Non-medical Personnel Research Articles

Preparing Community Health Workers to Empower Latino(a)s With Diabetes: A Real-World Implementation Study.

The purpose of the study was to evaluate the delivery of diabetes self-management education (DSME) to Latino(a) adults by community health workers (CHWs). Investigators developed an evidence-based, bilingual (Spanish/English) diabetes education curriculum and trained 10 CHWs on its content. CHWs then implemented the curriculum in 6-month diabetes group visit programs for low-income Latino(a)s with type 2 diabetes in nonacademic 501(c)3 community clinics. Investigators evaluated efficacy of the training through successful implementation, measured by participant group visit acceptance and attendance. Participants (n = 70) reported high levels of program satisfaction (3.8/4.0), improvement in quality of life (9.7/10), meeting of individual needs (3.8/4.0), and acceptability (9.7/10.0). Content analyses revealed that 87.1% of participants would not change the program or wanted to extend it. Participant attendance was 81.6%. Investigators demonstrated the ability to develop a training that nonmedical personnel (CHWs) successfully implemented in a real-world study. This study provides a curricular framework for CHW-led education that may serve as a template to extend to other diseases and populations.

Improving maternal safety: Usability and performance assessment of a new medical device for the treatment of postpartum haemorrhage

Postpartum haemorrhage (PPH) is an obstetric emergency causing nearly one-quarter of maternal deaths worldwide, 99% of these in low-resource settings (LRSs). Uterine balloon tamponade (UBT) devices are a non-surgical treatment to stop PPH. In LRSs, low-cost versions of UBT devices are based on the condom balloon tamponade (CBT) technique, but their effectiveness is limited. This paper discusses the experimental study to assess the usability and performance of a medical device, BAMBI, designed as an alternative to current CBT devices. The testing phase involved medical and non-medical personnel and was focused on testing BAMBI's usability and effectiveness compared to a standard CBT solution. We collected measures of the execution time and the procedure outcome. Different training procedures were also compared. Results show a significant preference for the BAMBI device. Besides, medical and non-medical subjects reached comparable outcomes. This aspect is highly relevant in LRSs where the availability of medical personnel could be limited.

Versatile Use of V-Y Advancement Flap for Facial Defect Reconstruction: A Case Series in Asian Patients.

V-Y advancement flap (VYAF) is a commonly used flap for facial reconstruction, but it is not popular in Asian society with limited aesthetic outcome evaluation. To demonstrate our experience of facial VYAF with the quantitative aesthetic outcome assessment. From January 2013 to December 2022, patients who underwent facial VYAF reconstruction were reviewed. Postoperative photographs were collected and independently graded by three plastic surgeons, three nurses, and six non-medical personnel using Manchester scar scale (MSS). The representative preoperative images were selected for surgeons' reconstruction preferences survey. Forty-eight patients (27 females and 21 males), with a mean age of 66.8 (23-97) years, were included in this study. All flaps survived with no flap necrosis. Only six patients (12.5%) developed minor postoperative complications, and they were treated conservatively and resolved uneventfully. The total MSS score was 7.8 ± 1.9 (scale of 4 [best scar] to 24 [worst scar]) and the overall scar VAS rating was 1.9 ± 1.1 (0 [best scar] to 10 [worst scar]), indicating satisfactory postoperative scar condition. From the survey of 22 plastic surgeons and 11 scenarios, VYAF was rarely chosen among other local flaps which only accounted for 8.7%. VYAF is an easy and safe method for facial reconstruction with low morbidity, but its usefulness is underappreciated. With a proper design and cautious dissection, we believe that good aesthetic and functional outcomes can be achieved with VYAF. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Attitude of district doctors, nurses and patients to the organizational model of primary health care delivery with redistribution of functions between medical and non-medical personnel

Attitude of district doctors, nurses and patients to the organizational model of primary health care delivery with redistribution of functions between medical and non-medical personnel

Effect of prebriefing in cardiopulmonary resuscitation education for laypeople on educational effectiveness and satisfaction

Bystander cardiopulmonary resuscitation (CPR) is important for improving survival rates and neurological outcomes in out-of-hospital cardiac arrest. However, laypeople often have psychological barriers to performing CPR, even if they have received training. Prebriefing provides psychological stability to the participants, enabling them to concentrate more comfortably during simulation. However, previous studies have mainly focused on simulation-based education for medical professionals, and no study has focused on prebriefing for laypeople. Therefore, we developed a structured prebriefing for laypeople and applied it to their CPR education to investigate its effect on educational effectiveness and satisfaction. This group randomization study was conducted from 09 November 2022 to 09 December 2022. Individuals aged ≥18 years who participated in CPR training as non-medical personnel were included. A 60-min CPR education focusing on hands-on skills was conducted. The Prebriefing Experience Scale for laypersons (PESL) was developed and surveyed using a 5-point Likert scale by modifying the Prebriefing Experience Scale for medical personnel based on existing research. During the study, a total of 382 people applied for education in 29 classes. Owing to logistical constraints resulting in randomization failure within the cohort of 10 classes, 82 participants were affected and subsequently excluded. In addition, 12 participants were excluded because of incomplete responses in the PESL survey. Ultimately, the experimental cohort consisted of 139 participants distributed across 10 classes, and the control group comprised 149 participants within the 9 classes. No difference in age and sex was found between the two groups. No statistically significant differences were observed between the two groups across all categories of the PESL assessment. In this study, when structured prebriefing was conducted on the general public, no statistically significant differences were found in PESL compared with conventional prebriefing. However, more improved research is needed.

Development of a Subjective Workload Assessment Technique Model as an Effort to Improve Performance Nurse in Home Inpatient Room Royal Prima Hospital

It is hoped that the performance of all medical and non-medical personnel at the Hospital will be in top condition. Nurses are expected to provide good service. This research aims to develop a subjective workload assessment technique model as an effort to improve the performance of nurses in the Inpatient Room at Royal Prima Hospital. This research is a quantitative study with a cross sectional study design which was carried out in the inpatient ward of the Royal Prima Hospital from June to July 2023. The population was 120 people. Respondents who were selected (inclusion) or excluded through the selection process were those who had more than 3 months of experience working in a care unit or related work. Data were analyzed univariate, bivariate and multivariate. The results of the research show that there is an influence of time pressure, working hour schedules, multiple roles, revetitive action on improving the performance of inpatient nursing personnel which is subjectively reasoned by inpatient nurses at Royal Prima Hospital. The variable that has the most dominant influence is the dual role variable.The suggestion of this research is that the health service should provide input in the context of continuous guidance to hospitals, especially in managing hospital management to improve better performance.

YouTube as a Patient Information Source for Gastrointestinal Reflux Disease.

Introduction Gastroesophageal reflux disease (GERD) affects a substantial portion of the global population, resulting in significant morbidity and impacting the quality of life. YouTube (YouTube,San Bruno, California) serves as a platform where medical professionals, individuals with personal experiences, and educational channels share their insights on GERD. However, with the vast amount of information available on YouTube, the question of credibility and reliability is a concern and, thus, is crucial to evaluate. This research paper aims to explore the impact of YouTube as a source of information on GERD. The aim of this study is to assess the quality and reliability of the information on YouTube about GERD. Methodology This cross-sectional observational study was conducted in June 2023.A questionnaire was designed using Google Forms (Google, Mountain View, California) with predetermined criteria such as characteristics of YouTube videos (time since uploaded, uploader, number of likes and comments); information about GERD (symptoms, investigations, treatment); and quality and reliability of information on YouTube about GERD using Global Quality Scale (GQS) and Reliability score. The Kruskal-Wallis Test was used to evaluate the difference in quality and reliability of information about GERD on YouTube based on the type of uploader. Results Out of 90 videos analyzed, 68 YouTube videos on GERD that met inclusion criteria were included in the study. The number of videos uploaded by hospitals was 28 (41.2%), those by doctors was 12 (17.6%), and the remaining by others (like pharmacists, patients, and non-medical personnel) was 28 (41.2%).A significant proportion of videos (88.24%) shared information pertaining to disease symptoms and cause/etiology. The videos uploaded by "others" hadsignificantly higher (p<0.05) reach as assessed by the Video Power Index (VPI) compared to those uploaded by doctors and hospitals. However, there was no significant difference (>0.05) in the quality and reliability of videos uploaded by doctors, hospitals, and othersources. Conclusion Although the YouTube videos uploaded by doctors and hospitals had less reach among viewers compared to other uploaders (patients, news agencies, pharmaceutical companies, and others unrelated to healthcare), the quality and reliability of videos uploaded by doctors, hospitals, and other uploaders were of goodquality and reliability and with no significant difference based on type of uploader. Healthcare organizations and government agencies should ensure that viewers have access to accurate and reliable information from social media like YouTube, which is crucial in their health decision-making.

Rethinking limb tourniquet conversion in the prehospital environment.

Limb tourniquets are among the most effective lifesaving interventions after severe injury. Tourniquets used for less than two hours have proven safe, even when in hindsight the tourniquet was determined not to have been necessary. However, tourniquets used for longer than 2 hours may result in severe ischemic changes, fasciotomy rhabdomyolysis, renal failure, amputation and death.Given their frequent use after even minor limb injury (>50%), as soon as safely feasible all limb tourniquets must be reassessed. They may be transitioned to a hemostatic dressing with tourniquet release, (tourniquet conversion, TC), or moved to just above the injury site (tourniquet replacement, TR). Their near ubiquitous application by medical and non-medical personnel has resulted in significant discussion regarding who should perform TC/TR if arrival at a forward medical location is delayed. In the ongoing war in Ukraine, the first near peer large scale combat operation in 80 years, prolonged evacuation times are common and have highlighted the need for early TC/TR prior to hospital arrival. Similar concerns exist in the austere rural and wilderness civilian setting where prolonged tourniquet application is common, given the long distances to a trauma center.This article describes proposed changes in tourniquet use and how the anticipated duration of tourniquet application dictates increased training requirements. Increased emphasis on who needs a tourniquet and then TC/TR is necessary to maximize benefit while minimizing potential harm.Level of Evidence and Study Type: N/A.

An approach to the characteristics of ophthalmologists’ daily work in five Peruvian Amazonian departments

Abstract Objective: The objective of the study was to describe the characteristics of the daily work of ophthalmologists in five Peruvian Amazonian departments, including aspects of professional practice, eye health services, and the effectiveness of the strategies implemented in the fight for vision. Materials and Methods: A descriptive case study based on a survey prepared and executed by the clinic’s team of ophthalmologists in the teaching and research area. Results: Of the 16 participating ophthalmologists, 56.3% have dual practice in the public and private sectors. The primary pathologies identified from their professional practice include cataracts, glaucoma, and refractive errors. More than 80% indicate that information on visual health in the Peruvian Amazonian departments is unavailable, insufficient, and outdated. Regarding the availability of visual health services, 68.8% agree that such services are accessible, whereas 75% agree that clinical and surgical ophthalmologists are available. However, 81.3% disagree that subspecialty ophthalmologists are readily available. Furthermore, over 80% disagree that visual health services are accessible to all population sectors geographically. In addition, more than 60% disagree that the information provided to patients regarding diagnosis and treatment has a culturally relevant approach. Key criteria for designing and implementing strategies to fight for vision include epidemiological analysis and fieldwork. Among the main strategies employed, there is a notable emphasis on the consultation process and coordination with various stakeholders. Notably, the applied strategies have increased through early detection and prevention actions. Lessons learned from this case study highlight the importance of training medical and nonmedical personnel as good practice while cautioning against the inappropriate handling of patient information. Conclusions: The findings provide valuable insights into the characteristics of ophthalmologists’ field of action and shed light on various aspects, such as the focus of professional practice, prevalent pathologies encountered in daily care, dimensions of information, availability, access, and cultural relevance of visual health services. In addition, the study examines the criteria used, strategies implemented, resulting outcomes, and lessons learned in the fight for vision.

Using Compression Therapy to Treat Bilateral Lower Limb Edema in Patients with Lung Cancer: A Case Series.

Although rare, marked bilateral leg edema (BLE) can occur in patients with lung cancer. Systemic therapy for the underlying disease is important, but adjunct therapy might also be helpful. In this case series, the authors report on treating BLE in patients with lung cancer with compression therapy using elastic stockings and bandages. From April 2013 to March 2022, the authors conducted a retrospective survey of seven patients who developed marked BLE and received compression therapy. They evaluated effects based on improvements in subjective symptoms as well as objective findings 2 months after the start of the therapy. The bandage therapy was useful in patients who were driver-gene negative, but it was not effective in those who already had "progressive disease" with specific agents for their driver genes. No adverse events were observed. Compression therapy, even when attached or detached by nonmedical personnel, may provide favorable effects and should be considered as an adjunct treatment option in this population, in addition to effective systemic cancer therapy. These results indicate that a prospective clinical trial would be worthwhile.

Алгоритм работы с обращениями граждан: опыт регионального офтальмологического центра.

Relevance. At present, the institution of citizens’ appeals is a dynamically developing model of interaction between the population and state and municipal authorities, including medical organizations. In the legislation of the Russian Federation, for the purpose of a comprehensive, timely and objective procedure for considering citizens’ appeals related to receiving medical care, a three-level hierarchy of regulatory legal regulation has been formed. Determination of the officials of the organization, forms and methods of working with appeals, analysis of the results of consideration of citizens’ appeals and the introduction of measures that correct the activities of employees of a medical organization (medical and non-medical personnel), the implementation of organizational and legal changes are an indispensable element of an effective management system of a modern healthcare institution. The purpose of the study: аnalysis of the organization and conduct of work with citizens’ appeals related to obtaining medical care for the adult population in the field of «ophthalmology» in the regional center of the Republic of Tatarstan – the state autonomous healthcare institution «Republican Clinical Ophthalmological Hospital of the Ministry of Health of the Republic of Tatarstan named after Professor E. V. Adamyuk» (GAUZ “RKOB MH RT named after prof. E. V. Adamyuk”), and the development of measures to improve the efficiency of the ophthalmological clinic. Materials and methods. The analysis of modern requirements of normative legal acts of quality control and safety of medical activity has been carried out, the main tools used in conducting external audits in the system of compulsory medical insurance have been systematized. We used mathematical and statistical analytical methods (quantitative, comparative, structural, expert). Results. A routing scheme for citizens’ appeals is presented, taking into account the channels of their receipt, and an algorithm for working with written appeals sent to the regional ophthalmological center of the Republic of Tatarstan. The trend of modern feedback services with applicants is noted, characterized by the active use of new Internet resources, social networks and instant messengers, various mobile applications for registering citizens’ appeals, and «fan» distribution of complaints about the activities of a medical organization. According to the statistics for 2021–2022 in the structure of the reasons for written appeals of the GAUZ “RKOB MH RT named after prof. E. V. Adamyuk” were in the lead in requests for the provision of medical documentation, which amounted to 2021. 45,4%, 2022 – 55,9% of all received applications. In second place were issues related to the organization of medical care, the share of which amounted to 2021 in 2021. 32,5%, in 2022 – 26,3%. Requests for assistance in the provision of medical care were made in 2021. 12,1%, in 2022 – 8,4% of the total considered appeals. Conclusions. Based on the results of consideration of citizens’ appeals by officials of the GAUZ “RKOB MH RT named after prof. E. V. Adamyuka, managerial decisions are made to increase the satisfaction of the adult population of the Republic of Tatarstan with the quality and availability of medical care in the field of ophthalmology, including changes in the organization of the clinic, the implementation of measures that correct the activities of medical and non-medical personnel.

Актуальные вопросы организации профессиональной переподготовки специалистов по физической реабилитации (кинезиоспециалистов) в условиях новой модели медицинской реабилитации.

The system of medical rehabilitation in Russia undergoes significant transformation which is reflected in the Federal Program «Optimal for health restoration medical rehabilitation in the Russian Federation». In such situation the issues of personnel training in the field of medical rehabilitation are becoming extremely relevant. The difficulties that arise along this path are associated with the interdisciplinarity of medical rehabilitation and the necessity to train specialists with medical education (doctors and nurses) as well as with higher non-medical education: physical therapists, ergotherapists, medical psychologists and medical speech therapists (according to the Order No. 788n of 31.07.2020). These allied health specialties are new for Russia but they are responsible for the main practical activity in the implementation of an individual medical rehabilitation plan. The difficulties in training non-medical personnel in rehabilitation largely arise from the requirement for them to have both medical and pedagogical competencies and to have the ability to work independently as well as in a rehabilitation team. This article summarizes the three-year experience of training specialists in medical rehabilitation with higher non-medical education at the National Research Nizhny Novgorod State University named after N. I. Lobachevsky. The article presents the main issues of the professional retraining program «Physical rehabilitation (physical therapy)» with a duration of 1020 hours, defines professional competencies, difficult issues of training, formation of practical skills and assessment of professional competencies in this category of students.

의료법인 명의 의료기관 개설·운영에 대한 의료법상 규제에 관한 고찰

Under the Medical Law, medical practice has a characteristic of serving public interest, so profitability should not be pursued. Therefore, in principle, medical institutions can only be opened by medical personnel and those who fall under each subparagraph of Article 33 (2) of the Medical Act. However, it takes a considerable amount of money to open a medical institution, so it is not easy for individual medical personnel to handle it. For this reason, a so-called “Non—medical personnel hospital”, a form in which non-medical personnel raise the funds necessary to open medical institutions, open practical medical institutions, and hire medical personnel to operate medical institutions, appears.&#x0D; Previously, although a medical institution formally appeared to be a legitimate one, if a non-medical person took the lead in opening and operating a medical institution, the Supreme Court considered it to be an illegal non-medial person medical institution. However, in the case of medical corporations, Section 2 of Chapter 3 of the Medical Act is separately regulated, and in addition to those stipulated in the Medical Act, the provisions on foundations under the Civil Act are applied mutatis mutandis. Therefore, in the case of a medical corporation, a legal personality is given to the substance of the contributed property, and the establishment of a medical corporation is possible only when a third party contributes to the property. At this time, a third party who contributed property can become a non-medical person, and in this situation, the non-medical person can be evaluated as playing a leading role in the opening and operation of a medical institution in the name of a medical corporation. According to the “Law of Leadership” established by the Supreme Court, this results in a violation of the qualification to open a medical institution, which is directly contrary to the regulation that non-medical personnel can legally intervene under the medical law.&#x0D; Therefore, if a medical corporation complies with the prescribed regulations and procedures of a medical corporation under the Medical Act, there is a room for a differentiated judgment standard from other types of non—medical personnel hospital. It is reasonable that the majority opinion of the target judgment established a new additional standard for determining whether the opening and operation of medical institutions in the name of medical corporations is illegal. However, measures are required to prevent non-medical personnel from becoming a for-profit corporation by intervening in the operation of medical institutions for the purpose of pursuing profit. For example, it is necessary to consider directly and clearly controlling and sanction violations of the qualifications of medical institutions in the name of medical corporations through legislative procedures and inducing them to establish medical corporations in medical vulnerable areas through policies.

ANALISIS KEPUASAN PASIEN BERDASARKAN ASPEK PELAYANAN DAN KOMUNIKASI INTERPERSONAL (Studi Pada Pasien RSUD Datu Beru Takengon Kab. Aceh Tengah)

The research aims to analyze patient satisfaction at the Datu Beru Takengon Regional General Hospital (RSUD) to obtain empirical input regarding the influence of service quality factors and interpersonal communication carried out by medical and non-medical employees in caring for patients and patient families. The research was based on a survey of 50 samples of patients who had previously used hospital services, with an associative type and using a path analysis model. The results of the research show that (a) there is a causal relationship (associative) between service quality and interpersonal communication between medical and non-medical personnel at Datu Beru Takengon Regional Hospital with a strong category (0.845), (b) Service quality factors have a causal relationship (associative) has an impact on cause and effect (associative) relationships. positive towards patient satisfaction, with a direct and indirect contribution of 68.11%. And the interpersonal communication aspect of RSUD officers was 30.58%. (C). Simultaneously, the quality of service and interpersonal communication at RSUD Datu Beru Takengon contributed to patient satisfaction, namely 77.10%.

DIY Flap Monitoring: The Glucose Index.

Flap loss is reduced by monitoring, which detects vascular compromise. Glucose levels vary in suffering flaps; therefore, we aimed to show that monitoring flaps with glucose pinprick test is a cheap, reliable, ubiquitous, and easy method. We reviewed a prospectively kept database. A pinprick test was performed to measure systemic and flap glucose levels. A glucose index (GI; flap glucose/systemic glucose) was calculated. Comparison between the groups (with occlusive event, and without occlusive event) was done. In total, 32 flaps in 29 consecutive patients were included. Eleven (34%) were free flaps. Of these, one (9%) was explored twice. Initially, salvage was achieved. However, 36 hours later, a second exploration was needed but was unsuccessful. Of the 21 pedicled flaps (66%), one (5%) needed exploration (suture release), and three (14%) had partial losses that were not clinically relevant. On the ROC curve, we found a cut-off value for a GI of 0.49 or less with a sensitivity of 95% [95% confidence interval (CI): 75.1 to 99.9%] and a specificity of 100% (95% CI: 98.5 to 100%), with a positive predictive value of 100% (95% CI: 81.5 to 100%) and a negative predictive value of 99.6% (95% CI: 97.8 to 100%) for flap suffering. The GI, as a complement, assists in defining treatment approach. It is an easy, reliable, accessible method that can be performed by nonmedical personnel. Its main drawback is the inability to monitor buried or hard to reach flaps.

A comparison of the fine particulate protection rate of face masks reused after washing

Objective: At the start of the coronavirus disease 2019 (COVID-19) pandemic, the Centers for Disease Control and Prevention and the World Health Organization recommended the use of face masks in public places to prevent the spread of COVID-19. Several mask types flooded the market with little information regarding their effectiveness. This study aimed to clarify the change in the fine particle protection rate (FPPR) of face masks reused after washing in an experimental study and to propose a method for reusing face masks that is suitable for nonmedical personnel. Technical Report: The FPPR was measured using a mask-fitting tester after one participant wore the new masks and after 5, 10, 15, 20, 25, and 30 washes. The dimensions of the masks were measured to determine whether shrinkage occurred after washing. The surgical mask had the highest FPPR, followed by the cloth, gauze, polyester, and polyurethane masks. Furthermore, all five mask types maintained the same FPPRs as those of new masks, even after washing 30 times. An interesting observation was that the FPPR of the surgical mask was higher even after the 30th wash, and therefore, it was more effective than the FPPRs of the other four face masks when they were new. Conclusions: Surgical masks were the most effective, even though all five types could be reused after 30 washes. The FPPR of the surgical masks showed better performance after 30 washes than the FPPRs of the other four types when they were new. These findings may start the discussion for the possibility to reuse face masks.

Penerapan Rekam Medis Elektronik di Rumah Sakit di Indonesia: Kajian Yuridis

&lt;p&gt;&lt;em&gt;Electronic Medical Record (RME) is a system that contains medical and disease history, diagnostic test results, information on medical expenses and other medical data. On September 12 2022, the Ministry of Health (Kemenkes) of the Republic of Indonesia issued the RME regulations contained in the Regulation of the Minister of Health or abbreviated as Permenkes No. 24 of 2022 concerning Medical Records. However, not all Health Service Facilities in Indonesia have implemented the practice of Electronic Medical Records. The Normative Juridical Method was used in this study, in which the main source of law used was Permenkes No. 24 of 2022 concerning Medical Records, Law no. 47 of 2021 concerning Hospitals and Law no. 29 of 2004 concerning Medical Practice. RME’s broad capabilities had led to its recognition as an important tool for improving patient safety and quality of care, particularly by promoting evidence-based medicine. Hospitals were also required to provide non-medical personnel in the field of information systems to support the implementation of electronic medical records in hospitals. On the other hand, the government needed to provide training so that officers and doctors in hospitals could implement RME according to the provisions of the applicable Health Regulations.&lt;/em&gt;&lt;/p&gt;

PENERAPAN LEAN HEALTHCARE DALAM PENGELOLAAN MANAJEMEN KEPERAWATAN DI RAWAT INAP DHAHA RSUD GAMBIRAN KOTA KEDIRI

Introduction &amp; aim: Lean is a new breakthrough in the era of digitalization which is a process improvement method used to improve service products, high use of consumables (hereinafter referred to as BHP) in hospitals, stock inventory of drugs and medical devices in the treatment room every month and found a buildup of inventory of consumables. This community service aimed to identify the application of lean healthcare applications in the BHP inventory for nursing management. Method of Activity: In finding the root of the problem using fishbone diagrams, the scoring method was to prioritize issues to be resolved using SWOT Analysis. This community service was conducted in the Dhaha inpatient room of Gambiran Hospital, Kediri City with 22 medical and 2 non-medical personnel. Results: The application of lean healthcare in the Dhaha inpatient room, material management, pharmaceutical supplies, and household logistics was carried out continuously according to what nurses needed. However, after the implementation of lean healthcare, it begins with the implementation of 5S which regulates supplies according to patient needs, assigns items that are always used in patient services according to nurses every shift not every room, and puts or parks in places that are easy to reach. Efficient from inventory adjustments in the inpatient room in the form of Rp. 1,035,566. Discussion: The implementation of Lean Health Care "KANBAN" is an important thing to do sustainably because quality service is also obtained from effective and efficient services including inventory management.

The Relationship between Burnout and Wellbeing Using Social Support, Organizational Justice, and Lifelong Learning in Healthcare Specialists from Romania.

Background and objectives: The goal of this study was to evaluate the levels of organizational justice, social support, wellbeing, and lifelong learning associated with the level of burnout experienced by medical and non-medical staff from public and private medical units. Materials and Methods: A cross-sectional study was conducted on a sample of 497 healthcare professionals: 367 medical personnel (Mage = 43.75 ± 0.50), including 216 nurses, 97 physicians, and 54 respondents with other medical specialities such as biologists, psychologists, physical therapists, pharmacists, etc., and 130 non-medical staff respondents (Mage = 45.63 ± 0.80), including administrative personnel. The Maslach Burnout Inventory, the ECO System, the Multidimensional Scale of Perceived Social Support, the WHO Wellbeing Index, and the revised Jefferson Scale of Physician's Lifelong Learning were used. Results: Burnout was measured in terms of emotional exhaustion, depersonalization, and personal accomplishment. Medical personnel registered higher values of personal accomplishment (38.66 ± 0.39 vs. 35.87 ± 0.69), while non-medical personnel registered higher values of depersonalization (6.59 ± 0.52 vs. 4.43 ± 0.26) and emotional exhaustion (27.33 ± 1.24 vs. 19.67 ± 0.71). In terms of organizational justice, higher scores were observed for medical staff, while non-medical staff recorded lower values (24.28 ± 0.24 vs. 22.14 ± 0.38). For wellbeing, higher scores were also registered for medical staff (11.95 ± 0.21 vs. 10.33 ± 0.37). Conclusions: For lifelong learning and social support, no statistically significant differences were found. In the case of the proposed parallel moderated mediation model, the moderated mediation effects of organizational justice, lifelong learning, and burnout on the relationship between social support and wellbeing were valid for every dimension of burnout (emotional exhaustion, depersonalization, and personal accomplishment), but lifelong learning was not found to be a viable mediating variable, even if high levels of social support correspond to high levels of lifelong learning and wellbeing.

The Influence ofAdvanced Hyperbaric Medical Training onArterial Gas Embolism Treatment.

3d Reconnaissance Battalion, a forward-deployed Marine Corps unit in Okinawa, Japan, frequently performs diving operations. Often throughout the year, several reconnaissance teams are diving simultaneously in different locations for training. We present a case of an otherwise healthy 30-year-old-male Reconnaissance Marine who surfaced from a dive with abnormal symptoms and received prompt care from exercise participants who were nonmedical personnel. Studies have demonstrated improved morbidity outcomes in decompression illness patients with shorter times to hyperbaric treatment following the onset of symptoms. High-risk military exercises with diving components have a mandatory safety structure that includes recompression chamber support. All United States Marine Corps Reconnaissance, Marine Corps Special Operations Command, and U.S. Navy dive operations are required to have at least one diving supervisor. To expand the diving capabilities of the unit, Marines are encouraged to attend training and qualify as diving supervisors. This case study demonstrates the efficacy and importance of training Recon Marines to recognize decompression illness as diving supervisors.