Medical Preparedness Research Articles

Self-reported generic learning skills proficiency: Another measure of medical school preparedness

Background. Strong generic learning skills may improve academic performance at medical school. Studies evaluating the generic learning skills proficiency of medical students use self-reported data. It is not known whether self-evaluation of discipline-independent skills exhibits the same problems of widely variable accuracy as self-assessment of discipline-related skills. Objective. To investigate whether the self-reported generic learning skills proficiency of medical school entrants was related to three objective measures of performance: pre-university admission aptitude-test scores, information technology (IT) proficiency on entry and early academic performance at university. Methods. This prospective study used a previously validated 31-item questionnaire to document the self-reported proficiency of medical school entrants (2011 - 2013) with regard to 6 categories of generic learning skills: information handling, technical and numeracy, computer, organisational, managing self-learning and presentation skills. The results of the questionnaire were compared with performance in pre-university admission aptitude tests, an IT placement test on entry and end-of-semester 1 examinations (after 6 months at university), which are the basis for promotion to semester 2. Results. A total of 640 of 648 (98.8%) students completed the questionnaire. Self-reported generic learning skills proficiency was found to be significantly related to pre-university admission aptitude test scores (medium effect size), IT proficiency on entry to university (large effect size) and early academic performance at university (small effect size). Academically weak students did not overestimate their skills proficiency. Conclusion. These findings support the opinion that self-reported generic skills proficiency can credibly contribute to determining the academic preparedness of medical school entrants.

Changes in Temporary Disability Reporting Following the Implementation of the Army Medical Readiness Transformation.

In November 2014, the U.S. Army held a readiness summit to address concerns about the accuracy of medical reporting systems. At the time, soldiers on temporary disability were tracked as a medical readiness classification (MRC) 3A or 3B. MRC 3A soldiers had a medical condition with recovery expected within 30 d and MRC 3B soldiers were expected to take longer than 30 d to recover. Both groups were considered "non-available" and presumably non-deployable. Starting June 1, 2016, with the implementation of the Army Medical Readiness Transformation, soldiers on temporary disability longer than 14 d began to be reported as MRC 3s and are considered "non-deployable." The purpose of this study is to compare the number of soldiers on temporary disability previously reported as MRC 3A and 3B to the number listed as MRC 3 under the new reporting system for a light infantry brigade and to quantify the types and relative percentage of medical conditions leading to temporary disability under the new system. This cross-sectional analysis was conducted between January 1 and December 31, 2016 at Fort Carson, Colorado and included all soldiers assigned to Second Brigade, Fourth Infantry Division. We calculated the average number and proportion of soldiers on temporary disability at any one time for the period prior to implementation of the new reporting system (January 1 through May 31, 2016) and compared this to the period after implementation on June 1, 2016. The difference between the two independent proportions was calculated along with the lower and upper limits of the 95% confidence interval for the difference. Between January 1 and May 31, 2016, the average number of soldiers on temporary disability at any one time was 186, accounting for 4.3% of the authorized unit strength. After June 1, 2016, the average number increased to 244 or 5.7%. The difference in the proportion of temporary profiles was 1.4% (95% confidence interval 0.43-2.3%). From June 1 through December 31, 2016, 936 soldiers were placed on temporary disability. The majority was for orthopedic-related conditions (68.6%). Lower extremity (18.3%) and knee (17.5%) conditions were the two most common orthopedic issues. Behavioral health-related conditions (6.9%) and postoperative recovery (5.6%) were the next two most common categories. Implementation of the Army Medical Readiness Transformation resulted in a statistically significant increase in reported "non-deployable" MRC 3 soldiers compared with the previous "non-available" MRC 3A/3B population. One possible reason for this relates to how temporary disability is reported under each system, especially for those soldiers with only mild limitations. Under the new system, musculoskeletal conditions accounted for the majority of disability. Important limitations include small sample sizes, a fluctuating denominator representing authorized unit strength, and that the study did not take into account seasonal variation and the operational cycle for the unit. Future studies should look at those conditions or soldier characteristics that can help guide commanders as they make deployability decisions and how to address wellness and injury prevention to mitigate the risk of soldiers going on temporary disability.

Enhanced Multi-Service Markets: An Evolution in Military Health System Governance.

The evolution of governance models for the Military Health System's (MHS) large hospitals, called medical treatment facilities (MTFs), has culminated with the effort to implement Enhanced Multi-Service Markets (eMSM). The term eMSM refers to two separate concepts. First, MSM refers to those geographic areas, that is, markets, which have the following characteristics: they have MTFs that are operated by two or more Department of Defense (DoD) Services, that is, Army, Navy, or Air Force; there is a large beneficiary population; there is a substantial amount of direct care (i.e., beneficiaries are treated at MTFs instead of TRICARE's purchased care from civilian providers); and there is a substantial readiness and training platform. Second, the term "enhanced" refers to an increase in management authority over clinical and business operations, readiness, and MTF workload. A retrospective review was conducted to study the evolution of military and civilian health care delivery models for the purpose of understanding how governance models have changed since the 1980s to design and manage MTFs with overlapping catchments areas. Primary and secondary data sources were analyzed through a comprehensive literature review. Since the 1980s, the MHS governance models have evolved from testing various managed care models to a regionally focused TRICARE model and culminating with an overlapping catchment area model entitled eMSMs. The eMSM model partially fulfills the original vision because the eMSM leaders have limited budgetary and resource allocation authority. The various models sought to improve governance of overlapping catchment areas with the intent to enhance medical readiness, community health, and individual health care while reducing costs. However, the success of the current model, that is, eMSMs, cannot be fully assessed because the eMSM model was not fully implemented as originally envisioned. Instead, the current eMSM model partially implements the eMSM model. As a result, the current eMSMs operate solely through cooperation and collaboration, without directive authority. Nevertheless, there have been some market-specific initiatives. Further analysis is necessary in the event that eMSM market managers are granted governance authority. This authority would include the ability to allocate the overall market's budget, determine common clinical and business functions, optimize the readiness of both the medical and the operational forces assigned to the market, and reallocate resources to optimize MTF workload. The results of this analysis may determine whether the fully implemented eMSMs optimize patient-centric initiatives as well as improve the market's efficiency and effectiveness.

Re-boot: Simulation Elective for Medical Students as Preparation Bootcamp for Obstetrics and Gynecology Residency.

Objective: To evaluate the impact of a simulation-based elective on medical student preparedness for obstetrics and gynecology (OB/GYN) residency.Methods: A two-week, simulation-based elective course for post-clerkship medical students was developed, and 10 students participated at a single academic institution in 2016 and 2017. Using standardized patients and team-based training, students practiced procedural and surgical skills, as well as the diagnosis, management, and work-up of commonly seen problems. Close coaching with a low student-faculty ratio was employed for each session, allowing for individualized feedback in real time. Prior to and after completing the elective, student knowledge was evaluated using the Preparation for Residency Knowledge Assessment tool (PrepForRes). Written course evaluations were also completed by students at the end of the course.Results: Mean scores on the PrepForRes exam increased from 63.6% to 75.3% (p=0.0136). Notably, the average post-course score improved to a passing level, and all but one student achieved a passing score on the post-course test. Course evaluations and student feedback showed high satisfaction rates with the course.Conclusions: This study demonstrates that a simulation-based elective course is an effective tool for helping medical students transition to OB/GYN residency. As medical schools work to facilitate the transition from undergraduate to graduate medical education, simulation can bridge gaps during this transition in order for students to meet entry-level residency requirements.

International medical electives in selected African countries: a phenomenological study on host experience.

ObjectivesTo explore the host experience on international medical electives at a selection of hospitals in low- and middle-income countries in Africa. Outcomes of the study may inform and improve the preparation of global health curriculum, pre-elective training and debriefing for international medical electives. MethodsA descriptive phenomenological study was undertaken, involving semi-structured interviews with ten elective hosts at seven study sites in three African countries. Purposive convenience sampling augmented by snowballing was utilised to recruit study participants. The data were thematically analysed and interpreted with reflexivity to generate an accurate aggregate of the experience of participants in hosting international medical electives. ResultsSix main themes emerged from the thematic analysis of interview data: international medical student contribution to host hospitals, host professional and personal fulfiment, barriers to student learning experience, international medical student preparedness, hope for reciprocity and barriers to cultural immersion and patient care. ConclusionsStudy participants described the experience of hosting international medical elective students as overwhelmingly positive. However, they highlighted issues such as barriers to students’ learning experience and the lack of reciprocity between host and sending institutions as areas which could be addressed to optimize the experience for both hosts and international medical students. An understanding of the host experience provides stakeholders with a clearer idea of what is important in preparation, organisation and evaluation of the elective experience. This study provides the impetus for further research to examine the effectiveness of introducing appropriate pre-departure training and post-elective debriefing to students embarking on international medical electives.

Prepared for Mission? A Survey of Medical Personnel Training Needs Within the International Committee of the Red Cross

BackgroundHumanitarian organizations such as the International Committee of the Red Cross (ICRC) provide worldwide protection and medical assistance for victims of disaster and conflict. It is important to gain insight into the training needs of the medical professionals who are deployed to these resource scarce areas to optimally prepare them. This is the first study of its kind to assess the self-perceived preparedness, deployment experiences, and learning needs concerning medical readiness for deployment of ICRC medical personnel.MethodsAll enlisted ICRC medical employees were invited to participate in a digital questionnaire conducted during March 2017. The survey contained questions about respondents’ personal background, pre-deployment training, deployment experiences, self-perceived preparedness, and the personal impact of deployment.ResultsThe response rate (consisting of nurses, surgeons, and anesthesiologists) was 54% (153/284). Respondents rated their self-perceived preparedness for adult trauma with a median score of 4.0 on a scale of 1 (very unprepared) to 5 (more than sufficient); and for pediatric trauma with a median score of 3.0. Higher rates of self-perceived preparedness were found in respondents who had previously been deployed with other organizations, or who had attended at least one master class, e.g., the ICRC War Surgery Seminar (p < 0.05). Additional training was requested most frequently for pediatrics (65/150), fracture surgery (46/150), and burns treatment (45/150).ConclusionICRC medical personnel felt sufficiently prepared for deployment. Key points for future ICRC pre-deployment training are to focus on pediatrics, fracture surgery, and burns treatment, and to ensure greater participation in master classes.

Assessing the Medical Emergency Preparedness of Dental Faculty, Residents, and Practicing Periodontists: An Exploratory Study.

With the increased number of elderly and medically compromised individuals receiving dental care and the presence of systemic comorbidities and associated treatment modalities in this patient population, it is imperative that dentists be prepared to manage a variety of medical emergencies. The aim of this study was to assess the knowledge of and preparedness to manage common medical emergencies of cohorts of practicing periodontists, specialty residents, and faculty members, both for comparative purposes and as an aid to refining a dental school's standardized case scenarios. The study, conducted in 2017, was designed for four groups of randomly selected participants with at least 20 in each group; the actual number of voluntary participants was 28 private practice periodontists, 22 residents in specialty programs, 21 specialist faculty members, and 24 general practice faculty members. Participants were asked to evaluate ten clinical emergency cases and identify the diagnosis and indicated intervention for each. Groups were also evaluated for differences among correct responses for each case. Overall, there were no statistically significant differences for number of correct diagnoses or interventions among the four groups. However, several cases had varying degrees of incorrect diagnoses and management across all groups. Participants who had recently graduated or were still in school were able to treat cases appropriately more often than the other participants. Further refinement of cases to assess provider preparedness to correctly diagnose and manage medical emergencies is needed, specifically establishing case-specific features and addressing areas of potential confusion before the cases are used for educational purposes.

Patient-Centered Medical Home Status and Preparedness to Assess Resident Milestones: A CERA Study.

The patient-centered medical home (PCMH) model has been proposed as the ideal model for delivering primary care and is focused on improving patient safety and quality, reducing costs, and enhancing patient satisfaction. The mandated Accreditation Council for Graduate Medical Education educational milestones for evaluation of resident competency represent the skills graduates will utilize after graduation. Many of these skills are reflected in the PCMH model. We sought to determine if residency programs whose main family medicine (FM) practice sites have achieved PCMH recognition are therefore more prepared to evaluate milestones. A national Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine program directors (PDs) was conducted during June and July 2015 to determine if PCMH recognition influences PDs' ability to evaluate training methods and their level of preparedness to evaluate milestones. The response rate for the survey was 53.3% (252/473). Nearly two-thirds of the PDs (62.7%) reported that their main FM practice site had earned PCMH recognition. There was no statistical difference between non-PCMH-recognized vs PCMH-recognized programs in how PDs perceived that their program was prepared to assess residents' milestone levels overall (P=0.414). Residents of PCMH-recognized programs were more likely to receive training for team-based care (P=0.009), system improvement plans (P<0.001), root-cause analysis (P=0.002), and health behavior change (P=0.003). PCMH recognition itself did not improve preparedness of FM residency programs to assess milestones. Residents from programs whose main FM practice site is PCMH-recognized are more likely to be trained in the key concepts and tasks associated with the PCMH model, tools that they are expected to utilize extensively after graduation.

Infant abuse diagnosis associated with abusive head trauma criteria: incidence increase due to overdiagnosis?

BackgroundThe hypothesis of this study is that the diagnosis of infant abuse is associated with criteria for shaken baby syndrome (SBS)/abusive head trauma (AHT), and that that changes in incidence of abuse diagnosis in infants may be due to increased awareness of SBS/AHT criteria.MethodsThis was a population-based register study. Setting: Register study using the Swedish Patient Register, Medical Birth Register, and Cause of Death Register. The diagnosis of infant abuse was based on the International Classification of Diseases, 9th and 10th revision. Participants: All children born in Sweden during 1987–2014 with a follow-up until 1 year of age (N = 2 868 933). SBS/AHT criteria: subdural haemorrhage, cerebral contusion, skull fracture, convulsions, retinal haemorrhage, fractures rib and long bones. Outcomes: Incidence, rate ratios, aetiologic fractions and Probit regression analysis.ResultsDiagnosis of infant abuse was strongly associated with SBS/AHT criteria, but not risk exposure as region, foreign-born mother, being born preterm, multiple birth and small for gestational age. The incidence of infant abuse has increased tenfold in Sweden since the 1990s and has doubled since 2008, from 12.0 per 100 000 infants during 1997–2007 to 26.5/100 000 during 2008–2014, with pronounced regional disparities.ConclusionsDiagnosis of infant abuse is related to SBS/AHT criteria. The increase in incidence coincides with increased medical preparedness to make a diagnosis of SBS/AHT. Hidden statistics and a real increase in abuse are less plausible. Whether the increase is due to overdiagnosis cannot be answered with certainty, but the possibility raises ethical and medico-legal concerns.

Biomarker Time Course Recovery Profile in Military Exertional Heat Stroke Populations

Current return‐to‐duty and training decisions following Exertional Heat Stroke (EHS) are based on ‘best‐guess' criteria. A time‐resolved progression of biomarker changes following EHS has previously not been determined to describe ‘normal’ recovery. In order to characterize EHS injury severity and recovery progression in military populations and identify objective measures of medical readiness, we performed a retrospective clinical records review focusing on available clinical laboratory values assessed on the day of injury, and all follow‐up visits. This dataset was limited to US active duty service members (ADSM) who had at least one EHS during the years 2008–2014. Incidence was identified using the International Classification of Disease 9th (ICD‐9) Revision code for Heat Stroke (992.0). We collated and analyzed daily clinical laboratory values of circulating biomarkers from de‐identified electronic medical records contained in the Medical Health System Data Repository (MDR). Lacking consensus laboratory reference ranges between treatment facilities, the most prevalent reported reference ranges were used as consensus values to orient the analysis. Over the prescribed period, 2,529 ADSM experienced at least one episode of EHS. A total of 181,918 daily clinical laboratory results for 50 laboratory analytes were used for this analysis including a range of blood counts, and serum/plasma or urine assays from 0–340 days following the initial injury. As expected, the median daily value for 11 analytes (ALT, AST, Cl, CK, hematocrit, creatinine, hemoglobin, LDH, myoglobin, WBC, RBC) exceeded the upper limit of the normal reference range, indicating multi‐organ damage or dysfunction. Notably, creatine kinase (CK; consensus reference range 22–269 unit/L) exhibited the highest deviation 3‐days following the initial injury, the median value topped at 4.65‐fold elevation above the upper reference limit; median = 1,251 units/L (interquartile range, 321.25–5,256.75) units/L. Median CK values persisted above the reference range for 8‐days. Each biomarker showed a distinct pattern of peaks (ranging from 0–3 days). In conclusion, this work exploited population‐based EHS responses to characterize injury severity and recovery progression that has not previously been defined. However, due to the high degree of inter‐individual variability in the magnitude and duration of biomarker fluctuations, it remains difficult to set a generalizable criterion for diagnosis, recovery and medical readiness following EHS. The opinions or assertions contained herein are the private views of the authors and should not be construed as official or reflecting the views of the Army or the Department of Defense.Support or Funding InformationSupported, in part, by Defense Health Program grant, award #W81XWH‐13‐MOMJPC5‐IPPEHA.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Exertional heat illness incidence and on-site medical team preparedness in warm weather.

To investigate the influence of estimated wet bulb globe temperature (WBGT) and the International Institute of Race Medicine (IIRM) activity modification guidelines on the incidence of exertional heat stroke (EHS) and heat exhaustion (HEx) and the ability of an on-site medical team to treat those afflicted. Medical records of EHS and HEx patients over a 17-year period from the New Balance Falmouth Road Race were examined. Climatologic data from nearby weather stations were obtained to calculate WBGT with the Australian Bureau of Meteorology (WBGTA) and Liljegren (WBGTL) models. Incidence rate (IR) of EHS, HEx, and combined total of EHS and HEx (COM) were calculated, and linear regression analyses were performed to assess the relationship between IR and WBGTA or WBGTL. One-way ANOVA was performed to compare differences in EHS, HEx, and COM incidence to four alert levels in the IIRM guidelines. Incidence of EHS, HEx, and COM was 2.12, 0.98, and 3.10 cases per 1000 finishers. WBGTA explained 48, 4, and 46% of the variance in EHS, HEx, and COM IR; WBGTL explained 63, 13, and 69% of the variance in EHS, HEx, and COM IR. Main effect of WBGTA and WBGTL on the alert levels were observed in EHS and COM IR (p < 0.05). The cumulative number of EHS patients treated did not exceed the number of cold water immersion tubs available to treat them. EHS IR increased as WBGT and IIRM alert level increased, indicating the need for appropriate risk mitigation strategies and on-site medical treatment.

Minor Behavioral Health Readiness and Profiling Barriers in the U.S. Army.

Medical readiness for deployment is arguably the most important component of personnel readiness in the U.S. Army. Administrative documents called profiles provide individualized medical recommendations to the commander regarding how to best provide for a soldier's health and welfare, and contribute to an aggregated enumeration of a unit's overall readiness to deploy. Profiles that convey behavioral health (BH) limitations thus reflect what can be called the "behavioral health readiness" of the force. In the Army, BH profiles are further broken into major (more severe BH conditions) and minor (less severe) categories. Recent reporting indicates that current profiling (both major and minor) substantially underestimates BH readiness, presenting a significant safety and personnel issue for the Army. Currently, little is understood regarding barriers to profiling. The intent of this paper is to establish a basis for understanding these barriers by examining provider perceptions on the issue. While the results may have broad applicability in determining BH profiling barriers in general, minor BH improvement efforts stand to benefit the most due to more reliance on provider judgment and less on mandatory guidelines. Selected themes and provider quotes regarding barriers to BH profiling from a qualitative study, "Return to Duty Practices of Behavioral Healthcare Providers in Garrison," are presented. Fourteen semi-structured interviews and three focus groups were conducted with a diverse convenience sample of Army BH providers in October 2015, resulting in input from 29 practitioners. Four general profiling barrier categories were identified and include provider proficiency level, environmental factors, stigma concern, and clinical time constraints. Suboptimal BH profiling rates suggest that a preponderance of factors currently tip the scale of BH profiling in a lopsided fashion that comes at the cost of soldier safety and increased risk of mission failure. Relief from one or more of the identified profiling barriers would likely be necessary to tip the scale of clinical judgment in favor of increased profiling, and may be more beneficial for improving minor BH profiling deficits in particular. Quantitative exploration of provider and soldier attitudes on this subject is worthy of further pursuit and would shed light on which of the identified barriers are most crucial to reducing BH profile deficits.

Interprofessional education and collaborative practice: Psychometric analysis of the Readiness for Interprofessional Learning Scale in undergraduate Serbian healthcare student context

BackgroundThere is an implicit expectation for medical sciences students to work together effectively as members of health-care team, and interprofessional education is therefore widely accepted. Students' attitudes, which are affected by various factors, have been recognized as the most important predictors of successful implementation of interprofessional education with the aim of developing collaborative practice. The Readiness for Interprofessional Learning Scale has often been used in studies to measure these perspectives. ObjectivesTo describe the psychometric properties of the Serbian cross-culturally adapted version of the original Readiness for Interprofessional Learning Scale, to assess the attitudes of undergraduate health science students towards interprofessional education and to evaluate whether a professional group and student characteristics have influence on attitudes towards collaborative practice and shared learning. DesignA descriptive/analytical and comparative cross-sectional study. SettingsFaculty of Medicine in Serbia. ParticipantsNursing and medical students after completed first clinical rotations (n = 257). MethodsThe Readiness for Interprofessional Learning Scale for assessing attitudes among students towards interprofessional learning, Professional Identity Questionnaire for Nursing Students for assessing professional identity in nursing students, Professional Nursing Image Survey for assessing attitudes of medical students towards the nursing profession, as well as a socio-demographic questionnaire were the instruments used in this research study. The data were analysed using descriptive and inferential statistics. ResultsExploratory factor analysis on 19 items revealed two-factors accounting for 51.1% of the total variance with the internal reliability α = 0.90. The mean total score of the Readiness for Interprofessional Learning Scale was 73.5 (SD = 11.5) indicating that students are ready for interprofessional learning. Nursing students, female students; students in their first years of studies, and those with previously completed education in the field of health care, have been more ready for interprofessional learning and collaborative practice. In the multiple linear regression analysis, gender and assessing professional nursing skills and abilities were significant predictors of medical students' readiness for interprofessional learning, whereas professional identity was for nursing students. ConclusionThe Serbian version of the Readiness for Interprofessional Learning Scale has proven to be reliable and valid for the “teamwork, collaboration and shared learning” subscale, while the “role and responsibilities” subscale showed lower stability. The results of this study revealed positive students' attitudes towards interprofessional learning, which is important for Serbia, as a candidate country for European Union membership, and thus making our educational system more inclusive for joining the European Higher Education Area.

Preparedness Is More Than a Plan: Medical Considerations for Radiation Response.

The goals herein are to describe and discuss existing plans for the medical preparedness and response to a radiological incident/nuclear detonation, present the systems approach to nuclear response, introduce methods to assess operational capabilities, and posit suggestions for the way forward to implementation. This discussion seeks to review where these U.S. government efforts began 10 y ago, then moves through the collective National progress in preparedness planning for an improvised nuclear device detonation and differentiates between important preparedness planning efforts and the challenges of understanding national implementation. Finally, a way forward for the immediate future is suggested.

The resurgence of leprosy in India: Findings from a survey assessing medical professionals' knowledge and preparedness

Background: Sufficient knowledge regarding presentation, clinical features, and further workup of leprosy, a stigmatized disease, is essential for physicians and other health professionals to effectively control the disease. This study aimed to investigate the current knowledge of leprosy among health professionals in India. Materials and Methods: An online survey was administered to 200 health-care professionals. Results: One hundred and thirteen health professionals representing various sectors completed the survey. Only 24% of participants correctly answered items regarding the treatment of mild reactions of Type 1 reversal reaction and Type 2 erythema nodosum leprosum. In addition, only 38% of participants correctly answered an image-based item depicting a blister calendar pack used for treatment. Conclusion: The survey results indicate that medical professionals need more educational training to combat this once declared “eliminated” disease.

STATE INSTITUTION NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2017.

Research activities and scientific advance achieved in 2017 at the State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine» (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. The report presents the results of fundamental and applied research works of the study of radiation effects and health effects of the Chornobyl accident; fulfillment of tasks of «State social program for improving safety, occupational health and working environment in 2014-2018 years».The report also shows the results of scientific-organizational and health care work, staff training.The NRCRM Annual Report was approved at the Scientific Council meeting of NAMS on March 23, 2018.

STATE INSTITUTION «NATIONAL RESEARCH CENTER FOR RADIATION MEDICINE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE» - RESEARCH ACTIVITIES AND SCIENTIFIC ADVANCE IN 2017.

The role and place of health care facilities of the highly specialized (tertiary) level in radiation emergencies in the conditions of martial law are considered taking into account the experience of overcoming of the Chornobyl catas-trophe consequences. The classification of emergencies and the main scenarios of radiation emergencies (nuclear terrorism, radiation accidents and incidents, the use of nuclear weapons) are presented. The principles of medical preparedness and providing the highly specialized medical care in a radiological emergency are presented on the base of the Chornobyl catastrophe experience. It is determined that the tertiary health care facilities in a radiological emergency should provide as follow: development and implementation of plans and protocols of highly specialized medical care; organization, direct provision, coordination and quality control of the highly specialized medical care; aggregation and coordination of efforts of all three levels of health care facilities; integration into the radiation emergency management system, and analysis and generalization of the experience gained.

Skills Decay in Military Medical Training: A Meta-synthesis of Research Outcomes.

In fiscal year 2012, the Medical Simulation and Information Sciences Research Program released two Skills Decay (SD) research program announcements (PAs) under the Medical Readiness Initiative entitled "Medical Practice Initiative Breadth of Medical Practice & Disease Frequency Exposure (MPI-BMP)" and the "Medical Practice Initiative Procedural Skill Decay and Maintenance (MPI-PSD)." The Office of Naval Research also released a PA entitled "Medical Modeling and Simulation (MM&S) for Military Training and Education." A total investment of $12 M was made. This article provides a meta-synthesis of the Skills Decay research conducted under these efforts. The MSIRRP Medical Simulation Portfolio collected, reviewed, and analyzed the final reports of the Skills Decay research efforts from the three PAs. This paper provides a meta-synthesis of the outcomes of those studies. Focus of this study was to determine if the anticipated goals of the Skills Decay PAs were met as well as to provide a summary of lessons learned to the research community. Fourteen research questions posed by the PAs were structured into four main goals: (1) Skills Decay identification, (2) creation/validity of Skills Decay tools and feasibility and viability of data extraction project, (3) refreshment training to prevent or alleviate Skills Decay project, and (4) Skills Decay education content. Using a combination of training styles, choosing variables known to have Skills Decay predication value, and developing better ways of mining available data that can, in turn, provide feedback to training needs, it is possible for accurate Skills Decay models to be developed. These technologies have the ability not only capture the learner's reaction during the simulation, but to capture the simulation outcomes to predict a medical professional's level of experience and background. Lessons learned from the investments made by the government are extremely important in order to ensure that the outcomes of the research touch the lives of the warfighter.

Medical and policy considerations for nuclear and radiation accidents, incidents and terrorism.

The purpose of this review is to address the increasing medical and public concern regarding the health consequences of radiation exposure, a concern shaped not only by fear of another Chernobyl or Fukushima nuclear power facility accident but also by the intentional use of a nuclear weapon, a radiological dispersion device, a radiological exposure device, or an improved nuclear device by rogue states such as North Korea and terrorist organizations such as Al Qaeda and ISIS. The United States has the medical capacity to respond to a limited nuclear or radiation accident or incident but an effective medical response to a catastrophic nuclear event is impossible. Dealing effectively with nuclear and radiation accidents or incidents requires diverse strategies, including policy decisions, public education, and medical preparedness. I review medical consequences of exposures to ionizing radiations, likely concomitant injuries and potential medical intervention. These data should help haematologists and other healthcare professionals understand the principles of medical consequences of nuclear terrorism. However, the best strategy is prevention.

Cosmetic surgery advertising exposure, attitudes toward the surgery and surgeons, and perceptions of the advertisement features

ABSTRACTIntroduction: Empirical research on cosmetic surgery advertisements is scarce, in spite of their increasing visibility and ensuing ethical controversies. In the current study, the effects of cosmetic surgery advertising on perceived benefits, risks, acceptance of cosmetic surgery and attitudes toward cosmetic surgeons were examined. Additionally, audience perceptions about the information utility of 27 common elements of cosmetic surgery advertisements were inquired.Method: A web-based cross-sectional survey was conducted with a convenience sample of 343 college students.Results: Exposure to cosmetic surgery advertisements was positively related to perceived benefits and surgery intention, but not related to perceived risk. Compared with doctors in general, cosmetic surgeons were trusted less, though exposure to cosmetic surgery advertisements improved some perceptions about cosmetic surgeons. Among the 27 elements examined, surgeon's education and training, price, financing options, before-and-after photos of patients, patient testimonials, surgeries/procedures available, risks of surgeries/procedures, hygiene-related practices, medical emergency preparedness, and consultation information were rated as helpful. Rated as not helpful were surgeon's portrait photos, office staff photos, highly attractive model photos, after-only photos of actual patients, and celebrity cosmetic surgery information. There were also differences in the evaluation of the 27 elements based on the level of cosmetic surgery advertising exposure and perceived risk.Conclusions: The findings justify marketing efforts of cosmetic surgeons. At the same time, the evaluation of cosmetic surgery advertising elements revealed many areas of confusion among consumers and thus warrants further research and education.