Allied Health Workers Research Articles

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

Impacts of COVID-19 on healthcare workers’ mental and physical health in Arab Countries

Background: Healthcare workers are under considerable psychological and physical pressure during the COVID-19 pandemic. However, in Arab countries, a comprehensive analysis of mental and physical health issues among healthcare workers (HCW) during the COVID-19 pandemic is still needed.Therefore, this systematic review aims to identify the mental and physical health impact among HCW in the Arab countries during the pandemic. Materials and Methods: This review was carried out using the PRISMA guidelines. Empirical studies were selected from the following databases PubMed, Scopus databases, Google Scholar, CINAHL (EBSCOhost), and MEDLINE (PubMed). Case reports, duplicate publications, reviews, and family-based studies were excluded. A total of 56 studies from 14 Arab countries reported the mental and physical health of HCW during the COVID-19 pandemic. The distribution of HCW analysed included doctors, nurses, paramedics, administrators and allied health workers. Results: The majority of the studies focused on HCW’s mental health (n=29), four studies focused on physical issues and 23 studies focused on both.The most-reported mental health issues were anxiety, depression, distress, stigmatization, risk of infection, and post-traumatic stress disorder (PTSD), while the most reported physical health issues were physical abuse, exposure to the virus, exhaustion, burnout, underachievement, sleep deprivation, low life standard, and financial problems.

Global prevalence of stigmatization and violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis.

PurposeDuring COVID‐19, stigmatization and violence against and between professional healthcare workers worldwide are increasing. Understanding the prevalence of such stigmatization and violence is needed for gaining a complete picture of this issue. Therefore, the purpose of this review was to update estimates of the prevalence of stigmatization and violence against healthcare workers during the pandemic.DesignA systematic review and meta‐analysis was conducted.MethodsThis review followed PRISMA guidelines and encompassed these databases: PubMed, Academic Search Complete, CINAHL, Web of Science, MEDLINE Complete, OVID (UpToDate), and Embase (from databases inception to September 15, 2021). We included observational studies and evaluated the quality of the study using the Joanna Briggs Institute methodology. Further, a random effects model was used to synthesis the pooled prevalence of stigmatization and violence in this study.FindingsWe identified 14 studies involving 3452 doctors, 5738 nurses, and 2744 allied health workers that reported stigmatization and violence during the pandemic. The pooled prevalence was, for stigmatization, 43% (95% confidence interval [CI]: 21% to 65%) and, for violence, 42% (95% CI: 30% to 54%).ConclusionsStigmatization and violence during the COVID‐19 pandemic were found to have affected almost half the studied healthcare workers. Healthcare professionals are more prone to be stigmatized by the community and to face workplace violence.Clinical RelevanceHealth administrators and policymakers should anticipate and promptly address stigmatization and violence against and between healthcare workers, while controlling the spread of COVID‐19. Health care systems should give serious attention to the mental health of all health providers.

Awareness and knowledge of ocular manifestation in COVID-19 patients among health care workers (HCWs) in Central India

To know the awareness and knowledge of ocular manifestation in COVID-19 patients among health care workers (HCWs) in central India A web-based survey, cross-sectional study was conducted to obtain responses from health care workers (HCWs) in central India from the month of May – July 2020 to access the awareness and knowledge of ocular manifestation in COVID 19 patients among HCWs in central India. This survey was divided into three parts: (i) Participant characteristics (ii) awareness / knowledge of COVID-19 disease (iii) awareness / knowledge regarding ocular manifestation of COVID 19 patients and their source of information. Knowledge regarding ocular manifestation of the disease was assessed by questions focusing on COVID-19 signs / symptoms and risk in eyes, its transmission, and prevention. Ethical clearance was taken and electronic informed consent was taken and confidentiality of each person was maintained throughout the study. A total of 408 healthcare workers participated in the study, in which approximately 59.06% (n = 241) of males and 40.94% (n= 167) females, majority of them belong to urban area 74% (n= 302). Most of the HCWs 39.9% were between 35-44 years of age, in which 51.71% (n = 211) were Doctors, 35.04% (n =143) were nursing staff and 6.61%, 1.47% were hospital attendant and sanitary workers respectively Almost all participants (n=408) had heard about COVID-19, out of which 92.15% agreed that corona patients can recover completely. The study reviled that most of HCWs had good knowledge about the disease and its transmission. However, 336 (82.35%) HCWs were aware that the disease can also affect the eye and 278 (68.13%) accepted that it can cause conjunctivitis. The study revealed that 193 doctors (91.46%), 120 (83.91%) nursing staff and only 23 allied health workers (42.59%) thought that COVID-19 can affect eyes. In which (n=119) 56.39% doctors, (n=61) 42.65% nursing staff, and only (n=19) 35.18% allied health care workers believed that corona can spread through tears. Most doctors (n=165, 78.19%) agreed that COVID 19 can cause conjunctivitis, Which was not same in the case of nursing staffs and other allied Health care workers. Hence, there was a knowledge gap between doctors and other HCWs regarding ocular manifestation of COVID-19 disease. The study concluded that most of the HCWs were aware about the disease (COVID-19) and had good knowledge about the general condition of the disease but participant’s knowledge regarding ocular manifestation of the disease was comparatively less, though most of the HCWs agreed that COVID-19 could also affect the eyes.

Value in primary care clinics: a service ecosystem perspective.

Summary In this article, we propose that value is a multidimensional construct, highlighting the need for a multi‐actor service ecosystem perspective of value in primary care clinics.We argue that different actors in the service ecosystem — for example, patients, their family members and carers, medical practitioners, practice managers, nurses, allied health workers, receptionists and practice owners — may value different aspects of health service delivery more highly than others.We describe ways in which value is perceived among actors in primary care, and highlight the need for a greater focus on a broader view of value involving the various stakeholders to realise better outcomes.

Prevalence of Major Neurocognitive Disorder in Patients Admitted with Hip Fractures and the Associated Postoperative Delirium and Other Surgical Outcomes - A Prospective Cohort Study (Hippod Study)

Introduction: Major Neurocognitive disorder (NCD) and hip fractures are two serious problems in aging population. They are associated with morbidities including postoperative delirium (POD). We aimed to look at the prevalence of major NCD in hip fractures in our locality and their association with POD. Methods: It was a prospective cohort study. Patients ≥ 65 years old with hip fractures communicable in Cantonese were included. They were screened with Hong Kong Montreal Cognitive Assessment 5-min protocol before operation. They were reviewed postoperatively with 3-Minute Diagnostic Interview for Confusion Assessment Method to assess the presence of POD. The primary outcome was the incidence of delirium between patients with or without preoperative major NCD. Secondary outcomes including surgical outcomes and length of hospital stay were investigated. Results: The study was conducted between November 2020 and March 2021. One hundred ninety-two patients were screened, and 122 patients were included. Among the 192 patients screened, 97 (50.5%) were found to have major NCD. POD was found in 68.1% and 21.3% of patients with or without major NCD respectively. (p<0.001, odds ratio 4.857 (95% CI 2.046-11.531)). Total length of stay in hospital was longer when POD developed (p<0.05). Conclusion: High prevalence of major NCD was found in geriatric hip fracture patients. Pre-existing major NCD was an independent risk factor in developing POD. Both major NCD and POD were prevalent but not sufficiently addressed in our locality. A multidisciplinary collaboration between anesthetists, geriatricians and allied health workers may help to prevent POD and reduce its severity.

Quality and reliability evaluation of online videos on carpal tunnel syndrome: a YouTube video-based study

ObjectivesWith the increasing popularity of searches for medical information on YouTube, the availability of videos concerning carpal tunnel syndrome (CTS) is increasing. This study aimed to evaluate the quality and...

Allied health workers’ role in patient education in the United States

Introduction: Patient education (PE) has been traditionally seen as the role of nurses and physicians, while allied health workers (AHWs)-who make up the biggest population of the US healthcare workforce-are sometimes reduced to providing supportive roles. This article reviews the available literature on the role of AHWs in providing PE in the US.Methods: This review was based on a search of the databases Academic Search Ultimate; Health Source-Consumer Edition; Health Source-Nursing/Academic Edition and MEDLINE initially conducted between January 10 and February 3, 2021, and later re-done between December 20 and December 22, 2021. This review applied guidelines for narrative reviews (Ferrari 2015). The search looked at papers published between 2001 and 2021, which discussed allied health professions relevant to the US health system.Results: The review derived 18 articles from the search and two articles from the reference lists of the 18 articles. The review found that AHWs seldom performed PE, although the profession of physical therapy made efforts to formalize participation in PE. It also found that expansion of roles for AHWs was warranted, although additional training may be required to develop effective PE competencies among AHWs. Finally, it found existing challenges such as interprofessional rivalries and time limitations that affected the incorporation of AHWs in PE.Conclusions: AHWs have untapped potential to contribute more to the US health system through delivery of effective PE. Policy adjustments are needed to maximize the input of AHWs in PE. Increased interprofessional collaboration in the US health system is needed to facilitate the extension of PE roles to AHWs. Further research is needed to better understand the factors limiting AHWs’ involvement in PE.

Assessment of depression, anxiety and stress experienced by health care and allied workers involved in SARS-CoV2 pandemic.

Introduction:The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing coronavirus disease 2019 (COVID-19) has led to a global health crisis. Health workforce has been working vigorously in COVID-19 management. So, we have planned this study with an aim to assess the psychological profile of healthcare and allied workers involved in SARS-CoV2 pandemic and to look for associated factors.Methodology:A cross-sectional observational study was planned at All India Institute of Medical Sciences, Patna. Study population comprised of Health care workers and allied health care workers involved in COVID-19 management.Results:Data from 254 study participants have been included in the study. The prevalence of severe and extremely severe depression among study participants was 8.3 and 3.1 percent. Severe and extremely severe anxiety prevalence was found to be 9.4 and 13.8 percent. The prevalence of severe and extremely severe stress was 2.4 and 2.4 percent each. Education till post-graduation, unmarried, occupation of doctor, Comorbidity of headache and occurrence of influenza-like illness in last 3 months had a statistically significant association with high depression score. With high Anxiety score and high-stress score statistically significant association was seen in education till postgraduation, unmarried, occupation of doctor, duration of 1 COVID-19 duty of ≥8 hours.Conclusion:The study highlights high psychological comorbidities in the form of depression, anxiety and stress among health care workers and allied health care workers working in COVID-19 pandemic. Prevalence of psychological morbidity is higher among doctors compared to nurses and allied health workers. COVID-19 duty of ≥8 hours have been found to be hampering mental health.

French nurses' and allied health professionals' perception of research in their fields: A descriptive qualitative study.

To gather information from nurses and allied health professionals in the French context of the emergence of research in the field so as to inform the development of a new tool: The research in nursing and allied health sciences' Ideas Generator (GénI) capable of sustaining the identification of research ideas from professionals in the field. In many countries, research in nursing and allied health sciences remains underdeveloped. Before developing the Ideas Generator tool, it was essential to explore professionals' basis of reference in providing care, then investigate (1) their representation of research in this field of science and (2) their perception of needs for and obstacles to starting a research process. The qualitative research design used focus groups. The study population included 24 participants naive to research in four hospitals in eastern France (13 nurses and 11 allied health professionals). Thematic analysis was used to analyze the data. The study was reported in compliance with the consolidated criteria for reporting qualitative research criteria. Professionals used tacit knowledge and their experiences to address care, but the culture of scientific evidence was clearly missing (lack of knowledge of the origin of care guidelines, few bibliographic skills). Participation in a research process could hardly be envisaged without a supervised collaboration with a physician. Research was perceived not to be part of professionals' culture. They self-censured for lack of methodological competencies. Findings underlined some leverage, obstacles, and need to consider to generate a stimulation in the field, especially in countries where such research is still in its infancy. Strengthening the field of nursing and allied health research is essential to extend the skills of nurses and allied health workers and to improve the quality of patient care by taking into account results from the literature. The Ideas Generator tool will be implemented to sustain learning the skills of research through education and training.

Workplace Violence Prevention: Flagging Practices and Challenges in Hospitals.

Flagging is a standardized way to communicate the risk of patient violence to workers. We add to the limited body of research on flagging by describing hospitals' approaches to and challenges with flagging patients with a history of violent behavior. We used a qualitative case study approach of hospitals in Ontario, Canada and their patient flagging practices. Key informants and our advisory committee identified 11 hospitals to invite to participate. Hospitals assisted in recruiting frontline clinical and allied health workers and managers to an interview or focus group. A document analysis of hospitals' flagging policies and related documents was conducted. Thematic analysis was used to analyze interview and focus group data. Five hospitals participated. Of the five hospitals, four had a flagging policy where frontline clinical workers (n = 58), frontline allied health workers (n = 31), and managers (n = 42) participated in an interview (n = 43) or focus group (n = 15). Participants described three challenges: patient stigmatization, patient privacy, and gaps in policy and procedures. Flagging patients with a history of violent behavior is one intervention that hospitals use to keep workers safe. While violence prevention was important to study participants, a number of factors can affect implementation of a flagging policy. Study findings suggest that hospital leadership should mitigate patient stigmatization (real and perceived) and perception of patient rights infringement by educating all managers and frontline workers on the purpose of flagging and the relationship between occupational health and safety and privacy regulations. Leadership should also actively involve frontline workers who are the most knowledgeable about how policies work in practice.

Expanded practice in rural community pharmacy: a macro-, meso and micro-level perspective.

Expanding community pharmacists' scope of practice, in rural and remote locations has the potential to improve access to health care and health outcomes. Internationally, a lack of support from other health professionals (HPs) has presented a barrier to the uptake of expanded pharmacy models. Rural allied health workers, including pharmacists, however, already work across an extended scope using generalist and specialist skills to meet unique community needs with limited infrastructure for support. Limited data on expanded practice from Australia prompted this study to explore Australian rural and remote doctor, nurse and allied health perspectives of expanded pharmacy services in non-metropolitan settings. An ethnographic lens of rural culture was applied to this descriptive qualitative study. Semi-structured, in-depth interviews were conducted with HPs working in rural and remote locations in Australia. Inductive and deductive thematic analysis was guided by a multi-level lens of macro- (policy level), meso- (HP level) and micro- (consumer and community level) perspectives. The World Health Organization (WHO) framework for integrated people-centred health services provided strategies to align to the theoretical framework for the analysis. Twenty-three rural and remote HPs (doctors (8), nurses (4), allied HPs (11)) participated. Key themes identified included supportive government and funding provisions (macro); collaboration with other health providers (meso); ensuring pharmacists have the required knowledge, skills, quality assurance and safety measures in place (meso); pharmacists' capacity, including time and space (meso); and opportunity to empower and engage consumers through rural community pharmacies (micro). As pharmacists internationally continue to develop their expanded scope of practice, these results provide the first evidence for Australian rural pharmacists to consider when planning for and developing expanded practice models. Recognition of challenges and motivators for pharmacists' expanded practice are highlighted. Engagement of both government and rural health providers is seen as crucial for expanded models of pharmacy practice to evolve to deliver improved health outcomes for rural and remote communities.

Psychological impact of COVID -19 pandemic on frontline health care workers in Bangladesh: A cross-sectional study

This study aimed to estimate the prevalence of depression, anxiety, post-traumatic stress disorder, and insomnia symptoms among frontline health workers during the corona virus disease 19 (COVID-19) pandemic in Bangladesh and to compare these between medical and allied health workers. We conducted a cross-sectional survey between June and August 2020. A total of 479 health care professionals participated in the study. Anxiety and depression were measured using Patient Health Questionnaire-4 (PHQ-4), post-traumatic stress disorder (PTSD) was measured by primary care post-traumatic stress disorder score (PC-PTSD score), and insomnia was measured by Insomnia Severity Index (ISI). We performed logistic regression to assess risk factors associated with psychological symptoms. Overall, prevalence of anxiety, depression, PTSD and insomnia symptoms were 17.6%, 15.5%, 7.6% and 5.9%, respectively. Compared to allied health workers, doctors had significantly higher prevalence of symptoms of anxiety: doctor versus allied health care worker; 21.1% vs 06%, (OR= 4.19; 95% CI= 1.88-9.35; p <0.001); depression: 18% vs 6.8%, (OR= 2.99; 95% CI= 1.40-6.42; p 0.005); PTSD: 9.4% vs 1.7%, (OR= 5.96; 95% CI= 1.41-25.11; p 0.015) and insomnia: 7.4% vs 0.9%, (OR= 9.22; 95% CI= 1.24-68.4; p 0.03),respectively. The logistic regression analysis showed pre-existing medical illness as a predictor of anxiety (OR= 2.85; 95% CI= 1.71-4.76; p <0.001) and depressive symptoms (OR= 2.29; 95% CI= 1.39-3.77; p 0.001). Working more than 6(six) weeks in COVID-19 dedicated hospitals was significantly associated with PSTD symptoms (OR= 2.83; 95% CI= 1.35-5.93; p 0.006) and insomnia (OR= 2.63; 95% CI= 1.15-6.02; p 0.022). Our study demonstrated a high prevalence of symptoms of depression, anxiety, PTSD, and insomnia among Bangladeshi frontline health workers during the COVID-19 pandemic. BSMMU J 2021; 14 (COVID -19 Supplement): 22-29

Enablers and hindrances to health promotion and disease prevention practices among healthcare workers in Nelson Mandela Bay Municipality, South Africa.

Health promotion (HP) and disease prevention (DP) practices among healthcare workers (HCWs) are key to achieving universal health coverage. This study identified HP and DP enablers and hindrances and compared them at different healthcare levels in Nelson Mandela Bay Municipality, South Africa.An exploratory cross-sectional study using a structured questionnaire was conducted among HCWs (n = 501) from 23 hospitals. Bivariate and multinomial regression were used to analyze the data. The highest number of participants (70.46%; n = 353) were from tertiary hospitals. Thirteen and Eight categories of enablers and hindrances respectively were identified. Of these, eleven enablers and six hindrances of HP and DP were associated with tertiary hospitals; no enabler was identified at both primary and secondary while one hindrance was associated with primary level of health care. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28–3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23–0.62) were the predictors of HP and DP among medical doctors, while staff induction training (Coeff: 0.62, 95% CI: 0.40–0.95) and performance appraisal (Coeff: 1.86, 95% CI: 1.16–2.98) were the enablers among allied health workers. On the other hand, ‘facility promoting treatment more than prevention’ (Coeff: 2.03, 95% CI: 1.30–3.14) and ‘practice guidelines incorporating HP’ (Coeff: 2.79, 95% CI: 1.66–4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers respectively. Our work indicates the need for an operational strategy designed considering enabling and hindering factors to HP and DP practices for empowering HCWs and enhancing health outcomes.

Health practitioner and student attitudes to caring for transgender patients in Tasmania: An exploratory qualitative study.

Healthcare practitioners struggle to provide inclusive and affirming care totransgender (trans) people. This studyexamined Tasmanian healthcare practitioners' and students' understandings and approaches totranshealth. The study comprised qualitative semi-structured interviews with 17 healthcare practitioners (doctors, psychologists, nurses and other allied health workers) and students (of medicine, nursing and pharmacy) across Tasmania, Australia. Data were analysed using a reflexive thematic analysis. The authors identified three key themes: lack of training in trans healthcare, limited resources to support trans patients, and the importance and challenges of trans-inclusive language. Healthcare practitioners faced challenges providing inclusive and affirming healthcare for trans people due to limited experience with trans patients, and few educational opportunities and referral pathways to support patients. Healthcare practitioners need better support and resources to improve quality of care.

Psychological Wellbeing of Healthcare Workers in Different Hospitals of Karachi (Pakistan) During COVID-19 Pandemic

Background: With increasing morbidity and mortality rates throughout the world, COVID-19 has caused a universal psychological impact on the lives of people.
 Aims: To examine psychological wellbeing of frontline healthcare professionals and compare mental health among doctors, paramedical staff and allied health workers.
 Methods: This cross-sectional study included 225 healthcare professionals from 13 different hospitals in Karachi, Pakistan. The symptoms of depression, anxiety and insomnia were assessed using the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) and the 7-item Insomnia Severity Index (ISI) respectively.
 Results: Major findings of the study were that 44.7% participants had no depression, 38% were reported to have mild anxiety and 3.5% had severe insomnia. Insomnia was correlated with anxiety and depression leading to moderate correlation of 0.516 and 0.694 in both with a highly significant p value (p=0.001 and p=0.001). A significant association of depression was seen with healthcare providers and years of experience with (p=0.009) and (p=0.010) respectively. Levels of anxiety were associated with occupation and years of experience that led to the finding that doctors suffered more from mild anxiety (83.5%) whereas years of experience had no significant association. Correlation of insomnia with occupation and years of experience led to the finding that sub threshold insomnia was found in 29% participants, where majority of participants were allied health workers. However, borderline significant association was found between insomnia and the number of years of work experience (p=0.049).
 Conclusion: It is concluded that frontline workers experienced different levels and symptoms of psychological distress in this pandemic.

MISMATCH BETWEEN AVAILABLE CAPACITY AND ESTIMATED NUMBER OF PHYSICIAN VISITS NEEDED FOR HYPERTENSION CARE: AN ANALYSIS OF WORLDWIDE DATA

Objective: In most countries, only physicians are allowed to prescribe antihypertensive medication. Thus physician capacity (number of clinic visits physicians can allocate for hypertension care) is a key determinant of hypertension control. The objective of this study is to estimate the gap in clinic visits between available visit capacity and number of visits needed for hypertension care worldwide. Design and method: Data from the Global Health Observatory of World Health Organization and the World Bank were used to calculate the total number of hypertensive patients in each country. We assumed that the average physician would have 5,000 clinic visits/year and patients with hypertension require at least three visits a year. The gap in clinic visits between available capacity and patient need was calculated for each country. The analysis was further stratified based on income group according to the World Bank classification. Results: We estimated that 67 countries do not have the capacity to provide at least three visits to each hypertensive patient (countries in light to dark orange/red in Figure). Most of those countries are in Sub-Sharan Africa (63%), East Asia and Pacific (16%) and South Asia (9%), and all are in lower middle income or low-income countries. Of these countries, 38 countries cannot provide even a single visit to a hypertensive patient. On the other hand, 98% of high-income countries and 77% of upper-middle-income countries have the capacity to provide at least three visits per patient per year. The largest gap is seen in India followed by Indonesia, Ethiopia and Bangladesh. Conclusions: There is a huge gap in clinic visits between available capacity and the estimated need for hypertension care in low and middle income countries. To fill this gap, countries will need additional physicians or more likely implement a system of task sharing with allied health workers, such as nurses and community health workers.

Clinical governance in radiologic practice: Evaluating the appropriateness of radiologic investigation considering patient clinical information using the radiology request form

Introduction: Clinical governance in radiology is an improved quality assurance program where the patient well-being is the central focus concerning radiologic service using the radiology request form (RRF). Methodology: The study was a 6-month descriptive study conducted from January 2020 to June 2020. A total of 2053 request forms were collated retrospectively and evaluated to ascertain the appropriateness of the clinical information with the investigation requested. A 3 stage Likert scale of appropriate somewhat appropriate and inappropriate was used and the data analyzed using the statistical package for the social sciences (SPSS) IBM Corp. version 23.0 (Armonk, NY: USA). The results were expressed in percentages and frequencies and presented in tables and charts. Results: Of the 2053 request forms, X-rays constitute 32.54% while ultrasound scans and computed tomography (CT) investigations constitute 43.21% and 5.46%, respectively. Clinical information was indicated in 51.39% of the RRF, out of which 75.95% of the clinical information were adequate while 13.93% were not in keeping with the investigation. Ultrasound scan request had the highest inappropriate clinical information (54.68%) followed by plain radiography request (41.73%) whereas all the CT request was in tandem with the investigation. Conclusion: There are occasional clinical information and radiologic request mismatch. This may be due to the filling of the RRF by medical interns or nonmedical personnel such as allied health workers with less knowledge on radiologic imaging modalities. The audit recommends proper supervision of young clinicians and continues medical education concerning the rational use of imaging modality.

Morningness, eveningness chronotype traits and sleep quality among healthcare workers in shift work-a cross-sectional study from a tertiary care hospital in Kerala

Background: Sleep is basic physiological requirement. Sleep quality have impact on employee behaviour like alertness at work, error-making and absenteeism. The sleep disorders of nurses and other allied health workers have been reported as a risk factor for patient safety.Studies have found high prevalence of poor sleep quality among nurses. Main objective of this study was aimed to find out the morningness, eveningness chronotypes and sleep quality among allied health workers in shift work.Methods: A descriptive cross-sectional study was carried out among nursing and other allied health workers working in shifts using Pittsburgh sleep quality index (PSQI) and morningness-eveningness questionnaire (MEQ). After final scores participants were categorized as having good or bad quality of sleep and different chronotypes as per the scoring guidelines given. Chi-square test, Pearson’s partial correlation analyses done using SPSS software.Results: Only 26.9% had good quality sleep (mean PSQI score 8.9±4.5). Among chronotypes 69.9% were intermediateness and 30.1% were moderate morningness (mean MEQ score 55.5±7). 87.1% participants go to sleep within one hour after dinner. 40% use mobile phones in bed. 31.2% took up to 30 mins (mean 22.15±13.8) to get asleep. Strong negative correlation found between the sleep hours and total PSQI score (r=-0.495; p=0.000).Conclusions: Higher prevalence of poor quality of sleep with intermediateness as preferred circadian chronotype, there was also a strong negative correlation found between the hours of sound sleep and the total PSQI score.

Pitfalls in Emergency Medicine: Survey-Based Identification of Learning Objectives for Targeted Simulation Curricula by Emergency Department Staff.

Introduction: The emergency department is a complex practice environment into which numerous factors may introduce both human and system error. Emergency physicians have to assemble and manage multidisciplinary teams with a moment’s notice to manage critically ill patients. The EM training programs across Canada are diverse with considerable variation among programs. Acquisition of both high acuity low occurrence (HALO) and crisis resource management (CRM) skills are crucial to the development of proficient emergency room physicians. Physicians and allied health workers were surveyed to identify potential causes of error in local emergency departments and to find simulation-driven solutions. Methods: An anonymous survey was prepared to evaluate potential pitfalls of emergency care in St. John’s, NL, Canada. It was distributed electronically to 108 medical staff, including physicians, nurses, and postgraduate year three (PGY3) residents. Respondents were asked about their experience with simulation education, and whether or not they feel that there is an opportunity for it in postgraduate emergency medicine training. Results: The response rate was 30%. Communication - with the emergency department team, consulting services, and patients - was identified as a potential topic for simulation, along with interruptions. Burnout, busy department, departmental crowding, end of shift handover, and incomplete/missing patient medical history were identified as topics that should be included in the emergency medicine curriculum. Following a review with the simulation expert panel, it was determined that end of shift handover could also be incorporated as a simulation in the existing curriculum.Discussion: This survey looked at pitfalls in emergency medicine through a CRM lens. Six pitfalls were identified as important for patient safety, but not best addressed with simulation. These could be incorporated into the half-day curriculum as didactic lectures. Four important patient safety pitfalls were identified that could potentially be addressed with simulation and incorporated in the existing emergency medicine simulation curriculum.