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Background: The purpose of this study was to clarify how the Regional Referral Clinical Pathway for Home-based Palliative Care (RRCP-HPC) and an outreach program by a palliative care team (PCT) lead to an improvement in the outcome. Design and Methods: We conducted questionnaire surveys using the mailing method involving the regional medical staff involved in cancer patients introduced to the PCT of a single hospital, as well as bereaved families. The questionnaire was prepared through interviews with the medical staff and bereaved families. Subsequently, factor analysis was performed to identify factor structures and calculate the correlation coefficient with each outcome. Results: For the questionnaire survey involving the medical staff, responses were collected from 119 regional medical institutions and 84 regional medical staff. The response rate per institution was 51.3%. Similarly, for the questionnaire survey involving bereaved families, the response rate was 42.4%. For the survey involving the medical staff, 6 factors, such as “improved awareness of an interdisciplinary team,” were extracted. For the survey involving the bereaved families, 4 factors, such as “improvement of communications between patients and healthcare professionals,” were extracted. There were significant (≥moderate) correlations between these factors and all outcomes. Conclusion: In this study, we clarified the process of achieving palliative care until death at home without difficulties using the outreach program and RRCP-HPC. The results suggest the importance of improving communications. The outreach program and RRCP-HPC may have contributed to palliative care at home without difficulties through an improvement in communications.

Introduction Ethical climate in medical contexts is referred to the organizational environment consisting of medical staff interpersonal relationships regarding patient care. This element affects staff behavior in an organization. The investigation and comparison of the effects of the interventions promoting ethical climate are among important nursing challenges that should be considered by researchers. The present study was conducted to compare the effect of nurses’ ethical decision-making skills and interpersonal communication training on their ethical climate. Materials and methods This experimental study was performed on 90 nurses working in the general teaching hospitals of Mashhad, Iran. The sampling process was conducted in two stages. Nurses were divided into three groups: intervention 1 (ethical decision-making skills group), intervention 2 (interpersonal communication skills group) and control group. The intervention was separate 12-h workshops for each of the intervention groups. The ethical climate questionnaire by Victor and Cullen was used to assess the score of ethical climate in the three groups both at the beginning and 4 weeks after the workshop. The data were analyzed in Statistical Package for Social Sciences software (version 16) using descriptive statistics, analysis of variance, Kruskal–Wallis, paired sample t-test, Wilcoxon test, and post hoc Tukey’s test. Ethical considerations were as follows: The study design was approved by the Research Ethics Committee of Mashhad University of Medical Sciences. Informed consent was obtained from all subjects, and they were ensured about the confidentiality terms. Results The mean scores of the ethical climate test at the first stage were obtained as 66.0 ± 5.5, 67.8 ± 6.9, and 67.7 ± 7.2 in the ethical decision-making, interpersonal communication, and control groups, respectively. Accordingly, the three groups were not significantly different in terms of this variable (df = 87, f = 0.70, P = 0.005). However, after the intervention (i.e. second stage), a significant difference was observed among the three groups regarding the mean scores of the ethical climate test In this regard, the calculated mean scores in the ethical decision-making, interpersonal communication, and control groups were 99.3 ± 6.3, 90.4 ± 7.7, and 67.4 ± 7.9, respectively (df = 87, f = 152.00, P Conclusion Training workshops about ethical decision-making skills and interpersonal communication on the ethical professional climate of nurses was effective. Nonetheless, the effect of ethical decision-making skill training was found to be higher than interpersonal communication skill training. Therefore, it is recommended that nursing managers hold training workshops to improve the ethical climate for nurses.

We describe a case of parents refusing a tracheostomy for an otherwise healthy newborn. The refusal was not honored because permitting the refusal would have violated state law, which required a child to have a qualifying condition (e.g. a terminal diagnosis, permanent unconsciousness, incurable condition with severe suffering) to remove or withhold life-sustaining treatment. However, this case strained the relationship between the parents and medical staff, who worried about sending the newborn home with a tracheostomy where she was not wanted. While many ethical issues arise in treatment refusal cases like this, we focus on the opportunity for ethicists to help the medical staff reflect on the technological alienation of the parents, which may help foster empathy, reduce moral distress, and strengthen the quality of the doctor-parent-patient triad.

This study investigated, using validated computational fluid dynamics techniques, the potential infection risks to medical staff when performing endotracheal intubation in the negative pressure isolation ward during treatment of COVID-19 patients. The research first simulated the airflow distribution in negative pressure isolation ward and then examined the potential infection risks to medical staff under two different respiratory conditions of a patient (i.e. patient with endotracheal intubation and patient with normal respiration). The results revealed that medical staff have high possibility to be contracted when performing endotracheal intubation. Personal protective equipment during endotracheal intubation is thus critical to mitigate the potential infection risk to medical staff. Space position and body posture of the medical staff (e.g. standing upright and bent over) would influence the contamination risk. Higher infection risk was noted for the medical staff who performs endotracheal intubation as compared to the other who delivers assistance. A bent-over posture of the medical staff encounters more particle exposure due to a closer distance to the patient head as well as the unfavourable airflow pattern/direction. Protection by using a plastic aerosol box over the head of the patient was studied, which shows promising improvement by preventing more than 75% of virus particles from spreading around.

Background: Having a proper approach to depression requires having sufficient depressive literacy in the affected person. Aims: This study aimed to evaluate the level of depression literacy among hospital staff affiliated to Isfahan University of Medical Sciences (IUMS) and to reveal the risk factors and knowledge gaps. Methods: This was a cross-sectional study with 760 participants from university hospital staff at IUMS who were selected by a census method from April 2018 to December 2018. The data regarding depression signs and symptoms, anti-depressant drugs safety, non-medical treatment efficacy, etc. were collected using the Depression Literacy Questionnaire (D-Lit-22) and were analysed by SPSS-20, using the Pearson correlation coefficient, independent Samples t-test and analysis of variance (ANOVA) ( p ⩽ .05). Results: The mean age of participants was 35.33 ± 8.00 years old and 77.6% of them were female. The mean of the total score of depression literacy was 11.62 ± 3.53. Depression Literacy score was significantly higher in those with higher education levels, female gender and clinical staff ( p < .001). The inability to distinguish depression from other mental disorders as well as having wrong beliefs about suitable treatment approaches were the most considerable gaps in depression literacy. Conclusion: Male gender, low level of academic education and working in non-medical wards are the main factors associated with lower depression literacy in our studied sample. The poor differentiation of depression and wrong beliefs in depression treatment modalities were the largest gaps which require more educational programmes.

The rapid spread of the COVID-19 virus around the world poses a real threat to public safety. Some COVID-19 symptoms are similar to other viral chest diseases, which makes it challenging to develop models for effective detection of COVID-19 infection. This article advocates a model to differentiate between COVID-19 and other four viral chest diseases under uncertainty environment using the viruses primary symptoms and CT scans. The proposed model is based on a plithogenic set, which provides higher accurate evaluation results in an uncertain environment. The proposed model employs the best-worst method (BWM) and the technique in order of preference by similarity to ideal solution (TOPSIS). Besides, this study discusses how smart Internet of Things technology can assist medical staff in monitoring the spread of COVID-19. Experimental evaluation of the proposed model was conducted on five different chest diseases. Evaluation results demonstrate that the proposed model effectiveness in detecting the COVID-19 in all five cases achieving detection accuracy of up to 98%.

This study investigates citizen assessments of government actions in the COVID-19 outbreak in China. Empirical analyses based on a large-scale online survey indicate that the Chinese public expects the government to improve its support for the frontline medical staff, management of public stress and anxiety, and disclosure of government information. Specifically, indirect exposure to COVID-19 through second-hand information is negatively associated with citizen assessments of government actions; by contrast, the first-hand frontline experience with the epidemic is positively associated with citizen assessments of government actions. Findings suggest that citizens with first-hand experience might be more able to judge government actions under the actual constraints of resources and opportunities, and are less likely to overemphasize the costs or risks associated with government actions than others without frontline experience. Our work suggests that governments should effectively communicate detailed information regarding government actions to the public during public health emergencies, as more informed citizens might be more supportive of governments with limited resources and, probably, more actively collaborate with governments.

Obstetric violence – psychological and physical violence by medical staff towards women giving birth – has been described as structural violence, specifically as gender violence. Many women are affected by obstetric violence, with awful consequences. The phenomenon has so far been mainly investigated by the health and social sciences, yet fundamental theoretical and conceptual questions have gone unnoticed. Until now, the phenomenon of obstetric violence has been understood as one impeding autonomy and individual agency and control over the body. In this article I will argue that the phenomenon of obstetric violence occurs in a specific state of embodied vulnerability and that might be destructive for subjectivity since it fails to recognize that state and instead disallows support and demolishes relationships (among women and their lived-bodies; among women and their others) and interdependence. This might introduce a conceptual shift and the phenomenon might be reconceptualized as a moment where vulnerability is misrecognized and ambiguity, relations and support (rather than autonomy) are banned. In this case violence is recognized as cutting the original links to our bodies and the world that constitute our phenomenological condition, instead of as hurting the autonomous subject. Obstetric violence, thus, calls to be reflected upon through de Beauvoir’s ideas on ambiguity, the embodied and situated subject and the subject as essentially construed in relations. I believe that de Beauvoir’s conception of the authentic embodied subject as necessarily ambiguous – immanent and transcendent at the same time and ineludibly linked to the world and its others – will be extremely useful for construing this new understanding of how obstetric violence happens and of what precisely constitutes its damage.

Background Clinical pharmacists are contributing to safe medication use by providing comprehensive management to patients and medical staff. The aim of this study is to document and evaluate the role of clinical pharmacy services in oncology department. Patients and methods A prospective, descriptive, observational study was carried out from July 2018 through June 2019 at the Department of Medical Oncology at the National Institute of Oncology, Morocco. Medication reviews concerning hospitalized adult cancer patients were performed every day by the clinical pharmacist assigned to the department. Results A total of 3542 prescriptions of 526 adult cancer patients were analyzed. The pharmacist identified 450 drug-related problems (12.7% of the prescriptions) primarily related to the analgesics (31.5%). Medication problems included mostly untreated indications (31.3%), overdosing (17.1%), drug–drug interactions (12.4%), underdosing (11.1%), administration omissions (6.7%), drug not indicated (6.0%), and contraindication (5.3%). Interventions ( n = 450) led to drug additions (30.7%), drug dosing adjustments (27.1%), treatment discontinuations (20.0%), recall of the treatment (6.2%), replacement of a drug with another one (5.1%), administration optimization (4.0%), therapeutic drug monitoring (3.1%), alternate routes of administration (2.5%), and extension of treatment duration (1.3%). Most (98%) of the interventions were accepted and implemented by the medical staff—172 (38.2%) having a significant clinical impact on the patient, 88 (19.6%) as having a very significant clinical impact, and 71(15.8%) as having a potential vital impact. Conclusion This work highlights the positive clinical relevance of pharmacists’ interventions in oncology and the importance of medicopharmaceutical collaboration to prevent medication error.

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

The ECHO (Extension for Community Health Outcomes) model has been introduced and implemented in several hospitals and health programs in Vietnam since 2015. In 2018, Vietnam National Children’s Hospital (VNCH) officially implemented the ECHO model to provide continuing medical education (CME) credits on pediatrics topics for medical staff in its satellite hospitals and health centers in the Northern region of Vietnam. This paper presents preliminary results of the ECHO program at VNCH. Methods included pre- and post-program assessments of pediatricians’ clinical knowledge, self-efficacy, and professional satisfaction. The analysis compared the differences between pre/post scores descriptively. Knowledge of participants increased by 22.5% points on average. More than 90% of Project ECHO-Pediatrics participants experienced increased confidence. Overall, there was an improvement in participants’ self-efficacy in the post-training compared to the pre-training (range 14.7%-22.6% difference from pre-training). All participants improved on their results in the clinical test immediately after the training and maintained it after 3 months. The study demonstrated the ability Project ECHO to improve healthcare worker knowledge and satisfaction.

Objective: The COVID-19 pandemic has resulted in health professionals facing unprecedented challenges and changes in practice. Responding to humanitarian crises involves saving lives and reducing suffering and as such, palliative care is an essential component of the response to COVID-19. This study aimed to explore health professionals’ perspectives of the role of palliative care during the COVID-19 pandemic by analyzing their views and experiences expressed in articles and blogs located via Twitter. Method: Qualitative content analysis of 33 online articles and blogs written by health professionals from 1 February 2020 to 30 June 2020. Online articles and blogs were included if the URL was posted on Twitter. The consolidated criteria for reporting qualitative research (COREQ) guided data collection and reporting. Results: The health professionals whose viewpoints were analyzed were from Europe, North America, Oceania and Asia. The themes derived from content analysis were (a) the recognized value of palliative care during the pandemic, (b) positioning palliative care as every health professional’s responsibility and (c) specialist palliative care supporting and guiding health professionals Conclusions: This study utilizes a unique approach to exploring the perspectives of health professionals from several countries during a global pandemic. The study emphasizes the value of palliative care and identifies gaps in end-of-life care provision including resource allocation. This brings to light the urgent need to equip all health professionals with palliative care knowledge and skills, including discussing and planning care. Specialist palliative care teams are well placed to support health professionals to provide quality care.

Ideal management of chronic disease includes team based primary care, however primary care medical staff face a lack of training when addressing nutritional counseling and lifestyle prevention. Interactive culinary medicine education has shown to improve knowledge and confidence among medical students. The aim of this study was to determine whether a culinary medicine curriculum delivered to a multidisciplinary team of primary care medical staff and medical students in a community setting would improve self-reported efficacy in nutritional counseling and whether efficacy differed between participant roles. A 4-h interactive workshop that took place within the neighborhood of a primary care medical home was delivered to medical staff and students. Participants completed a voluntary questionnaire before and after the workshop that addressed participants’ attitudes and confidence in providing nutritional counseling to patients. Chi-square tests were run to determine statistically significant associations between role of participant and survey question responses. Sign Rank tests were run to determine if pre-workshop responses differed significantly from post-workshop responses. Thirteen of seventeen responses related to attitudes and efficacy demonstrated significant improvement after the workshop compared with prior to the workshop. Significant differences noted between roles prior to the workshop disappear when asking the same questions after the workshop. Delivery of culinary medicine curricula to a primary care medical home team in a community setting is an innovative opportunity to collaboratively improve nutritional education and counseling in chronic disease prevention.

We have elaborated on the research on the COVID-19 epidemic with regards to the roles of frontline medical staff and emerging technologies and explained the study method, results, and discussion in detail. It will make the reader feel happy in terms of the findings of this rapid review in the prevailing COVID-19 situation. We hope that it would help enrich the readers' knowledge.

This study explores the perspectives of doctors, nurses, and technicians on the medical clown. A total of 35 subjects were interviewed one on one. Interviews were transcribed and analyzed for common themes. Medical staff outlined novel limitations and views of future directions for the field of medical clowning. Most importantly, many previously unpublished benefits of medical clowns were described. These reported benefits included cost-saving measures for the hospital, increases in staff efficiency, better patient outcomes, and lower stress in medical staff. Given that most of the limitations on medical clowning are financial in nature, these findings have substantial implications for the future of the field. As medical clowning continues to grow, this study outlines the potential for various future research projects within this field of study.

Objectives: Determine the relative impact of 11 building wellness features on preference and on the ability to deliver/receive quality care for two groups: patients and caregivers. Background: The impact of building features that promote wellness is of increasing interest to the building owners, designers, and occupants. Methods: This study performed a postoccupancy evaluation of two user groups at a healthcare facility with specific wellness features. Seventy-six staff and 62 patients of a cancer center were polled separately to determine their preferences in 11 categories. Results: Results showed that all wellness features were viewed favorably by the two groups, with natural lighting, views of nature, and thermal comfort as top categories for both. The t-test comparisons were performed, and significant differences ( p < .05) between the two groups were found for three of the features (views of nature, art and murals, and indoor plants). Discussion of these differences and the interaction of competing design goals (thermal comfort, views of nature, natural light, and desire for privacy) are included. Conclusions: Designers and owners will want to consider the preferred use of roof gardens, art and murals, and indoor plants for patient spaces, where their relative value is greater. Access to private and quiet spaces is the top need for caregivers. Ease of movement, thermal comfort, and natural light were top needs for patients.

Background: Occupational burnout syndrome generally develops in individuals of helping professions and is considered to result from long-standing stress. Burnout syndrome is characterized by loss of interest, fatigue, or frustration, the negative consequences of which affect the individual’s performance, thus being a major factor that influences the quality of work. Objectives: The aim of the study was to assess the existence of burnout syndrome in medical staff working at hospital emergency department. Methods: The study included 120 subjects working at emergency departments. The following two questionnaires were used: Copenhagen Burnout Inventory and Copenhagen Psychosocial Questionnaire. Likert scale was employed on scoring the answers offered in the questionnaires. Statistical analysis was performed using the exploratory factor analysis, analysis of variance, Bonferroni test, and Pearson correlation coefficient. The level of statistical significance was set at p < 0.05. Results: Study results revealed that the subjects suffer mostly from the symptoms of fatigue due to occupational burnout and exhaustion at the end of the day. The prevalence of burnout syndrome was highest among subjects with 11–15 years work in emergency department, while lower risk was recorded in those nurses and physicians who reported a higher level of social support, sense of community, and feedback information. Conclusion: Results of the study confirmed the existence of burnout syndrome in medical staff working at hospital emergency department, with the highest prevalence recorded in those working at this department for more than 11 years. The main burnout symptoms reported by study subjects were fatigue, exhaustion at the end of the day, and feeling that they were giving more than they were receiving in return. Burnout syndrome was found to be less common among those nurses and physicians who reported a higher level of social support, sense of community, and feedback information.

This study clarified the evaluation of the information about palliative care units (PCUs) from the oncologists by the bereaved family members of Japanese patients with cancer at the time of their first referral. A multicenter questionnaire survey examining the amount, timing, and adequacy of information received about PCUs was conducted. Half of the respondents (N = 465, mean age = 60 years) were spouses. Findings showed that 55% of the respondents thought the amount of information was inadequate and 33% thought the timing of the information about PCU from the oncologist was inadequate. Greater perceived inadequacy of the amount of information was significantly associated with (1) obtaining information from other patients and/or family member who had no experience with PCUs and (2) not acquiring information about the availability of medical staff and medical treatments at PCUs. Greater perceived inadequacy of the timing of the information was significantly associated with acts by the oncologist and/or nurses, such as providing insufficient information or saying there is nothing more that can be done any longer; however, this was not significantly associated with the actual timing of the oncologists’ information. Medical staff should understand what information families desire and provide enough detail for patients to imagine accurately what time spent in a PCU would be like. Moreover, practitioners should strive to improve methods of communication and engagement after the information provision, rather than prioritizing the timing of the information.

Trauma center readiness costs are incurred to maintain essential infrastructure and capacity to provide emergent services on a 24/7 basis. These costs are not captured by traditional hospital cost accounting, and no national consensus exists on appropriate definitions for each cost. Therefore, in 2010, stakeholders from all Level I and II trauma centers developed a survey tool standardizing and defining trauma center readiness costs. The survey tool underwent minor revisions to provide further clarity, and the survey was repeated in 2013. The purpose of this study was to provide a follow-up analysis of readiness costs for Georgia's Level I and Level II trauma centers. Using the American College of Surgeons Resources for Optimal Care of the Injured Patient guidelines, four readiness cost categories were identified: Administrative, Clinical Medical Staff, Operating Room, and Education/Outreach. Through conference calls, webinars and face-to-face meetings with financial officers, trauma medical directors, and program managers from all trauma centers, standardized definitions for reporting readiness costs within each category were developed. This resulted in a survey tool for centers to report their individual readiness costs for one year. The total readiness cost for all Level I trauma centers was $34,105,318 (avg $6,821,064) and all Level II trauma centers was $20,998,019 (avg $2,333,113). Methodology to standardize and define readiness costs for all trauma centers within the state was developed. Average costs for Level I and Level II trauma centers were identified. This model may be used to help other states define and standardize their trauma readiness costs.

The performance of a polymerase chain reaction–based point-of-care assay, the cobas Strep A Nucleic Acid Test for use on the cobas Liat System (cobas Liat Strep A assay), for the detection of group A Streptococcus bacteria was evaluated in primary care settings. Throat swab specimens from 427 patients were tested with the cobas Liat Strep A assay and a rapid antigen detection test (RADT) by existing medical staff at 5 primary care clinics, and results were compared with bacterial culture. The cobas Liat Strep A assay demonstrated equivalent sensitivity (97.7%) and specificity (93.3%) to reference culture with a 15-minute turnaround time. In comparison to RADTs, the cobas Liat Strep A assay showed improved sensitivity (97.7% Liat vs 84.5% RADT). The Clinical Laboratory Improvement Amendments–waived cobas Liat Strep A assay demonstrated the ease of use and improved turnaround time of RADTs along with the sensitivity of culture.

Objectives: Endoscopy confers high risk for acquiring coronavirus disease 2019. Although guidelines recommend that medical staff use personal protective equipment, no infection control equipment have been established for patients. This study aimed to clarify the usefulness of two face masks we had designed for transnasal and transoral endoscopy. Methods: The efficacy of the masks was evaluated by simulating coughing in a mannequin with fluorescent dyes and mapping the droplet trajectory and number. The number of aerosols generated during endoscopy was clinically evaluated in the endoscopy room. Overall, 4356 screening endoscopies were performed with the patients wearing our masks at Medcity21, a health checkup facility, between June and December 2020; the effects of the masks on the patient’s condition were evaluated retrospectively. An 11-item paper-based survey was performed by the endoscopy staff 6 months after the adoption of the mask-based infection control method. Results: Use of both masks reduced the number of droplets released during the simulation. Clinically, the use of both masks did not affect the patients’ conditions during endoscopy and prevented an increase in the aerosols in the endoscopy room. This mask-based infection control method was favorably received, and all staff indicated that understanding the efficacy of our mask-based infection control reduced their anxiety regarding infection. Until December 2020, none of our staff had contracted SARS-CoV-2. Conclusion: Our mask-based infection control method is easy to adopt, inexpensive, and effective; understanding its effectiveness may help ease the fear of infection among endoscopy staff.

To evaluate the current views on doctor–patient relationship (DPR) between citizens and medical staff in post-Corona Virus Disease 2019 (COVID-19) period and predict the possible factors of DPR, we distributed questionnaires by a online questionnaire platform--Questionnaire Star (https://www.wjx.cn) to evaluate DPR in post-COVID-19 period. Overall, 312 questionnaires for citizens and 421 questionnaires for medical staff were completed. Citizens felt that service attitude and communication with medical staff, and registering process have been improved. And their trust in doctors has increased by 86.8%. Majority of citizens (66.0%) preferred the tertiary hospitals. If doctor–patient contradictions occurred, 62.9% citizens preferred internal negotiation (with the doctor involved, 44.6%; with hospital management department, 18.3%). There was significant difference of views on the causes of medical violence incidents and the reasons for doctor–patient conflicts in the future between citizens and medical staff. The DPR score of medical staff was lower than citizens at each stage, and even showed a downward tendency in post-COVID-19 period. Furthermore, 20.4% medical staff believed that harmonious DPR would not be maintained, which was distinct from that of the citizens. Combating the COVID-19 provided an important opportunity to improve the DPR. However, unbalanced allocation of high-quality medical resources, gap between the actual treatment efficacy and patient’s expectation, fairness and efficiency issues, financial conflicts, and medical information symmetry were still the influencing factors of DPR.

Background Patients with thoracic trauma caused by gunshots face a high risk of death, and medical staff often encounter technical difficulties in resolving these cases. Most gunshot wounds result in an entrance and exit wound. In cases with no exit wound, missiles are seen in other areas with screening radiographs. The bullet may migrate depending on gravity, coughing, swallowing, blood flow, or local erosion. Case presentation We present the case of a teenager who was hospitalized in critical condition owing to a left hemithorax injury caused by an improvised explosive device. The patient underwent two surgeries: an anterior left thoracotomy during which a hole in the myocardium was sutured, and after radiography, anterolateral right thoracotomy was performed, in which a deformed projectile was found at the level of the intermediate right pulmonary artery. Conclusions This case highlights the crucial importance of repeated imaging to assess the possibility of projectile migration within the cardiovascular system in similar cases of penetrating injury. Immediate surgery was necessary and very important for the survival of our patient, despite the difficulties presented by this complicated case.

Recent technological advances in esophageal manometry allowed the definition of new classification methods for the diagnosis of disorders of esophageal motility and the implementation of innovative computational tools for the autonomic, reliable and unbiased detection of different disorders. Computational models can be developed aiming to interpret the mechanical behavior and functionality of the gastrointestinal tract and to summarize the results from clinical measurements, as high-resolution manometry pressure plots, into model parameters. A physiological model was here developed to interpret data from esophageal high-resolution manometry. Such model accounts for parameters related to specific physiological properties of the biological structures involved in the peristaltic mechanism. The identification of model parameters was performed by minimizing the discrepancy between clinical data from high-resolution manometry and model results. Clinical data were collected from both healthy volunteers ( n = 35) and patients with different motor disorders, such as achalasia patterns 1 ( n = 13), 2 ( n = 20) and 3 ( n = 5), distal esophageal spasm ( n = 69), esophago-gastric junction outflow obstruction ( n = 25), nutcracker esophagus ( n = 11) and normal motility ( n = 42). The physiological model that was formulated in this work can properly explain high-resolution manometry data, as confirmed by the evaluation of the coefficient of determination R2 = 0.83 − 0.96. The study finally led to identify the statistical distributions of model parameters for each healthy or pathologic conditions considered, addressing the applicability of the achieved results for the implementation of autonomic diagnosis procedures to support the medical staff during the traditional diagnostic process.

Noise in the operating theatre environment has remained a persistent and unresolved problem (Szalma & Hancock 2011). The problem currently lacks an effective solution (Schafer et al 2012). In order to partially resolve this issue, the authors created a behavioural noise reduction tool called ‘Below Ten Thousand’. This study identifies a potential solution to the problem of behavioural noise in the operating theatre, and indicates further research must be undertaken to identify the full scale of benefits this technique can deliver to the team environment in the operating theatre.

We need more GPs in the UK if we are to manage our ageing and increasingly multi-morbid population. However, there is a manpower crisis in NHS primary care, with GP recruitment falling and older doctors taking early retirement. Although there has been considerable research into medical staff stress, there are relatively few studies of coping and resilience in doctors. However, there is some evidence that intensive, brief resilience training can be beneficial. Our aim was to establish if REFRAME could help GPs develop skills that improve their well-being and resilience and to establish whether participants feel the outcome measures employed capture their experience.

This article examines the feminist foundations, style and performances of key writer-stars Jo Brand, Vicki Pepperdine and Joanna Scanlan in the British Broadcasting Corporation sitcom Getting On (2009–2012). Paying close attention to the ‘life experience’ of these women, it aims to think through the multiple, acute politics of representation that the show offers up, suggesting that sex, class and age operate as key emotional loadstones. Examining the hierarchical interactions between medical staff, this article also argues that the minutiae of social exchanges made visible in the sitcom reveal the sickness of the National Health Service to be connected to new managerialism and male privilege.

Playing hurt is a widespread phenomenon in elite sports that often goes along with using painkillers, disregarding medical guidelines, and hiding pain from coaches, teammates and medical staff. This paper theoretically conceptualizes the phenomenon of playing hurt as a sport-specific sickness presenteeism problem. To empirically analyse the willingness to play hurt, we refer to survey data from 723 elite German athletes, both male and female, in the sports of handball and track and field. Factor analysis, cluster analysis and binary logistic regression analysis are applied to reveal the athletes’ cognitive representation of absence legitimacy and to identify athlete groups with varying levels of willingness to compete hurt. Our results show that subtle distinctions are made between different kinds of health problems. In particular, there is a high willingness to compete despite psychosocial complaints. Cluster analysis reveals two clusters: ‘athletes conditionally willing to rest’ and ‘rest-averse and pain-trivializing athletes’. Athletes who perceive more social pressure to compete hurt, who have a higher performance level and who participate in handball, are more likely to be in the group of rest-averse and pain-trivializing athletes. The findings enhance our understanding of presenteeism and absenteeism in a highly competitive work context, and can contribute to the development of more target-group-specific health prevention programmes for athletes.

Medicine has been intimately associated with ionising radiation since the discovery of x rays in 1895; the first adverse effects of radiation were observed in persons working in research and on medical staff using x rays. Consequently, in 1925, the first International Congress of Radiology considered the need for a protection committee, which was established at its second congress in Stockholm in 1928 and is known today as the International Commission on Radiological Protection (ICRP). The first ICRP recommendations in 1928 were devoted to the protection of medical staff in the use of x rays for diagnosis and radiotherapy, and radium for radiotherapy. Later, ICRP devoted increased attention to the protection of patients, starting in 1970 with Publication 16 on protection of the patient in x-ray diagnosis, followed by three reports on the broad areas of radiation medicine: diagnostic radiology, radiation therapy, and nuclear medicine. A major change was made at the end of the 20th Century with the introduction of a series of short reports, focussed on specific problems and addressing specific medical practices. Since then, as many as 20 reports have been published on issues such as prevention of accidental exposure in radiotherapy, avoidance of radiation injuries from interventional procedures, managing radiation dose in digital radiology and computed tomography, protection in paediatric radiology, and many others.

Background: Floorball is an indoor team sport with growing popularity worldwide characterized by rapid accelerations, decelerations, and cutting and pivoting movements. While injuries are common, there are few high-quality epidemiological investigations of floorball injuries. Therefore, the aim of this study was to determine the incidence and severity of injuries in male and female elite-level floorball players in Sweden. Hypothesis: The incidence of injuries has not decreased; female players are more vulnerable to injury than male players. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: Twelve floorball teams (6 male, 6 female) in the Swedish premiere leagues were followed for 1 year (preseason, game season, and the entire year). The team medical staff reported injury incidence, location, type (traumatic or overuse), and severity. Differences between male and female players were analyzed using the Mann-Whitney U test. Results: The injury incidence was greater in female players during preseason (22.9 vs 7.4, P = 0.01), game season (39.5 vs 28.3, P = 0.002), as well as the whole year combined (33.9 vs 20.8, P = 0.02). The thigh was the most common injury location in male players and the ankle in female players. Overuse injuries were more common among men and were primarily back problems. Traumatic injuries were more common in women—mainly knee and ankle injuries. Most injuries were of mild severity. A greater number of anterior cruciate ligament injuries occurred in women (n = 11) than in men (n = 2). Conclusion: The injury incidence was significantly greater in female floorball players throughout the entire floorball year. Male players sustained mostly overuse injuries while female players suffered traumatic injuries. The majority of injuries in floorball were mild, irrespective of player sex. Clinical Relevance: Knowledge of the incidence and severity of floorball injuries is an essential step in the sequence of injury prevention. Future research should focus on identifying injury mechanisms and risk factors for these injuries to develop injury prevention strategies.

Background Patients with multimorbidity (two or more chronic conditions) are now the norm in clinical practice, and place an increasing burden on the healthcare system. Management of these patients is challenging, and requires doctors who are skilled in the complexity of multiple chronic diseases. Objective To perform a systematic review of the literature to ascertain whether there are education and training formats which have been used to train postgraduate medical doctors in the management of patients with multimorbidity in primary and/or secondary care, and which have been shown to improve knowledge, skills, attitudes, and/or patient outcomes. Methods Overall, 75,110 citations were screened, of which 65 full-text articles were then independently assessed for eligibility by two reviewers, and two studies met the inclusion criteria for the review. Results The two included studies implemented and evaluated multimorbidity workshops, and highlight the need for further research addressing the learning needs of doctors tasked with managing patients with multimorbidity in their daily practice. Conclusion While much has been published about the challenges presented to medical staff by patients with multimorbidity, published research regarding education of doctors to manage these problems is lacking. Further research is required to determine whether there is a need for, or benefit from, specific training for doctors to manage patients with multimorbidity. PROSPERO registration number: CRD42013004010.

Objective. The Japan Obstetric Compensation System for Cerebral Palsy (JOCSC) was launched in January 2009 as the first nationwide nofault compensation system. The aim of the study was to clarify the present status of functioning of the JOCSC in pediatric and obstetric departments at a general hospital. Method. Children eligible for compensation are as follows: (1) Gestational week at 32 weeks or later and birth weight of 1400 g or more, or 28 weeks or later with apparent asphyxia at birth. (2) Severe cerebral palsy related to hypoxia at delivery, not caused by congenital reasons or factors during the neonatal period. Results. Applications for the JOCSC were submitted for 11 cases (5 cases born at our hospital and 6 cases born at other childbirth facilities). Eight cases (4 cases born at our hospital and 4 cases born at other childbirth facilities) were authorized for the JOCSC. Remaining 3 cases were judged as not being eligible because of 2 cases with congenital reasons for the condition and 1 case with the judgement as mild cerebral palsy. Conclusion. Ten years have elapsed since the establishment of the JOCSC. Improved awareness of the medical staff and caregivers of children with cerebral palsy about the JOCSC should be promoted.

Preseason in rugby union is a period of intensive training where players undergo conditioning to prepare for the competitive season. In some cases, this includes modifying body composition through weight gain or fat loss. This study aimed to describe the macronutrient intakes of professional rugby union players during pre-season training. It was hypothesized that players required to gain weight would have a higher energy, carbohydrate and protein intake compared to those needing to lose weight. Twenty-three professional rugby players completed 3 days of dietary assessment and their sum of eight skinfolds were assessed. Players were divided into three groups by the team coaches and medical staff: weight gain, weight maintain and weight loss. Mean energy intakes were 3,875 ± 907 kcal·d−1 (15,965 ± 3,737 kJ·d−1) (weight gain 4,532 ± 804 kcal·d−1; weight maintain 3,825 ± 803 kcal·d−1; weight loss 3,066 ± 407 kcal·d−1) and carbohydrate intakes were 3.7 ± 1.2 g·kg−1·d−1 (weight gain 4.8 ± 0.9 g.kg−1·d−1; weight maintain 2.8 ± 0.7 g·kg−1·d−1; weight loss 2. 6 ± 0.7 g·kg−1·d−1). The energy and carbohydrate intakes are similar to published intakes among rugby union players. There were significant differences in energy intake and the percent of energy from protein between the weight gain and the weight loss group.

Objective. Over the past 8 years, natural orifice transluminal endoscopic surgery (NOTES) has developed from preclinical to routine clinical practice. However, there are still concerns regarding the transvaginal approach. In our survey, we were interested in females with a professional medical background, thus having at least a basic medical understanding, which might discriminate between objective and subjective concerns. Material and Methods. A questionnaire with 14 items was distributed among 1895 female physicians and nursing and administration staff of the University Medical Center Hamburg-Eppendorf. In addition, a qualitative literature review was performed. Data analysis was carried out using statistical package R version 2.15.0. Results. The questionnaire was answered anonymously by 553 employees (29%). Fifty-seven percent were nurses, 18.6% belonged to administration, and 17% were physicians. A total of 63.1% of our respondents would choose the transvaginal NOTES technique for an assumed ovariectomy, while only 30.4% would choose this access for cholecystectomy. Doubts regarding transvaginal NOTES were related to sexual dysfunction (44.8%), its experimental nature (43.8%), future pregnancies (36.8%), and ethical reasons (30.3%). The literature review showed that women’s perception of the transvaginal access is documented very heterogeneously and therefore difficult to compare. Conclusions. Despite the good reported results of NOTES and the medical background of the surveyed female employees, our study and the literature review clearly shows that there are fears regarding the transvaginal access, which might be a result of limited information. More accurate explanation of the available methods by the attending surgeon can lead to a better choice of the patient’s preferred method.

Introduction Computed tomography (CT) brain has become a popular modality to detect head injury related problems for patients seen at the Emergency Departments (ED) in Hong Kong. This study aims to assess the diagnostic accuracy of local ED medical staff in interpretation of head injury related CT and to assess the association between years of working experience of ED medical staff and the diagnostic accuracy of CT brain interpretation. Methods This is a retrospective cohort study reviewing all patients attending the ED of Princess Margaret Hospital in three years (from 2008 to 2010) with head injuries requiring CT brain during ED stay. The findings of CT brain by ED medical staff were compared with those by radiologists, the reference standard. Results A total of 1716 cases were assessed. The overall sensitivity and specificity for detecting an abnormal CT were 0.66 (95% confidence interval [CI] 0.60-0.71) and 0.96 (95% CI 0.95-0.97), respectively. The sensitivity showed an increasing trend from 0.63 (95% CI 0.54-0.72) in ED staff with 0-3 years of working experience, to 0.71 (95% CI 0.59-0.84) with 4-6 years of experience and 0.75 (95% CI 0.63-0.86) with 7-10 years of experience. It dropped to 0.59 (95% CI 0.47-0.71) with more than 10 years of experience. Conclusions The head injury related CT interpretation skill by ED medical staff is suboptimal. More training is necessary. (Hong Kong j.emerg.med. 2015;22:241-247)

Telemedicine is useful in monitoring patients, and in particular those, such as lung transplant recipients, suffering from chronic illnesses. This prospective cohort study was conducted on 15 lung transplant recipients. The patients provided physicians with data from spirometry as well as their clinical respiratory symptoms via SMS messages. In cases where spirometry results or clinical symptoms required follow-up, the monitoring physician contacted the patient according to guidelines and gave appropriate instructions. Qualitative assessment of satisfaction showed that the sense of increased support from medical staff was rated highest (92.9%). Telespirometry is an efficient method of monitoring lung transplant recipients which leads to patient satisfaction, compliance, adherence to study and sense of security. Nevertheless, for optimal implementation of this method, thorough training of both medical staff and patients is required.

Introduction To promote the increase in patients undergoing peritoneal dialysis (PD) in Japan, the Japanese Society for Dialysis Access started offering workshops on peritoneal access (PA) preparation procedures for doctors with less experience. Since the transfer of technology used in surgical procedures is difficult in small communities such as individual hospitals, a specialist group such as a society should take the initiative and fulfill this responsibility. Methods Here we used a hybrid simulator developed by Terumo Medical Pranex that uses the abdominal wall of an edible pig (a lump from the peritoneum to skin) and a mannequin. Since the structure of the porcine abdominal wall is similar to that of humans, the PA procedure can be simulated in this actual procedure. With three-dimensional reproduction of the Douglas pouch and other features of the pelvis using human computed tomography images, we created a system in which even drainage is possible if the catheter is well placed. Results Using this simulator, students were able to experience the PA access preparation procedure 2-4 times and easily observed the catheter position after insertion by peeling the abdominal wall from the mannequin. Conclusions In the future, by leveraging the advantages of the hybrid simulator, we aim to promote the training of medical staff interested in PD health care and increase the number of patients able to benefit from the many advantages of PD.

Palliative sedation (PS) is indicated for refractory symptoms among dying patients. This retrospective descriptive study examines PS in an Israeli hospice. Palliative sedation was defined as PS to unconsciousness (PSU), PS proportionate to symptoms (proportional palliative sedation [PPS]), or intermittent PS (IPS). Among 179 patients who died during 2012, PS was used among 21.2% (n = 38): (PSU 34.2%, PPS 34.2%, and IPS 31.6%), using midazolam (n = 33/38), halidol (21/38), and concurrent morphine (n = 35/38). Indications included agitation (71%), pain (36.8%), and dyspnea (21%). Survival following initiation of PS was 73 ± standard deviation 54 hours. No differences in survival were observed according to who initiated the decision to use PS (patients/medical staff/family) or type of PS (PSU/PPS/IPS). Survival following PS was longest with higher sedative doses, an observation that may help dispel fears concerning the use of PS to hasten death.

Secondary traumatic stress (STS) is an issue of significant concern among providers who work with survivors of sexual assault. Although STS has been studied in relation to individual-level characteristics of a variety of types of trauma responders, less research has focused specifically on rape crisis centers as environments that might convey risk or protection from STS, and no research to knowledge has modeled setting-level variation in correlates of STS. The current study uses a sample of 164 staff members representing 40 rape crisis centers across a single Midwestern state to investigate the staff member-and agency-level correlates of STS. Results suggest that correlates exist at both levels of analysis. Younger age and greater severity of sexual assault history were statistically significant individual-level predictors of increased STS. Greater frequency of supervision was more strongly related to secondary stress for non-advocates than for advocates. At the setting level, lower levels of supervision and higher client loads agency-wide accounted for unique variance in staff members’ STS. These findings suggest that characteristics of both providers and their settings are important to consider when understanding their STS.

Patients can acutely deteriorate unexpectedly. Junior medical officers (JMOs) are often first to review patients who become unwell. Opportunities to escalate care to a senior colleague may exist prior to the need for a rapid response team review. Little is known about the factors that influence JMO decisions to escalate care. In this study, our objective was to investigate the self-reported factors that influence escalation of care by JMOs in a university-affiliated, tertiary level hospital. We designed a face-to-face questionnaire of JMOs using standardised introduction to minimise interviewer bias. Fifty JMOs participated in the study (a 100% response rate). Most (63.3%) felt that they would be able to identify a clinically deteriorating patient. They would be more likely to escalate care if they were not familiar with the patient's clinical problem. If handover plans were seen to be adequate, JMOs felt it was less necessary to escalate care. Few JMOs (12%) agreed that they limited escalation due to fear of criticism or fear of conflict with senior medical staff. Although 36% agreed that they were concerned about waking seniors overnight, only 6% feared that escalating care overnight would affect their future career prospects. Escalation of care appears to be mostly influenced by the confidence and familiarity of the JMO with the cause of deterioration. JMOs identified clear handover with documented goals of treatment and suggested actions in event of clinical deterioration as the best means by which to improve the process of escalation of care for clinically deteriorating patients.