotherapy.

Removal of internal fixation in pediatric patients.

OBJECTIVE: Internal fixation devices are commonly used in the surgical treatment of many orthopedic conditions. Their prolonged presence, however, has been associated with potential complications. Many surgeons advocate the routine removal of internal fixation in the pediatric age group. In this report we present our experience with removal of internal fixation in pediatric patients and evaluate the benefits and difficulties of doing so. METHODS: A retrospective analysis of 304 pediatric patients who underwent removal of internal fixation implants for various indications at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between January 1985 and December 1999, was carried out. RESULTS: A total of 176 males and 128 females were included. Their mean age at time of removal of internal fixation was 11 years (range 2-18). The fixation device was removed at an average of 16.3 months (range 10-40) after implantation. One hundred and twenty (39.5%) patients had the initial fixation for the treatment of fractures. For all 304 patients, late removal of the implant was found to be more difficult than early removal. Implants around the hip and pelvis were more difficult to remove than other locations. CONCLUSION: Our experience supports the indication for timely removal of internal fixation devices in the pediatric population. When carried out on a routine basis it can avoid the difficulties associated with the late removal of implants.