key: cord-0915743-4yj05r15
authors: Bhalla, Natasha; Dym, Harry
title: The Psychological Impact of COVID-19 on Hospital Trainees in a New York City Hospital
date: 2021-04-30
journal: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
DOI: 10.1016/j.oooo.2020.12.028
sha: a7145eb4ab7b3b4299405d397ffd584186264cce
doc_id: 915743
cord_uid: 4yj05r15

Purpose On January 7, 2020, China reported a group of cases of pneumonia caused by the novel coronavirus 2019 (COVID-19). This novel virus spread rapidly to other countries. As of August 2020, there are close to 6 million diagnosed cases in the United States and 460,000 diagnosed cases in New York State. The purpose of this article is to examine the psychological impact of the COVID-19 outbreak on trainees in a New York City hospital. To achieve this goal, trainees of the Brooklyn Hospital Center were sent a questionnaire via e-mail. The questionnaire asked about the residents’ demographic characteristics, health information, and self-report questions regarding anxiety, depression, and PTSD (posttraumatic stress disorder). Methods Participants were trainees at the Brooklyn Hospital Center from the OMFS (oral and maxillofacial surgery), general dentistry, and other medical departments. A 3-part survey including demographic information, a PHQ-9 (Patient Health Questionnaire-9), and an impact of events score revised (IES-R) questionnaire was obtained. Descriptive analysis assessed participant demographic characteristics and mean scores on questionnaires. Additionally, independent samples t-test was used to determine statistical difference in mean scores on PHQ-9 and IES-R questionnaires between dental (OMFS and general dentistry) and medical specialties. Bivariate correlation was used to assess the relationship between scores on the PHQ-9 and IES-R questionnaires. Level of significance was accepted at .05. Results The mean score on the PHQ-9 questionnaire was significantly higher for dental compared to medical specialties (18.9 vs 7.24, P < .001). Likewise, for the IES-R questionnaire, the dental group scored significantly higher than the medical group (61.9 vs 30.36, P < .001). Furthermore, depression severity was much worse for the dental group: 7 (33.3% vs 8.9% medical, P < .001) were classified as severe and 12 (57.1% vs 8.9% medical, P = .013) were moderately severe. Conclusion Currently, trainees are facing enormous isolation, burnout, and fear of contracting and transmitting COVID-19.1 Trainees are also facing concerns about inadequate training (clinical and didactic). Previous literature has demonstrated that one's physical location and holding an intermediate title during a pandemic were associated with severe depression, distress, and anxiety.2-4 The participants of our study were trainees from the oral and maxillofacial surgery, general dentistry, and other medical specialty departments. The trainees from the dental department scored significantly higher on the IES-R and PHQ-9 questionnaires. Many participants had graduated from dental school less than a year ago. Additionally, this study was conducted in New York, which was the epicenter to the pandemic for a period of time. Being aware of the impact of the coronavirus on health care workers is an important step in providing intervention. This intervention may prevent the anxiety, depression, and PTSD seen after previous pandemics.

Ameloblastoma is a benign but aggressive odontogenic tumor of the jaws that may be divided into unicystic and multicystic/solid histologic subtypes. Unicystic lesions can be further subdivided based on the presence of mural involvement of the surrounding bone, and these classifications are important in directing treatment. Ameloblastomas are relatively rare in the pediatric population and there remains controversy surrounding their management in these patients. Classically, pediatric ameloblastomas have been reported as presenting with the unicystic subtype the majority of the time (76.5%), 1 yet recurrence rates in pediatric ameloblastomas have been reported to be much higher than recurrence rates for ameloblastoma overall. 2 Methods: A retrospective chart review was conducted of patients under the age of 18 years with biopsy-proven ameloblastoma who presented to the University of Maryland Oral and Maxillofacial Surgery Department from 1991 to 2019. This review yielded 29 patients, including 27 patients who were treated at our institution. Data were collected regarding demographic characteristics, radiographic and clinical presentation, histology, treatment modalities, and recurrence.

Results: Average age at diagnosis was 12.9 years (range, 3-17 years). There was an equal distribution of male (52%) and female (48%) patients. The majority of patients were black (52%). Average length of follow-up was 55.4 months (range, 1 month to 23 years). The majority of the lesions were located in the mandible (93%) and lesions most commonly involved the body (59%), followed by the angle (52%) and symphysis (41%). Most lesions were primary (90%), 2 of which had been previously treated but were re-excised in order to remove suspected residual disease. Among tumors for which adequate histologic data were available, 43% were solid/multicystic subtype, 52% were unicystic (55% mural subtype), and 1 was ultimately determined to be an ameloblastic carcinoma. Treatment modalities included both enucleation (37%) and resection (63%). Reconstruction was performed using either nonvascularized autologous bone grafting (53%) or fibula free flap (47%). Two patients developed a recurrence (7% overall, 20% for enucleation), with both cases involving a unicystic mandibular lesion treated initially with enucleation. Both patients were ultimately treated with segmental resection and reconstruction using fibula free flaps.

Previous studies of pediatric ameloblastomas have suggested high rates of recurrence irrespective of treatment modality and recommend initially conservative treatment based on these findings. 2 However, our data suggest that resection serves as an effective treatment modality for this patient population. Our series demonstrates a larger percentage of solid/ multicystic and mural unicystic type lesions than has been classically described. Therefore, it may be prudent to view management of these lesions in a manner more similar to the management of adult ameloblastoma. Given the range of reconstructive options available to these patients, we feel that resection represents the most appropriate initial treatment for mural unicystic and solid/multicystic ameloblastomas, regardless of age.

Social factors have been implicated in the development of various peri-implant pathologies, including implant failure. This study aims to investigate whether varying levels of alcohol consumption affects late dental implant failures.

Methods: A retrospective cohort study was performed to evaluate implants placed between 2006 and 2012 at the Philadelphia Veterans Affairs Medical Center. The primary predictor variable was alcohol consumption, measured as nonconsumption or mild, moderate, and heavy consumption. The primary outcome variable was late dental implant failure. Other study variables included age, sex, and the type of implant restoration used. Appropriate univariate, bivariate, and multivariate statistics were applied, with P < .05 used to define statistical significance.

Results:

Our retrospective cohort consisted of 103 unique patients and 295 implants with a 5-year minimum followup period. Most patients were male (93%) with an average age of 60 at the time of implant placement. Late dental implant failure was associated with 30 implants (10%). Compared to nonconsumption, mild alcohol consumption was associated with a 75% decrease in late implant failure (P = .0494), moderate consumption was associated with a 60% decrease in late implant failure (P = .3826), and heavy consumption was associated with a 200% increase in late implant failure (P < .1782). Compared to mild alcohol consumption, heavy consumption was associated with an 847% increase in late implant failure (P = .0135).

The results from this retrospective cohort analysis suggest mild alcohol consumption is associated with a decrease in late dental implant failures, and heavy consumption is associated with an increase in late dental implant failures. This article describes a novel technique for replacing the temporomandibular joint (TMJ) with a prosthesis. The technique applies a simple endaural incision to approach the temporomandibular joint in order to place a total joint prosthesis. This is followed by small trochar site incisions for plating of the prosthesis. The technique was performed on 4 patients (8 TMJs).

Mental health among otolaryngology resident and attending physicians during the COVID-19 pandemic: National study

Evolution of COVID-19 Guidelines for University of Washington Oral and Maxillofacial Surgery Patient Care

Resident Education in the Time of a Global Pandemic: Development of the Collaborative OMS Virtual Interinstitutional Didactic (COVID) Program

Early Effects of COVID-19 on Oral and Maxillofacial Surgery Residency Training-Results From a National Survey

Prevalence of self-reported depression and anxiety among pediatric medical staff members during the COVID-19 outbreak in Guiyang, China. Psychiatry research

Correction to: COVID-19 outbreak situation and its psychological impact among surgeons in training in France. World journal of urology

Impact of COVID-19 on the mental health of surgeons and coping strategies

Intervention for physician burnout: A systematic review

Psychological status of surgical staff during the COVID-19 outbreak

Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review

The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics. General hospital psychiatry

Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease

The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China

During the Outbreak of Coronavirus Disease 2019 (COVID19) in Hubei, China. Medical science monitor : international medical journal of experimental and clinical research

Ameloblastoma in children

Recurrence factors in pediatric ameloblastoma: clinical features and a new classification system