Randomised trial of the fascia iliaca block versus the ‘3-in-1’ block for femoral neck fractures in the emergency department

Introduction: Femoral neck fractures are a common and painful injury. Femoral nerve blocks, and a variant of this technique termed the ‘3-in-1’ block, are often used in this patient group, but their effect is variable. The fascia iliaca compartment block (FIB) has been proposed as an alternative, but the relative effectiveness of the two techniques in the early stages of care is unknown. We therefore compared the FIB versus the 3-in-1 block in a randomised trial conducted in two UK emergency departments. Methods: Parallel, two-group randomised equivalence trial. Consenting patients >18 years with a femoral neck fracture were randomly allocated to receive either a FIB or a 3-in-1 block. The primary outcome was pain measured on a 100 mm visual analogue scale at 60 min. The between-group difference was adjusted for centre, age, sex, fracture type, pre-block analgesia and pre-block pain score. Results: 178 patients were randomised and 162 included in the primary analysis. The mean 100 mm visual analogue pain scale score at 60 min was 38 mm in the FIB arm and 35 mm in the 3-in-1 arm. The adjusted difference between the arms was 3 mm, with a 95% CI (−4.7 to 10.8) that excluded a clinically important difference between the two interventions. Conclusions: FIB is equivalent to the 3-in-1 block for immediate pain relief in adult neck of femur fractures

Implementation and evaluation of a multi-level mental health promotion intervention for the workplace (MENTUPP): study protocol for a cluster randomised controlled trial

Abstract Background Well-organised and managed workplaces can be a source of wellbeing. The construction, healthcare and information and communication technology sectors are characterised by work-related stressors (e.g. high workloads, tight deadlines) which are associated with poorer mental health and wellbeing. The MENTUPP intervention is a flexibly delivered, multi-level approach to supporting small- and medium-sized enterprises (SMEs) in creating mentally healthy workplaces. The online intervention is tailored to each sector and designed to support employees and leaders dealing with mental health difficulties (e.g. stress), clinical level anxiety and depression, and combatting mental health-related stigma. This paper presents the protocol for the cluster randomised controlled trial (cRCT) of the MENTUPP intervention in eight European countries and Australia. Methods Each intervention country will aim to recruit at least two SMEs in each of the three sectors. The design of the cRCT is based on the experiences of a pilot study and guided by a Theory of Change process that describes how the intervention is assumed to work. SMEs will be randomly assigned to the intervention or control conditions. The aim of the cRCT is to assess whether the MENTUPP intervention is effective in improving mental health and wellbeing (primary outcome) and reducing stigma, depression and suicidal behaviour (secondary outcome) in employees. The study will also involve a process and economic evaluation. Conclusions At present, there is no known multi-level, tailored, flexible and accessible workplace-based intervention for the prevention of non-clinical and clinical symptoms of depression, anxiety and burnout, and the promotion of mental wellbeing. The results of this study will provide a comprehensive overview of the implementation and effectiveness of such an intervention in a variety of contexts, languages and cultures leading to the overall goal of delivering an evidence-based intervention for mental health in the workplace. Trial registration Please refer to Item 2a and registration ISRCTN14104664. Registered on 12th July 2022

IGLOO: a framework for return to work among workers with mental health problems

It is important for society and for organizations to support workers returning to work following mental health-related absence. Recent evidence points to an increase in mental health problems among the general population, with approximately 38.2% of the EU population suffering from a mental disorder each year (European Commission 2008, 2016). Of those who take a period of sick leave, 55% of workers make unsuccessful attempts to return to work (RTW), and 68% of those who do return have less responsibility and are paid less than before (Matrix Insight 2013). A number of challenges have been reported by workers following a period of long-term sickness absence; however current research has been somewhat limited by a focus on the initial return and a siloed approach where work and non-work contexts are considered separately. In this book chapter, we apply the IGLOO (individual, group, leader, organizational and overarching contextual factors that may support sustainable RTW) model (Nielsen et al. 2018). In doing so, we focus on the sickness absence before return to work and consider the factors that could support return to work following long-term sickness absence. We provide an overview of the resources that may facilitate return to work among workers who are on sick leave with mental health problems. Based on the IGLOO framework, we identify and discuss resources, i.e., factors that facilitate return to work at five levels: the individual (e.g., beliefs about being able to manage a successful return to work, health behaviors), the group (work groups, friends, and family), the leader (line managers and healthcare provides who take the lead in supporting workers return), the organizational (Human Resource policies and external organizations such a charities), and the overarching context (social security systems). We discuss these resources that pertain to the work context but also the non-work context and highlight the importance of understanding how resources apply at different levels. We argue that there is a need to understand how societal factors, such as legislation, culture, and national policies, impact return to work outcomes. We propose a holistic approach that focuses on integrating the resources in and outside work and is needed to facilitate successful and sustainable return to work for workers with mental health problems