Background: Coronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally.Method: Bamford–Kowal–Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice.Results: There was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB).Conclusion: Wearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.

Intensive care units (ICUs) are acknowledged for their propensity for noise, often exhibiting higher sound levels on average than other departments. This is mainly ascribed to a high concentration of medical devices and staff, creating an acoustic environment characterised by a high level of staff activity and a concoction of alarms from therapeutic and monitoring devices. Excessive noise in ICUs has been associated with adverse health effects and human factor impacts acknowledged to negatively affect both patients and healthcare providers. This study aimed to evaluate the sound levels of the Royal Liverpool University Hospital (RLUH) ICU and compare it against recommended guidelines. Prospective sound level measurements were taken from a six-bedded bay within the RLUH ICU between 15th June and 1st July 2022. This audit focussed on sound data that equal or exceeded 87 dBA, in accordance with levels in the UK Noise Regulations. The data involved 11 patients admitted to the bay within the defined timeframe. A retrospective review of the patients’ records was conducted to identify potential noisy events during the recording period. Results revealed all L_Aeq and L _Amax measurements exceeded the recommended guidelines. Although HSE exposure limit values were not exceeded, the lowest L _Amin value recorded was 44.2 dBA and only one hour from 16 days of recording (less than 1% of the time) fell below international daytime guidelines of 45 dBA. The top documented potential causes of noise were patient repositioning/personal care, medication administration and suctioning. Sound levels in the RLUH ICU considerably exceed national and international guidelines. These findings highlight the need to address the issue of noise pollution in the ICU setting. Hospital staff should consider implementing strategies and interventions for noise reduction in ICUs.

There is a wide chasm in access to essential and emergency surgery between high and low/middle income countries (LMICs). Surgeons worldwide are integral to solutions needed to address this imbalance. Involving surgical trainees, who represent the future of surgery, is vital to this endeavour. The Association of Surgeons in Training (ASiT) is an independent charity that support surgical trainees of all ten surgical specialties in the UK and Ireland. ASiT convened a consensus meeting at the ASiT conference in Liverpool 2016 to discuss trainee engagement with global surgery, including potential barriers and solutions. A face-to-face consensus meeting reviewed the engagement of, and roles for, surgical trainees in global surgery at the ASiT Conference (Liverpool, England), March 2016. Participants self-identified based on experience and interest in the field, and included trainees (residents and students) and consultants (attending grade). Following expert review, seven pre-determined core areas were presented for review and debate. Extensive discussion was facilitated by a consultant and a senior surgical trainee, with expertise in global surgery. The draft derived from these initial discussions was circulated to all those who had participated, and an iterative process of revision was undertaken until a final consensus and recommendations were reached. There is increasing interest from trainee surgeons to work in LMICs. There are however, ethical considerations, and it is important that trainees working in LMICs undertake work appropriate to their training stage and competencies. Visiting surgeons must consider the requirements of the hosting centres rather than just their own objectives. If appropriately organised, both short and long-term visits, can enable development of transferable clinical, organisational, research and education skills. A central repository of information on global surgery would be useful to trainees, to complement existing resources. Challenges to trainees considering a global surgery placement include approval for placements while on a training program, financial cost and dangers inherent in working in a resource poor setting. Currently global surgery experience is generally as an out of program experience and does not count for certificate of completion of training (CCT). Methods to recognise surgical trainee global surgery experience as an integrated part of training should be explored, similar to that seen in other specialties. There is a role for surgical trainees to become involved in Global Surgery, especially in partnership with local surgeons and with appropriate ethical consideration. Trainees develop translational skills in resource poor settings. Development of appropriate pathways for recognition of global surgery experience for CCT should be considered.

Bone conduction devices (BCDs) are an established form of treatment for conductive hearing loss or single-sided sensorineural deafness (SSD). The BCDs work by converting sound energy to vibration of the skull bones, which results in a wave in the basilar membrane of the cochlea similar to that produced through air conduction of sound.¹ It is well known that BCDs improve hearing outcomes in patients with SSD, via the principle of rerouting sound from the affected side of the head to the contralateral normally hearing ear.^2-4 To our knowledge, the effects of BCDs on quality of life (QOL) have been less well evaluated. Studies have explored individual nonhearing benefits of BCDs in SSD without demonstrating improvement.⁵ In literature reviews evaluating the association of BCDs with overall QOL in patients with unilateral and bilateral hearing loss,^2,6 many studies are underpowered or show only modest benefits (reporting safety and “satisfaction”), meaning it remains unclear from these publications whether patients with SSD experience a meaningful QOL benefit.