Day and Time of Admission to ICU Affects Patient Outcome: An Illogical Belief?

How to cite this article: Krishna B. Day and Time of Admission to ICU Affects Patient Outcome: An Illogical Belief? Indian J Crit Care Med 2024;28(5):414-415.

The association between midwifery staffing and reported harmful incidents: a cross-sectional analysis of routinely collected data

BACKGROUND

Independent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies.

METHODS

We conducted a cross-sectional analysis of daily reports of clinical incidents in maternity inpatient areas matched with inpatient staffing levels for three maternity services in England, using data from April 2015 to February 2020. Incidents resulting in harm to mothers or babies was the primary outcome measure. Staffing levels were calculated from daily staffing rosters, quantified in Hours Per Patient Day (HPPD) for midwives and maternity assistants. Understaffing was defined as staffing below the mean for the service. A negative binomial hierarchical model was used to assess the relationship between exposure to low staffing and reported incidents involving harm.

RESULTS

The sample covered 106,904 maternal admissions over 46 months. The rate of harmful incidents in each of the three services ranged from 2.1 to 3.0 per 100 admissions across the study period. Understaffing by registered midwives was associated with an 11% increase in harmful incidents (adjusted IRR 1.110, 95% CI 1.002,1.229). Understaffing by maternity assistants was not associated with an increase in harmful incidents (adjusted IRR 0.919, 95% 0.813,1.039). Analysis of specific types of incidents showed no statistically significant associations, but most of the point estimates were in the direction of increased incidents when services were understaffed.

CONCLUSION

When there is understaffing by registered midwives, more harmful incidents are reported but understaffing by maternity assistants is not associated with higher risk of harms. Adequate registered midwife staffing levels are crucial for maintaining safety. Changes in the profile of maternity service workforces need to be carefully scrutinised to prevent mothers and babies being put at risk of avoidable harm.

Obstetric anaesthesiology: manpower and service provision issues in India

Obstetric anaesthesiologists play a pivotal role as peripartum physicians steering the team of obstetric healthcare providers towards a continuum of medical education, enhanced training and safer patient care. However, in resource-limited countries, deficiency of human resources and hence services available poses challenges to those attempting to reduce maternal mortality rates. Measures to fill the gap include creating a cadre of uniformly well-trained and certified non-physician anaesthesia providers (NPAPs) supervised by a physician obstetric anaesthesiologist and well-equipped rural and urban health care facilities. The Association of Obstetric Anaesthesiologists of India needs to upscale their outreach programs with regular knowledge updates and practical skill training to the NPAPs, medical graduates and postgraduate doctors in these regions. A combination of strong local administrative will, legislation for the provision of essential supplies and a global collaborative effort using checklists and protocols may help to stem gaps in the provision of safe maternal care.

Obstetric anaesthesia manpower and service provision issues (introduction and European perspective)

Global health is an important and far-reaching concept in which health and access to surgical and anaesthetic care is crucial. Universal access to anaesthesia is a challenge in many countries. Manpower shortages are an important cause of difficulties and each European country has found different ways of facing a lack of healthcare professionals. In obstetric anaesthesia, the availability of competent anaesthesiologists has been related to the morbidity and mortality outcomes of patients. In this narrative review, authors from different European countries explain how manpower is managed in obstetric anaesthesia in delivery suites and obstetric operating rooms in different settings. To address manpower difficulties and issues, the goals are to achieve a minimum standard of care and at the same time, to promote clinical excellence through training, delegation to younger or less experienced colleagues, direct or at-a-distance supervision, or other means. The experience of sharing knowledge about the way in which manpower and service provision are organised in other healthcare settings is a significant opportunity to develop strategies for advancing tomorrow's obstetric anaesthesia in the world. While taking into account the level of socio-economic development in different countries, the aim is to standardise practice and workload organisation. Co-operative international projects in training and education in obstetric anaesthesia are ways in which better obstetric patient care can be achieved in the future.

Evaluating workload and manpower planning among pediatric emergency department nurses in Turkey during COVID-19: A cross-sectional, multicenter study

PURPOSE

Quality nursing care in pediatric emergency departments (PEDs) can be achieved only through sustained workload-based manpower planning. The purpose of this paper to evaluate perceptions of workload and manpower planning in the PED setting in Turkey from the nurses' point of view.

DESIGN AND METHODS

This cross-sectional, multicenter study that was conducted among 187 nurses working in a PED setting in Turkey between June and September 2021. Data were collected using a questionnaire that measured nurses' perceptions of workload and manpower planning. The reporting of this study adhered to STROBE guidelines.

RESULTS

The majority of the respondents perceived the number of patients-per-nurse during a shift to be too high, the number of nurses to be insufficient in proportion to the workload, and the nursing manpower-planning to be insufficient and biased. Those with ≤1 year of nursing experience in the PED perceived an increased workload and more burnout during the COVID-19 pandemic period.

CONCLUSIONS

Nurses working in PED setting perceived the workload and manpower planning to be inadequate. In addition, nurses who were less experienced or felt burnout perceived their workload to be increased during the COVID-19 pandemic.

PRACTICE IMPLICATIONS

Further exploration of workload and manpower planning in PEDs is required. Quantifying nurses' perspectives of workload and manpower when managing emergency pediatric patients is essential for designing appropriate interventions to improve the working environment. Future studies should focus on comparing nurses' perceptions with actual workloads and manpower planning in PEDs using appropriate measurement tools.

Rheumatology manpower in the public system in Catalonia (Spain)

OBJECTIVE

To determine the current state of Rheumatology in Catalonia and to update the information regarding previous studies.

MATERIAL AND METHODS DESIGN

Observational, descriptive and cross-sectional study. Data collection from January to June 2017.

SAMPLE

Rheumatologists practising public healthcare activity in Catalonia. An online questionnaire was sent to gather individual data and data from rheumatology services/sections.

RESULTS

Information was obtained on 109 rheumatologists: 39 men and 70 women; mean age: 47±9 years. The number of rheumatologists has increased by 8% over the past 5 years. One hundred and one (92.7%) doctors qualified as rheumatologists through the MIR. Rheumatology practice was mostly in a hospital setting: 68 (62.4%) physicians. Ninety-six (88.1%) rheumatologists were full-time practitioners. Fifty-four (50%) rheumatologists also practiced in the private sector. Clinical practice was predominant: 76% of daily time was devoted to this area. Of note, it was found that most of the rheumatology services, 24 (705), were dependent hierarchically on other services, namely internal medicine and orthopaedic surgery. There are still 6 hospitals in Catalonia without a rheumatologist.

CONCLUSIONS

The number of rheumatologists in the public health sector of Catalonia has increased over the past 5 years. The mean age of rheumatologists is advanced and there is a clear predominance of female practitioners in the specialty. Many rheumatology services depend on other services. Rheumatology activity is primarily focussed in the city of Barcelona.

Implementation of web-based open-source radiotherapy delineation software (WORDS) in organs at risk contouring training for newly qualified radiotherapists: quantitative comparison with conventional one-to-one coaching approach

BACKGROUND

Due to the role expansion of radiotherapists in dosimetric aspect, radiotherapists have taken up organs at risk (OARs) contouring work in many clinical settings. However, training of newly qualified radiotherapists in OARs contouring can be time consuming, it may also cause extra burden to experienced radiotherapists. As web-based open-source radiotherapy delineation software (WORDS) has become more readily available, it has provided a free and interactive alternative to conventional one-to-one coaching approach during OARs contouring training. The present study aims to evaluate the effectiveness of WORDS in training OARs contouring skills of newly qualified radiotherapists, compared to those trained by conventional one-to-one coaching approach.

METHODS

Nine newly qualified radiotherapists (licensed in 2017 - 2018) were enrolled to the conventional one-to-one coaching group (control group), while 11 newly qualified radiotherapists (licensed in 2019 - 2021) were assigned to WORDS training group (measured group). Ten OARs were selected to be contoured in this 3-phases quantitative study. Participants were required to undergo phase 1 OARs contouring in the beginning of the training session. Afterwards, conventional one-to-one training or WORDS training session was provided to participants according to their assigned group. Then the participants did phase 2 and 3 OARs contouring which were separated 1 week apart. Phase 1 - 3 OARs contouring aimed to demonstrate participants' pre-training OARs contouring ability, post-training OARs contouring ability and knowledge retention after one-week interval respectively using either training approach. To prevent bias, the computed tomography dataset for OARs contouring in each phase were different. Variations in the contouring scores for the selected OARs were evaluated between 3 phases using Kruskal-Wallis tests with Dunn tests for pairwise comparisons. Variations in the contouring scores between control and measured group in phase 1 - 3 contouring were analyzed using Wilcoxon signed-rank test. A p-value < 0.05 was considered to be statistically significant.

RESULTS

In both control group and measured group, significant improvement (p < 0.05) in phase 2 and 3 contouring scores have been observed comparing to phase 1 contouring scores. In comparison of contouring scores between control group and measured group, no significant differences (p > 0.05) were observed in all OARs between both groups.

CONCLUSIONS

The results in this study have demonstrated that the outcome of OARs contouring training using WORDS is comparable to the conventional training approach. In addition, WORDS can offer flexibility to newly qualified radiotherapists to practice OARs contouring at will, as well as reduce staff training burden of experienced radiotherapists.

Improvements in Dental Health and Dentists' Workload in Norway, 1992 to 2015

OBJECTIVES

There has been a marked improvement in dental health in Norway during the last few decades. What effect has this had on provision of dental services, and how has private dental practitioners' assessment of their workload changed?

METHODS

The data were from 2 large surveys of private dental practitioners carried out in 1992 (n = 1056) and 2015 (n = 1237). An analysis of nonresponders showed that they were evenly distributed according to their age, gender, and the region in which their practice was located. Thus, the samples were representative of private dental practitioners. For 1 representative week in practice, the practitioners were asked to report the number of visits and the number of patients who received 1 or more of the following items of treatment: filling, crown, bridge, denture, root filling, extraction, and periodontal treatment. As a measure of patient supply, the responses from the following questions were used: "Based on an overall assessment of economy, workload, and other personal factors, is the number of regular patients adequate? If not, do you wish to have more patients or fewer patients?"

RESULTS

From 1992 to 2015, the annual number of visits per practitioner decreased by 23%. The number of patients per practitioner who received fillings, crowns, bridges, dentures, root fillings, or extractions decreased by 50% or more. The decrease was largest for practitioners younger than 35 years and for men. The proportion of practitioners who reported a deficit of patients increased from 20% to 37%.

CONCLUSIONS

Many dentists will have too few patients and a fall in income in the years to come is expected.

Flattening the World of Pathology Education and Training and Shortening the Curve of Pathology Learning

OBJECTIVES

We review how the pandemic-related education disruption may interplay with pathology manpower worldwide and shifts in disease burden to identify workable solutions.

METHODS

Literature related to pathology education, pathology services in low-resource settings, and application of digital tools to pathology education was reviewed for trends and training gaps. Publications covering pathology manpower and cancer incidence worldwide were also included to assess needs.

RESULTS

Pandemic-related virtual teaching has produced abundant online training materials. Pathology learning resources in low- to middle-income countries remain considerably constrained and dampen pathology manpower growth to meet current needs. Projected increases in disease burden toward the developing world thus pose a major challenge. Digital pathology resources have expanded and are beginning to appear beyond the developed countries.

CONCLUSIONS

This circumstance offers a unique opportunity to leverage digital teaching resources to enhance and equitize training internationally, potentially sufficient to meet the rising wave of noncommunicable diseases. We propose four next steps to take advantage of the current opportunity: curate and organize digital training materials, invest in the digital pathology infrastructure for education and clinical care, expand student exposure to pathology through virtual electives, and develop further competency-based certification pathways.

Gaps in facilities available at Community Health Centers/Rural Hospitals as per Indian public health standards - Study from Western Maharashtra

Background:

The launch of the National Rural Health Mission (NRHM) gives us the opportunity to review the functioning and bring up the Community Health Centers (CHC) services to the level of Indian Public Health Standards and thus improve the lives of citizens.

Objectives:

Assessment of the gaps in the facilities available at Community health centers/Rural hospitals as per Indian Public health standards.

Methods:

Facility based cross-sectional study was conducted in the Satara district of Maharashtra.

Results:

This study in the majority showed that the gap in the delivery of healthcare according to IPHS. It was observed that the Funded CHCs had a better quality of services than the non-funded CHCs. The non-funded CHCs lacked essential emergency services. Along with ANC care, newborn care in the first few minutes of life is very crucial, but very little priority was given to the newborn care as those services were not as per norms. Specialists as well as paramedical and other support staff are deficient in both funded and non funded CHCs/rural hospitals (RHs).

Conclusion:

Standards were greatly influenced by funds delivered by IPHS itself. A staffing pattern is one of the important pillars in delivering various health services. A better salary, working place with continuous water supply, electricity, and cleanliness will improve the staffing pattern. Therefore, competent manpower and well-built infrastructure will help in the standard delivery of healthcare at CHC/RH and will thus serve the purpose of dispensing basic health services to every individual in the remotest areas.

Rheumatology Manpower in the Public System in Catalonia (Spain)

OBJECTIVE

To determine the current state of Rheumatology in Catalonia and to update the information regarding previous studies.

MATERIAL AND METHODS DESIGN

Observational, descriptive and cross-sectional study. Data collection from January to June 2017.

SAMPLE

Rheumatologists practising public healthcare activity in Catalonia. An online questionnaire was sent to gather individual data and data from rheumatology services/sections.

RESULTS

Information was obtained on 109 rheumatologists: 39 men and 70 women; mean age: 47±9 years. The number of rheumatologists has increased by 8% over the past 5 years. One hundred and one (92.7%) doctors qualified as rheumatologists through the MIR. Rheumatology practice was mostly in a hospital setting: 68 (62.4%) physicians. Ninety-six (88.1%) rheumatologists were full-time practitioners. Fifty-four (50%) rheumatologists also practiced in the private sector. Clinical practice was predominant: 76% of daily time was devoted to this area. Of note, it was found that most of the rheumatology services, 24 (705), were dependent hierarchically on other services, namely internal medicine and orthopaedic surgery. There are still 6 hospitals in Catalonia without a rheumatologist.

CONCLUSIONS

The number of rheumatologists in the public health sector of Catalonia has increased over the past 5 years. The mean age of rheumatologists is advanced and there is a clear predominance of female practitioners in the specialty. Many rheumatology services depend on other services. Rheumatology activity is primarily focussed in the city of Barcelona.

Developments in oral health care in the Netherlands between 1995 and 2018

Background

Over the past several decades, changes in legislation and regulations have been implemented in oral health care in the Netherlands. In 1995, for example, a major transformation in the funding of oral health care was implemented, after which most oral health care for adults was no longer covered by national insurance. In 1997, the Individual Healthcare Professions Act, in which the authorizations of care providers were described, was established. The Healthcare Quality, Complaints and Disputes Act, established in 2016, concerns the accountability of professional behavior. Regulations concerning employment have changed several times since 1995. These changes have affected the work and practice situation of oral health care providers.

Methods

Data from many publicly available sources were gathered and combined with internal reports mainly derived from the Data Stations project of the Royal Dutch Dental Association. This project was established in 1995 and, since its initiation, 6716 dentists have participated an average of 6.7 times.

Results

Between 1995 and 2018, nearly all professional groups in oral health care increased, particularly those of dental hygienists and prevention assistants. The number of dental practices decreased, but practices got larger in terms of dental units, number of patients, and personnel. The percentage of inhabitants visiting oral health care professionals remained unchanged, but the type of care provided moved towards more prevention. Oral health care providers exploited new opportunities to enhance and express their professional behavior.

Conclusions

Oral health care in the Netherlands has evolved in recent years toward more collaboration in teams, and professions have established institutions to promote the quality and safety of care. Greater emphasis has been placed on prevention of dental diseases. These processes were influenced by new legislation and regulations, demographic changes within professional groups, and other social developments.

Predicting patient nurse-level intensity for a subsequent shift in the intensive care unit: A single-centre prospective observational study

BACKGROUND

A dynamic optimized nurse staffing model for the Intensive Care Unit (ICU), requires a tool for monitoring nurse-level intensity with validated cut-offs to identify patients requiring 1:1, 2:1 or 3:1 patient-to-nurse ratios.

OBJECTIVES

We aimed to determine the Nursing Activities Score (NAS) cut-off values which can best distinguish between high, average and lower nurse-level intensity as unanimously perceived by care providers, and to evaluate whether these NAS cut-offs allow to predict nurse-level intensity in the next shift or the same shift the next day.

DESIGN

A prospective observational study.

SETTING

9 ICUs in a Belgian tertiary care center.

PARTICIPANTS

All 3295 patients admitted between March 20, 2013, and September 12, 2013 were included. NAS was quantified at the end of each shift using automatically derived and manually entered care information. Additionally, 412 nurses, 24 nurse managers and 37 physicians rated perceived nurse-level intensity.

METHODS

We first assessed concordance between nurses', nurse managers' and physicians' perceptions of lower (3:1 patient-to-nurse ratio), average (2:1 patient-to-nurse ratio) and high (1:1 patient-to-nurse ratio) nurse-level intensity. Next, receiver operating characteristic (ROC) analysis was applied to determine the NAS cut-offs that best distinguish between different levels of perceived intensity for cases with concordant opinions. Last, logistic regression analysis was applied to estimate the ability of these NAS cut-offs to predict low and high perceived intensity during the next shift and during the same shift the next day.

RESULTS

Nurses', nurse managers' and physicians' perceptions were concordant in 57.1% (n = 4693) of cases, mostly concerning lower or average intensity. Optimal NAS cut-offs for lower and high intensity patients equaled 52.7% and 69.8%, respectively. The lower intensity NAS cut-off showed 74.0% accuracy to predict lower intensity in the next shift and 75.9% accuracy to predict lower intensity for the same shift the next day. The high intensity NAS cut-off showed 67.9% accuracy to predict high intensity in the next shift and 72.0% accuracy to predict high intensity for the same shift the next day.

CONCLUSIONS

NAS cut-offs could contribute considerably in predicting patient nurse-level intensity, and thus patient-to-nurse staffing ratios, in the next shift or day. Identification or prediction of high intensity, nevertheless, appears most complex and requires further study. Future studies need to account for the many confounding variables which complicate nurse staffing planning.

Manpower capacity and reasons for staff shortage in primary health care maternity centres in Nigeria: a mixed-methods study

Background

The heart-breaking maternal and neonatal health indicators in Nigeria are not improving despite previous interventions, such as ‘Health for all’ and ‘Millennium Development Goals. The unattained health-related goals/targets of previous interventions put the success of the new Sustainable Development Goals in doubt if the existing paradigm remains unchanged. Thus, mere branding of health policies without improving what constitutes the health system such as manpower capacity and quality as well as staff-patients ratio will be wasteful efforts. This issue of global public health concern provided an indication for describing the capacity of manpower and reasons for staff shortage in primary level of health that are providing maternity services to women and their new-borns in Nigeria.

Methods

This is an embedded mixed-methods study. Its quantitative strand collected data with the aid of a structured questionnaire from 127 health workers across the 21 purposively selected primary health care centres in five local government areas. Descriptive statistics were employed for analysis. The qualitative strand of the study collected data through in depth interviews from medical officers of health or their representatives. The tape recorded and transcribed data were thematically coded, while reporting was by direct quotes. The mixing of the data from both strands was done in the discussion section.

Results

Twenty-nine (22.8%) of the health workers were between ages 51–58; 111 (87.4%) were married, while 44 (34.6%) had worked for duration of 21–33 years in service. Evidences of incompetence were observed among the health workers. A total of 92 (72.4%) had been performing episiotomies on women in labour. Similarly, 69.8% had been repairing vaginal traumas. Nine (7.1%) knew the necessary steps of controlling postpartum vaginal bleeding, while 115 (91.3%) of them had not been trained in Life-Saving Scheme and post-abortions care.

Conclusion

The shortage of manpower, disproportional skilled/semi-skilled ratio, lack of framework for staff recruitment, staff incompetence and inappropriate childbirth practices show that women were not receiving quality maternal and neonatal cares at the maternity centres.

REVIEW OF DENTISTRY IN WEST AFRICA- CHALLENGES AND PROSPECTS

Oral health as an integral component of overall health is provided by dental professionals (Dental surgeons/stomatologists, hygienists, dental nurses, technicians, community extension workers). Oral diseases in West Africa are dominated by gum/periodontal diseases, dental caries, orofacial trauma, cancrum oris/noma and oral cancer. Human resources and infrastructure for oral health services in West Africa are skewed towards the urban areas where the rich live, while the rural poor have relatively little or no human resources and infrastructure. The development of human resources for oral health started much later than for other health services in West Africa. In all countries, the training of dentists at undergraduate level started after independence. In Nigeria, postgraduate training in dental surgery took off more than 10 years after the graduation of the first set of undergraduate dental surgeons. To meet contemporary realities for improved dental services with a substantial reduction of all oral health diseases in the region, there is need to review the 1998 WHO health strategies.

The practice of intensive care in Latin America: a survey of academic intensivists

Background

Intensive care medicine is a relatively young discipline that has rapidly grown into a full-fledged medical subspecialty. Intensivists are responsible for managing an ever-increasing number of patients with complex, life-threatening diseases. Several factors may influence their performance, including age, training, experience, workload, and socioeconomic context. The aim of this study was to examine individual- and work-related aspects of the Latin American intensivist workforce, mainly with academic appointments, which might influence the quality of care provided. In consequence, we conducted a cross-sectional study of intensivists at public and private academic and nonacademic Latin American intensive care units (ICUs) through a web-based electronic survey submitted by email. Questions about personal aspects, work-related topics, and general clinical workflow were incorporated.

Results

Our study comprised 735 survey respondents (53% return rate) with the following country-specific breakdown: Brazil (29%); Argentina (19%); Chile (17%); Uruguay (12%); Ecuador (9%); Mexico (7%); Colombia (5%); and Bolivia, Peru, Guatemala, and Paraguay combined (2%). Latin American intensivists were predominantly male (68%) young adults (median age, 40 [IQR, 35–48] years) with a median clinical ICU experience of 10 (IQR, 5–20) years. The median weekly workload was 60 (IQR, 47–70) h. ICU formal training was between 2 and 4 years. Only 63% of academic ICUs performed multidisciplinary rounds. Most intensivists (85%) reported adequate conditions to manage patients with septic shock in their units. Unsatisfactory conditions were attributed to insufficient technology (11%), laboratory support (5%), imaging resources (5%), and drug shortages (5%). Seventy percent of intensivists participated in research, and 54% read scientific studies regularly, whereas 32% read no more than one scientific study per month. Research grants and pharmaceutical sponsorship are unusual funding sources in Latin America. Although Latin American intensivists are mostly unsatisfied with their income (81%), only a minority (27%) considered changing to another specialty before retirement.

Conclusions

Latin American intensivists constitute a predominantly young adult workforce, mostly formally trained, have a high workload, and most are interested in research. They are under important limitations owing to resource constraints and overt dissatisfaction. Latin America may be representative of other world areas with similar challenges for intensivists. Specific initiatives aimed at addressing these situations need to be devised to improve the quality of critical care delivery in Latin America.

Electronic supplementary material

The online version of this article (10.1186/s13054-018-1956-6) contains supplementary material, which is available to authorized users.

Association between Metabolic Syndrome and Job Rank

Background:

The occupation of the people can influence the development of metabolic syndrome.

Objective:

To determine the association between metabolic syndrome and its determinants with the job rank in workers of a large car factory in Iran.

Methods:

3989 male workers at a large car manufacturing company were invited to participate in this cross-sectional study. Demographic and anthropometric data of the participants, including age, height, weight, and abdominal circumference were measured. Blood samples were taken to measure lipid profile and blood glucose level. Metabolic syndrome was diagnosed in each participant based on ATPIII 2001 criteria. The workers were categorized based on their job rank into 3 groups of (1) office workers, (2) workers with physical exertion, and (3) workers with chemical exposure. The study characteristics, particularly the frequency of metabolic syndrome and its determinants were compared among the study groups.

Results:

The prevalence of metabolic syndrome in our study was 7.7% (95% CI 6.9 to 8.5). HDL levels were significantly lower in those who had chemical exposure (p=0.045). Diastolic blood pressure was significantly higher in those who had mechanical exertion (p=0.026). The frequency of metabolic syndrome in the office workers, workers with physical exertion, and workers with chemical exposure was 7.3%, 7.9%, and 7.8%, respectively (p=0.836).

Conclusion:

Seemingly, there is no association between metabolic syndrome and job rank.

[Reimbursement of intensive care services in Austria : Use of the LKF system]

In Austria, the reimbursement of intensive care services is based on a Diagnosis-Related Groups (DRG) system which has been adapted to the Austrian framework conditions. Compared to Germany where economic considerations had led to personnel cuts, mandatory targets outlined in both the LKF ("Leistungsorientierte Krankenanstaltenfinanzierung", Performance-oriented Hospital Financing) and ÖSG ("Österreichischer Strukturplan Gesundheit", Austrian Health Care Structure Plan) plans ensure a high level of medical and intensive care. A clearly defined minimal nurse-to-bed ratio should ensure adequate care of critically ill patients. However, such a staffing ratio is still lacking for intensive care unit physicians. The following article is meant to outline the fundamental structures of the Austrian intensive care units and provide consideration about further optimization of intensive care medicine provided in Austria to ensure the high level of care in the future.

Factors affecting intent to immigration among Iranian health workers in 2016

BACKGROUND

Loss of human resources in the health sector through migration has caused many problems in the delivery of healthcare services in developing countries.

OBJECTIVE

The aim of this study was to determine factors influencing intention to migrate in skilled human resources in Iran's healthcare sector.

METHODS

This cross-sectional study was carried out in 2016 in Iran. The study population included health sector human resources at the Tehran and Iran University of Medical Sciences. Using multi-stage cluster sampling, 827 people were selected for participation. Participants included four groups: hospital staff, health workers, medical students, and postgraduate students (Masters and PhD). Data were collected using a valid and reliable questionnaire and analyzed by descriptive parameters, chi-square and logistic regression test using SPSS version 18.

RESULTS

Inclination to migrate, in the study population, was 54.77%. There was a significant relationship between inclination to migrate and age, work experience, employment status, marital status, familiarity with a foreign language, foreign language skills, foreign language courses, having relatives or family living abroad, and prior experience of being abroad (p<0.05). The most important factors influencing inclination to migrate were: reaching out for better life (81.92±21.95), interdisciplinary discrimination (80.83±20.75), and experience of living and studying abroad. (80.55±18.12).

CONCLUSION

Considering the high rate of intention to emigrate in the studied population (54.77%), a lot of whom will emigrate if their situation is ready, it can be a serious problem for the health system in the near future in which it will face lack of skilled health workers, and so requires more attention of health sector authorities.

What is the future for General Surgery in Model 3 Hospitals?

BACKGROUND

General Surgery consultant recruitment poses considerable challenges in Model 3 Hospitals in Ireland.

AIM

The aim of this paper is to examine General Surgery activity and consultant staffing in order to inform future manpower and service planning.

METHODS

General surgical activity in Model 3 Hospitals was examined using the validated 2014 Hospital Inpatient Enquiry (HIPE) dataset. Current consultant staffing was ascertained from hospital personnel departments and all trainees on the National Surgical Training Programme were asked to complete a questionnaire on their career intentions.

RESULTS

Model 3 Hospitals accounted for 50% of all General Surgery discharges. In the elective setting, 51.5% of all procedures were endoscopic investigations and in the acute setting only 22% of patients underwent an operation. Most surgical procedures were of low acuity and included excision of minor lesions, appendicectomy, cholecystectomy and hernia repair. Of 76 General Surgeons who work in Model 3 Hospitals 25% were locums and 54% had not undergone formal training in Ireland. A further 22% of these surgeons will retire in the next five years. General Surgical trainees surveyed indicated an unwillingness to take up posts in Model 3 Hospitals, while 83% indicated that a post in a Model 4 Hospital is 'most desirable'. Lack of attractiveness related to issues regarding rotas, lack of ongoing skill enhancement, poor experience in the management of complex surgical conditions, limited research and academic opportunity, isolation from colleagues and poor trainee support.

CONCLUSIONS

These data indicated that an impending General Surgery consultant manpower crisis can only be averted in Model 3 Hospitals by either major change in the emphasis of surgical training or a significant reorganisation of surgical services.

[Medical supply planning : dynamic registry of physicians, sixth reform of the State and numerus clausus]

INTRODUCTION

The last few years have seen major changes in the Belgian medical planning. The paper aims to describe them and to assess how they will affect the medical demography.

METHOD

Grey literature review and federal and federated entities legislation summary.

RESULTS

A new dynamic register allows a better knowledge of medical workforce in all sectors of labour market. Recent legislation evolutions induce fragmentation of competences related to human resource for health planning : federal authorities are responsive for the fixation of number of GP and specialists and community authorities for registration of health professionals and fixation of sub-quotas in different branches of specialised medicine. Finally, the French Community has setting up a multiple selection system of medical students that have to past an 'orientation test', a possible reorientation after January examinations and then a numerus fixus at the end of the first academic year.

CONCLUSIONS

Dynamic register improves the knowledge of medical workforce repartition. However, the assessment of its volume shows methodological limitations. From an operational viewpoint, the fragmentation of competences will ask coordination effort from all authority levels to avoid impairment in planning process. Finally, French Community has to consider evaluation and ambitious revision of medical workforce planning in their region.

Assessing the Effect of Simultaneous Exposure to Noise and Cigarette Smoke on Workers' Blood Pressure

INTRODUCTION

Noise, as the most common pollutant in the industrial environment, can lead to hearing loss and negatively affect other organs such as the cardiovascular system. Cigarette smoking is a popular habit among some workers, and can also have a negative effect on the cardiovascular system. This study was aimed to investigate the effect of simultaneous exposure to noise and cigarette smoke on the blood pressure of workers at a manufacturing factory.

MATERIALS AND METHODS

This cross-sectional study enrolled 604 workers at a steel factory. Information relating to workers' demography, employment, and risk factors were recorded. Based on the level of smoking per day, workers exposed to noise fell into one of the four following groups: 1) Non-smokers exposed to noise <85 DB; 2) Smokers exposed to noise <85 DB; 3) Non-smokers exposed to noise ≥85 DB; 4) Smokers exposed to noise ≥85 DB. A t-test, analysis of variance (ANOVA), and logistic regression were applied for analysis using SPSS v11.5.

RESULTS

The prevalence of hypertension, cigarette smoking, and exposure to noise ≥85 DB was 11.6%, 15.3%, and 56.4%, respectively, among the workers. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 112.3 and 73.9 mmHg, respectively. A significant difference was observed between systolic and diastolic blood pressures in four groups (P=0.001). Posthoc test showed a significant difference between groups 1 and 3 (P=0.001). Regression analysis indicated no significant difference in workers who were simultaneously exposed to noise and cigarette smoke.

CONCLUSION

This study demonstrates that noise is an important factor in terms of hypertension, with no significant differences observed in the prevalence of hypertension between workers who were simultaneously exposed to noise and cigarette smoke. It is suggested that workers' blood pressure should be regularly monitored in noisy environments.

Migration of Spanish nurses 2009-2014. Underemployment and surplus production of Spanish nurses and mobility among Spanish registered nurses: A case study

BACKGROUND

After the financial crisis of 2008, increasing numbers of nurses from Spain are going abroad to work.

OBJECTIVES

To examine the health and workforce policy trends in Spain between 2009 and 2014 and to analyze their correlation with the migration of nurses.

DESIGN

Single embedded case study.

DATA SOURCES

We examined data published by: Health Statistics, Organization for Economic Cooperation and Development (1996 to 2013); Ministry of Education, Culture and Sports (2006 to 2013); Ministry of Employment and Social Security (2009 to 2014); Ministry of Health, Social Services and Equality (1997 to 2014); and National Institute of Statistics (1976 to 2014). In addition to reviewing the scholarly literature on the topic in Spanish and English, we also examined Spanish mobility laws and European directives.

POPULATION

We used the Organization for Economic Cooperation and Development definition of "professionally active nurses" which defines practising nurses and other nurses as those for whom their education is a prerequisite for employment as a nurse. Moreover, we used the term "nursing graduate" as defined by Spanish Ministry of Education to describe those who have obtained a recognized qualification in nursing in a given year, the term "registered nurses" is defined by Spanish law as nurses registered in the Nurses Associations and "unemployed nurses" are those without work and registered as seeking employment.

RESULTS

A transformation of the Spanish health system has reduced the number of employed nurses per capita since 2010. Moreover, reductions in public spending, labour market reforms and widespread unemployment have affected nurses in two ways: first by increasing the number of applicants per vacancy between 2009 and 2013, and second, by an increase in casual positions. However, despite the poor job market and decreasing job security, the number of registered nurses and nursing graduates in Spain per year has continued to grow, increasing the pressure on the labour market.

CONCLUSIONS

Spain is transforming from a stable nursing labour market, to one that is increasingly producing nurses for foreign markets, principally in Europe. With its low birth rate, increased life expectancy and increasing rates of chronic disease, it is critical for Spain to have sufficient nurses now and into the future. It is important that there be continued study of this phenomenon by Spanish policy makers, health service providers and educators in order for Spain to develop health human resources policies that address the health care needs of the Spanish population.

Assessment and Availability of Trauma Care Services in a District Hospital of South India; A Field Observational Study

OBJECTIVE

To assess the availability of trauma care services in a district referral hospital of Southern India.

METHODS

This was a cross-sectional study being performed during 2013 in a tertiary healthcare centre in Southern Indian. A detailed assessment of trauma care services was done in a 400 bed speciality hospital which is an apex referral hospital in the public health system using a check list based on WHO guidelines for evaluation of essential trauma care services, along with in-depth interviews of hospital stake holders and key informants.

RESULTS

The hospital had physical infrastructure in terms of emergency room, inpatient wards, operation theatres, intensive care unit and blood bank facilities. The recently constructed designated building for trauma care services was not operational and existing facilities were used beyond capacity. A designated trauma team was lacking and speciality services for managing polytrauma were deficient and thus, existing personnel were performing multiple tasks. Neurosurgeons and rehabilitative nursing staff were unavailable, and a radiographer was not available on a 24/7 basis. Existing nursing personnel had not received any formal training in trauma care and standard operating protocols were not available for trauma care. Resources for acute resuscitation were partially adequate. The hospital lacked adequate resources to manage head, abdomen, chest and spine injuries, and most of the polytrauma cases were referred to nearby city hospitals.

CONCLUSION

District hospital, the only referral hospital in public health system for trauma victims of that region, had inadequate resources to manage trauma victims, which was probably responsible for delay in trauma care, improper referrals, high cost of care and poor outcomes.

What is the Future of Pediatric Neurology in Canada? Resident and Faculty Perceptions of Training and Workforce Issues

BACKGROUND

Pediatric neurology trainee numbers have grown considerably in Canada; recent research, however, has shown that the number of pediatric neurology graduates is outpacing the need for future pediatric neurologists. The purpose of this study was to seek the opinion of pediatric neurology program directors and trainees regarding possible solutions for this issue.

METHODS

Two focus groups were convened during the Canadian Neurological Sciences Federation annual congress in June 2012; one consisted of current and former program directors, and the other of current pediatric neurology trainees. Groups were asked for their perceptions regarding child neurology manpower issues in Canada as well as possible solutions. Focus groups were audio-recorded and transcribed for analysis. Theme-based qualitative analysis was used to analyze the transcripts.

RESULTS

Major themes emerging from both focus groups included the emphasis on community pediatric neurology as a viable option for trainees, including the need for community mentors; recognizing the needs of underserviced areas; and establishing academic positions for community preceptors. The need for career mentoring and support structures during residency training was another major theme which arose. Program directors and trainees also gave examples of ways to reduce the current oversupply of trainees in Canada, including limiting the number of trainees entering programs, as well as creating a long-term vision of child neurology in Canada.

CONCLUSIONS

A nationwide dialogue to discuss the supply and demand of manpower in academic and community pediatric neurology is essential. Career guidance options for pediatric neurology trainees across the country merit further strengthening.

Job Satisfaction and Relocation Desire among Pediatric Dentists in Puerto Rico

OBJECTIVE

To determine the levels of satisfaction, license status, and desire to relocate of pediatric dentists in Puerto Rico.

METHODS

Pediatric dentists in Puerto Rico were surveyed via telephone interviews. Data were collected through a 34-item questionnaire that explored satisfaction as related to income, continuing education, professional goals, and participation in the Mi Salud program. Frequencies, chi-square analysis, and Fisher's exact 2-tailed t-test were utilized to determine the relationships between satisfaction and the demographics of the pediatric dentists.

RESULTS

Sixty pediatric dentists participated in our survey-77% of the total number of pediatric dentists practicing in Puerto Rico. Overall, 65% of the participating pediatric dentists expressed dissatisfaction. Male pediatric dentists were more dissatisfied than their female colleagues were. Most pediatric dentists participating in Mi Salud expressed dissatisfaction. When asked about whether or not they had considered migrating to the mainland, those who were dissatisfied were more likely to have considered that idea than were those who were satisfied. Overall, 57% of the pediatric dentists comprising our sample had considered relocating to the continental United States.

CONCLUSION

In general, the pediatric dentists who participated in our study expressed dissatisfaction in most areas except when asked about their ability to reach professional goals. Determining the levels of satisfaction of health care providers is important in the maintaining of an adequate workforce. As current levels of dissatisfaction are high, it is important to determine what variables are related to satisfaction so that corrective measures can be taken to ensure that retention rates improve, thereby maintaining an adequate pediatric dental workforce.

Geographic Distribution of Urologists in Korea, 2007 to 2012

The adequacy of the urologist work force in Korea has never been investigated. This study investigated the geographic distribution of urologists in Korea. County level data from the National Health Insurance Service and National Statistical Office was analyzed in this ecological study. Urologist density was defined by the number of urologists per 100,000 individuals. National patterns of urologist density were mapped graphically at the county level using GIS software. To control the time sequence, regression analysis with fitted line plot was conducted. The difference of distribution of urologist density was analyzed by ANCOVA. Urologists density showed an uneven distribution according to county characteristics (metropolitan cities vs. nonmetropolitan cities vs. rural areas; mean square=102.329, P<0.001) and also according to year (mean square=9.747, P=0.048). Regression analysis between metropolitan and non-metropolitan cities showed significant difference in the change of urologists per year (P=0.019). Metropolitan cities vs. rural areas and non-metropolitan cities vs. rural areas showed no differences. Among the factors, the presence of training hospitals was the affecting factor for the uneven distribution of urologist density (P<0.001). Uneven distribution of urologists in Korea likely originated from the relatively low urologist density in rural areas. However, considering the time sequencing data from 2007 to 2012, there was a difference between the increase of urologist density in metropolitan and non-metropolitan cities.

Benefits of a Dedicated Breastfeeding Facility and Support Program for Exclusive Breastfeeding among Workers in Indonesia

PURPOSE

A mother's working environment is believed to be a major determinant of exclusive breastfeeding (EBF) practice. We aimed to define the influence of a facility dedicated to breastfeeding and a breastfeeding support program at the workplace on breastfeeding practice.

METHODS

A cross-sectional study was performed in five workplaces. The inclusion criteria were female workers whose last child was between 6 and 36 months old. Observational data were obtained and a questionnaire was filled out. The World Health Organization definition for EBF was used.

RESULTS

Data from 186 subjects (74 office workers and 112 factory workers) were collected. Just over half (52%) of the mothers were between 20 and 46 years old, 75.3% had graduated from high school and university, 12.9% had more than two children and 36.0% owned a house. The prevalence of EBF during the last 6 months was 32.3%. A proper dedicated breastfeeding facility was available for 21.5% of the mothers, but only 7.5% had been in contact with a breastfeeding support program. The presence of a dedicated breastfeeding facility increased EBF practice almost threefold, by an odds ratio (OR) of 2.74 and a 95% confidence interval (CI) of 1.34-5.64 (p<0.05). Knowledge of the breastfeeding support program increased EBF practice by almost six times (OR, 5.93; 95% CI, 1.78-19.79) (p<0.05).

CONCLUSION

Our findings suggest that Governments should make it obligatory for employers to offer a breastfeeding support program and a dedicated breastfeeding facility at the workplace as these simple measures significantly increase EBF.

Rheumatology assistance care in Catalonia (Spain): year 2012

OBJECTIVE

To determine the current state of Rheumatology in Catalonia (Spain) and to update information regarding previous studies

METHODS

STUDY DESIGN

observational, descriptive and transversal.

SAMPLE

Physicians practicing rheumatology in the public system of Catalonia. An epidemiological questionnaire was sent to all rheumatologists. The results were compared with previously published studies.

RESULTS

Information was obtained on 130 rheumatologists (62 men/68 women, mean age 47±9 years). Seventy five (57.7%) physicians worked at a hospital, 5 (3.8%) in primary care and 50 (38.5%) in both. Seven (11.9%) hospitals had no rheumatologist. Eight hospitals were accredited by the National Commission to develop a training program in Rheumatology. The number of residents accredited by each hospital was variable.

CONCLUSIONS

The number of rheumatologists in the public health sector in Catalonia has increased 4.8% during the last seven years, unlike the 2005 study in which there was an increase of 40% over the previous eight years. There were 7 hospitals without a rheumatologist.

Health-related Quality of Life and Related Factors in Full-time and Part-time Workers

BACKGROUND

There has been a rapid increase in the number of part-time workers in Korea with little information available on associated changes in quality of life. This study was designed to compare part-time and full-time workers in terms of the quality of life and related factors.

METHODS

Data were extracted from the 4th Korea National Health and Nutrition Examination Survey, conducted in 2008. Of the 1,284 participants selected, 942 were females (range, 20 to 64 years). Based on the information provided by self-administered questionnaire, subjects were categorized according to the working pattern (full-time and part-time) and working hours (<30 and ≥30 hours). Differences in socio-demographic characteristics, health-related behaviors, and job characteristics were assessed by t-test and chi-square test. EuroQol-five dimensions (EQ-5D) index was implemented in order to measure the quality of life. Differences in the EQ-5D index scores between the groups were compared by t-test, stepwise multivariate logistic regression analyses.

RESULTS

Quality of life did not differ by work patterns. In males, the Organization for Economic Cooperation and Development part-time group was associated with poorer quality of life (odds ratio [OR], 0.49; P = 0.028). For both sexes, the non-stress group was linked with superior quality of life in comparison to the stress group (OR, 2.64; P = 0.002; OR, 2.17; P < 0.001). Female employees engaged in non-manual labor had superior quality of life than those engaged in manual labor (OR, 1.40; P = 0.027).

CONCLUSION

This study concludes that working less than 30 hours per week is related to lower quality of life in comparison to working 30 hours or more in male employees in Korea.

The Dermatology workforce in Saudi Arabia: Current trends, challenges and future directions

OBJECTIVES

To provide a snapshot of the dermatology work force in Saudi Arabia.

METHODS

We collected data on the supply and distribution of dermatologists in Saudi Arabia. We discussed the current status of dermatology manpower issues in Saudi Arabia.

RESULTS

We found that between 1987 and 2007, the availability of dermatologists to population in Saudi Arabia rose by 60 %, from 2.35 to 3.76 dermatologists per 100,000 Saudi Arabian individuals. However, the current workforce is already out of balance in several ways. We have an excess of non-Saudi citizen dermatologists and a barely adequate supply of Saudi dermatologists. The dermatologist population is unbalanced with regard to gender and uneven in terms of geographic distribution.

CONCLUSIONS

The dermatology workforce does not match well with the nation's health care goals. We should create a more successful and stable match between the talent supply and health care system requirements.

Gastroenterology training in private hospitals: India vs South Africa

In South Africa, nurses and doctors are emigrating in significant numbers. Job satisfaction, safety and ensuring career progression are important in retaining doctors to make a career in Republic of South Africa (RSA). Due to budgetary constraints many hospitals have not been upgraded. Coming home after overseas training seems difficult. In RSA it takes a minimum of 13 years for a young specialist to become registered and 15 years for subspecialists. Career progression, creating more specialist trainees in public and private hospitals and shortening the period of professional training are potential solutions to the problem. India, which has a population of more than 1 billion people, is struggling with similar problems. For the past 10-15 years, private hospitals have assisted in manpower development for medical specialist and subspecialist careers. Currently their private sector trains 60% of their recognised (sub)specialities fellows. A national task force for specialist training in RSA should be instituted. It should discuss, based on the current status and projected specialist and subspecialist personnel requirements, the future structure and logistics of training needs. This is required in all subspecialities including gastroenterology, as has been done in India. It is hoped that as a consequence well-trained doctors, similar to those in India, might move to provincial hospitals in rural areas, upgrading the medical services and keeping medical power in South Africa. South Africa should become a model for Sub-Saharan Africa, as India already is for South-East Asia.