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Taccioli F, Blessent CGF, Paganelli A, Fagioli F, Chester JM, Kaleci S, Costantini M, Ferrari B, Fiorentini C, De Santis G, Magnoni C. Delay in Cutaneous Squamous Cell Carcinoma Diagnosis Due to Interrupted Services Is Associated with Worse Prognoses and Modified Surgical Approaches. Cancers (Basel) 2024; 16:1469. [PMID: 38672551 PMCID: PMC11048546 DOI: 10.3390/cancers16081469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The delayed diagnosis of skin tumors is associated with a worsened prognosis. The impact of the interruption of clinical and surgical health services during the COVID-19 pandemic lockdowns has been documented among many pathologies. The impact of delayed diagnoses on patients with cutaneous squamous cell carcinomas (cSCCs) is poorly defined. OBJECTIVE To compare patient and lesion characteristics and the surgical management of excised cSCCs prior to the pandemic shutdown of services (2018-2019) with the phase following the pandemic's second wave (2021-2022). METHODS An observational, single-center, cross-sectional study of 416 surgically excised cSCCs over the course of two years was performed. Only patients with histologically confirmed cSCC were enrolled. Data collection included patient demographics and lesion characteristics, time to surgery, surgical approach, and histological data. RESULTS More cSCC lesions were excised prior to the interruption of services (n = 312 vs. n = 186). Lesions were significantly larger (1.7 ± 1.2 vs. 2.1 ± 1.5 cm; p = 0.006) and more invasive (52% vs. 89%; p < 0.001), in the period 2021-2022. Surgical reconstructive techniques were significantly different (p = 0.001). Metastatic involvement was confirmed in three subjects (one in 2018-2019 and two in 2021-2022). There were no significant differences in the time to surgery or patient characteristics. Multivariable regression analysis identified a 4.7-times higher risk of tumor invasion (OR 4.69, 95%CI 2.55-8.16, p < 0.001), a two-times higher chance of dermo-epidermal grafts (OR 2.06, 95%CI 1.09-3.88, p = 0.025), and a 3.2-times higher risk of positive surgical margins (OR 3.21, 95%CI 1.44-7.17, p = 0.004). CONCLUSIONS Diagnostic delays of cutaneous SCCs associated with reduced patient access to clinical and diagnostic services are associated with a 4.7-times increased risk of more severe invasion, a three-times increased risk of positive surgical margins, and a significant impact on surgical management, compared to the pre-pandemic period. Comparable patient cohort characteristics and time to surgery remained unchanged.
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Affiliation(s)
- Filippo Taccioli
- Department of Plastic Reconstructive and Aesthetic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Claudio Gio Francesco Blessent
- Department of Plastic Reconstructive and Aesthetic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Alessia Paganelli
- PhD Course in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Francesca Fagioli
- Health Directorate, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Johanna Mary Chester
- Surgical, Medical, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (J.M.C.); (S.K.)
| | - Shaniko Kaleci
- Surgical, Medical, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (J.M.C.); (S.K.)
| | - Matteo Costantini
- Institute of Pathology, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Barbara Ferrari
- Department of Dermatology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (B.F.); (C.F.); (C.M.)
| | - Chiara Fiorentini
- Department of Dermatology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (B.F.); (C.F.); (C.M.)
| | - Giorgio De Santis
- Department of Plastic Reconstructive and Aesthetic Surgery, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Cristina Magnoni
- Department of Dermatology, University of Modena and Reggio Emilia, 41125 Modena, Italy; (B.F.); (C.F.); (C.M.)
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Santos-Cebrián M, Morales-Moya MÁ, De-Pablos-Heredero C, Pacheco-Olivares MDR. How Much Dialogic Coordination Practices Matter to Healthcare Professionals-A Delphi Approach towards a Tool for Identification and Measurement. Healthcare (Basel) 2023; 11:2961. [PMID: 37998453 PMCID: PMC10671251 DOI: 10.3390/healthcare11222961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
The study of coordination practices in health policy is a central aspect. The need for further research has been recently highlighted because of COVID-19. In this sense, dialogic practices (DP) have been identified but not validated yet. The purpose of this study is to develop and validate a DP questionnaire for healthcare teams. Items were identified based on a literature review, and the content validation was carried out by means of a Delphi study. A total of 10 experts assessed the clarity and appropriateness of the items and their corresponding measurement scales. After two rounds, a high level of consensus was reached, with agreement of 90% or higher on all items, and a high degree of stability and concordance in the results. This study resulted in a questionnaire consisting of four items, one for each identified DP initially proposed to the experts, as no other practices were revealed. From a practical perspective, the validation of these items constitutes a methodological innovation that responds to the call in the literature to open new avenues for comparative studies, and the possibility of generalising the findings and bringing together different approaches to the problem of coordination, which is key in health policy where unforeseen situations emerge.
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Affiliation(s)
- Mónica Santos-Cebrián
- Financial Economy and Accounting Department, Rey Juan Carlos University, 28032 Madrid, Spain; (M.S.-C.);
| | - Miguel-Ángel Morales-Moya
- Financial Economy and Accounting Department, Rey Juan Carlos University, 28032 Madrid, Spain; (M.S.-C.);
| | - Carmen De-Pablos-Heredero
- Department of Business Economics (Administration, Management, and Organization), Applied Economics II and Fundamentals of Economic Analysis, Rey Juan Carlos University, 28032 Madrid, Spain;
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Sohrabizadeh S, Mockel L, Yarmohammadian MH, Zare M. Editorial: Health system response to the coincidence of the COVID-19 pandemic and disasters: a call for action. Front Public Health 2023; 11:1281042. [PMID: 37786786 PMCID: PMC10541957 DOI: 10.3389/fpubh.2023.1281042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- Sanaz Sohrabizadeh
- Air Quality and Climate Change Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health in Emergencies and Disasters, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Luis Mockel
- IU Internationale Hochschule GmbH, University of Applied Sciences, Düsseldorf, Germany
| | - Mohammad H. Yarmohammadian
- Health in Disasters Department, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- World Business Institute at the US (WBIUS), Fairfax, VA, United States
| | - Mehdi Zare
- Earthquake Prediction Center and Engineering Seismology Department, International Institute of Earthquake Engineering and Seismology (IIEES), Tehran, Iran
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Tsuboi M, Sasaki H, Park H, Usuda Y, Hanashima M, Saito M, Takahashi S, Sakisaka K, Hibiya M, Kiyota K, Hatsugai K, Nishizawa M, Sugawara Y, Tsuji I, Egawa S. Evacuation at Home Delayed the First Medical Intervention in Minamisanriku Town after the 2011 Great East Japan Earthquake. Prehosp Disaster Med 2023:1-10. [PMID: 37184063 DOI: 10.1017/s1049023x2300050x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION In Japan, evacuation at home is expected to increase in the future as a post-disaster evacuation type due to the pandemic, aging, and diverse disabilities of the population. However, more disaster-related indirect deaths occurred in homes than in evacuation centers after the 2011 Great East Japan Earthquake (GEJE). The health risks faced by evacuees at home have not been adequately discussed. STUDY OBJECTIVE This study aimed to clarify the gap in disaster health management for evacuees at home compared to the evacuees at the evacuation centers in Minamisanriku Town, which lost all health care facilities after the 2011 GEJE. METHODS This was a retrospective cross-sectional and quasi-experimental study based on the anonymized disaster medical records (DMRs) of patients from March 11 through April 10, 2011, that compared the evacuation-at-home and evacuation-center groups focusing on the day of the first medical intervention after the onset. Multivariable Cox regression analysis and propensity score (PS)-matching analysis were performed to identify the risk factors and causal relationship between the evacuation type and the delay of medical intervention. RESULTS Of the 2,838 eligible patients, 460 and 2,378 were in the evacuation-at-home and evacuation-center groups, respectively. In the month after the onset, the evacuation-at-home group had significantly lower rates of respiratory and mental health diseases than the evacuation-center group. However, the mean time to the first medical intervention was significantly delayed in the evacuation-at-home group (19.3 [SD = 6.1] days) compared to that in the evacuation-center group (14.1 [SD = 6.3] days); P <.001). In the multivariable Cox regression analysis, the hazard ratio (HR) of delayed medical intervention for evacuation-at-home was 2.31 with a 95% confident interval of 2.07-2.59. The PS-matching analysis of the adjusted 459 patients in each group confirmed that evacuation at home was significantly associated with delays in the first medical intervention (P <.001). CONCLUSION This study suggested, for the first time, the causal relationship between evacuation at home and delay in the first medical intervention by PS-matching analysis. Although evacuation at home had several advantages in reducing the frequencies of some diseases, the delay in medical intervention could exacerbate the symptoms and be a cause of indirect death. As more evacuees are likely to remain in their homes in the future, this study recommends earlier surveillance and health care provision to the home evacuees.
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Affiliation(s)
- Motohiro Tsuboi
- International Cooperation for Disaster Medicine Lab., International Research Institute of Disaster Science (IRIDeS), Tohoku University, Miyagi, Japan
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Hiroyuki Sasaki
- International Cooperation for Disaster Medicine Lab., International Research Institute of Disaster Science (IRIDeS), Tohoku University, Miyagi, Japan
| | - Hyejeong Park
- International Cooperation for Disaster Medicine Lab., International Research Institute of Disaster Science (IRIDeS), Tohoku University, Miyagi, Japan
- Disaster Medical Informatics Lab., IRIDeS, Tohoku University, Miyagi, Japan
| | - Yuichiro Usuda
- National Research Institute for Earth Science and Disaster Resilience (NIED), Ibaraki, Japan
| | - Makoto Hanashima
- National Research Institute for Earth Science and Disaster Resilience (NIED), Ibaraki, Japan
| | | | | | - Kayako Sakisaka
- Faculty of International Liberal Arts, Kaichi International University, Chiba, Japan
| | - Manabu Hibiya
- Teikyo Academic Research Center, Teikyo University, Tokyo, Japan
| | - Kazuya Kiyota
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | | | | | - Yumi Sugawara
- Department of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Ichiro Tsuji
- Department of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Shinichi Egawa
- International Cooperation for Disaster Medicine Lab., International Research Institute of Disaster Science (IRIDeS), Tohoku University, Miyagi, Japan
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Goniewicz K, Sarker MNI, Schoch-Spana M. Reimagining natural hazards and disaster preparedness: charting a new course for the future. BMC Public Health 2023; 23:581. [PMID: 36978174 PMCID: PMC10053712 DOI: 10.1186/s12889-023-15497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Affiliation(s)
- Krzysztof Goniewicz
- Department of Security Studies, Polish Air Force University, Deblin, Poland.
| | - Md Nazirul Islam Sarker
- School of Social Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia.
- Department of Development Studies, Daffodil International University, Dhaka, Bangladesh.
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Ortíz-Barrios M, Jaramillo-Rueda N, Gul M, Yucesan M, Jiménez-Delgado G, Alfaro-Saíz JJ. A Fuzzy Hybrid MCDM Approach for Assessing the Emergency Department Performance during the COVID-19 Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4591. [PMID: 36901601 PMCID: PMC10001734 DOI: 10.3390/ijerph20054591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The use of emergency departments (EDs) has increased during the COVID-19 outbreak, thereby evidencing the key role of these units in the overall response of healthcare systems to the current pandemic scenario. Nevertheless, several disruptions have emerged in the practical scenario including low throughput, overcrowding, and extended waiting times. Therefore, there is a need to develop strategies for upgrading the response of these units against the current pandemic. Given the above, this paper presents a hybrid fuzzy multicriteria decision-making model (MCDM) to evaluate the performance of EDs and create focused improvement interventions. First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) technique is used to estimate the relative priorities of criteria and sub-criteria considering uncertainty. Then, the intuitionistic fuzzy decision making trial and evaluation laboratory (IF-DEMATEL) is employed to calculate the interdependence and feedback between criteria and sub-criteria under uncertainty, Finally, the combined compromise solution (CoCoSo) is implemented to rank the EDs and detect their weaknesses to device suitable improvement plans. The aforementioned methodology was validated in three emergency centers in Turkey. The results revealed that the most important criterion in ED performance was ER facilities (14.4%), while Procedures and protocols evidenced the highest positive D + R value (18.239) among the dispatchers and is therefore deemed as the main generator within the performance network.
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Affiliation(s)
- Miguel Ortíz-Barrios
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia
| | - Natalia Jaramillo-Rueda
- Department of Productivity and Innovation, Universidad de la Costa CUC, Barranquilla 081001, Colombia
| | - Muhammet Gul
- School of Transportation and Logistics, Istanbul University, Istanbul 34320, Turkey
| | - Melih Yucesan
- Department of Emergency Aid and Disaster Management, Munzur University, Tunceli 62000, Turkey
| | - Genett Jiménez-Delgado
- Department of Industrial Engineering, Institución Universitaria de Barranquilla IUB, Barranquilla 080002, Colombia
| | - Juan-José Alfaro-Saíz
- Research Centre on Production Management and Engineering, Universitat Politècnica de València, 46022 Valencia, Spain
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Tovar MA, Zebley JA, Higgins M, Herur-Raman A, Zwemer CH, Pierce AZ, Ranniger C, Sarani B, Phillips JP. Exposure to a Virtual Reality Mass-Casualty Simulation Elicits a Differential Sympathetic Response in Medical Trainees and Attending Physicians. Prehosp Disaster Med 2023; 38:1-9. [PMID: 36606324 PMCID: PMC9885434 DOI: 10.1017/s1049023x22002448] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Previous studies have demonstrated the use of virtual reality (VR) in mass-casualty incident (MCI) simulation; however, it is uncertain if VR simulations can be a substitute for in-person disaster training. Demonstrating that VR MCI scenarios can elicit the same desired stress response achieved in live-action exercises is a first step in showing non-inferiority. The primary objective of this study was to measure changes in sympathetic nervous system (SNS) response via a decrease in heart rate variability (HRV) in subjects participating in a VR MCI scenario. METHODS An MCI simulation was filmed with a 360º camera and shown to participants on a VR headset while simultaneously recording electrocardiography (EKG) and HRV activity. Baseline HRV was measured during a calm VR scenario immediately prior to exposure to the MCI scenarios, and SNS activation was captured as a decrease in HRV compared to baseline. Cognitive stress was measured using a validated questionnaire. Wilcoxon matched pairs signed rank analysis, Welch's t-test, and multivariate logistic regression were performed with statistical significance established at P <.05. RESULTS Thirty-five subjects were enrolled: eight attending physicians (two surgeons, six Emergency Medicine [EM] specialists); 13 residents (five Surgery, eight EM); and 14 medical students (six pre-clinical, eight clinical-year students). Sympathetic nervous system activation was observed in all groups during the MCI compared to baseline (P <.0001) and occurred independent of age, sex, years of experience, or prior MCI response experience. Overall, 23/35 subjects (65.7%) reported increased cognitive stress in the MCI (11/14 medical students, 9/13 residents, and 3/8 attendings). Resident and attending physicians had higher odds of discordance between SNS activation and cognitive stress compared to medical students (OR = 8.297; 95% CI, 1.408-64.60; P = .030). CONCLUSIONS Live-actor VR MCI simulation elicited a strong sympathetic response across all groups. Thus, VR MCI training has the potential to guide acquisition of confidence in disaster response.
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Affiliation(s)
- Matthew A. Tovar
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
| | - James A. Zebley
- Department of Surgery, George Washington University, Washington, DCUSA
| | - Mairead Higgins
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
| | - Aalap Herur-Raman
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
| | - Catherine H. Zwemer
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
| | - Ayal Z. Pierce
- Department of Emergency Medicine, George Washington University, Washington, DCUSA
| | - Claudia Ranniger
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
- Department of Emergency Medicine, George Washington University, Washington, DCUSA
| | - Babak Sarani
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
- Department of Surgery, George Washington University, Washington, DCUSA
- Department of Emergency Medicine, George Washington University, Washington, DCUSA
| | - James P. Phillips
- School of Medicine and Health Sciences, George Washington University, Washington, DCUSA
- Department of Emergency Medicine, George Washington University, Washington, DCUSA
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Kelly D, Koay A, Mineva G, Volz M, McCool A, McLoughlin E, Ó Conluain R, Sharma M, Kerr A, Franklin BD, Grimes T. A scoping review of non-professional medication practices and medication safety outcomes during public health emergencies. Public Health 2023; 214:50-60. [PMID: 36521272 DOI: 10.1016/j.puhe.2022.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Public health emergencies (PHE) can disrupt personal medication practices and increase the risk of medication-related harm and other negative medication-related outcomes. Our aim was to examine the extent and nature of published research on this topic to guide future research and practice. STUDY DESIGN Scoping review. METHODS Standard electronic databases were searched. PRISMA-ScR guidelines were followed. Extracted data were organised in response to review questions and narrative accounts developed. RESULTS A total of 129 studies were included, conducted across 32 countries, mostly in the USA (n = 42). Sixty-eight (53%) reported on infectious events, 49 (39%) climatological or ecological events and the remainder a mixture of terrorism, war or other disasters. The studies described several medication safety outcomes (medication-related harm, adherence, supply) and adaptive medication practices (self-altering prescribed medications, sharing medications and changing healthcare providers). Challenges to maintaining routine medication practices during a PHE included transport, finance, quarantine and knowledge-related issues. Twenty-eight studies (22%) examined health inequalities pertaining to adverse medication-related outcomes, with findings suggesting that gender, age, ethnicity, educational and socio-economic status may be related to inequalities. Research gaps identified included carers', children's and minority communities' experiences and intervention studies. CONCLUSIONS There is considerable evidence of disruptions to routine personal medication practices during PHEs and of medication-related harm and other negative outcomes. Maintaining medication supply for the management of chronic conditions is a universal problem across all emergency types. Research is needed to address these disruptions, particularly amongst people who experience health inequalities who may need additional support.
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Affiliation(s)
- Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aaron Koay
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Gabriela Mineva
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Monika Volz
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Aoibhin McCool
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Eavan McLoughlin
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | | | - Manuj Sharma
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Aisling Kerr
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
| | - Bryony Dean Franklin
- Imperial College Healthcare NHS Trust, London, UK; NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK; UCL School of Pharmacy, London, UK
| | - Tamasine Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
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9
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Kivlehan SM, Hexom BJ, Bonney J, Collier A, Nicholson BD, Quao NSA, Rybarczyk MM, Selvam A, Rees CA, Roy CM, Bhaskar N, Becker TK. Global emergency medicine: A scoping review of the literature from 2021. Acad Emerg Med 2022; 29:1264-1274. [PMID: 35913419 DOI: 10.1111/acem.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective was to identify the most important and impactful peer-reviewed global emergency medicine (GEM) articles published in 2021. The top articles are summarized in brief narratives and accompanied by a comprehensive list of all identified articles that address the topic during the year to serve as a reference for clinicians, researchers, and policy makers. METHODS A systematic PubMed search was carried out to identify all GEM articles published in 2021. Title and abstract screening was performed by trained reviewers and editors to identify articles in one of three categories based on predefined criteria: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Included articles were each scored by two reviewers using established rubrics for original (OR) and review (RE) articles. The top 5% of articles overall and the top 5% of articles from each category (DHR, ECRLS, EMD, OR, and RE) were included for narrative summary. RESULTS The 2021 search identified 44,839 articles, of which 444 articles screened in for scoring, 25% and 22% increases from 2020, respectively. After removal of duplicates, 23 articles were included for narrative summary. ECRLS constituted the largest category (n = 16, 70%), followed by EMD (n = 4, 17%) and DHR (n = 3, 13%). The majority of top articles were OR (n = 14, 61%) compared to RE (n = 9, 39%). CONCLUSIONS The GEM peer-reviewed literature continued to grow at a fast rate in 2021, reflecting the continued expansion and maturation of this subspecialty of emergency medicine. Few high-quality articles focused on DHR and EMD, suggesting a need for further efforts in those fields. Future efforts should focus on improving the diversity of GEM research and equitable representation.
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Affiliation(s)
- Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Braden J Hexom
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Global Health and Infectious Disease Research Group, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Benjamin D Nicholson
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nana Serwaa A Quao
- Department of Emergency Medicine, Accident and Emergency Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Megan M Rybarczyk
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlotte M Roy
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
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10
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Ford JD, Zavaleta-Cortijo C, Ainembabazi T, Anza-Ramirez C, Arotoma-Rojas I, Bezerra J, Chicmana-Zapata V, Galappaththi EK, Hangula M, Kazaana C, Lwasa S, Namanya D, Nkwinti N, Nuwagira R, Okware S, Osipova M, Pickering K, Singh C, Berrang-Ford L, Hyams K, Miranda JJ, Naylor A, New M, van Bavel B. Interactions between climate and COVID-19. Lancet Planet Health 2022; 6:e825-e833. [PMID: 36208645 PMCID: PMC9534524 DOI: 10.1016/s2542-5196(22)00174-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 06/25/2022] [Accepted: 07/12/2022] [Indexed: 05/22/2023]
Abstract
In this Personal View, we explain the ways that climatic risks affect the transmission, perception, response, and lived experience of COVID-19. First, temperature, wind, and humidity influence the transmission of COVID-19 in ways not fully understood, although non-climatic factors appear more important than climatic factors in explaining disease transmission. Second, climatic extremes coinciding with COVID-19 have affected disease exposure, increased susceptibility of people to COVID-19, compromised emergency responses, and reduced health system resilience to multiple stresses. Third, long-term climate change and prepandemic vulnerabilities have increased COVID-19 risk for some populations (eg, marginalised communities). The ways climate and COVID-19 interact vary considerably between and within populations and regions, and are affected by dynamic and complex interactions with underlying socioeconomic, political, demographic, and cultural conditions. These conditions can lead to vulnerability, resilience, transformation, or collapse of health systems, communities, and livelihoods throughout varying timescales. It is important that COVID-19 response and recovery measures consider climatic risks, particularly in locations that are susceptible to climate extremes, through integrated planning that includes public health, disaster preparedness, emergency management, sustainable development, and humanitarian response.
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Affiliation(s)
- James D Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK.
| | - Carol Zavaleta-Cortijo
- Intercultural Citizenship and Indigenous Health Unit, Cayetano Heredia University, Lima, Peru
| | - Triphini Ainembabazi
- Department of Geography, Geo-Informatics, and Climatic Sciences, Makerere University, Kampala, Uganda
| | - Cecilia Anza-Ramirez
- Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Joana Bezerra
- Community Engagement, Rhodes University, Makhanda, South Africa
| | | | | | - Martha Hangula
- Department of Livestock Production, Agribusiness, and Economics, University of Namibia, Oshakati, Namibia
| | | | - Shuaib Lwasa
- Department of Geography, Geo-Informatics, and Climatic Sciences, Makerere University, Kampala, Uganda
| | | | - Nosipho Nkwinti
- Community Engagement, Rhodes University, Makhanda, South Africa
| | | | - Samuel Okware
- Uganda National Health Research Organisation, Entebbe, Uganda
| | - Maria Osipova
- Arctic State Institute of Culture and Arts, North-Eastern Federal University, Yakutsk, Russia
| | - Kerrie Pickering
- Sustainability Research Centre, University of the Sunshine Coast, Buderim, QLD, Australia
| | - Chandni Singh
- School of Environment and Sustainability, Indian Institute for Human Settlements, Bangalore, India
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
| | - Keith Hyams
- Department of Politics and International Studies, University of Warwick, Coventry, UK
| | - J Jaime Miranda
- Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angus Naylor
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Mark New
- Environmental and Geographical Science, University of Cape Town, Cape Town, South Africa
| | - Bianca van Bavel
- Priestley International Centre for Climate, University of Leeds, Leeds, UK
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11
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Mousavi SH, Khankeh H, Atighechian G, Yarmohammadian MH, Memarzadeh M. Challenges of prehospital aerial operations in response to earthquake hazards: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:268. [PMID: 36325237 PMCID: PMC9621378 DOI: 10.4103/jehp.jehp_1302_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/22/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUNDS Due to the severity of the earthquake, it may need immediate treatment and transfer of the injured people to advanced medical centers, as well as dispatch of the expert team and specialized health equipment to the accident-affected area. Aerial emergency is an important responsibility of the health care system in this situation. The study aimed to extract the prehospital emergency challenges of Iran aerial operations emergency in response to the earthquake. MATERIALS AND METHODS The study was qualitative content analysis with conventional approach. Sampling was done in a purposive method and data were collected through semi-structured interview. The panel involved consists of 26 health professionals in medical emergencies. Recorded interviews were transcribed into written and then conventional content analysis was used to derive coding categories directly from the text data. RESULTS Content analysis is provided 97 initial codes, 20 subcategories and 4 main categories including challenges of "response assessment," "support," "pre-hospital staff-management," and "response operation," respectively. CONCLUSIONS The results showed that the necessity to assess the affected area, staffing, and management actions, including integrated operations command and the development of a dedicated response plan, as well as the use of strategies inter-organizational coordination in the response phase to earthquake. This study also emphasized that providing standard equipment, support actions, and strengthening communication infrastructure, and updating the aerial emergency system should be considered as one of the priorities of the emergency organization of Iran to provide a desired response to the earthquake.
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Affiliation(s)
- Seyed Hossein Mousavi
- Department of Health in Disaster and Emergencies, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Khankeh
- Research Center for Emergency and Disaster Health, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Golrokh Atighechian
- Department of Health in Emergencies and Disasters, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mehrdad Memarzadeh
- Department of Surgery, School of Medicine Craniofacial and Cleft Research Center, Imam Hossein Children Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Mentrasti G, Cantini L, Zichi C, D'Ostilio N, Gelsomino F, Martinelli E, Chiari R, La Verde N, Bisonni R, Cognigni V, Pinterpe G, Pecci F, Migliore A, Aimar G, De Vita F, Traisci D, Spallanzani A, Martini G, Nicolardi L, Cona MS, Baleani MG, Rocchi MLB, Berardi R. Alarming Drop in Early Stage Colorectal Cancer Diagnoses After COVID-19 Outbreak: A Real-World Analysis from the Italian COVID-DELAY Study. Oncologist 2022; 27:e723-e730. [PMID: 35815922 PMCID: PMC9438923 DOI: 10.1093/oncolo/oyac129] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/05/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has triggered the disruption of health care on a global scale. With Italy tangled up in the pandemic response, oncology care has been largely diverted and cancer screenings suspended. Our multicenter Italian study aimed to evaluate whether COVID-19 has impacted access to diagnosis, staging, and treatment for patients newly diagnosed with colorectal cancer (CRC), compared with pre-pandemic time. METHODS All consecutive new CRC patients referred to 8 Italian oncology institutions between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset, radiological and cytohistological diagnosis, treatment start and first radiological evaluation were analyzed and compared with the same months of 2019. RESULTS A reduction (29%) in newly diagnosed CRC cases was seen when compared with 2019 (360 vs 506). New CRC patients in 2020 were less likely to be diagnosed with early stage (stages I-II-III) CRC (63% vs 78%, P < .01). Gender and sidedness were similar regardless of the year. The percentage of tumors with any mutation among BRAF, NRAS, and KRAS genes were significantly different between the 2 years (61% in 2020 vs 50% in 2019, P = .04). Timing of access to cancer diagnosis, staging, and treatment for patients with CRC has not been negatively affected by the pandemic. Significantly shorter temporal intervals were observed between symptom onset and first oncological appointment (69 vs 79 days, P = .01) and between histological diagnosis and first oncological appointment (34 vs 42 days, P < .01) during 2020 compared with 2019. Fewer CRC cases were discussed in multidisciplinary meetings during 2020 (38% vs 50%, P = .01). CONCLUSIONS Our data highlight a significant drop in CRC diagnosis after COVID-19, especially for early stage disease. The study also reveals a remarkable setback in the multidisciplinary management of patients with CRC. Despite this, Italian oncologists were able to ensure diagnostic-therapeutic pathways proper operation after March 2020.
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Affiliation(s)
- Giulia Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Luca Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | | | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Erika Martinelli
- UOC Oncologia ed Ematologia, Dipartimento di Medicina di Precisione, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Nicla La Verde
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Renato Bisonni
- Department of Oncology, Ospedale Augusto Murri di Fermo, Fermo, Italy
| | - Valeria Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giada Pinterpe
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Federica Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Antonella Migliore
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giacomo Aimar
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Francesca De Vita
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Donatella Traisci
- Medical Oncology, ASL2 Abruzzo, Ospedale San Pio da Pietralcina, Vasto, Italy
| | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Giulia Martini
- UOC Oncologia ed Ematologia, Dipartimento di Medicina di Precisione, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Linda Nicolardi
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Maria Silvia Cona
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | | | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
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13
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Mushonga FB, Mishi S. Natural hazard insurance demand: A systematic review. JAMBA (POTCHEFSTROOM, SOUTH AFRICA) 2022; 14:1223. [PMID: 35747365 PMCID: PMC9210195 DOI: 10.4102/jamba.v14i1.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
Abstract
The mitigation of natural hazard costs such as loss of property, life, crops and medical costs can be achieved through the adoption of insurance. It is, however, not clear whether there is corresponding demand for insurance given the increasing frequency and veracity of natural hazards, especially in South Africa. This study follows the guideline of Preferred Reporting items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to identify the relevant works on the subject. A total of 645 articles emerged on initial search and after screening, 39 remained which have been reviewed in this study. Reviewing the studies and conflating with the study objectives, the following themes emerged for discussion on demand for natural hazard insurance, is there demand for natural hazard insurance?; psychology of decision-making; risk perception; risk preference and willingness to pay. The study found that studies of demand for insurance have identified that there is low demand for tailor-made insurance products for natural hazards. Further analysis of the demand revealed that normative and descriptive decision-making of buying natural hazard insurance is part of the psychological factors that determine demand. Whilst risk preference and perception have sub-attributes that affect their impact on demand such as experience, age and salience to natural hazards in communities. Whilst willingness to pay is also a broad concept which is analysed using both monetary and non-monetary factors in literature, the results also identified that there is a huge gap in literature in terms of studies that cover risk preference and perception in Africa and in the Southern African Development Community (SADC) region.
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Affiliation(s)
- Farai B Mushonga
- Department of Economics, Faculty of Business and Economic Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Syden Mishi
- Department of Economics, Faculty of Business and Economic Sciences, Nelson Mandela University, Gqeberha, South Africa
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14
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Mutual Impacts of the COVID-19 Pandemic and the Recent Earthquakes: A Scoping Review of the Lessons Learned. Disaster Med Public Health Prep 2022; 17:e188. [PMID: 35317871 PMCID: PMC9095856 DOI: 10.1017/dmp.2022.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to review the articles dealing with the mutual impacts of the coronavirus disease 2019 (COVID-19) pandemic and the recent earthquakes to elicit the various scopes of the lessons learned including the challenges, the successful measures, and the recommendations. METHODS To detect the relevant studies published between February 1, 2020, and June 9, 2021, PubMed, Web of Science, Scopus, and Google Scholar were searched. Having considered specific inclusion/exclusion criteria, 18 studies were included. RESULTS Seven major earthquakes have occurred concurrently or before the pandemic era in Albania, Croatia, Haiti, Great East Japan, Mexico, Nepal, and Utah. Thematic analysis revealed 5 themes for the "challenges" (management inefficiency, increased life-threatening, economic, socially related, and dual psychological challenges); 4 themes for the "efficient response measures" (health-care services measures, government measures, community-based cooperative activities, and disaster management response); and 3 major themes with 7 sub-themes for the "recommendations" including "the mitigation phase" (identifying probable natural disasters), "the preparedness phase" (preparing necessary equipment), and "the response phase" (mental care response measures, health-care-related COVID-19 measures, economic improvement measures, recognizing community-based capabilities, and government-related boosting measures). CONCLUSIONS It is suggested that these scopes of the mutual impacts of the COVID-19 pandemic and the earthquakes be studied in systematic reviews.
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15
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Kaneda Y, Ozaki A, Wada M, Kurokawa T, Sawano T, Tsubokura M, Tanimoto T, Kanemoto Y, Ejiri T, Kanzaki N. Possible association of Typhoon Hagibis and the COVID-19 pandemic on patient delay in breast cancer patients: A case report. Clin Case Rep 2022; 10:e05621. [PMID: 35356170 PMCID: PMC8939041 DOI: 10.1002/ccr3.5621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Little is known on how different types of disasters interact in their impacts on patient care. We experienced a breast cancer patient whose initial presentation was delayed for 2 years due to the COVID-19 pandemic and Typhoon Hagibis. Increasing awareness is needed on the combined impacts of disasters on breast cancer management.
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Affiliation(s)
- Yudai Kaneda
- School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Akihiko Ozaki
- Department of Breast SurgeryJyoban Hospital of Tokiwa FoundationIwakiFukushimaJapan
| | - Masahiro Wada
- Department of Breast SurgeryJyoban Hospital of Tokiwa FoundationIwakiFukushimaJapan
- Department of Breast SurgerySano Kosei General HospitalSanoTochigiJapan
| | - Tomohiro Kurokawa
- Department of SurgeryJyoban Hospital of Tokiwa FoundationIwakiFukushimaJapan
| | - Toyoaki Sawano
- Department of SurgeryJyoban Hospital of Tokiwa FoundationIwakiFukushimaJapan
- Department of Radiation Health ManagementFukushima Medical University School of MedicineIwakiFukushimaJapan
| | - Masaharu Tsubokura
- Department of Radiation Health ManagementFukushima Medical University School of MedicineIwakiFukushimaJapan
| | - Tetsuya Tanimoto
- Department of Internal MedicineJyoban Hospital of Tokiwa FoundationIwakiFukushimaJapan
| | - Yoshiaki Kanemoto
- Department of SurgeryJyoban Hospital of Tokiwa FoundationIwakiFukushimaJapan
| | - Tomozo Ejiri
- Department of SurgeryJyoban Hospital of Tokiwa FoundationIwakiFukushimaJapan
| | - Norio Kanzaki
- Department of SurgeryJyoban Hospital of Tokiwa FoundationIwakiFukushimaJapan
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16
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Medved S, Imširagić AS, Salopek I, Puljić D, Handl H, Kovač M, Peleš AM, Štimac Grbic D, Romančuk L, MuŽić R, Zeeman LS, Kuzman MR. Case Series: Managing Severe Mental Illness in Disaster Situation: the Croatian Experience After 2020 Earthquake. Front Psychiatry 2022; 12:795661. [PMID: 35185639 PMCID: PMC8847377 DOI: 10.3389/fpsyt.2021.795661] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/22/2021] [Indexed: 12/19/2022] Open
Abstract
On the 29th of December 2020, amidst the COVID-19 pandemic, Petrinja in the Croatian Sisak-Moslavina County experienced a strong earthquake, resulting in a severe disruption in mental health service delivery. Specialized care community mental health teams were introduced days within the event with the aim to bridge the gap in psychiatric care that was severely disturbed in the region affected by the earthquake. Through a case series of patients with SMI, we describe how care was quickly deployed and delivered after a natural disaster and during a pandemic resulting in their functional recovery. Community mental health teams have the potential to provide feasible, comprehensive, and accessible mental health services, and their continued implementation in the post-disaster period in Croatia could be beneficial for care management of people with severe mental illness.
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Affiliation(s)
- Sara Medved
- Department of Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
| | | | - Igor Salopek
- Department of Psychiatry, General Hospital Karlovac, Karlovac, Croatia
| | - Dragan Puljić
- Neuropsychiatric Hospital “Dr Ivan Barbot”, Popovača, Croatia
| | - Hrvoje Handl
- University Psychiatric Clinic “Sveti Ivan”, Zagreb, Croatia
| | - Marina Kovač
- Neuropsychiatric Hospital “Dr Ivan Barbot”, Popovača, Croatia
| | - Alma Mihaljević Peleš
- Department of Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Danijela Štimac Grbic
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Luka Romančuk
- Department of Psychiatry, General Hospital Karlovac, Karlovac, Croatia
| | - Roberto MuŽić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Laura Shields Zeeman
- Department of Mental Health Prevention, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands
| | - Martina Rojnić Kuzman
- Department of Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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17
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Wilson E, Hanson LC, Tori KE, Perrin BM. Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions. BMC Health Serv Res 2021; 21:819. [PMID: 34391412 PMCID: PMC8364439 DOI: 10.1186/s12913-021-06864-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Background The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre. Methods This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data. Results Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context. Conclusions This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.
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Affiliation(s)
- Elena Wilson
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.
| | - Lisa C Hanson
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Kathleen E Tori
- School of Nursing, College of Health and Medicine, University of Tasmania, Locked Bag 1351, Launceston, Tasmania, 7250, Australia
| | - Byron M Perrin
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
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