Journal articles on the topic 'Pre-hospital practitioners'
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Williams, P., C. Bond, P. Hannaford, and L. Ritchie. "Influences on general practitioners' use of pre-hospital thrombolysis: a qualitative study." Journal of Public Health 26, no. 1 (March 1, 2004): 38–41. http://dx.doi.org/10.1093/pubmed/fdh108.
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Scott, Chloe, and Suman Mitra. "PP15 Situational awareness in pre-hospital practice – observational study using simulated scenarios." Emergency Medicine Journal 37, no. 10 (September 25, 2020): e8.2-e8. http://dx.doi.org/10.1136/emermed-2020-999abs.15.
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BackgroundThe concept of situation awareness (SA) has become a core theme throughout human factors research. SA is a cognitive process, put simply, it refers to a person’s ability to be aware of what’s going on and to anticipate what will happen next. In an acute pre-hospital setting, practitioners are required to make decisions quickly and often under pressure, these decisions depend on their SA. However, we do not yet know if the type of incident affects a person’s SA. Despite the importance of SA in medicine, few studies have examined SA in the pre-hospital setting. The aim of this study was to determine whether pre-hospital responders are more situationally aware in a familiar or unfamiliar environment using simulated scenarios.MethodThis observational study recruited 22 pre-hospital responders to participate two simulated scenarios; one familiar and the other unfamiliar. Following completion of the simulation participants individually completed a modified SAGAT questionnaire to quantitively analyse SA across 10 different factors.ResultsThe results showed that participants were more situationally aware in an unfamiliar environment (mean familiar: 18.75, mean unfamiliar: 22.75, P value = 0.003). However, participants felt more confident completing the familiar scenario (mean familiar = 4.09 compared to mean unfamiliar=3.87).ConclusionPre-hospital responders were more situationally aware in an unfamiliar environment, one reason for this could be due to the lack of experience in these environments practitioners may be more vigilant. Regardless of whether the environment is familiar or unfamiliar, responders are often exposed to complex environments where patients with serious injuries have to be managed and good SA is essential for safely managing a patient. Due to the small sample size and limited knowledge on this topic there would be a value in conducting more research considering the importance of SA in pre-hospital medicine.
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Eadie, Kathy, Marissa J. Carlyon, Joanne Stephens, and Matthew D. Wilson. "Communicating in the pre-hospital emergency environment." Australian Health Review 37, no. 2 (2013): 140. http://dx.doi.org/10.1071/ah12155.
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Aim. To develop and evaluate the implementation of a communication board for paramedics to use with patients as an augmentative or alternative communication tool to address communication needs of patients in the pre-hospital setting. Method. A double-sided A4-size communication board was designed specifically for use in the pre-hospital setting by the Queensland Ambulance Service and Disability and Community Care Services. One side of the board contains expressive messages that could be used by both the patient and paramedic. The other side contains messages to support patients’ understanding and interaction tips for the paramedic. The communication board was made available in every ambulance and patient transport vehicle in the Brisbane Region. Results. A total of 878 paramedics completed a survey that gauged which patient groups they might use the communication board with. The two most common groups were patients from culturally and linguistically diverse backgrounds and children. Staff reported feeling confident in using the board, and 72% of interviewed paramedics agreed that the communication board was useful for aiding communication with patients. Feedback from paramedics suggests that the board is simple to use, reduces patient frustration and improves communication. Conclusion. These results suggest that a communication board can be applied in the pre-hospital setting to support communication success with patients. What is known about the topic? It is imperative that communication between patient and paramedic is clear and effective. Research has shown that communication boards have been effective with people with temporary or permanent communication difficulties. What does this paper add? This is the first paper outlining the development and use of a communication board by paramedics in the pre-hospital setting in Australia. The paper details the design of the communication board for the unique pre-hospital environment. The paper provides some preliminary data on the use of the communication board with certain patient groups and its effectiveness as an alternative communication tool. What are the implications for practitioners? The findings support the use of the tool as a viable option in supporting the communication between paramedics and a range of patients. It is not suggested that this communication board will meet the complete communication needs of any individual in this environment, but it is hoped that the board’s presence within the Queensland Ambulance Service may result in paramedics introducing the board on occasions where communication with a patient is challenging.
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Brown, Nick, Timothy Edwards, Ian McIntyre, and Mark Faulkner. "A retrospective cohort study of pre-hospital agitation management by advanced paramedic practitioners in critical care." British Paramedic Journal 7, no. 3 (December 1, 2022): 8–14. http://dx.doi.org/10.29045/14784726.2022.12.7.3.8.
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Introduction: Pre-hospital clinicians can expect to encounter patients with agitation, including acute behavioural disturbance (ABD). These situations carry significant risk for patients and emergency medical services. Advanced paramedics within the London Ambulance Service (LAS) are frequently tasked to these incidents. At present, little evidence exists regarding clinical decision-making and management of this patient group. We sought to explore the demographics of patients presenting with potential ABD and quantify the degree of agitation, physical restraint, effectiveness of chemical sedation and any associated complications.Methods: A retrospective analysis of pre-hospital clinical records for patients coded with ABD and attended by LAS advanced paramedics between 1 October 2019 and 30 September 2020. Sedation assessment tool (SAT) scores were used as the primary outcome measure.Results: A total of 237 patient records were identified. Of the patients, 147 (62%) were physically restrained and 104 (44%) were chemically sedated. Sedation was more commonly administered where patients were exposed to physical restraint. High SAT scores were associated with the administration of sedative agents and at higher doses. Of patients undergoing sedation, 89 (85%) had a SAT score reduction of 2 points or a final score ≤ 0. The mean SAT score reduction was 2.72. Three cases of minor injury were reported following physical restraint.Conclusion: Advanced paramedics undertook sedation in less than half the cohort, suggesting that other strategies such as communication and positioning were utilised. Most patients were managed into a state between being restless and rousable, largely negating the need for ongoing physical restraint during hospital transfer. Appropriately trained advanced paramedics can utilise sedation safely and effectively in selected cases.
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Griffin, Bronwyn R., Roy M. Kimble, and Maleea Holbert. "761 Burn first aid in Australian pre-hospital environments." Journal of Burn Care & Research 43, Supplement_1 (March 23, 2022): S187—S188. http://dx.doi.org/10.1093/jbcr/irac012.314.
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Abstract Introduction Best-practice burns first aid is well defined as 20 minutes of cool running water (CRW) within three hours of injury and an expectation of burn care in Australia. This study aims to identify barriers to applying this intervention and assess burn first aid knowledge amongst Australian paramedics. Methods Using multiple methods we assessed; 1) burn first aid adequacy in a cross-sectional study of health care professionals, utilizing a prospectively collected registry of patients managed at an Australian tertiary children’s hospital. Logistic regression models were used to evaluate the relationship between first aid adequacy between health services (eg. Paramedics and emergency departments). Then 2) paramedics completed a questionnaire containing demographic and clinical expertise and environment as well as recording immediate first aid management across five multiple choice burn case scenarios Results Overall, 31.3% of children received adequate CRW from caregivers. Factors associated with caregiver inadequacy of CRW were very young age and early adolescence (p< 0.001) rural location ( P = 0.045), low socioeconomic status ( P = 0.030) amongst others. Paramedics and general practitioners provided adequate cooling to 184/735 (25.0%) and 52/215 (24.2%) of their patients, respectively. Local general hospitals provided adequate CRW to 1019/1809 (56.3%) patients. Paramedic questionnaire responses (n=326) identified 56% of paramedics answered all burn case scenarios correctly. Respondents who treated a burn within six months scored higher on burn first aid scenarios compared to paramedics who had not recently treated a burn (p=0.004). Conclusions : deficiencies remain in the cooling of paediatric burns patients at all levels of initial management. First aid delivery was significantly worse in children aged 0-2, adolescents aged 15-16, those living rurally, and the socioeconomically disadvantaged.
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Brichko, Lisa, Paul Jennings, Christopher Bain, Karen Smith, and Biswadev Mitra. "Selecting cases for feedback to pre-hospital clinicians – a pilot study." Australian Health Review 40, no. 3 (2016): 306. http://dx.doi.org/10.1071/ah15079.
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Background There are currently limited avenues for routine feedback from hospitals to pre-hospital clinicians aimed at improvements in clinical practice. Objective The aim of this study was to pilot a method for selectively identifying cases where there was a clinically significant difference between the pre-hospital and in-hospital diagnoses that could have led to a difference in pre-hospital patient care. Methods This was a single-centre retrospective study involving cases randomly selected through informatics extraction of final diagnoses at hospital discharge. Additional data on demographics, triage and diagnoses were extracted by explicit chart review. Blinded groups of pre-hospital and in-hospital clinicians assessed data to detect clinically significant differences between pre-hospital and in-hospital diagnoses. Results Most (96.9%) patients were of Australasian Triage Scale category 1–3 and in-hospital mortality rate was 32.9%. Of 353 cases, 32 (9.1%; 95% CI: 6.1–12.1) were determined by both groups of clinical assessors to have a clinically significant difference between the pre-hospital and final in-hospital diagnoses, with moderate inter-rater reliability (kappa score 0.6, 95% CI: 0.5–0.7). Conclusion A modest proportion of cases demonstrated discordance between the pre-hospital and in-hospital diagnoses. Selective case identification and feedback to pre-hospital services using a combination of informatics extraction and clinician consensus approach can be used to promote ongoing improvements to pre-hospital patient care. What is known about the topic? Highly trained pre-hospital clinicians perform patient assessments and early interventions while transporting patients to healthcare facilities for ongoing management. Feedback is necessary to allow for continual improvements; however, the provision of formal selective feedback regarding diagnostic accuracy from hospitals to pre-hospital clinicians is currently not routine. What does this paper add? For a significant proportion of patients, there is a clinically important difference in the diagnosis recorded by their pre-hospital clinician compared with their final in-hospital diagnosis. These clinically significant differences in diagnoses between pre-hospital and in-hospital clinicians were most notable among acute myocardial infarction and trauma subgroups of patients in this study. What are the implications for practitioners? Identification of patients who have a significant discrepancy between their pre-hospital and in-hospital diagnoses could lead to the development of feedback mechanisms to pre-hospital clinicians. Providing pre-hospital clinicians with this selective feedback would be intended to promote ongoing improvements in pre-hospital assessments and thereby to improve service delivery.
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Butt, Hira, Hira Sheikh, Syed Ghyour Ali Mohsin, Nauman Rauf Khan, Tajwar Jafar, Taimur Hassan Shah, and Maria Jabbar. "Barriers to the Maintenance of COVID 19 Cross Infection Control Protocols among Medical and Dental Practitioners." Pakistan Journal of Medical and Health Sciences 16, no. 10 (October 30, 2022): 708–10. http://dx.doi.org/10.53350/pjmhs221610708.
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Objective: To determine the barriers to the maintenance of COVID 19 cross infection control protocols among medical and dental practitioners Methodology: A cross sectional study was conducted in College of Dentistry, Sharif Medical and Dental College, Lahore from July 2021 to July 2022 on medical and dental practitioners. The sampling technique employed was convenient sampling. Medical and dental practitioners irrespective of their age, gender and specialty of practice were included in the study. Data was collected using a pre-validated questionnaire with a Cronbach alpha value of 0.7. Results: There was s statistically significant difference in the scores of barriers to maintenance of COVID 19 cross infection control protocols of overcrowding in the hospital (p= ≤0.001), limitation of infection control material (p=≤0.001), insufficient training in infection control (p=0.05), lack of handwashing (p=0.022), not wearing a mask while examining the patient (p=≤0.001) and lack of knowledge about mode of transmission of COVID 19 (P=0.036) Conclusion: The barriers faced to maintenance of cross infection control protocols pertaining to the hospital administration were reported to be higher for medical practitioners in comparison to the dental practitioners. The barriers faced to maintenance of cross infection control protocols pertaining to the attitude and practices of health care workers were also higher for medical practitioners in comparison to the dental practitioners. Keywords: Cross infection control, COVID 19 pandemic, medical practitioners, dental practitioners
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Yang, Juan, Jie Zhang, Shu Ou, Ni Wang, and Jian Wang. "Knowledge of Community General Practitioners and Nurses on Pre-Hospital Stroke Prevention and Treatment in Chongqing, China." PLOS ONE 10, no. 9 (September 18, 2015): e0138476. http://dx.doi.org/10.1371/journal.pone.0138476.
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Knox, S., S. S. Dunne, M. Hughes, S. Cheeseman, and C. P. Dunne. "Regulation and registration as drivers of continuous professional competence for Irish pre-hospital practitioners: a discussion paper." Irish Journal of Medical Science (1971 -) 185, no. 2 (February 12, 2016): 327–33. http://dx.doi.org/10.1007/s11845-016-1412-z.
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Moy, Ross, and C. Wright. "Ketamine for military prehospital analgesia and sedation in combat casualties." Journal of the Royal Army Medical Corps 164, no. 6 (April 9, 2018): 436–37. http://dx.doi.org/10.1136/jramc-2018-000910.
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Ketamine is an effective drug for battlefield analgesia. Recent evidence suggests that it can be safely and effectively used by Level 6 Pre-Hospital Emergency Care (PHEC) practitioners. This article presents a review of the evidence, and outlines the future use of ketamine for provision of analgesia and sedation in combat casualties.
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Hall, Alex, Gail Ewing, Christine Rowland, and Gunn Grande. "A drive for structure: A longitudinal qualitative study of the implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention during hospital discharge at end of life." Palliative Medicine 34, no. 8 (June 3, 2020): 1088–96. http://dx.doi.org/10.1177/0269216320930935.
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Background: Informal carers are essential in enabling discharge home from hospital at end of life and supporting palliative patients at home, but are often ill-prepared for the role. Carers’ support needs are rarely considered at discharge. If carers are less able to cope with home care, patient care may suffer and readmission may become more likely. Aim: To investigate the implementation of an evidence-based Carer Support Needs Assessment Tool (CSNAT) intervention to support carers during hospital discharge at end of life. Design: Longitudinal qualitative study with thematic analysis. Setting/participants: One National Health Service Trust in England: 12 hospital practitioners, one hospital administrator and four community practitioners. We provided training in CSNAT intervention use and implementation. Practitioners delivered the intervention for 6 months. Data collection was conducted in three phases: (1) pre-implementation interviews exploring understandings, anticipated benefits and challenges of the intervention; (2) observations of team meetings and review of intervention procedures and (3) follow-up interviews exploring experiences of working with the intervention. Results: Despite efforts from practitioners, implementation was challenging. Three main themes captured facilitators and barriers to implementation: (1) structure and focus within carer support; (2) the ‘right’ people to implement the intervention and (3) practical implementation challenges. Conclusions: Structure and focus may facilitate implementation, but the dominance of outcomes measurement and performance metrics in health systems may powerfully frame perceptions of the intervention and implementation decisions. There is uncertainty over who is best-placed or responsible for supporting carers around hospital discharge, and challenges in connecting with carers prior to discharge.
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G. Bolton, Patrick, Sharon M. Parker, Kylie J. Fergusson, and Jannifer D. Orman. "The Impact of a Clinical Audit on GP Detection of Depression." Australian Journal of Primary Health 9, no. 1 (2003): 88. http://dx.doi.org/10.1071/py03011.
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Objective: To determine if a clinical audit and linked educational workshop would improve the ability of general practitioners to accurately detect depression. Design: Pre- and post-data collection over a six-month period (two eight-week collection periods), associated educational workshop, and comprehensive treatment guidelines. Setting: General Practice in the Central Sydney Area. Study participants: A total of 1106 patients (592 pre-, 514 post-collection) from six general practices. Patients were required to be 18-65yrs and willing and able to complete a self-administered depression rating scale. Main Outcome Measures: General practitioner rating of consecutive patients using a tick box scale matched to patients' self-report on the Hospital Anxiety and Depression Scale. Comparison of patients' scores on the two sub-scales of the Scale (depression and anxiety) and the reason for presentation rated by the general practitioner. Results: The mean age of participants was 35 years for audit one and 33 years for audit two with substantially more females participating (73.6% and 68.1%) as opposed to males (26.4% and 31.9%). The presence of psychological problems as identified by the HADS was higher than that reported in the literature and actually decreased from 65.9% in audit one to 59.7% in audit two. There were non-significant increases in the rate at which participating general practitioners detected depression with the proportion of "true negatives" increasing between the audits and the proportion of "false negatives" decreasing. No change occurred in either the true or false positive rates. Conclusions: Within this study, the audit, feedback and educational workshop in combination achieved poor results. This, and the prevalence of depression in the population, suggests further research is warranted to determine an effective method of educating general practitioners to detect depression.
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Jefford, Michael, Georgina Wiley, Amanda Piper, Judy Evans, Linda Nolte, Allison Drosdowsky, Liz Simkiss, et al. "A multisite cancer survivorship clinical placement program for primary care practitioners (PCPs)." Journal of Clinical Oncology 35, no. 5_suppl (February 10, 2017): 95. http://dx.doi.org/10.1200/jco.2017.35.5_suppl.95.
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95 Background: Following a successful pilot, a survivorship placement program for PCPs (general practitioners (GPs) and general practice nurses (GPN)) was refined and extended to additional sites. The program aimed to facilitate collaborative learning, with an emphasis on the post treatment phase. Objectives were to improve clinical knowledge of the health needs of survivors and enhance confidence with shared care (ShC). Methods: Four cancer centres participated. Each received an implementation toolkit and videos, developed to promote the role of PCPs in survivorship care. PCPs received pre-placement materials and attended multidisciplinary meetings and specialist clinics for 10 hours. PCPs and hospital-based specialists completed pre and post-placement surveys, assessing perceptions of the program, perceived barriers to ShC, perceived knowledge regarding survivorship issues (9 items), confidence managing survivorship issues (8 items) and with ShC (1). Results: Forty-seven PCPs (32 GPs, 15 GPN) completed placements and pre and post-placement surveys. Median scores for all confidence items and 8 of 9 knowledge items increased; 1 remained the same. Matching of pre and post responses assessed individual changes. Across the 9 knowledge items, 57-86% of PCPs reported an increase; for the 9 confidence items, 68-89% reported improvement (no decreases). Data from specialists is currently available from 1 site; 16 specialists completed the pre- and 14 (88%) the post-survey. The majority of median knowledge and confidence scores were high and remained unchanged. Specialists (n=14, 88%) and PCPs (n=37, 76%) identified the biggest barrier to ShC as ‘lack of systems to support transition of care.’ All PCPs and specialists agreed/strongly agreed the ‘program was relevant to my clinical practice.’ Conclusions: The program enhanced PCP’s knowledge and confidence regarding survivorship care, was highly regarded and identified perceived barriers to ShC.
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Yang, Juan, Jie Zhang, Shu Ou, Ni Wang, and Jian Wang. "Correction: Knowledge of Community General Practitioners and Nurses on Pre-Hospital Stroke Prevention and Treatment in Chongqing, China." PLOS ONE 14, no. 3 (March 13, 2019): e0213969. http://dx.doi.org/10.1371/journal.pone.0213969.
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Perkin, Michael R., Richard M. Pearcy, and Jocelyn S. Fraser. "A Comparison of the Attitudes Shown by General Practitioners, Hospital Doctors and Medical Students towards Alternative Medicine." Journal of the Royal Society of Medicine 87, no. 9 (September 1994): 523–25. http://dx.doi.org/10.1177/014107689408700914.
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The aim of this study was to compare and contrast the views of general practitioners (GPs), hospital doctors and medical students to alternative medicine. A questionnaire was sent to a random sample of 100 GPs and 100 hospital doctors in the South West Thames Regional Health Authority (SWTRHA). A convenience sample of 237 pre-clinical medical students at St George's Hospital Medical School was also given a questionnaire. Eighty-seven GPs and 81 hospital doctors replied. Five therapies were investigated: acupuncture; chiropractice; homoeopathy; naturopathy; and osteopathy. All respondents were asked about their attitude towards and knowledge of these therapies. Doctors were asked how often they referred patients for such treatment and whether they practised it themselves. GPs and hospital doctors had similar levels of knowledge of the therapies. Medical students were the least informed but the most enthusiastic respondents. Seventy per cent of hospital doctors and 93% of GPs had, on at least one occasion, suggested a referral for alternative treatment. GPs were making these referrals more frequently and earlier. Twelve per cent of hospital doctors and 20% of GPs were practising alternative medicine. The majority of the respondents felt that alternative medicine should be available on the National Health Service (NHS) and that medical students should receive some tuition about alternative therapies. A considerable proportion of those doctors referring patients to alternative practitioners were ignorant of their official qualifications.
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Fish, David, Fiona Bell, Clare O’Connell, Alison Walker, Laura Evans, and Shammi Ramlakhan. "PP40 Pre-hospital and emergency department analgesia for paediatric trauma – a survey of UK trauma centres and ambulance services supports consideration of alternatives such as ketamine." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A16.3—A17. http://dx.doi.org/10.1136/emermed-2021-999.40.
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BackgroundStudies have found that pre-hospital and emergency department (ED) analgesia for children is sub-optimal. In the pre-hospital setting, barriers include limited parenteral routes, education or clinical experience and practice legislation restricting the use of opioids by paramedics. Ketamine is safe and effective with multiple administration routes. It is not bound by the controlled drugs limitations in the pre-hospital setting, and is familiar to pre-hospital and ED practitioners.MethodsQuestionnaires were sent to all UK Ambulance Service Medical Directors and Paediatric Major Trauma Centres to establish current use of parenteral analgesics, and acceptability of alternatives in pre-hospital care such as ketamine. Descriptive analysis was undertaken.ResultsIntranasal opiates were the first line parenteral analgesics in injured children in all EDs. Frequent shortages of IN diamorphine resulted in more variability of second line choices, with 40% opting for another opioid. 96% of EDs would support the use of ketamine by pre-hospital clinicians, although concerns regarding inappropriate (IV) use and use by technician crews were raised. Most ED clinicians were unaware of the limited analgesic choices available to paramedics, with many suggesting alternative opiates as well as ketamine.All ambulance service directors recognised the need for alternative analgesics being made available. Without legislative changes, inhaled/IN agents or oral opiates were the only current options. All services were supportive of research to explore the use of ketamine by paramedics for injured children.ConclusionsThere is support for the addition of IN ketamine into paramedics’ repertoire of analgesics and recognition of potential benefit. However, there is a lack of experience and evidence around its use, thus warranting research to consider the impact on analgesic timeliness, adequacy and effectiveness. An analgesia ‘system of care’ which integrates pre- and in-hospital practice would be facilitated by the use of medicines effective in managing pain and familiar to practitioners in both settings.
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Käckenmester, Wiebke, Claas Güthoff, Dana Mroß, Gertrud Wietholt, Kristina Zappel, and Ingo Schmehl. "Evaluation of Post-Hospital Care of Traumatic Brain Injury in Children, Adolescents and Young Adults—A Survey among General Practitioners and Pediatricians in Germany." Diagnostics 12, no. 9 (September 19, 2022): 2265. http://dx.doi.org/10.3390/diagnostics12092265.
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Background: The long-term effects of mild Traumatic Brain Injury (TBI) in children and adolescents are increasingly discussed due to their potential impact on psycho-social development and education. This study aims to evaluate post-hospital care of children and adolescents after mild TBI using a physician survey. Methods: A self-developed, pre-tested questionnaire on diagnostics and treatment of TBI in outpatient care was sent to a representative sample of general practitioners and pediatricians in Germany. Results: Datasets from 699 general practitioners, 334 pediatricians and 24 neuropediatricians were available and included in the analysis. Nearly half of the general practitioners and most pediatricians say they treat at least one acute pediatric TBI per year. However, a substantive proportion of general practitioners are not familiar with scales assessing TBI severity and have difficulties assessing the symptoms correctly. Pediatricians seem to have better knowledge than general practitioners when it comes to treatment and outpatient care of TBI. Conclusions: To increase knowledge about TBI in outpatient physicians, targeted training courses should be offered, especially for general practitioners. Moreover, handing out written information about long-term effects and reintegration after TBI should be encouraged in outpatient practice.
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Alam, Nadia, Kirtiedevi BNS Doerga, Tahira Hussain, Sadia Hussain, Frits Holleman, Mark H H Kramer, and Prabath WB Nanayakkara. "Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study." Acute Medicine Journal 15, no. 4 (October 1, 2016): 168–75. http://dx.doi.org/10.52964/amja.0632.
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Introduction: General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis in the pre-hospital setting and patient outcomes. Methods Design: prospective, observational study during a 12 week period in the emergency department (ED) of two academic hospitals. Study population: Patients >18 years presenting with sepsis at the ED. The information available in the ED discharge letter and the ED charts was used to make a definite diagnosis of sepsis, severe sepsis and septic shock Outcome measures: primary: recognition/documentation of sepsis. Secondary: ED arrival time to antibiotic administration, in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) admission. Results: A total of 301 patients were included in the study. GPs and EMS personnel correctly identified and documented 31.6% (n=114) and 41.4% of all sepsis patients (n=140) respectively. Recognition and documentation of sepsis improved with increasing severity. The mean time to administration of antibiotics (TTA) was nearly halved for the group of patients where sepsis was documented (GP: 66,4 minutes, EMS: 65,6 minutes) compared to the group in which sepsis was not documented (GP: 123,9 minutes, EMS: 101,5 minutes; p= 0.365 and p= 0.024 respectively). Conclusions: There is room for improvement in the recognition of sepsis, severe sepsis and septic shock by practitioners working in the pre-hospital setting. Documentation of sepsis prior to arrival in hospital led to a reduced time delay in administration of antibiotics.
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Mwizerwa, Oscar, Christian Umuhoza, Mark H. Corden, Tom Lissauer, and Peter Thomas Cartledge. "Closing the communication gap in neonatal inter-hospital transfer: a neonatal referral form for resource-limited settings - a modified e-Delphi-consensus study." F1000Research 10 (May 10, 2021): 365. http://dx.doi.org/10.12688/f1000research.50980.1.
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Background: Standardised neonatal referral forms (NRFs) facilitate effective communication between healthcare providers and ensure continuity of care between facilities, which are essential for patient safety. We sought to determine the essential data items, or core clinical information (CCI), that should be conveyed for neonatal inter-hospital transfer in resource-limited settings (Rounds 1 to 3) and to create an NRF suitable for our setting (Round 4). Methods: We conducted an international, four-round, modified Delphi-consensus study. Round-1 was a literature and internet search to identify existing NRFs. In Round-2 and -3, participants were Rwandan clinicians and international paediatric healthcare practitioners who had worked in Rwanda in the five years before the study. These participants evaluated the draft items and proposed additional items to be included in an NRF. Round-4 focused on creating the NRF and used five focus groups of Rwandan general practitioners at district hospitals. Results: We identified 16 pre-existing NRFs containing 125 individual items. Of these, 91 items met the pre-defined consensus criteria for inclusion in Round-2. Only 33 items were present in more than 50% of the 16 NRFs, confirming the need for this consensus study. In Round-2, participants proposed 12 new items, six of which met the pre-defined consensus criteria. In Round-3, participants scored items for importance, and 57 items met the final consensus criteria. In Round-4, 29 general practitioners took part in five focus groups; a total of 16 modifications were utilised to finalise the NRF. Conclusions: We generated a novel, robust, NRF that may be readily employed in resource-limited settings to communicate the essential clinical information to accompany a neonate requiring inter-hospital transfer.
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Mwizerwa, Oscar, Christian Umuhoza, Mark H. Corden, Tom Lissauer, and Peter Thomas Cartledge. "Closing the communication gap in neonatal inter-hospital transfer: a neonatal referral form for resource-limited settings - a modified e-Delphi-consensus study." F1000Research 10 (June 7, 2022): 365. http://dx.doi.org/10.12688/f1000research.50980.2.
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Background: Standardised neonatal referral forms (NRFs) facilitate effective communication between healthcare providers and ensure continuity of care between facilities, which are essential for patient safety. We sought to determine the essential data items, or core clinical information (CCI), that should be conveyed for neonatal inter-hospital transfer in resource-limited settings (Rounds 1 to 3) and to create an NRF suitable for our setting (Round 4). Methods: We conducted an international, four-round, modified Delphi-consensus study. Round-1 was a literature and internet search to identify existing NRFs. In Round-2 and -3, participants were Rwandan clinicians and international paediatric healthcare practitioners who had worked in Rwanda in the five years before the study. These participants evaluated the draft items and proposed additional items to be included in an NRF. Round-4 focused on creating the NRF and used five focus groups of Rwandan general practitioners at district hospitals. Results: We identified 16 pre-existing NRFs containing 125 individual items. Of these, 91 items met the pre-defined consensus criteria for inclusion in Round-2. Only 33 items were present in more than 50% of the 16 NRFs, confirming the need for this consensus study. In Round-2, participants proposed 12 new items, six of which met the pre-defined consensus criteria. In Round-3, participants scored items for importance, and 57 items met the final consensus criteria. In Round-4, 29 general practitioners took part in five focus groups; a total of 16 modifications were utilised to finalise the NRF. Conclusions: We generated a novel, robust, NRF that may be readily employed in resource-limited settings to communicate the essential clinical information to accompany a neonate requiring inter-hospital transfer.
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Roberts, John D., Biree Andemariam, Janis Bozzo, Cindy Du, Susanna A. Curtis, Douglas Latham, Mary Ann Cyr, and Lawrence Magras. "Statewide Intervention to Improve Medical Care Services Utilization Patterns of Adults Living with Sickle Cell Disease." Blood 134, Supplement_1 (November 13, 2019): 517. http://dx.doi.org/10.1182/blood-2019-124462.
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Introduction: Adults living with sickle cell disease (SCD) have high utilization of emergency departments (ED) and hospitals, and utilization typically is skewed with a subgroup with very high utilization. We sought to promote a shift from ED/hospital utilization to ambulatory care (Amb) services in our state through ED/hospital visit-prompted communication with ED/hospital and Amb practitioners. Methods: The Community Health Network of Connecticut, Inc. (CHNCT) is the medical administrative services organization (contractor) for the physical health benefit of the state's Medicaid Program, HUSKY Health. Among HUSKY members ages 16 years and older (16+) with Medicaid-only insurance and with at least one Medicaid payment claim with a primary or secondary ICD-9/ICD-10 diagnosis of sickle cell disease from Feb 28, 2016 thru Feb 25, 2017, we identified high ED/hospital utilizing members. CHNCT monitored high utilizing 16+ member ED/hospital visits in real time using admission, discharge, and transfer data, and provided practitioner team members with individual member utilization data (mUD) to be shared via telephone contact with ED/hospital and Amb practitioners when 16+ members visited an ED or were hospitalized. Shared mUD included numbers of ED/hospital visits, names of ED/hospital facilities visited, and information about Amb services visits. ED/hospital practitioners were encouraged to advise members to seek regular care from one of the state's hospital-based SCD programs or other practitioners. No formal hypotheses were declared for testing for statistical significance. Differences in utilization were compared with the Mann-Whitney U test. Results: We identified 705 16+ members living with SCD. In phase 1, high utilizing members (HUM1) were defined as individuals with 12+ ED visits or 8+ hospital visits in the reference year. We identified 45 (6%) HUM1 who accounted for approximately half of all 16+ member ED visits [1364 (56%) of 2436] and hospital visits [368 (47%) of 788]. Among HUM1, the distribution of visits was highly skewed with individual HUM1 accounting for up to 184 ED and up to 27 hospital visits. HUM1 used up to 27 facilities, some out-of-state. In phase 2, we identified an additional 47 members (HUM2) with 6+ ED visits or 4+ hospital visits in the reference year. From Aug 2017 to Jun 2019, CHNCT notified clinical team members of 504 ED/hospital visits involving 51 HUM, and clinical team members shared mUD with practitioners on 342 (68%) occasions. For data analysis, the HUM1 pre-information sharing period was defined as 1/1/16 thru 11/9/16; the post-information sharing period was defined as 7/11/16 thru 7/10/17. For HUM2, pre- 6/6/17 thru 6/5/18, and post- 6/6/18 thru 12/13/18. As the duration of time periods differed, data were expressed as visits (or dollars) per year. ED visit rates fell by one third for HUM1 (33%), but were little changed for HUM2 (see Table 1). Hospitalization rates fell by about one third for both HUM1 (39%) and HUM2 (32%). P values for changes in ED visit rates for HUM1 and HUM2 and in hospitalization rates for HUM2 ranged from 0.005 to 0.01. Medicaid ED and hospital expenditures per year fell more than one third (35%), or about $2.2M. Conclusions: Six percent of CT Medicaid members 16 years and older living with SCD accounted for approximately half of all those members ED and hospital utilization. Visit-prompted sharing of utilization data of these high utilizing members with ED, hospital, and Amb practitioners coupled with a recommendation to advise these members to seek regular Amb services led to decreases in ED visits, hospitalizations, and total expenditures by about one third. The same intervention applied to a cohort of the next highest utilizing members resulted in a similar change in hospitalizations but minimal change in ED visits. Medicaid expenditures for ED visits and hospitalizations for the groups combined fell by about one third, or $2.2 million per year. It will be important to ascertain whether information sharing changed utilization of Amb services. This quality improvement project is HIPAA compliant; no institutional review board approval was required. Table Disclosures Roberts: Community Health Network of Connecticut: Consultancy; Truven Health Analytics: Consultancy. Andemariam:Emmaus: Membership on an entity's Board of Directors or advisory committees; New Health Sciences: Membership on an entity's Board of Directors or advisory committees; Sanofi Genzyme: Membership on an entity's Board of Directors or advisory committees; Terumo BCT: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Other: DSMB Member; Imara: Research Funding; Cyclerion: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; NovoNordisk: Membership on an entity's Board of Directors or advisory committees; Bluebird Bio: Membership on an entity's Board of Directors or advisory committees; Community Health Network of Connecticut: Consultancy. Latham:Community Health Network of Connecticut: Employment. Cyr:Community Health Network of Connecticut: Employment. Magras:Community Health Network of Connecticut: Employment.
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Smith, Hazel, and Heidi Doughty. "Training trial of critical care paramedics for non-medical authorisation of blood." British Paramedic Journal 6, no. 4 (March 1, 2022): 55–59. http://dx.doi.org/10.29045/14784726.2022.03.6.4.55.
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The use of pre-hospital blood transfusion by air ambulance crews is increasing. Blood transfusion is traditionally ‘authorised’ by doctors, not prescribed. However, there is an increasing interest in extending the capability of authorisation to other practitioners ‐ that is, non-medical authorisation (NMA). A UK framework for nurses and midwives has existed since 2007, but training for critical care paramedics (CCPs) has been limited.The Resuscitation with Pre-Hospital Blood Products (RePHILL) trial was launched in 2016, requiring pre-hospital administration of red cells and LyoPlas. Authorisation was initially restricted to doctors, leading to missed recruitment by paramedic-only crews. The trial protocol was amended in 2019 to permit NMA following suitable training and stakeholder consultation. We present a targeted training programme designed to support paramedic-led transfusion within the framework of the pre-hospital trial.We considered the knowledge and skills required for NMA and compared this with baseline knowledge from paramedic training to identify the training gap. We examined examples of existing military and civilian NMA training to develop a targeted programme for a single air ambulance. The four elements of our training programme were pre-course online training, previous trial participation, face-to-face training and competency assessment.Training was delivered to three CCPs, who cascaded the training to 14 colleagues. The training time was one morning, including a face-to-face session and assessment. Novel topics included physiological triggers for transfusion and transfusion risks in the pre-hospital environment. Paramedics were encouraged to recognise and report new patterns of adverse events. Reflective feedback suggests the programme provided CCPs the knowledge to autonomously recruit trial patients and authorise transfusion.
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Hans, Gurdeep K., Surina Bhola, and Zahra Ahmad. "The Role of the General Dental Practitioner in the Management of Mandibular Fractures." Dental Update 47, no. 5 (May 2, 2020): 433–39. http://dx.doi.org/10.12968/denu.2020.47.5.433.
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Mandibular fractures are a common presentation to emergency departments in hospital. Although the majority of mandibular fractures are treated in secondary care, General Dental Practitioners (GDPs) should have the basic knowledge to be able to support fracture patients in practice, whether that is in an emergency situation, managing associated sequelae, or through post-operative recovery. CPD/Clinical Relevance: This article highlights the importance of management of trauma in a primary care setting by GDPs, including pre- and post-operative care of mandibular fractures.
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Sulke, A. N., V. E. Paul, C. J. Taylor, R. H. Roberts, and ADC Norris. "Open Access Exercise Electrocardiography: A Service to Improve Management of Ischaemic Heart Disease by General Practitioners." Journal of the Royal Society of Medicine 84, no. 10 (October 1991): 590–94. http://dx.doi.org/10.1177/014107689108401007.
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An initial study of the use of open access exercise electrocardiography by general practitioners (GPs) in South East Kent showed that patient selection and interpretation of test results was frequently incorrect. After issuing guidelines, modifying the request form and instituting registrar review of all requests, significant improvements in both referral pattern, result interpretation and patient management have resulted. Forty-nine GPs requested 110 exercise tests during 1988/89. Twelve per cent were not undertaken after discussion with the referring practitioner. Eighty-four per cent of those tested would have been referred to the district general hospital cardiology outpatient department in the absence of open access exercise electrocardiography service. Six per cent of patients were referred directly for invasive investigation. Thirty-five per cent were referred to the district general hospital cardiology outpatient department, whilst 42% were spared hospital referral based on the result of the investigation. Better use of the modified service was suggested by: Referral of fewer patients with non-cardiac chest pains (P= 0.002); more patients with a moderate pre-test probability of ischaemic heart disease (P<0.05); fewer inappropriate requests (P<0.01); and fewer inappropriately undertaken tests (P< 0.001) than in the previous study. All patients with strongly positive test results were appropriately managed. Open access exercise electrocardiography in the format investigated is potentially a cost-effective and useful tool to improve diagnosis and management of heart disease bv GPs.
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Latimer, Sharon, Jayne Hewitt, Trudy Teasdale, Carl de Wet, and Brigid M. Gillespie. "The accuracy, completeness and timeliness of discharge medication information and implementing medication reconciliation: A cross-sectional survey of general practitioners." Australian Journal of General Practice 49, no. 12 (December 1, 2020): 854–58. http://dx.doi.org/10.31128/ajgp-04-20-5375.
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Background and objectives General practitioners (GPs) require accurate medication information to care for recently discharged hospital patients. Pre-discharge medication reconciliation improves the accuracy of patient medication lists that GPs receive. This study aimed to explore GPs’ perceptions of the accuracy, completeness and timeliness of hospital discharge medication information, and how they undertake medication reconciliation. Methods Using a cross-sectional online survey, quantitative and qualitative data were collected from a convenience sample of GPs practising across the Gold Coast, Australia. Data were analysed using descriptive statistics and content analysis. Results Twelve GPs were recruited. Patient hospital discharge medication information was mostly accurate and complete, but delays in receiving this information affected the ability of GPs to undertake medication reconciliation. Discussion Receiving accurate and timely patient discharge medication information can reduce errors. Optimising the communication of medication information to GPs may improve patient safety.
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Kumar, Sandeep, Arpit Kumar Agarwal, Akshay Kumar, G. G. Agrawal, Sushant Chaudhary, and Varsha Dwivedi. "A study of knowledge, attitude and practice of hospital consultants, resident doctors and private practitioners with regard to pre-hospital and emergency care in Lucknow." Indian Journal of Surgery 70, no. 1 (February 2008): 14–18. http://dx.doi.org/10.1007/s12262-008-0003-2.
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Kirkland, S. W., A. Soleimani, B. H. Rowe, and A. S. Newton. "P070: Mixed effectiveness of emergency department diversion strategies: a systematic review." CJEM 19, S1 (May 2017): S102. http://dx.doi.org/10.1017/cem.2017.272.
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Introduction: Diverting patients away from the emergency department (ED) has been proposed as a solution for reducing ED overcrowding. The objective of this systematic review is to examine the effectiveness of diversion strategies designed to either direct patients seeking care at an ED to an alternative source of care. Methods: Seven electronic databases and grey literature were searched. Randomized/controlled clinical trials and cohort studies assessing the effectiveness of pre-hospital and ED-based diversion interventions with a comparator were eligible for inclusion. Two reviewers independently screened the studies for relevance, inclusion, and risk of bias. Intervention effects are reported as proportions (%) or relative risks (RR) with 95% confidence intervals (CI). Methodological and clinical heterogeneity prohibited pooling of study data. Results: From 7,306 citations, ten studies were included. Seven studies evaluated a pre-hospital diversion strategy and three studies evaluated an ED-based diversion strategy. The impact of diversion on subsequent health services was mixed. One study of paramedic practitioners reported increased ED attendance within 7 days (11.9% vs. 9.5%; p=0.049) but no differences in return visits for similar conditions (75.2% vs. 72.1%; p=0.64). The use of paramedic practitioners was associated with an increased risk of subsequent contact with health care services (RR=1.21, 95% CI 1.06, 1.38), while the use of deferred care was associated with no increase in risk of subsequently seeking physician care (RR=1.09, 95% CI 0.23, 5.26). While two studies reported that diverted patients were at significantly reduced risk for hospitalization, two other studies reported no significant differences between diverted or standard care patients. Conclusion: The evidence regarding the impact of pre-hospital and ED-based diversion on ED utilization and subsequent health care utilization is mixed. Additional high-quality comparative effectiveness studies of diversion strategies are required prior to widespread implementation.
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Harvey, Desley, Ruth Barker, and Elizabeth Tynan. "Writing a manuscript for publication: An action research study with allied health practitioners." Focus on Health Professional Education: A Multi-Professional Journal 21, no. 2 (July 31, 2020): 1–16. http://dx.doi.org/10.11157/fohpe.v21i2.397.
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Introduction: Writing a manuscript for publication is a challenge for those health practitioners whose primary role is to provide clinical services. The aim of this study was to increase the capacity of allied health practitioners who are employed in a clinical setting to submit manuscripts for publication in peer-reviewed journals.Methods: An action research study design was used to develop a “Writing for Publication” program for nine allied health practitioners who had not previously published a manuscript as lead author. Between May and November 2018, at a regional public hospital service, three 90-minute writing workshops were offered, which included manuscript plan and preparation guide, academic writing instruction, peer review and mentoring by experienced researchers. Data were collected using participant pre- and post-program surveys, post-workshop focus groups and facilitator reflections.Results: All participants reported that their writing skills had improved. Enablers to completing a manuscript for publication included structured preparation, mentoring, training in academic writing skills, protected writing time and external accountability. Challenges included not knowing where or how to start, competing priorities and distractions within and outside of work hours, inadequate academic writing skills and loss of momentum. Two participants submitted their manuscripts for publication by the end of the study and a further manuscript was submitted by the time of writing.Conclusions: Strategies to ensure publication of allied health practitioner research findings need to be integrated into project planning and monitoring processes embedded within a well-supported health service-wide research culture.
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Wang, X. W., J. Xu, and Y. J. Shen. "(P2-53) Investigation of Comprehension of Disaster/Emergency Nursing in Nurse Practitioners in Ningbo Area, China." Prehospital and Disaster Medicine 26, S1 (May 2011): s153. http://dx.doi.org/10.1017/s1049023x11004973.
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BackgroundKnowledge of disaster/emergency nursing is essential to nurse practitioners (NP) due to the increasing frequency of disasters. The objective of this study was to identify the knowledge and the response relating D/EN and to investigate whether the reactions vary among NPs in different level hospitals in Ningbo Area, China.MethodsPre- and post-test questionnaires were used. A total of 297 NPs in five hospitals (two tertiary hospitals, two secondary hospitals, one primary hospital) were involved in this study. Five lectures were implemented based on disaster/emergency nursing from 8 December 2009 to 14 April 2010.ResultsThe mean age of the sample was 31.54 years. Average working experience was 9.57 years. Only 12 participants from the emergency department attended the lecture, yet the lecture was advertised one week in advance. The mean score was 8.88 (pre-test), 12.97 (post-test). Most of the low scores (< 7) on the pre-test were from primary hospitals (43%), while only 0.6% of staff from tertiary hospitals scored that low. A total of 45% of NPs failed to distinguish the contribution of different zones of triage. Nearly 24% of participants considered that the frequency of ALS training should no more than once a month. All participants comprehended the contribution of a triage system after attending lecture, 35% of NPs received perfect scores on the post-test.ConclusionsComprehension of disaster/emergency nursing in NPs in Ningbo is deficient. Primary hospital NPs had a lower score than high-level hospitals. Education and training programs associated with disaster/emergency nursing are necessary for NPs.
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Hamayoshi, Miho, Sayoko Goto, Chiyo Matsuoka, Ayumi Kono, Kyoko Miwa, Kumi Tanizawa, Catherine Evans, and Masayuki Ikenaga. "Effects of an advance care planning educational programme intervention on the end-of-life care attitudes of multidisciplinary practitioners at an acute hospital: A pre- and post-study." Palliative Medicine 33, no. 9 (July 1, 2019): 1158–65. http://dx.doi.org/10.1177/0269216319860707.
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Background:Advance care planning is a crucial end-of-life care practice. However, an advance care planning educational programme for practitioners in an acute care setting has not yet been established. Consequently, we examined the effects of an advance care planning educational programme in an acute hospital in the hope of achieving increased awareness of end-of-life care.Design:A mixed-methods, pre- and post-design was employed to evaluate the change in attitudes of practitioners post-programme. The intervention programme was conducted thrice over 3 months in 90-min sessions.Setting/participants:This study included 85 participants in the baseline assessment working at B acute hospital in Osaka.Results:Participants’ scores on the ‘Positive attitude for end-of-life care’ subscale on the short version of the Frommelt Attitude Toward Care of Dying scale significantly increased after the 6-month intervention. A ‘Positive attitude for end-of-life-care’ implies that participants would not be afraid to practice end-of-life care. Further, participants’ scores on the ‘Death relief’ subscale of the Death Attitude Inventory also significantly increased. The term ‘Death relief’ means that death helps in ending suffering. It means participants are not afraid of death. Qualitative results implied that participants believed advance care planning implementation and communicating with patients and patients’ families were critical.Conclusions:Six months post-intervention, participants displayed sustained positive attitudes towards end-of-life care. These results suggest that the present programme was effective at improving practitioners’ attitudes towards patients’ end-of-life care.
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Hausman, Gary J. "Dimensions of Authenticity in Siddha Medical and Clinical Research." Asian Medicine 17, no. 1 (March 14, 2022): 115–47. http://dx.doi.org/10.1163/15734218-12341509.
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Abstract The article discusses three methods of combining biomedicine with traditional medicine in pre-Independence Madras State in India, with comparative examples drawn from ethnographic studies in South India in the 1990s. In the mid to late 1920s, two officers of modern medicine from the Madras presidency were delegated to be trained in the Calcutta School of Tropical Medicine to investigate the properties of the indigenous drugs of India using laboratory and physiological techniques. In the 1930s, Srinivasamurti, the first principal of the Government School of Indian Medicine in Madras, trialed a collaborative approach between clinical practitioners of ayurveda, siddha, and unani, and allopathic medical registrars with the ideal of developing a universal and synthetic textbook encompassing all medical systems on an equal setting. In the 1940s, a traditional practitioner was permitted to practice bone setting in the Government Hospital of Indian Medicine in Madras. These examples illustrate various dimensions of asymmetric relations between traditional and modern medicine in twentieth- and twenty-first-century India.
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Olaoye, Titilayo, Oyewole O. Oyerinde, Oluwatoyin J. Elebuji, and Oluwapelumi Ologun. "Knowledge, Perception and Management of Pre-eclampsia among Health Care Providers in a Maternity Hospital." International Journal of MCH and AIDS (IJMA) 8, no. 2 (August 8, 2019): 80–88. http://dx.doi.org/10.21106/ijma.275.
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Background: Morbidity and mortality of women and children associated with pre-eclampsia present major global health problems in low and middle income countries. The prevalence of pre-eclampsia in Nigeria ranges from 2% to 16.7%, with approximately 37,000 women dying from preeclampsia annually. This study examines knowledge, perception and management of preeclampsia among healthcare providers in a major maternity hospital in Lagos, southwest Nigeria.
Methods: In this descriptive cross-sectional study, 110 health care providers comprising of 75 Nurses, 9 Consultant Physicians, and 26 General Medical Practitioners with varying years of service were selected using purposive sampling technique. Data were collected using a self-administered 36-item semi-structured questionnaire. Data were analysed using the Statistical Package for Social Sciences to generate descriptive and inferential statistics with level of significance set at 0.05.
Results: Health care providers in the study had an average knowledge of pre-eclampsia with a mean score of 16.69±3.53. There was generally a good perception of pre-eclampsia with a mean sore of 28.31±3.71. The most-prevalent clinical management practices were emergency cesarean section (16%), magnesium sulphate infusion (29%), and fluid/electrolyte management (9%). Knowledge of pre-eclampsia and years of practice were significantly associated (F=3.31; p= 0.023).
Conclusion and Global Health Implications: Gaps in the knowledge of causes, diagnoses, and treatment of pre-eclampsia may be attributable to lack of refresher trainings and absence of written practice guidelines on pre-eclampsia management. Health care providers at this hospital may benefit from training courses that include current nationally and internationally-approved management of preeclampsia.
Key words: • Pre-eclampsia • Eclampsia • Knowledge • Perception • Management • Health care providers • Nigeria
Copyright © 2019 Olaoye et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Moskaleva, P. V., N. A. Shnayder, M. M. Petrova, and R. F. Nasyrova. "Сonvulsive syndrome. Part 2." Siberian Medical Review 1 (2022): 102–13. http://dx.doi.org/10.20333/25000136-2022-1-102-113.
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Th e convulsive syndrome is an urgent and potentially life-threatening condition in neurological, pediatric and general medical practice. Over the past decade, there has been a reconsideration of the definition of epilepsy and epileptic syndromes, including the convulsive syndrome. Additionally, the arsenal of pharmaceuticals for the relief of seizures in children and adults has expanded. In this connection, this lecture was created in two parts: this second part will consider treatment of convulsive syndrome at the pre-hospital and the hospital stages. Th e lecture is intended for neurologists, pediatricians, general practitioners, emergency doctors, anesthesiologists. In the system of continuing medical education, convulsive syndrome is considered within the framework of the postgraduate training program for doctors of these specialties.
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Malone, Victoria, James McLennan, and David Hedger. "Smoke-free hospital grounds." Australian Health Review 44, no. 3 (2020): 405. http://dx.doi.org/10.1071/ah19125.
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This study investigated whether the implementation of a multicomponent intervention project could improve compliance with the New South Wales (NSW) Health smoke-free healthcare policy. Environmental interventions were implemented on the hospital grounds for a 12-week period. Compliance was measured by a pre- and postintervention observational count of smokers on the hospital grounds. After implementation, there was a significant 73% reduction in people smoking on the hospital grounds, indicating improved compliance with the NSW smoke-free healthcare policy through the use of a non-punitive multicomponent intervention. What is known about the topic?Lack of compliance with the NSW Health smoke-free healthcare policy was reflected by the large numbers of smokers outside the front of an inner-city hospital in Sydney, Australia. This issue had been raised by staff, patients and visitors as an ongoing problem requiring a solution. What does this paper add?Designing and implementing a non-punitive multicomponent intervention using modelling, operant and associative learning principles can successfully increase compliance with policies designed to stop smoking on hospital grounds. What are the implications for practitioners?Implementing non-punitive multicomponent interventions to improve compliance with the NSW Health smoke-free healthcare policy may increase patients’ acceptance of smoking cessation support when offered. Healthcare staff need to be equipped with the knowledge and confidence to offer this support.
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Jee, Samuel David, Ellen Ingrid Schafheutle, and Peter Raymond Noyce. "Is pharmacist pre-registration training equitable and robust?" Higher Education, Skills and Work-Based Learning 9, no. 3 (August 12, 2019): 347–58. http://dx.doi.org/10.1108/heswbl-07-2018-0071.
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Purpose Against a backdrop of concerns regarding the quality and equity of the final practice-based pre-registration training year, the purpose of this paper is to examine how robust and equitable current education and training arrangements in Great Britain are in preparing newly qualified pharmacists (NQPs) for practice. Design/methodology/approach In addition to considering relevant regulator, policy and research literature, this paper presents findings from a longitudinal qualitative study that tracked 20 pharmacy trainees and their tutors during pre-registration training and early registered practice. Trainees were interviewed four times over a 12-month period; tutors were interviewed twice. Semi-structured interviews explored learning and development, work environment and support received. Interview transcripts were analysed thematically using template analysis. Findings Currently, there are no requirements tor training pre-registration tutors, or for accreditation or quality assurance of training sites. Longitudinal interview findings showed that community trainees developed knowledge of over-the-counter and less complex, medicines whereas hospital trainees learnt about specialist medicines on ward rotations. Hospital trainees received support from a range of pharmacists, overseen by their tutor and other healthcare professionals. Community trainees generally worked within a small pharmacy team, closely supervised by their tutor, who was usually the sole pharmacist. NQPs were challenged by having full responsibility and accountability as independent practitioners, without formal support mechanisms. Originality/value The variability in trainee experience and exposure across settings raises concerns over the robustness and equity of pre-registration training. The lack of formal support mechanisms post-registration may pose risks to patient safety and pharmacists’ well-being.
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Molinari, Giuseppe, Martina Molinari, Matteo Di Biase, and Natale D. Brunetti. "Telecardiology and its settings of application: An update." Journal of Telemedicine and Telecare 24, no. 5 (January 13, 2017): 373–81. http://dx.doi.org/10.1177/1357633x16689432.
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Among the wide range of medical specialties in which telemedicine has been successfully applied, cardiology can be considered as one of the most important fields of application. Through the transmission of clinical data and the electrocardiogram, telecardiology allows access to a real-time assessment (teleconsultation) without any need to travel for both patient and cardiologist. This review discusses the impact of telecardiology in different clinical settings of application. Pre-hospital telecardiology has proved to be useful either in the clinical management of remote patients with acute coronary syndrome or in supporting the decision-making process of general practitioners. In the setting of in-hospital telecardiology, most of the applications refer to real-time echocardiography transmissions between rural small hospitals and tertiary care centres, particularly for the diagnosis or exclusion of congenital heart disease in newborns. Finally, many trials show that post-hospital telecardiology improves outcomes and reduces re-admissions or outpatient contacts in patients with heart failure, arrhythmias or implantable devices.
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Todhunter, S. L., P. J. Clamp, S. Gillett, and D. D. Pothier. "Readability of out-patient letters copied to patients: can patients understand what is written about them?" Journal of Laryngology & Otology 124, no. 3 (December 3, 2009): 324–27. http://dx.doi.org/10.1017/s0022215109991770.
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AbstractThe National Health Service Plan of 2000 proposed that patients should receive a copy of all correspondence regarding their care. There is concern that the readability of patients' letters may not be appropriate for many patients.Materials and methods:This study determined readability scores for sequential letters written to general practitioners and copied to patients, following ENT consultations at the Royal United Hospital in Bath. Intervention involved educating clinicians in techniques to improve readability.Results and analysis:A total of 295 letters from eight clinicians were assessed in the pre-intervention phase. The mean Flesch reading ease score was 61.8 (standard deviation 8.7) and the mean Flesch–Kincaid reading grade was 9.0 (standard deviation 1.7). Re-audit analysed a further 301 letters. There was no significant change in the readability of the letters post-intervention.Discussion:It may not be feasible to present medical information intended for general practitioners in a way that is readable to most of the UK adult population.
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Lopez-Jeng, Cassie, and Steven D. Eberth. "Improving Hospital Safety Culture for Falls Prevention Through Interdisciplinary Health Education." Health Promotion Practice 21, no. 6 (April 9, 2019): 918–25. http://dx.doi.org/10.1177/1524839919840337.
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Background. Falls are a serious public health problem, with an estimated 37.3 million falls a year requiring medical assistance. Improving hospital culture to address safety and falls prevention is a major organizational challenge that requires interdisciplinary teams and evidence-based education to change individual behaviors and improve outcomes. Methods. We collaborated with an interdisciplinary team of health practitioners at a critical access hospital to develop a health education program tailored to their internal assessment of falls and safety issues. The resulting program used the Five As behavior change model and evidence-based health education. Education session activities and posttests were used to measure participant outcomes, and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture was distributed hospital-wide to measure patient safety culture pre- and postintervention. Results. Participants reported increased knowledge, attitudes, and motivations with attendance at education sessions. The AHRQ Hospital Survey showed positive improvements in 10 of the 11 composite categories, 4 of which were statistically significant. Conclusion. The use of the Five As, along with an interdisciplinary health education approach, can improve individual hospital employee falls prevention knowledge, attitudes, and motivations. That individual-level change can improve patient safety culture at the organizational level.
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Rae-Grant, Alexander, Sharon R. Kimmel, Nancy Eckert, Richard Schall, Maureen Beilman, and Deborah Kimmel. "Professional Education in Multiple Sclerosis Care Through a Multidisciplinary Program for Health Care Practitioners." International Journal of MS Care 9, no. 4 (January 1, 2007): 148–53. http://dx.doi.org/10.7224/1537-2073-9.4.148.
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Multiple sclerosis (MS) is a common and long-term condition. It requires the intervention of various health care practitioners over a spectrum of care ranging from first diagnosis to end-of-life decisions. We developed a multispecialty program of education and worked with groups from a multisite community-based teaching hospital and a comprehensive rehabilitation network. We used a demographic questionnaire and pre- and postintervention testing. Participants consistently scored higher on the postsession (89.70 ± 8.09%) than on the presession (76.50 ± 17.61%) questionnaire (P < .001). No statistically significant differences were found in percentage points improved across level of education, previous training status, experience in caring for MS patients, or position classification. Ninety-five percent of participants responded that the information provided through the session related to their current role as part of a multidisciplinary health care team. In conclusion, this format was useful in providing key knowledge about the biological, psychological, and social care of patients with MS. A targeted educational program for health care practitioners should become part of the curriculum offered by MS centers to enhance the care provided to their patient population.
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Hinton, Jean. "Mentorship: The Experiences of a Tutor in a Pre-registration Operating Department Practice Education Programme." Journal of Perioperative Practice 19, no. 7 (July 2009): 221–24. http://dx.doi.org/10.1177/175045890901900703.
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Introduction The author is a theatre nurse with more than twenty years experience of perioperative care. For the majority of her time in clinical practice the author was involved in the training and education of both student nurses and student operating department practitioners (ODPs). This involvement started, following training, as a mentor and assessor for both groups of students, leading to the position of internal verifier for the NVQ programmes for ODPs and perioperative health support workers. This experience in education and training led to promotion as training co-ordinator for the critical care directorate of a busy district general hospital. For the past seven years the author has been employed as a senior lecturer on a three year ODP pre-registration programme at a North West university.
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Sen, Sukanta, Sk Rafikul Rahaman, Dattatreyo Chatterjee, Shatavisa Mukherjee, Somnath Mondal, and S. K. Tripathi. "Knowledge, attitudes and practice of adverse drug reaction monitoring among physicians in India." International Journal of Basic & Clinical Pharmacology 6, no. 6 (May 23, 2017): 1497. http://dx.doi.org/10.18203/2319-2003.ijbcp20172249.
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Background: Underreporting of ADRs still remains a major obstacle in the complete success of pharmacovigilance programs. In order to improve ADR monitoring, it is thus imperative to assess the current knowledge, attitude, and practices of doctors. Therefore, the primary objective of this study was to evaluate the knowledge, attitude, and practices (KAP) of the healthcare professionals about pharmacovigilance in various tertiary care government teaching hospital vis-a-vis private clinics in West Bengal.Methods: A cross sectional, questionnaire based survey was conducted among healthcare practitioners in several tertiary care government set-ups and private set-ups in the state of West Bengal (India). The study instrument was a pre-validated structured questionnaire designed to obtain information on the knowledge of the ADRs reporting, the attitudes towards the reporting, and the factors that in practice could hinder the reporting among the doctors.Results: About 89.62% public practitioners correctly spotted the WHO definition for pharmacovigilance, while 77.5% of the private practitioners did the same. Only 19.81% of the public practitioners documented a suspected ADR in any surveillance form, while there were only 3.75% private practitioners who documented it. About 59.43% of the physicians in government hospitals published an ADR case report in any medical journal, while 81.25% private practitioners did no.Conclusions: Study revealed lack of time, incentive less extra work load being major factors responsible for ADR underreporting. In order to improve ADR reporting, continuous medical education, training and proper sensitization of healthcare professionals can help combating the existing scenario and promising an improved tomorrow. The PvPI should be widely publicized in the visual and print media to make health professionals, as well as the general population at large aware of its presence and scope. Pharmacovigilance should be integrated in undergraduate and postgraduate medical courses.
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Tan, Kieng, Angela Cashell, and Amanda Bolderston. "Encouraging reflection: Do professional development workshops increase the skill level and use of reflection in practice?" Journal of Radiotherapy in Practice 11, no. 3 (August 5, 2011): 135–44. http://dx.doi.org/10.1017/s1460396911000203.
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AbstractReflection is a way of evaluating best practice and challenging existing norms, while at the same time, considering one’s personal values and assumptions in our personal and professional lives. However, many health practitioners may lack the skills to do this effectively. Through participation in a series of three workshops, practitioners in the Radiation Medicine Program at Princess Margaret Hospital have learned and acquired new skills to encourage reflection and reflective practice in themselves, their colleagues as well as with their students. A pre- and post-course survey was used to ascertain their level of knowledge of reflection and reflective practice. An additional survey at 3 months assessed the frequency of use and ongoing comfort level with reflective practice. Results of the evaluation indicate that the participants’ knowledge of reflective practice has improved their understanding of reflection in clincal practice. They recognize the importance of reflection and anticipate increasing their use of reflection in/on practice. As well, participants have been able to sustain the positive momentum 3 months after the course was delivered.
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Lum, E. H., and T. J. Gross. "Telemedical education: teaching spirometry on the Internet." Advances in Physiology Education 276, no. 6 (June 1999): S55. http://dx.doi.org/10.1152/advances.1999.276.6.s55.
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Advances in portable equipment have led to routine spirometry testing outside of formal pulmonary function laboratories. Practitioners ordering these tests are not formally trained in spirometry interpretation. Providing effective off-site training can be challenging. Our objective was to develop a remotely accessible computer-based tutorial for teaching spirometry interpretation to nonpulmonologists. We designed an educational module that was accessible via the Internet and tested by 65 medical trainees at a major university medical center. In addition, the module was posted within the Virtual Hospital on the World Wide Web. Increases in spirometry interpretative skills were assessed using pre- and post-tests submitted electronically. The spirometry module significantly improved spirometry interpretation by nonspecialist trainees. This improvement included a broad increase in knowledge base and was observed independent of training level and prior spirometry reading experience. We conclude that computer-based tutorials can effectively train off-site practitioners in spirometry interpretation. This technology allows for the dissemination of educational material from a central site of expertise and provides a valuable adjunct to limited teaching resources.
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Soltanzadeh, Ladan, Arezou Taheri, and Mohammad Rabiee. "Role of Information Technology in Implementation of Telemedicine System." INTERNATIONAL JOURNAL OF RESEARCH IN EDUCATION METHODOLOGY 6, no. 2 (August 30, 2015): 824–29. http://dx.doi.org/10.24297/ijrem.v6i2.3878.
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Introduction: Telemedicine is the wide description of providing medical and healthcare services by means of telecommunications.Methodology: A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,230 abstracts that were reviewed, result of 39 articles and 3 books and author 's experiences were gathered.Findings:Technologies do not only assist medical practitioners and patients receiving treatment, they also benefit perfectly healthy people by providing a wide range of general health assessments.Conclusion: telemedicine is medical services through the use of telecommunications.
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Mobin, Khalil, Riaz Khanzada, Shakeel Ahmed, Farooq Memon, Hina Naz, Abdul Samad, Shehla Naseem, and Mohammad Zaman Shaikh. "Type 2 Diabetes Mellitus and Associated Major Risk Factors." Pakistan Journal of Medical and Health Sciences 16, no. 7 (July 30, 2022): 298–300. http://dx.doi.org/10.53350/pjmhs22167298.
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Objective: To determine association of T2DM with depression, Covid-19, hypertension, junk food, weight, age, physical activity, smoking, family history, education and income. Study Design: Cross-sectional, multicenter study Duration and Place of Study: Family Health Clinic, Mehmoodabad, Ahmad Medical Centre, FB Area Karachi, Al-khidmat Hospital North Karachi, Rafah-E-Aam Hospital FB Area Karachi, from 1st November 2020 to 30th April 2021. Methodology: Pre-tested, researcher administered questionnaire was used through medics and paramedics. Information was collected from general patients and care givers. Non–diabetics and non-hypertensives were tested/checked on the spot. Results: Mean age of the participants was 35 years with minimum 18 and maximum 70 years. Males were 279 (95%). In males 30 (11%) were diabetic and in females 7 (47%) were diabetic. 168 (57%) of the participants got above matric education. Low-income group consisted of 271 (92%) participants. Diabetes was present in 37 (13%). Forty six percent diabetics were diagnosed incidentally. Most (24; 65%) were diagnosed by general practitioner, six (16%) by Family Physician, four (11%) by specialist and one (3%) by self. Conclusions: General practitioners play a pivotal role in diagnosing and managing diabetes mellitus. To reduce the burden of diabetes in Pakistan, modifiable risk factors like low education and high inflation have to be addressed. More over marriages between first cousins need to be discouraged. Keywords: Diabetes mellitus, Junk food, Lifestyle, Obesity
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Scully, Helena, Eamon Laird, Martin Healy, Vivion Crowley, James Bernard Walsh, and Kevin McCarroll. "Vitamin D retesting by general practitioners: a factor and cost analysis." Clinical Chemistry and Laboratory Medicine (CCLM) 59, no. 11 (July 19, 2021): 1790–99. http://dx.doi.org/10.1515/cclm-2021-0607.
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Abstract Objectives Vitamin D testing by Primary Care doctors is increasing, placing greater workloads on healthcare systems. There is little data though on vitamin D retesting in Ireland. This study aims to investigate the factors associated with vitamin D retesting by Irish General Practitioners (GPs) and examine the resulting costs. Methods This is a retrospective analysis over 5 years (2014–2018) of GP requested 25-hydroxyvitamin D (25(OH)D) results in 36,458 patients at a major city hospital in Dublin, Ireland. Those with one test were compared with individuals who were retested and samples categorised to determine changes in status between tests. Results Nearly one in four patients (n=8,305) were retested. Positive predictors of retesting were female (p<0.001), age (60–69 years, p<0.001), location (Co. Kildare, p<0.001) and initial deficiency (<30 nmol/L, p<0.001) or insufficiency (30–49.9 nmol/L, p<0.001). Vitamin D status improved on retesting, with deficiency halving on first retest (9 vs. 18%, p<0.001) and dropping to 6% on further retests. About 12.2% of retests were done within 3 months and 29% had ≥2 retests within 1 year. 57% of retests were in those initially vitamin D replete (>50 nmol/L). The annual cost of inappropriate testing was €61,976. Conclusions One in four patients were retested and this varied by age, gender and patient location. Over 10% of retests were inappropriately early (<3 months), a third too frequent and over half were in replete individuals incurring significant costs. Clear guidance for GPs on minimum retesting intervals is needed, as well as laboratory ordering systems to limit requests using pre-defined criteria.
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O' Donnell, Desmond, Anne O'Mahony, Alice O' Donoghue, Clare McMahon, Marie Doyle, Millie O' Gorman, Riona Mulcahy, George Pope, and John Cooke. "244 Point Prevalence of Frailty and Confusion Exceeds the Capacity of a Single Ward - Specialist Geriatric Wards to Lead Best Practice." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.148.
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Abstract Background Our Model 4 Hospital will open a Specialist Geriatric Ward in the coming months. This ward will focus on the provision of evidence-based care to confused and frail older adults. Careful selection of patients who would most benefit from this care will be vital to ensure success. We aim to determine the prevalence of frailty and confusion in our inpatient cohort to determine expected demand on this new service and to inform admission criteria. Methods All adult inpatients were screened for frailty (pre-admission status) using the Rockwood Clinical Frailty Scale (CFS). Point prevalence of confusion (combination of pre-existing dementia and incident delirium) was calculated by measuring 4AT scores on all adult inpatients (>16 years of age), with the exclusion of obstetric, paediatric, critical care and psychiatric wards. Eleven wards were visited by a team of six experienced geriatric practitioners during a one-week period in April 2019. Results In total, 257 patients were assessed. The median age was 74 years (16-99). The majority were male (54.9 %). 152 patients resided on a dedicated medical ward (59.1%). The point prevalence of pre-morbid frailty (CFS Score ≥ 5) was 39.9%. The point prevalence of confusion (4AT score ≥4) was 24.4%. Conclusion Our data show that frailty and delirium are highly prevalent in hospital inpatients. It is not feasible for this number of frail and confused patients to be cohorted in a single specialist area. It is therefore important that each hospital determine admission criteria to identify those at greatest need. Clearly, given the prevalence outlined here, there will be a large number of patients likely to benefit from but unable to access a Specialist Geriatric Ward. These wards therefore need to also serve as exemplars of best practice so that evidence-based care for this vulnerable cohort can be disseminated within an institution.
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Kim, Yun Jin, Linchao Qian, and Muhammad Shahzad Aslam. "Development of a Personalized Mobile Mental Health Intervention for Workplace Cyberbullying Among Health Practitioners: Protocol for a Mixed Methods Study." JMIR Research Protocols 9, no. 11 (November 20, 2020): e23112. http://dx.doi.org/10.2196/23112.
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Background Workplace cyberbullying harms the psychological and social functioning of professionals working in an organization and may decrease the productivity and efficiency of daily life tasks. A recent study on trainee doctors across 8 different United Kingdom National Health Service trusts found health issues and job dissatisfaction in people who have experienced workplace cyberbullying. This disabling effect is even more noticeable in low-socioeconomic communities within low-income countries. In Malaysia, there is a need to create a personalized mobile mental health intervention program for health care professionals. These programs should be directed to prevent and decrease psychosocial issues and enhance coordination among health care professionals to solve health issues in the community. Objective Our main objective is to study the pre-effects and posteffects of the Personalized Mobile Mental Health Intervention (PMMH-I) for workplace cyberbullying in public and private hospitals in Malaysia. Methods A hospital-based multimethod multi-analytic evidential approach is proposed, involving social and psychological health informatics. The project has been subdivided into 3 stages, starting with Phase 1, a prevalence study, followed by exploratory studies. Phase 2 consists of a quasi-experimental design, whereas the development of a prototype and their testing will be proposed in Phase 3. Each stage includes the use of quantitative and qualitative methods (mixed-method program), using SPSS (version 26.0; IBM Corp) and Stata (version 16.1; StataCorp) as tools for quantitative research, and NVivo (version 1.0; QSR International) and Atlas.ti (version 9.0.16; ATLAS.ti Scientific Software Development GmbH) for qualitative research. Results The results of this study will determine the pre- and posteffectiveness of an integrated PMMH-I for health care professionals. The prototype system platform will be developed and implemented in a public and private hospital. Results from Phase 1 will be published in 2021, followed by the implementation of Phase 2 in subsequent years. Conclusions This study will provide evidence and guidance regarding the implementation of a personalized mobile mental health intervention for health care professionals into routine public and private hospitals to enhance communication and resolve conflicts. International Registered Report Identifier (IRRID) PRR1-10.2196/23112
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Mahejabinl, Farzana, Shamima Parveen, and Pranay Datta. "Utilization and Satisfaction With Major Health Care Services Amongst the Slum Dwellers of Dhaka City." Journal of Chittagong Medical College Teachers' Association 25, no. 2 (November 2, 2014): 7–13. http://dx.doi.org/10.3329/jcmcta.v25i2.61743.
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The main objectives of this study are to find out the extent of utilization of health care services and satisfaction with major types of health care services amongst the slum dwellers of Dhaka city. This descriptive cross sectional study was conducted for a period of 6 months starting from July 2013 to December 2013. A house to house survey was conducted and a total of 1029 slum dwellers were enrolled for the study. Purposive sampling technique was used in the study. Data were collected through pre-tested and semi-structured questionnaire. The study showed that pharmacy quacks 476 (46.3%) were the most dominant source of health care for the slum dwellers in Dhaka city. Medical College Hospital 238 (23.1%) was the second most dominant source of health care in slum areas. The other main sources were government hospitals, private practitioners respectively. Most of the respondents 429 (41.69%) were satisfied with the services of pharmacy quack and 268 (26.04%) respondents were satisfied with the services of medical college hospital. Among rest, 132 (12.82%) were satisfied with government hospitals and 121(11.75%) were satisfied with private practitioners. Majority of the respondents selected pharmacy quack to receive health care services due to affordability 127 (24.6%) and feasibility 107 (20.7%). In the study, 51 (16.1%) respondents selected medical college hospital for availability of facilities, effective treatment, good doctor-patient communication and better investigation facilities. According to the respondents 291 (38.1%) the main barrier to access health care was treatment cost. Highly significant association was found between educational status of the slum dwellers and selection of pharmacy quack (p=0.000) and medical college hospital (p=0.000). Significant association was also found between occupational status and selection of pharmacy quack (0.003) and medical college hospital (0.011). Highly significant association was found between monthly income and selection of medical college hospital (p=0.000). Pharmacy quack was the most dominant healthcare service in slum area. As persons running pharmacy quacks often provide poor quality of healthcare services, they need continuous training and back-up supports to improve their quality of services and to strengthen the overall healthcare system in Bangladesh.
JCMCTA 2014 ; 25 (2) : 7-13
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Alroumi, Fahad, Donna Cota, Jonathan Chinea, Nakul Ravikumar, Bogdan Tiru, Victor Pinto-Plata, and Mark Tidswell. "Rapid Intensive Care Unit Onboarding in Response to a Pandemic." Journal of Medical Education and Curricular Development 8 (January 2021): 238212052110207. http://dx.doi.org/10.1177/23821205211020741.
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Background: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, hospital resources have been stretched to their limits. We introduced an innovative course to rapidly on-board a group of non-intensive care unit (ICU) nurse practitioners as they begin to practice working in a critical care setting. Objective: To assess whether a brief educational course could improve non-ICU practitioners’ knowledge and comfort in practicing in an intensive care setting. Methods: We implemented a multi-strategy blended 12-week curriculum composed of bedside teaching, asynchronous online learning and simulation. The course content was a product of data collected from a targeted needs assessment. The cognitive learning objectives were taught through the online modules. Four simulation sessions were used to teach procedural skills. Bedside teaching simultaneously occurred from critical care faculty during daily rounds. We assessed learning through a pre and post knowledge multiple choice question (MCQ) test. Faculty assessed learners by direct observation and review of clinical documentation. We evaluated learner reaction and comfort in critical practice by comparing pre and post surveys. Results: All 7 NPs were satisfied with the course and found the format to work well with their clinical schedules. The course also improved their self-reported comfort in managing critically ill patients in a medical ICU. There was an increase in the mean group score from the pre-to the post-course MCQ (60% vs 73%). Conclusions: The COVID-19 Critical Care Course (CCCC) for NPs was implemented in our ICU to better prepare for an anticipated second surge. It focused on delivering practical knowledge and skills as learners cared for critically ill COVID-19 patients. In a short period of time, it engaged participants in active learning and allowed them to feel more confident in applying their education.