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Background Process evaluation within clinical trials provides an assessment of the study implementation's accuracy and quality to explain causal mechanisms and highlight contextual factors associated with variation in outcomes. Objectives This study aimed to identify the barriers and facilitators of implementing early mobilisation (EM) within a trial. Methods This is a qualitative process evaluation study within the Trial of Early Activity and Mobilisation (TEAM) phase 3 randomised controlled trial. Semistructured interviews were conducted remotely with multiprofessional clinicians (physiotherapists, medical staff, and nursing staff) involved in the delivery of the TEAM intervention at Australian hospitals participating in the TEAM study. Inductive coding was used to establish themes which were categorised into the Behaviour system involving domains of Capability, Opportunity, and Motivation (COM-B), which allowed barriers and enablers affecting EM to be identified. Findings Semistructured interviews were conducted in three different states of Australia. There were 16 participants, including 10 physiotherapists, five physicians, and one nurse. The key themes that facilitated EM were mentoring, champions, additional staff, organisation of the environment, cultural changes, communication, and documented safety criteria. In contrast, the main factors that hindered EM were lack of expertise and confidence in delivering EM, heavy sedation, interdisciplinary conflicts, and perceived risks related to EM. Conclusion A wide range of barriers and facilitators that influenced EM within the TEAM study were identified using the COM-B framework. Many of these have been previously identified in the literature; however, participation in the study was viewed positively by multidisciplinary team members.

Management of healthcare waste has gained wide attention in the recent years. This work reviews recent sustainable management of healthcare waste practices, the importance of legalizations, role of clinical waste producing bodies, emerging management trends, and treatment technologies. Furthermore, waste generated in the treatment processes and the health and environmental impacts of recent technologies are also examined. Sustainable assessment of technologies, to this point, revealed that in often cases, autoclave assisted with shredder could be a better alternative for the treatment of hazardous healthcare wastes while landfilling of healthcare waste received the lowest ranking. Studies are required to consider more reliable assessment methods for treatment technologies. This work can serve educators, researchers, as well as all the medical staff from nurses to doctors and volunteers who tirelessly contribute to the society in keeping people away from many diseases including the current global pandemic outbreak due to severe acute respiratory syndrome coronavirus 2 through the best and most sustainable practices in medical waste management.

INTRODUCTION: Peripheral intravenous cannulation (PIVC) insertion is challenging for some patients, leading to delays in care and workflow. A few easy-to-identify risk factors can differentiate difficult to cannulate (DIVA) patients. METHODS: A prospective observational study of adults undergoing PIVC was undertaken. Nursing and medical staff inserted PIVC using their usual practices. Patient, PIVC characteristics, number of attempts and staff characteristics were captured. Indicators of high-risk-for-DIVA were: no vein seen, and/or no vein palpable, and/or a history of difficult PIVC. The experience and outcomes for high-risk-for-DIVA patients were compared to non-DIVA. RESULTS: 1084 adults with PIVCs inserted were observed; with (378 (34.9%)) qualifying as high-risk-for-DIVA. First attempt success was achieved for 831 (76.7%) patients overall, with high-risk-for-DIVA significantly less likely to require one attempt (61.1% vs 85.0%, p

Background The hospital environment is characterised by a dense network of interactions between healthcare workers (HCWs) and patients. As highlighted by the coronavirus pandemic, this represents a risk for disease transmission and a challenge for contact tracing. We aimed to develop and pilot an automated system to address this challenge and describe contacts between HCWs and patients. Methods We developed a bespoke Bluetooth Low Energy (BLE) system for the hospital environment with anonymous tags worn by HCWs and fixed receivers at patient room doors. Proximity between wearable tags inferred contact between HCWs. Tag-receiver interactions inferred patient room entry and exit by HCWs. We performed a pilot study in four negative pressure isolation rooms from 13 April to 18 April 2021. Nursing and medical staff who consented to participate were able to collect one of ten wearable BLE tags during their shift. Results Over the four days, when divided by shift times, 27 nursing tags and 3 medical tags were monitored. We recorded 332 nurse–nurse interactions, for a median duration of 58 s [interquartile range (IQR): 39–101]. We recorded 45 nursing patient room entries, for a median 7 min [IQR: 3–21] of patient close contact. Patient close contact was shorter in rooms on airborne precautions, compared to those not o transmission-based precautions. Conclusion This pilot study supported the functionality of this approach to quantify HCW proximity networks and patient close contact. With further refinements, the system could be scaled-up to support contact tracing in high-risk environments.

Objective There was increasingly demand of participation in surgical decision-making among Chinese patients with prostate cancer. However, due to the complex healthcare system and advanced care settings, it is quite challenging for the patients to gain sufficient support from the institute and the government. This research will investigate the factors that impact the degree of participation in surgical decision-making among Chinese prostate cancer patients. Methods A phenomenological approach of qualitative research based on the results of semi-structured interviews were adopted, to explore the influencing factors which hinder the participation in surgical decision-making. COREQ reporting guidelines were utilized. Up to 160 post-operative patients who had undergone radical prostatectomy along with 68 medical and nursing staffs, were purposively recruited in this research. This retrospective study was carried out from September 2018 to August 2019. After recording and transcribing the interviews, the interview materials were evaluated via the Colaizzi's seven step approach and the QSR Novivo10.0 software to analyze the interview content. Results According to the analysis and summary of the interviews, there are three factors affecting the degree of participation in surgical decision-making: Firstly, insufficient communication time between medical staff and patients before surgery, lack of communication skills, difficulty in developing patient assisted decision-making tools, lack of career experience of young medical staff, and inconsistent in the availability of resources between different hospitals, resulting in insufficient information provided by medical and nursing staff. Secondly, the cognitive level of decision-making among patients is relatively low due to poor psychological endurance, insufficient amount of education, senility and less knowledge and information demand. And ultimately, decisions are constantly made by family members with/without patients. Conclusions The degree of participation of Chinese prostate cancer patients in the surgical decision-making had much space for improvement.

The medical field is in dire need of more qualified medical laboratory scientists (MLS) and medical laboratory technicians (MLT). Medical laboratory educational programs are diminishing, and medical staff in hospitals are unaware of the unequivocal value trained lab scientists bring to the quality of their patients’ lab results. The national need for more qualified laboratory testing personnel is outpacing the supply. A survey to determine current marketing trends and methods was sent out to 469 program directors of MLS and/or MLT programs, with a 35% response rate. Responses were compared with proven marketing methods to give marketing suggestions relevant to the MLS field. This paper describes the research in how MLS programs currently market themselves. Explanations of marketing techniques are discussed with the intent to help simplify marketing efforts for a more effective marketing strategy. This study showed that medical and clinical laboratory educational programs nationwide should increase marketing and promote the MLS value to local communities.

Background: Patient safety culture is a critical element in promoting safety and improving the quality of patient care. To enhance this culture, evaluation of the present culture is necessary. This study aims to investigate the dimensions of patient safety culture from the perspective of the staff of Saveh teaching hospitals, Saveh City, Iran. Methods: This descriptive cross-sectional study was performed in two hospitals affiliated with Saveh University of Medical Sciences in 2019. The research sample consisted of 196 medical staff selected through the proportional stratified sampling method. The study data were collected through the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire and analyzed by the independent t-test and Mann-Whitney test in SPSS software v. 21. The level of significance was set as P

Background/aims This study aimed to investigate the perceptions and behaviors of patients with inflammatory bowel disease (IBD) during the early coronavirus disease 2019 (COVID-19) pandemic in the major epidemic area in Korea. Methods Between April and May 2020, a cross-sectional survey was performed at two tertiary hospitals in Daegu, South Korea, on patients' experiences, coping strategies and perceptions. Results Most of the 544 patients participating in the survey strictly adhered to personal protection guidance against COVID-19. In the early COVID-19 crisis, many patients canceled or postponed hospital visits (57.5%) and rescheduled biologics administrations (26.4%). Although 13.6% utilized telemedicine, the frequency of individuals leaving their homes remained unchanged. Although 50.4% were concerned about their susceptibility to COVID-19, 72.2% adhered to their treatment for IBD. In patients taking biologics or Janus kinase inhibitors, 86.8% disagreed that they should discontinue their medication as a preventative measure against COVID- 19, but 21.9% actually discontinued their medications. Of those with discordance between the perception of IBD drug adherence and active behaviors, 5.4% of all and 39.4% of biologics or Janus kinase inhibitors withheld drugs specifically due to fear of COVID-19. Only 7% of all patients discussed drug safety with their physicians. The level of concern for COVID-19 depended on the type of drug used. Conclusions Patients with IBD showed concerns about the increased risk of COVID-19 due to IBD or their medications, and a considerable number of patients withheld their medications without consulting medical staff. Enhanced active communications with patients with IBD and appropriate health-related education should be provided.

Hand hygiene of medical staff plays a significant role in the prevention of nosocomial infections in healthcare facilities. Therefore, there is a need to identify approaches to facilitate proper adherence to hand hygiene. The study aims to substantiate the need for hand hygiene of medical staff, to explore modern methods for evaluating the effectiveness of hand hygiene supplies and problems associated with the use of these supplies along with their solutions. The authors have carried out the general and targeted analysis and expert evaluation of research results regarding measures for the prevention of nosocomial infections in health facilities. Analytical study of a large number of sources (over 50) on modern approaches to ensure hand hygiene of medical staff has been conducted with Content analysis and Open Source Intelligence methods. As a result of the study, authors have identified the need for further development of strategies to facilitate hand hygiene in health facilities and for the improvement of existing educational and motivational programs dedicated to hand hygiene of medical staff. Factors that may affect the effectiveness of antiseptics usage have been highlighted. The authors emphasize adverse reactions associated with the use of hand hygiene supplies (contact dermatitis and contact allergy) and the need for the development of measures to reduce risks of these adverse reactions among medical staff., Гігієна рук медичного персоналу відіграє істотну роль у профілактиці внутрішньолікарняних інфекцій у закладах охорони здоров’я, у зв’язку з чим необхідно виявити підходи, що сприятимуть належному дотриманню правил гігієни рук. Мета роботи — обґрунтувати необхідність забезпечення гігієни рук медичного персоналу, розглянути сучасні методи оцінки ефективності засобів для гігієни рук, пов’язані з використанням цих засобів проблеми і сучасні підходи до їх вирішення. Проведено загальний і цілеспрямований аналіз та виконано експертну оцінку результатів дослідження засобів профілактики внутрішньолікарняних інфекцій у закладах охорони здоров’я. Проведено аналітичне дослідження великої кількості інформаційних джерел (більше 50) щодо сучасного підходу до різноманітних методів забезпечення гігієни рук медичного персоналу з використанням методів Content analysis і Open Source Intelligence (OSINT). У результаті дослідження виявлено потребу в подальшій розробці стратегій, що сприяють поліпшенню гігієни рук у закладах охорони здоров’я, та вдосконаленні чинних освітніх і мотиваційних програм щодо гігієни рук медичного персоналу. Висвітлені чинники, що можуть впливати на ефективність застосування антисептиків. Автори акцентують увагу на небажаних реакціях, пов’язаних із використанням засобів для гігієни рук (контактний дерматит і контактна алергія), та необхідності розробки заходів, що знижують ризик розвитку цих небажаних реакцій у медичного персоналу.

Video surveillance and detection of players with visible signs of concussion by experienced medical staff facilitates rapid on-field screening of suspected concussion in professional sports. This method, however has not been validated in community sports where video footage is unavailable. This study aimed to explore the utility of visible signs of concussion to identify players with decrements in performance on concussion screening measures. In this observational prospective cohort study, personnel with basic training observed live matches across a season (60 matches) of community male and female Australian football for signs of concussion outlined in the community-based Head Injury Assessment form (HIAf). Players identified to have positive signs of concussion (CoSign+) following an impact were compared with players without signs (CoSign-). Outcome measures, the Sport Concussion Assessment Tool (SCAT3) and Cogstate, were administered at baseline and post-match. CoSign+ (

Zusammenfassung Hintergrund Eine adäquate Anpassung der Glukokortikoidsubstitution an unterschiedliche Situationen ist essenziell für Leistungsfähigkeit und Lebensqualität von Patienten mit Nebennierenrindeninsuffizienz (NNRI). Sie dient darüber hinaus der Vermeidung lebensbedrohlicher adrenaler Krisen. Ziel der Arbeit Verbesserung der Versorgung von Patienten mit Nebennierenrindeninsuffizienz. Material und Methoden Selektive Literaturrecherche unter besonderer Berücksichtigung neuerer Studien. Ergebnisse Eine optimale Glukokortikoidsubstitution hat das Ziel, die physiologischen Kortisolschwankungen möglichst genau nachzuahmen. Hier haben in den letzten Jahren Präparate mit veränderter Pharmakokinetik das Therapiespektrum erweitert. Im Vordergrund stehen eine adäquate Anpassung der Substitution in Stresssituationen sowie die Vermeidung und adäquate Behandlung adrenaler Krisen, die mit einer Inzidenz von 4,8 bis 8,3 Krisen pro 100 Patientenjahre auftreten und mit einer Mortalität von etwa 0,5 pro 100 Patientenjahre weiterhin eine tödliche Bedrohung darstellen. Schlussfolgerung Zur Verhinderung lebensbedrohlicher Nebennierenkrisen ist eine Schulung von Patienten, Angehörigen und insbesondere auch medizinischem Personal notwendig.

The objective of this study is to develop an evidence-based nursing practice protocol to cope with anaphylaxis by identifying the effect of early administration of epinephrine on the recovery of patients when anaphylaxis occurs due to computed tomography (CT) contrast agents, and to evaluate its feasibility. Anaphylaxis caused by CT contrast agents is a life-threatening systemic hypersensitivity reaction compared to normal allergic reactions, requiring immediate administration of epinephrine and other emergency drugs; however, no practical guidelines have been established for such emergency management, requiring the development of evidence-based nursing practice protocols. The study design is a methodological and cross-sectional study that aims to develop an evidence-based nursing practice protocol. An evidence-based nursing practice protocol for anaphylaxis management generated by contrast agents was developed in accordance with the 3-step (12 more specific steps) development of clinical practice guideline based on the literature of the final 12 selected (including 2 guidelines). It was applied to practice after implementing the training of the medical staff on the final protocol developed, and evaluated the effectiveness of anaphylaxis management for 6 months before and after the application of the protocol. Based on the analysis of the evidence, we make six recommendations for managing anaphylaxis caused by contrast agents based on early administration of epinephrine and apply the protocol to clinical practice. After protocol application, awareness of anaphylaxis and onset time of epinephrine administration was accelerated, but significant differences were not confirmed. In the case of anaphylaxis due to CT contrast agents, evidence-based coping protocols were created. The developed protocol should be continued for use in practice, with continued assessment of its effectiveness.

This study sought to explore the effects of COVID-19 exposure, pandemic-related appraisals and coping strategies on psychological symptoms among the front-line healthcare workers based on the transactional theory of stress and coping. A cross-sectional study was conducted in a Wuhan hospital designated for inpatients with COVID-19, assessing COVID-19 exposure (whether or not exposed to confirmed patients at workplace), psychological symptoms, appraisals, and coping strategies in 311 participants. Results revealed that the pandemic markedly affected healthcare workers' mental well-being through appraisal and coping, with 38.9% reporting high levels of psychological symptoms. Primary appraisal related closely with COVID-19 exposure, especially in female, while secondary appraisal was associated with problem-focused coping. Both problem-focused and emotion-focused coping had a protective effect against psychological symptoms, but also showed gender differences in its relations with other variables. These findings could potentially benefit to enrich relevant theories, and to develop psychological programs for future epidemics.

Spinal cord injury (SCI) is a common disease in spinal surgery. SCI affects the metabolism of patients and changes their lifestyle. Nutritional problems may occur, which may be manifested as insufficient or overnutrition. Nutrition status is related to many complications and final outcome after SCI. In this paper, the nutritional status of patients with SCI and the progress of nutritional intervention were reviewed by comprehensive domestic and foreign literature. Medical staff should routinely screen and evaluate the nutrition of patients after SCI operation, and provide comprehensive nutritional intervention such as diet, exercise and dietary supplement.

Összefoglaló. Bevezetés: A neonatalis intenzív centrumokban kezelt betegek naponta számos fájdalmas beavatkozáson eshetnek át. A kezeletlen fájdalom következményeinek ismerete ellenére, fájdalmuk csillapítása még messze nem ideális. Célkitűzés: Obszervációs tanulmányunk célja az osztályunkon kezelt koraszülötteket és beteg újszülötteket ért fájdalmas beavatkozások gyakoriságának és természetének meghatározása volt. Vizsgáltuk a procedurális fájdalom esetén alkalmazott gyógyszeres és nonfarmakológiai fájdalomcsillapítók használatát, valamint a beavatkozások számát és a fájdalomcsillapítás alkalmazását befolyásoló tényezőket. Módszerek: A vizsgálatba az osztályunkon 2019. 09. 01. és 2019. 12. 31. között kezelt betegeket vontuk be. Prospektív adatgyűjtést végeztünk a hospitalizáció első 14 napján, egy erre a célra kialakított kérdőíven, amelyet az egészségügyi személyzet valós időben töltött ki. Eredmények: Kutatásunkba 143 gyermeket tudtunk bevonni. A vizsgálati időszak alatt 43-féle fájdalmas beavatkozás történt, összesen 13 314 alkalommal, amiből 12 953 első, 361 többszöri kísérlet volt. Gyermekenként átlagosan 93,1 beavatkozást végeztünk a hospitalizáció első 2 hetében, ami átlagosan 8,2 fájdalmas procedúrát jelentett naponta és gyermekenként. Fájdalomcsillapítás összesen 4190 alkalommal, a beavatkozások 31,5%-ában történt. Ennek 55,5%-a folyamatos gyógyszeres, 40,7%-a nem gyógyszeres, 2,5%-a alkalmi gyógyszeres, 1,3%-a kombinált terápia volt. A legkisebb születési súlyú, legrövidebb gestatiós időre született és a lélegeztetett koraszülöttek szenvedték el a legtöbb fájdalmas beavatkozást. Következtetés: Betegeink nagyszámú fájdalmas beavatkozáson esnek át, és ezek nagyobb részénél nem történik fájdalomcsillapítás. A beavatkozások tervezésével, összehangolásával, a gyógyszeres és nem gyógyszeres fájdalomcsillapítás kiterjedtebb alkalmazásával jobb fájdalommenedzsment lenne elérhető. Orv Hetil. 2021; 162(48): 1931–1939. Summary. Introduction: Preterm infants and sick neonates treated in neonatal intensive care units may undergo numerous painful interventions. Despite rapidly growing knowledge about consequences of untreated pain, pain management of neonates is far from ideal. Objective: To determine the frequency and nature of painful procedures and corresponding analgesic therapies in neonates treated in a neonatal intensive care unit of a university teaching hospital in Hungary. Methods: A prospective observational study was performed between September and December 2019. We collected data of all painful procedures, pharmacological and non-pharmacological analgesic therapy performed on neonates during the first 14 days of hospitalization. For data collection, we used a questionnaire designed for this purpose, which was completed in real time by the medical staff. Results: 143 children were enrolled. 43 types of painful interventions were performed, a total of 13,314 times, of which 12,953 were the first, 361 multiple attempts. Each neonate was subjected to a mean of 93.1 interventions in the first 2 weeks of hospitalization, representing an average of 8.2 painful procedures per day per child. Pain relief was performed a total of 4190 times, in 31.5% of the interventions. Of this, 55.5% were continuous pharmacological, 40.7% non-pharmacological, 2.5% occasional drug, and 1.3% combination therapy. Ventilated neonates and preterm infants with shorter gestational age and lower birth weight had the most painful procedures. Conclusion: Patients treated in our unit undergo a large number of painful interventions, most of which are not accompanied by analgesia. Increased efforts are needed to promote our better pain management. Orv Hetil. 2021; 162(48): 1931–1939.

Communication during the treatment process is vital as it relates directly to the treatment outcomes. For patients and their family members, obtaining and possessing reliable information is essential for building successful and strong communication between physician, patient and in cases of paediatric cancer, the official guardians of the child and family members. The purpose of the study is to identify and analyse communication barriers in communication between physicians and parents (guardians), medical staff and parents (guardians) of paediatric cancer patients. Materials and methods. A retrospective cohort research among parents of paediatric cancer patients who took care of their children while receiving programmed chemotherapy was carried out. The information was collected indirectly: the information was provided by respondents remotely and anonymously using Google Forms. Results. The survey involved 106 family members of paediatric cancer patients receiving treatment at Ukrainian medical institutions specializing in the paediatric cancer treatment. 66% (n=70) of the respondents indicated that it was difficult to find contact with physicians; 85% (n=90) of respondents stated that it was difficult to find the contact with nurses and medical staff; 39,2% of the respondents reported the communication lapses with their attending physicians because the latter were busy and had no enough time to communicate. Considering that the overwhelming majority of respondents (79, 3%) noted physicians and medical staff as the most convenient source of reliable information on paediatric cancer, the researchers proposed to create an information platform for parents of paediatric cancer patients in order to provide access to information on the main issues of paediatric cancer. Conclusions. The research has revealed the following challenges: lack of adequate communication between the patients’ parents and physicians and / or medical staff; parents’ feeling unprepared to receive and comprehend information because of emotional trauma; poor communication between parents and physicians and / or medical staff due to the lack of time. A tool to eliminate these communication barriers can be suggested: this implies the creation of a video channel with visual thematic and clearly structured content for parents of paediatric cancer patients.

The article presents an analysis of the incidence of mental disorders in Ukraine and European countries, describes the WHO action plans for the mental health of the planet, and ways to overcome the incidence of mental and behavioral disorders. The complication of deinstitutionalization (reduction of psychiatric hospitals and reduction of days in them) in European countries and the creation of new institutions, conditions of stay in a nearby “therapeutic/healing environment”, which return about 90% of patients to independent living in the community. In Ukraine, the process of deinstitutionalization reduced psychiatric facilities by 34.7% but, no new premises have been building, and the old premises of psychiatric hospitals, which have been building from 1786 to 2013, were not reconstructed according to the old sanitary and hygienic requirements – the socalled “corridor system”, which did not take into account the comfort for mentally ill patients, but only stay/treatment for a long time up to 53 days (up to 33 days in the Ministry of Health) for 20 days in European countries. With an increased incidence of mental disorders in Ukraine (2015) by 9.4% compared to European countries – 3.8% of the total population, the staff decreased to 21.4% for the period 2010/2017. In Ukraine, which leads to the use of existing hospitals with their overcapacity and higher workload of health workers, and conditions for both the mentally ill and medical staff have not improved.

AIM: The aim of this study was to conduct a psychological analysis and summarize information on womens experiences of late pregnancy termination for fetal anomaly. MATERIALS AND METHODS: The study included 105 patients aged 19 to 43 years who experienced late pregnancy termination for fetal anomaly after 22 weeks of gestation and who received psychological support during their stay in the maternity hospital. The method of data collection involved structured clinical interview with subsequent analysis and summarizing the information received. The data obtained were compared with the literature, thus leading to a conclusion about long-term psychological consequences after late pregnancy termination. RESULTS: The general psychological patterns of womens experiencing of several consequential steps of late pregnancy termination were revealed: during the primary diagnosis, in the decision-making process, during the feticide procedure, during delivery, and in the postpartum period. The tasks of psychological support were formulated; the types of reasons for termination decision were described; the key influence of the psychological status of the fetus on the subjective character of experience was determined. The analysis of foreign issues was made and faraway traumatic consequences of late pregnancy termination for the woman and her family were depicted. CONCLUSIONS: Late pregnancy termination is a traumatic choice for a woman and her family and it has medical, psychological, ethical and legal contexts. Psychological maintenance can optimize the patients contact with the medical staff during her stay in the maternity hospital. Psychologically conceived experience ensure a constructive attitude towards the future pregnancy and its positive conditions.

SUMMARY OBJECTIVE: This study aimed to assess the attitudes of Chinese residents toward COVID-19 vaccines and explore the potential drivers for Chinese residents' vaccine hesitancy. METHODS: A cross-sectional survey was conducted from February 16 to March 16, 2021, by administering an online questionnaire to the Chinese residents. RESULTS: Of 5240 residents who completed the survey, 464 (8.9%) participants reported to have had one shot, and 348 (6.6%) reported to have had 2 shots. At the time the questionnaire was administered, 2298 (43.9%) participants reported they wanted to get vaccinated, while 2255 (43.0%) declared that they still did not know, and 687 (13.1%) respondents declared vaccine refusal. Overall, 2255 (43%) participants were categorized as vaccine hesitancy. Female participants (p=0.000)

Inborn errors of metabolism (IEM) are genetic disorders due to a defective metabolic pathway. The incidence of each disorder is variable and depends on the respective population. Some disorders such as urea cycle disorders (UCD) and organic acidurias, pose a high risk for a metabolic crisis culminating in a life-threatening event, especially during infections; thus, vaccines may play a crucial role in prevention. However, there are different triggers for decompensations including the notion that vaccines themselves can activate fever and malaise. Additionally, many of the IEM include immunodeficiency, placing the patients at an increased risk for infectious diseases and possibly a weaker response to immunizations. Since metabolic crises and vaccine regimens intersect in the first years of life, the question whether to vaccinate the child occupies parents and medical staff. Many metabolic experts hesitate to vaccinate IEM patients, disregarding the higher risk from the direct infections. In this paper we summarize the published data regarding the safety and recommendations for vaccinations in IEM patients, with reference to the risk for decompensations and to the immunogenic component.

Our aim was to investigate whether the previously observed higher contrast-to-noise ratio (CNR) and better image quality of Digital Variance Angiography (DVA) - compared to Digital Subtraction Angiography (DSA) - can be used to reduce radiation exposure in lower limb X-ray angiography. This prospective study enrolled 30 peripheral artery disease patients (mean ± SD age 70 ± 8 years) undergoing diagnostic angiography. In all patients, both normal (1.2 µGy/frame; 100%) and low-dose (0.36 µGy/frame; 30%) protocols were used for the acquisition of images in three anatomical regions (abdominal, femoral, crural). The CNR of DSA and DVA images were calculated, and the visual quality was evaluated by seven specialists using a 5-grade Likert scale. For investigating non-inferiority, the difference of low-dose DVA and normal dose DSA scores (DVA30-DSA100) was analyzed. DVA produced two- to three-fold CNR and significantly higher visual score than DSA. DVA30 proved to be superior to DSA100 in the crural region (difference 0.25 ± 0.07, p p = 0.435) and abdominal (− 0.10 ± 0.09, p = 0.350) regions. Our data show that DVA allows about 70% reduction of DSA-related radiation exposure in lower limb X-ray angiography, providing a potential new radiation protection tool for the patients and the medical staff.

Wen-Chun Lin,1,* Yi Qin,1,* Xiao Chun,2 Ru-Lin Huang,1 Rong-Shan Chen,1 Dongwei Zhang1 1Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 2Pediatric Intensive Care Unit, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dongwei ZhangDepartment of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, 510120, People’s Republic of ChinaTel +86 20 38076135Fax +86 20 38076626Email zhangdw137@126.comObjective: The present study evaluates the psychosocial care and the bronchoalveolar lavage (BAL)/fiberoptic bronchoscopy (FB) procedure in children with pediatric acute exogenous lipoid pneumonia (ELP) and summarizes the critical points of nursing.Methods: Data on the psychosocial factors of the patients and clinical information were collected. Participants comprised 41 children within three years of age.Results: All the children were cooperative with the BAL/FB procedure. The children’s pain scores were between 4– 6, and the psychological conditions of the children and caregivers were nervous/anxious upon admission. After the medical staff’s psychological care and health education, the children’s postoperative pain scores were reduced to 0– 3, and the psychological state of the caregivers was positive.Conclusion: Psychological care can alleviate families’ adverse emotions and promote treatment cooperation and recovery from the acute ELP.Keywords: children, acute exogenous lipoid pneumonia, psychological care, bronchoscopy, bronchoalveolar lavage

Die Rehabilitation ist im Gesundheitswesen der Bundesrepublik Deutschland fest im Sozialrecht verankert (Sozialgesetzbuch IX – Rehabilitation und Teilhabe von Menschen mit Behinderung). Behinderte oder von Behinderung bedrohte Menschen konnen auf dieser Grundlage Rehabilitationsleistungen in Anspruch nehmen. Von der Anspruchsgrundlage bis zur Durchfuhrung sind fur den Rehabilitationsmediziner zahlreiche sozialmedizinische Fragestellungen zu beantworten. Dies setzt Wissen und Kenntnis rechtlicher Bestimmungen ebenso wie den sicheren Umgang mit relevanten Begrifflichkeiten und Definitionen voraus.

Objective COVID-19 spreads through aerosols produced in coughing, talking, exhalation, and also in some surgical procedures. Use of CO2 laser in laryngeal surgery has been observed to generate aerosols, however, other techniques, such cold dissection and microdebrider, have not been sufficiently investigated. We aimed to assess whether aerosol generation occurs during laryngeal operations and the effect of different instruments on aerosol production. Methods We measured particle concentration generated during surgeries with an Optical Particle Sizer. Cough data collected from volunteers and aerosol concentration of an empty operating room served as references. Aerosol concentrations when using different techniques and equipment were compared with references as well as with each other. Results Thirteen laryngological surgeries were evaluated. The highest total aerosol concentrations were observed when using CO2 laser and these were significantly higher than the concentrations when using microdebrider or cold dissection (p p p p p = 0.146, p = 0.753). In comparing all three techniques, microdebrider produced the least aerosol particles. Conclusions Microdebrider and cold dissection can be regarded as aerosol-generating relative to background reference concentrations, but they should not be considered as high-risk aerosol-generating procedures, as the concentrations are low and do not exceed those of coughing. A step-down algorithm from CO2 laser to cold instruments and microdebrider is recommended to lower the risk of airborne infections among medical staff.

Introduction. The method of kinesio taping (Kenzo Kase, 1973) is actively gaining popularity among various medical specialists. This is due to the safety of the method and its proven effectiveness in certain pathological conditions and functional disorders. There are isolated publications showing the effectiveness of kinesio taping to reduce the manifestations of algomenorrhea.The aim of the study is to evaluate the effectiveness of using the kinesio taping method for relieving pain in adolescent girls with functional algomenorrhea in a children′s rehabilitation hospital.Materials and methods. The material for the study was the results of observation of 38 girls aged 13 to 17 years, who were on inpatient treatment in the St. Petersburg Children′s rehabilitation center of orthopedics and traumatology «Ogonyok» and turned to the medical staff for help with painful mēnsēs in order to receive pharmacological correction (taking antispasmodics and/or NSAIDs), as well as with a request to change the rehabilitation program (cancellation of physical therapy or physiotherapy procedures for the period of pain). Based on the experience of Seyda Toprak Celenay and María Isabel Tomás-Rodríguez, in order to influence the severity of algomenorrhea syndrome in patients, kinesio taping of the suprapubic region was performed with a 5 cm wide cotton tape with a light tension in the range of 10–15 %. The intensity of the pain syndrome before and after kinesio taping was evaluated by the patient himself using a modified facial pain Scale [The Faces Pain Scale-Revised (FPS-R) according to Von Baeyer C. L. et al., 2001], and an instrumental assessment of the intensity of pain sensations was additionally performed using a dynamometer-algometer «MEGEON 04300».Results. The method of kinesio taping allows you to exclude (in 58 % of patients) or reduce (in 16% of patients) the use of pharmacological drugs. The inverse relationship between the subjective assessment of the intensity of pain syndrome by patients and the reduction of pain syndrome was established: that is, the greater the intensity of pain, the less likely the analgesic effect from the use of kinesio tape. The decrease in the pain syndrome of the girls was noted in the period of 1–12 hours (on average 3 hours 51 minutes) from the moment of applying the kinesio tape. Unfortunately, in the remaining 26 % of cases, the kinesiotaping method was not effective.Conclusion. The kinesiotaping method is justified for use in patients with algomenorrhea and often allows you to exclude or reduce the intake of pharmacological drugs.

Background Primary medical and health care facilities are the first lines of defense for the health of population. This study aims to evaluate the current state and trend of equity and coupling coordination degree (CCD) of staff in primary medical and health care institutions (SPMHCI) based on the quantity and living standards of citizens in China 2013–2019. The research findings are expected to serve as a guideline for the allocation of SPMHCI. Methods The data used in this study including the quantity and living standards of citizens, as well as the number of SPMHCI in 31 provincial administrative regions of China, were obtained from the China Statistical Yearbook and the China Health Statistics Yearbook. The equity and CCD for SPMHCI were analyzed by using the Gini coefficient and the CCD model, and the Grey forecasting model GM (1, 1) (GM) was used to predict the equity and CCD from 2020 to 2022. Results Between 2013 and 2019, the number of SPMHCI increased from 3.17 million to 3.50 million, and the population-based Gini coefficient declined from 0.0704 to 0.0513. In urban and rural areas, the Gini coefficients decreased from 0.1185 and 0.0737 to 0.1025 and 0.0611, respectively. The CCD between SPMHCI and citizens’ living standards (CLS) changed from 0.5691, 0.5813, 0.5818 to 0.5650, 0.5634, 0.6088 at national, urban, and rural levels, respectively. The forecasting results of GM revealed that at the national, urban and rural levels from 2020 to 2022, the Gini coefficient would rise at a rate of − 13.53, − 5.77%, and − 6.10%, respectively, while the CCD would grow at a rate of - 0.89, 1.06, and 0.87%, respectively. Conclusions In China, the number of SPMHCI has increased significantly, with an equitable allocation based on the population. The interaction between SPMHCI and CLS is sufficient, but the degree of mutual promotion is moderate. The government could optimize SPMHCI and improve the chronic disease management services to improve CLS and to ensure the continued operation of primary medical and health care institutions in urban areas.

In recent years the role of the specialist nurse with respect to gynecology and women’s health has gained significant importance. The advancement in the nursing practice has provided an insight to interact with patients to explore their history. Such hysteroscopy procedures may not only give a better feel to the patient but also explore the need for doctor treatment. The review updates about the ongoing advances in the field of nursing science to upgrade the life of patients with gynecological diseases. Evidence has suggested the promising role of nurses to motivate patients with improved health after the treatment. The present review will cover the various health issues of women including menstrual dysfunction, fertility, and management of pregnancy’s termination, uro-gynecological issues, and gyne-oncology, etc. The role of nurses during the above health issue will be discussed via various procedures. Therefore, the present review will conclude the significant importance of nurses in women’s health issues to sustain happiness and to strengthen the need to bring advances in the curriculum of nurses to full fill the requirement of medical staff.

Objective: To explore the emotional impact of psychological nursing intervention on patients with malignant tumor radiotherapy, and further verify the specific application value of this nursing model in the oncology department. Methods: A total of 129 patients with tumor radiotherapy admitted to our hospital from June 2018 to June 2021 were selected as subjects, and they were divided into control group and observation group by random number method. Among them, 64 cases in the control group received routine clinical nursing. 65 cases in the observation group received psychological nursing intervention. Then, the clinical nursing effect, self-rating anxiety scale (SAS) score, self-rating depression scale (SDS) score, immune function level change condition and clinical nursing satisfaction were compared under the two nursing modes, in order to fully verify the clinical application value of psychological nursing intervention mode for patients with cancer radiotherapy. Results: Comparing the clinical indexes of the two groups, SDS and SAS scores of the observation group were significantly lower than those of the control group. In terms of nursing satisfaction, the observation group is 96.92% and the control group is 90.62%, the difference was significant, and had clinical statistical significance (P < 0.05); After the comprehensive evaluation of the immune function of the two groups, it was found that the observation group was significantly better than the control group, and the difference between the two groups was statistically significant (P < 0.05). Conclusion: In the mode of psychological nursing, medical staff can carry out precise psychological nursing intervention and nutritional nursing for patients according to the specific conditions and treatment process of patients, which can greatly promote the psychological stability of patients, significantly reduce patients’ negative emotions. In addition, the scientific implementation of psychological nursing intervention in the treatment of tumor radiotherapy patients can effectively strengthen the improvement of the immune function of patients, which has a very important application value to improve the physical function of patients, promotes the patient’s body rehabilitation, and is worth in the field of widespread application.

Wstęp. Pielęgniarstwo to zawód obciążony wieloma czynnikami. Jednymi z wielu problemów jest praca zmianowa, narażenie na zmęczenie, problemy ze snem, bezsenność. Do czynników społecznych zaliczyć można błędy w komunikacji między personelem i pacjentem. W pracy przybliżono zagadnienie zespołu przewlekłego zmęczenia. Cel. Celem pracy jest ocena chronicznego zmęczenia i bezsenności wśród pielęgniarek oraz określenie jaki wpływ mają one na relacje w zespole pielęgniarskim. Materiał i metody. Populacją, która została poddana badaniu była grupa 100 pielęgniarek pediatrycznych, chirurgicznych, internistycznych oraz podstawowej opieki zdrowotnej. Narzędziami były: Skala Zmęczenia Chronicznego (FAS), Ateńska Skala Bezsenności (AIS), kwestionariusz ankiety własnego autorstwa. W pracy wykorzystano metodę sondażu diagnostycznego oraz metodę szacowania. Wyniki. Blisko połowa pielęgniarek w grupie badanej miała objawy zmęczenia chronicznego, a 36% pielęgniarek w grupie badanej przejawiała bezsenność. Wnioski. Chroniczne zmęczenie pielęgniarek często jest spowodowane specyfiką oddziałów, na których pracują. Na bezsenność wpływa praca zmianowa, która zwiększa odczuwanie zmęczenia i desynchronizuje biologiczny zegar. Lata stażu nie wpływają znacząco na poziom zmęczenia i senności pielęgniarekNa bezsenność wpływa praca zmianowa oraz zła organizacja pracy.

Background Emergence delirium is one of the problems that occur when a child wakes from anesthesia. Research results indicate that psychological factors are associated with this phenomenon. The relationship between adult behavior before child surgery and pediatric emergence delirium has not been investigated before. Aims The aim of this study was to explore the associations of parent, anesthesiologist, and nurse behaviors before child surgery with pediatric emergence delirium. Methods The study included 99 pediatric patients (aged 2-17 years) undergoing surgery with general anesthesia, their accompanying parents, an anesthesiologist, and nurses. The study was conducted directly before surgery and after recovery from anesthesia. Before surgery, the behaviors of children, parents, and medical staff were videotaped and then scored using the Child-Adult Medical Procedure Interaction Scale-Revised. Emergence delirium was measured with the Pediatric Anesthesia Emergence Delirium Scale. Results Parent reassuring comments (ꞵ = 0.22, B=1.32, 95% CI 0.14-2.49, P=0.028) and parent giving control to child (ꞵ = 0.21, B=7.02, 95% CI 0.68-13.56, P=0.031) were positive predictors of emergence delirium in the group of children aged 2-8 years. Parent behavior explained an additional 10% of the variance in pediatric emergence delirium. Conclusions Our results suggest that parent reassuring comments and giving control to the child before surgery are related to the level of child emergence delirium in children aged 2 to 8 years.

The current pandemic has highlighted the need to protect both patients and medical staff. The increased use of regional anaesthesia as a primary anaesthetic modality for operations and other invasive procedures has limited the number of aerosol-generating procedures performed during general anaesthesia. Its use is further characterized by decreases in postoperative pain and length of hospitalization. This article provides an overview of regional anaesthetic techniques (peripheral nerve locks, epidural and spinal anaesthesia) and their uses during the COVID pandemic.

Dialogue on physician well-being was concerning even prior to onset of the COVID-19 pandemic, which introduced additional unprecedented strain on healthcare workers compounded by increased personal and family stress. This paper describes our process for a rapid needs assessment and creation of a pandemic resiliency and well-being support infrastructure for physicians and healthcare staff at an academic medical center. In March 2020, executive leadership from our health system and physician group created a Resiliency and Support Steering Committee (RSSC) for rapid development of a pandemic needs response for our healthcare providers. RSSC identified key priorities: psychological care, medical care, basic care, and communication. A brief pandemic-focused needs survey was designed and distributed to healthcare professionals and targeted efforts focused on initiatives prioritized by respondents. A shared drive database allowed initiatives and outcomes to be communicated in real time. A wellness webpage was rapidly built and disseminated. Psychological support initiatives included proactive and reactive support. Providers were offered rapid access scheduling for primary medical care. Vetted resources were shared for regional grab-and-go food, grocery delivery, laundry services, and childcare. Additional resources included personal protective equipment (PPE) supply chain information, PPE guideline updates and training and access to scrubs/scrub laundering. Our pandemic support will fold into ongoing wellness initiatives that will be tailored and intentionally communicated. Multimodal and intentional communication processes will continue with a focus on enhancing bidirectional platform functionality. Cultural awareness of the importance of mitigating distress and supporting well-being will be prioritized through partnership with frontline members and leadership.

Being a nurse was demonstrated to be a risk factor for post-traumatic stress symptoms (PTS) and insomnia among frontline staff during COVID-19 pandemic. The unidirectional relationship between insomnia and PTS highly suggested that insomnia could mediate the increasing risk of PTS among frontline nurses. However, no study had tried to clarify this mediation effect of insomnia during COVID-19 pandemic. This study aimed to investigate prevalence of insomnia and PTS among frontline doctors and nurses and to clarify the relationship between career (doctor/nurses), insomnia and PTS. A total of 211 frontline doctors and nurses completed the investigation. Insomnia was measured using a self-drafted questionnaire and PTS was assessed using primary care post-traumatic stress disorder screen (PC-PTSD). Three logistics regression models and one mediation model were performed to explore relationships between career, insomnia and PTS. The prevalence of PTS (PC-PTSD≥2) and insomnia (with 1 item in self-drafted insomnia questionnaire≥2) was 24.17% and 36.97%, respectively. Being a nurse was a shared risk factor of insomnia (OR = 4.16, 95%CI: 1.30 ~ 5.77, P = 0.023) and PTS (OR = 7.51, 95%CI: 1.89 ~ 40.50, P = 0.008). Compared to doctors, nurses had significantly higher prevalence of insomnia (46.32% vs. 20%, χ2 = 13.27, P

ZusammenfassungDie SARS-CoV-2-Pandemie hat nicht nur die Gesellschaft, sondern auch das Gesundheitssystem vor Herausforderungen gestellt. Bei medizinischem Fachpersonal ist eine psychische Belastung reichlich vorhanden. Die vorliegende Arbeit reflektiert die Bedeutung von Einfluss- und schützenden Faktoren im Umgang mit der psychischen Belastung bei medizinischem Personal insgesamt. Vor diesem Hintergrund ist es möglich, neue Erkenntnisse mit Blick auf das Rettungsdienstpersonal abzuleiten, in Zeiten der SARS-CoV-2-Pandemie.Dabei kristallisieren sich belastende Faktoren, wie erhöhte Arbeitsanforderungen und gesellschaftliche Erwartungen an das Gesundheitssystem, das Risiko einer Infektion und die damit verbundene Sorge um Infektion der eigenen Angehörigen, heraus. Rollenkonflikte zwischen beruflicher Verantwortung, Angst und Schuldgefühlen bestehen. Die rechtzeitige Gegensteuerung gegen Belastungen ist ein effektiver Weg, um langfristige negative Beanspruchungsfolgen bei medizinischem Personal zu vermeiden.Ein gemeinsames Handeln von Arbeitgebern, Führungskräften, Angestellten und Betriebsärzten im präventiven Kontext erscheint insbesondere während der Pandemie wichtig. Es werden Hinweise zum Umgang mit psychischen Belastungen für medizinisches Personal unterschiedlicher Verantwortungsebenen dargestellt und Präventionsansätze abgeleitet.

Purpose The aim of this study was to compare aerosol exposure with or without an aerosol box in a pressurized/depressurized room during aerosol-generating procedures using an experimental model. Methods Cake flour (aerosol model) was expelled from an advanced life support training mannequin. The primary outcome measure was the number of 0.3–10 µm-sized particles at three locations corresponding to the physician, medical staff, and environmental aerosol exposure levels. The aerosol dispersion was visualized using a high-resolution video. The number of expelled particles was measured after artificial coughing during simulated tracheal intubation and extubation in four situations, with or without an aerosol box in a pressurized or depressurized room (≤ 2.5 Pa). Results The particles arising from tracheal intubation at the three positions in the four groups differed significantly in size (p

Background: Major trauma is a life-threatening emergency condition that requires immediate intervention. Resuscitation of low volume fluid or decreasing maintenance fluids maintains tissue perfusion and decreases the negative consequences of early vigorous resuscitation. Aim of the study was to evaluate the effect of normovolemic versus decreasing maintenance fluids on ICU multiple trauma patient’s clinical outcomes. Method: A quasi experimental comparative research design was utilized in this study, purposive sample of 40 adult critically ill patients with multiple traumas would be enrolled sequentially into two groups, each group consists of (20) patients. This study was carried out in trauma intensive care unit at Emergency Hospital affiliated to Tanta University Hospitals, Egypt .Three tools were used to conduct the study. Tool I: social- demographic and clinical data sheet, Tool II: injury severity score, Tool III: patients' outcome sheet. Results: There were sixty percent of patients in control group had age more than 30 years compared to 45% of patients in the study group. The male patient represents the highest percentage in this both groups. It was observed 90.0% of the study groups had injury severity score between (17-25) score. While 80.0% of the control groups has < 25 injury severity score level. a significant improvement regarding mean scores of pulse rate, respiratory rate, and Fio2 on discharge. The mean score of sodium, urea and creatinine was improved significantly among study groups compared with control groups on discharge where P= 0.022 and 0.00 respectively. Seventy percent of patients in control group had long duration of stay in ICU more than 20 days compared to (55.0%) of patients in the study group. Conclusion: It can be concluded that trauma patients in the ICU who received decreasing maintenance fluids at 30 mL/h in normotensive trauma patients had improved physiological parameters, decreased ICU stay and days on ventilator. Recommendations: Emergency hospital should include decreasing maintenance fluids for trauma patients admitted to the ICU if not contraindicated. Nursing and medical staff should be informed with the updated protocols of fluid resuscitation therapy and its application in clinical practice for emergency and critically ill patients.

Graphical abstract There is ambiguity about the airborne transmission of the SARS-CoV-2. While a distance of 6 feet is considered a safe physical distance, new findings show that the virus can be transmitted more than that distance and cause infection. In hospitals, this may cause the virus to be transmitted from the treatment wards of COVID-19 patients to adjacent wards and infect medical staff, non-COVID-19 patients, and patient companions. The aim of this study was to investigate the presence of coronavirus in the air of ICU and adjacent wards. The low volume sampler (LVS) with two separate inlets for PM2.5 and PM10 was applied to collect indoor air of intensive care unit (ICU) with confirmed COVID- 19 patients and its surroundings. The samples were collected on 0.3μ PTFE filter fitted to the holder. Sampling was done at flow rate of 16.7 l/min for 24 h. The SRAS-CoV-2 virus was isolated using a SinaPure™ Virus Extraction Kit (SINACLON, Iran). The presence of SARS-CoV-2 genome was assessed using a commercially available SARS-CoV-2 Test Kit (Pishtaz-Iran), according to the manufacturer’s instructions using One Step plus Real-Time PCR system tool (Applied Biosystems, USA). A total of sixteen samples were taken, and the positive test rate for SRAS-CoV-2 was 12.5 % (2/16). All samples from surrounding (rest room and hallway) were negative, but two air samples from indoor of ICU (next to the patient bed and nursing station) were found to be positive. The results support the possibility of transmitting the SRAS-CoV-2 through the air at a greater distance than what is known as a safe physical distance. Therefore, in addition to maintaining a safe physical distance, other precautions including wearing a face mask, preventing air recirculation, and maximizing the use of natural ventilation should be considered, especially in crowded and enclosed environments. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-021-16010-x.

Mohammed M AlMaani,1 Khaled F Salama2 1King Abdulaziz-National Guard Hospital Al-Ahsa, Dammam, Saudi Arabia; 2Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Khaled F SalamaDepartment of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, PO Box 1982, Dammam, 31441, Saudi ArabiaEmail ksalama@iau.edu.saIntroduction: An effective leadership is critical to the development of a safety culture within an organization. Patient safety in primary health care is an emerging field of research of increasing importance.Objective: This study has been conducted to explore the safety culture attitude toward patient safety to improve the quality and patient safety in primary health-care centers.Methods: A cross-sectional survey involving 288 medical staff in primary health-care centers in Al-Ahsa was conducted using an Arabic translated safety attitude questionnaire to assess the safety attitudes among health care center staff toward patient safety culture.Results: This study showed that the attitude of medical staff in primary health-care centers is somewhat positive toward patient safety culture where the average of job satisfaction score in the current study was higher at 80% and the overall score for safety climate was 68%. The overall score for safety attitudes was highest in Al-Ayoun Health Center (79%) and lowest in Al Faisaliah Health Center (58%). The score of teamwork and stress recognition was high and statistically significant (p< 0.05) among females. However, staff perception toward management was significantly higher (p< 0.05) among males. Staff perception toward management was significantly low (p< 0.05) among clinicians. The overall score for safety attitudes was remarkably high (p< 0.05) among those with less than 10 years’ experience, the overall safety culture score was significantly high (p< 0.05) among administrative staff and all correlations were significant (p< 0.01) except for recognition of stress with teamwork, job satisfaction, management perception, and safety climate. In addition, there were different attitudes toward patient safety culture between gender and physician vs non-physician and management staff vs non-management staff.Conclusion: The findings suggested that certain improvements are needed, especially in the field of communication and stress recognition with regard to patient safety culture.Keywords: primary health-care center, safety attitude, patient safety, safety climate, work condition

BACKGROUND Due to improvements in living standards, people are now paying more attention to their health. In China, more patients choose to go to large or well-known hospitals, which leads to constant crowding of outpatient clinics in these hospitals. AIM To establish precision valuation reservation registration aimed at shortening waiting time, improving patient experience and promoting the satisfaction of outpatients and medical staff. METHODS On the basis of the implementation of a conventional appointment system, more reasonable time intervals were set for different doctors by evaluating the actual capacity of each doctor to receive patients, and appointment times were made more accurate through intervention. The change in consultation waiting time of patients was then compared. Correlations between the consultation waiting time of patients and the satisfaction of patients or satisfaction of medical staff were analyzed. RESULTS After precision valuation reservation registration, the average consultation waiting time of patients reduced from 18.47 min to 10.11 min (t = 8.90, P < 0.001). The satisfaction score of patients increased from 91.33 to 96.27 (t = -8.62, P < 0.001), and the satisfaction score of medical staff increased from 90.51 to 96.04 (t = -10.50, P < 0.001). The consultation waiting time of patients was negatively correlated with their satisfaction scores (γ = -0.89, P < 0.001). The consultation waiting time of patients was also negatively correlated with medical staff satisfaction scores (γ = -0.96, P < 0.001). CONCLUSION Precision valuation reservation registration significantly shortened outpatient waiting times and improve the satisfaction of not only patients but also medical staff. This approach played an important role in improving outpatient services, provided a model that is supported by relevant evidence and could continuously improve the quality of management. Precision valuation reservation registration is worth promoting and applying in the clinic.

In the COVID-19 outbreak we are living currently, the lung ultrasound can be considered as an advantageous tool to examine patients as it can be easily used by a maximum of two trained operators, at the bedside. Likewise, the Electrical impedance tomography is useful to monitor and optimize the patient’s ventilation strategies in real time. Here, we present the impact and implication of ultrasonography and electrical impedance as management tools for treating critical patients in times of COVID-19. Clinical Ultrasound has been used more and more in developing countries in Latin America such as Colombia, Argentina, and Uruguay among others, however it is still underutilized due to different issues amongst we found the absence of equipment or the lack of basic training from the medical staff and poor skills to use the machines despite their availability. The use of lung ultrasound and the Electrical impedance tomography is highlighted as a safe manner to manage COVID-19 patients, not as a replacement of a CT scan, but as an easy-to-use and fast complementary tool. © 2021 Sociedad de Anestesiologia de Chile. All rights reserved.

Persistent therapy is the continuation of treatment despite having assessed the patient’s clinical condition as showing no prospect of improvement, having exhausted all available treatment options and having found that continued therapy would extend the patient’s suffering with no chance of improvement. Persistent therapy is an exception from the physician’s obligation to provide medical assistance in each case when delay could result in the threat of loss of life, serious bodily injury or serious health disorder. Provisions of Polish law do not provide for any special procedure for consent by an authorized body (e.g. court) for discontinuation of treatment as the result of a finding of no medical indications for its continuation. Accordingly, it rests upon the medical staff to make and implement the decision in this regard. This includes first and foremost making a collective decision, reflecting all circumstances relating to the patient’s clinical condition in the medical records, and giving effect in practice to the patient’s rights — including the right to be informed about the condition of one’s health, to give informed consent to the provision of a medical service, and to die peacefully and with dignity — as appropriate given the patient’s state of consciousness.

Among most Medical staff the orthopaedic complaint is very common and, in this research, we focused on the overall Prevalence of orthopaedic disorders among Medical workers, orthopaedic conditions differences between genders and educational levels. Then we overviewed the rates of orthopaedic diseases in different age groups in the general population. This study participants were Medical workers from Saudi Arabia and the results may not be applied to different sittings due to differences in facilities and work conditions.

Introduction Patient satisfaction and physician empathy are important indicators of health care services quality. The purpose of this study is to investigate the factors related to the health care users’ perception about physician empathy and their satisfaction with the services offered by the Medical Department of a Hellenic Air Force Combat Wing Health Service. Materials and Methods One hundred and twenty six individuals who randomly visited the Medical Department from January to February 2019 participated in the survey. The “Measuring the satisfaction of visitors to hospital outpatient clinics” questionnaire by Aletras et al. and the Greek version of the “Jefferson Scale of Patient Perceptions of Physician Empathy” questionnaire were used for data collection. Results High satisfaction scores were found in relation to the medical staff (mean 20.45, max 25), the examination room (mean 18.23, max 25), the nursing staff/secretarial support (mean 16.93, max 25), and the overall satisfaction (mean 17.15, max 25). The satisfaction score related to the infirmary was low (mean score 8.8, max 25). Physician empathy score was extremely high (mean 21.2, max 25). Statistically significant correlations were detected between physician empathy satisfaction score and the medical staff, nursing staff/secretarial support, and the overall satisfaction scores (P Conclusion Health care users reported high physician empathy and overall satisfaction scores but low infirmary satisfaction scores. The more positively that patients evaluated physician empathy, the more satisfaction that patients had with other measures.

A majority of patients with newly diagnosed malignant disease are 70 years old or older. Frailty - i. e. increased vulnerability towards stressors at older age - is a major challenge during the oncological work-up and treatment in the elderly. Therefore, older cancer patients should receive a systematic assessment of frailty by use of standard tools. Assessment results should be carefully considered during oncological treatment decisions, e. g. in interdisciplinary tumor conferences. Moreover, they are prerequisite to initiate geriatric co-management for which there is emerging new evidence. Advances in tumor surgery and irradiation as well as personalized precision medicine with novel targeted drugs have facilitated the treatment of cancer even in old age and frailty. However, patients with such characteristics are at increased risk of complications compared to younger subjects. Physicians and medical staff involved in treatment must therefore co-operate well. This article provides an overview of the current evidence and highlights key aspects of diagnosis and treatment of malignant diseases in the elderly.

In Thailand, the rapid and constant rise in the number of confirmed COVID-19 cases, together with the increasing number of patients requiring respiratory and other medical life support during the third wave of COVID-19, has drastically overwhelmed the existing country’s healthcare facilities, physicians, and other healthcare workers. Hence, early identification of vulnerable patients at risk and early COVID-19 pneumonia is crucial for timely management and treatment by antivirals or corticosteroids to prevent them from developing severe COVID-19 pneumonia. A prompt chest X-ray report with clear and concise information at baseline screening in alternative healthcare facilities, especially in resource-constrained conditions, is essential. The article presents the incorporation of Rama Co-RADS (a categorical assessment scheme for chest X-ray findings for diagnosing pneumonia in patients with confirmed COVID-19). Its use facilitates a rapid, clear, and concise X-ray report despite the various levels of radiologists’ experience. Comprehensibleand consistent chest X-ray information successfully reduces the time lapse and communication gap among medical staff and assists on-duty, frontline physicians to make prompt and more accurate decisions regarding the management and treatment of COVID-19 patients in accordance with the current national guideline.

Zusammenfassung Hintergrund Neuropathische Schmerzsyndrome zeichnen sich durch hohe Chronifizierungsraten sowie lange und intensive Schmerzepisoden aus. Ein treffsicheres Erkennen stellt eine Grundkompetenz von Physiotherapeuten dar, ermöglicht eine ursachengerechte Therapie und kann die Entstehung von Folgeschäden verhindern. Die quantitative sensorische Testung (QST) wird im medizinischen Rahmen als Ergänzung zur klinischen Sensibilitätsprüfung eingesetzt, konnte inzwischen eine beachtliche Stellung in der Forschung einnehmen, wird in der klinischen Praxis jedoch weniger häufig eingesetzt. Fragestellung Welchen Mehrwert hat die QST in der Untersuchung neuropathischer Schmerzen? Was sind die Ursachen für die begrenzte klinische Anwendung der QST? Was sind potenzielle Wege für einen erfolgreichen Übertrag der QST in die physiotherapeutische Praxis? Methode Literaturrecherche im Zuge einer Bachelorarbeit Physiotherapie. Ergebnisse Als valides Untersuchungsinstrument, das zur Evaluierung des gesamten somatosensorischen Profils geeignet ist, bietet die QST vor allem im Bereich der Small-fibre-Neuropathien einen erheblichen Vorteil gegenüber konventionellen Testverfahren. Diese kleinen Fasern scheinen insbesondere in der Frühphase von Neuropathien betroffen zu sein und können über konventionelle Testverfahren nicht evaluiert werden. Das macht den Einsatz von Teilaspekten der QST zu einem nützlichen Instrument für Physiotherapeuten und medizinisches Personal, was besonders in der Früherkennung von Neuropathien von großem Nutzen ist. Diskussion Trotz des bestehenden großen Nutzens existieren bis dato noch Limitationen, die den klinischen Routineeinsatz der QST behindern. Einige davon können durch exakte Testausführungen und Vorkehrungen bis zu einem gewissen Grad überwunden werden, andere, für die Klinik hochrelevante Bereiche wie die hohen Anschaffungskosten der Geräte und der hohe zeitliche Aufwand der Durchführung konnten bislang noch nicht zufriedenstellend gelöst werden. Weniger umfassende Testprotokolle sowie die Entwicklung handlicher und kostengünstiger Testgeräte könnten diesbezüglich erste Lösungsansätze darstellen. Die Ergänzung der konventionellen Bedside-Untersuchung um Testungen zur Wärmesensibilität und Schmerzschwellenbestimmung kann eine weitere Möglichkeit darstellen, um den dargestellten Mehrwert der QST in den klinischen Alltag zu integrieren. Schlussfolgerung Die QST steuert einen wesentlichen Beitrag zur Untersuchung und Diagnose von Neuropathien bei. Physiotherapeuten sind dazu angehalten, Teilaspekte aus der QST in eine standardmäßige Untersuchung zu implementieren, um sowohl in der Früherkennung als auch in der Behandlung positiv einzuwirken.

Burn injuries can be life-threatening, thus standardized procedures are essential to ensure the best medical care is provided after injury. Therefore, burn care guidelines were created throughout the world. There are many similarities within the different burn guidelines, especially in basic burn care procedures. Taking a closer look, it becomes clear that there are also a lot of disparities within the guidelines. In this review the guidelines of the German Society of Burn Treatment (DGV), British Burn Association (BBA), European Burns Association (EBA), American Burn Association (ABA), Australian and New Zealand Burn Association (ANZBA), and the International Society for Burn Injuries (ISBI) are compared. The DGV-guidelines focus on pre-hospital treatment measures, intensive care treatment and acute wound therapy, whereas the BBA puts emphasis on infrastructure and staff qualification. The EBA created guidelines for medical practitioners and non-medical staff to standardize burn care in European countries with special focus on clear treatment recommendations and best infrastructural facilities. The ABA underlines the need for best qualified medical staff and ABLS- (Advanced Burn Life Support) standards. The ANZBA focuses on best treatment options including novel wound healing biotechnologies and post-burn return-to-function rehabilitation. In contrast to all other guidelines, the ISBI does not only deal with burn care in developed countries but also in resource-limited settings. Special focus lies on the discussion of ethical issues and cost-effectiveness. In this review, advantages and disadvantages of each guideline are discussed. These findings are supposed to help improving burn care procedures worldwide.

Background It has been reported that in conventional open surgery, approximately 10% of surgical gloves are perforated during surgery without being noticed. To protect both the patient and medical staff from harm, double gloving or changing gloves routinely at certain intervals during surgery is recommended. However, whether these protective measures are also necessary for laparoscopic colorectal surgery is unknown because the actual perforation rate during laparoscopic procedures is unclear. Methods Seventy-seven laparoscopic colorectal surgeries were evaluated, and a total of 616 surgical gloves used in the surgeries were collected for analysis. The presence of glove perforation was tested by the standard water-leak test method (EN455-1). Results Seven perforations were detected (1.1%). The duration of the laparoscopic procedure was not a statistically significant risk factor for glove perforation (p = 0.41). Postoperative surgical site infections (SSIs) were observed in 12 cases (15.6%), but there was no significant correlation between the presence of glove perforation and SSI (p = 0.92). According to the bacterial cultivation results, the majority of causative agents of SSI were enterobacteria, which belong to the major gut flora. Conclusion Although the perforation rate was considerably lower than that in open surgery, surgical glove perforation occurred during laparoscopic procedures. Double gloving in laparoscopic colorectal surgery is recommended not to prevent SSI but to protect medical workers from harmful infections after direct contact with the patient.

Violence over doctors and medical staff is a serious social issue that has been neglected in modern society. Numerous attacks on emergency medical care workers and ward and office medical professionals have been witnessed in recent years, and in most cases these incidents were left without consequence or with occasional convictions. This survey aims to study the attitudes among the students of the Medical University of Sofia regarding the problem with aggression and violence against medical professionals and employees in the medical sector in Bulgaria and the opportunities that self-defence training at the Medical University gives. The study was carried out by means of applying the survey method with students who participated in the elective course (module) of Self-defense which was conducted during the second semester of 2020 – 2021 academic year. The conclusions that can be drawn, indicate that the participants are very well informed about the problem with aggression against medical professionals, and they consider poor organization in the healthcare sector as the main cause of the problem. Nevertheless, survey participants believe that incriminating aggressive behavior against medical staff is not going to bring the desired results against this kind of behavior. The attitude of the students who participated in the self-defense training sessions was extremely positive as they claim that this type of additional training could be the first step of future doctors to opposing aggression in the health-care sector.

Objectives: The impact of COVID-19 pandemic on endovascular therapy (EVT) for acute ischemic stroke in China is unknown. This study was aimed to verify the volume change of EVT for acute ischemic stroke affected by COVID-19 and its potential factors.Methods: This cross-sectional study was conducted via an online questionnaire survey in China. The questionnaire was mainly composed of descriptive information, volume change of EVT for acute ischemic stroke, and the protection status of medical staff.Results: A total of 103 stroke physicians in 28 provinces across China completed the survey questionnaire. A volume decline in EVT for acute stroke occurred in 93 (90.3%) hospitals after lockdown (23 January 2020). Nearly half of the hospitals (51/103, 49.5%) experienced a volume decline of EVT case more than 50% and 14 (13.6%) hospitals completely ceased offering EVT. Hospitals with decline >50% of EVT case had higher proportion of hospitals with a designated area for COVID-19 screening in the emergency room (44/51, 86.3% vs 34/52, 65.4%, p= 0.01) and medical staff in quarantine (19/51, 37.3% vs 7/52, 13.5%, p