Two-stage mental health survey of first-line medical staff after ending COVID-19 epidemic assistance and isolation

Facing with COVID-19 epidemic such a catastrophic health emergency, the mental health status of medical staff deserves attention. We conducted a two-stage of psychological status monitoring after the end of the assistance and 14 days of isolation, further targeted the vulnerable groups in need of intervention. The study is a cross-sectional survey on 1156 Yunnan medical staff aid to Hubei. Used Cluster sampling method to collect data at 2 time points (at the end of returning from Wuhan and the 14th day of isolation), from March 18, 2020 to April 6, 2020. Female and nurse had higher rates of depressive symptoms than male and doctors and other occupations. The proportion of female with mild and above moderate anxiety levels (22.91%, 2.61%) was higher than male (17.35%, 1.03%) (p < 0.05). Female had a better impaired sleep quality (45.06%, 17.49%) more than male (28.57%, 7.94%). Medical staff supported in Wuhan and with junior professional titles reported a higher proportion of sleep quality impairment. At the 14th isolation day stage, the proportion of nurses changed from depression to health (9.15%) and from health to depression (6.1%) better than doctors. The front-line medical staffs had suffered greater psychological pressure in the treatment process of major public health emergency. Researches on the dynamic monitor for the change of psychological status after aiding epidemic areas were still in relatively blank stage. Targeting the vulnerable characteristics of aiding medical staff is significant for effective psychological intervention and sustainable operation of health system.

Mentorship Initiatives in Radiation Oncology: A Scoping Review of the Literature

PURPOSE

Although mentorship is described extensively in academic medical literature, there are few descriptions of mentorship specific to radiation oncology. The goal of the current study was to investigate the state of mentorship in radiation oncology through a scoping review of the literature.

METHODS AND MATERIALS

A search protocol was defined according to Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Predefined search terms and medical subject headings were used to search PubMed for English language articles published after January 1, 1990, on mentorship in radiation oncology. Additionally, in-press articles from major radiation oncology and medical education journals were searched. Three reviewers determined article eligibility. Included articles were classified based on predefined evaluation criteria.

RESULTS

Fourteen publications from 2008 to 2019 met inclusion criteria. The most commonly described form of mentorship was the dyad (64.3%), followed by team (14.3%) and peer (7.1%); 2 articles did not specify mentorship type (14.3%). The most commonly mentored participants were residents (35.7%), followed by medical students (35.7%) and attendings (21.4%); 1 study included participants of all levels (7.1%). Thirteen studies (92.9%) identified an experimental study design, most of which were cross-sectional (42.9%), followed by cohort studies (28.6%) and before/after (21.4%). Median sample size, reported in 12 of 13 experimental studies, was 132 (coefficient of variation, 1.06). Although outcomes varied widely, the majority described successful implementation of mentorship initiatives with high levels of participant satisfaction.

CONCLUSIONS

Although few initiatives are currently reported, the present study suggests that these initiatives are successful in promoting career development and increasing professional satisfaction. The interventions overwhelmingly described mentorship dyads; other forms of mentorship are either less common or understudied. Limitations included interventions not being evaluated in a controlled setting, and many were assessed using surveys with low response rates. This review highlights rich opportunities for future scholarship to develop, evaluate, and disseminate radiation oncology mentorship initiatives.

Prevalence and influencing factors of anxiety and depression symptoms among the first-line medical staff in Wuhan mobile cabin hospital during the COVID-19 epidemic: A cross-sectional survey

To investigate the prevalence of anxiety and depressive symptoms and the associated risk factors among first-line medical staff in Wuhan during the coronavirus disease 2019 (COVID-19) epidemic.From March 5 to 15, 2020, the Hamilton Anxiety Scale and Hamilton Depression scale were used to investigate the anxiety and depression status of medical staff in Wuhan Cabin Hospital (a Hospital). Two hundred seventy-six questionnaires were received from 96 doctors and 180 nurses, including 79 males and 197 females.During the COVID-19 epidemic, the prevalence rate of anxiety and depression was 27.9% and 18.1%, respectively, among 276 front-line medical staff in Wuhan. The prevalence rate of anxiety and depression among doctors was 19.8% and 11.5%, respectively, and the prevalence rate of anxiety and depression among nurses was 32.2% and 21.7%, respectively. Females recorded higher total scores for anxiety and depression than males, and nurses recorded higher scores for anxiety and depression than doctors.During the COVID-19 epidemic, some first-line medical staff experienced mental health problems such as depression and anxiety. Nurses were more prone to anxiety and depression than doctors. Effective strategies toward to improving the mental health should be provided to first-line medical staff, especially female medical staff and nurses.

Epidemiological, Clinical, Radiological Characteristics and Outcomes of Medical Staff with COVID-19 in Wuhan, China: Analysis of 101 Cases

Objectives: As of 11 Feb 2020, a total of 1,716 medical staff infected with laboratory-confirmed the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) in China had been reported. The predominant cause of the infection among medical staff remains unclear. We sought to explore the epidemiological, clinical characteristics and prognosis of infected medical staff. Methods: Medical staff who infected with SARS-Cov-2 and admitted to Union Hospital, Wuhan between 16 Jan to 25 Feb, 2020 were included in this single-centered, retrospective study. Data were compared by occupation and analyzed with the Kaplan-Meier and Cox regression methods. Results: A total of 101 medical staff (32 males and 69 females; median age: 33) were included in this study and 74.3% were nurses. A small proportion of the cohort had contact with specimens (3%) as well as patients infected with SARS-Cov-2 in fever clinics (15%) and isolation wards (3%). 80% of medical staff showed abnormal IL-6 levels and 33% had lymphocytopenia. Chest CT mainly manifested as bilateral (62%), septal/subpleural (77%) and groundglass opacities (48%). The major differences between doctors and nurses manifested in laboratory indicators. As of the last observed date, no patient was transferred to intensive care unit or died. Fever (HR=0.57; 95% CI 0.36-0.90) and IL-6 levels greater than 2.9 pg/ml (HR=0.50; 95% CI 0.30-0.86) were unfavorable factors for discharge. Conclusions: Our findings suggested that the infection of medical staff mainly occurred at the early stages of SARS-CoV-2 epidemic in Wuhan, and only a small proportion of infection had an exact mode. Meanwhile, medical staff infected with COVID-19 have relatively milder symptoms and favorable clinical course than ordinary patients, which may be partly due to their medical expertise, younger age and less underlying diseases. The potential risk factors of fever and IL-6 levels greater than 2.9 pg/ml could help to identify medical staff with poor prognosis at an early stage.

Lacking Communication Would Increase General Symptom Index Scores of Medical Team Members During COVID-19 Pandemic in China: A Retrospective Cohort Study

There are few studies on the psychological status of medical staff during the COVID-19 outbreak. Our study addresses whether lack of communication affects the psychological status of medical team members supporting Wuhan during the COVID-19 pandemic in China. We used general symptom index (GSI) scores of the Symptom Checklist-90 (SCL-90) to evaluate participants' psychological status. We adopted a stratified sampling method and selected the fourth team, with a total of 137 members, as participants. In total 76.6% and 69.7% of female and male participants, respectively, had bachelor's degrees; 41.6% and 21.2% of female and male participants, respectively, were unmarried. Regarding communication, 14.29% and 6.06% of female and male participants, respectively, reported a lack of communication with the team (LCWT). Additionally, 13.0% and 6.1% of female and male participants, respectively, experienced fear of being infected (FoBI). LCWT and FoBI were positively correlated with GSI score (estimated change = 0.2, 95% CI [0.1-0.3]). When adjusted for gender, age, and FoBI, LCWT was positively correlated with GSI score (P < .05). Increasing communication among medical team members can reduce GSI scores.

Pressure injury related to the use of personal protective equipment in COVID-19 pandemic

OBJECTIVE

To describe the prevalence and factors associated with pressure injuries related to the use of personal protective equipment during the COVID-19 pandemic.

METHODS

Cross-sectional study conducted using an instrument made available in social networks with 1,106 health professionals. The data were analyzed using descriptive statistics and compared, considering pvalue < 0.05.

RESULTS

There was a prevalence of 69.4% for pressure injuries related to the use of personal protective equipment, with an average of 2.4 injuries per professional. The significant factors were: under 35 years of age, working and wearing personal protective equipment for more than six hours a day, in hospital units, and without the use of inputs for protection.

CONCLUSION

Pressure injuries related to the use of medical devices showed a high prevalence in this population. The recognition of the damage in these professionals makes it possible to advance in prevention strategies.

The mediation effects of coping style on the relationship between social support and anxiety in Chinese medical staff during COVID-19

BACKGROUND

The COVID-19 has been a pandemic around the world, which affirmatively brought mental health problems to medical staff. We aimed to investigate the prevalence of anxiety in Chinese medical staff and examine the mediation effects of coping styles on the relationship between social support and anxiety.

METHODS

A cross-sectional study via internet survey was conducted from 15 March to 30 March, 2020. The social demographic data, Self-rated Anxiety Scale, Social Support Rate Scale and Trait Coping Style Scale were collected. Pearson correlation and a structural equation model were performed to examine the relationships of these variables. The bootstrap analysis was conducted to evaluate the mediation effects.

RESULTS

A total of 453 medical staff participated in this study. The mean score of SAS was 46.1 (SD = 10.4). Up to 40.8% of the participants had anxiety symptoms. The participants lived with family members had lower SAS score (45.1 ± 9.8 vs 49.6 ± 11.8). Social support was negatively associated with anxiety, mediated by positive coping and negative coping partially significantly with an effect size of - 0.183.

CONCLUSIONS

Chinese medical staff had a high level of anxiety during the COVID-19 pandemic. Coping styles had effects on the association between social support and anxiety. Sufficient social support and training on positive coping skills may reduce anxiety in medical staff.

Risk of SARS-CoV-2 transmission to medical staff and patients from an exposure to a COVID-19-positive ophthalmologist

PURPOSE

To evaluate the risk of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after exposure to a COVID-19+ physician in a retina clinic.

METHODS

A retrospective observational study. Records of 142 patients and 11 staff members from a single retina clinic that were exposed to a COVID-19+ ophthalmologist were reviewed. All 153 individuals were placed in quarantine for 14 days. They were contacted after the quarantine period to inquire about symptoms consistent with COVID-19, and the results of diagnostic test for SARS-CoV-2 when performed.

RESULTS

All patients (n = 142) were contacted successfully. The mean age was 72.8 ± 13.6 years; 54.2% (n = 77) were females. Twenty-three patients (16.2%) were exposed during an ophthalmic exam, 111 (78.2%) during intraocular injection, 4 (2.8%) underwent exam and injection, 3 (2.1%) underwent surgery, and one patient (0.7%) had laser photocoagulation. Half of the patients (50%; n = 71) were in contact with the COVID-19+ physician while he was symptomatic. Forty-four patients (31%) wore a mask on the day of their visit. 11.3% (n = 16) of the patients, and all involved staff had been tested for the virus and all were negative. One patient (0.7%) reported transient cough and sore throat, and the remaining 141 (99.3%) patients and 11 (100%) staff did not develop symptoms.

CONCLUSIONS

Low risk for SARS-CoV-2 transmission in the ophthalmic setting was observed when universal safety measures such as social distancing, meticulous hand hygiene, enlarged breath shields, and mask wear during procedures were taken.

Cross-infection of adenovirus among medical staff: A warning from the intensive care unit in a tertiary care teaching hospital in China

•

Human adenovirus-55 in a single patient had strong transmission potential in ICU.

•

This infectious event involved more than 20 medical staff members in adult ICU.

•

Contact with patient, lack of hand hygiene or gloving adherence, were risk factors.

Rationale

In 2019, a small HAdV55-associated outbreak of adenovirus infection occurred among the intensive care unit (ICU) staff in Xiangya Hospital of Central South University in Hunan Province, China, during the treatment of a patient.

Objective

To investigate the characteristics of a nosocomial adenovirus outbreak in an ICU.

Methods

We evaluated all the patients treated and the medical staff working in the ICU from August 1 to September 4, 2019. We further performed an epidemiological and molecular analysis for this outbreak from patient to healthcare workers and between healthcare workers. After the outbreak, we adopted exposure prevention and droplet prevention measures based on standard precautions.

Measurements and main results

Between August 1 and August 27, 2019, 27 cases of human adenovirus cross-infection were reported in our institution. Among the cases, eleven were doctors (41%), eleven were nurses (41%), three were respiratory therapists (11%), and two were caregivers (7%). The attack rate was 28.4%, and the fatality rate was 0. The results showed that contact with the index case, lack of hand hygiene or gloving adherence were risk factors for infection after adenovirus exposure. After taking specific precautions, no new cases of infection have appeared since August 27.

Conclusions

Our results show that HAdV55 in a single patient had strong transmission potential in an intensive care unit with adequate facilities and standardized operation. We provide convincing evidence indicating that attention could be highlighted on the role of standard and specific precautions for controlling the spread of adenovirus in ICUs.

[Psychological and behavior status of minor children of medical staff during the COVID-19 epidemic in Hubei province]

OBJECTIVE

To investigate the psychological and behavior status of minor children of medical staff in Hubei province during the coronavirus disease 2019 (COVID-19) epidemic.

METHODS

A cross-sectional questionnaire survey was conducted through WeChat from March 13 to 15, 2020, which included a general data questionnaire and Conners parental assessment questionnaire (PSQ). The questionnaires received from outside of Hubei province were excluded through IP address, and the questionnaires with answer time <150 s were also excluded. The influence of parental work status on the psychological behavior was analyzed in children of different age groups.

RESULTS

A total of 391 valid questionnaires were collected, there were 207 males (52.9%) and 184 females (47.1%); 91 (23.3%) aged 3 to 6, 183 (46.8%) aged 6 to 10, and 117 (29.9%) aged 10 to 16. Both parents were medical staff in 87 participants(22.3%), one parent was medical staff in 139(35.5%) participants, and no parents were medical staff in 165 (42.2%) participants. In 3-<6 years group, there was no significant difference in the PSQ scores of the children in each factor level (all P>0.05) between children with parents as medical staff and those without. In 6-<10 years group, children with both parents as medical staff had higher hyperactivity-impulse factor score, learning problem factor score and total score than those without parents as medical staff (all P<0.05), while they had higher learning problem factor score than those with one parent as medical staff (P<0.05); the anxiety score of children with one or both parents as medical staff was higher than that of those without parents as medical staff (all P<0.05). In 10 to 16 years group, the behavior problems, learning problems, hyperactivity-impulse, more dynamic index and the total score in children with one parent as medical staff were lower than those with both parents as medical staff or without parents as medical staff (P<0.05 or P<0.01); while there were no significant differences in psychosomatic problems, anxiety factor scores between children with one parent as medical staff and other two groups (all P>0.05).

CONCLUSIONS

s During COVID-19 epidemic period, the psychological and behavior status of minor children of Hubei medical staff with different ages shows differences with those without parents as medical staff, particularly in 6-<10 years and 10 to 16 year groups. It is necessary to pay attention to the psychological and behavioral status of children of medical staff in these age groups.

Influenza vaccine acceptance by healthcare workers in Saudi Arabia: A questionnaire-based analysis

The aim of this study was to gauge the reasons for accepting or declining influenza vaccine in healthcare staff in Saudi Arabia. A questionnaire was administered to healthcare workers in Saudi Arabia. In all, 633 respondents who provided gender, nationality and profession were included. Reasons for vaccine uptake or refusal were assessed according to profession and educational level. Uptake of vaccine was lower in the period from 2010 to 2014 (3-13.3%) compared to pre-2010 figures (20.7%), rising to 44.1% in 2015. Comparing data for 'never having been vaccinated' to 'being vaccinated in 2015', there was no significant difference in distribution between nurses (9.27% v 38.8%), physicians (13.9% v 56.0%) and laboratory technicians (15.9% v 33.5%) (p= 0.08). The top reason for vaccination was protection of self and family, while the top reason for refusal was not considering the vaccine to be necessary. Education level had no significant effect on the likelihood of being vaccinated. Improvement of healthcare worker vaccination levels in Saudi Arabia might be achieved by addressing staff concerns on vaccine safety and efficacy, emphasizing the potential dangers of influenza and capitalizing on the staff's focus on protecting themselves and their families.

[The interplay between isolation and precariousness, and hospitalization duration in French Guiana]

BACKGROUND

French Guiana faces singular health challenges: poverty, isolation, structural lag, difficulties in attracting health professionals. Hospital stays exceed the recommended durations. The present study aimed to model the impact of precariousness and geographic isolation on the hospital duration performance indicator and to recalculate the indicator after incrementing severity by 1 unit when patients were socially precarious.

METHODS

Cayenne hospital data for 2017 were used to model the hospital duration performance indicator (IP-DMS) using quantile regression to study the impact of geographic and social explanatory variables. This indicator was computed hypothesizing a 1 unit increment of severity for precarious patients and by excluding patients from isolated regions.

RESULTS

Most excess hospitalization days were linked to precariousness: the sojourns of precarious patients represented 47% of activity but generated 71% of excess days in hospital. Quantile regression models showed that after adjustment for potential confounders, patients from western French Guiana and Eastern French Guiana, precarious patients and the interactions terms between residence location and precariousness were significantly associated with IP-DMS increases. Recalculating the IP-DMSafter exclusion of patients from the interior and after increasing severity by 1 notch if the patient was precarious led to IP-DMS levels close to 1.

CONCLUSION

The results show the nonlinear relationship between the IP-DMS and geographical isolation, poverty, and their interaction. These contextual variables must be taken into account when choosing the target IP-DMS value for French Guiana, which conditions funding and number of hospital beds allowed in a context of rapid demographic growth.

Occupational Doses to Medical Staff Performing or Assisting with Fluoroscopically Guided Interventional Procedures

Background Staff who perform fluoroscopically guided interventional (FGI) procedures are among the most highly radiation-exposed groups in medicine. However, there are limited data on monthly or annual doses (or dose trends over time) for these workers. Purpose To summarize occupational badge doses (lens dose equivalent and effective dose equivalent values) for medical staff performing or assisting with FGI procedures in 3 recent years after accounting for uninformative values and one- versus two-badge monitoring protocol. Materials and Methods Badge dose entries of medical workers believed to have performed or assisted with FGI procedures were retrospectively collected from the largest dosimetry provider in the United States for 49 991, 81 561, and 125 669 medical staff corresponding to years 2009, 2012, and 2015, respectively. Entries judged to be uninformative of occupational doses to FGI procedures staff were excluded. Monthly and annual occupational doses were described using summary statistics. Results After exclusions, 22.2% (153 033 of 687 912) of the two- and 32.9% (450 173 of 1 366 736) of the one-badge entries were judged to be informative. There were 335 225 and 916 563 of the two- and one-badge entries excluded, respectively, with minimal readings in the above-apron badge. Among the two-badge entries, 123 595 were incomplete and 76 059 had readings indicating incorrect wear of the badges. From 2009 to 2015 there was no change in lens dose equivalent values among workers who wore one badge (P = .96) or those who wore two badges (P = .23). Annual lens dose equivalents for workers wearing one badge (median, 6.9 mSv; interquartile range, 3.8213.8 mSv; n = 6218) were similar to those of staff wearing two badges (median, 7.1 mSv; interquartile range, 4.6-11.2 mSv; n = 1449) (P = .18), suggesting a similar radiation environment. Conclusion These workers are among the highest exposed to elevated levels of ionizing radiation, although their occupational doses are within U.S. regulatory limits. This is a population that requires consistent and accurate dose monitoring; however, failure to return one or both badges, reversal of badges, and improper badge placement are a major hindrance to this goal. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Karellas in this issue.

Health-Care Workers' Perception of Reimbursement for Complex Surgical Oncology Procedures

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers' views. Our study examined health-care workers' perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures-hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60-64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.

Using language descriptors to recognise delirium: a survey of clinicians and medical coders to identify delirium-suggestive words

OBJECTIVE

To develop a library of delirium-suggestive words.

DESIGN

Cross-sectional survey.

SETTING

Single tertiary referral hospital.

PARTICIPANTS

Medical, nursing and allied health staff and medical coders.

MAIN OUTCOME MEASURES

Frequency of graded response on a 5-point Likert scale to individual delirium-suggestive words.

RESULTS

Two-hundred and three complete responses were received from 227 survey respondents; the majority were medical and nursing staff (42.4% and 43.8% respectively), followed by allied health practitioners and medical coders (10.3% and 3.4%). Words that were "very likely" to suggest delirium were "confused/ confusion", "delirious", "disoriented/disorientation" and "fluctuating conscious state". Differences in word selection were noted based on occupational background, prior knowledge of delirium, and experience in caring for intensive care unit patients. Distractor words included in the survey were rated as "unlikely" or "very unlikely" by respondents as expected. Textual responses identified several other descriptors of delirium-suggestive words.

CONCLUSION

A comprehensive repertoire of delirium-suggestive words was validated using a multidisciplinary survey and new words suggested by respondents were added. The use of natural language processing algorithms may allow for earlier detection of delirium using our delirium library and be deployed for real-time decision making and clinical care.

[Vascular access survey in the Triveneto area: data analysis for the year 2017]

In 2017 the Italian Society of Nephrology operating in the Triveneto area investigated through a questionnaire, distributed to the various nephrological centers in the regions of Friuli Venezia Giulia, Trentino Alto Adige and Veneto, the differences concerning organizational models, choice of dialysis, creation and management of vascular access. The results emerging from the analysis of the collected data are presented.

A qualitative study on the impact of the 2016 US election on the health of immigrant families in Southeast Michigan

BACKGROUND

Given the anti-immigrant rhetoric and policy proposals by President Donald Trump during the 2016 presidential campaign and afterwards, his election to president in November 2016 and subsequent policy changes has affected immigrant families. In this study, we aim to better understand how post-election policy change may have impacted the health and well-being, including health and social service utilization, of Latino immigrants in Southeastern Michigan.

METHODS

We conducted 28 in-depth interviews with frontline staff at two Federally Qualified Health Centers and a non-profit agency. These staff had intimate knowledge of and insights into the lived experiences of the mixed-status immigrant families they serve. The interviews were audio recorded, transcribed, and analyzed thematically.

RESULTS

Our findings show three major themes: (1) An increased and pervasive fear of deportation and family separation among mixed-status immigrant clients, (2) The fear of deportation and family separation has resulted in fractures in community cohesion, and (3) Fear of deportation and family separation has had an impact on the healthcare utilization and health-related behaviors of mixed-status families. Staff members report that these three factors have had an impact on physical and mental health of these immigrant clients.

CONCLUSIONS

These results add to previous literature on the effect of immigration policies on the health and provide key insights for interventions to improve the health of immigrants within this socio-political environment.

Factors Shaping Attitudes of Medical Staff towards Acceptance of the Standard Precautions

Standard precautions (SPs) guidelines are the minimum infection prevention practices that apply to all types of patient care, regardless of suspected or confirmed infection status of the patient. They are based on risk assessment, make use of common sense practices and personal protective equipment that protect healthcare providers from infection and prevent the spread of infection from patient to patient. The aim of this study was to determine medical staff’s attitudes towards SPs and analyse the factors shaping these attitudes. The study was conducted using a questionnaire that comprised 25 statements describing the attitudes of medical personnel towards SPs. They were designed to pinpoint the factors that determine these attitudes. There were five factors identified that shape employees’ attitudes towards SPs: assessment of the situation, favourable patterns of behaviour, negative norms, unfavourable patterns of behaviour and rationalising. The study analysed 505 questionnaires filled in by hospital workers from five Polish cities. The majority of the respondents were women (92.1%), nurses (87.5%); the average age was 41.8 and the average seniority was 19.2 years. Over one-third of the respondents worked in non-surgical (36.4%) and surgical (31.6%) wards, 12.3% were employed in intensive care units (ICUs) and 8.9% in emergency departments (EDs). The variable significantly affecting the level of acceptance of SPs was seniority: initially the support was high, then it later decreased, with the greatest decrease occurring between the third and eighth year of work. The staff of medical wards and ICUs demonstrated significantly lower support for SPs and strong environmental impact on SPs perception; low degree of acceptance among medical ward staff correlated negatively with factors from the category “favourable patterns of behaviour”. The substantially strongest support for SPs was found in ED workers. The results indicate the need for continuous education of individual groups of workers concerning the application of SPs, but also the necessity to change the organisational culture in Polish hospitals.

UK physician associate primary care placements: staff and student experiences and perceptions

OBJECTIVES

To provide an insight into the experiences and perceptions of physician associate students and primary care staff involved in primary care educational placements in the United Kingdom.

METHODS

A qualitative study was conducted. Data were collected from focus groups and semi-structured interviews with eight first year physician associate students and six primary care staff in two general practice surgeries in East Sussex, United Kingdom. Recruitment was via purposeful sampling. Thematic Analysis was used to identify themes.

RESULTS

Three themes were identified: perceptions of the physician associate role, interprofessional working, and the physician associate course structure and placements. Staff demonstrated a lack of familiarity with the physician associate programme and there was a risk of unrealistic expectations. Overall, staff and students were positive about their experiences. However, students expressed anxiety over a large amount of learning in a short timeframe, the perceptions of others, and the reluctance of staff to train them in phlebotomy skills. In addition, students were unsure about their career aspirations for the future.

CONCLUSIONS

Participants were positive about their experiences however students expressed a number of anxieties, with a scope to improve interprofessional education. Practice staff demonstrated an overall lack of knowledge of the curriculum and physician associates in general leading to a risk of unrealistic expectations. Further studies on these themes with a larger sample size across relevant training institutions in the United Kingdom is required to explore this further.

A MOOC as an immediate strategy to train health personnel in the cholera outbreak in Mexico

BACKGROUND

In September 2013, two cases of cholera were reported in Mexico; 1 week later, a new outbreak was reported in the Huasteca region of Hidalgo. Upon the determination that the diagnostic and therapeutic interventions implemented by health personnel overlooked predefined procedures, the National Institute of Public Health, in coordination with the Ministry of Health, immediately designed the massive open online course "Proper cholera containment and management measures" to strengthen and standardize basic prevention and control practices.

METHODS

During the first 5 months, 35,968 participants from across the country finished the course: medical and nursing personnel, health promoters, and hospital staff. To understand the magnitude of the data, an analysis was performed to calculate the MOOC coverage, and multiple linear regression models were generated to relate the score earned in the course to the characteristics of the participants. In addition, a qualitative analysis was performed to identify the dissemination of information, technological barriers, and feedback on course design. A total of 17% of participants were from the state where the outbreak originated, and 33.5% were from its neighboring states.

RESULTS

This study shows that the need for information is greater when an emergency occurs, and the involvement of the authorities increased the extent of the training response.

CONCLUSION

A MOOC can be a useful training strategy to prepare personnel for emergency situations.

Work-Related Musculoskeletal Disorders and Risk Factors among Chinese Medical Staff of Obstetrics and Gynecology

Medical staff in the department of obstetrics and gynecology are a group of professionals reportedly at high risk of work-related musculoskeletal disorders (WMSD), however, little is known about the current status of this problem in China. The aim of this study was to investigate prevalence and risk factors of work-related musculoskeletal disorders among this population in China. A self-developed questionnaire was distributed to 1017 obstetrics and gynecology practitioners to collect information on musculoskeletal symptoms and relevant factors. Prevalence and severity of work-related musculoskeletal disorders in different parts of the body were calculated and the relationship between personal and ergonomic factors and work-related musculoskeletal disorders was analyzed using Chi-square test and unconditional logistic regression models. The results indicated a high prevalence of 85.5% among the subjects, with the shoulder (n = 575, 62.0%), neck (n = 560, 60.3%) and lower back (n = 504, 54.3%) being the three most affected regions. Individual, postural, work-environmental as well as psychosocial factors were recognized to be associated with WMSDs in different body parts. Therefore, attention must be given to the problem of musculoskeletal disorders among Chinese obstetrics and gynecology staff. It is recommended to develop good life habits, improve work environment, adjust work organization as well as train on proper postures in their daily operation.

Education of hand rubbing technique to prospective medical staff, employing UV-based digital imaging technology

The aim of this study was to objectively assess the hand hygiene performance of medical students. Hand rubbing technique was evaluated by employing innovative UV-light-based imaging technology, identifying patterns and trends in missed areas after applying WHO's six-step protocol. This specially designed hand hygiene education and assessment program targeted 1,344 medical students at two distant sites in Central Europe. Students were introduced to a short video, presenting the basics of hand hygiene, and then received further demonstration from professional trainers, focusing on the correct execution of WHO's six-step technique. To verify the acquired skill, participants rubbed their hands with UV-marked alcohol-based solution. Digital images of the hands were recorded under UV light, followed by computer evaluation and assessment. Immediate objective visual feedback was given to the participants showing missed areas on their hands. The statistical analysis of missed spots was based on retrospective expert-driven manual evaluation. Significant difference in rubbing quality was found between female and male participants [35.3% (CI 95%: 33-38%) versus 29.0% (CI 95%: 27-31%), p < 0.001], dominant and non-dominant hands [43.4% (CI 95%: 39-48%) versus 34.9% (CI 95%: 32-38%), p = 0.002], and various zones of the hands' dorsal side. Based on the participants' feedback and the evaluation of the infection control specialists, it can be stated that the identification of typically missed patterns and the instant visual feedback have a vital role in improving the hand hygiene technique of prospective medical staff.

Telerehabilitation Services in Pakistan: A Rehabilitation Professional's Perspective

Disabled community spending a miserable life and having no or very less access to basic health and rehabilitation care across Pakistan. WHO developed objectives for the provision of standard health and rehabilitation care to disables and emphasizes to achieve them till 2021. The Purpose of this study was to assess the future of tele-rehabilitation services in Pakistan. It was quantitative study with Sample size of 100 rehabilitation professionals across the country. Result showed that Telerehabilitation Services are strongly needed in Pakistan and professionals rated it as a best alternate of facility based rehabilitation services. We can provide a wide range of services through Telerehabilitation Services ranging from simple consultation to delivery of different therapeutic sessions and online monitoring.

INFORMED CONSENT IN PSYCHIATRIC MEDICAL CARE: A PROSPECTIVE QUANTITATIVE STUDY

Respecting fundamental ethics principles entails the process of obtaining an informed consent, which is a necessary requirement for offering good psychiatric medical care and conducting research studies on human subjects, who are regarded as the vulnerable population. Presently, in Romania, the informed consent regarding medical interventions is covered by the law of the patient's rights, Law 46/2003, chapter 3. The aim of this study is to evaluate the medical staff's perception of the need of the informed consent in the practice of psychiatric medical care.

MATERIAL AND METHODS

This is a quantitative, inquiry based study, with prospective evaluation, based on the responses of 217 medical staff members involved in treating patients with psychiatric disorders. The study unfolded between July 2012 and July 2013, and the questionnaires were answered by medical staff members (psychiatrists, general practitioners, other clinical specialists, psychologists) from Iasi, Botosani, Vaslui, Suceava counties.

RESULTS

The age group distribution of the medical staff involved in the medical care shows statistically significant differences between the groups questioned (χ2 = 227.14; df = 5; p = 0.001). Concerning the answers recorded at question no. 2, regarding informing the psychiatric patient, and comparing the studied groups of medical staff, a majority of affirmative answers was noted.

CONCLUSIONS

The medical staff members involved in the patient's treatment recognizes the necessity of a full informed consent when discussing about psychiatric medical care. In psychiatry, the variation of competence raises multiple ethics discussions.

A Survey of the Knowledge of Venous Thromboembolism Prophylaxis among the Medical Staff of Intensive Care Units in North China

Background

Guideline concordance for venous thromboembolism (VTE) prophylaxis in critically ill patients in intensive care units (ICUs) varies across different countries.

Objective

To explore how the medical staff of ICUs in China comprehend and practice VTE prophylaxis.

Method

Questionnaires comprising 39 questions and including 4 dimensions of thromboprophylaxis were administered in ICUs in North China.

Results

In all, 52 ICUs at 23 tertiary hospitals in 7 Chinese provinces and municipalities were surveyed. A total of 2500 questionnaires were sent, and 1861 were returned, corresponding to a response rate of approximately 74.4%. Of all surveyed medical staff, 36.5% of physicians and 22.2% of nurses were aware of the guidelines in China, and 19.0% of physicians and 9.5% of nurses comprehended the 9^th edition of the guidelines of the American College of Chest Physicians (ACCP). Additionally, 37.6% of the medical staff chose a prophylaxis method based on the related guidelines, and 10.3% could demonstrate the exact indication for mechanical pattern application. Worries about skin injury, difficulty with removal and discomfort during mechanical thromboprophylaxis were cited by more than 30% of nurses, which was significantly more frequent than for physicians (graduated compression stockings: 54.3% VS 34.1%, 60.7% VS 49%, and 59.4% VS 54%, p = 0.000; intermittent pneumatic compression: 31% VS 22.2%, 19.2% VS 13.9%, and 37.8% VS 27.2%, p = 0.000).

Conclusions and Relevance

The knowledge of VTE prophylaxis among the medical staff of ICUs in North China remains limited, which may lead to a lack of standardization of VTE prophylaxis. Strengthened, standardized training may help medical staff to improve their comprehension of the relevant guidelines and may finally reduce the occurrence of VTE in ICUs and improve the prognosis of critically ill patients with VTE.

Longitudinal Examination of Medical Staff Utilization in Substance Use Disorder Treatment Organizations

This study examined changes in utilization of medical staff within organizations specializing in treatment of patients with substance use disorder (SUD) at two points in time (2007 and 2010). Utilization was calculated as the number of hours paid weekly for psychiatrists, physicians, nurses, and other medical staff working as employees or on contract. Study data come from a longitudinal national sample of 274 substance use disorder treatment centers. Average utilization of medical staff by these SUD treatment organizations increased by 26% from 2007 to 2010. The results showed that growing SUD treatment centers that obtained more referrals from health care providers, used case managers to coordinate comprehensive approaches to patient care, provided medication assisted treatment (MAT), and that were connected more closely with hospitals made increased use of medical staff over the 2007-2010 period. In 2010, these organizations seem to have been moving in directions consistent with trends forecasted for the SUD treatment environment after implementation of the Affordable Care Act.

[Questionnaire survey on current status of home care and support for patients with hematological diseases]

In order to survey the current status of home care and support for patients with hematological diseases, questionnaires were sent to 3,591 hospitals and home care facilities in Tokyo and surrounding prefectures. The first survey showed that 81.7% of medical staff members at hospitals reported that they had experience with home care and support, but only 24.9% of home care facility staff members had such experience. The second questionnaire, surveying 1,202 personnel, identified four factors hampering successful establishment of home care and support networks for hematological diseases. These included insufficient familial support for patients, difficulty making end of life decisions by family members and patients, limited access to transfusion support, and financial problems.

Research priorities in spiritual care: an international survey of palliative care researchers and clinicians

CONTEXT

Spiritual distress, including meaninglessness and hopelessness, is common in advanced disease. Spiritual care is a core component of palliative care, yet often neglected by health care professionals owing to the dearth of robust evidence to guide practice.

OBJECTIVES

To determine research priorities of clinicians/researchers and thus inform future research in spiritual care in palliative care.

METHODS

An online, cross-sectional, mixed-methods survey was conducted. Respondents were asked whether there is a need for more research in spiritual care, and if so, to select the five most important research priorities from a list of 15 topics. Free-text questions were asked about additional research priorities and respondents' single most important research question, with data analyzed thematically.

RESULTS

In total, 971 responses, including 293 from palliative care physicians, 112 from nurses, and 111 from chaplains, were received from 87 countries. Mean age was 48.5 years (standard deviation, 10.7), 64% were women, and 65% were Christian. Fifty-three percent reported their work as "mainly clinical," and less than 2.5% stated that no further research was needed. Integrating quantitative and qualitative data demonstrated three priority areas for research: 1) development and evaluation of conversation models and overcoming barriers to spiritual care in staff attitudes, 2) screening and assessment, and 3) development and evaluation of spiritual care interventions and determining the effectiveness of spiritual care.

CONCLUSION

In this first international survey exploring researchers' and clinicians' research priorities in spiritual care, we found international support for research in this domain. Findings provide an evidence base to direct future research and highlight the particular need for methodologically rigorous evaluation studies.

An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil

OBJECTIVE

To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life.

METHODS

Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil.

RESULTS

Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU.

CONCLUSIONS

The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital emergencies. A disrespectful labor scenario was also found; the evaluation of quality of life showed a notable presence of pain on the SF-36 among physicians at SAMU and especially among doctors who had worked for a longer length of time at SAMU.

Healing the healer: stress and coping strategies in the field of temporary medical work

Temporary medical workers provide a vital role for the medical profession. These individuals, however, occupy a unique work arrangement as professional-specific temporary workers. Temporary medical workers often find themselves bearing the burdens of both medical workers and temporary workers. In partnership with the largest medical temporary agency in the United States, we content analyzed the responses of 86 medical temporary workers, geared at uncovering the primary stressors and coping strategies this sample enacted. Our findings concluded that temporary medical workers experienced stressors associated with both their medical and temporary roles, although more stressors were associated with temporary work than with medical care. Participants also relied heavily on coping strategies that allowed them to avoid these stressors.

Clinician-dependent variations in inappropriate use of myocardial perfusion imaging: training, specialty, and location

BACKGROUND

Inappropriate use of myocardial perfusion imaging (MPI) may vary depending on the training, specialty, or practice location of the clinician.

METHODS

We conducted a cross-sectional investigation of consecutive patients who underwent MPI at our Veterans Affairs medical center between December 2010 and July 2011. Characteristics of the MPI ordering clinicians were extracted to investigate any associations with inappropriate use.

RESULTS

582 patients were included, 9.8% were inappropriate. No difference in inappropriate use was observed between cardiology and non-cardiology clinicians (n = 21, 9.5% vs n = 36, 10.0%, P = .83); no difference was noted between nurse practitioners/physician assistants, attending physicians, and housestaff (7.5% vs 11.2% vs 1.8%, P = .06). Comparing inpatient, emergency department and outpatient clinician groups, the difference was null (8.6% vs 6.3% vs 10.1%, P = .75). For most clinician groups, the most common inappropriate indication was an asymptomatic scenario; however, some groups were different: definite acute coronary syndrome for inpatient clinicians and low risk syncope for emergency medicine clinicians.

CONCLUSIONS

Clinician groups appear to order inappropriate MPI at similar rates, regardless of their training, specialty, or practice location. Differences in the most common type of inappropriate testing suggest that interventions to reduce inappropriate use should be tailored to specific clinician types.

Exposed medical staff: challenges, available tools, and opportunities for improvement

Medical staff doses have increased over the past decade, as there is an increasing need for the benefits and use of radiation in medicine. While current average medical staff doses are well within limits, some doses to individuals could exceed 20 mSv y deep dose equivalent or lens dose equivalent (if unprotected), and there is the potential for some workers to exceed 500 mSv y shallow dose equivalent without careful assessment and protection. Nuclear medicine radiochemistry and patient dose preparation present challenging opportunities for improved dose control. In addition, fluoroscopically guided intervention procedures continue to represent an important area for careful protection implementation. Optimization of radiation protection in the medical setting should include tried and true principles of justification, optimization, and limitation with emphasis on training, credentialing, planning, and quality management. As newer and developing uses of radiation in medicine are tested and implemented, it is important to consider effective dosimetric monitoring, lens of eye doses, extremity doses, novel uses, and novel radionuclide characteristics. An ongoing assessment of current and future patterns of use for radiation in medicine is an essential activity to assist in prioritizing limited resources for staff protection. Introduction of Exposed Medical Staff (Video 1:27, http://links.lww.com/HP/A20).

[THE SOCIAL DEMAND FOR PERINATAL SERVISES GIVEN BY MIDWIFES AMONG WOMEN FROM ZACHODNIOPOMORSKIE PROVINCE AND INVESTIGATE THE KNOWLEDGE BASE OF MEDICAL STAFF IN REGARD TO THE MIDWIFE'S RIGHTS AND DUTIES RESULTING FROM POLISH LAW]

INTRODUCTION

The midwife's profession has evolved across the ages to become--in the vast majority of countries, including Poland--an independent medical occupation. The aim of this thesis was to define how big is the social demand for perinatal servises given by midwifes among women from Zachodniopomorskie province and investigate the knowledge base of medical staff in Zachodniopomorskie province in regard to the midwife's rights and duties resulting from Polish law.

MATERIAL AND METHODS

Research was carried out from 1.10.2009 to 30.06.2010. It included 115 active midwifes in the city of Szczecin and beyond it (Zachodniopomorskie province). Additionally, 40 doctors, 99 nurses and 1 master of physiotherapy took part in the survey (all of them based in Zachodniopomorskie province). Research was also conducted among 150 women from the same province. The survey was presented in the form of a questionnaire. Since the available literature did not include a standardized research tool which could be used to achieve appointed goals a new method was devised. Results were subjected to mathematical and statistical analysis.

CONCLUSIONS

After the compilation of results presented in this paper the following conclusions were made: 1. Some of the medical personnel who participated in the survey do not perceive midwifes as independent medical practitioners. 2. Most midwifes are aware of their rights and obligations outlined in Polish legislation. In their opinion the lack of independence in their profession is caused by unclear clauses and paragraphs in Polish law. The women who participated in the survey showed an interest in services provided by midwifes. 3. They stated that there is a common need for this kind of service. There are grounds to intensify the promotion of midwifery as an independent occupation.

Assessment of individual dose equivalents Hp(0.07) of medical staff occupationally exposed to ionizing radiation in 2012

BACKGROUND

The paper presents the Nofer Institutes of Occupational Medicine in Łódź's results of the assessment of individual dose equivalents Hp(0.07) of medical staff exposed to X-rays in Poland in 2012. In addition, the collected data was analysed in terms of types of medical units performing medical procedures and the categorization of personnel.

MATERIAL AND METHODS

Dosimetric service was provided for medical staff of interventional radiology departments occupationally exposed to ionizing radiation in terms of individual dose equivalents Hp(0.07). In 2012, personal dosimetry Hp(0.07) determinations were performed by the Nofer Institute of Occupational Medicine in Łódź and covered 2044 employees from 174 health facilities. The determinations were performed using thermoluminescence dosimetry according to the procedure accredited by the Polish Centre for Accreditation (document number AB 327). The measurements were performed using ring-dosimeters in the periods of 1 or 2 months.

RESULTS

Mean annual individual dose equivalent Hp(0.07) in 2012 was equal to 3.3 mSv (annual limit for Hp(0.07) is 500 mSv). The average value of annual individual dose equivalent Hp(0.07) decreased comparing to the previous year. In 2012, no single case of exceeding the annual limit for Hp(0.07) was reported. Data stored in the file indicates that more than 96% of all of the annual doses did not exceed the level of 10 mSv.

CONCLUSIONS

The analysis of data on occupational exposure to ionizing radiation confirms a stable level of exposure and satisfactory radiological protection in interventional radiology facilities monitored by the Nofer Institute of Occupational Medicine in Łódź in Poland in 2012.

[Professional absenteeism in the pediatric service of the general hospital of Loandjili in Pointe-Noire (Congo)]

The supply and the quality of care dispensed in a service depend on the quality of the technical and human tray, but also from effective presence of the staff during the work time. The purpose of this study is to determine the absenteeism level of the paramedical staff in General Pediatric and Neonatology of Loandjili General Hospital (Pointe Noire) and identifying causes. A cross-sectional study has been conducted from January 1(st) to June 30(th) 2011 on 21 nurses in General Pediatric and 20 in Neonatology. The absenteeism level was obtained by the link of the number of missing days out of the number of the work days x 100. The absence was justified when it relieved from a reason informed by the administrative texts of the firm; and authorized when it requested the authorization of the administration of the firm. In total, 370 absences have been unregistered, the average absenteeism level was of 8.4%. The absence was justified in 242 cases (65.4%) and authorized in 178 cases (48.1%) which 84 times in writing and 94 times verbally. When the absence was justified, it was the fact of the disease of a member of the family in 82 cases, of the death or the burial of a member of the family in 81 cases, of the agent disease, 84 cases, or other reasons in the remains of cases. The absence occurred between 7 a.m. and 14 p.m. in 57.3%, 14 p.m. and 7 p.m.in, 25.7% and between 7 p.m. and 7 a.m. in 17.0%. The absenteeism was mainly observed (85.7%) for the nurses of about 30 years old and those (59.5%) whom the seniority in the service was inferior or equal 5 years. The absences justified were more observed (p< 10(-4)) for nurses of about 30 years old and those whom the seniority did not pass 5 years. The absenteeism of nurses constitutes a real social and administrative problem that deserves a particular attention considering its impact on the supply and the quality of cares.

Assessment of eye and body dose for interventional radiologists, cardiologists, and other interventional staff

A dose limit for the eye of 20 mSv, as proposed by the ICRP, could be exceeded by interventional clinicians. Data on eye dose levels for interventional radiologists and cardiologists provided by medical physicists from hospitals around the UK have been collated. The results indicate that most hospitals would require one or more interventional clinicians to be classified and several would have exceeded a 20 mSv limit. Dose data in the literature have been reviewed to derive factors that might be used to predict eye dose levels based on dose per procedure or kerma-area product workload. These could be used in prior risk assessments to establish monitoring practice. An alternative approach to personnel dose monitoring in radiology applications using a collar dosimeter worn outside the lead apron as the first dosimeter is proposed. The collar dosimeter would provide an assessment of eye dose in terms of Hp(3) and body dose in terms of Hp(10), which could be divided by ten to provide an assessment of effective dose. If Hp(3) exceeded 1 mSv per month, regular monitoring with a head dosimeter would be recommended, and if Hp(10) exceeded 2 mSv per month, then an under-apron dosimeter should also be worn.

Evaluation of health professionals in the use of internet information retrieval systems in health: a literature review

This paper presents a literature review on how health professionals are seeking health information using internet retrieval systems, databases. Publications present many attitude scales which evaluate the behavior of the users and the barriers that they face through the information research. On the following review are mentioned the characteristics that health professionals encounter on the use of computing. Also, is mentioned a number of problems which are associated with the information recourses such as reliability that were elicited and reviewed.

[Analysis medical staff opinion according to quality management in health care]

The practice of documenting the credibility of quality management system of companies in the medical sector in Poland does not have a long history. In the recent years hospitals have started to work in a system similar to a competitive market with features specific for medical service preserved. As a result quality focused activity instruments were introduced to the medical service market, such as ISO family of standards. The aim of the work objective was to get to know the opinion of medical staff about the changes resulting in the quality management system implementation.

MATERIAL AND METHODS

The answers of a team of 200 medical staff from two Polish hospitals were analysed. The respondents were employed in medical institutions before and after the introduction of ISO 9001.

RESULTS

A large number of participants claimed that standardization in work organization made a significant improvement (45.50%, n = 91), but part of them (36.50%, n = 73) claimed that this new organization improved the situation not very much. And a small group (18,00%, n = 36) said that the organization did not change after the introduction of standardization. Nurses and medical rescue workers more often claimed (the result being statistically significant) that their work organization improved after the standardization implementation (48.54%), differently from doctors (27.59%, p = 0.008). Doctors in the research often claimed that the changes after the introduction of standardization caused an increase in the requirements of their professional qualifications (79.13%), but the nurses and medical rescue workers found it a bit less (74.85%). Most participants (87.50%, n = 175) claimed that the changes which appeared as a result of the introduction of standardization motivated them to compete against others health care institutions.

CONCLUSIONS

Medical staff in the research claimed that the changes after the introduction of standardization resulted in work organization improvement. Nurses and medical rescue workers more often claimed (the result being statistically significant) that their work organization improved after the standard implementation. Most of the respondents were convinced about the benefits of standardization implementation. Changes that took place as a result of the introduction of quality management system based on ISO are a motivating factor for competing against other health care institutions. The system of quality insurance based on ISO is constructed in such a way so as to strive for satisfying constantly changing customers' needs, because quality is not an ideal notion but a goal that needs to be pursued.

One-third of doctors completing specialist training in diabetes fail to secure a substantive consultant post: young Diabetologists' Forum Survey 2010

Reports have highlighted a shortage of consultant diabetologist posts in the UK. The number of doctors completing specialist training in diabetes has increased in recent years, but little is known about their employment after they receive their certificate of completion of training. An online survey was sent to all doctors who completed specialist diabetes training from January 2008 to September 2010. Of the 95 eligible respondents, 69 (73%) completed the survey (61% men; median age 36 years). Forty-three (62%) respondents secured substantive NHS consultant posts, and of those who gave their job breakdown, 48/51 (94%) were contributing to specialist diabetes care. Five (7%) respondents held substantive academic positions, while 11 (16%) were locum consultants. Seven (9%) respondents worked abroad, with half of these attributing their emigration to lack of opportunities in the UK. When asked about alternative choices, 39% of respondents were likely to seek 'general physician' roles, which equalled the number who would consider emigrating. Overall, only two-thirds of doctors who complete specialist training in diabetes secure substantive NHS consultant positions, which suggests a failure in workforce planning and a lack of expansion of the number of consultant posts despite progression of the diabetes epidemic.

Influence of gender, age, and social norm on digital imaging use

BACKGROUND

The adoption of digital imaging technology is a critical investment decision, and problems related to employee acceptance of the technology often are underestimated. Literature indicates that subjective normative factors, gender differences, and age may affect employee acceptance and use of new technology. Thus, understanding these influential factors is highly important to organizations.

OBJECTIVE

To explore the relationships between gender, age, subjective normative factors, and the intention to use digital imaging technology in an environment where its use is mandatory.

METHODS

A survey was used to investigate the applicability of a modified, theoretical technology acceptance model as a proposed model of radiographers' intention to use digital imaging technology. Structural equation modeling was used to test the theoretical model, and path analysis was used to examine dependence between variables.

RESULTS

Although the data supports the modified versions of the theoretical technology acceptance model, the relationship between age and gender was very weak. When age and gender were removed from the model, voluntariness had a weak effect, suggesting other environmental factors play a larger role in explaining subjective normative factors within a radiologic environment.

CONCLUSION

In contrast to other technology adoption studies, age and gender were not significantly associated with radiographers' acceptance and use of technology. Age and gender patterns do not apply to the adoption of digital imaging for this population. Therefore, one can conclude that in an environment in which digital imaging equipment use is mandated, additional sociocontextual variables play a role in the radiographers' intention to use the technology.

Log analysis to understand medical professionals' image searching behaviour

This paper reports on the analysis of the query logs of a visual medical information retrieval system that provides access to radiology resources. Our analysis shows that, despite sharing similarities with general Web search and also with biomedical text search, query formulation and query modification when searching for visual biomedical information have unique characteristics that need to be taken into account in order to enhance the effectiveness of the search support offered by such systems. Typical information needs of medical professionals searching radiology resources are also identified with the goal to create realistic search tasks for a medical image retrieval evaluation benchmark.

eHealth education of professionals in the Baltic Sea Area

In this paper we present a study on the extent, level and content of e-Health in existing formal educational systems in Lithuania, Germany, Finland, Norway and Denmark with the objectives of identifying future educational needs within this area. The study was carried out as a desk-top study and took place within the context of the ICT for Health project. The results of the study on the one hand revealed a wide range of programs and courses that included e-Health, but on the other hand also showed that in the educations of health care professionals (physicians, nurses etc.) the integration of e-Health elements are often marginal or non-existing. Thus the study indicates that there is a need for a higher integration of e-Health in the education of health care professionals. We discuss what kind of knowledge of e-Health is needed and how it could or should be integrated in these educations. We argue that providing possibilities for applying and experimenting with e-Health system in a concrete and tangible manner is central in order to raise the acceptance and capabilities of health care professionals to use e-Health systems.

[The awareness of carcinogenic effect of tobacco smoke--a questionnaire survey of students and employees of Collegium Medicum of Nicolaus Copernicus University]

Smoking is currently the most significant risk factor for health according to WHO statements. It has been proven that smoking is the cause of many diseases, for example cardiovascular and respiratory tract diseases as well as impaired fertility and decreased immunity. The adverse effects of cigarette smoking on pregnancy and health of children were also proved. However, special attention is laid on impact of smoking on the development of cancer. In tobacco smoke there are over 4,000 different chemical substances and compounds, of which more than 50 are carcinogens. The present study was aimed to assess the knowledge of students and employees of Collegium Medicum of Nicolaus Copernicus University in Torun (CM UMK), first on number and types of carcinogens contained in tobacco smoke and secondly on types of diseases caused by smoking. There were 480 responders included to the study(253 women and 227 men). Among them there were 416 students of CM UMK, 59 students of biomedical engineering at the University of Technology and Life Sciences in Bydgoszcz and 5 employees of CM UMK. Among the respondents there was considerable ignorance about the number of carcinogens contained in tobacco smoke with over 50% of them indicating the incorrect answer. Among the carcinogens there were mentioned mostly tar and nicotine, and among the diseases caused by tobacco smoke most often pointed response there were lung and larynx cancer and heart and blood vessels diseases and to reduce the weight of newborns. In summary, we can conclude that the awareness of students and employees of CM UMK about the carcinogenic properties of tobacco smoke was not sufficient. Respondents were aware of the dangers of smoking, they knew the basic carcinogenic substances and pointed a few diseases caused by smoking cigarettes. Unfortunately their knowledge does not refer to a number of diseases which in common believe are not connected to cigarette smoking, but in fact tobacco smoke is very important for their development.

[Occupational HBV and HCV infections among health care workers]

BACKGROUND

Analysis of the number of reported occupational hepatitis cases in the years 1971-2009 reveals a clear upward trend in the late 1980's, followed by a downward trend that has continued to the present. The aim of this study was to determine the number of recorded occupational hepatitis B and C in the Pomorskie voivodeship in the years 1999-2009 by the type and location of health care institutions and workpost category.

MATERIALS AND METHODS

To analyze the epidemiological situation of occupational hepatitis among health care workers in the Pomorskie voivodeship, the data from 338 occupational disease certificates were obtained.

RESULTS

In the period under study 341 cases of occupational hepatitis B and C (hepatitis B, 229; hepatitis C 112) were recorded in the province of Pomerania. The number of occupational hepatitis B decreased by 96.6% in the years 1999-2009, and hepatitis C by 90.5% in the years 2000-2009. The majority of infections occurred in large cities (Gdańsk, Gdynia and Słupsk). The total number of cases included 301 (89%) women and 37 (11%) men. The largest number of infections was observed among nurses and midwives (155 and 10 cases, respectively). Definitely the highest incidence was observed in hospitals (230 cases), analytical laboratories (42 cases), medical and dental clinics (20 cases).

CONCLUSIONS

The obtained data show a significant decrease in the incidence of occupational hepatitis during the discussed period. The highest number of infections was found among employees of hospitals and laboratories. A high number of cases in a small occupational group, employees of analytical laboratories, attracted our attention.

[Analysis of results of excerpts of generalized parametric indicators of facet classification of occupations in medicine, practical, industrial pharmacy, cosmetology and major of related occupations introduced to State classifiers 003:2010]

A comparative analysis of the content and the list of codified occupations (CO) of State classifiers (SC) of occupations SC 003-95 and SC 003:2010 (total 15 000 positions) is considered. Found that the number of corresponding CO in the SC 003-95 consist of 906 items including 57 of Vol. 78 "Care of public health", as well as in SC 003:2010 - 799 and 59 respectively.

Whom do physicians work for? An analysis of dual practice in the health sector

This article presents a thorough analysis of dual practice among physicians who work in both the public and private sectors. A conceptual framework is presented to help the reader understand dual practice and the contexts where it takes place. The article reviews the existing theoretical and empirical literature on this form of dual practice among physicians. It analyzes the extent of this phenomenon, the underlying factors that motivate physicians to engage in dual practice, and the main implications of their decision to do so. It also examines and discusses current policies that address dual practice. In this regard, the article provides some qualified support for the use of "rewarding" policies to retain physicians in the public sectors of more developed countries, while "limiting" policies are recommended for developing countries - with the caveat that the policies should be accompanied by the strengthening of institutional and contracting environments. The article highlights the lack of quality evaluative evidence regarding the consequences of dual practice on the delivery of health care services. It concludes that the overall impact of dual practice remains an open question that warrants more attention from researchers and policy makers alike.

U.S. Technologists' radiation exposure perceptions and practices

BACKGROUND

Despite early recognition of the potential hazards of ionizing radiation and research documenting these hazards over the past 115 years, problems persist regarding the safety of medical procedures that use ionizing radiation for imaging.

OBJECTIVE

This investigation sought to evaluate current attitudes and radiation protection practices among radiologic technologists following recent reports of the dramatic increase in radiation dose in the United States.

METHOD

A survey was sent to a stratified random sample of 2000 radiologic technologists in the U.S. whose names were obtained from the American Registry of Radiologic Technologists.

RESULTS

Radiographers are aware of the increase in exposure to the U.S. population from medical sources and some of their self-reported observations and practices are contributing to this increase.

CONCLUSION

Radiologic technologists are aware of exposure increases and may be contributing to the increase in patient dose in the U.S., largely because there is a lack of in-service education. Commonly recognized and accepted methods of radiation protection practices are being applied to reduce dose to U.S. patients, but not routinely so. These skills require periodic updates and reminders.