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Background: Physicians from resource-constrained rural areas being lone lifesavers pose a unique challenge in resuscitating emergencies like cardiac arrest. Rural Emergency Care Training for Physicians (RECTIFY) was devised as a short course training to equip them to deal with occasional emergencies using minimal gadgets. This study was conceived to assess the effectiveness of the RECTIFY-Cardiac Arrest Resuscitation Short course (CARS) module in improving current knowledge and practice of cardiopulmonary resuscitation (CPR) among interested rural physicians of Asia. Methods: A three-tier observational study was conducted to assess current CPR knowledge with a pretested structured questionnaire and skills using a checklist, followed by a 3-h hands-on training and posttest evaluation using the same study instruments. Data were entered into Microsoft Excel and analyzed using SPSS 13.0. Results: Out of 622 participants, most of the participants (603; 96.9%) were willing to provide CPR despite poor knowledge and skills. Pretest scores averaged 1.5 ± 0.99 and 0.1 ± 0.3 for CPR knowledge and skills, respectively. Posttest scores for CPR knowledge (10.5 ± 1.5) and skills (2.8 ± 1.6) improved significantly (both P = 0.001). Whereas a majority improved upon chest compression skills, appropriate use of sophisticated gadgets like automated external defibrillators (AED) was low (2.4%) despite training. Conclusion: The level of knowledge and skill among participants was poor despite the enthusiasm and positive intent. The impact of RECTIFY-CARS on knowledge and skills among participant physicians was significant and is recommended for implementation by health policymakers in resource-poor rural settings. However, essential gadgets like AED were not impactful which necessitates the use of simpler rural alternatives.

Background: Resource limitation, staff deficiency, and variability in patient inflow contribute to emergency department (ED) overcrowding, associated with delayed care, poor care, and poor patient outcomes. This study seeks to describe and analyze patient inflow variability and staffing trends on Sundays versus other days in a tertiary academic ED from South India. Methods: Patient inflow and staffing data for 2 years were collected from hospital records, cross-checked, and statistically analyzed using Epi Info 7.0. Results: Significant increase in patient inflow (45.6%) was noted on Sundays compared to other days (155.9 [95% confidence interval (CI): 152.75-159.05] vs. 107.1 [95% CI: 105.98-108.22]; P < 0.001), with higher inflow in the morning shifts (67.4 [95% CI: 65.41-69.45] vs. 32.1 [95% CI: 31.45-32.70]; P < 0.001). All categories of ED staff were deficient across all shifts (2.1 [95% CI: 2.05-2.15] tier-2 physicians, 4.9 [95% CI: 4.86-4.94] nurses, and 1.9 [95% CI: 1.88-1.92] nurse assistants on an average), especially tier-1 physicians (0.3 [95% CI: 0.24-0.36] on Sundays and 0.5 [95% CI: 0.48-0.52] on other days; P < 0.001). Patient-per-hour (PPH)-per-provider based on patient arrival rate was generally high. PPH per tier-1 physician was the highest, being 10.6 (95% CI: 9.95-11.14) versus 5.4 (95% CI: 5.26-5.59; P < 0.001) in the morning and 7.2 (95% CI: 6.95-7.45) versus 6.6 (95% CI: 6.43-6.74; P = 0.08) in the evening shifts on Sundays and other days, respectively. Conclusions: There were deficiencies in all categories of ED staff on all days, and this was pronounced on Sundays due to significantly higher patient inflow. Inadequate ED staffing, especially due to a significant dearth of tier-1 physicians is a pointer toward quality compromise in developing EDs. Authors recommend adequate staff deployment in developing EDs for optimum quality care. This should be implemented such that staffing is based on expected patient inflow so that a PPH-per-provider goal of 2.5 is targeted across all shifts. [ABSTRACT FROM AUTHOR]

Objective: Nursing professionals are expected to have updated knowledge of clinical blood transfusion guidelines while catering to cancer patients requiring bedside transfusions., Methods: A cross-sectional study was conducted to evaluate the knowledge and current practice of nurses at a tertiary-level cancer hospital in rural Kerala using a pretested self-administered structured 20-item questionnaire, and results were analyzed., Results: Among 246 nurses who participated, a response rate of 93.08% ( n = 229) was obtained. Mean scores of 4.64 ± 1.20 out of eight for knowledge-based questions (58.00%) and 6.16 ± 1.49 out of 12 for practical aspects (51.33%) were obtained among respondents. Whereas overall scores were fair (84.28% and 65.94% nurses scoring ≥50% in knowledge-based and practice-based questions, respectively), we noticed poor knowledge-level scores for the key aspects such as time taken for cross-matching, cross-match test taking least time, storage temperature, and mandatory transfusion-transmitted infection tests before initiating transfusion. Poor scores were also noted for key clinical practices relating to warming of blood products, posttransfusion patient monitoring, rate of nonemergency blood transfusions, administration of premedications, and disposal of blood bags among the respondents. Data also revealed that there was a lack of adherence to a uniform cannula size for routine blood transfusion among nurses. Work experience or qualification had no significant relation to the nurses' scores for knowledge or practice-based questions., Conclusions: Overall, a fair amount of theoretical and practical knowledge about bedside transfusion practices were observed among nurses with some inconsistencies not related to qualification or work experience. This illuminates inherent lacunae in the existing training system and merits urgent redressal., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Ann & Joshua Medical Publishing Co. Ltd.)

COVID-19 is one of the deadliest viral infections to have hit the planet. There is urgent need to bridge the gaps in handling this pandemic by methodically synthesising available literature through a unique holistic perspective. A systematic review of articles regarding emergency and primary care during COVID-19 pandemic was carried out. PubMed, Scopus, Science Direct, Web of Science, and Google Scholar were screened for articles and qualitative data across various studies were coded and thematically analyzed. Narrative synthesis was achieved by themes identified from findings of studies. Out of n = 953 articles retrieved, we identified and critically appraised n = 7 articles of which n = 5 were narrative reviews, one was systematic review and one was scoping review from researchers across ten countries. Nine overlapping themes were identified under three broad domains - clinical understanding of the disease, social aspects of the disease, and its contextual implications during pandemic. This narrative synthesis draws up a holistic picture of recent reviews on clinical and social understanding of COVID-19 as a disease and as a pandemic. The overlap among nine themes identified in this review could mean that primary care-level screening, triaging, referral, and emergency care of COVID-19 patients in the backdrop of current clinical understanding of the pandemic are all intertwined. Coping with COVID-19 co-habitation and managing undifferentiated illnesses require a syndromic approach and deft handling at grass root levels. Inclusive health policy empowering inherent holistic specialties like family medicine and emergency medicine could be the prudent way forward during this pandemic., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)