Training Of Medical Staff Research Articles

Protocol Adherence for Adult Sickle Cell Patients Presenting with Vaso-Occlusive Crises on a Tertiary Teaching Hospital Emergency Department

Background Patients with Sickle cell disease (SCD) suffer from frequent vaso-occlusive crises (VOC) that heavily contribute to morbidity and mortality. VOC's constitute the principal cause of emergency department (ED) presentation and hospital admission and the ED visit serves to diagnose underlying disorders, VOC complications and to institute pain relieve most often requiring intravenous opioids. The need for prompt and adequate treatment and pain relieve is reflected by standardized protocols for acute care in SCD. Adherence to these protocols has been shown to increase the quality of care, while improving overall patient pain control, decreasing frequency of ED visits and ED patient crowding and decreasing total hospital days. Several studies have demonstrated that negative health care provider attitudes interfere significantly with adequate assessment of pain and in turn may lead to insufficient treatment. We recently (October 2019) introduced novel protocols for management of SCD patients presenting with VOC's at the ED, but local the actual protocol adherence has not been evaluated. Aim Retrospective analysis of adherence to ED protocols for management of SCD patients on the ED. Methods We included all patients with SCD presenting at the ED between March 2021 and March 2022. Children and patients that presented for alternative causes than a VOC were excluded from analysis. The SCD protocol contained a circumscriptive manual with indicated timing of interventions that could be analysed for adherence. Interventions were divided into three groups: diagnostics, supportive care and analgesics. Diagnostics contained physician consultation within 60 minutes of arrival, measurement of vital parameters (SpO2, respiratory frequency, heart rate, blood pressure and body temperature), and extensive laboratory testing. In patients with chest pain it prescribed chest imaging and arterial blood gas analysis. Supportive measures included oxygen supplementation in hypoxic patients and administration of intravenous hyper hydration in absence of contraindications such as a history of fluid overload. Analgesia included treatment using a predefined personalized pain plan (PPP) if available. In all other patients, treatment consisted of acetaminophen, NSAIDs and opioids until the NRS pain score was 6 or lower or pain was deemed acceptable by the patient. Opioid treatment consisted of IV fentanyl in a maximal cumulative dose of 2 mcg/kg within the first hour followed by opioid escalation with intravenous (IV) morphine in a maximal cumulative dose of 50mg. In patients with renal failure (eGFR<30 ml/min), buprenorphine was advised instead of morphine. When analgesic treatment remained insufficient after 15 minutes the protocol prescribed consultation of the pain specialist for administration of clonidine or esketamine. Results We analyzed data from a total of 109 ED visits of 70 unique patients (median age: 31,1 years (IQR 14,0), 49.5% male) between March 2021 and March 2022 in a tertiary teaching hospital in The Netherlands. Results of protocol adherence are shown in table 1. Adherence to the complete protocol was extremely low (0.9%). For most individual components of the protocol adherence was above 50%. For fluid administration, timing of initial fentanyl and morphine escalation, adherence was 39.4%, 19.3% and 11.9%, respectively. Conclusion In patients with sickle cell disease, protocols aim to increase accuracy and speed of diagnostics and analgesia which is related to outcomes such as overall patient pain control, frequency of ED visits and total hospital days. This study evaluates protocol adherence in a large tertiary university hospital. Whereas adherence to individual components of the SCD is above 50%, total patients in which complete protocol adherence is observed is extremely low. We identify fluid administration and opioid administration as protocol components to which adherence is most insufficient. Further research on the reasons for these impaired adherence together with training of medical and nursing staff is required to improve the quality of healthcare for this patient group. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Evaluating the relationship between neurological function, neuromuscular fatigue, and subjective performance measures in professional rugby union players.

Managing the health and wellbeing of full-time professional athletes is a multifaceted task. In elite high-performance environments, medical staff and strength training coaches attempt to identify improved methods to monitor player health. Monitoring player health could indicate potential injury risk and assist in adjustments to training and workload management. Measuring fatigue is a notable component of monitoring player readiness before and after training sessions, and after competitive fixtures. In the present study, a novel method of gathering non-invasive player data was investigated by utilizing the Omegawave (OW) to monitor direct current (DC) potential brainwave activity. This method allowed for non-invasive data gathering to assess recovery, player readiness and indicators of workload that may affect optimal performance. DC potential is based on recording low electrical frequencies (>0.5 Hz) that is derived from (1) Stabilization point of DC potential (mV), (2) Stabilization time (1.0-7.0) and (3) Curve shape (1.0-7.0). These measures evaluate the athlete's internal stress, readiness to perform, and neurological function through DC potential brain wave activity and heart rate variability (HRV) assessments. The primary aim of this case series was to compare the efficacy of objective DC potential brainwave activity measurements (neurological function) with neuromuscular fatigue data using reactive strength index modified (RSImod) and profile of mood states (POMS) questionnaires to assess a player's state of readiness to train. The participants in this study were eleven male senior professional rugby union players with a mean stature (±SD) of 185.2 ± 8.6 cm, mass of 101.1 ± 12.9 kg, and age of 27.1 ± 2.1 years. All players were tested 3 days per week over a 6-week mid-season period. Results from this case study suggest that DC potentials could be used as an objective measure to indicate player readiness and managing individual player workload. The final analyses identified a weak negative correlation (r = -0.17) between the RSImod data and the DC potential data was observed. DC potential brainwave activity data could be used in conjunction with subjective measures such as POMS, RSImod and reported injury status to adjust player daily activity.

Rehabilitation in EMTs: AUSMAT COVID-19 Deployments

Background/Introduction:The WHO has recommended the inclusion of rehabilitation capabilities in EMTs responding to disasters and health emergencies since 2013. Likewise, the importance of rehabilitation input across the continuum of care for patients experiencing COVID-19 illness has been highlighted since the onset of the global COVID-19 pandemic. Despite recognition of the role and value of rehabilitation, both in EMTs and the management of COVID-19, evidence that EMTs activated in response to COVID-19 have deployed rehabilitation professionals remains limited.Objectives:This paper will describe the experiences of the Australian Medical Assistance Team (AUSMAT) in deploying rehabilitation professionals as an integrated capability of multi-disciplinary EMTs responding to COVID-19 health emergencies.Method/Description:In response to COVID-19 emergencies in Papua New Guinea, Fiji, Timor-Leste, and the Solomon Islands, AUSMAT deployed rehabilitation professionals alongside multi-disciplinary EMTs on four occasions in 2021-2022. The rehabilitation professionals engaged in direct clinical care and capacity-building activities.Results/Outcomes:The work of the deployed AUSMAT rehabilitation professionals facilitated important capacity building and support for local rehabilitation staff and services, enhanced the time critical multi-disciplinary training of local nursing and medical staff, and improved the quality of clinical care of COVID-19 patients.Conclusion:AUSMAT’s experience has demonstrated that the deployment of rehabilitation professionals as part of a multi-disciplinary team adds significant value to the work of EMTs responding to COVID-19 health emergencies. Nursing and medical staff cannot readily replicate the knowledge, skills, and perspectives of rehabilitation professionals. Appropriately skilled rehabilitation professionals should be deployed to support national rehabilitation staff when EMTs respond to health emergencies.

The Impact of the Covid-19 Pandemic on the Education of Medical Students

The full-time education only was the traditional basic condition for the development of professional competencies of future health professionals. The COVID-19 pandemic, the digitalization of the medical field, and the effective global experience of distance learning have demonstrated the need to reengineer the established paradigm of medical education. The aim of the study was to assess the effectiveness of distance learning of Ukrainian medical students during the COVID-19 pandemic. The study involved content analysis, Computer Audio-Recorded Interviewing (CARI), face-to-face interviews, in-depth interviews, qualitative and quantitative analysis of the results of empirical research. Universal and specific problems of distance education are identified. The model of two-stage diagnostics of the state of distance education in medical vocational colleges of Ukraine (2020 - 2021) is presented. The results of the linear experiment showed a positive trend in: the quality of the Internet and the workplace arrangement of medical students (from 40% to 90%), special training in distance education technologies (from 13% to 74%), the use of unified educational platforms (from 39% to 100%), reduced stress level in students (from 100% to 60%), increased assessment objectivity (from 37% to 55%). Stereotypes about distance education as forced and ineffective in the development of practical skills (from 98% to 76%) remained steady. Online technologies in medical education require qualified scientific and methodological support of teaching. It is appropriate to develop and implement a national strategy, proven technologies of distance education for medical vocational colleges. The focus of further research is the development of reference models, distance education technologies that can provide effective training of mid-level medical staff.

Management of Foreign Bodies in the Ear, Nose and Throat in Pediatric Patients: Real-Life Experience in a Large Tertiary Hospital.

Foreign body (FB) injuries occur frequently in children. The aim of this paper is to provide an update on the experience of the Department of Otolaryngology, San Camillo Forlanini Hospital in Rome concerning the management of FB injuries in children. This study was carried out by collecting data from the medical reports of our Pediatric Emergency Room stored between 2007 and 2021. Inclusion criteria were diagnosis of FB in pediatric patients based on the ENT evaluation. Pediatric patients included children and preteens ranging from six months to 15 years. Between 2007 and 2021, 1,623 cases of FBs in young patients (840 males, 783 females, mean age: 5.5 years) were observed at the Pediatric Emergency Room and treated by the ENT Department. The ear was the most frequently involved site (700 patients), followed by the nose (517 cases), pharynx (319 cases), mouth (76 patients) and airways (11 cases). The most common management strategy was FBs' removal in the emergency room and home discharge (1,409 patients), 99 cases required outpatient discharge, 64 patients moved away from the Emergency Care refusing treatment, 35 patients were hospitalized, 10 patients refused hospitalization, five were transferred to the pediatric hospital and one died in the emergency room. A quick diagnosis of FB followed by an effective removal is crucial to avoid injuries and complications. Surveillance registries have a key role in the prevention and management of FB injuries. Moreover, it is necessary to train medical and nursing staff of emergency, pediatric and otolaryngologist departments to best recognize and manage FB injuries.

"To Be Treated as a Person and Not as a Disease Entity"-Expectations of People with Visual Impairments towards Primary Healthcare: Results of the Mixed-Method Survey in Poland.

Primary care is the core part of the Polish healthcare system. Improving its quality for vulnerable populations is among the principal goals of global and national health policies. Identifying patients’ needs is critical in this process. People who are blind or have low vision often demonstrate comorbidities and require more specific healthcare. The aim of this study was to explore the needs of Polish persons with visual impairments when they use primary care services. 219 respondents answered the “Patient value” questionnaire from the project Quality and Costs of Primary Care in Europe (QUALICOPC) and an open question regarding additional patients’ needs. Statistical and content analyses were used. The expectations of the study group regarding primary care appeared to be higher than those described in studies among other populations. Equity and accessibility were the most valued dimensions of care. Among particular aspects of care, those connected with psychosocial competencies and awareness of disability among medical staff appeared most frequently. Some personal characteristics were associated with preferences, including age, gender, longstanding conditions, quality of life, and disability-related variables. Our study indicates a need for multilevel interventions in legislation, economics, and medical staff training, with the people-centered approach as the option maximizing chances to meet diverse healthcare needs arising from particular disabilities.

The prevalence of incidental findings on pelvis MRI of 8-13-year-old children.

The prevalence and clinical relevance of incidental findings (IF(s)) on imaging assessing the pelvis in children has not been well documented. Three-thousand two-hundred thirty-one children (mean age 10.2 (range 8.6-12.9) years) were evaluated with MRI of the hips, pelvis, and lumbar spine, as part of a prospective population-based pediatric cohort study. Scans were reviewed by trained medical staff for abnormalities. IFs were categorized by clinical relevance and need for further clinical evaluation. 8.3% (n = 267) of children featured at least one IF. One or more musculoskeletal IFs were found in 7.9% (n = 254) of children, however, only 0.8% (n = 2) of musculoskeletal IFs required clinical evaluation. Most frequent abnormalities were simple bone cysts 6.0%(n = 195), chondroid lesions 0.6% (n = 20), and perineural cysts 0.5% (n = 15). Intra-abdominal IFs were detected in 0.5% (n = 17) of children, with over half (n = 9) of these requiring evaluation. The three most common intra-abdominal IFs were a duplex collecting system 0.09% (n = 3), significant ascites 0.06% (n = 2), and hydroureteronephrosis 0.06% (n = 2). IFs on MRI of the lower abdominal and hip region are relatively common in children aged 8-13 years, most of these can be confidently categorized as clinically irrelevant without the need for additional clinical or radiologic follow up. Our research contributes greatly to the knowledge of the prevalence of (asymptomatic) pathology in children. We evaluated MR images of 3231 children, covering hip joints, pelvic skeleton, lower and mid-abdomen, and lumbar and lower thoracic spine as part of a population study. One or more musculoskeletal incidental finding were found in 7.9% of children. Most of these can be confidently categorized as clinically irrelevant without the need for additional follow up. However 0.8% of musculoskeletal findings required further evaluation. Intra-abdominal incidental findings were detected in 0.5% of children, with over half of the abdominal and urogenital findings requiring furtherevaluation.

Application strategy and effect analysis of nutritional support nursing for critically ill patients in intensive care units.

We investigate nutritional support and nursing status of critical patients in intensive care units (ICUs) to understand the latest nutritional support guidelines’ implementation by clinical medical staff; identify problems in nutritional support and nursing for these patients, analyze causes, and present suggestions; and provide a clinical/theoretical bases to improve nutritional support implementation and nursing strategies for them. Clinical case information of 304 critically ill ICU patients admitted from July 2017 to July 2021 was analyzed. They were divided into the experimental (nutritional support) and control (no nutritional support) groups to compare their laboratory indicators, 28-day case fatality rate, and infection incidence. Least significant difference was used for postanalysis of statistically significant items to obtain pairwise comparisons. Nutrition support strategies for ICU patients are consistent with guidelines but have an implementation gap. No statistically significant differences were found in hemoglobin (HB), total serum protein (TP), serum albumin (ALB), transferrin (TF), prealbumin (PA), and total lymphocyte count (TLC) in experimental group patients compared with the control group within 24 hours (before nutritional support, P > .05). No statistically significant differences were also found in HB, TP, TLC, and ALB between the enteral nutrition + parenteral nutrition (EN + PN), total EN (TEN), total PN (TPN), and control groups on admission day 7 (after nutritional support, P > .05), while statistically significant differences existed between PA and TF (P < .05). TF of patients supported by TEN was higher (statistically significant difference, P < .05). PA in patients receiving TEN and EN + PN support was higher than in control group patients (statistically significant difference, P < .05). Compared with the control group, in experimental group patients, infection incidence was significantly lower (40.2% vs 62.9%, P < .05); incidence of complications was lower, but not statistically significant (40.2% vs 57.1%, P > .05); and 28-day mortalities were significantly lower (26.7% vs 45.7%, P < .05). Nutritional support can reduce hospitalization complications and 28-day mortality in critical patients, but its implementation must be standardized. Especially for patients with gastrointestinal dysfunction, personalized/standardized nutrition strategies and nursing procedures are needed when PN support is applied, and training of clinical medical staff should be strengthened to improve nutrition support’s efficiency.

'Next Stop: Mum': Evaluation of a Postpartum Depression Prevention Strategy in Poland.

In the article we present a mid-point evaluation of the postpartum depression (PPD) prevention strategy in Poland. As PPD is associated with potential negative consequences for the mother and infant, the need to introduce screening and treatment is vital. The project covered over 21,500 women in the first year postpartum. The average score in the Edinburgh Postnatal Depression Scale (EPDS), in a screening provided in direct contact, was 4.73 (SD = 4.14, n = 7222), and increased in 55% of women in the follow-up study. In online screening the average score in the EPDS assessment was 16.05 (SD = 5.975, n = 10,454). The ‘probable depression’ rate (EPDS > 12) in ‘direct’ contact is 7.3%, and on the online platform—77%. Additionally, 26% of possibly affected mothers assessed in ‘direct’ contact benefited from psychological consultations. The average score in the EPDS among mothers who benefitted from consultations is 16.24 (SD =4.674, n = 231). Approx. 82% of healthcare providers raised their knowledge of PPD after training sessions. Maintaining the assumptions of the program: training for medical staff, screening conducted throughout the first twelve months postpartum, online platform with the possibility of self-screening and early psychological intervention seem to be justified actions, leading to a higher number of women with risk of PPD referred.

Age at Menarche and Menopause, Reproductive Lifespan, and Risk of Cardiovascular Events Among Chinese Postmenopausal Women: Results From a Large National Representative Cohort Study.

BackgroundAt present, the association between age at menarche and menopause, reproductive lifespan, and cardiovascular disease (CVD) risk among Chinese postmenopausal women is not clear, and some related researches are contradictory.MethodsA total of 6,198 Chinese postmenopausal women with a mean age of 63.6 years were enrolled at baseline in 2012–2015 and followed up for 5 years. A standardized questionnaire was used to collect relevant information by well-trained interviewers. Physical examination of the participants was performed by trained medical staff. CVD events were observed during follow-up. Cox proportional hazards models were used to estimate hazard ratios between reproductive characteristics and CVD events.ResultsAge at menarche was positively associated with CVD events (HR, 1.106; 95%CI, 1.047–1.167). There was a negative association between age at menopause and CVD risk in postmenopausal women with comorbidity (HR, 0.952; 95%CI, 0.909–0.996). Reproductive lifespan was negatively associated with CVD events (HR, 0.938; 95%CI, 0.880–0.999). The CVD risk increased by 10.6% for every 1-year increase in age at menarche. The CVD risk reduced by 6.2% for every 1-year increase in age at menopause in women with comorbidity. The CVD risk reduced by 3.8% for every 1-year increase in reproductive lifespan.ConclusionsBased on the large prospective study with a nationally representative sample, Chinese postmenopausal women with late age at menarche and shorter reproductive lifespan have higher risk of CVD events.

Evaluation of solid biomedical waste management practices in six health facilities in southern Benin

Introduction: Health care generates biomedical waste that present risks to humans and the environment if poorly managed. The objective of this study was to assess the management practices of solid biomedical waste in southern Benin. Methods: This was a descriptive cross-sectional study conducted in six health facilities. The study included 12 administrative agents selected by reasoned choice and 431 health care agents selected by convenience. The data were collected by questionnaire, interview, and observation. They concerned variables related to the production, the practice of managing, knowledge of the impact of solid biomedical waste on the environment and health, training and protection of personnel. Data analysis was done with R 4.5.0 software. Quantitative variables were described by median and interquartile range. Proportions were compared with the chi-square test or that of Fisher at the threshold of 0.05. Results: The health facilities did not have solid biomedical waste management database. Sorting was not systematic in 59.5 %. Final storage locations did not meet standards. Almost one in four health workers (24.4 %) were injured by biomedical waste. Overall, 45.8 % of the staff had been trained at least once on biomedical waste management. 61 % of the staff surveyed were vaccinated, hepatitis B (41.3 %), tetanus (32.9 %). Conclusion: In view of the results, it is necessary to ensure the on ongoing awareness and training of medical staff in the sorting and packaging of biomedical waste and to set up an efficient and sustainable solid biomedical waste management system with effective monitoring mechanisms.

Reproductive lifespan in association with risk of hypertension among Chinese postmenopausal women: Results from a large representative nationwide population.

BackgroundThe association between reproductive lifespan and risk of hypertension among postmenopausal women is unclear.MethodsA total of 94,141 postmenopausal women with a mean age of 64.8 years from the China Hypertension Survey were enrolled at baseline from 2012 to 2015. A standardized questionnaire was used to collect relevant information by well-trained interviewers. Blood pressure and physical examination of the participants were performed by trained medical staff. Logistic regression was used to estimate the odds ratios for hypertension by years of reproductive lifespan.ResultsThe average years of reproductive lifespan in Chinese women was 34.0 years. Women who were longer in reproductive lifespan were more likely to have older age at recruitment, higher body mass index, larger waist circumference, lower mean systolic blood pressure, and higher mean diastolic blood pressure (p < 0.05). After adjustments, odds ratios (95% confidence interval) for hypertension were 1.035 (0.988–1.085), 1.007 (0.966–1.048), 1.000 (reference), 0.932 (0.899–0.967), and 0.953 (0.909–0.997) for those with reproductive lifespan at ≤ 28, 29–31, 32–34 (reference), 35–37, and ≥ 38 years, respectively, with a significantly inverse association was seen in those with reproductive lifespan at 35–37 and ≥ 38 years. The overall risk of hypertension declined with the increase in reproductive lifespan, and the risk of hypertension was reduced by 1.1% for every 1-year increase in the reproductive lifespan (odds ratio, 0.989; 95% confidence interval, 0985–0.994) per year. The negative association between reproductive lifespan and hypertension was evident among age at recruitment groups, body mass index categories, and education levels, with the strongest association among women aged ≥ 70 years. Positive associations between reproductive lifespan and risk of hypertension were evident among women aged < 60 years, and this association was stronger among current alcohol drinkers.ConclusionBased on the large nationally representative sample, Chinese postmenopausal women with a shorter reproductive lifespan have a higher risk of hypertension.

EVALUATION OF THE ENVIRONMENTAL IMPACTS OF MEDICAL TRAINING: THE CASE OF THE MADINGRING DISTRICT MEDICAL CENTER, NORTH CAMEROON

Purpose: The environment is increasingly threatened by human activities. The purpose of this study is to assess the impact of the different activities carried out at Madingring Medical Center on the various environmental components.&#x0D; Methodology: To do this, the identification, characterization, and evaluation of the impacts were carried out during several field works using the Léopold and Fecteau matrices. The analysis of the waste management system was done using the Ishikawa 5M diagram.&#x0D; Findings: During the study, the real and potential impacts were identified on the various environments. The incineration of medical waste is classified as hazardous and the poor management of toilets emits polluting and toxic substances into the air, as well as unpleasant odors that modify air quality. The presence of stagnant water from the activities of the medical center due to the lack of good drainage degrades soil quality. Added to this, there is a development of algae and moss on the site. Concerning waste management, it appears that the Center does not have an environmental permit and a waste management plan, the sorting carried out is approximate, hazardous waste is incinerated illegally and others are dumped in landfills, contributing to environmental pollution. For each impact identified, corrective measures have been proposed and may make it possible to mitigate or eliminate the negative effects and improve the positive aspects, by implementing the environmental specifications.&#x0D; Unique contribution to theory, practice and policy: At the end of this study, some recommendations were made. These include training of medical staff in best practices and techniques for medical waste management, monitoring of the implementation of regulations on hospital waste management in Cameroon, information and sensitization of users on the social and environmental impacts of environmental degradation, as well as the best practices and behaviors to adopt within health facilities, the use of bins for the collection and sorting of waste, the creation of a pre-collection unit of waste within the health centers of Cameroon in general and those of Madingring in particular.

Understanding Best Practices in Implementation of Behavioral Emergency Response Teams Through a Scoping Review.

Health care providers are at risk of suffering physical or emotional abuse from patients, family members, and visitors. This results in decreased job satisfaction, high turnover, increased rates of patient physical and pharmacologic restraint, and poor patient outcomes. Behavioral emergency response teams (BERTs) have proven effective in reducing workplace assaults directed at staff, reducing the rate at which behaviorally disruptive patients are physically or pharmacologically restrained and are associated with increased staff satisfaction. This scoping review seeks to highlight the best practices and limitations of BERT use with adult populations in hospital settings to guide future implementation across academic medical centers. A literature review was conducted using PubMed, Tisch Library, and Tufts University School of Medicine's search tool "Jumbo Search" to screen articles for a duration from 2000 to 2021. The review was conducted following PRISMA-ScR guidelines using three screens for the inclusion of papers most relevant to the review's aims. BERTs are commonly implemented with trained medical staff. The most common interventions used by the BERTs are de-escalation techniques and education for staff about the incidents. Most BERT implementation involves a proactive screening protocol for identifying high-risk patients and a team-based approach. BERTS are effective at reducing assaults directed at staff and are associated with increased staff satisfaction. Using a proactive process to identify high-risk patients for disruptive behavior in conjunction with a team-based response to behavioral emergencies, academic medical centers can decrease the use of physical restraints and increase staff satisfaction leading to a higher quality of care.

Use of Social Media for Implementing Diagnoses, Consultation, Training, and Case Reporting Among Medical Professionals to Improve Patient Care: Case Study of WeChat Groups Across Health Care Settings.

BackgroundHealth professionals in low- and middle-resource settings have limited access to up-to-date resources for diagnosing and treating illnesses, training medical staff, reviewing newly disseminated guidelines and publications, and preparing data for international disease reporting. A concomitant difficulty in high-resource settings is the need for continuing education and skills up-training in innovative procedures on unfamiliar social media platforms. These challenges can delay both patient care and epidemiological surveillance efforts. To overcome these challenges, health professionals have adapted WeChat Groups to implement timely, low-cost, and high-quality patient care.ObjectiveThe primary study aim was to describe the processes taken by medical professionals across their diverse physical and virtual networks in adapting a bottom-up approach to collectively overcome resource shortages. The secondary study aim was to delineate the pathways, procedures, and resource/information sharing implemented by medical professionals using an international publicly available popular social media app (WeChat) to enhance performance of facility-based procedures and protocols for improved patient care.MethodsIn-depth interviews, observations, and digital ethnography of WeChat Groups communications were collected from medical professionals in interconnected networks of health care facilities. Participants’ WeChat Groups usage and observations of their professional functions in interconnected networks were collected from November 2018 to 2019. Qualitative analysis and thematic coding were used to develop constructs and themes in NVivo. Constructs incorporated descriptions for the implementation and uses of WeChat Groups for professional connections, health care procedures, and patient care. Themes supporting the constructs focused on the pathways and venues used by medical professionals to build trust, to establish and solidify online networks, and to identify requests and resource sharing within WeChat Groups.ResultsThere were 58 participants (males 36 and females 22) distributed across 24 health care settings spanning geographical networks in south China. Analysis yielded 4 constructs and 11 themes delineating the bottom-up usage of WeChat Groups among clinicians, technicians, nurses, pharmacists, and public health administrators. Participants used WeChat Groups for collectively training hospital staff in complex new procedures, processing timely diagnoses of biological specimens, staying abreast of latest trends and clinical procedures and symptoms, and contributing to case reporting for emergent illnesses and international surveillance reporting. An unexpected strength of implementing clinical, training, and research support on a popular app with international coverage is the added ability to overcome administrative and geographic barriers in resource distribution. This advantage increased a network’s access to WeChat Groups members both working within China and abroad, greatly expanding the scope of shared resources.ConclusionsThe organic, bottom-up approach of repurposing extant social media apps is low cost and efficient for timely implementation to improve patient care. WeChat’s international user base enables medical staff to access widespread professional networks across geographic, administrative, and economic barriers, with potential to reduce health disparities in low-resource settings.

Treatment of status epilepticus in pediatrics: curriculum learning combined with in-situ simulations

BackgroundAppropriate and timely treatment of status epilepticus (SE) reduces morbidity and mortality. Therefore, skill-based identification and management are critical for emergency physicians.PurposeTo assess whether the ability of training physicians, residents, nurses, and others to respond to SE as a team could be improved by using curriculum learning [Strategies and Tools to Enhance Performance and Patient Safety of Team (TeamSTEPPS) course training] combined with in-situ simulations of emergency department (ED) staff.ApproachA pre-training-post-training design was used on SE skills and teamwork skills. Emergency training, residents, and N1 and N2 nurses completed the SE skill and teamwork assessments (pre-training) through in-situ simulation. Next, the participating physicians and nurses attended the SE course [Strategies and Tools to Enhance Performance and Patient Safety of Team (TeamSTEPPS) course training], followed by conscious skill practice, including in-situ simulation drills every 20 days (eight times total) and deliberate practice in the simulator. The participants completed the SE skill and teamwork assessments (post-training) again in an in-situ simulation. Pre-training-post-training simulated SE skills and teamwork performance were assessed. The simulation training evaluation showed that the training process was reasonable, and the training medical staff had different degrees of benefit in increasing subject interest, improving operational skills, theoretical knowledge, and work self-confidence.FindingsSixty doctors and nurses participated in the intervention. When comparing the SE skills of 10 regular training physicians pre-training and post-training, their performance improved from 40% (interquartile range (IQR): 0–1) before training to 100% (IQR: 80.00–100) after training (p < 0.001). The teamwork ability of the 10 teams improved from 2.43 ± 0.09 before training to 3.16 ± 0.08 after training (p < 0.001).ConclusionSE curriculum learning combined with in-situ simulation training provides the learners with SE identification and management knowledge in children and teamwork skills.

Identifying the Challenges of Simulating the Hospital Emergency Department in the Event of Emergencies and Providing Effective Solutions: A Qualitative Study.

Emergencies and disasters occur in any society, and it is the hospitals and their emergency department staff who must be prepared in such cases. Therefore, 1 of the effective methods of training medical care staff is the use of simulators. However, when introducing new simulation approaches, we face many challenges. The aim of this study was to identify challenges of the simulation of the hospital emergency department during disasters and provide effective solutions. This conventional content, thematic, analysis study was conducted in 2021. Participants were selected from Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. After analyzing the data, the challenges of simulating the hospital emergency department during disasters were identified in 2 main components and 6 perspectives, which included organizational components (inappropriate and aimless training methods, lack of interaction and cooperation, lack of funding, and inadequate physical space) and technological components (weak information management and lack of interdisciplinary cooperation). Solutions included management (resource support) and data sharing and exchange (infrastructures, cooperation and coordination). The simulation technology can be used as a method for training and improving the quality of health care services in emergencies. Considering that most of these challenges can be solved and need the full support of managers and policy makers, by examining these issues, supporting staff of health care centers are advised to make a significant contribution to the advancement of education and problem reduction in the event of disasters.

Preliminary Reproducibility Evaluation of a Phage Susceptibility Testing Method Using a Collection of Escherichia coli and Staphylococcus aureus Phages.

Increasing antimicrobial resistance combined with a lagging pipeline of novel antimicrobial compounds have resulted in a resurgence of interest in phage therapy. To select optimal phage or phage combinations for patients for whom phage therapy is considered, assessment of activity of a panel of phages against the patients' bacterial isolate(s) should ideally be performed. Classical phage susceptibility testing methods (i.e., agar overlay) may be laborious, with expertise outside of normal training and competency of medical laboratory science staff needed. Adaptive Phage Therapeutics™ leveraged a commercially available phenotyping system (Biolog OmniLog®) to generate the PhageBank Susceptibility Test™, which uses a custom data analysis pipeline (PhageSelect™) to measure the delay in reaching log-phase metabolic activity ("hold time") when a given isolate is challenged with a specific phage. The goal of this study was to preliminarily assess reproducibility of this approach by testing 2 bacterial species at 2 sites, APT and an academic site. Nineteen Escherichia coli phages were tested against 18 bacterial isolates, and 21 Staphylococcus aureus phages, against 11 bacterial isolates. Result comparisons were statistically excellent for E. coli (κ = 0.7990) and good/fair for S. aureus (κ = 0.6360). The described method provides good/fair to excellent statistical reproducibility for assessment of phage susceptibility of 2 commonly encountered bacterial species.

Association of Egg Consumption Frequency and Quantity with Dyslipidemia in Chinese Rural Adults

Objective The aim was to estimate the association of egg consumption with dyslipidemia and its subtypes in Chinese adults. Methods The cross-sectional health survey was conducted in Hanzhong city of Shaanxi province in 2010. Consumption of eggs (alone and mixed in foods) and nutrients were assessed using a semi-quantitative 81-item food frequency questionnaire (FFQ). Serum lipids and other physical measurements were measured by trained medical staff. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from multivariable logistic regressions. Restricted cubic spline was used to visualize the possible non-linear association. Results A total of 2241 participants (mean age, 48.0 years; 34.5% men) were included. The age- and gender- standardization dyslipidemia prevalence was 21.1% in men and 18.4% in women, respectively. Approximately 42.1% of individuals never or rarely consumed egg, while 9.4% consumed ≥2 times/week. The mean egg intake was 21.5 g/d in men and 17.4 in women. In women, after adjustment for demographics and lifestyle factors, the ORs (95%CI) for dyslipidemia and hypertriglyceridemia were 0.57(0.32–1.05) and 0.38 (0.17–0.85) for individuals consuming egg ≥2 times/week, compared with never or rarely consumers. When further adjustment of BMI and dietary factors, the inverse relation persisted for hypertriglyceridemia but attenuated to margin of significance for dyslipidemia (P-trend = 0.050). Increment of 25 g/d was associated with 15% (OR: 0.85, (0.71–1.00)) lower risk of dyslipidemia. Results from restricted cubic splines showed a substantial reduction of the risk within lower range of consumption, which reached the minimum risk around 20–50 g/d (P-nonlinearity = 0.069). No associations were observed in men. Conclusion Egg consumption was associated with decreased risk of dyslipidemia among Chinese women but not men. Additionally, the beneficial effect tended to be stronger at 20–50 g egg per day. Further study is warranted to validate these findings and clarify the causality.

P1728: THE FUTURE OF MYELODYSPLASTIC SYNDROME – PATIENT PRIORITIES AND OUTCOMES THAT MATTER

Background: Without a definitive curative option available to many patients, learning to live with myelodysplastic syndrome (MDS) and manage symptoms effectively becomes a priority in their care. Anaemia is an almost universal feature of MDS but other cytopenias are common and may be linked to bleeding and infection. Individuals suffer differently and better individualisation of care is needed. Most MDS patient information offers scant appreciation for disease heterogeneity, variable response to treatment and each patient’s likely trajectory. Aims: We undertook to discuss what matters most to people living with MDS and provide feedback on discussions in patient support programmes. The aim was to inform lived experience views on research prioritisation in MDS. Methods: We conducted a 2-part interactive online workshop using Zoom and the online platform Miro, with the assistance of a skilled technical facilitator, to replicate a face-to-face environment (eg white board, post-it notes and sticky dots for voting). Patients were invited to generate questions about their condition which they felt should be addressed by research or a change in how their care is delivered. These were then grouped into themes, and reframed to create individual non-overlapping topics. Using a model inspired by the James Lind Alliance Priority Setting Partnerships, patients voted on the importance of each topic, creating a final “prioritised” list of issues. Results: 14 participants of varying age and experience took part raising 56 unique questions under the themes of: Prognosis; End of life; Treatment; Supportive Care; Medical Staff Training; Diagnosis; Communication; Organisations; resource sharing. Using the voting system, patients prioritised 14 key outcomes (shown in Figure 1). These reflect the symptoms of MDS, improving quality of life (QoL), communication, access to healthcare professionals and individualising care. Image:Summary/Conclusion: There are few studies in MDS where QoL is the primary outcome, hence the paucity of evidence around best practice when prioritising this. Given the pervasiveness of anaemia in MDS, managing this, and subsequent fatigue is of vital importance. Although haemoglobin (Hb) levels have been found to be correlated to QoL, it is widely reported that other factors are important in determining QoL and need for transfusions can vary despite a stable Hb level. Indeed, a key finding from patient discussions showed that Hb levels and the need for transfusions is not comparable between different patients and even non-comparable over time meaning that the maximal benefit and timing of transfusions cannot be determined from Hb level alone. Better communication with patients can ensure transfusions are given to improve symptoms. Previously, evaluation of success of transfusion and the clinical decision to transfuse has been determined only by the effect on Hb levels. This workshop highlighted patient dissatisfaction with the ‘numbers-led’ approach and the need for an alternative method to determine when to transfuse. While studies show using liberal transfusion targets improve QoL there are conflicting results showing a prolonged increase in Hb requires more transfusions which would in turn require more time in hospital. Further research is required to define optimal transfusion policies and improved use of blood products alongside other key outcomes highlighted in this workshop. There is growing evidence that treatment needs to be individualised and with the growing use of lifestyle monitoring devices such as smartwatches, this wealth of information could be utilised to determine transfusion need.