Acil servis tanilari ile paramediklerin ilk degerlendirme tanilarinin karsilastirilmasi.

BACKGROUND: This study aims to evaluate the accuracy and quality of prehospital assessments and preliminary diagnoses made by Emergency Medical Services (EMS) providers compared to the final diagnoses given by Emergency Department physicians in a metropolitan area. METHODS: This retrospective observational study utilized records from the Yenimahalle EMS Command Center in Ankara, Türkiye, from January 1, 2021, to December 31, 2022. Data were recorded as cases rather than individual patients, with repeated EMS admissions counted separately. Cases were categorized by EMS call time, reasons for EMS requests, age, gender, nationality, and weekday of hospital arrival to assess socioeconomic impacts and congestion patterns. The study included 2.528 pediatric cases, excluding patients aged 18 and older, those who refused EMS transfer, and cases resolved at the scene. Data analysis was conducted using IBM SPSS 27.0, with statistical significance set at p<0.05. RESULTS: The study included 2.528 cases. The data revealed that EMS providers had an average of 9.9±4.7 years of experience. In 1.839 cases (72.7%), the EMS provider was female, and in 689 cases (27.3%), the EMS provider was male. Patients had an average age of 9.2±5.8 years, with 1.173 (46.4%) being female and 1.355 (53.6%) being male. Preliminary diagnosis accuracy was higher in cases involving younger and male patients. Additionally, a lower preliminary diagnosis accuracy rate was observed during office hours (08: 00-15: 59) compared to non-office hours (16: 00-23: 59). The majority of EMS calls were for medical reasons (1,783 cases, 70.5%), followed by trauma-related calls (745 cases, 29.5%). CONCLUSION: This study highlights the need for improved on-field training for EMS providers to enhance the accuracy and quality of prehospital assessments and preliminary diagnoses. The findings suggest that younger and male patients have higher preliminary diagnosis accuracy rates, and there is a noticeable decrease in accuracy during office hours, indicating potential areas for targeted training and protocol adjustments.

Exploring palliative care practice and learning needs of allied health professionals in the Loddon Mallee region of Victoria: a cross-sectional survey.

Objectives The objectives of this study were to examine the roles and needs of allied health professionals (AHPs) working in public healthcare settings in rural and regional Victoria, Australia in providing components of palliative care in their routine practice. Methods A cross-sectional study was conducted between March and May 2023. Surveys were collected from AHPs working in public healthcare settings in the Loddon Mallee region of Victoria, Australia. Clinicians reported on the frequency of provision of care to patients with terminal illness, and their self-reported skill and confidence in providing interventions to patients with palliative care needs. Results In total, 121 clinicians completed the survey. Almost every respondent reported they had provided care to patients with a terminal illness, with 41% of clinicians providing this care daily or weekly. The respondents were confident carrying out generalist interventions such as maintaining physical function but reported lower confidence in managing common symptoms of terminal illness such as loss of appetite, swallowing difficulties and changing communication needs. Two-thirds of respondents had not undertaken any training specific to palliative care, with many unaware of how to access palliative care-specific training. Conclusion AHPs in rural and remote areas regularly provide care to patients with terminal illness. As the number of patients seen in non-specialist palliative care settings is likely to increase in rural and regional areas, the low self-reported confidence in providing common components of care, and the low uptake of palliative care-specific training must be addressed to ensure AHPs can provide high-quality care to people with terminal illness.

Musculoskeletal symptoms among radiation technologists in Saudi Arabia: prevalence and causative factors.

BACKGROUND: Radiation technologists usually perform several physical tasks as part of their work routine that are related to imaging equipment and handling patients. These kinds of physical activities increase their risk of developing musculoskeletal symptoms (MSS). PURPOSE: To determine the prevalence and causative factors of MSS among radiation technologists in Saudi Arabia. MATERIAL AND METHODS: A previously validated and published questionnaire was sent electronically to 800 radiation technologists in Saudi Arabia. It focused on the presence and prior diagnosis of MSS. Questions to determine risk factors were included. RESULTS: A total of 381 responses were obtained. MSS were indicated by 326 responders (85.6%). Furthermore, it was reported that 309 responders (81.1%) spent more than 2 h per day in awkward postures. Of the responders, 164 (43%) stated that they worked 4 h per day on a personal computer or PACS. The most frequently selected reasons for MSS included patient transfer (50.6%), chairs (38.5%), lead aprons (25.6%), moving heavy equipment (23.1%), and fixed table height (19.4%). An association between work-related MSS and gender was observed (χ2(1) = 5.338; P = 0.021). Similarly, an association between work-related MSS and age was also observed (χ2(3) = 48.58; P = 0.000). CONCLUSION: Radiation technologists in Saudi Arabia reported a fairly high incidence of MSS, more commonly among female and senior workers. To have a better and safer workplace for radiation technologists, this study suggests preventive measures on organizational and individual levels.

The impact of COVID-19 on patient safety attendant use.

ABSTRACT: Patient safety attendants (PSAs) provide constant direct observation to patients who have cognitive impairments or thoughts. Some estimates report that an acute care hospital in the United States may spend more than $1 million annually on PSAs, an expenditure often not reimbursed. With no national defined standards to regulate or monitor PSA use, this study sought to determine the impact of COVID-19 on a PSA reduction program in a large Midwestern healthcare system.

Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting.

STUDY OBJECTIVE: The bougie is typically treated as a rescue device for difficult airways. We evaluate whether first-attempt success rate during paramedic intubation in the out-of-hospital setting changed with routine use of a bougie. METHODS: A prospective, observational, pre-post study design was used to compare first-attempt success rate during out-of-hospital intubation with direct laryngoscopy for patients intubated 18 months before and 18 months after a protocol change that directed the use of the bougie on the first intubation attempt. We included all patients with a paramedic-performed intubation attempt. Logistic regression was used to examine the association between routine bougie use and first-attempt success rate. RESULTS: Paramedics attempted intubation in 823 patients during the control period and 771 during the bougie period. The first-attempt success rate increased from 70% to 77% (difference 7.0% [95% confidence interval 3% to 11%]). Higher first-attempt success rate was observed during the bougie period across Cormack-Lehane grades, with rates of 91%, 60%, 27%, and 6% for Cormack-Lehane grade 1, 2, 3, and 4 views, respectively, during the control period and 96%, 85%, 50%, and 14%, respectively, during the bougie period. Intubation during the bougie period was independently associated with higher first-attempt success rate (adjusted odds ratio 2.82 [95% confidence interval 1.96 to 4.01]). CONCLUSION: Routine out-of-hospital use of the bougie during direct laryngoscopy was associated with increased first-attempt intubation success rate.

Occupational radiation and haematopoietic malignancy mortality in the retrospective cohort study of US radiologic technologists, 1983-2012.

OBJECTIVES: To evaluate cumulative occupational radiation dose response and haematopoietic malignancy mortality risks in the US radiologic technologist cohort. METHODS: Among 110 297 radiologic technologists (83 655 women, 26 642 men) who completed a baseline questionnaire sometime during 1983-1998, a retrospective cohort study was undertaken to assess cumulative, low-to-moderate occupational radiation dose and haematopoietic malignancy mortality risks during 1983-2012. Cumulative bone marrow dose (mean 8.5 mGy, range 0-430 mGy) was estimated based on 921 134 badge monitoring measurements during 1960-1997, work histories and historical data; 35.4% of estimated doses were based on badge measurements. Poisson regression was used to estimate excess relative risk of haematopoietic cancers per 100 milligray (ERR/100 mGy) bone-marrow absorbed dose, adjusting for attained age, sex and birth year. RESULTS: Deaths from baseline questionnaire completion through 2012 included 133 myeloid neoplasms, 381 lymphoid neoplasms and 155 leukaemias excluding chronic lymphocytic leukaemia (CLL). Based on a linear dose-response, no significant ERR/100 mGy occurred for acute myeloid leukaemia (ERR=0.0002, 95% CI <-0.02 to 0.24, p-trend>0.5, 85 cases) or leukaemia excluding CLL (ERR=0.05, 95% CI <-0.09 to 0.24, p-trend=0.21, 155 cases). No significant dose-response trends were observed overall for CLL (ERR<-0.023, 95% CI <-0.025 to 0.18, p-trend=0.45, 32 cases), non-Hodgkin lymphoma (ERR=0.03, 95% CI <-0.2 to 0.18, p-trend=0.4, 201 cases) or multiple myeloma (ERR=0.003, 95% CI -0.02 to 0.16, p-trend>0.5, 112 cases). Findings did not differ significantly by demographic factors, smoking or specific radiological procedures performed. CONCLUSION: After follow-up averaging 22 years, there was little evidence of a relationship between occupational radiation exposure and myeloid or lymphoid haematopoietic neoplasms.

Investigation of radiation protection and safety measures in Rwandan public hospitals: Readiness for the implementation of the new regulations.

BACKGROUND: An essential concept that all radiographers are required to implement is the use of techniques and the provision of protective devices to minimize radiation to patients and staff. Methods to achieve this could include good communication, immobilization, beam limitation, justification for radiation exposure, shielding, appropriate distances and optimum radiographic exposures factors. PURPOSE: The aim of this study was to assess the availability and utilization of radiation protection and safety measures by medical imaging technologists (MITs) in Rwandan hospitals. METHODS: A quantitative, non-experimental descriptive design was used and data collected by means of a self-designed questionnaire. One hundred and sixteen MITs (n = 116) representing 96.67% of the total population participated in the study. RESULTS: The study found radiation safety measures were not adequately implemented in government hospitals. Only 58.62% of MITs had radiation-measuring devices, with 29% receiving dose readings inconsistently. Lead rubber aprons were available at 99.13% of the hospitals; however, 59% of the participants had never checked the integrity of the aprons. Lead rubber aprons and lead equivalent barriers were most prevalent in the facilities. CONCLUSION: The study found there was a lack of adequate radiation safety equipment. Exposure charts and immobilization devices were not adequately implemented in the hospitals. The level of education and experience of the MITs did not appear to influence the radiation safety practice significantly. There is a need for concerted efforts between the Rwanda Utilities Regulatory Authority (RURA), Ministry of Health, University of Rwanda and hospital management to improve the radiation safety culture, especially in view of the law governing radiation protection that was recently promulgated.

Prevalence of occupational exposure and its influence on job satisfaction among Chinese healthcare workers: a large-sample, cross-sectional study.

OBJECTIVES: This study had three objectives: (1) describe the prevalence of occupational exposure among Chinese medical personnel in detail, (2) verify the partial mediating role of work environment satisfaction in the relationship between occupational exposure and job satisfaction, and (3) examine if stress symptoms moderate the relationship between occupational exposure and job satisfaction. DESIGN: A large cross-sectional online survey was conducted in July 2018 in China. SETTING: A survey was conducted in 54 cities across 14 provinces of China. PARTICIPANTS: A total of 12 784 questionnaires were distributed, and 9924 healthcare workers (HCWs) completed valid questionnaires. The response rate was 77.63%. OUTCOME MEASURES: A confidential questionnaire was distributed to HCWs. The relationships among and the mechanisms of the variables were explored using descriptive statistical analyses, Pearson's correlation coefficient and multiple linear regression analysis. RESULTS: The most common occupational exposures among HCWs in the past 12 months were psychosocial and organisational hazards (85.93%). Overall, physicians (93.7%) and nurses (89.2%) were the main victims of occupational exposure. Occupational exposure correlated negatively with work environment satisfaction and job satisfaction, and positively with stress symptoms. Moreover, work environment satisfaction fully mediated the relationship between occupational exposure and job satisfaction, and stress symptoms moderated the relationship between occupational exposure and job satisfaction. CONCLUSION: The incidence of occupational exposure among HCWs is generally high. The high frequency of psychosocial and organisational hazards among physicians and nurses should be taken seriously and dealt with in a timely manner by hospital managers. The negative impact of occupational exposure on job satisfaction must be buffered by measures to reduce stress symptoms and enhance working environment satisfaction, ultimately improving the overall quality of life of HCWs and promoting comprehensive development of the medical team.

A comparative analysis on human resources among the specialized ophthalmic medical institutions in China.

BACKGROUND: This study compares perspectives on specialized ophthalmic medical institutions, identifies the gaps in property and geographic offerings, and explores the ways that ophthalmic medical institutions can better allocate resources. The results of this research will increase patient's access to equitable and high-quality ophthalmic care in China. METHODS: The data for this research was gathered from the Survey of China National Eye Care Capacity and Resource for the year 2015. The paper specified the number, professional level of expertise, and educational background of ophthalmic health personnel. The authors of the paper analyzed and compared the differences in ophthalmic care in public vs. private and urban vs. rural regions in China. Descriptive statistics were used. RESULTS: Of the 395 specialized ophthalmic hospitals surveyed, 332 were private medical institutions (84%), and 63 were public (16%). Of the 26 607 ophthalmic personnel surveyed, working in specialized ophthalmic hospitals, 17 561 were in private hospitals (66%) and 9 046 were in public ones (34%). Furthermore, 22 578 of those personnel worked in urban ophthalmic institutions (85%) and 4 029 worked in rural ones (15%). As for regional differences, 14 090 personnel were located in eastern China (53%), 8 828 in central regions (33%), and 3 689 in the western regions (14%). CONCLUSIONS: Public ophthalmic medical institutions still face challenges in providing equitable and widespread care. The availability of well-staffed health centers varies significantly by region. These variations impact resource allocation and directly lead to inequalities and inaccessibility of health services in certain regions of China.

Running on empathy: Relationship of empathy to compassion satisfaction and compassion fatigue in cancer healthcare professionals.

OBJECTIVE: The aim of this study is to examine the relationship of empathy and professional quality of life in cancer healthcare professionals. METHODS: A Professional Quality of Life instrument measuring compassion satisfaction and compassion fatigue, and the Interpersonal Reactivity Index measuring empathy were distributed to healthcare professionals working in cancer care in the Republic of Ireland. Final analysis was conducted on 117 participants. RESULTS: A quarter of participants experience high levels of compassion satisfaction, and a quarter are at risk of compassion fatigue. A positive correlation was found between personal distress and compassion fatigue, and a negative correlation was found between personal distress and compassion satisfaction. A positive correlation was found between empathic concern and secondary traumatic stress. CONCLUSION: These findings suggest that healthcare professionals working in cancer care are at risk of compassion fatigue. Also, healthcare professionals working in cancer care experience personal distress that may impact negatively on professional quality of life. Implications for practice include a need to identify those HCPs who are at risk of compassion fatigue. The implication for further research suggests further exploration of the impact of personal distress felt by cancer healthcare professionals during empathic engagement.

Staffing Levels and Workload for Radiation Therapists in Canada.

PURPOSE: The safe delivery of radiation therapy is dependent in part on the provision and organization of oncology professionals. General recommendations for staffing of radiation oncologists, medical physicists, and radiation therapists have been published, but most of these provide little detail, especially in the case of radiation therapists (RTs). In Canada, there are no guidelines or national standards for the staffing of RTs, and there is a paucity of Canadian data on the existing staffing levels of RTs and the models used to establish these levels. This project sought to identify and compare the staffing models used for Canadian RTs, and the staffing levels and workload resulting from these models. METHODS AND MATERIALS: In January 2016, a survey was sent to managers of the 46 radiation treatment centres in Canada. This survey sought information on a range of staffing and practice variables for the fiscal year 2014/2015. Respondents were requested to provide the staffing model used for RTs at each centre and enough additional information to calculate the staffing levels and workload resulting from their staffing model. The survey included further variables that had the potential to influence staffing levels and workload, and centres were compared to establish if these variables did indeed impact staffing. RESULTS: Of the 46 centres contacted, 37 centres responded, representing an 80.4% response rate. Survey results showed there are a variety of ways used to determine staffing across the country. Twenty of the 37 responding centres include some type of workload measurement in their staffing model, whereas 17 centres base staffing solely on historic levels or operating funds. There is a great deal of variation in the staffing levels and workload of RTs in Canada, with staff at some centres planning and treating twice the number of patients as RTs at other centres. Radiation therapist staffing levels at most radiation treatment centres in Canada are below the level recommended in recent publications. Differences in staffing levels or workload could not be accounted for by treatment complexity, number of specialty programs, use of relief staff, or number of RTs working in specialty nontreatment roles. CONCLUSIONS: A high degree of variability in staffing levels and workload exists for RTs in Canada, which is not explained by differences in patterns of practice. It is likely that workload for RTs exceed safe levels at some Canadian centres. It is recommended that treatment centres use an up-to-date staffing model for RTs and continue to review staffing levels at regular intervals.

Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya.

OBJECTIVES: (1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research. METHODS: This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention. RESULTS: Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders. CONCLUSIONS: Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.

Risk of professional accidental exposure to biological agents in health care workers: a retrospective analysis carried out in a southern Italian tertiary hospital.

Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital "Federico II" in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10.1 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.

Limits and possibilities for teaching and learning about breastfeeding / Límites y posibilidades para la enseñanza-aprendizaje de la temática sobre lactancia materna / Limites e possibilidades para o ensino-aprendizagem da temática sobre aleitamento materno

ABSTRACT Objective: To point out limits and possibilities involved in the teaching and learning process of undergraduate students from Health of a Federal Public Higher Education Institution on breastfeeding. Method: Instantaneous photography study carried out in undergraduate courses in the area of Health with professors and students involved in the teaching and learning process on breastfeeding. For data collection, the Focal Group technique was used with the students and the semi-structured interview with the professors. The speeches were submitted to the thematic content analysis of Bardin. Results: It was identified the thematic category: Limits and possibilities for the teaching and learning process on breastfeeding, from two sub-categories: Structural limitations of the courses; and Advances and obstacles in the relationship between theory and practice. Final considerations: Limits indicated as workload deficit and professor-centered teaching made progress in learning about breastfeeding difficult, and interdisciplinarity was a step forward in this process.

RESUMEN Objetivo: Aponte límites y posibilidades involucrados en el proceso de enseñanza-aprendizaje de graduandos del área de la Salud de una Institución de Enseñanza Superior Pública Federal sobre el tema "lactancia materna". Método: Estudio de fotografía instantánea realizado en los cursos de graduación del área de la Salud con profesores y estudiante involucrados en el proceso de enseñanza-aprendizaje de la temática sobre lactancia materna. Para la recolección de datos se utilizó la técnica de Grupo Focal con los estudiantes, y la entrevista semiestructurada con los profesores. Las palabras se sometieron al análisis de contenido temático de Bardin. Resultados: Se identificó la categoría temática: Límites y posibilidades para el proceso de enseñanza-aprendizaje en la temática sobre lactancia materna, a partir de dos subcategorías: Limitaciones de la estructura de los cursos; y Avances y obstáculos en la relación entre teoría y práctica. Consideraciones finales: Los límites apuntados como déficit de carga horaria y enseñanza centrada en el profesor dificultaron el progreso en el aprendizaje de la temática sobre lactancia materna, siendo la interdisciplinaridad un avance para ese proceso.

RESUMO Objetivo: Apontar limites e possibilidades envolvidos no processo de ensino-aprendizagem de graduandos da área da Saúde de uma Instituição de Ensino Superior Pública Federal sobre o tema "aleitamento materno". Método: Estudo de fotografia instantânea realizado nos cursos de graduação da área da Saúde com docentes e discentes envolvidos no processo de ensino-aprendizagem da temática sobre aleitamento materno. Para a coleta de dados foi utilizada a técnica de Grupo Focal com os discentes, e a entrevista semi-estruturada com os docentes. As falas foram submetidas à análise de conteúdo temática de Bardin. Resultados: Foi identificada a categoria temática: Limites e possibilidades para o processo de ensino-aprendizagem na temática sobre aleitamento materno, a partir de duas sub-categorias: Limitações da estrutura dos cursos; e Avanços e entraves na relação entre teoria e prática. Considerações finais: Os limites apontados como déficit de carga horária e ensino centrado no docente dificultaram o progresso na aprendizagem da temática sobre aleitamento materno, sendo a interdisciplinaridade um avanço para esse processo.

Caesarean section performed by medical doctors and associate clinicians in Sierra Leone.

BACKGROUND: Many countries lack sufficient medical doctors to provide safe and affordable surgical and emergency obstetric care. Task-sharing with associate clinicians (ACs) has been suggested to fill this gap. The aim of this study was to assess maternal and neonatal outcomes of caesarean sections performed by ACs and doctors. METHODS: All nine hospitals in Sierra Leone where both ACs and doctors performed caesarean sections were included in this prospective observational multicentre non-inferiority study. Patients undergoing caesarean section were followed for 30 days. The primary outcome was maternal mortality, and secondary outcomes were perinatal events and maternal morbidity. RESULTS: Between October 2016 and May 2017, 1282 patients were enrolled in the study. In total, 1161 patients (90·6 per cent) were followed up with a home visit at 30 days. Data for 1274 caesarean sections were analysed, 443 performed by ACs and 831 by doctors. Twin pregnancies were more frequently treated by ACs, whereas doctors performed a higher proportion of operations outside office hours. There was one maternal death in the AC group and 15 in the doctor group (crude odds ratio (OR) 0·12, 90 per cent confidence interval 0·01 to 0·67). There were fewer stillbirths in the AC group (OR 0·74, 0·56 to 0·98), but patients were readmitted twice as often (OR 2·17, 1·08 to 4·42). CONCLUSION: Caesarean sections performed by ACs are not inferior to those undertaken by doctors. Task-sharing can be a safe strategy to improve access to emergency surgical care in areas where there is a shortage of doctors.

Self-reported occupational blood exposure among paramedics in Poland: a pilot study.

Introduction. Paramedics are at risk of occupational blood exposure, increased by the immediacy of provided treatment. However, the issue has not been acknowledged to date by any research in Europe. Methods. This research aimed at assessing occupational blood exposure among paramedics in Poland. Respondents represented 21 Polish medical institutions. Their participation was voluntary and anonymous. Paramedics were provided with a self-directed job-specific questionnaire adapted to Polish conditions from an original US version. Results. 118 paramedics participated in the study from institutions constituting the National Emergency Medical System in Poland; including ambulance crews, Helicopter Emergency Medical Services and emergency department employees. Occupational exposure was reported by 18.64% of respondents and the main route of exposure was needlestick events. Conclusions. There is a further need to improve education among paramedics concerning the threat of being infected with blood-borne pathogens through all existing routes. Our findings point to the problem as being hidden and considered a shameful issue.

Burnout in radiation therapists: Systematic review with meta-analysis.

The main aim of this review is to evaluate the burnout levels experienced by radiation therapists. PubMed, Lilacs and Google Scholar were searched for articles reporting burnout levels in radiation therapists. Only studies explicitly assessing burnout and using a validated instrument were retrieved. Meta-analyses were undertaken, based on articles that used the Maslach Burnout Inventory to assess burnout, to determine 95% confidence intervals for the overall prevalence of radiation therapists with high burnout risk in three dimensions: emotional exhaustion, depersonalisation or low personal accomplishment. Additionally, meta-analyses were also performed to determine the overall mean reported for each of the three dimensions. A total of eleven studies were found to be eligible for inclusion in this systematic review, nine of which used the Maslach Burnout Inventory questionnaire. The 95% confidence intervals for radiation therapists with high emotional exhaustion scores, high depersonalisation scores and low personal accomplishment scores were [24.8; 54.6], [10.1; 40.2] and [17.4; 41.6] respectively. The 95% confidence intervals for the corresponding means were found to be [20.0; 26.2], [5.1; 8.8] and [35.9, 39.6] respectively. The meta-analysis revealed an arguably high prevalence of burnout in radiation therapists in spite of it varying substantially between studies.

Patients' attendance patterns to different healthcare settings and perceptions of stakeholders regarding screening for chronic, non-communicable diseases in high street dental practices and community pharmacy: a cross-sectional study.

OBJECTIVE: Non-communicable diseases (NCDs) impose a significant health and economic burden. This study aimed to assess the differential attendance patterns of public to different healthcare professionals and gauge the opinions of key stakeholders towards screening of NCDs by allied healthcare professionals. DESIGN: Questionnaires were designed piloted and subsequently completed by key stakeholders. The results were analysed descriptively. SETTING: Public questionnaires were undertaken in a West Midlands transport station and Public Markets. High street dental and community pharmacy settings were selected via local clinical and research networks. Healthcare professionals were identified using professional networks and were emailed a web link to an online survey. PARTICIPANTS: 1371 members of the public, 1548 patients and 222 healthcare professionals (doctors general practitioner (GP), dentists general dental practitioner (GDP) and pharmacists) completed the questionnaires. OUTCOME MEASURES: The outcome was to compare attendance patterns at GDP and GP practices to determine whether different populations were more likely to access different healthcare professionals, this included determining when patients were last screened for NCDs by their GP. Additionally, the willingness of patients to undergo the required intervention and the opinions of stakeholders regarding the concept of screening for the specified NCDs in general dental and community pharmacy settings were also explored. RESULTS: 12% of patients who reported seeing a GDP biannually reported that they had not had contact with a GP in the last year. Over 61% of the public reported attending a GDP biannually, of this group 48% reported having never had a check-up at the GP. All stakeholders surveyed were in broad support of the concept of allied health professionals undertaking screening for specific general health conditions. CONCLUSIONS: This study has established that allied healthcare professionals may have access to different cohorts of the population to GPs. If GDPs and pharmacists have access to patients who are not using healthcare services elsewhere, they may be ideally placed to risk assess, and where appropriate offer preventative advice and test for NCDs.

Identifying Opportunities to Improve Intimate Partner Violence Screening in a Primary Care System.

BACKGROUND AND OBJECTIVES: Intimate partner violence (IPV) is a silent epidemic affecting one in three women. The US Preventive Services Task Force recommends routine IPV screening for women of childbearing age, but actual rates of screening in primary care settings are low. Our objectives were to determine how often IPV screening was being done in our system and whether screening initiated by medical assistants or physicians resulted in more screens. METHODS: We conducted a retrospective chart review to investigate IPV screening practices in five primary care clinics within a university-based network in Northern California. We reviewed 100 charts from each clinic for a total of 500 charts. Each chart was reviewed to determine if an IPV screen was documented, and if so, whether it was done by the medical assistant or the physician. RESULTS: The overall frequency of IPV screening was 22% (111/500). We found a wide variation in screening practices among the clinics. Screening initiated by medical assistants resulted in significantly more documented screens than screening delivered by physicians (74% vs 9%, P<0.001). CONCLUSIONS: IPV screening is an important, but underdelivered service. Using medical assistants to deliver IPV screening may be more effective than relying on physicians alone.

[Risk of occupational exposure to blood-borne pathogens in paramedics]. / Ryzyko ekspozycji zawodowej na patogeny krwiopochodne u ratowników medycznych.

Paramedics constitute a group of professionals who are constantly exposed to potentially infectious biological material through frequent and close contact with patients, possibly resulting in occupationally acquired infections. The paper's objective has been to assess the occupational risk regarding blood-borne infections and identify preventive measures used among paramedics worldwide, on the basis of the related literature review. The literature search, covering the period 1987-2017, was performed using PubMed, Elsevier, Springer and Google Scholar databases. A comparative analysis of blood exposure was conducted and the report of such events and the use of personal protective equipment among paramedics in Poland and other countries worldwide was developed. The data on occupational blood exposures among paramedics is sparse. The resulting comparisons obtained in various scientific studies are difficult due to diverse data collection methods, influencing the resulting consistency. Additionally, there were some methodological errors found in previously published studies, such as selection bias. The percentage rate of paramedics exposed to blood in the last 12 months varies from 22% in the USA to 63% in Thailand; in Poland that rate fluctuates widely, ranging between 14-78%. Paramedics are frequently exposed to blood while performing their duties, but almost 50% of paramedics do not report any exposure which is mitigated by the systematic use of personal protective equipment: gloves are regularly used by 53-98% of paramedics, masks and goggles are worn by 33-62% of them. This fact puts the paramedics group at risk of blood-borne infections. Therefore, there is an urgent need to conduct further, methodologically correct, multi-center studies to accurately assess occupational blood exposure in paramedics. Med Pr 2018;69(6):685-694.