To Study Acute Changes in Brain Oxygenation on MRI in Healthcare Workers Using N95 Mask and PPE Kits for Six Hours a Day

Background Due to long working hours wearing an N95 mask and PPE kit during the COVID-19 pandemic, the healthcare workers (HCWs) complained of headaches, confusion, and exhaustion. This study was therefore performed to study the changes in brain oxygenation. Aim To compare brain oxygenation in health care workers wearing an N95 mask with a PPE kit versus a three-ply mask during an intensive care setting for 6 hours. Materials and Methods Thirty clinicians and 30 paramedical staff participated in the study. The control (three-ply mask) and subject (N95 mask with PPE) groups included 15 clinicians and 15 paramedical staff. A comparative analysis of brain oxygenation using a 3T magnetic resonance imaging (MRI) machine was performed in these two groups at the beginning and the end of their work shift. Results The mean age of the individuals in the control and subject groups was 30.8 and 30.13 years, respectively. The median value of brain oxygenation in the control and subject groups in the pre-shift was between 33 and 31 and post-shift was 30 and 24. The drop in brain oxygenation in subjects was more than the controls (p = 0.004) in the post-shift assessments. The cerebral blood flow (CBF) in the bilateral middle cerebral artery (MCA) using arterial spin labeling (ASL) showed a rise in CBF in both groups post-shift as compared with the pre-shift values. The median values of the right and left MCA in the control and subject groups pre-shift were 82.75/83.45 and 89.75/106.65. The post-shift median values of both MCAs of the control and subject groups were 115.65/115.55 and 109.60/119.49. Conclusion MRI-BOLD imaging revealed a significant drop in brain oxygenation in the subject group as compared with the control group. Multiphasic-ASL showed a compensatory rise in CBF in both groups.

Impact of Job Stress on Employee Performance among Paramedical Staff during Covid-19

Objective: The study aimed to explore the job stress on the performance of paramedical staff working in dental hospital during Covid-19 pandemic Methodology: The study conducted on 75 participants from Paramedical staff at tertiary care teaching hospital using convenient sampling technique. Currently employed paramedical staff was the participant of interest. All basic demographic information of each variable (age, gender, qualification, experience, and residency) was also recorded. Analysis was carried out by applying ANOVA test. Results: The results of One-way ANOVA revealed that there was a negative significant difference in the job performance of paramedical staff due to the stress they are facing in their institution (F= 15.74, P>.001). Conclusion: Paramedical staff is facing stress due to insecurity of job which is effecting their job performance. Keywords: Covid-19, Corona virus, paramedical staff, dental college

ENT SURGEONS AS MASTER TRAINERS OF CRICOTHYROIDOTOMY WILL SAVE PRECIOUS LIVES IN EMERGENCIES

Objective: To train young doctors and paramedical staff on needle cricothyroidotomy and surgical cricothyroidotomy and provision of kits in trauma centers, main operation theatres and medical reception centers of the hospitals. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Peshawar and Pakistan Naval Ship Shifa, Karachi Pakistan, from Nov 2017 to Oct 2020. Methodology: Doctors and paramedical staff were selected on volunteer basis. Small groups were trained in 2-3hours. The participants were shown two videos of two procedures in Urdu language first and then were trained on mannequin. Results: A total of 345 participants including 205 males and 140 females were trained with mean age was 28.2667 ± 6.24 (SD) years. Out of 61 residents, 54 medical officers, 143 house officers, 35 nurses and 52 paramedical staff were participants. Conclusion: ENT surgeons must arrange mannequins and conduct training sessions of small groups after every 1 to 2 months.

Psychological impact of COVID-19 pandemic on medical and paramedical staff at a tertiary care center: an observational, cross sectional, survey-based study

Background: The health-care workers experienced various adverse psychological reactions due to COVID-19 pandemic. We aim to assess the anxiety and stress faced by the medical and paramedical staff while dealing with the pandemic.Methods: Analysis of 190 respondents of the survey was performed. Medical and paramedical staff included those of Bhaktivedanta hospital and research institute, Mumbai only. Data based on two questionnaires GAD-7 and “stress and anxiety assessment scale (SAAS)” was collected in the form of a survey from 15August 2020 till 31 May 2021 to assess the individual’s mental health.Results: Analysis of responses from GAD-7, a 7-item assessment scale and SAAS, a 14-item assessment scale were obtained. From the GAD-7 scale, 3.53% and from the SAAS scale, 9.09%, of the total health-care workers were found to have high anxiety and stress due to the Covid-19 pandemic.Conclusions: Although mediocre levels of stress and anxiety were found to be prevalent among the medical health-care workers, proper and timely mental health support and care must be provided to them even in normal conditions. This ensures safe and efficient execution of one’s duties even during crisis.

Mental Health Status of Health Care Professionals During COVID-19 Pandemic at a Tertiary Care Hospital of Central Punjab

Introduction: Frontline medical workers are at risk of not just adverse physical outcomes from Corona Virus Disease 2019 (COVID-19) but psychological ones too. Healthcare workers might develop symptoms of Post-traumatic stress disorder, depression, anxiety and substance use disorders. Objective: To assess the mental health status of health care professionals during COVID-19 Pandemic at a tertiary care hospital of Central Punjab. Methodology: Study design: Cross-Sectional study. Study setting: Sheikh Zayed Medical College/Hospital, R.Y.Khan. Study Duration: 20th May 2020 to 20th August 2020. Study subjects: Healthcare professionals including medical and paramedical staff. Sample size: A total of 215 Subjects were included in the study. Sampling technique: Convenient sampling technique. Inclusion criteria: Male and female health care professionals of SZMC/H, R.Y.Khan present in a single working shift. Exclusion criteria: Subjects who refused to give informed verbal consent and those absent from the shift of data collection. Data collection method: Data was collected on pre-designed questionnaire. The questionnaire included information regarding age, sex, job title, working station, etc. Data analysis: Data was entered in and analyzed by using SPSS Version. 21. Numerical variables like age was presented as mean ± standard deviation. Categorical variables like sex, job title, working station were shown as percentages. Results: Our study shows that sex ratio was Male (41.4%) and Female (58.6%). We compared the subjects on variables of Sex, Job title and Ward/Department. The prevalence of depression among Males was Normal 69.7%, Borderline 18.0% and Abnormal 12.4% while in Females it was Normal 56.3%, Borderline 20.6% and Abnormal 23.0%. The prevalence of anxiety among Males was Normal 67.4%, Borderline 18.0% and Abnormal 14.6% while in Females it was Normal 38.1%, Borderline 28.6% and Abnormal 33.3%. Our study on the basis of Job title showed that Medical Staff has prevalence of depression of Normal 67.8%, Borderline 18.3% and Abnormal 13.9% while in Paramedical Staff it was Normal 31.4%, Borderline 25.7% and Abnormal 42.9%. The prevalence of anxiety among Medical Staff was Normal 55.6%, Borderline 22.8% and Abnormal 21.7% while in Paramedical Staff it was Normal 22.9%, Borderline 31.4% and Abnormal 45.7%. On the basis of Wards/Department, the prevalence of Depression in Medicine and Allied was Normal 62.7%, Borderline 23.9% and Abnormal 13.4%; in Surgery and Allied was Normal 67.2%, Borderline 22.4% and Abnormal 10.3%; in Paeds and Gynae/Obs. was Normal 63.5%, Borderline 11.5% and Abnormal 25.0%; in Flu Filter Clinic/Isolation Ward/ICU was Normal 50.0%, Borderline 18.4% and Abnormal 31.6%. The prevalence of Anxiety in Medicine and Allied was Normal 52.2%, Borderline 20.9% and Abnormal 26.9%; in Surgery and Allied was Normal 55.2%, Borderline 24.1% and Abnormal 20.7%; in Paeds and Gynae/Obs. was Normal 46.2%, Borderline 26.9% and Abnormal 26.9%; in Flu Filter Clinic/Isolation Ward/ICU was Normal 44.7%, Borderline 26.3% and Abnormal 28.9%. Conclusion: COVID-19 Pandemic has some major effects on the mental health status of health care professionals in terms of depression and anxiety that need to be addressed by providing better health care facilities, by arranging awareness seminars and counseling sessions. Keywords: Health Care Professionals, COVID-19, Anxiety, Depression

Knowledge awareness and attitude about biomedical waste management among dental care professionals

Background: Health care workers are constantly associated with generation, segregation and disposal of biomedical wastes. Knowledge, attitude and awareness of BMW management among HCWs are the three determinants used to evaluate the effective functioning of BMW management system of the Institution. This study aims to detect the degree of Knowledge, attitude and awareness of BMW management among HCWs in a dental hospital.Methods: This study included 90 HCWs from three groups (dentists, interns, and paramedical staffs), each group comprising of 30 individuals. They were instructed to tick their response in the questionnaire containing 22 questions and were graded as good, average and poor based on individual score.Results: Order of decreasing knowledge and attitude seen among the three groups was dentists followed by interns and paramedical staff. Decreasing order of awareness was postgraduates, interns and laboratory technicians with same score, followed by nurses and sanitary staffs. In our study, 88%, 86.7% and 69.33% of participants had above average KAA values respectively.Conclusions: Doctors and interns had better understanding of BMW management than other Paramedical staff members. Sanitary workers were highly ignorant regarding BMW management. So a continuing medical education program on BMW management should be conducted on yearly basis to train and update newly appointed as well as existing HCWs.

Anaesthesia and anaesthesiologist speciality's knowledge assessment of paramedics in armed forces hospital: a questionnaire study

Background: Science of anaesthesia has revolutionized from traditional only application of relieving patient from pain induced during surgery to wide spectrum approaches like palliative care, critical care, perioperative care along with pain management. Despite of such critical roles in health care sector there is still a lack of awareness about anaesthesiology and anaesthesiologists. Current investigation was aimed towards assessing the awareness of paramedical staff regarding the role of anesthesiology.Methods: Current investigation was a prospective cross-sectional questionnaire-based study conducted on 100 paramedical staff posted in different departments of military hospital Jaipur. All the study participants were interviewed face to face orally by an investigator using the set of questions listed in the questionnaire. Participants responses were documented and statistically represented as percentage.Results: Current study findings reveal that even though majority of the study participants (91) had experience more than 5 years in the hospital and most of them (˃90%) of participants were having educational level of higher secondary or graduation still the role of anaesthesiologist outside operation theatre was poorly known to paramedical staff. It was also observed in current investigation that role of anesthetist in pain clinic was poorly known to most of the participating paramedical staff.Conclusions: Providing knowledge about expertise of anesthesiologist among paramedical staffs by incorporating anaesthesia in the curriculum, in house training programs, use of pamphlets, internet and other easily assessable techniques is highly desirable for spreading awareness of anaesthesia and anesthetist among paramedical staff, so that patient can avail anaesthesia related services effectively.

AWARENESS ABOUT BREAST, CERVICAL AND ORAL CANCERS AMONG THE NURSING AND PARAMEDICAL STAFF OF A HOSPITAL IN CENTRAL INDIA

BACKGROUND: Breast, cervical and oral cancers are the leading causes of cancers in India. High mortality with these cancers is due to presentation in the advanced stages. In India, doctors practically cannot treat each and every patient due to a huge doctor: patient ratio. In such a situation, nursing and paramedical staff can be helpful in providing their services in identication, screening and diagnosing of these cancers. AIM: The present study was undertaken with an aim to evaluate the awareness of nurses and paramedical staff regarding breast, cervical and oral cancers. STUDY SETTING AND DESIGN: The prospective, observational study was conducted at at Smt. Rajmata Vijyaraje Sindhia Medical College & Hospital, Shivpuri and at District Hospital, Shivpuri. PARTICIPANTS AND METHODS: 300 nursing and paramedical staff working in the above institutions were enrolled after verbal consenting. A self-administered structured questionnaire was administered to them. After an intervention in the form of discussion, the same questionnaire was readministered. The data from these questionnaires were evaluated and results presented. This questionnaire consisted of sections related to prevention, risk factors, associated symptoms and detection methods. RESULTS: Before intervention, 17.3% participants had knowledge about prevention, 19% about risk factors, 10% about the symptoms and 8% about early detection technique. After intervention, there was an improvement in these domains. The mean post-test knowledge score was signicantly higher than pre-test knowledge score (P<0.05). CONCLUSION: Overall we found that nursing and paramedical staff lack knowledge about these three major cancers. After imparting knowledge, there was an improvement in their knowledge. To make these nursing and paramedical staff competent enough to identify, screen, diagnose these cancers, there is requirement of knowledge centers.

Best practices in the performance of District Hospitals in India

NITI Aayog undertook this novel exercise on the assessment of the performance of District Hospitals across the country for the financial year 2017-18 in collaboration with the Ministry of Health and Family Welfare, NABH and WHO Country Office for India. The assessment framework covers 10 Key Performance Indicators (KPIs) across the domains of Structure and Output. A total of 707 district hospitals across all States and Union Territories participated in the performance assessment. The framework classifies hospitals in three categories namely Small Hospitals (less than or equal to 200 beds), Mid-sized Hospitals (between 201-300 beds) and Large Hospitals (more than 300 beds). Three top-performing district hospitals in each of the hospital categories across the 10 KPIs were identified and their best practices collected and documented. In all, 75 district hospitals across 24 States and Union Territories emerged as top performers on indicators ranging from availability of beds, medical and paramedical staff, core health and diagnostic testing services to outputs such as bed occupancy rate and number of surgeries per surgeon etc. We believe that this country-wide assessment of district hospitals will serve as a valuable resource for them to learn best practices from each other in a spirit to improve their performance. It will also provide an opportunity to showcase progress.

The major worldwide stress of healthcare professionals during the first wave of the COVID-19 pandemic – the international COVISTRESS survey

Introduction The COVID-19 pandemic has initiated an upheaval in society and has been the cause of considerable stress during this period. Healthcare professionals have been on the front line during this health crisis, particularly paramedical staff. The aim of this study was to assess the high level of stress of healthcare workers during the first wave of the pandemic. Materials and methods The COVISTRESS international study is a questionnaire disseminated online collecting demographic and stress-related data over the globe, during the pandemic. Stress levels were evaluated using non-calibrated visual analog scale, from 0 (no stress) to 100 (maximal stress). Results Among the 13,537 individuals from 44 countries who completed the survey from January to June 2020, we included 10,051 workers (including 1379 healthcare workers, 631 medical doctors and 748 paramedical staff). The stress levels during the first wave of the pandemic were 57.8 ± 33 in the whole cohort, 65.3 ± 29.1 in medical doctors, and 73.6 ± 27.7 in paramedical staff. Healthcare professionals and especially paramedical staff had the highest levels of stress (p < 0.001 vs non-healthcare workers). Across all occupational categories, women had systematically significantly higher levels of work-related stress than men (p < 0.001). There was a negative correlation between age and stress level (r = -0.098, p < 0.001). Healthcare professionals demonstrated an increased risk of very-high stress levels (>80) compared to other workers (OR = 2.13, 95% CI 1.87–2.41). Paramedical staff risk for very-high levels of stress was higher than doctors’ (1.88, 1.50–2.34). The risk of high levels of stress also increased in women (1.83, 1.61–2.09; p < 0.001 vs. men) and in people aged <50 (1.45, 1.26–1.66; p < 0.001 vs. aged >50). Conclusions The first wave of the pandemic was a major stressful event for healthcare workers, especially paramedical staff. Among individuals, women were the most at risk while age was a protective factor.