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1.
Musculoskelet Sci Pract ; 52: 102340, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33571900

RESUMO

BACKGROUND: Telehealth services have helped enable continuity of care during the coronavirus pandemic. We aimed to investigate use and views towards telehealth among allied health clinicians treating people with musculoskeletal conditions during the pandemic. METHODS: Cross-sectional international survey of allied health clinicians who used telehealth to manage musculoskeletal conditions during the coronavirus pandemic. Questions covered demographics, clinician-related factors (e.g. profession, clinical experience and setting), telehealth use (e.g. proportion of caseload, treatments used), attitudes towards telehealth (Likert scale), and perceived barriers and enablers (open questions). Data were presented descriptively, and an inductive thematic content analysis approach was used for qualitative data, based on the Capability-Opportunity-Motivation Behavioural Model. RESULTS: 827 clinicians participated, mostly physiotherapists (82%) working in Australia (70%). Most (71%, 587/827) reported reduced revenue (mean (SD) 62% (24.7%)) since the pandemic commenced. Median proportion of people seen via telehealth increased from 0% pre (IQR 0 to 1) to 60% during the pandemic (IQR 10 to 100). Most clinicians reported managing common musculoskeletal conditions via telehealth. Less than half (42%) of clinicians surveyed believed telehealth was as effective as face-to-face care. A quarter or less believed patients value telehealth to the same extent (25%), or that they have sufficient telehealth training (21%). Lack of physical contact when working through telehealth was perceived to hamper accurate and effective diagnosis and management. CONCLUSION: Although telehealth was adopted by allied health clinicians during the coronavirus pandemic, we identified barriers that may limit continued telehealth use among allied health clinicians beyond the current pandemic.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Atitude do Pessoal de Saúde , COVID-19/reabilitação , Doenças Musculoesqueléticas/reabilitação , Telemedicina/estatística & dados numéricos , Adulto , Pessoal Técnico de Saúde/psicologia , Austrália , COVID-19/epidemiologia , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos
2.
Medicine (Baltimore) ; 100(6): e24666, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578597

RESUMO

BACKGROUND: Cardiopulmonary resuscitation (CPR) performance depends on individual ability and training. Well-trained or professional rescuers can maintain high-quality CPR for longer than laypeople. This study aimed to examine the effects of reducing resting intervals on CPR performance, physiological parameters, and hemodynamic parameters during prolonged CPR in well-trained providers. METHODS: The study enrolled 90 volunteers from the paramedic students of our institution. They were randomly divided into 3 groups: 2 minutes, 1 minute 45 seconds, and 1 minute 30 seconds rest groups. Each participant performed 5 cycles of chest compression only CPR (2 min/cycle) with different resting intervals according to grouping. CPR quality, physiological variations, and hemodynamic variations were measured for each cycle and compared across the groups. RESULTS: Of the 90 volunteers, 79 well-trained providers were finally included. The variation of the average chest compression depth across the 5 cycles showed significant differences between the 3 groups: from cycle 1 to 2: 1.2 (3.1) mm, -0.8 (2.0) mm, and -2.0 (3.0) mm in the 2 minutes, 1 minute 45 seconds, and 1 minute 30 seconds groups, respectively (P < .001); from cycle 1 to 3: 0.0 (3.0) mm, -0.7 (3.2) mm, and -2.6 (3.9) mm, respectively (P = .030). However, all 3 groups maintained the recommended rate and chest compression depth for all 5 cycles. Physiological and hemodynamic parameters showed no significant differences between the groups. CONCLUSIONS: Well-trained providers were able to maintain high-quality CPR despite reducing rest intervals. Adjusting the rest interval may help maintain overall CPR quality in special situations or where layperson rescuers are involved.


Assuntos
Reanimação Cardiopulmonar/educação , Hemodinâmica/fisiologia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Descanso/fisiologia , Pessoal Técnico de Saúde/educação , Pessoal Técnico de Saúde/estatística & dados numéricos , Reanimação Cardiopulmonar/estatística & dados numéricos , Oscilação da Parede Torácica/estatística & dados numéricos , Oscilação da Parede Torácica/tendências , Auxiliares de Emergência/educação , Auxiliares de Emergência/estatística & dados numéricos , Fadiga , Feminino , Humanos , Masculino , Fenômenos Fisiológicos/fisiologia , Estudos Prospectivos , Treinamento por Simulação/métodos , Estudantes , Fatores de Tempo , Adulto Jovem
3.
Ann Emerg Med ; 77(3): 296-304, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33342596

RESUMO

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.


Assuntos
Serviços Médicos de Emergência/métodos , Intubação Intratraqueal/instrumentação , Laringoscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoal Técnico de Saúde/normas , Pessoal Técnico de Saúde/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/normas , Intubação Intratraqueal/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-33374768

RESUMO

To evaluate the prevalence of bloodborne infections (BBIs) and assess the incidence and selected risk factors for sharps injuries (SIs), a cross-sectional serosurvey was performed between December 2018 and October 2019 among 286 paramedics (76.5% males; mean age, 37 years) from 17 randomly selected ambulance stations in the West Pomeranian region of Poland. An ELISA system was used to detect anti-HBc, anti-HCV, and anti-HIV. HBV vaccination uptake was 95.6%; 7.3% (95% CI: 4.6-11.0%) paramedics were anti-HBc positive, and anti-HCV/anti-HIV seropositivity was not reported. Almost one-fourth of paramedics reported having had ≥1 SI during the preceding year (Me = 6.0, range 1-100). Most recent exposures primarily took place during an emergency procedure (76.7%), in an ambulance (45.2%), caused by hollow-bore needles (73.8%), and were not reported (50.0%). Additionally, 52.2% of paramedics reported needle recapping, and 52.6% did not use safety engineered devices (SEDs) at work. Mean knowledge score was low (2.6 ± 1.7); 3.4% had never participated in infection-control (IC) training, and those not trained were more likely to suffer a SI (odds ratio (OR) 4.64; p = 0.03). Due to frequent SIs, of which half are unreported, paramedics remain at risk of acquiring occupational BBIs. SI risk could be reduced by providing training on IC procedures, ensuring better compliance with safe work practices, and supplying more SEDs.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Infecções Transmitidas por Sangue/epidemiologia , Ferimentos Penetrantes Produzidos por Agulha , Exposição Ocupacional , Adulto , Ambulâncias , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Polônia/epidemiologia
6.
PLoS One ; 15(9): e0239559, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986736

RESUMO

BACKGROUND: Overdose response has become an increasingly relevant component of paramedic practice, particularly in light of increased opioid overdose globally. Previous studies have noted gaps in our understanding regarding the unique challenges which paramedics face during this form of pre-hospital emergency care. The aim of this study is to explore and describe the ways in which paramedics experience overdose response, specifically within a community markedly affected by the overdose crisis. METHODS: Ten participants were recruited from a single ambulance station located in an urban center in Western Canada. Two rounds of semi-structured individual interviews were conducted, and data saturation was found to have been reached. Verbatim transcripts were produced and subject to two rounds of descriptive and pattern coding. A second researcher reviewed all of the codes, with disagreements being handled by discussion until agreement was obtained. Themes were identified, along with a Core Category which seeks to describe the underlying dynamics of overdose response represented in our data. The concept of a Core Category was borrowed from Grounded Theory methodology. FINDINGS: Five major themes were identified: Connecting with patients' lived experiences; Occupying roles as clinicians and patient advocates; Navigating on-scene hazards; Difficulties with transitions of care; and Emotional burden of the overdose crisis. A core category was identified as One's capacity to help. CONCLUSIONS: This research contributes to existing literature on overdose response by specifically examining paramedic experiences during this form of emergency care. While paramedics felt highly confident in providing clinical care, their capacity to address underlying causes of drug use was understood as much more limited. Participants found ways to address this lack of control, along with feelings of frustration, by trying to understand patient perspectives and adopting empathetic attitudes.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Overdose de Drogas/diagnóstico , Ambulâncias/estatística & dados numéricos , Canadá , Serviços Médicos de Emergência/estatística & dados numéricos , Auxiliares de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Profissionalismo , Pesquisa Qualitativa , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
7.
PLoS One ; 15(7): e0235315, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634172

RESUMO

BACKGROUND: The effect of paramedic crew size in the resuscitation of patients with out-of-hospital cardiac arrest (OHCA) remains inconclusive. We hypothesised that teams with a larger crew size have better resuscitation performance including chest compression fraction (CCF), advanced life support (ALS), and teamwork performance than those with a smaller crew size. METHODS: We conducted a randomized controlled study in a simulation setting. A total of 140 paramedics from New Taipei City were obtained by stratified sampling and were randomly allocated to 35 teams with crew sizes of 2, 3, 4, 5, and 6 (i.e. 7 teams in every paramedic crew size). A scenario involving an OHCA patient who experienced ventricular fibrillation and was attached to a cardiopulmonary resuscitation (CPR) machine was simulated. The primary outcome was the overall CCF; the secondary outcomes were the CCF in manual CPR periods, time from the first dose of epinephrine until the accomplishment of intubation, and teamwork performance. Tasks affecting the hands-off time during CPR were also analysed. RESULTS: In all 35 teams with crew sizes of 2, 3, 4, 5, and 6, the overall CCFs were 65.1%, 64.4%, 70.7%, 72.8%, and 71.5%, respectively (P = 0.148). Teams with a crew size of 5 (58.4%, 61.8%, 68.9%, 72.4%, and 68.7%, P<0.05) had higher CCF in manual CPR periods and better team dynamics. Time to the first dose of epinephrine was significantly shorter in teams with 4 paramedics, while time to completion of intubation was shortest in teams with 6 paramedics. Troubleshooting of M-CPR machine decreased the hands-off time during resuscitation (39 s), with teams comprising 2 paramedics having the longest hands-off time (63s). CONCLUSION: Larger paramedic crew size (≧4 paramedics) did not significantly increase the overall CCF in OHCA resuscitation but showed higher CCF in manual CPR period before the setup of the CPR machine. A crew size of ≧4 paramedics can also shorten the time of ALS interventions, while teams with 5 paramedics will have the best teamwork performance. Paramedic teams with a smaller crew size should focus more on the quality of manual CPR, teamwork, and training how to troubleshoot a M-CPR machine.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência/métodos , Parada Cardíaca Extra-Hospitalar/prevenção & controle , Adulto , Cuidados Críticos/métodos , Auxiliares de Emergência , Medicina de Emergência/métodos , Epinefrina/administração & dosagem , Feminino , Humanos , Intubação/métodos , Masculino , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/patologia , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/prevenção & controle
8.
Disaster Med Public Health Prep ; 14(3): 406-412, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32576316

RESUMO

OBJECTIVES: Previous research has identified a lack of clarification regarding paramedic professional obligation to work. Understanding community expectations of paramedics will provide some clarity around this issue. The objective of this research was to explore the expectations of a sample of Australian community members regarding the professional obligation of paramedics to respond during pandemics. METHODS: The authors used qualitative methods to gather Australian community member perspectives immediately before the onset of the coronavirus disease 2019 (COVID-19) pandemic. Focus groups were used for data collection, and a thematic analysis was conducted. RESULTS: The findings revealed 9 key themes: context of obligation (normal operations versus crisis situation), hierarchy of obligation (individual versus organizational obligation), risk acceptability, acceptable occupational risk (it's part of the job), access to personal protective equipment, legal and ethical guidelines, education and training, safety, and acceptable limitations to obligation. The factors identified as being acceptable limitations to professional obligation are presented as further sub-themes: physical health, mental health, and competing personal obligations. CONCLUSIONS: The issue of professional obligation must be addressed by ambulance services as a matter of urgency, especially in light of the COVID-19 coronavirus pandemic. Further research is recommended to understand how community member expectations evolve during and after the COVID-19 coronavirus pandemic.


Assuntos
Pessoal Técnico de Saúde/ética , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Responsabilidade Social , Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/estatística & dados numéricos , Grupos Focais/métodos , Humanos , Motivação , Pandemias/ética , Pandemias/estatística & dados numéricos , Papel Profissional , Pesquisa Qualitativa
9.
Brain Behav Immun ; 88: 559-565, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32330593

RESUMO

OBJECTIVE: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, there are reports on the increased prevalence of physical symptoms observed in the general population. We investigated the association between psychological outcomes and physical symptoms among healthcare workers. METHODS: Healthcare workers from 5 major hospitals, involved in the care for COVID-19 patients, in Singapore and India were invited to participate in a study by performing a self-administered questionnaire within the period of February 19 to April 17, 2020. Healthcare workers included doctors, nurses, allied healthcare workers, administrators, clerical staff and maintenance workers. This questionnaire collected information on demographics, medical history, symptom prevalence in the past month, Depression Anxiety Stress Scales (DASS-21) and the Impact of Events Scale-Revised (IES-R) instrument. The prevalence of physical symptoms displayed by healthcare workers and the associations between physical symptoms and psychological outcomes of depression, anxiety, stress, and post-traumatic stress disorder (PTSD) were evaluated. RESULTS: Out of the 906 healthcare workers who participated in the survey, 48 (5.3%) screened positive for moderate to very-severe depression, 79 (8.7%) for moderate to extremely-severe anxiety, 20 (2.2%) for moderate to extremely-severe stress, and 34 (3.8%) for moderate to severe levels of psychological distress. The commonest reported symptom was headache (32.3%), with a large number of participants (33.4%) reporting more than four symptoms. Participants who had experienced symptoms in the preceding month were more likely to be older, have pre-existing comorbidities and a positive screen for depression, anxiety, stress, and PTSD. After adjusting for age, gender and comorbidities, it was found that depression (OR 2.79, 95% CI 1.54-5.07, p = 0.001), anxiety (OR 2.18, 95% CI 1.36-3.48, p = 0.001), stress (OR 3.06, 95% CI 1.27-7.41, p = 0.13), and PTSD (OR 2.20, 95% CI 1.12-4.35, p = 0.023) remained significantly associated with the presence of physical symptoms experienced in the preceding month. Linear regression revealed that the presence of physical symptoms was associated with higher mean scores in the IES-R, DASS Anxiety, Stress and Depression subscales. CONCLUSIONS: Our study demonstrates a significant association between the prevalence of physical symptoms and psychological outcomes among healthcare workers during the COVID-19 outbreak. We postulate that this association may be bi-directional, and that timely psychological interventions for healthcare workers with physical symptoms should be considered once an infection has been excluded.


Assuntos
Ansiedade/epidemiologia , Infecções por Coronavirus , Depressão/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estresse Psicológico/epidemiologia , Adulto , Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/estatística & dados numéricos , Betacoronavirus , Feminino , Cefaleia/epidemiologia , Pessoal de Saúde/psicologia , Humanos , Índia/epidemiologia , Internacionalidade , Letargia/epidemiologia , Masculino , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Faringite/epidemiologia , Médicos/psicologia , Médicos/estatística & dados numéricos , Prevalência , Singapura/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Inquéritos e Questionários
10.
Medicine (Baltimore) ; 99(17): e19812, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332624

RESUMO

The European Higher Education Area was implemented more than a decade ago with the aim of improving internationally the competitiveness of European university education putting the spotlight on skills and competence development (and not only on knowledge acquisition). This work intends to analyze the impact of competence-based teaching methodologies on university students, as well as to contribute to the study of the individual personality traits differences regarding this impact. For this, a descriptive, quantitative, cross-sectional study was conducted with a non-randomised sample of university students. The sample was composed of a total of 499 students of the University of Huelva (350 from the Health Sciences degree, and 149 form other degrees), who completed a questionnaire on professional skills and teaching methods developed ad hoc for this research, as well as the brief version of the Spanish adaptation of the NEO Five-Factor Inventory. The results show that Health Sciences students feel more satisfied with the most participative and active methodologies, and they consider these better contribute to their future professional competence development. On the other hand, in relation to the big 5 personality traits studied, links have been found between competence development perception and personal preferences and the dimensions of extraversion, agreeableness, conscientiousness and openness to experience. This last factor, openness to experience, appears when analyzing the main differences among both groups, being Health Sciences students more intellectually curious, showing more openness and diversity of interests, in addition to being more creative, innovative, and flexible.


Assuntos
Pessoal Técnico de Saúde/educação , Pessoal Técnico de Saúde/psicologia , Inventário de Personalidade/estatística & dados numéricos , Adolescente , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Educação Baseada em Competências/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Personalidade/estatística & dados numéricos , Inquéritos e Questionários
11.
West J Emerg Med ; 21(2): 463-468, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32191205

RESUMO

INTRODUCTION: Prehospital and emergency medical services (EMS) providers are usually the first to respond to an individual's urgent health needs, sometimes in emotionally charged circumstances. Because violence toward EMS providers in the Czech Republic is often overlooked and under-reported, we do not have a complete understanding of the extent of such violence, nor do we have recommendations from EMS professional organizations on how to resolve this problem in prehospital emergency medicine. METHODS: We conducted this study to explore the process of violence against EMS providers, using the Strauss/Corbin systematic approach of grounded theory to create a paradigm model. The participants in this research included personnel who had at least two years experience in the EMS systems of the city of Prague and the Central Bohemian Region, and who had been victims of violence. Our sample included 10 registered paramedics and 10 emergency medical technicians ages 23-33 (mean ± standard deviation: 27.7). The impact of communication during EMS delivery, in the context of violence from patients or their relatives, emerged as the core category and the main focus of our study. The five main groups of the paradigm model of violence against EMS personnel included causal, contextual and intervening conditions, strategies, and consequences. RESULTS: Of the 20 study participants, 18 reported experiencing an attack during the night shift. Ten participants experienced violence on the street, and 10 inside an ambulance. The perpetrators in all 18 cases were men. The behavior of EMS personnel plays a crucial role in how violent confrontations play out: nonprofessional behavior with drunken or addict patients increases the possibility of violence in 70% of cases. CONCLUSION: We found that paramedics and EMTs were exposed to verbal abuse and physical violence. However, in 10 of the violent encounters reported by our 20 participants, the attack was perpetrated by otherwise-ordinary people (ie, individuals with strong family support and good jobs) who found themselves in a very stressful situation. Thanks to grounded theory we learned that for all 20 participants there was a potential opportunity to prevent the conflict.


Assuntos
Pessoal Técnico de Saúde , Serviços Médicos de Emergência/estatística & dados numéricos , Violência no Trabalho , Adulto , Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/estatística & dados numéricos , República Tcheca/epidemiologia , Dissidências e Disputas , Medicina de Emergência , Feminino , Humanos , Masculino , Profissionalismo , Pesquisa Qualitativa , Fatores de Risco , Violência no Trabalho/prevenção & controle , Violência no Trabalho/psicologia , Violência no Trabalho/estatística & dados numéricos
12.
BMC Health Serv Res ; 20(1): 105, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041600

RESUMO

BACKGROUND: There is consistent evidence highlighting the mal-distribution of the health workforce between urban and rural and remote regions. To date, addressing this mal-distribution has focused on medicine and nursing with limited initiatives targeted at allied health. Therefore, the aim of this research was to explore the enablers of and barriers to transition to rural practice by allied health professionals across South Australia in Australia. METHOD: Qualitative descriptive methodology was used to underpin this research. Individual, in-depth semi-structured interviews were conducted with employers, managers and allied health professionals from rural regions of South Australia who were identified using purposive maximum variation sampling strategy. RESULTS: A total 22 participants shared their perspectives on the enablers of and barriers to transition to rural practice by allied health professionals across South Australia. Thematic analysis of the interview data resulted in a number of key issues impacting transition to rural-based practice. These findings could be broadly categorised into three stages during the transition: 'before'; 'during' and 'after'. DISCUSSION: This study identified a range of enablers of and barriers to transition to rural practice by allied health professionals. Five overarching themes - nature of rural practice, exposure to rural 'taster', social/lifestyle, job availability/characteristics, and mentor and support were identified. In particular, exposure to rural 'taster', social/lifestyle, and mentor and support were the key themes reported by the stakeholders. The multifactorial nature of the barriers and enablers highlight the complexity underpinning how AHPs transition to rural-based practice. These barriers/ enablers are often inter-linked and continually evolving which pose significant challenges for health care stakeholders to successfully addressing these. CONCLUSION: This research sheds light on the complexities that confront and successful strategies that are required for health care stakeholders when considering how best to support allied health professional transition to rural practice.


Assuntos
Pessoal Técnico de Saúde/psicologia , Atitude do Pessoal de Saúde , Serviços de Saúde Rural/organização & administração , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Feminino , Mão de Obra em Saúde , Humanos , Masculino , Pesquisa Qualitativa , Austrália do Sul , Serviços Urbanos de Saúde/organização & administração , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-32033482

RESUMO

Medicine and healthcare professions are prestigious and valued careers and, at the same time, demanding, challenging, and arduous jobs. Medical and allied health professions students, experiencing a stressful academic and clinical workload, may suffer from sleep disturbances. In Iran, several studies have been conducted to explore the prevalence rate among medical and healthcare professions students. The aim of this systematic review and meta-analysis was to quantitatively and rigorously summarize the existing scholarly literature, providing the decision- and policy-makers and educators with an updated, evidence-based synthesis. Only studies utilizing a reliable psychometric instrument, such as the Pittsburgh sleep quality index (PSQI), were included, in order to have comparable measurements and estimates. Seventeen investigations were retained in the present systematic review and meta-analysis, totaling a sample of 3586 students. Studies were conducted between 2008 and 2018 and reported an overall rate of sleep disturbances of 58% (95% confidence interval or CI 45-70). No evidence of publication bias could be found, but formal analyses on determinants of sleep disturbances could not be run due to the dearth of information that could be extracted from studies. Poor sleep is highly prevalent among Iranian medical and healthcare professions students. Based on the limitations of the present study, high-quality investigations are urgently needed to better capture the determinants of poor sleep quality among medical and healthcare professions students, given the importance and the implications of such a topic.


Assuntos
Pessoal Técnico de Saúde/psicologia , Pessoal Técnico de Saúde/estatística & dados numéricos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Estudantes de Ciências da Saúde/psicologia , Estudantes de Ciências da Saúde/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Prevalência , Adulto Jovem
14.
J Foot Ankle Res ; 13: 5, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31998410

RESUMO

Background: This study sought to explore professional perspectives on the assessment and management of symptomatic pes planus in children. Methods: Data was collected from three professional groups (podiatrists, physiotherapists, and orthotists) with experience of managing foot problems in children. The survey was undertaken in the United Kingdom via a self-administered, online survey. Data was captured over a four-month period in 2018. Results: Fifty-five health professionals completed the survey and the results highlighted that assessment techniques varied between professions, with standing tip-toe and joint range of motion being the most common. Treatment options for children were diverse and professionals were adopting different strategies as their first line intervention. All professions used orthoses. Conclusions: There were inconsistencies in how the health professionals assessed children presenting with foot symptoms, variation in how the condition was managed and differences in outcome measurement. These findings might be explained by the lack of robust evidence and suggests that more effort is needed to harmonise assessment and treatment approaches between professions. Addressing discrepancies in practice could help prioritise professional roles in this area, and better support the management of children with foot pain.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Pé Chato/diagnóstico , Podiatria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Avaliação de Sintomas/estatística & dados numéricos , Criança , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Reino Unido
15.
Australas Emerg Care ; 23(2): 126-136, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31843496

RESUMO

BACKGROUND: Factors that hinder the pivotal role frontline clinicians play in STEMI management are under-reported. We aimed to explore perceived barriers to effective STEMI management by addressing the following questions: 1. What are the most commonly occurring barriers to timely STEMI management for paramedics and emergency nurses? 2. Are there differences in barriers experienced by paramedics and emergency nurses? 3. Are there differences in barriers experienced by frontline clinicians in rural and metropolitan settings? METHODS: A 79-item online survey was offered to paramedics and emergency nurses. Descriptive statistics and exploratory factor analysis identified the most frequently experienced types of barriers. Professional groups and geographical locations were compared. RESULTS: There were 333 respondents. Response rates for paramedics was 10% and 9% for members of an emergency nursing association. Most commonly occurring barriers across all respondents were: 'lack of skills development'; 'lack of feedback'; 'untimely support'; 'distance to scene/hospital facilities'; 'hospital-related delays'. Statistically significant differences were found by professional group and geographical location. CONCLUSION: Barriers to timely management were present, but not frequently experienced. Survey responses indicate a need for improved continuing professional development opportunity, clearer feedback mechanisms, streamlined facilitation of STEMI processes in hospitals, and enhanced access to expert advice/resources for all frontline clinicians.


Assuntos
Pessoal Técnico de Saúde/psicologia , Enfermeiras e Enfermeiros/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Adulto , Pessoal Técnico de Saúde/estatística & dados numéricos , Gerenciamento Clínico , Eletrocardiografia/métodos , Enfermagem em Emergência/métodos , Enfermagem em Emergência/normas , Enfermagem em Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Inquéritos e Questionários
17.
Injury ; 51(2): 224-229, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31679833

RESUMO

INTRODUCTION: A patient-relevant, focused Core Outcome Set (COS) is essential to the design of clinical trials dealing with chest wall trauma, in order to maximise quality of evidence regarding impact of interventions and to reduce research waste. METHODS: Outcome measures were collated by way of systematic review and entered into a three round Delphi consensus completed anonymously online. Participants were international clinicians and allied health professionals (AHP) involved in the treatment of rib fractures as well as patients who had experienced severe chest trauma. Consensus thresholds for statements were defined a priori as a group rating of more than 70% or less than 15% for 'important' or 'not important'. RESULTS: Sixty-five participants responded to the first round and the final round Final round consisted of five AHP, two patients and 16 clinicians from eight different countries. Twenty-three outcomes were regarded as important for the COS; eight adverse events, three mortality, five clinical or physiological outcomes, six life impact and one resource-related. Health related quality of life was rated highest of the life impact outcomes but participants thought it was also important to assess disability, physical function, quality of life, return to activities and return to work. CONCLUSION: Collecting serious adverse outcomes was important to all stakeholders as were life impact outcomes such as quality of life, physical function and return to activities. Resource use outcomes were considered less important. We recommend this Core Outcome Set, developed with multiple relevant stakeholders, for use in future clinical trials, following further work on the most appropriate methods and instruments for measurement.


Assuntos
Fixação de Fratura/efeitos adversos , Fraturas das Costelas/cirurgia , Parede Torácica/lesões , Ferimentos e Lesões/complicações , Pessoal Técnico de Saúde/estatística & dados numéricos , Consenso , Técnica Delfos , Humanos , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida/psicologia
18.
Prehosp Emerg Care ; 24(2): 180-187, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31225772

RESUMO

Background: Workforce diversity can reduce communication barriers and inequalities in healthcare delivery, especially in settings where time pressure and incomplete information may exacerbate the effects of implicit biases. Emergency medical services (EMS) professionals represent a critical entry point into the healthcare system for diverse populations, yet little is known regarding changes in the demographic composition of this workforce. Our primary objective was to describe the gender and racial/ethnic composition of emergency medical technicians (EMTs) and paramedics who earned initial National EMS Certification from 2008 to 2017. Secondarily, we compared demographic characteristics of the 2017 EMT and paramedic cohorts to the U.S. population. Methods: As a proxy for recent graduates likely to enter the workforce, we conducted a serial cross-sectional analysis of all EMTs and paramedics earning initial National EMS Certification from January 1, 2008 to December 31, 2017. Cuzick's non-parametric test of trend was used to assess for changes in the gender and racial/ethnic composition of the EMS cohorts over time. For 2017, we calculated differences the gender and racial/ethnic composition of the EMT and paramedic cohorts to the U.S population, stratifying by Census region. Results: The study population included 588,337 EMTs and 105,356 paramedics. The proportion of females earning initial EMT certification rose from 28% in 2008 to 35% in 2017. Throughout the study period, less than one-fourth of newly certified paramedics were female (range: 20-23%). The proportion of EMS professionals identifying as black remained near 5% among EMTs and 3% among paramedics. The proportion of newly-certified Hispanic EMS professionals rose from 10% to 13% among EMTs and from 6% to 10% among paramedics. Compared to the U.S. population, females and racial/ethnic minorities were underrepresented among EMTs and paramedics earning initial certification and these representation differences varied across geographic regions. Conclusions: The underrepresentation of females and minority racial/ethnic groups observed during this 10-year investigation of EMTs and paramedics earning initial certification suggests that EMS workforce diversity is unlikely to undergo substantial change in the near future. The representation gaps were larger and more stable among paramedics compared to EMTs and suggest an area where concerted efforts are needed to encourage students of diverse backgrounds to pursue EMS.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Serviços Médicos de Emergência/organização & administração , Auxiliares de Emergência/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Certificação/estatística & dados numéricos , Estudos Transversais , Demografia , Feminino , Humanos , Masculino , Distribuição por Sexo , Estados Unidos
19.
Am J Emerg Med ; 38(8): 1594-1598, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31522929

RESUMO

OBJECTIVE: Evaluate an established scribe program on throughput and revenue capture in an Emergency Department (ED) undergoing an EMR transition. METHODS: A prospective cohort design comparing patients managed with and without scribes in an academic ED. Throughput metrics (medians, min) and relative value units (RVUs, means) were collected. Data was evaluated in its entirety (three months), as well as in two subsets: go live (immediate two weeks) and adoption (two weeks post implementation to end). RESULTS: All patients: There was no significant difference in throughput or RVUs during the three month period. During go-live, scribes showed improvement in total RVUs per patient (4.63 vs 4.40, p = 0.048). During adoption, scribed patients had decreased length of stay (LOS, 221 vs 231, p = 0.023). Adults: Door to provider (28 vs 37, p = 0.014) and total RVUs (5.20 vs 4.92, p = 0.042) were improved with scribes in the go-live period. Scribes improved go-live morning and overnight shifts, while lengthening provider to disposition during afternoon shifts. No significant differences were seen in the adoption period, except for increased provider to disposition time overnight with scribes (154 vs 146, p = 0.030). Pediatrics: When all pediatric patients were compared, scribe patients had a decreased professional RVU charge (2.78 vs 2.90, p = 0.037). During go live and adoption, no significant differences were found in any other parameter or subgrouping. CONCLUSIONS: A scribe's ability to mitigate operational inefficiencies introduced by an EMR transition seems limited in an academic hospital. Previous research highlighting the impact of scribes on revenue was not replicated during this study.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Eficiência Organizacional , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência , Fluxo de Trabalho , Humanos , Estudos Prospectivos , Escalas de Valor Relativo
20.
BMC Womens Health ; 19(1): 137, 2019 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727041

RESUMO

BACKGROUND: Female sexual dysfunction (FSD) is increasingly being identified as a problem around the world. Women can have problems in various parts of the sexual cycle - desire, arousal, lubrication, orgasm or they may experience pain related to sexual activity. The only study involving Singapore with regard to sexual dysfunction in women, the Asian Global Studies of Sexual Attitudes and Behaviours in 2002, reported that Singapore had one of the lowest age-standardised sexual dysfunction rates of 32% compared with other Asian countries. This pilot study aims to evaluate the prevalence of female sexual dysfunction and to investigate the independent significant risk factors among allied health workers in a tertiary hospital in Singapore. METHODS: A cross-sectional study where an anonymous questionnaire which included 19 questions in the FSFI (Female Sexual Function Index) was distributed to all allied health workers in a tertiary hospital in Singapore aged between 18 to 70 years old. RESULTS: Three hundred thirty completed questionnaires were involved in analysis. 56.0% of women were found to have sexual dysfunction. A significant difference was found in the prevalence of FSD when comparing nurses to other allied health staff, where nurses had a decreased risk of developing FSD. Age was not found to be a significant risk factor in our study. Respondents below 40 years of age had significantly lower satisfaction scores than those above 40. Indians and Filipinos were found to have lower scores than the Chinese and Malay respondents in the lubrication (p = 0.02) and pain domains (p = 0.02). CONCLUSION: A significant proportion our female allied health workers suffer from sexual dysfunction. In this study, we found that the overall prevalence was independent of age, race and marital status. Nurses had a lower risk of developing FSD. We will need further studies to assess the prevalence of female sexual dysfunction in the general population, to evaluate the independent significant risk factors for developing FSD, in addition to classical risk factors, as well as to assess the psychological impact of this condition and whether people would be willing to seek help for such problems.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Prevalência , Fatores de Risco , Singapura/epidemiologia , Inquéritos e Questionários , Centros de Atenção Terciária , Adulto Jovem
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