Preparing for Burn Disasters: Predictors of Improved Perceptions of Competency after Mass Burn Care Training

2007 ◽  
Vol 22 (5) ◽  
pp. 448-453 ◽  
Author(s):  
Ruth Wetta-Hall ◽  
Gina M. Berg-Copas ◽  
Janet Cusick Jost ◽  
Gary Jost

AbstractIntroduction:Prehospital and community hospital healthcare providers in the United States must be prepared to respond to burn disasters. Continuing education is the most frequently utilized method of updating knowledge, skills, and competence among healthcare professionals. Since preparedness training must meet multiple educational demands, it is vital to understand how participants'work and educational experience and the program's content and delivery methods impact knowledge acquisition, and how learning influences confidence and competence to perform new skills.Purpose:The purpose of this exploratory, convenience sample study was to identify healthcare provider characteristics and continuing education training content areas that were predictive of self-reported improvement in competence after attending a mass-casualty burn disaster continuing education program.Methods:Logistic regression analysis of data from a post-training evaluation from nine, one-day continuing education conferences on mass burn care was used to identify factors associated with improved self-reported competency to respond to mass burn casualties.Results:The following factors were associated most closely with increased self-reported competency: (1) prehospital work setting (odds ratio (OR) = 3.06, confidence interval (CI) = 0.83–11.30, p = 0.09); (2) 11 or more years of practice (OR = 0.31, CI = 0.09–1.08, p = 0.07); and (3) practice in an urban setting (OR = 0.01, CI = 0.18–0.82, p >0.01). Confidence items included: (1) ability to implement appropriate airway management modalities (OR = 2.31, CI = 1.03–5.17, p >0.04); (2) manage patients with electrical injuries (OR = 4.86, CI = 1.84–12.85, p >0.001); (3) identify non-survivable injuries (OR = 2.24, CI = 0.93–5.43, p = 0.07); and (4) recognize special problems associated with burns in young children or older adults (OR = 2.14, CI = 0.87–5.23, p = 0.10). The final model explained 89.9% of the variability in self-reported competence.Conclusions:Interventions used to train healthcare providers for burn disasters must cover a broad range of topics. However, learning needs may vary by practice setting, work experience, and previous exposure to disaster events. This evaluation research provides three-fold information for continuing education research: (1) to identify content areas that should be emphasized in future burn care training; (2) to be used as a model for CE evaluation in other domains; and (3) to provide support that many factors must be considered when designing a CE program. Results may be useful to others who are planning CE training programs.

2020 ◽  
Vol 8 ◽  
pp. 205031212093821 ◽  
Author(s):  
Leticia A. Shea ◽  
Micheline A. Goldwire ◽  
David Hymel ◽  
Doan Bui

Objectives: With one of the highest prevalence rates for marijuana use in the United States, Colorado provides a great opportunity for insight on common encounters with consumers in the community pharmacy setting. Currently, there is limited data on community pharmacists and their experiences with patients and marijuana. This study aims to identify the most common questions community pharmacists receive about marijuana, how comfortable they are in answering those questions, and to identify knowledge gaps regarding marijuana and pharmaceutical care. Methods: A cross-sectional study design was chosen to survey community pharmacists. A convenience sample of community pharmacists from the greater Denver metro area counties were surveyed about recreational and medical marijuana questions they receive from patients and consumers. Statistical methods included descriptive statistics, Chi-square, Kruskal–Wallis, and Mann–Whitney. Results: Of the 51 pharmacists who completed the survey, 20% received questions about medical marijuana daily or weekly, 57% monthly, and 22% never, while 16% received questions about recreational marijuana weekly, 41% monthly, and 43% never. In addition, 53% were comfortable answering questions about medical marijuana, while 41% were comfortable answering questions about recreational marijuana. The most common questions received were related to indications, uses, and efficacy (33%), followed by drug interactions (30%). Conclusion: The increased acceptance of marijuana by patients warrants pharmacists and other healthcare providers to be confident and familiar with its use. Our findings suggest that the majority of pharmacists are not asking about marijuana use/consumption, and this may be a gap in care. Studies support that other healthcare providers also exhibit hesitancy in initiating these conversations. Consumers are using marijuana products now, so increasing marijuana education for all healthcare professionals during both didactic education and continuing education will be key to ensuring patients have access to evidence-based care regarding the use of marijuana, rather than care based on belief, alone.


2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Rachel A. Parry ◽  
William A. Zule ◽  
Christopher B. Hurt ◽  
Donna M. Evon ◽  
Sarah K. Rhea ◽  
...  

Abstract Background Pharmacists are among the most accessible healthcare providers in the United States and uniquely positioned to provide harm reduction services. The availability of pharmacy-based harm reduction services and pharmacist attitudes toward delivering these services have been understudied to date. We examine North Carolina (NC) pharmacists’ experiences with and attitudes about harm reduction services and explore differences between rural and urban pharmacists. Methods A convenience sample of NC pharmacists participated in an anonymous, online survey regarding harm reduction services: non-prescription syringe sales; naloxone dispensing; and human immunodeficiency virus (HIV) and hepatitis C virus (HCV) screening. Urban–rural differences were analyzed using Pearson’s chi-square or Fisher’s exact tests. Open-ended responses were analyzed thematically. Results Three hundred pharmacists responded to the survey; 68 (23%) practiced in rural counties. Dispensing non-prescription syringes and naloxone at least occasionally was reported by 77% (n = 231) and 88% (n = 263) pharmacists, respectively. Pharmacy-delivered HIV or HCV screening was rare. Urban pharmacists dispensed naloxone more frequently than rural pharmacies (p = 0.04). Only 52% of pharmacists agreed that persons who inject drugs should always be allowed to buy non-prescription syringes. Rural pharmacists’ attitudes toward harm reduction services for persons who inject drugs were statistically, though marginally, less supportive when compared to urban pharmacists’ attitudes. The most common barrier to non-prescription syringe access was requiring patients to provide proof of prescription injection medication use, which 21% of pharmacists reported was required by their pharmacy’s policy on non-prescription syringe sales. Conclusions Although most pharmacies distributed naloxone and sold non-prescription syringes, pharmacy store policies and personal beliefs inhibited naloxone and non-prescription syringe dispensing. NC community pharmacies infrequently offer HIV and HCV screening. Paired with disseminating the evidence of the positive impact of harm reduction on individual and public health outcomes to NC pharmacists, institutional and systems changes to practice and policy may be important to promote harm reduction service availability, particularly for rural NC residents. Trial registration: N/A.


2016 ◽  
Vol 6;19 (6;7) ◽  
pp. 363-372
Author(s):  
Carlos J. Roldan

Background: Pain of myofascial origin is a well-recognized pathology characterized by the presence of two components: referred pain; which is often distant from its source and specific to each muscle, and the trigger point, a localized hyperirritable band present in the affected muscle and able to reproduce the referred pain when stimulated. Myofascial pain (MP) commonly coexists in patients with acute or chronic pain of other etiologies. The uniqueness of the clinical presentation of some MPs and the lack of training of most specialties represent a clinical challenge. Thus, many patients with MPS receive less than optimal management of this condition. Objective: Pain at the anterior torso, originating at the posterior torso, can mimic common pathologies that correlate with the same anatomical area such as cardiac and intra-abdominal conditions. These clinical characteristics could be caused by MP of the iliocostalis thoracis-lumborum (ITL) muscle. However, this entity has not been well addressed in the medical literature. In this report we characterize the manifestations, diagnosis, and clinical implications of ITL MP. Study Design: Observational assessment. Setting: Two university-based academic emergency medicine departments (ED) in an urban setting in the United States. Methods: A convenience sample of 43 patients who presented to the ED with pain at the anterior aspect of the torso (chest, abdomen, or pelvis) and clinical evidence of MP originated in the ITL muscle. Of a clinical trial of patients with MP, we describe a subgroup of patients with MP of the ITL which was clinically evident by the presence of a trigger point (TP) in its ability to reproduce the referred pain present at the anterior aspect of the torso. Patients received a TP injection. In this trial we intend to demonstrate that TP injections using particulate steroids mixed with a local are no more effective than saline alone to treat MP. The primary outcome was pain control (decrease in intensity of 50% or more below baseline numeric pain rating). A follow-up telephone interview was performed by third-party abstractors. Results: Forty-three patients presented with pain of the anterior torso and ipsilateral back, both correlating with the level of the TP of the ITL muscle. The pain had been present from 2 days to 7 years. The most common locations of pain were the right-lower quadrant and the left side of the chest. In many of them a pattern of missed diagnosis was evident despite extensive workups and consultations. Only 17 patients were able to identify the precipitating event; the most common was coughing. Two weeks after TP injection, all patients still had satisfactory pain control. After treatment, no missed pathology or returns to the ED were reported. Limitations: This descriptive portion of the ongoing study does not affect the integrity of the trial itself but could be subject to the introduction of subject selection and selective reporting bias. Similarly, this convenience sample does not establish the incidence of this pathology and challenges the external validity to other clinical settings. Conclusions: Anterior torso pain often resulted in extensive workups before ITL myofascial pain was diagnosed. TP injections were diagnostic and therapeutic of ITL myofascial pain. Key words: Iliocostalis thoracis-lumborum muscle, myofascial pain, referred pain, trigger point injection


2020 ◽  
Vol 7 (2) ◽  
pp. 67-82
Author(s):  
Susan Andrews

Background:  Recent reviews of published guidelines for conducting short-term medical missions (STMM) identify significant concerns about the lack of adherence and of formal regulations concurrent with the increasing number of individuals and organizations participating in STMM. Method: A descriptive survey methodology was used. A 44-item survey that identifies current practices utilized by healthcare providers (HCP) who have participated in STMM was used based on the literature and prior research, and distributed electronically to HCP participating in STTM to identify current best practices and compare findings with the most recent recommendations for short-term global health activities. A focus on current operational practices was surveyed and analyzed to develop operational recommendations for the ethical and safe care provided during STMM. Results: Eighty-seven surveys were included in the final analysis, with 33% (N=29) serving as coordinators for the trip. The majority of the respondents were female (67%) and the primary roles represented were: MD (N=17; 20%), nurse practitioner (N=20; 23%), and registered nurse (N=18; 21%). A majority (N=48; 67%) traveled to South America or Latin America, with 38% (N=33) having participated in four or more STMM. Language proficiency was reported as deficient (N=35; 40%) along with little or no knowledge of the basic culture (N=39; 45%). Additional data were collected on trip preparation, clinic operations, and outcomes follow up. Conclusions: Using a convenience sample, the results of the survey provide information on the current best practices utilized by HCP who have participated in STMM and compare the findings to assess for adherence with the most recent recommendations for short-term global health activities. There was variation in the degree to which HCP were knowledgeable about specific aspects related to knowledge of local culture, language proficiency, and adherence to recommended practices for STMM. Additional research on STMM is needed, along with further exploration of how evidence based practices for STMM can be implemented to improve access and safety to the care provided while in the host country.


2020 ◽  
Author(s):  
Shabbir Syed-Abdul ◽  
Shwetambara Malwade ◽  
Sim-Mei Choo

UNSTRUCTURED The outbreak of COVID-19 that started in December 2019, was declared a pandemic in March 2020. Currently, there is no specific treatment recommended and healthcare providers are struggling to find appropriate treatment regimes. Medication misinformation spread through social media has caused panic situations and self-prescription leading to harmful drug effects. The situation worsened following false propaganda via social media, leading to shortage of some medications. Our study shows the frequency of search for the medications Hydroxychloroquine (HCQ), Azithromycin and Bacillus Calmette-Guérin (BCG) vaccine in Google Trends, across 6 countries. Public interests from the United States, Italy and Spain leaned towards HCQ, whereas those from Taiwan, Japan and South Korea were keen towards learning about the BCG vaccine. Our article aimed to inform the general public of the adverse drug reactions to avoid self-prescription or yield to the assumptions of leaders and unanimous social media posts. Proactive participation and preventive measures such as social distancing, use of face masks and hand sanitizers are recommended to help curb COVID-19 and other infections.


2020 ◽  
Vol Volume 12 ◽  
pp. 201-210
Author(s):  
Benjamin D Lindquist ◽  
Kathryn W Koval ◽  
Peter C Acker ◽  
Corey B Bills ◽  
Ayesha Khan ◽  
...  

2021 ◽  
pp. 000313482110110
Author(s):  
Rahima Khatun ◽  
Banan W. Otaibi ◽  
Anna Ssentongo ◽  
Joshua P. Hazelton ◽  
AmandaB. Cooper

Background In situations of increased need, such as mass casualty incidents (MCIs) and COVID-19, donated blood products are in shortage across the United States. Medical students are a potential pool for blood donors. The aim of this study was to determine overall attitudes of medical students at a single academic institution toward blood donation during times of increased need. Methods Three anonymous REDCap surveys were administered to all medical students at a rural academic institution. Surveys 1 and 2 were administered preceding and after an institution-wide MCI drill, in September and November 2019, respectively. Survey 3 was administered following a student-organized COVID-19 blood drive in June 2020. Multivariable analysis was performed to determine if factors, ie, experience with MCI drills and emergency medical services (EMS) training, were associated with willingness to donate blood. Furthermore, barriers to donation among those not willing to donate were assessed. Results Overall response rate for MCI surveys (surveys 1 and 2) was 38% (mean age 25.2 years and 50% women). 91% (n = 210) of respondents were willing to donate blood. Previous participation in MCI drills and EMS training was not associated with higher willingness to donate blood. Response rate for survey 3 was 15.6% (59.4% women), and 30 (31.3%) respondents indicated they did not volunteer to donate blood during the COVID-19 drive. Most common reasons for not donating were “other,” medical concerns, and being out-of-town. Conclusions Majority of medical students are willing to donate blood during times of increased need and offer a possible solution to increase blood donor pool.


2002 ◽  
Vol 28 (4) ◽  
pp. 491-502
Author(s):  
Mary L. Durham

While the new Health Insurance Privacy and Accountability Act (HIPAA) research rules governing privacy, confidentiality and personal health information will challenge the research and medical communities, history teaches us that the difficulty of this challenge pales in comparison to the potential harms that such regulations are designed to avoid. Although revised following broad commentary from researchers and healthcare providers around the country, the HIPAA privacy requirements will dramatically change the way healthcare researchers do their jobs in the United States. Given our reluctance to change, we risk overlooking potentially valid reasons why access to personal health information is restricted and regulated. In an environment of electronic information, public concern, genetic information and decline of public trust, regulations are ever-changing. Six categories of HIPAA requirements stand out as transformative: disclosure accounting/tracking, business associations, institutional review board (IRB) changes, minimum necessary requirements, data de-identification, and criminal and civil penalties.


2021 ◽  
Vol 15 ◽  
pp. 117954682110152
Author(s):  
Jose Nativi-Nicolau ◽  
Nitasha Sarswat ◽  
Johana Fajardo ◽  
Muriel Finkel ◽  
Younos Abdulsattar ◽  
...  

Background: Because transthyretin amyloid cardiomyopathy (ATTR-CM) poses unique diagnostic and therapeutic challenges, referral of patients with known or suspected disease to specialized amyloidosis centers is recommended. These centers have developed strategic practices to provide multidisciplinary comprehensive care, but their best practices have not yet been well studied as a group. Methods: A qualitative survey was conducted by telephone/email from October 2019 to February 2020 among eligible healthcare providers with experience in the management of ATTR-CM at US amyloidosis centers, patients with ATTR-CM treated at amyloidosis centers, and patient advocates from amyloidosis patient support groups. Results: Fifteen cardiologists and 9 nurse practitioners/nurses from 15 selected amyloidosis centers participated in the survey, with 16 patients and 4 patient advocates. Among participating healthcare providers, the most frequently cited center best practices were diagnostic capability, multidisciplinary care, and time spent on patient care; the greatest challenges involved coordination of patient care. Patients described the “ideal” amyloidosis program as one that provides physicians with expertise in ATTR-CM, sufficient time with patients, comprehensive patient care, and opportunities to participate in research/clinical trials. The majority of centers host patient support group meetings, and patient advocacy groups provide support for centers with physician/patient education and research. Conclusions: Amyloidosis centers offer comprehensive care based on staff expertise in ATTR-CM, a multidisciplinary approach, advanced diagnostics, and time dedicated to patient care and education. Raising awareness of amyloidosis centers’ best practices among healthcare providers can reinforce the benefits of early referral and comprehensive care for patients with ATTR-CM.


2021 ◽  
Vol 149 ◽  
Author(s):  
Chien-Hsiang Weng ◽  
Andrew Saal ◽  
Daniel C. McGuire ◽  
Philip A. Chan

Abstract Hispanic/Latino populations are disproportionately impacted by coronavirus disease 2019 (COVID-19) in the United States. The impact of state reopening on COVID-19 in this population after stay-at-home orders is unknown. We evaluated the incidence, prevalence and trends during reopening of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at a major federally qualified health centre in Providence, Rhode Island. A total of 14 505 patients were tested for SARS-CoV-2 from 19 March to 18 August 2020, of which, data on 13 318 (91.8%) patients were available; 70.0% were Hispanic/Latino, and 2905 were positive for SARS-CoV-2 infection. The urban Hispanic/Latino population was almost five times more likely to test positive for SARS-CoV-2 (risk ratio 4.97, 95% CI 2.59–9.53, P < 0.001) compared to non-Hispanic White. The positivity rates among the urban Hispanic/Latino population remained >10% during all phases of reopening. The trends of the incidence rates showed similar associations to those we observed for positivity rates. Public health interventions to address SARS-CoV-2 in Hispanic/Latino communities are urgently needed, even in latter phases of state reopening.


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