Parenteral medications at Role 1: do doctors in the British Army require improved training and experience?

2021 ◽  
pp. bmjmilitary-2021-001841
Author(s):  
Luke John Turner ◽  
A J Martin-Bates

Role 1 doctors in the British Army work predominantly in primary healthcare, but also provide prehospital emergency care and administer potent parenteral medications in the field. Role 1 doctors have theoretical training in the use of these medications on short courses but then have little refresher training and use them infrequently in their routine practice, introducing the risk of skill fade. This may lead to higher rates of medication errors in an environment where the consequences may be significant. This article explores the current training of Role 1 doctors, the threat of skill fade and how the safety of drug administration can be improved. This includes recommendations for the development of training competencies, bespoke courses and clinical placements, e-learning and the use of new technology. Application of these recommendations has the potential to improve patient safety and the confidence of doctors in the use of parenteral analgesia.

Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Enno Swart ◽  
Bernt-Peter Robra

Abstract Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.


2021 ◽  
Vol 12 (1) ◽  
pp. 73-94
Author(s):  
Pham Quang Huy ◽  
Vu Kien Phuc

Abstract This research ferreted out to inspect the interconnection between emotional intelligence (EI), Blockchain technology application (BLO) and the effectiveness of Accounting information system (AIS). Survey-based data obtained from 412 respondents were applied to validate the model hypotheses. Building on the statistical analysis with the support of SPSS 25.0 and SMART- PLS (partial least squares) 3.2.8 software package, the model results inferred the impact of EI on BLO. Besides, the outputs of the study accentuated on the importance of BLO on the effectiveness of AIS. These significant additions will optimistically inspire other scholars to carry on exploring the relationship between EI and BLO in enhancing the effectiveness of AIS in research settings as well as in explaining the results. On the other hand, taking these results into consideration could promote much better solutions for issues relevant to EI and new technology application among public sector organization (PSO) in term of increasing the performance of AIS.


Author(s):  
Ian Howard ◽  
Peter Cameron ◽  
Maaret Castrén ◽  
Lee Wallis ◽  
Veronica Lindström

ABSTRACT Background Quality Indicator (QI) appraisal protocols are a novel methodology that combines multiple appraisal methods to comprehensively assess the "appropriateness" of QIs for a particular healthcare setting. However, they remain inadequately explored compared to the single appraisal method approach. This paper aimed to describe and test a QI appraisal protocol versus the single method approach, against a series of QIs potentially relevant to the South African Prehospital Emergency Care setting. Methods An appraisal protocol was developed consisting of two categorical-based appraisal methods, combined with the qualitative analysis of the discussion generated during the consensus application of each method. The output of the protocol was assessed and compared with the application and output of each method. Inter-rater reliability of each particular method was evaluated prior to group consensus rating. Variation in the number of non-valid QIs and the proportion of non-valid QIs identified between each method and the protocol were compared and assessed. Results There was mixed IRR of the individual methods. There was similarly low to moderate correlation of the results obtained between the particular methods (Spearman’s rank correlation=0.42,p<0.001). From a series of 104 QIs, 11 non-valid QIs were identified that were shared between the individual methods. A further 19 non-valid QIs were identified and not shared by each method, highlighting the benefits of a multi-method approach. The outcomes were additionally evident in the group discussion analysis, which in and of itself added further input that would not have otherwise been captured by the individual methods alone. Conclusion The utilization of a multi-method appraisal protocol offers multiple benefits, when compared to the single appraisal approach, and can provide the confidence that the outcomes of the appraisal will ensure a strong foundation on which the QI framework can be successfully implemented.


Author(s):  
Eva Toth-Pal ◽  
Cecilia Fridén ◽  
Stefano Torres Asenjo ◽  
Christina B. Olsson

Abstract Aim: To evaluate person-centred home visits as an interprofessional learning (IPL) activity for undergraduate students during clinical placements in primary healthcare. Background: Interprofessional collaboration is known to improve patient safety, increase job satisfaction, and reduce stress among healthcare professionals. Students should already during their basic training experience interprofessional collaboration. Methods: Students from six different educational programmes and supervisors and adjunct clinical lecturers from different professions participated in the learning activity. The students read a description of the patient history before the visit together with a supervisor. During the home visit, the students were responsible for history-taking and for performing relevant examinations. Afterwards, the students made a joint care plan for the patient. Students, supervisors, and adjunct clinical lecturers discussed the outcomes in a seminar and reflected on each other’s professional roles. The students and the patients answered a questionnaire about the activity, and the supervisors and the adjunct clinical lecturers were interviewed in focus groups. Findings: Thirty interprofessional home visits were conducted, involving 109 students from six different healthcare professions. The students reported that they had gained insights into how different professions could collaborate and an increased understanding of teamwork. All patients were satisfied with the visits and felt that they had been listened to. The interview analysis showed one overarching theme: ‘Interprofessional home visits in primary healthcare were an appreciated and effective pedagogical learning activity with a sustainability dependent on organisational factors’. Conclusions: The students felt that participation in the activity increased their understanding of collaboration and of other professions’ skills. The supervisors found the home visits to be an appreciated and effective learning activity. The results indicate that this learning activity can be used in primary healthcare settings to promote students’ IPL, but organisational factors need to be considered in order to support sustainability.


2020 ◽  
Vol 35 (5) ◽  
pp. 546-553 ◽  
Author(s):  
Canaan J. Hancock ◽  
Peter G. Delaney ◽  
Zachary J. Eisner ◽  
Eric Kroner ◽  
Issa Mahamet-Nuur ◽  
...  

AbstractIntroduction:The World Health Organization (WHO; Geneva, Switzerland) recommends lay first responder (LFR) programs as a first step toward establishing formal Emergency Medical Services (EMS) in low- and middle-income countries (LMICs) to address injury. There is a scarcity of research investigating LFR program development in predominantly rural settings of LMICs.Study Objective:A pilot LFR program was launched and assessed over 12 months to investigate the feasibility of leveraging pre-existing transportation providers to scale up prehospital emergency care in rural, low-resource settings of LMICs.Methods:An LFR program was established in rural Chad to evaluate curriculum efficacy, using a validated 15-question pre-/post-test to measure participant knowledge improvement. Pre-/post-test score distributions were compared using a Wilcoxon Signed-Rank test. For test evaluation, each pre-test question was mapped to its corresponding post-test analog and compared using McNemar’s Chi-Squared Test to examine knowledge acquisition on a by-question basis. Longitudinal prehospital care was evaluated with incident reports, while program cost was tracked using a one-way sensitivity analysis. Qualitative follow-up surveys and semi-interviews were conducted at 12 months, with initial participants and randomly sampled motorcycle taxi drivers, and used a constructivist grounded theory approach to understand the factors motivating continued voluntary participation to inform future program continuity. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide design, analysis, and reporting the qualitative results.Results:A total of 108 motorcycle taxi participants demonstrated significant knowledge improvement (P <.001) across three of four curricular categories: scene safety, airway and breathing, and bleeding control. Lay first responders treated 71 patients over six months, encountering five deaths, and provided patient transport in 82% of encounters. Lay first responders reported an average confidence score of 8.53/10 (n = 38). In qualitative follow-up surveys and semi-structured interviews, the ability to care for the injured, new knowledge/skills, and the resultant gain in social status and customer acquisition motivated continued involvement as LFRs. Ninety-six percent of untrained, randomly sampled motorcycle taxi drivers reported they would be willing to pay to participate in future training courses.Conclusion:Lay first responder programs appear feasible and cost-effective in rural LMIC settings. Participants demonstrate significant knowledge acquisition, and after 12 months of providing emergency care, report sustained voluntary participation due to social and financial benefits, suggesting sustainability and scalability of LFR programs in low-resource settings.


2021 ◽  
Vol 58 ◽  
pp. 101051
Author(s):  
Veronica Vicente ◽  
Lenny Bergqvist ◽  
Moa Kvist ◽  
Rebecka Rubenson Wahlin ◽  
Helena Sjölin

2021 ◽  
Author(s):  
Mihaela Vlaicu ◽  
Vasile Marius Nae ◽  
Patrick Christian Buerssner ◽  
Stefan Liviu Firu ◽  
Natalya Logashova

Abstract Paraffin represents one of the main case of failures and production losses which facing the entire oil industry. Prevention of paraffin deposition on the subsurface/surface equipment can be achieved by keeping the paraffin dissolved in crude oil or minimizing the adhesion or aggregation process of wax crystals. The paraffin problems which occur, conduct to gradual reduction of the tubular and pipelines internal diameter, restriction or valves blockages, and reduce the equipment capacity until the production is stop. Problems due to paraffin deposition varies and is different according with each commercial field, sometime the difference is from a well to well which producing from the same reservoir with different consistency. How we shall proceed? Before or after paraffin is field on the equipment? How could be avoid the future paraffin deposition? How long the selected method is proper for well ? The decision represents a combination based on oil's chemical & physical characteristics, well's behavior, method selected for prevention or elimination and combined with economic analysis and field experience. The paraffin inhibition applying is a common practice in OMV Petrom, which cover majority of the production wells. For the special wells, which the paraffin inhibition didn't provided satisfying results (multiple intervention due to paraffin deposition) was selected the Down Hole Heating technology (DHH) which was successfully tested in our company since 2014 thanks according with the yearly New Technology Program. The operating principle consists in heating the fluid volume from tubing using the heating cable which can be installed inside tubing, for NF and ESP wells or outside tubing for SRP or PCP wells. The cable is designed and located at the interval of wax crystallization appearance and heats the fluid to the temperature higher than the wax crystallization point (WAT). Since then, the DHH technology had an upward course, proven by high run life (highest value 2500 days / average 813 days) of the technology at the total 47 wells equipped, until this moment. Based on the successful results, recorded of 64% of old production wells equipped, it was decided to apply the technology at first completion of the new wells (36%), thus ensuring the protection of the new equipment. The paper offers an overview of DHH technology implementation, achievements, benefits and online monitoring of technology implementation starting with 2014 until today. The total impact shown a decreasing of no.of failures with 73,8%, the cost of intervention with 76,5%. The production losses decreased only with 5%, which certifies the fact that the technology helping production maintaining during the exploitation in comparison with production losses due paraffin issues recorded at wells without equipped with DHH technology. During 6 years of down hole heating technology application were developed candidate selection decision tree, monitoring the electrical efficiency, using the adaptability capacity of the technology from one well to another and integrate the temperature parameters in online monitoring system as part of digitalization concept of OMV Petrom, aspects which will be present in this article.


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