The Golden Hour: Early Interventions for Medical Emergencies during Pregnancy

Maternal mortality has increased in the last decades in the United States as a result of increased prevalence of coexisting medical diseases such as hypertension, diabetes, and both acquired and congenital heart diseases. Obstetricians and maternal–fetal medicine physicians should have the basic medical knowledge to initiate appropriate diagnostic and early therapeutic interventions since they may be the only provider available at the time of presentation. The goal of this article is not to extensively discuss the management of complex medical diseases during pregnancy, rather we provide a concise review of key early medical interventions that will likely result in improved clinical outcomes. Key Points

Competency requirements for the assessment of patients with mental illness in somatic emergency care: A modified Delphi study from the nurses’ perspective

Patients suffering from mental illness are vulnerable, and they do not always have access to proper emergency care. The aim of this study was to identify competency requirements for the assessment of patients with mental illness by soliciting the views of emergency care nurses. A modified Delphi method comprising four rounds was used. Data were collected in Sweden between October 2018 and March 2019. The data were analyzed using content analysis and descriptive statistics. The panel of experts reached the highest level of consensus regarding basic medical knowledge: the capability to listen and show respect to the patient are essential competency requirements when assessing patients with mental illness in emergency care. Awareness of these competency requirements will enhance teaching and training of emergency care nurses.

Improvised first aid techniques for terrorist attacks

Terrorist acts occur every day around the world. Healthcare professionals are often present as bystander survivors in these situations, with none of the equipment or infrastructure they rely on in their day-to-day practice. Within several countries there has been a move to disseminate the actions to take in the event of such attacks: in the UK, Run, Hide, Tell, and in the USA, Fight Back. This paper outlines how a very basic medical knowledge combined with everyday high-street items can render highly effective first aid and save lives. We discuss and summarise modern improvised techniques. These include the <C> ABCDE approach of treating catastrophic haemorrhage before airway management, bringing together improvised techniques from the military and wilderness medicine. We explain how improvised tourniquets, wound dressings, splinting and traction devices can be fabricated using items from the high street: nappies, tampons, cling film, duct tape and tablecloths. Cervical spine immobilisation is a labour-intensive protocol that is often practised defensively. With little evidence to support the routine use of triple immobilisation, this should be replaced with a common sense dynamic approach such as the Montana neck brace. Acid or alkali attacks are also examined with simple pragmatic advice. Analgesia is discussed in the context of a prehospital setting. Pharmacy-obtained oral morphine and diclofenac suppositories can be used to treat moderate pain without relying on equipment for intravenous/intraosseous infusion in prolonged hold situations. The differentiation between concealment and cover is summarised: scene safety remains paramount.

Health Literacy and Use of Preventative Care of Female Undergraduate Nursing vs. Non-Nursing Students

Background: Health literacy and use of preventative care are important aspects of health care. Health literacy, or the ability to understand basic medical knowledge, affects a person’s understanding and use of preventative health care. Aim: This study was designed to investigate the perception of health literacy and use of preventative care resources by female undergraduate college students. Method: This is a quantitative, non-experimental descriptive research study with a cross-sectional design. A 30-item demographic yes or no and a Likert-type scale was used to survey 62 female college students living in a dormitory. The goal was to discover if additional education is needed to obtain optimal utilization of health care resources for this population. Result: Surveying the undergraduate nursing and non-nursing students helped raise awareness of health literacy of the female students. Conclusion: Understanding the use of preventative care resources by this population may influence the way nursing interventions are formulated.

Miért mennek/mentek külföldre a debreceni orvosok? Egy felmérés eredményei

Introduction: Numerous beliefs have arisen in relation to the emigration of doctors. First of all, in most cases emigration has been attributed to, almost exclusively, low salaries. There are a number of non-financial issues that could possibly be more easily addressed. Method: In order to get closer to these issues, we sent out a 37-item questionnaire to doctors, who originally graduated from the University of Debrecen. Altogether 82 of them sent back the questionnaire. Results: The mean age at the time of emigration was 32 years. The most popular destination was the United States, however, many colleagues left for the US to do research, as well as clinical practice. Among the European countries, the most popular ones were Sweden, Germany, United Kingdom, Switzerland and Norway. The five most popular clinical specialties were general practice, internal medicine, anesthesiology/intensive care, laboratory/pathology and surgery. With respect to the planned duration of working abroad, at the time of emigration one-fourth of our colleagues planned very short (<2 years) stay. When we asked them now, 38% plans much longer, even indefinite stay. The most common reasons of emigration were also assessed. The most common one was the lack of career track, followed by low salary, quality of life, family issues and adventurousness. Interestingly, burnout and “gratuities” were at the end of the list. A mean 1.3 million HUF per month would make our colleagues satisfied but they think that a mean 486.000 HUF would be realistic and would keep most doctors within the country. As far as university education is concerned, our colleagues agreed that the basic medical knowledge of Hungarian doctors is excellent, but their practical skills are much worse. Conclusions: Although returning to Hungary would be unrealistic by most colleagues, low salaries are definitely not the most important or exclusive reason for leaving the country. These issues are rather complex, there are numerous non-financial issues, which could be addressed much easier by expressing a positive attitude. Orv Hetil. 2017; 158(37): 1458–1468.

Wilderness First Aid Training as a Tool for Improving Basic Medical Knowledge in South Sudan

IntroductionThe challenges presented by traumatic injuries in low-resource communities are especially relevant in South Sudan. This study was conducted to assess whether a 3-day wilderness first aid (WFA) training course taught in South Sudan improved first aid knowledge. Stonehearth Open Learning Opportunities (SOLO) Schools designed the course to teach people with limited medical knowledge to use materials from their environment to provide life-saving care in the event of an emergency.MethodsA pre-test/post-test study design was used to assess first aid knowledge of 46 community members in Kit, South Sudan, according to a protocol approved by the University of New England Institutional Review Board. The course and assessments were administered in English and translated in real-time to Acholi and Arabic, the two primary languages spoken in the Kit region. Descriptive statistics, t-test, ANOVA, and correlation analyses were conducted.ResultsResults included a statistically significant improvement in first aid knowledge after the 3-day training course: t(38)=3.94; P<.001. Although men started with more health care knowledge: (t(37)=2.79; P=.008), men and women demonstrated equal levels of knowledge upon course completion: t(37)=1.56; P=.88.ConclusionsThis research, which may be the first of its kind in South Sudan, provides evidence that a WFA training course in South Sudan is efficacious. These findings suggest that similar training opportunities could be used in other parts of the world to improve basic medical knowledge in communities with limited access to medical resources and varying levels of education and professional experiences.KatonaLB, DouglasWS, LenaSR, RatnerKG, CrothersD, ZondervanRL, RadisCD. Wilderness first aid training as a tool for improving basic medical knowledge in South Sudan. Prehosp Disaster Med. 2015;30(6):574–578.

MS in prose, poems and drama

Background and objective: Presentations of MS in fictional literature have not been previously researched. This paper surveys and analyses these portrayals of the disease for the first time. Material and methods: Relevant works in English and German were identified by means of keyword searches in online public access catalogues and search engines as well as old-fashioned research. The neurological and literary evaluation of these 7000 pages of text combines qualitative and quantitative methods. Results: Between 1954 and 2012 at least 55 literary works appeared with an MS motif (35 novels, 18 poems, one novella and one drama). The authors were predominantly female and a third of them suffered from the disease. Patients in the novels largely reflect real epidemiology as regards symptoms and disease progression, while diagnostic and therapeutic options play a secondary role. From a literary point of view, ‘entwicklungsromane’, ‘relationship novels’ and ‘young adult books’ can be discerned. MS is often portrayed in metaphoric language as the enemy: a demon, an animalistic being, prison or an abyss. Conclusion: The MS motif evidences a medicalization of the literature as well as a literary portrayal of anthropological experiences. Well-written novels can contribute to the de-stigmatization of MS and impart basic medical knowledge.

The Special Purpose Examination: An Evaluation of Physicians Taking SPEX and their Pass Rates

ABSTRACT State medical boards have long recognized the importance of evaluating the ongoing knowledge and competence of licensed physicians under a variety of circumstances. Before granting or renewing a license, it may be necessary for state boards to evaluate physicians as part of a disciplinary process or following a period of inactivity for either disciplinary or non-disciplinary reasons. The Post-Licensure Assessment System (PLAS), a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME), has played a role in assisting state boards with evaluating physicians' basic medical knowledge in all of these circumstances by providing the Special Purpose Examination (SPEX). While SPEX has been administered since 1988, there has not been a nationally published study summarizing the characteristics of physicians taking the exam and their examination pass rates. To address this, we examined physicians who took SPEX between 2003 and 2011, and the outcomes of their exams. Our research demonstrates that the majority of examinees take SPEX for non-disciplinary reasons, with those who take SPEX for disciplinary reasons having lower pass rates. Future research should focus on evaluating the ultimate outcomes for physicians taking SPEX, including the ability to attain and retain a license to practice medicine.