The “Crisis and Concerns: A cross-sectional study on Junior Doctors during COVID-19 pandemic”.

Introduction: Doctors committed to the care of patients are trying to fulfill their duty in a difficult situation, but the consequential impacts of COVID-19 outbreak on Junior Doctors mental health are far too complex. Objective: The objective of this study was to gain insight into Junior Doctors’levels of concerns during a global pandemic of COVID-19. Methods: A quantitative cross-sectional study, utilizing a 23-item validated questionnaire was conducted on two hundred and fifty doctors of various disciplines and nationalities working on training and non-training posts. Results: The response rate was (77 %) and the levels of concern score among Junior doctors during COVID-19 pandemic in the NHS was found to be (41.35±4.9). With regard to gender differences, 32.5% of males and 27.5% females had a moderate concern score of 40 to 47. In regard to safety at work (85%) agreed that they are not safe, (100%) agreed that they are at risk to contract a COVID-19 infection at work and (100%) felt that they will transmit COVID-19 to their families but (95%) agreed that were obliged to take care of patients. In addition, (97.5%) doctors were not confident with the current infection control measures and (77.5%) felt frustrated with poor infection control training offered to them. Conclusion: Therefore, measures to strengthen personal protection and adequate support to Junior Doctors should be addressed urgently by the Healthcare system. KEYWORDS: COVID-19, Doctors, PPE, Concerns, Psychological impact.  

The Effect of a Preanaesthesia Clinic Consultation on Adult Patient Anxiety in Aga Khan University Hospital; a Cohort Study

Background: Preoperative anxiety is a common perioperative complication, according to studies done it is seen in approximately 11-80% of adults undergoing surgery. Various pharmacological and non pharmacological techniques have been used to reduce preop anxiety. One of the goals of the preanaesthesia clinic is to allay anxiety. Literature shows that a preanaesthesia clinic evaluation reduces anxiety however b current studies done on anxiety and the preanaesthesia clinic have not quantified this reduction. Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward. Study Design: A cohort and before – after study Setting: The surgical outpatient clinics, the gynaecological outpatient clinic, the antenatal clinic, the wards and operating theatres at the Aga Khan University Hospital, Nairobi. Population: All the adult patients scheduled for non-cardiac elective surgical procedures during the study period. Sample size: 44 adult patients with 22 patients in each of the 2 groups i.e. anaesthesia clinic (AC) group and the ward group (W). Methods: 51 adult patients with 28 patients in anaesthesia clinic group and another 23 in the ward were sequentially recruited from both the surgical outpatient clinic, gynaecology outpatient clinic and antenatal clinic. The patient’s State Trait Anxiety Index (STAI) was taken once the patient was booked for theatre. The patient then had a preanaesthesia evaluation either in the preanaesthesia outpatient clinic (PAC) or in the wards. Another STAI score was taken in the preoperative area in theatre on the day of surgery. The patients were then traced back as to whether they had their intervention in the ward or the clinic and hence divided into two groups. The difference in the change of STAI scores in both groups was then analysed. Results: 51 adult patients were recruited i.e. 28 in the clinic group and 23 in the ward group. The majority of the recruited patients were female (n=38). Statistically significant difference was seen in the reduction of the anxiety scores between the clinic group 2.143(C.I=1.384-2.902) and ward group 0.739(C.I=0.168-1.311) with a p value=0.0051.There was also significant difference in reduction in anxiety scores within ward group in the patients with no prior anaesthetic experience having a greater reduction than those a prior anaesthetic experience. There were no other significant differences between the 2 groups. Conclusion: Patients evaluated in the anaesthesia clinic had a greater reduction in their anxiety but it was not as much as hypothesised which may