Objectives. The purpose of this observational study was to investigate and analyze the nature of the shared content of lower extremity total joint arthroplasty (TJA) patients on Instagram. Specifically, we evaluated: 1) perspective and timing of the social media posts (pre-, peri-, or post-operative); 2) tone of the post (positive or negative); 3) focus of the post (including activities of daily living (ADLs), rehabilitation, return-to-work (RTW)); and 4) compare these findings between hip and knee arthroplasties. Methods. A search of the public Instagram domain was performed over a 6 month period. Total hip and knee arthroplasty were selected for the analysis using the following terms: “#totalhipreplacement,” “#totalkneereplacement,” and associated terms. A total of 1,287 individual public posts of human subjects were shared during the period. A categorical scoring system was manually applied for media format (photo or video), time (pre-, peri- or post-operative) period, tone (positive or negative), RTW reference, ADLs reference, rehabilitation reference, surgical site reference, radiograph image, satisfaction and dissatisfaction references. The post perspective was recorded. Results. 91% of the posts by patients were shared during the post-operative period. 93% of posts had a positive tone to them.34% of posts focused on both ADLs and 33.8% rehabilitation. TKA patients shared more about their surgical site (14.5% vs. 3.3%, p < .001) and rehabilitation (58.9% vs. 8.8%, p < .001) than THA patients, whereas THA patients shared more about their ADLs than TKA patients (60.5% vs. 7.6%, p < .001). Conclusions. When sharing their experience on Instagram, arthroplasty patients did so with a positive tone, starting a week after surgery. TKA posts focused more on rehabilitation and wound healing than THA patients, while THA patients shared more posts on ADLs. The analysis of social media posts provides insight into what matters to patients following TJA

The 2020-2021 Canadian Residency Matching Service (CaRMS) match year was altered on an unprecedented scale. Visiting electives were cancelled at a national level, and the CaRMS interview tour was moved to a virtual model. These changes posed a significant challenge to both prospective students and program directors (PDs), requiring each party to employ alternative strategies to distinguish themselves throughout the match process. For a variety of reasons, including a decline in applicant interest secondary to reduced job prospects, the field of orthopaedic surgery was identified as vulnerable to many of these changes, creating a window of opportunity to evaluate their impacts on students and recruiting residency programs. This longitudinal survey study was disseminated to match-year medical students (3rd and 4th year) with an interest in orthopaedic surgery, as well as orthopaedic surgery program directors. Responses to the survey were collected using an electronic form designed in Qualtrics (Qualtrics, 2021, Provo, Utah, USA). Students were contacted through social media posts, as well as by snowball sampling methods through appropriate medical student leadership intermediates. The survey was disseminated to all 17 orthopedic surgery program directors in Canada. A pre-match and post-match iteration of this survey were designed to identify whether expectations differed from reality regarding the effect of the COVID-19 pandemic on the CaRMS match 2020-2021 process. A similar package was disseminated to Canadian orthopaedic surgery program directors pre-match, with an option to opt-in for a post-match survey follow-up. This survey had a focus on program directors’ opinions of various novel communication, recruitment, and assessment strategies, in the wake of the COVID-19 pandemic. Students’ responses to the loss of visiting electives were negative. Despite a reduction in financial stress associated with reduced need to travel (p=0.001), this was identified as a core component of the clerkship experience. In the case of virtual interviews, students’ initial trepidation pre-CaRMS turned into a positive outlook post-CaRMS (significant improvement, p=0.009) indicating an overall satisfaction with the virtual interview format, despite some concerns about a reduction in their capacity to network. Program directors and selection committee faculty also felt positively about the virtual interview format. Both students and program directors were overwhelmingly positive about virtual events put on by both school programs and student-led initiatives to complement the CaRMS tour. CaRMS was initially developed to facilitate the matching process for both students and programs alike. We hope to continue this tradition of student-led and student-informed change by providing three evidence-based recommendations. First, visiting electives should not be discontinued in future iterations of CaRMS if at all possible. Second, virtual interviews should be considered as an alternative approach to the CaRMS interview tour moving forward. And third, ongoing virtual events should be associated with a centralized platform from which programs can easily communicate virtual sessions to their target audience

Aims. The adequate provision of personal protective equipment (PPE) for healthcare workers has come under considerable scrutiny during the COVID-19 pandemic. This study aimed to evaluate staff awareness of PPE guidance, perceptions of PPE measures, and concerns regarding PPE use while caring for COVID-19 patients. In addition, responses of doctors, nurses, and other healthcare professionals (OHCPs) were compared. Methods. The inclusion criteria were all staff working in clinical areas of the hospital. Staff were invited to take part using a link to an online questionnaire advertised by email, posters displayed in clinical areas, and social media. Questions grouped into the three key themes - staff awareness, perceptions, and concerns - were answered using a five-point Likert scale. The Kruskal-Wallis test was used to compare results across all three groups of staff. Results. Overall, 315 staff took part in our study. There was a high awareness of PPE guidance at 84.4%, but only 52.4% of staff reported adequate PPE provision. 67.9% were still keen to come to work, despite very high levels of anxiety relating to contracting COVID-19 despite wearing PPE. Doctors had significantly higher ratings for questions relating to PPE awareness compared to other staff groups, while nursing staff and OHCPs had significantly higher levels of anxiety compared to doctors in relation to PPE and contracting COVID-19 (p < 0.05 using a Kruskal-Wallis test). Conclusion. We believe four recommendations are key to improve PPE measures and decrease anxiety: 1) nominated ward/department PPE champions; 2) anonymized reporting for PPE concerns; 3) formal PPE education sessions; and 4) drop-in counselling sessions for staff. We hope the insight and recommendations from this study can improve the PPE situation and maintain the health and wellbeing of the clinical work force, in order to care for COVID-19 patients safely and effectively

Abstract. Background. Healthcare workers have had to make rapid and drastic adjustments to their practice in response to the COVID-19 pandemic. This work describes the effect on their physical, mental, financial and family well-being and assesses the support provided by their institutions. Methods. An online survey was distributed through medical organisations, social media platforms and collaborators to staff based in an operating theatre environment. Results. 1590 responses were received from 54 countries. Average age of participants was between 30 and 40 years old, 64.9% were male, 79.5% were surgeons, 6.2% nurses, 5.4% assistants, 4.2%. Of the total 32.0% had become physically ill since the start of the pandemic. Physical illness was more likely in those with reduced access to personal protective equipment (OR 4.62; CI 2.82–7.56; p<0.001) and regular breaks (OR 1.56; CI 1.18–2.06; p=0.002). Those with a decrease in salary (29% of participants) were more likely to have an increase in anxiety (OR 1.50; CI 1.19–1.89; p=0.001) and depression scores (OR 1.84; CI 1.40–2.43; p<0.001) and those who spent less time with family (35.2%) were more likely to have an increase in depression score (OR 1.74; CI 1.34–2.26; p<0.001). In terms of support, only 36.0% had easy access to occupational health services, 44.0% to mental health services, 16.5% to 24 hour rest facilities and 14.2% to 24 hour food and drink facilities. Conclusion. This work has highlighted a need and ways in which to improve conditions for the health workforce, which will inevitably have a positive impact on the care received by patients

The requirement for the peer support groups were born out of concern for the psychological wellbeing of the paediatric patients and to assess if this would improve their wellbeing during their treatment. Groupwork is a method of Social Work which is recognised as a powerful tool to allow people meet their need for belonging while also creating the forum for group members to empower one another. Social Work meet with all paediatric patients attending the limb reconstruction service in the hospital. The focus of the Medical Social Worker (MSW) is to provide practical and emotional support to the patient and their parent/guardian regarding coping with the frame. Some of the challenges identified through this direct work include patient's struggling with the appearance of the frame and allowing peers to see the frame. The peer support group aims to offer its attendees the opportunities to engage with fellow paediatric patients in the same position. It allowed them to visually identify with one another. We wanted to create a safe space to discuss the emotional impact of treatment and the frames. It normalises the common problems paediatric patients face during treatment. We assisted our participants to identify new coping techniques and actions they can take to make their journey through limb reconstruction treatment more manageable. Finally, we aimed to offer the parents space to similarly seek peer support with regard to caring for a child in treatment. All paediatric patients were under the care of the Paediatric Orthopaedic Consultant and were actively engaging with the limb reconstruction multi-disciplinary team (MDT). The patient selection was completed by the MDT; based on age, required to be in active treatment, or their frames were removed within one month prior to the group's commencement. Qualitative data was collected through written questionnaires and reflection from participants in MSW sessions. We also used observational data from direct verbal feedback from the MDT. In the first group, parents gave feedback due to participants age and completed written feedback forms. For our second group, initial feedback was collated from the participants after the first session to get an understanding of group expectations. Upon completion, we collected data from both the participants and the parents. Qualitative and scaling questions gathered feedback on their experience of participating in the group. We held two peer support groups in 2022:One group for patients aged between 3–6 years in January 2022 across two sessions, which was attended by four patients. The second group for young teenage patients aged between 11–15 years in April 2022 across four sessions, which was attended by five patients. The written feedback received from group one focused on eliciting the participant's experience of the groupwork. 100% of participants identified the shared experience as the main benefit of the groupwork. 100% of participants agreed they would attend a peer support group again, and no participant had suggestions for improvement to the group. Feedback did indicate that group work at the beginning of treatment could be more beneficial. In relation to the second group, 60% of the paediatric patients and their parents returned the questionnaires. All of the parent's feedback identified that it was beneficial for their child to meet peers in a similar situation. They agreed that it was beneficial to meet other parents, so they could get support and advice from one another. On a scale between 1 and 5, 5 being the highest score, the participants scored high on the group work meeting their expectations, enjoyment of the sessions, and the group work was a beneficial aspect of their treatment. All respondents would strongly recommend groupwork to other paediatric patients attending for limb reconstruction treatment. Overall, the MDT limb reconstruction team, found the peer support group work of great benefit to the participants and their parents. The MSW team identified that during a period on the limb reconstruction team, when a high number of patients were in active treatment, the workload of the MSW also increased reflecting this activity. Common issues and concerns were raised directly to MSW (particularly from group two) regarding numerous difficulties they experienced trying to cope with the frame. The group work facilitators created a space where the participants could get peer support, share issues caused by the frame, hear directly from others, and that they too experience similar feelings or issues. Collectively, they identified ways of coping and promoting their own wellbeing while in treatment. The participants in group two, subsequently created a group on social media, to be able to continue their newly formed friendships and to continue to update one another on their treatment journeys. The participants self-requested another group in the future. This was facilitated in November 2023, the facilitators sought more feedback from all participants and their parents after this session. These findings will contribute towards the analysis for the presentation. Peer support groupwork was presented at the hospital's foundation day and has been well received by senior management in the hospital, as a positive addition to the limb reconstruction service. The focus of the MDT in 2024, is to further develop and facilitate more peer support groups for our paediatric patients

Aim. In our Bone Infection Unit, epidural anaesthesia and sedation (EA+Sed) is the technique of choice for complex orthoplastic surgery involving lower limb free tissue transfer (LLFTT) (1) as it avoids complications of prolonged general anaesthesia (GA). Following our initial reports of successful use of audio-visual distraction (AVD) as an adjunct to regional anaesthesia we wished to evaluate the AVD effect on the patients’ experience during long duration, complex orthoplastic surgery for chronic osteomyelitis under EA+Sed. Method. Our AVD equipment consists of a WiFi connected tablet and noise reducing head phones, providing access to downloaded music, films and the internet. Patients are also allowed to use their own equipment. All patients were fully informed about AVD and EA+Sed as a choice of anaesthesia. EA was established in the anaesthetic room and continued perioperatively. Sedation with propofol was titrated to the patients’ requirements to ensure comfort during surgery. All patients were followed up postoperatively with a structured questionnaire. Results. Ten patients underwent LLFTT surgery for chronic bone infection under EA+Sed+AVD (picture). Mean duration of surgery was 550 min (480 −600 min). Patients used the AVD to listen to music, watch movies, play internet games and use e-mail and social media. All 10 patients were very satisfied, and 9 reported feeling comfortable or very comfortable intraoperatively. All rated their experience better than previous GAs, with quicker general recovery. All patients would recommend this technique to others. Conclusions. Our case series of patients undergoing prolonged surgery for osteomyelitis under EA+Sed has shown very positive impact of AVD on patients’ experience and confirmed our earlier encouraging observations. This clinical service improvement deserves further evaluation and funding

Orthopaedics has been left behind in the worldwide drive towards diversity and inclusion. In the UK, only 7% of orthopaedic consultants are female. There is growing evidence that diversity increases innovation as well as patient outcomes. This paper has reviewed the literature to identify some of the common issues affecting female surgeons in orthopaedics, and ways in which we can address them: there is a wealth of evidence documenting the differences in the journey of men and women towards a consultant role. We also look at lessons learned from research in the business sector and the military. The ‘Hidden Curriculum’ is out of date and needs to enter the 21st century: microaggressions in the workplace must be challenged; we need to consider more flexible training options and support trainees who wish to become pregnant; mentors, both male and female, are imperative to provide support for trainees. The world has changed, and we need to consider how we can improve diversity to stay relevant and effective.

Cite this article: Bone Jt Open 2021;2-10:893–899.

Aims

Healthcare systems have been rapidly restructured to meet COVID-19 demand. Clinicians are working to novel clinical guidelines, treating new patient cohorts and working in unfamiliar environments. Trauma and orthopaedics (T&O) has experienced cancellation of routine clinics and operating, with redistribution of the workload and human resources. To date, no studies have evaluated the mental health impact of these changes on the T&O workforce. We report the results of a novel survey on the impact of the pandemic on the mental health of our orthopaedic workforce and the contributory factors.