This editorial reviews the `Mind the Implementation Gap' report, which calls for the government, parliamentarians and NHS leaders to take action to address the underlying causes of avoidable harm in healthcare and details specific recommendations relating to the areas of the implementation gap.

This editorial reviews the Safety for All campaign, which is calling for improvements in, and between, patient and healthcare worker safety to prevent safety incidents and deliver better outcomes for all.

BackgroundBurnout is a pervasive health condition affecting many doctors at various stages in their careers. Characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment it can result in significant personal and professional consequences putting patient care at risk. Emotion regulation describes a capacity to self-modulate emotions to achieve desirable emotional outcomes. Emotional intelligence theory suggests that emotion regulation skills facilitate the maintenance of appropriate emotions, reducing or adapting undesirable emotions in oneself and others. Emotion regulation is usually automatic but can be controlled through learnt strategies. There is evidence that occupationally stressed individuals are less capable of down-regulating negative emotions. This paper systematically reviews studies of the role of emotion regulation in burnout in doctors.AimsTo examine the relationship between emotion regulation and burnout among doctors.MethodsFour online databases (Psych Info 1833-2017, Medline 1928-2017, Scopus 1960-2017 and Embase 1974-2017) were searched in August 2017. Searches returned 15 539 citations, which after de-duplication yielded 12 295 citations. After title and abstracts screening 12 273 citations were excluded. Twenty-two full text articles were read and eight excluded for ineligibility. Following data extraction, bias and methodological quality assessment, findings were synthesized using descriptive analysis and presented according to relevant themes.ResultsA correlative relationship was observed between emotion regulation and burnout in doctors. Findings also indicated that-using self-regulatory or taught emotion regulation skills or interventions such as mindfulness were associated with a reduction in burnout.ConclusionEmotion regulation is an important psychological variable associated with burnout.

Review Group (with institutions) Advisory group (with institutions) Conflicts of interest (if any) Neither Sultan Barakat nor Kathryn Rzeszut has any personal, financial or professional interests which would influence the conduct or outcomes of this systematic review. However, Sultan Barakat has previously published on the topic of multidonor trust funds (see ‘The Failed Promise of Multi-Donor Trust Funds’, Policy Studies, 2009) and thus may be perceived as having a bias towards confirming previous findings.

Introduction Common mental health disorders (CMHD) are highly prevalent in the working population. Sick leave due to CMHDs is contributing to the exclusion form the labour market. Aims To give an overview of the efficacy and effectiveness of interventions to increase chances of sooner and sustained return to work (RTW) in staff who go on sick leave with CMHDs. We aimed to include a wide variety of study designs, mental health conditions and types of interventions to allow for increased generalizability of the findings. Methods We systematically searched MEDLINE, EMBASE, CINAHL, PsychINFO, and Cochrane Database of Systematic Reviews for studies published between 2009 and 2016. We included workplace- based interventions that focused on initiatives undertaken or strongly facilitated by the employer or the insurer. We used a narrative synthesis. Results We retrieved 934 articles and 56 included in the qualitative synthesis. Of these 16 were randomised controlled trials. There was strong evidence that workplace focused interventions reduce the time until RTW (i.e. the number of sick-leave days), but did not improve RTW rates compared with controls. The evidence regarding lasting return to work and job performance is less clear. There is strong evidence that multiple domain interventions are more effective compared with single domain interventions. Conclusions Individual-based interventions are more prevalent. However, more studies on workplace-focused interventions are needed, especially since connecting healthcare and workplace systems appears vital to influence the return-to-work process. There remains an evidence gap for which, if any, interventions lead to sustained return to productive work.

Musculoskeletal disorders are a major cause of suffering and disability among working-age adults. Although working in ergonomically unsound jobs may lead to the development of certain musculoskeletal disorders, it is increasingly recognised that well-designed work is generally good for health and individuals with musculoskeletal disorders generally benefit from working. This chapter explores how health-care professionals should assess patients' fitness for work, what factors should be considered and how the results should be communicated and to whom. Of necessity, this chapter describes current United Kingdom (UK) schemes and systems. Nevertheless, the principles described can be extended to most countries but the reader is advised to familiarise themselves with the detail of the equivalent national services in their own practice. The new UK Fit for Work service is explained together with advice on how best to use a fit note to optimise patients' short- and long-term health. We detail what benefits are available to those who are unable to work because of poor health and how health professionals can achieve an optimum balance between supporting those who are genuinely unfit to work through benefits from a welfare state and encouraging and facilitating those who can earn an independent living to do so.

It is 30 years since the Stockholm workshop on ‘Symptomatology and Diagnostic Methods in HandArm Vibration Syndrome’ proposed the introduction of a new clinical scoring system for hand arm vibration syndrome (HAVS) to replace the Taylor-Pelmear scale. In the October 2016 issue of Occupational Medicine, Lawson [1] published an editorial questioning whether the Stockholm Workshop Scale (SWS) was still fit for purpose. It had quickly been recognized that terms like ‘frequent’ and ‘occasional’ were too vague and that the gap between stage 1 sensorineural (intermittent numbness) and stage 3 sensorineural (reduced tactile discrimination and/or manipulative dexterity) was too large. In 2003, Lawson himself proposed a revised scale defining terms like ‘frequent’ and ‘occasional’ and splitting stage 2 sensorineural into early and late. In his editorial, Lawson argued that while the modified SWS is not perfect, given the lack of an alternative scale that takes into account function and pathology and the lack of access to tier 5 testing, the modified SWS is still the best option for staging and managing HAVS. In this issue of Occupational Medicine, Poole responds to Lawson and challenges the validity of the SWS in a letter to the editor. Poole proposes changes, including using photographs and laboratory tests [2]. Lawson welcomes Poole’s contribution to the debate but defends the continued use of the modified SWS while access to tier 5 testing remains limited [3]. I suspect there is quite a lot more mileage in this debate. Occupational asthma is relatively well understood and there is a wealth of research on causative agents. Workrelated chronic obstructive pulmonary disease (COPD) is somewhat more obscure, despite up to 20% of cases of COPD being associated with exposures at work. Borup et al. [4] undertook a systematic review of the evidence relating to COPD in construction workers. They found that COPD occurred more commonly in construction workers exposed to dust at work than in workers not exposed to dust. However, the constituents of the dust were not identified and as subgroups of construction workers were not analysed it was not possible to identify materials or processes associated with COPD. This highlights the difficulties of using job title as a surrogate marker for exposure and delineating the contribution of individual agents in the mixed exposures commonly encountered in the real world of industry. There remains a lot of work to be done to tease out the agents associated with occupational COPD. Staying on the theme of occupational lung disease, it is almost a century since the health effects of asbestos began to be recognized. However, due to the long latency of asbestos-related disease, it continues to be a significant cause of morbidity and mortality. Countries with large construction and ship-building sectors have been particularly badly hit. A major factor in the different epidemiology seen in different countries is the timing of the introduction of legislation and the enforcement of that legislation. Another paper in this issue looks at the incidence of asbestos-related disease in Poland [5]. Use of asbestos-based products was not banned in Poland until 1997. The authors estimate that 150,000 people were exposed to asbestos mainly in state-owned asbestoscement plants. Nearly 5000 cases including asbestosis, lung cancer and mesothelioma were reported between 1970 and 2015. With a latency of many decades, asbestos-related disease will likely remain a significant problem in Poland well into the second half of this century.

In Fashion victims Paul Grime briefly explores the work conditions for those in the garment manufacturing industry, remembering the fatal collapse of a garment factory at the Rana Plaza complex in Dhaka, Bangladesh in 2013 due to unsafe conditions.

In Are you ready for the EU Sharps Directive 2010/32/EU? Sabine Wicker and Paul Grime briefly explore the ‘Sharps Directive’ legislation introduced to reduce workplace needlestick injuries in hospitals and the healthcare sector.

In March 2007, England’s Department of Health finally published definitive guidance on health clearance for tuberculosis, hepatitis B, hepatitis C and HIV for new health care workers [1]. In summary, this new guidance recommends that all new health care workers have checks for tuberculosis disease and immunity and are offered hepatitis B immunization, with post-immunization testing of response, and offered tests for hepatitis C and HIV. This is termed ‘standard’ health clearance and is to be completed on appointment. ‘Additional’ health clearance, including confirmation of freedom from HIV, hepatitis B and hepatitis C infection, is required for new health care workers who will perform ‘exposure-prone procedures’ (EPPs), before confirmation of appointment to an EPP post. But is such large-scale screening justified by the risks it aims to mitigate? 544 OCCUPATIONAL MEDICINE

BACKGROUND Undergraduate teaching in occupational medicine in UK medical schools is in decline. We developed a teaching programme for the new curriculum at our medical school, and then used student evaluation to tailor it to students' perceived learning needs. AIMS To examine medical students' perception of a teaching session in occupational medicine after changes made in the light of earlier student evaluation, and in particular their views on the inclusion of a workplace visit. METHODS Questionnaire evaluation feedback completed immediately after teaching sessions, triangulated with a student focus group session conducted by an external facilitator to explore what students valued most and least and why. Comparison of student evaluations before and after changes introduced in the light of student evaluations. RESULTS Students' perception of the usefulness and relevance of the session significantly improved after the changes. Students consistently identified the use of case scenarios as helpful but demonstrated a dichotomy of opinion about the value of a workplace visit. Overall, students valued the brevity of the session that resulted from removing the workplace visit. CONCLUSIONS It is possible to enhance students' perception of the value of a teaching session by modifying the session in the light of student-based evaluation.

BACKGROUND:An occupational health service was set up in 2002 for general practitioners (GPs) and their staff in a London primary care trust (PCT). The service was based on a needs assessment undertaken in the locality in 1998.AIMS:To evaluate awareness, usage and perceived helpfulness of the service amongst GPs and practice managers, and to ascertain current perceived priorities for what to include in the service.METHODS:Questionnaire survey sent postally and electronically to 199 named GPs and 69 practice managers in 78 practices in the PCT.RESULTS:Overall 119/268 (44%) responses were received from 54/78 practices (69%). Awareness of the existence of the service was high (76%), and although uptake had been poor, this was not related to a perception that the service was unlikely to be helpful. Almost all those who had used the service had found it helpful. Nineteen (16%) respondents asked for more information about the service. Advice on health and safety law and fitness for work assessments were the highest priorities and hepatitis B immunization lowest, as in the 1998 needs assessment. However, a discrepancy between GPs and practice managers with regard to the perceived relative importance of pre-employment health screening and counselling/stress management emerged.CONCLUSIONS:The service is valued by users but could be developed by exploring new ways to disseminate information about the service and deliver it.

Medical EducationVolume 37, Issue 11 p. 1033-1034 A new undergraduate teaching session in occupational medicine Paul Grime, Paul GrimeSearch for more papers by this authorSiân Williams, Siân WilliamsSearch for more papers by this authorSandra Nicholson, Sandra NicholsonSearch for more papers by this author Paul Grime, Paul GrimeSearch for more papers by this authorSiân Williams, Siân WilliamsSearch for more papers by this authorSandra Nicholson, Sandra NicholsonSearch for more papers by this author First published: 22 October 2003 https://doi.org/10.1046/j.1365-2923.2003.01656.xCitations: 3 Dr Paul Grime MBChB, MSc, MRCPI, MFOM, Consultant/Honorary Senior Lecturer in Occupational Medicine, Occupational Health & Safety Unit, Royal Free Hospital, Pond Street, London NW3 2QG, UK. Tel.: 00 44 20 7830 2519; Fax: 00 44 20 7830 2512; E-mail: paul.grime@royalfree.nhs.uk Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume37, Issue11November 2003Pages 1033-1034 RelatedInformation

After introducing the scope of the Australian National Waste Database and some basic terminology, a review of approaches to waste characterisation is provided. The place of direct sampling and analysis is shown to be a part of a broader range of characterisation tools, each having an appropriate part to play in characterising waste streams. Guidance, illustrated with examples from case studies, is then provide on the different components of a waste characterisation study; namely, sampling from a waste stream, sorting the sample into its component material types, undertaking physical/chemical analysis on these material types in order to derive the properties of the parent waste stream, and finally presenting the results in a form that can readily be entered into the Australian National Waste Database.