Work outcomes in public safety personnel after potentially traumatic events: A systematic review

BACKGROUND

It is well documented that public safety personnel are exposed to potentially traumatic events (PTEs) at elevated frequency and demonstrate higher prevalence of trauma-related symptoms compared to the general population. Lesser studied to date are the organizational consequences of workplace PTE exposure and associated mental health outcomes such as acute/posttraumatic stress disorder (ASD/PTSD), depression, and anxiety.

METHODS

The present review synthesizes international literature on work outcomes in public safety personnel (PSP) to explore whether and how PTE and trauma-related symptoms relate to workplace outcomes. A total of N = 55 eligible articles examining PTE or trauma-related symptoms in relation to work outcomes were systematically reviewed using best-evidence narrative synthesis.

RESULTS

Three primary work outcomes emerged across the literature: absenteeism, productivity/performance, and costs to organization. Across n = 21 studies of absenteeism, there was strong evidence that PTE or trauma-related symptoms are associated with increased sickness absence. N = 27 studies on productivity/performance demonstrated overall strong evidence of negative impacts in the workplace. N = 7 studies on cost to organizations demonstrated weak evidence that PTE exposure or trauma-related mental health outcomes are associated with increased cost to organization.

CONCLUSIONS

Based on available evidence, the experience of workplace PTE or trauma-related symptoms is associated with negative impact on PSP occupational functioning, though important potential confounds (e.g., organizational strain and individual risk factors) remain to be more extensively investigated.

Estimating Ejection Fraction from the 12 Lead ECG among Patients with Acute Heart Failure

Background

Identifying patients with low left ventricular ejection fraction (LVEF) in the emergency department using an electrocardiogram (ECG) may optimize acute heart failure (AHF) management. We aimed to assess the efficacy of 527 automated 12-lead ECG features for estimating LVEF among patients with AHF.

Method

Medical records of patients >18 years old and AHF-related ICD codes, demographics, LVEF %, comorbidities, and medication were analyzed. Least Absolute Shrinkage and Selection Operator (LASSO) identified important ECG features and evaluated performance.

Results

Among 851 patients, the mean age was 74 years (IQR:11), male 56% (n=478), and the median body mass index was 29 kg/m2 (IQR:1.8). A total of 914 echocardiograms and ECGs were matched; the time between ECG-Echocardiogram was 9 hours (IQR of 9 hours); ≤30% LVEF (16.45%, n=140). Lasso demonstrated 42 ECG features important for estimating LVEF ≤30%. The predictive model of LVEF ≤30% demonstrated an area under the curve (AUC) of 0.86, a 95% confidence interval (CI) of 0.83 to 0.89, a specificity of 54% (50% to 57%), and a sensitivity of 91 (95% CI: 88% to 96%), accuracy 60% (95% CI:60 % to 63%) and, negative predictive value of 95%.

Conclusions

An explainable machine learning model with physiologically feasible predictors may be useful in screening patients with low LVEF in AHF.

Occurrence of Transient Myocardial Ischemic Events among Non-ST Segment Elevation Acute Coronary Syndrome Patients Before or After Invasive Coronary Angiography

BACKGROUND

The occurrence of transient myocardial ischemia (TMI) is an important pathology in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), yet studies are scarce regarding when TMI occurs during hospitalization, particularly in relation to invasive coronary angiography (ICA). This study examined: (1) TMI before or after ICA; (2) patient characteristics and ischemic burden by TMI group (before or after ICA); and (3) major in-hospital complications (transfer to critical care, death) and length of stay (LOS) by TMI group (before or after ICA).

METHODS

Secondary data analysis in hospitalized NSTE-ACS patients with TMI event(s) identified from 12-lead electrocardiographic (ECG) Holter. Patient records were reviewed to assess ischemic burden (TMI time [minutes] ÷ hours recording duration), outcomes and TMI timing, before or after ICA.

RESULTS

In 38 patients, 3 (8%) had TMI before and after ICA. Of the remaining 35 patients (92%), TMI occurred before ICA (16; 46%), and after ICA (9; 26%), and 10 (28%) did not have ICA. Patient characteristics, untoward outcomes, and TMI duration (minutes) did not differ by group. Ischemic burden was higher in patients with TMI after ICA (7.29±8.82 min/hr) compared to before ICA (2.54±2.11 min/hr), p=0.039. Hospital LOS by TMI group was 113±113 (before), 226±244 (after), and 85±65 hr (no ICA); p=0.172.

CONCLUSION

Almost half of the sample had TMI before ICA; one-third had TMI but did not have ICA. Patients with TMI after an ICA had higher ischemic burden. Future studies with larger sample sizes are needed to investigate further the short- and long-term clinical significance of TMI among NSTE-ACS patients.

Disparities in 30-Day Readmission Between Medicare/Medicaid and Private Insurance Among Patients With Heart Failure Screened for Cognitive Impairment

BACKGROUND

Racial disparities exist among patients with heart failure (HF). HF is often comorbid with cognitive impairment. Appropriate self-care can prevent HF hospital readmissions but requires access to resources through insurance. Racial differences exist between insurance types, and this may influence the disparity between races and patients with HF and cognitive impairment.

OBJECTIVE

The objectives of this study were to examine the relationships between insurance type and self-care stratified by race and to assess for differences in time-to-30-day readmission among patients with HF with cognitive impairment.

METHODS

This is a secondary analysis of data collected among hospitalized patients with HF with cognitive impairment. Patients completed surveys on self-care (Self-Care of Heart Failure Index), HF knowledge (Dutch Heart Failure Knowledge Scale), depression (Geriatric Depression Scale), and social support (Enhancing Recovery in Coronary Heart Disease Social Support Inventory). Socioeconomic data were collected. Linear models were created to examine the relationships between insurance type and self-care by race. Kaplan-Meier curves and Cox regression were used to assess readmission.

RESULTS

The sample of 125 patients with HF with cognitive impairment was predominantly Black (68%, n = 85) and male (53%, n = 66). The sample had either Medicare/Medicaid (62%, n = 78) or private insurance (38%, n = 47). Black patients with HF with cognitive impairment and private insurance reported higher self-care confidence compared with Black patients with HF with cognitive impairment and Medicare/Medicaid (P < .05). Medicare/Medicaid was associated with a higher frequency of 30-day readmission and a faster time-to-readmission.

CONCLUSIONS

Patients with HF with cognitive impairment and Medicare/Medicaid insurance reported lower self-care confidence and more likely to be readmitted within 30 days.

The Effect of Mandatory Fitness Requirements on Cardiovascular Events: A State-by-State Analysis Using a National Database

BACKGROUND

Cardiovascular events are known to be the leading cause of death among on-duty firefighters. Implementing fitness standards may help reduce the incidence of cardiovascular deaths; however, standards vary between firefighter type and states. We aimed to investigate the rate of cardiovascular events among firefighters across states.

METHODS

Using publicly available data from the United States Fire Administration, we explored the rates of cardiovascular deaths between firefighter type (e.g., career, volunteer, and wildland) and state. Specifically, we examined rates of cardiovascular deaths between California and Tennessee, which have fitness standards for all firefighters, and New York, which does not have fitness standards for volunteer firefighters. We used descriptive statistics and trend analysis to examine the data.

FINDINGS

Most cardiovascular events occur among volunteer firefighters (60.6%, n = 877). Volunteer firefighters had 7.5 (95% CI = [4.8, 11.7], p < .001) greater odds of cardiovascular events compared to wildland firefighters, who had the lowest incidence of cardiovascular events (1.7%, n = 24). New York reported the most cardiovascular events (n = 161), primarily among volunteer firefighters (73.9%, n = 119). After the passage of legislation mandating fitness standards in California, a downtrend in the number of volunteer firefighter fatalities is observed. However, a null effect was observed in Tennessee after the passage of similar fitness standards as in California.

CONCLUSIONS/APPLICATIONS TO PRACTICE

Volunteer firefighters are significantly more likely to die of a cardiovascular event than career and wildland firefighters, both of which have stricter fitness standards. However, the effect of legislation mandating stricter fitness standards among volunteers did not produce a clear benefit for preventing fatalities. Nurses need to promote cardiovascular health among volunteer firefighters.

Signs and Symptoms Clusters Among Patients With Acute Heart Failure: A Correlational Study

BACKGROUND

Patients with acute heart failure present to the emergency department with a myriad of signs and symptoms. Symptoms evaluated in clusters may be more meaningful than those evaluated individually by clinicians.

OBJECTIVE

Among emergency department patients, we aimed to identify signs and symptoms correlations, clusters, and differences in clinical variables between clusters.

METHODS

Medical record data included adults older than 18 years, International Classification of Diseases, Tenth Revisions codes , and positive Framingham Heart Failure Diagnostic Criteria. Exclusion criteria included medical records with a ventricular assist device and dialysis. For analysis, correlation, and the Gower distance, the independent t test, Mann-Whitney U test, χ 2 test, and regression were performed.

RESULTS

A secondary analysis was conducted from the data set to evaluate door-to-diuretic time among patients with acute heart failure in the emergency department. A total of 218 patients were included, with an average age of 69 ± 15 years and predominantly White (74%, n = 161). Two distinct symptom clusters were identified: severe and mild congestion. The severe congestion cluster had a more comorbidity burden compared with the mild congestion cluster, as measured by the Charlson Comorbidity index (cluster 1 vs cluster 2, 6 [5-7] vs 5 [4-6]; P = .0019). Heart failure with preserved ejection fraction was associated with the severe congestion symptom cluster ( P = .009), and heart failure with mildly reduced ejection fraction was associated with the mild congestion cluster ( P = .019).

CONCLUSIONS

In conclusion, 2 distinct symptom clusters were identified among patients with acute heart failure. Symptom clusters may be related to ejection fraction or overall cardiac output and comorbidity burden.

Trends in NIH-funding to schools of nursing in the last 17 years

BACKGROUND

Growing clinical demands, faculty retirements, fewer PhD-prepared graduates, and funding instability are challenges for nursing science.

PURPOSE

The purpose of this analysis was to investigate National Institutes of Health (NIH) funding patterns in schools of nursing (SONs).

METHODS

Data were extracted from the Blue Ridge Institute for Medical Research between 2006 and 2022. Growth modeling examined changes in funding over time between private and public SONs.

DISCUSSION

In the last 17 years, NIH funding for SONs has risen nearly 25% but remains only 1% of the total NIH budget for extramural research. Overall, 109 (75%) of the SONs were public and 36 (25%) were private institutions. Regarding geography, 90% of the States received NIH funding except six: ID, ME, MS, NH, VT, and WY. Private SONs consistently received more funding than public SONs but the difference was only statistically significant in 2022.

CONCLUSION

NIH funding has significantly increased to SONs, there is better geographic distribution but a funding disparity exists between public and private SONs.

Integrative review of electrocardiographic characteristics in patients with reduced, mildly reduced, and preserved heart failure

INTRODUCTION

Electrocardiographic (ECG) changes in heart failure with reduced, mildly reduced, and preserved ejection fractions can be critical in clinical assessment while waiting to perform echocardiograms or when it is unavailable. This integrative review aimed to identify ECG characteristics among hospitalized patients demonstrating three types of heart failure during acute decompensation.

METHODS

We searched an electronic database of PubMed, Web of Science, EMBASE, Scopus, Google Scholar, and ClinicalTrials.gov using medical subject headings (MeSH) terms and keywords. Sixteen studies were synthesized and reported.

RESULTS

Heart failure with reduced ejection fraction (HFrEF) was more common in men, comorbid with coronary artery diseases and diabetes mellitus, higher BNP/Pro-BNP, wide QRS, and left bundle branch block on ECG. On average, clients with heart failure with preserved ejection fraction (HFpEF) were older and more likely to have a history of atrial fibrillation, valvular heart diseases, hypertension, chronic obstructive pulmonary, and atrial fibrillation (AF) on ECG. Patients with mildly reduced (HFmrEF) were more similar to HFpEF in older patients, comorbid with hypertension, AF and valvular diseases, and AF on ECG.

CONCLUSIONS

ECG characteristics might be related to left ventricular ejection fraction. Demographics, BNP/Pro-BNP, and ECG changes might help differentiate different heart failure types. Therefore, ECG might be a prognostic tool while caring for heart failure patients when highly skilled resources are unavailable. These identified ECG characteristics help generate research hypotheses and warrant validation in future research.

Ventricular tachycardia and in-hospital mortality in the intensive care unit

Background

Continuous electrocardiographic (ECG) monitoring is used to identify ventricular tachycardia (VT), but false alarms occur frequently.

Objective

The purpose of this study was to assess the rate of 30-day in-hospital mortality associated with VT alerts generated from bedside ECG monitors to those from a new algorithm among intensive care unit (ICU) patients.

Methods

We conducted a retrospective cohort study in consecutive adult ICU patients at an urban academic medical center and compared current bedside monitor VT alerts, VT alerts from a new-unannotated algorithm, and true-annotated VT. We used survival analysis to explore the association between VT alerts and mortality.

Results

We included 5679 ICU admissions (mean age 58 ± 17 years; 48% women), 503 (8.9%) experienced 30-day in-hospital mortality. A total of 30.1% had at least 1 current bedside monitor VT alert, 14.3% had a new-unannotated algorithm VT alert, and 11.6% had true-annotated VT. Bedside monitor VT alert was not associated with increased rate of 30-day mortality (adjusted hazard ratio [aHR] 1.06; 95% confidence interval [CI] 0.88-1.27), but there was an association for VT alerts from our new-unannotated algorithm (aHR 1.38; 95% CI 1.12-1.69) and true-annotated VT(aHR 1.39; 95% CI 1.12-1.73).

Conclusion

Unannotated and annotated-true VT were associated with increased rate of 30-day in-hospital mortality, whereas current bedside monitor VT was not. Our new algorithm may accurately identify high-risk VT; however, prospective validation is needed.

Correlates of Autonomic Function, Hemodynamics, and Physical Activity Performance During Exercise Stress Testing Among Firefighters

BACKGROUND

Autonomic dysfunction is an important propagator of cardiometabolic disease and can be measured using multiple metrics such as heart rate variability (HRV) and heart rate recovery (HRR). The relationships between HRV and HRR have not been fully examined, nor have the relationships between HRV, HRR, and other physiological measures linked to cardiometabolic disease (e.g., blood pressure recovery). Evaluation of these additional relationships may provide new insights into the association between autonomic function and cardiometabolic disease especially among high-risk groups like firefighters.

METHODS

92 firefighters (96% male, 81% white) without overt cardiovascular disease underwent exercise testing with continuous heart rate (HR) and blood pressure (BP) monitoring. HRR was the difference between maximal HR and HR 1-minute post-exercise; BP recovery (BPR) was the difference between maximal BP and BP 2-minute post-exercise. Afterwards, participants underwent 24-hour electrocardiographic monitoring to measure HRV. Unadjusted Spearman correlations and adjusted partial Spearman correlations were computed. Between group analyses were also conducted with Kruskal-Wallis test.

RESULTS

Associations between HRV and HRR poorly converged (RMSSD and HRR, unadjusted = 0.235; adjusted = 0.144). SDNN Index exhibited the strongest association with parasympathetic tone exhibited by overall lower HRs (unadjusted = -0.600; adjusted = -0.631). HRR demonstrated stronger associations with systolic and diastolic BP responses during exercise (SBP Recovery unadjusted = 0.267; adjusted = 0.297; DBP Recovery unadjusted = -0.276; adjusted = -0.232).

CONCLUSIONS

Overall, while HRV metrics converged and were associated with lower resting heart rates, HRV and HRR poorly converged. Interestingly, HRR was related with measures of hemodynamics indicating a potential relationship with vascular function during both maximal exercise and exercise recovery.

Secondary electrocardiographic stratification of NSTEMI to identify an acutely occluded culprit artery

In the United States, approximately 720,000 adults will experience a myocardial infarction (MI) every year. The 12-lead electrocardiogram (ECG) is quintessential for the classification of a MI. About 30% of all MIs exhibit ST-segment elevation on the 12-lead ECG and is therefore classified as an ST-Elevation Myocardial Infarction (STEMI), which is treated emergently with percutaneous coronary intervention to restore blood flow. However, in the remaining 70% of MIs, the 12-lead ECG lacks ST-segment elevation and instead exhibits a motley of changes, including ST-segment depression, T-wave inversion, or, in up to 20% of patients, have no changes whatsoever; as such, these MIs are classified as a Non-ST Elevation Myocardial Infarction (NSTEMI). Of this large cluster of MIs, 33% of NSTEMI actually have an occlusion of the culprit artery consistent with a Type I MI per the 4th Universal Definition of MI. This is a serious clinical problem because NSTEMI with an occluded culprit artery have similar myocardial damage like STEMI and are more likely to suffer from adverse outcomes compared to NSTEMI without an occluded culprit artery. &#xD;&#xD;In this review article, we review the extant literature on NSTEMI with an occluded culprit artery. Afterward, we generate and discuss hypotheses for the absence of ST-segment elevation on the 12-lead ECG: (1) Transient Occlusion (2) Collateral Blood Flow and Chronically Occluded Artery and (3) ECG-Silent Myocardial Regions. Lastly, we describe and define novel ECG features that are associated with an occluded culprit artery in NSTEMI which include T-wave morphology abnormalities and novel markers of ventricular repolarization heterogeneity.&#xD.

An annotated ventricular tachycardia (VT) alarm database: Toward a uniform standard for optimizing automated VT identification in hospitalized patients

BACKGROUND

False ventricular tachycardia (VT) alarms are common during in-hospital electrocardiographic (ECG) monitoring. Prior research shows that the majority of false VT can be attributed to algorithm deficiencies.

PURPOSE

The purpose of this study was: (1) to describe the creation of a VT database annotated by ECG experts and (2) to determine true vs. false VT using a new VT algorithm created by our group.

METHODS

The VT algorithm was processed in 5320 consecutive ICU patients with 572,574 h of ECG and physiologic monitoring. A search algorithm identified potential VT, defined as: heart rate >100 beats/min, QRSs > 120 ms, and change in QRS morphology in >6 consecutive beats compared to the preceding native rhythm. Seven ECG channels, SpO₂ , and arterial blood pressure waveforms were processed and loaded into a web-based annotation software program. Five PhD-prepared nurse scientists performed the annotations.

RESULTS

Of the 5320 ICU patients, 858 (16.13%) had 22,325 VTs. After three levels of iterative annotations, a total of 11,970 (53.62%) were adjudicated as true, 6485 (29.05%) as false, and 3870 (17.33%) were unresolved. The unresolved VTs were concentrated in 17 patients (1.98%). Of the 3870 unresolved VTs, 85.7% (n = 3281) were confounded by ventricular paced rhythm, 10.8% (n = 414) by underlying BBB, and 3.5% (n = 133) had a combination of both.

CONCLUSIONS

The database described here represents the single largest human-annotated database to date. The database includes consecutive ICU patients, with true, false, and challenging VTs (unresolved) and could serve as a gold standard database to develop and test new VT algorithms.

Methodological correlates of variability in the prevalence of posttraumatic stress disorder in high-risk occupational groups: A systematic review and meta-regression

BACKGROUND

Although numerous studies have reported on PTSD prevalence in high-risk occupational samples, previous meta-analytic work has been severely limited by the extreme variability in prevalence outcomes.

METHODS

The present systematic review and meta-regression examined methodological sources of variability in PTSD outcomes across the literature on high-risk personnel with a specific focus on measurement tool selection.

RESULTS

The pooled global prevalence of PTSD in high-risk personnel was 12.1% [6.5%, 23.5%], and was similar to estimates obtained in other meta-analytic work. However, meta-regression revealed that PTSD prevalence differed significantly as a function of measurement tool selection, study inclusion criteria related to previous traumatic exposure, sample size, and study quality. PTSD prevalence estimates also differed significantly by occupational group and over time, as has also been reported in previous work, though exploratory examination of trends in measurement selection across these factors suggests that measurement strategy may partially explain some of these previously reported differences.

CONCLUSIONS

Our results highlight a pressing need to better understand the role of measurement strategies and other methodological choices in characterizing variable prevalence outcomes. Understanding the role of methodological variance will be critical for work attempting to reliably characterize prevalence as well as risk and protective factors for PTSD.

The Use of Interactive Technology to Improve Student Accuracy on Electrocardiographic Interpretation

ABSTRACT

Electrocardiography (ECG) instruction relies heavily on memorization of interpretation rules and lacks opportunities for hands-on practice. Consequently, nursing students struggle with ECG interpretation. In an online undergradute nursing course, we implemented interactive technology to facilitate kinesthetic pedagogy. Accuracy was evaluated at midterm and during final assessments by two experts using a standardized rubric. Students who engaged with interactive technology at both assessments demonstrated consistent accuracy of ECG interpretation; students who did not failed to demonstrate consistent accuracy with ECG interpretation. Incorporating interactive technology to facilitate psychomotor learning may be essential in improving the accuracy of ECG interpretation.

Delays in Door-to-Diuretic Time and 1-Year Mortality Among Patients With Heart Failure

BACKGROUND

Achieving prompt euvolemic state in heart failure (HF) is associated with reduced mortality. Time-sensitive metrics such as door-to-diuretic time , or the time between presentation and administration of intravenous diuretics, may be an important facilitator of achieving a faster euvolemic state and reducing mortality.

OBJECTIVE

The aim of this study was to investigate whether reduced door-to-diuretic time was associated with lower odds of death among hospitalized patients with HF.

METHODS

A retrospective chart review of patients with HF admitted to a medical center was performed between 2020 and 2021. Inclusion criteria were an International Classification of Diseases, 10th Revision code for HF with positive Framingham Criteria and the use of intravenous bolus furosemide. Exclusion criteria included ventricular assist devices, dialysis, and ultrafiltration therapy. Data collected from the medical records included demographics, echocardiography, staff notes, and medications. The end point was 1-year all-cause mortality. Descriptive statistics, t tests or median test, and multivariate logistic regression were used to describe the sample, evaluate group differences, and determine odds of mortality, respectively.

RESULTS

Among 160 charts from patients with HF (age, 70 ± 14.4 years; 52%, n = 83, male; 53%, n = 85, ischemic cardiomyopathy; 83%, n = 134, New York Heart Association classes III-IV), 30% (n = 48) died within 1 year. The median diuretic dose was 40 mg (interquartile range, 20 mg), with a median time of administration of 247 minutes (4.12 hours) (interquartile range, 294 minutes to 4.9 hours). After covariate adjustment, prolonged door-to-diuretic time more than doubled (2.22; 95% confidence interval, 1.03-4.8; P = .04) the odds of 1-year mortality.

CONCLUSIONS

On the basis of this sample of charts from older highly symptomatic patients with HF, delayed door-to-diuretic time was associated with significantly greater odds of 1-year all-cause mortality.

Use of Diaries for Family Members of Intensive Care Unit Patients to Reduce Long-Term PTSD: A Pilot Study

Many family members whose loved ones stay in the intensive care unit (ICU) have post-traumatic stress disorder (PTSD) after the hospitalization. A mixed-methods longitudinal randomized trial studying family members of medical ICU (MICU) patients was conducted. Participants were randomized into 2 groups (intervention and control). Post-traumatic stress symptoms checklist-14 scores for the intervention group trended downward over time, but no differences were detected in PTSD risk between the intervention and control groups. The ICU experience for family members is traumatizing. A simple gesture of providing ICU diaries for them to use during the ICU stay may help reduce their emotional burden and requires further investigation.

PREVALENCE AND PREDICTORS OF POSTTRAUMATIC STRESS DISORDER, DEPRESSION, AND ANXIETY IN PERSONNEL WORKING IN EMERGENCY DEPARTMENT SETTINGS: A SYSTEMATIC REVIEW

BACKGROUND

Professionals working in the emergency department (ED) are regularly exposed to traumatic events. Rates of posttraumatic mental health conditions vary widely in the literature and there is no agreement that rates in ED staff are elevated relative to other populations.

OBJECTIVE

We conducted a systematic review of international literature reporting prevalence of posttraumatic stress disorder (PTSD), depression, and anxiety in ED personnel to determine whether prevalence is elevated compared to the general community, and to evaluate convergent evidence across the literature for predictive factors. To our knowledge, there is no comprehensive review on this topic in the literature at this time.

METHODS

Seven databases were searched for studies reporting rates of PTSD, depression, and anxiety in ED personnel. Two independent researchers screened studies and assessed quality using Munn's Prevalence Critical Appraisal Instrument. Best-evidence synthesis determined whether conditions demonstrated elevated prevalence compared to the general population of Canada, a conservative benchmark.

RESULTS

Twenty-four studies from 12 countries and a combined sample size of 4768 were included. PTSD rates ranged from 0% to 23.6% (mean 10.47%), depression ranged from 0.7% to 77.1% (mean 24.8%), and anxiety rates ranged from 2.4% to 14.6% (mean 9.29%). Each condition was elevated compared to the general population. Sociodemographic variables were not consistent predictors. Elevated PTSD seemed most strongly related to workplace exposure and maladaptive coping.

CONCLUSIONS

ED professionals have an elevated risk of experiencing PTSD, depression, and anxiety. Identification of organizational and workplace predictors are needed to inform interventions that will reduce risk and provide optimal treatment and management of PTSD, depression, and anxiety in ED settings.

Mindfulness for Outpatient Oncology Nurses: A Pilot Study

This prospective pre-/posttest pilot studied a mindfulness-based stress reduction (MBSR) intervention first, to reduce self-reported stress and improve compassion satisfaction; and second, to reduce physiological indices of stress. Even small interventions of MBSR before a shift effectively reduces the physiological indices of stress and may help reduce compassion fatigue and burnout in nurses.

Nursing Care for the Initial Resuscitation of Severe Sepsis Patients

Sepsis is recognized as a major health care problem worldwide. In the United States, mortality from severe sepsis and septic shock remains a serious health problem; yet, the early recognition of sepsis by nurses reduces can reduce mortality, morbidity, and long-term consequences of sepsis for patients. Improving the knowledge of nurses to first recognize the early signs of sepsis and then how to apply the most up-to-date evidence-based treatments can improve outcomes. Enhanced monitoring includes the use of computerized early warning systems to alert nurses of worrisome clinical patterns and promote the early recognition of sepsis.

Nursing Care for the Initial Resuscitation of Burn Patients

Serious burn injuries may have lifelong impacts for individuals that experience them and require timely medical treatment in order to reduce associated morbidity and mortality. Initial management of a burn is nursing intensive and focuses primarily on stopping the burning process, maintaining homeostasis by keeping the patient warm, and replacing lost fluid and electrolytes. As healing progresses, nurses meet the critical needs of the patient and must skillfully manage pain levels, perform burn care, prevent infection, help the patient meet increased nutrient requirements, and address psychological concerns with the goal to restore health and function to the highest possible level.

Severity of Myocardial Ischemia Is Related to Career Length Rather Than Age Among Professional Firefighters

BACKGROUND

Ischemic heart disease (IHD) is the major cause of duty-related fatalities in the fire service. Age and career length are not only important risk factors associated with IHD, but are also highly correlated. The aim of this secondary analyses was to assess the relationship between age, career length, and IHD, based on ischemic severity, to identify whether age or career length had a stronger relationship to IHD.

METHODS

This was a secondary, correlational analysis of on-duty firefighters without known cardiovascular or respiratory disease who underwent exercise treadmill testing with 12-lead electrocardiography. Ischemia was defined based on current guidelines. Maximum ST-segment depression was measured to determine IHD ischemic severity. Age, years of employment, demographics, weight, blood pressure were recorded. Multiple correlations were computed between age, career length, and IHD.

FINDINGS

Twenty-two firefighters were included (96% male, 82% White, 82% overweight or obese, 77% hypertensive). The partial correlation between maximum ST-segment depression and age controlled for career length was not significant (r = -.392, p = .079). The partial correlation between maximum ST-segment depression and career length controlled for age was statistically significant (r = .466, p = .033).

CONCLUSION/APPLICATION TO PRACTICE

Career length, not age, moderately correlates with IHD ischemic severity among firefighters. Career length is a proxy measure of occupational exposures which contributes to IHD. When assessing IHD risk in firefighters, health practitioners should consider incorporating the occupational exposure history (i.e., career length) in addition to age when providing risk reduction services.

The prevalence of PTSD, major depression and anxiety symptoms among high-risk public transportation workers

OBJECTIVE

Public transportation workers are exposed to higher levels of stress related to accidents, injuries, and person-under-train events when compared to other workers. This systematic review integrates the existing literature on mental health among high-risk public transportation workers to estimate the prevalence of post-traumatic stress disorder (PTSD), major depressive and anxiety symptoms following critical incidents while on duty.

METHODS

This systematic review is part of a larger systematic review which examines mental health and work outcomes of individuals working in professions at high risk of critical incident exposure, i.e., high-risk professions. Articles were included if they measured the prevalence of PTSD, Major Depressive Disorder (MDD) and Anxiety Disorder (AD) in a transportation population following exposure to a major incident, for example, a person-under-a-train.

RESULTS

Among the ten articles, all reported prevalence of PTSD which ranged from 0.73 to 29.9%. Four articles reported prevalence of depression among transportation workers exposed to a critical incident and prevalence outcomes ranged from 0.05 to 16.3%. Only two reported prevalence of anxiety from 1.3 to 13.9%.

CONCLUSIONS

This literature reports that transportation workers are prone to involvement in traumatic accidents leading to higher rates of PTSD compared to the general population. Strategies to reduce transportation accidents and to provide transportation workers follow-up mental health support is needed for this vulnerable population.

An eye toward the future: Pressing questions for our discipline in today's academic and research climate

This paper seeks to open a dialogue concerning the current trend in hiring non-nurse faculty (NNF) to tenure track positions in schools/colleges of nursing. The evolution of non-nurses as faculty, including a review of contemporary papers in affecting this trend, is offered. Three means of involving non-nurses in advancing our discipline are presented. The impact of the growing trend of NNF is discussed relative to the integrity of our discipline and effects on education. We conclude by suggesting a manner of proceeding and raise questions for furthering dialogue.

Systematic review of posttraumatic stress disorder in police officers following routine work-related critical incident exposure

BACKGROUND

The prevalence of PTSD in police officers has been the subject of a large and highly variable empirical literature. The present systematic review evaluates the extant literature on PTSD in police officers using an international dataset.

METHODS

We employed best-evidence narrative synthesis to evaluate whether PTSD prevalence in police is elevated in comparison to the general population of Canada (8%), which itself has a higher lifetime PTSD prevalence than many other regions and thus serves as a conservative standard of comparison.

RESULTS

PTSD prevalence in police varied considerably across studies from 0% - 44% (M = 14.87%, Median = 9.2%). Despite this variability, strong evidence exists to suggest PTSD prevalence is elevated in police officers. Examination of possible sources of variability in prevalence outcomes highlighted substantial variability in outcomes due to the selection of measurement tool for assessing PTSD (e.g., DSM vs. IES). Examination of commonly-assessed predictive factors for PTSD risk across the literature showed that individual-difference factors (e.g., age, years of service) bear weak-to-nonexistent relationships with PTSD risk, while incident-specific factors (e.g., severity of exposure) are more strongly and consistently associated with PTSD prevalence. Organizational factors (e.g., low support from supervisor) are at present understudied but important possible contributors to PTSD risk.

CONCLUSIONS

PTSD prevalence is elevated in police officers and appears most strongly related to workplace exposure. Measurement variability remains a critical source of inconsistencies across the literature with drastic implications for accurate detection of officers in need of mental health intervention.

Exercise-Induced Premature Ventricular Contractions Are Associated With Myocardial Ischemia Among Asymptomatic Adult Male Firefighters: Implications for Enhanced Risk Stratification

BACKGROUND

Exercise-induced premature ventricular contractions (EI-PVCs) are associated with an increased risk of cardiovascular disease among asymptomatic adult males, but the underlying mechanisms remain understudied. Myocardial ischemia due to cardiovascular disease reduces coronary blood flow, may impair exercise performance, and initiates EI-PVCs; thus, EI-PVCs may be an early indicator of cardiovascular disease.

OBJECTIVE

The objective of this study was to determine whether EI-PVCs are associated with myocardial ischemia and reduced exercise performance among asymptomatic adult firefighters.

METHODS

Asymptomatic adult firefighters free of known cardiovascular disease underwent exercise treadmill testing. A 12-lead electrocardiography was placed on participants for 24 hr afterward to measure EI-PVCs in recovery. Univariate and multivariate binary logistic regression models were used to assess the odds of myocardial ischemia. Sensitivity and specificity analyses were conducted. Statistical significance was set at p < .05.

RESULTS

Participants comprised 86 asymptomatic adult males. The prevalence of myocardial ischemia was 30.8%. A single EI-PVC was associated with myocardial ischemia (χ² = 8.98; p = .003). EI-PVC remained a significant predictor despite adjustment for other cardiovascular risks (odds ratio = 4.281, p = .038). Although not statistically significant, the EI-PVC group achieved lower total exercise time (11.4 ± 2.9 vs. 12.4 ± 3.0 min, p = .13), lower metabolic equivalent of tasks (METs; 11.6 ± 2.6 vs. 12.8 ± 2.3 METs, p = .06), and a lower maximum exercise speed (4.4 ± 0.7 vs. 4.7 ± 0.8 miles/hr, p = .07).

DISCUSSION

EI-PVCs are associated with myocardial ischemia among asymptomatic male firefighters, providing additional evidence of the association between EI-PVCs and myocardial ischemia and suggesting EI-PVCs as an early indicator of cardiovascular disease.