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Introduction: Globally, resident doctors face challenges like long work hours, critical decision-making stress, and exposure to death and distress, prompting concern for their wellbeing. This study addresses the need for interventions to improve their working conditions, vital for enhancing quality of life, patient care and retaining a skilled workforce. Methods: Following PRISMA guidelines, a systematic literature review until 3 January 2024 explored interventions for resident Ddoctors pre- and post-COVID-19. It evaluated intervention effectiveness, metrics and feasibility, excluding studies with high bias risk. Results: The review identified diverse interventions, from mentoring to wellness resources, showing significant improvements in job satisfaction, mental health and professional growth among resident doctors. Due to methodological variations, a narrative synthesis was conducted. Conclusion: Effective interventions addressing resident doctors’ challenges can notably enhance their wellbeing and job satisfaction. Scaling such interventions is vital for fostering supportive work environments, sustaining the healthcare workforce and improving patient care quality.

Introduction: Low levels of morale and wellbeing amongst doctors represent serious concerns for both staff health and patient safety.1 At University Hospitals Birmingham (UHB), the ‘Bewick Report’ was commissioned in response to the tragic death of a colleague and growing concerns about safety.2 This report, in combination with the National Training Survey,3 revealed a pattern of falling aggregate training benchmarks, along with high levels of staff sickness and dissatisfaction. In response, a trainee-led survey was conducted to identify and quantify factors affecting the working lives of non-consultant doctors at UHB. Subsequently, the ‘Doctor Wellbeing Group’ (DWG) – trainee-led and supported at executive level – was established to target areas of concern, champion the cause, and generate measurable change. Materials and methods: The initial QIP cycle aimed to: quantitatively measure risk of burnout and level of wellbeing amongst non-consultant doctors in UHB; identify key factors affecting wellbeing; audit rest and wellbeing provision against national, regional and locally accepted charters;4-6 identify key areas for urgent intervention; and influence change using robust evidence presented directly to key stakeholders at the trust. Data was collected via an anonymous online survey between Mar – Apr 2023. Results and discussion: 176 responses were recorded. 95% of respondents were aged 25-45, 50% female, 29.1% international medical graduates. A range of training programmes and all grades from FY1 to ST5+, as well as locally employed doctors, were represented. An aggregate Oldenburg Burnout Inventory Score was calculated and compared to previously published risk stratification in healthcare workers.7 This showed 38.3% of respondents were at high risk of burnout, 57.4% at medium risk and only 4.3% at low risk. Issues were identified with lack of adequate facilities (73% of responses); rota management (70%); and workplace culture (40%) including widespread unacceptable behaviours and perceived barriers to raising concerns.Following the survey, initial direct interventions included: raising awareness of survey findings through presentations to key stakeholders; improving rest/mess facilities and making them more accessible; employing extra Junior Doctor Wellbeing Officers; and arranging medical workforce and study leave drop-in sessions.The DWG has subsequently supported non-consultant doctor ‘Members’ to run a series of QIPs, supervised by consultants on a ‘Senior Supervisory Board.’ QIPs relate to working conditions, with topics such as increasing use of exception reporting, supporting locally employed doctor training opportunities, developing mentorship schemes, out of hours hot food access, and Civility Saves Lives campaigning.8 Through this work, the DWG promotes importance of wellbeing, supports portfolio requirements, and aims to implement measurable, sustainable change. Regular reports to the Trust Board are in progress. A trust-wide rep forum has also been established, to identify common issues and escalate concerns to Medical Education teams and Hospital Medical Directors. Conclusion: A repeat survey will be performed in May 2024 to re-assess and identify both improvements and continued challenges. Embedding the DWG within the Trust structures should continue to support positive change in the years to come.

There is a dearth of qualitative studies exploring the lived experiences of frontline healthcare personnel (HCP) during the coronavirus disease (COVID-19) pandemic. We examined workplace stressors, psychological manifestations of said stressors, and coping strategies reported through coded open-text responses from 1024 online surveys completed over two months by 923 HCP participating in three nationwide cohorts from Spring 2020. Our findings suggest that risk, job insecurity, frustration with hospital administration, inadequate access to personal protective equipment, and witnessing patient suffering and death contributed to deteriorating mental and physical health. Negative health impacts included the onset or exacerbation of anxiety, depression, and somatic symptoms, including weight fluctuation, fatigue, and migraines. Coping mechanisms included substance use and food consumption, meditation and wellness, fitness, socializing with loved ones, and religious activities. Insights garnered from participants' responses will enable more personalized and effective psychosocial crisis prevention and intervention for frontline HCP in future health crises.

Effective public health messages to encourage behaviours to reduce the spread of COVID-19 should be informed by existing research that identifies the factors that are associated with these preventive behaviours.This rapid review summarises the existing research on the determinants of behaviours that aim to prevent the spread of COVID-19. The review focuses on the body of research (excluding research conducted with health care workers) that was produced in the context of viruses other than SARS CoV-2 that cause severe respiratory illness and are transmitted in a similar way.A total of 58 published peer-reviewed studies included in the review were identified through searches of Medline, Embase, PsychInfo and CINAHL. Most were conducted in the context of the influenza A (H1N1) pandemic in 2009. Most studies examined the determinants of wearing a face covering, handwashing and social or physical distancing.The findings suggest that public health messages to encourage preventive behaviours should emphasise the potential seriousness of COVID-19 to elicit appropriate concern, strengthen perceptions of risk or threat from COVID-19, enhance self-efficacy about preventive behaviours, and improve knowledge about SARS-CoV-2, how it is transmitted, and how preventive behaviours can reduce the risk of transmission.

Patient presents with dyspnea after recovering from COVID-19 pneumonia and is found to have pneumothorax. This represents an under-reported sequelae of COVID-19.

Comprehensive transcriptome studies of cancers often rely on corresponding normal tissue samples to serve as a transcriptional reference. In this study, we performed in-depth analyses of normal kidney tissue transcriptomes from the TCGA and demonstrate that the histological variability in cellularity, inherent in the kidney architecture, lead to considerable transcriptional differences between samples. This should be considered when comparing expression profiles of normal and cancerous kidney tissues. We exploited these differences to define renal-cell-specific gene signatures and used these as a framework to analyze renal cell carcinoma (RCC) ontogeny. Chromophobe RCCs express FOXI1-driven genes that define collecting duct intercalated cells, whereas HNF-regulated genes, specific for proximal tubule cells, are an integral part of clear cell and papillary RCC transcriptomes. These networks may be used as a framework for understanding the interplay between genomic changes in RCC subtypes and the lineage-defining regulatory machinery of their non-neoplastic counterparts.

Objective: Clostridium tertium is considered an uncommon pathogen in humans, but is a cause of bacteremia in patients with underlying hematological malignancies and neutropenia. A case series highlighting 10 years of experience with C. tertium as a cause of bacteremia in this population is presented; the cases were seen at a National Cancer Institute designated cancer center. Methods: Institutional review board approval was obtained prior to the start of the study. All cases of C. tertium bacteremia seen at H. Lee Moffitt Cancer Center and Research Institute from 2005 to 2015 were reviewed. The study population was identified by positive blood cultures obtained from the microbiology laboratory over the same time period. Results: Seven patients were found to have had C. tertium bacteremia. These patients had a temperature of >38.3 °C at the time of diagnosis and severe neutropenia. All patients had a history of hematological malignancy, five having acute myeloid leukemia and two having myelodysplastic syndrome. All of the patients’ blood cultures cleared within ≤3 days of antibiotic therapy. Conclusions: The unusual susceptibility pattern of C. tertium, with resistance to beta-lactams and clindamycin, likely explains its presence in immunosuppressed patients. Vancomycin remains the drug of choice. The pathogen continues to have a low virulence and a low mortality when treated appropriately.