Analysis of occupational risk factors causing diseases of the circulatory system in medical workers: Literature review

The review focuses on analysis of domestic and foreign literature sources concentrating on influence exerted by occupa-tional factors and factors related to labor process on prevalence of diseases of the circulatory system (CSD) among medical workers. At present, specific features typical for occupational activities performed by medical workers are proven to be among major causes of high CSD prevalence among them. Experts have established most common occupational factors and labor-related factors that are able to induce and stimulate development of cardiovascular pathology. Labor intensity associated with neuro-emotional loads, high responsibility, round-the-clock working regime and night shifts (hazard category 3.2–3.3) is estab-lished to have a leading role among adverse labor-related factors for medical workers. Other significant contributions are made by adverse chemicals and biological agents, noise and ultrasound, laser exposure and ionizing radiation. Some authors showed that CSD prevalence was considerably higher among medical workers than among people employed in other industries. The highest CSD prevalence was detected among medical workers with the most adverse working conditions (hazard category 3.2–3.3). A high degree of occupational conditionality for CSD is typical for surgeons, therapists, and phthisiatricians. Emergency doctors run the highest risk of CSD (RR = 3.1; EF = 67.7 %). Assessment cardiovascular risks according to the SCORE system revealed that approximately 15 % medical workers older than 40 ran moderate cardiovascular risks; medical workers older than 50, high (20.0–22.0 %) or extremely high (10.0–12.5 %) total risks of death due to CSD.

Knowledge, Attitude, and Practice of Evidence-Based Medicine among Emergency Doctors in Kelantan, Malaysia

This study aimed to determine the prevalence of high levels of knowledge, positive attitude, and good practice on evidence-based medicine (EBM) and identify the associated factors for practice score on EBM among emergency medicine doctors in Kelantan, Malaysia. This cross-sectional study was conducted in government hospitals in Kelantan. The data were collected from 200 emergency physicians and medical officers in the emergency department using the Noor Evidence-Based Medicine Questionnaire. Simple and general linear regressions analyses using SPSS were performed. A total of 183 responded, making a response rate of 91.5%. Of them, 49.7% had a high level of knowledge, 39.9% had a positive attitude and 2.1% had good practice. Sex, race, the average number of patients seen per day, internet access in workplace, having online quick reference application, and attitude towards EBM were significantly associated with EBM practice scores. It is recommended that appropriate authorities provide emergency doctors with broader access to evidence resources. EBM skill training should be enhanced in the current medical school curriculums.

New Professional Competences of Inpatient Emergency Department Staff

The purpose of the study is to determine the professional competencies that are in demand among emergency medical personnel when they provide medical care in an inpatient department. Materials and research methods. We compared the impersonal reports on the work done by 20 doctors of specialized substations of the emergency medical service in St. Petersburg for 2015–2017 with the information about work in the mode of daily activities in 2017 of 10 doctors in the intensive care unit of the inpatient department of the Emergency Medical Service of the First St. Petersburg State Medical University named after academician I.I. Pavlov, stored in the qMS medical information system of the University. The volume of instrumental examination of patients who sought medical help, received it in the required volume and were discharged in a satisfactory condition within the first day, was assessed. We compared the results of ultrasound diagnostics performed by the emergency doctors in the screening mode using portable equipment with the results of the work of a consultant-specialist. 701 medical records of inpatients from among those admitted to the Medical University were analyzed. By studying 4573 medical records, possibility and effectiveness of independent primary triage of the incoming patients by the nursing staff was determined. In addition, with the help of the FlexSim HealthCare program, which allows to effectively predict and to simulate changes in work processes within medical institutions, computer simulation of the department’s work was carried out in the conditions of autonomous work of an emergency doctor. Statistical comparison was performed using the Mann-Whitney test, Student’s t-test for unrelated values, and analysis of four-field tables using the χ-square test. Research results and their analysis. Analysis of the research results showed: fundamental principles of work of the staff of inpatient department — multidisciplinarity, multitasking, autonomy. An ambulance doctor working in a stationary environment must be able to independently diagnose, to treat patients with various pathologies, and to simultaneously supervise several patients; having the level of practical and theoretical training specified in the professional standard, the emergency doctor can effectively provide resuscitation care in the volume of I – II levels, which is especially important, given the short time spent by patients in the department; professional standard of the emergency doctors requires to master ultrasound diagnostics to identify gross pathological conditions and to perform a number of manipulations; nursing staff working in the inpatient department must be able to work in an autonomous environment. Triage by nurses is effective and allows to identify patients who need an immediate examination by an EMS doctor. The use of a three-level sorting algorithm does not contradict basic principles of medical triage used in world practice.

627 Improving the Timing of Abdominal Ultrasonography for Women Presenting with Suspected Appendicitis: A Closed-Loop Audit

Introduction Right iliac fossa (RIF) pain in women is a common presentation to accident and emergency (A&E). Abdominal ultrasonography (A-US) is particularly helpful due to the ability to detect various pathologies. The aim of this audit was to reduce delays in performing A-US. Method The timing of A-US taking place following referral to general surgeons by emergency doctors was analysed. The data was retrospectively collected between April 2018-April 2010 in two hospitals from the same trust. Posters of the results were put up in the surgical department to highlight the importance of obtaining A-US early on. A re-audit was consequently carried out collecting data between July 2019 - April 2020. Results 69 females were included in the first audit cycle and 39 in the re-audit. The average time from referral to A-US taking place was 14 hours and 15 minutes in the first audit and 4 hours and 37 minutes in the re-audit. Conclusions The A-US findings with correlated histology highlights that A-US plays a role in improving diagnostic accuracy. The results from the re-audit revealed a shorter average time taken for A-US to be performed following referral. There is scope for the development of a pathway allowing emergency doctors to request A-US.

Attitudes and educational needs of emergency doctors providing palliative and end-of-life care in Hong Kong: a cross-sectional analysis based on a self-report study

Background Due to the ageing population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are coming under the spotlight. The objectives of this study were to evaluate the attitudes of emergency doctors in providing palliative and EOL care in Hong Kong, and to investigate the educational needs of emergency doctors in these areas. Methods A questionnaire was used to study the attitudes of ED doctors of six different hospitals in Hong Kong. The questionnaire recorded the attitudes of the doctors towards the role of palliative and EOL care in EDs, the specific obstacles faced, their comfort level and further educational needs in providing such care. The attitudes of emergency doctors of EDs with EOL care services were compared with those of EDs without such services. Results In total, 145 emergency doctors completed the questionnaire, of which 60 respondents were from EDs with EOL care services. A significant number of participants recognized that the management of the dying process was essential in ED. Providing palliative and EOL care is also accepted as an important competence and responsibility, but the role and priority of palliative and EOL care in ED are uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Doctors from EDs with EOL care services are more comfortable in providing such care and discuss it with patients and their relatives. Further educational needs were identified, including the management of physical complaints, communication skills, and EOL care ethics. Conclusions The study identified obstacles in promoting palliative and EOL care in the EDs Hong Kong. With the combination of elements of routine ED practice and a basic palliative medicine skill set, it would promote the development of palliative and EOL care in Emergency Medicine in the future.

Relation between Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Cerebral Infarct Volume in patients with Ischemic Stroke.

: Objectives: The activation of inflammatory processes in ischemic stroke might be important for the pathophysiological processes of ischemic stroke. The correlation between the Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR) and stroke volume is increasingly being recognized as a prognostic biomarker for patient outcome after an ischemic stroke incidence. This retrospective study aimed at determining if there is existed correlation between the NLR, PLR and stroke volume in patients presenting with ischemic stroke at the emergency department. The results will aid emergency doctors to gain an understanding on how to rapidly identify the most high-risk patients based on the NLR and taPLR obtained from routine blood tests permitting rapidly therapeutic interventions and better long-term survival outcomes for patients with ischemic strokes. Methods: A retrospective study was performed between May 2016-2019. Patients 18 years and older of both genders presented to the emergency department with symptoms of ischemic stroke with time of onset of symptoms within the last 24 hours of whom complete blood count (CBC) tests were conducted and ischemic stroke was confirmed by Diffusion weighted Magnetic Resonance Imaging (DWI-MRI) were enrolled. NLR and PLR were calculated from CBC tests and ischemic stroke volume was measured in mm3 using Manual Segmentation Process. Results: A total of 489 patients were enrolled in this study of which 266 (54.5%) were male and 223 (45.6%) were female. It was observed a statistically significant correlation between the ischemic stroke volume and NLR while no significant correlation was observed between stroke volume and PLR. Conclusion: There is a significant weak positive relationship between NLR and ischemic stroke volume. NLR is significantly correlated with cerebral ischemic stroke volume and thus can be utilized as a guide by emergency doctors in the emergency department to predict the severity and the outcome of patients diagnosed with ischemic stroke.

Increasing consultant-level staffing as a proportion of overall physician coverage improves emergency department length of stay targets

Objectives One goal of Emergency Department (ED) operations is achieving an overall length of stay (LOS) that is less than four hours. The goal of the current study was to assess for association between increasing number of on-duty EM Consultants and LOS, while adjusting for overall (all-grade) on-duty emergency doctors’ numbers and other operational factors. Methods This was a retrospective analysis of three years (2016–2019) of data, employing a unit of analysis of 3276 eight-hour ED shifts. The study was conducted using a prospectively populated ED database in a busy (annual census 420,000) Middle Eastern ED with staffing by Consultants and multiple non-Consultant grades (Specialists, fellows, and residents). Using logistic regression, the main predictor variable of “on-duty Consultant n” was assessed for association with the study’s primary (dichotomous) endpoint: whether a shift’s median LOS met the target of < 240 min. Linear regression was used to assess for association between on-duty Consultant n and the study’s secondary (continuous) endpoint: median LOS for the ED shift. Results Multivariate logistic regression adjusting for a number of operations factors (including total EP on-duty complement) identified an association between increasing n of on-duty Consultants and the likelihood of a shift’s meeting the 4-h ED LOS target (OR 1.27, 95% CI 1.20 to 1.34, p < .0001). Multiple linear regression, which also adjusted for total on-duty EP n and other operational factors, also indicated LOS benefit from more on-duty Consultants: each additional on-duty Consultant was associated with a shift’s median LOS improving by 5.4 min (95% CI 4.3 to 6.5, p < .0001). Conclusions At the study site, in models that adjusted for overall on-duty EP numbers as well as myriad other operational factors, increasing numbers of on-duty Consultants was associated with a statistically and operationally significant reduction in ED LOS.

A manikin study comparing the performance of the GlideScope®, the Airtraq® and the C-MAC® in endotracheal intubation using suction-assisted laryngoscopy airway decontamination techniques in a simulated massive haematemesis scenario by emergency doctors

Background: The suction-assisted laryngoscopy and airway decontamination (SALAD) techniques (level 1, SALAD-1 and level 2, SALAD-2) are newly proposed airway management skills to facilitate endotracheal intubation in patients with massive haematemesis. A pilot study using GlideScope® demonstrated the superior performance of SALAD-1 technique in massive haematemesis simulation. Objectives: To compare the performance of three different video laryngoscopes (the GlideScope®, the Airtraq® and the C-MAC®) in endotracheal intubation using SALAD techniques by emergency doctors in a manikin simulating massive haematemesis. Methods: Forty-eight emergency doctors were recruited. The participants’ performance of endotracheal intubation using the GlideScope®, the Airtraq® and the C-MAC® with the conventional and the two SALAD techniques in a manikin simulating massive haematemesis was evaluated. The time for intubation, number of attempts, rate of failed intubation, amount of aspirated fluid and the subjective ease of different devices and techniques were compared. Results: The C-MAC® had shorter intubation time compared with GlideScope® when using conventional (mean intubation time: 28.48 vs 47.00 s, p = 0.018) and SALAD-1 technique (mean intubation time: 29.35 vs 43.25 s, p < 0.039). The intubation time of all three video laryngoscopes was similar in SALAD-2 technique. There was no significant difference in the number of attempts and failed intubation rate among different video laryngoscopes in using different techniques. Intubation with the C-MAC® resulted in the least mean amount of aspiration in all the conventional (35.63 mL), SALAD-1 (14.06 mL) and SALAD-2 (18.13 mL) techniques. However, the results were not significantly different from the GlideScope® and the Airtraq®. The C-MAC® was rated the most favourable video laryngoscope for the SALAD-1 technique (p < 0.001). There was no significant preference for different video laryngoscopes in using the SALAD-2 technique (p = 0.111). Conclusion: All the video laryngoscopes have similar intubation performance with the SALAD-1 and SALAD-2 techniques. The C-MAC® performed better than GlideScope® in terms of intubation time. The C-MAC® was the most favourable video laryngoscope for the SALAD-1 technique.