Mindfulness Applications: Can They Serve as a Stress, Anxiety, and Burnout Reduction Tool in Orthopaedic Surgery Training? A Randomized Control Trial

Stress and burnout are prevalent within the orthopaedic surgery community. Mindfulness techniques have been shown to improve wellness, yet traditional courses are generally time-intensive with low surgeon utilization. We sought to determine whether the introduction of a simple mindfulness-based phone application would help decrease stress, anxiety, and burnout in orthopaedic surgery residents.

Methods

Twenty-four residents participated in this prospective, randomized controlled trial. After simple 1:1 randomization, the treatment group received access to a mindfulness-based phone application for 2 months while the control group did not receive access. All participants completed the Perceived Stress Scale, Generalized Anxiety Disorder-7, and Maslach Burnout Inventory with emotional exhaustion (EE), depersonalization (DP), and personal accomplishment subscores to measure stress, anxiety, and burnout at baseline and after 2 months. Paired t tests were used to compare baseline scores and conclusion scores for both groups.

Results

There was no difference in baseline burnout scores between groups, but the treatment group had higher stress and anxiety scores at baseline. On average, the treatment group spent approximately 8 minutes per day, 2 days per week using the mindfulness application. After 2 months, the treatment group had significantly decreased stress (mean = -7.42, p = 0.002), anxiety (mean = -6.16, p = 0.01), EE (mean = -10.83 ± 10.72, p = 0.005), and DP (mean = -5.17 ± 5.51, p = 0.01). The control group did not have any significant differences in stress, anxiety, or burnout subscores.

Conclusions

Use of a mindfulness-based phone app for 2 months led to significant reductions in stress, anxiety, and burnout scores in orthopaedic surgery residents. Our results support the use of a mindfulness-based app to help decrease orthopaedic resident stress, anxiety, and burnout. Benefits were seen with only modest use, suggesting that intensive mindfulness training programs may not be necessary to effect a change in well-being. The higher baseline stress and anxiety in the treatment group may suggest that mindfulness techniques are particularly effective in those who perceive residency to be more stressful.

Level of Evidence

I.

A simple surgical mask modification to pass N95 respirator-equivalent fit testing standards during the COVID-19 pandemic

Background

The COVID-19 pandemic has infected hundreds of millions of people resulting in millions of deaths worldwide. While N95 respirators remain the gold standard as personal protective equipment, they are resource-intensive to produce and obtain. Surgical masks, easier to produce and obtain, filter ≥95% submicron particles but are less protective due to a lack of seal around a user’s face. This study tested the ability of a simple surgical mask modification using rubber bands to create a seal against particle exposure that would pass N95 standards.

Methods and findings

Forty healthcare workers underwent TSI PortaCount mask fit testing using an ASTM Level 1 surgical mask modified with rubber bands. Fit Factor was determined after testing four standard OSHA N95 fit testing scenarios. Performance of the properly-modified surgical mask was compared to that of a poorly-modified surgical mask, an unmodified standard surgical mask, and an N95 respirator. Thirty-one of forty (78%) healthcare workers passed Fit Factor testing using a properly-modified mask. The Fit Factor success rate significantly improved by subsequent test date (p = 0.043), but was not associated with any other participant characteristics. The average Fit Factor score for the properly-modified mask was 151 (SD 65.2), a significantly better fit than the unmodified mask score of 3.8 (SD 3.1, p<0.001) and the poorly-modified mask score of 24.6 (SD 48.4, p<0.001) but significantly lower than a properly fitted N95 score of 199 (SD 4.5, p<0.001).do.

Conclusions

Rubber bands, a low-cost and easily-accessible modification, can improve the seal and protective ability of a standard surgical mask to the level of an N95 respirator. This could mitigate N95 respirator shortages worldwide and provide individuals in under-resourced regions a practical means for increased personal respiratory protection.

Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity Procedures

Background: The purpose of this study was to investigate the relationship between insurance status and patient-reported pain both before and after upper extremity surgical procedures. We hypothesized that patients with Medicaid payer status would report higher levels of pre- and postoperative pain and report less postoperative pain relief. Methods: In all, 376 patients who underwent upper extremity procedures by a single surgeon at an academic ambulatory surgery center were identified. Patient information, including insurance status and Visual Analog Scale pain score (VAS-pain) at baseline, 2 weeks, and 1, 3, and 6 months, were collected. VAS-pain scores were compared with t-tests and linear regression. Results: Preoperatively and at 2-week, 1-month, and 3-month follow-up, Medicaid patients reported statistically significant higher pain levels than patients with Private insurance, finding a mean adjusted increase of 0.51 preoperatively, 0.39 at 1 month, and 0.79 at 3 months. Preoperatively and at 3-month follow-up, Medicaid patients reported statistically significant higher pain than patients with Medicare, finding increases in VAS-pain of 0.99 preoperatively and 0.94 at 3 months. There was no difference in pain improvement between any insurance types at any time point (all P values > .05). Conclusions: Patients with Medicaid report higher levels of preoperative pain and early postoperative pain, but reported the same improvement in pain as patients with other types of insurance. As healthcare systems are becoming increasingly dependent on patient-reported outcomes, including pain, it is important to consider that differences may exist in subjective pain depending on insurance status.

Arthroscopic Diagnosis of Occult Posterolateral Meniscocapsular Separations: Another Hidden Lesion

Purpose

The purpose of this study was to describe the surgical findings and clinical outcomes in a series of patients with occult posterolateral meniscocapsular separations diagnosed arthroscopically after a negative magnetic resonance imaging (MRI) scan.

Methods

A retrospective analysis of prospectively collected data of consecutive patients who underwent surgical arthroscopy with repair of an occult posterolateral meniscocapsular separation by 2 fellowship-trained orthopaedic sports medicine surgeons at a single institution was performed. All lesions were identified arthroscopically in the posterolateral aspect of the lateral compartment as a distinct pathologic separation between the posterolateral capsule and adjacent meniscal tissue with increased excursion on probing. Clinical examination notes, MRI scans, and operative reports were reviewed. Patient-reported outcome measures were assessed via patient questionnaire.

Results

A total of 6 patients were included for analysis. MRI evaluation of the lateral meniscus was unrevealing in 4 patients, suggesting a possible tear of the body of the lateral meniscus in one patient and demonstrating a parameniscal cyst abutting the anterior root of the lateral meniscus in another patient. Arthroscopic examination revealed meniscocapsular separations of the posterolateral meniscus in all 6 knees, with 2 knees demonstrating concomitant bucket-handle meniscus tears. Patient-reported outcomes were determined for 67% of study patients. The average reported International Knee Documentation Committee score was 63.8, the average Knee Outcome Survey Activities of Daily Living Scale score was reported as 63, the 12-Item Short Form Survey (SF-12) Physical score averaged 46.8 with an average SF-12 Mental score of 59.9.

Conclusions

The diagnosis of occult posterolateral meniscocapsular separations (MCS) could be missed on advanced imaging, such as MRI, so arthroscopic diagnosis may be required. This study indicates that arthroscopic diagnosis and repair of occult posterolateral MCS results in good functional and clinical outcomes.

Level of Evidence

IV, therapeutic case series.

1H and 13C NMR assignments for the cyanine dyes SYBR Safe and thiazole orange

Analysis of (1)H and (13)C NMR and mass spectral data for the fluorescent nucleic acid stain SYBR Safe indicates that it contains a cyanine-based cationic core structure identical to thiazole orange. The difference between these two compounds is the type of N-substitution on the quinolinium ring system (SYBR Safe, n-Pr; thiazole orange, Me). The (1)H and (13)C NMR resonances for both compounds were assigned on the basis of one- and two-dimensional (COSY, ROESY, HSQC, and HMBC) experiments. The preferred conformation of these compounds was computed by ab initio methods and found to be consistent with the NMR data.

A comparison of static near stereo acuity in youth baseball/softball players and non-ball players

BACKGROUND

Although many aspects of vision have been investigated in professional baseball players, few studies have been performed in developing athletes. The issue of whether youth baseball players have superior stereopsis to nonplayers has not been addressed specifically. The purpose of this study was to determine if youth baseball/softball players have better stereo acuity than non-ball players.

METHODS

Informed consent was obtained from 51 baseball/softball players and 52 non-ball players (ages 10 to 18 years). Subjects completed a questionnaire, and their static near stereo acuity was measured using the Randot Stereotest (Stereo Optical Company, Chicago, Illinois). Stereo acuity was measured as the seconds of arc between the last pair of images correctly distinguished by the subject.

RESULTS

The mean stereo acuity score was 25.5 +/- 1.7 seconds of arc in the baseball/softball players and 56.2 +/- 8.4 seconds of arc in the non-ball players. This difference was statistically significant (P < 0.00001). In addition, a perfect stereo acuity score of 20 seconds of arc was seen in 61% of the ball players and only 23% of the non-ball players (P = 0.0001).

CONCLUSIONS

Youth baseball/softball players had significantly better static stereo acuity than non-ball players, comparable to professional ball players.