On the Competition Act 1998 (Health Services for Patients in England) (Coronavirus) (Public Policy Exclusion) Order 2022 (SI 2022/124)

Report for the House of Lords' Secondary Legislation Scrutiny Committee in its consideration of legislation relevant to the provision of care for patients with coronavirus and long covid. My report set out the reasons why the legislation would disincentivise quality control among healthcare providers, reduce patient choice, reduce compliance with clinical standards, and reduce value for money for the government. The government responded confirming that the proposed legislation was being applied only for a short period of time, addressing the issues set out in my report

Sexism experienced by consultant cardiologists in the United Kingdom

Objectives – The aim was to compare the frequency with which male and female cardiologists experience sexism, and to explore types of sexism experienced in cardiology. Methods – A validated questionnaire measuring experiences of sexism and sexual harassment was distributed online to 890 UK consultant cardiologists between March and May 2018. Chi squared tests and pairwise comparisons with a Bonferroni correction for multiple analyses compared the experiences of male and female cardiologists. Results – 174 cardiologists completed the survey (24% female; 76% male). The survey showed that 61.9% of female cardiologists have experienced discrimination of any kind, mostly related to gender and parenting, compared to 19.7% of male cardiologists. 35·7% of female cardiologists experienced unwanted sexual comments, attention or advances from a superior or colleagues, compared to 6.1% of male cardiologists. Sexual harassment affected the professional confidence of female cardiologists more than it affected the confidence of male cardiologists (42·9% vs. 3·0%), including confidence with colleagues (38% vs. 10·6%) and patients (23·9% vs. 4·6%). 33.3% of female cardiologists felt that sexism hampered opportunities for professional advancement compared to 2.3% of male cardiologists. Conclusion – Female cardiologists in the UK experience more sexism and sexual harassment than male cardiologists. Sexism impacts the career progression and professional confidence of female cardiologists more, including their confidence when working with patients and colleagues. Future research is urgently needed to test interventions against sexism in cardiology, and to protect the welfare of female cardiologists at work

Burnout and fear of COVID-19 among medical students in Japan: impact of infection history, gender, and social support

The COVID-19 pandemic caused significant changes in medical students' lives and study methods, with online learning replacing in-person classes and limited opportunities for clinical practice. However, there are few studies about burnout and fear of COVID-19 among medical students, especially in East Asia, and a need for research investigating the impact of gender, a history of COVID-19 infection, and social support. In March 2022, we conducted a cross-sectional web-based survey of 4th/5th year medical students who completed a clinical clerkship in Japan. Our survey included the Japan Burnout Scale (JBS, range 5-85, comprising of emotional exhaustion, depersonalization and reduced personal accomplishment), fear of COVID-19 scale (range, 1-4), gender, school year, COVID-19 history, household composition, online education use, and financial burden. There were 343 respondents and 42.4% were women. Multivariable adjusted linear regression analyses showed that students with a COVID-19 infection history had significantly higher overall burnout, depersonalization, reduced personal accomplishment, and lower fear of COVID�19. Students with low social support (living alone and greater financial burden) had higher overall burnout, emotional exhaustion, and depersonalization. Gender had no significant effect on burnout (mean JBS among women was 38.6 versus 39.3 among men). Gender significantly predicted fear of COVID-19, with women scoring higher (1.60 versus 1.50). The findings of the present study have implications that medical schools should provide pastoral care for their students according to students’ circumstances, especially those who live alone, have a high financial burden, and/or were infected with COVID-19

Anxiety, depression, working from home, and health-related behaviours during COVID-19: structural equation modelling and serial mediation of associations with angina, heart attacks and stroke

Based on the vulnerability-stress model and coping theory, this study of 1,920 people in Scotland investigated how sex, age, occupational factors, anxiety, depression, and maladaptive coping behaviours are associated with cardiovascular health. Structural equation modelling and serial Sobel mediation tests were conducted. Anxiety was associated with past arrhythmia, whereas depression was associated with past heart attacks, stroke, and angina. Females reported more anxiety, past arrhythmia, confectionary and alcohol consumption, whereas males had more heart attacks. Confectionary consumption was associated with past arrhythmia, and alcohol consumption was associated with past heart attacks. Being older was associated with depression, past stroke, arrhythmia, and alcohol consumption. Being younger was associated with anxiety and smoking. Depression and smoking mediated the relationship between type of working and cardiovascular health history, potentially because of socioeconomic factors. Clinicians can use these results to advise clients about cardiovascular risks associated with anxiety, depression, demographics, and health-related coping behaviours

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research