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Criteria for the classification of carpal tunnel syndrome for use in epidemiologic studies were developed by means of a consensus process. Twelve medical researchers with experience in conducting epidemiologic studies of carpal tunnel syndrome participated in the process. The group reached agreement on several conceptual issues. First, there is no perfect gold standard for carpal tunnel syndrome. The combination of electrodiagnostic study findings and symptom characteristics will provide the most accurate information for classification of carpal tunnel syndrome. Second, use of only electrodiagnostic study findings is not recommended. Finally, in the absence of electrodiagnostic studies, specific combinations of symptom characteristics and physical examination findings may be useful in some settings but are likely to result in greater misclassification of disease status.

The coronavirus disease 2019 (COVID-19) pandemic has put considerable physical and emotional strain on frontline healthcare workers. Among frontline healthcare workers, physician trainees represent a unique group-functioning simultaneously as both learners and caregivers and experiencing considerable challenges during the pandemic. However, we have a limited understanding regarding the emotional effects and vulnerability experienced by trainees during the pandemic. We investigated the effects of trainee exposure to patients being tested for COVID-19 on their depression, anxiety, stress, burnout and professional fulfillment. All physician trainees at an academic medical center (n = 1375) were invited to participate in an online survey. We compared the measures of depression, anxiety, stress, burnout and professional fulfillment among trainees who were exposed to patients being tested for COVID-19 and those that were not, using univariable and multivariable models. We also evaluated perceived life stressors such as childcare, home schooling, personal finances and work-family balance among both groups. 393 trainees completed the survey (29% response rate). Compared to the non-exposed group, the exposed group had a higher prevalence of stress (29.4% vs. 18.9%), and burnout (46.3% vs. 33.7%). The exposed group also experienced moderate to extremely high perceived stress regarding childcare and had a lower work-family balance. Multivariable models indicated that trainees who were exposed to COVID-19 patients reported significantly higher stress (10.96 [95% CI, 9.65 to 12.46] vs 8.44 [95% CI, 7.3 to 9.76]; P = 0.043) and were more likely to be burned out (1.31 [95% CI, 1.21 to1.41] vs 1.07 [95% CI, 0.96 to 1.19]; P = 0.002]. We also found that female trainees were more likely to be stressed (P = 0.043); while unmarried trainees were more likely to be depressed (P = 0.009), and marginally more likely to have anxiety (P = 0.051). To address these challenges, wellness programs should focus on sustaining current programs, develop new and targeted mental health resources that are widely accessible and devise strategies for creating awareness regarding these resources.

Background The response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created an unprecedented disruption in work conditions. This study describes the mental health and well-being of workers both with and without clinical exposure to patients with coronavirus disease (COVID-19). Objective The aim of this study is to measure the prevalence of stress, anxiety, depression, work exhaustion, burnout, and decreased well-being among faculty and staff at a university and academic medical center during the SARS-CoV-2 pandemic and describe work-related and personal factors associated with their mental health and well-being. Methods All faculty, staff, and postdoctoral fellows of a university, including its medical school, were invited in April 2020 to complete an online questionnaire measuring stress, anxiety, depression, work exhaustion, burnout, and decreased well-being. We examined associations between these outcomes and factors including work in high-risk clinical settings and family/home stressors. Results There were 5550 respondents (overall response rate of 34.3%). Overall, 34% of faculty and 14% of staff (n=915) were providing clinical care, while 61% of faculty and 77% of staff were working from home. Among all workers, anxiety (prevalence ratio 1.37, 95% CI 1.09-1.73), depression (prevalence ratio 1.28, 95% CI 1.03-1.59), and high work exhaustion (prevalence ratio 1.24, 95% CI 1.13-1.36) were independently associated with community or clinical exposure to COVID-19. Poor family-supportive behaviors by supervisors were also associated with these outcomes (prevalence ratio 1.40, 95% CI 1.21-1.62; prevalence ratio 1.69, 95% CI 1.48-1.92; and prevalence ratio 1.54, 95% CI 1.44-1.64, respectively). Age <40 years and a greater number of family/home stressors were also associated with these poorer outcomes. Among the subset of clinicians, caring for patients with COVID-19 and working in high-risk clinical settings were additional risk factors. Conclusions Our findings suggest that the pandemic has had negative effects on the mental health and well-being of both clinical and nonclinical employees. Mitigating exposure to COVID-19 and increasing supervisor support are modifiable risk factors that may protect mental health and well-being for all workers.

Objectives Most studies of carpal tunnel syndrome (CTS) incidence and prevalence among workers have been limited by small sample sizes or restricted to a small subset of jobs. We established a common CTS case definition and then pooled CTS prevalence and incidence data across six prospective studies of musculoskeletal outcomes to measure CTS frequency and allow better studies of etiology. Methods Six research groups collected prospective data at >50 workplaces including symptoms characteristic of CTS and electrodiagnostic studies (EDS) of the median and ulnar nerves across the dominant wrist. While study designs and the timing of data collection varied across groups, we were able to create a common CTS case definition incorporating both symptoms and EDS results from data that were collected in all studies. Results At the time of enrollment, 7.8% of 4321 subjects met our case definition and were considered prevalent cases of CTS. During 8833 person-years of follow-up, an additional 204 subjects met the CTS case definition for an overall incidence rate of 2.3 CTS cases per 100 person-years. Conclusions Both prevalent and incident CTS were common in data pooled across multiple studies and sites. The large number of incident cases in this prospective study provides adequate power for future exposure– response analyses to identify work- and non-work-related risk factors for CTS. The prospective nature allows determination of the temporal relations necessary for causal inference.

Women and minorities with PD obtain specialist care less often than white men. Neurologist care of patients with PD may be associated with improved selected clinical outcomes and greater survival.

Objective: To combine human factors engineering techniques with qualitative observation of nurses in practice to analyze the nature of nurses' cognitive work and how environmental factors create disruptions that pose risks for medical errors. Background: Few researchers have examined the nature of nurses' cognitive work while in practice with patients. Researchers have described the broad range of thinking processes required in the acute care work setting, but have failed to examine how such processes are conducted and influenced by the complex care environment. A combined research methodology enables researchers to better understand how the nursing process becomes disrupted and the potential influence of this disruption on the safe and effective care of patients. Methods: An ethnographic study, using mixedmethodological approaches, involved 7 staff registered nurses. The quantitative and qualitative data collection included field observation and summarative interviews. Findings: A high number of cognitive shifts and interruptions, and a nurse's cumulative cognitive load, create the potential for disrupting a nurse's attention focus during care of patients. A majority of interruptions occurred as nurses performed interventions, particularly medication preparation. Conclusion: New attention must be given to how care systems and work processes complement or interfere with nurses' cognitive work.

OBJECTIVE: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.DESIGN: Case-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/ or nurses and review of adverse event reports, medical records, and nurse staffing records.SETTING: Large urban academic hospital.PATIENTS: Ninety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall. MEASUREMENTS AND MAIN RESULTS:In a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of ''up with assistance'' compared with ''bathroom privileges'' (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).CONCLUSIONS: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling. Due to the risk of significant injury and the increased cost, reduction of falls in hospitals is a major priority for hospital quality and patient safety. While falls have been relatively well studied in community and nursing home settings, less is known about the prevention of hospital falls. Previous research has identified risk factors for falling in the hospital, including impaired balance or gait, history of falling, increasing age, impaired cognition, depression, dizziness or vertigo, orthostatic hypotension, visual impairment, urinary frequency, nocturia, incontinence, specific diagnoses, and use of certain medications, such as benzodiazepines, antipsychotics, and sedatives. 10,[12][13][14][15][16][17][18] Yet comparative studies on hospital falls have been limited in several ways, including variations in study design, setting, patient population, and definitions of risk factors. Some studies have continued to focus solely on the elderly or relied only on data included in hospital incident reports or chart review. Furthermore, environmental and care-related factors, including patient-to-nurse ratio, are often overlooked as potential risk factors for falling in these studies. Because fall prevention programs should be linked to the etiologic factors of fa...