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Medical Team (medical + team)
Selected AbstractsDeveloping Expert Medical Teams: Toward an Evidence-based ApproachACADEMIC EMERGENCY MEDICINE, Issue 11 2008Rosemarie Fernandez MD Abstract Current health care literature cites communication breakdown and teamwork failures as primary threats to patient safety. The unique, dynamic environment of the emergency department (ED) and the complexity of patient care necessitate the development of strong interdisciplinary team skills among emergency personnel. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," our workshop group identified key theory and evidence-based recommendations for the design and implementation of team training programs. The authors then conducted an extensive review of the team training literature within the domains of organizational psychology, aviation, military, management, and health care. This review, in combination with the workshop session, formed the basis for recommendations and need for further research in six key areas: 1) developing and refining core competencies for emergency medicine (EM) teams; 2) leadership training for emergency physicians (EPs); 3) conducting comprehensive needs analyses at the organizational, personnel, and task levels; 4) development of training platforms to maximize knowledge transfer; 5) debriefing and provision of feedback; and 6) proper implementation of simulation technology. The authors believe that these six areas should form an EM team training research platform to advance the EM literature, while leveraging the unique team structures present in EM to expand team training theory and research. [source] Technical and non-technical skills can be reliably assessed during paramedic simulation trainingACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2009T. VON WYL Background: Medical teams depend on technical skills (TS) as well as non-technical skills (NTS) for successful management of critical events. Simulated scenarios are an opportunity for presentation of similar crisis situations. The aim of this study was to test whether TS and NTS are assessable with satisfactory interrater reliability (IRR) during a regular paramedic training. Methods: Thirty paramedics were rated by two independent observers using video-recording and previously validated checklists while managing two simulated emergency scenarios as a team of two. The observed items of the team's TS included type, order, and time of adequate medical care. The NTS were restricted to six team-oriented dimensions. The IRR was quantified by calculating the intraclass correlation coefficient (ICC). The z -transformed values of the TS and NTS were correlated by Pearson's correlation. Internal consistency was controlled using Cronbach's ,. Results: The average measures ICC for the IRR was between 0.97 [95% confidence interval (CI) 0.91,0.99] and 0.98 (95% CI 0.94,0.99) for the TS sum-score, and was 0.94 (95% CI 0.87,0.97) for the NTS sum-score; the Cronbach's , of this NTS sum-score was 0.86. There is a positive correlation between the normalised TS and NTS sum-scores (r=0.53; P<0.05). Conclusion: Assessment of TS and NTS is feasible and reliable during paramedic training in emergency scenarios. TS can be reliably assessed by one trained observer; for NTS, two trained raters provide a suitable condition for excellent observations. There is a significant positive correlation between TS and NTS. [source] Oro-facial injuries in Central American and Caribbean sports games: a 20-year experienceDENTAL TRAUMATOLOGY, Issue 3 2005Enrique Amy Abstract,,, Dental services in sports competitions in the Games sponsored by the International Olympic Committee are mandatory. In every Central American, Pan American and Olympic Summer Games, as well as Winter Games, the Organizing Committee has to take all the necessary measures to assure dental services to all competitors. In all Olympic villages, as part of the medical services, a dental clinic is set up to treat any dental emergency that may arise during the Games. Almost every participating country in the Games has its own medical team and some may include a dentist. The major responsibilities of the team dentist as a member of the national sports delegation include: (i) education of the sports delegation about different oral and dental diseases and the illustration of possible problems that athletes or other personnel may encounter during the Games, (ii) adequate training and management of orofacial trauma during the competition, (iii) knowledge about the rules and regulations of the specific sport that the dentist is working, (iv) understanding of the anti-doping control regulations and procedures, (v) necessary skills to fabricate a custom-made and properly fitted mouthguard to all participants in contact or collision sports of the delegation. This study illustrates the dental services and occurrence of orofacial injury at the Central American and Caribbean Sports Games of the Puerto Rican Delegation for the past 20 years. A total of 2107 participants made up the six different delegations at these Games. Of these 279 or 13.2% were seen for different dental conditions. The incidence of acute or emergency orofacial conditions was 18 cases or 6% of the total participants. The most frequent injury was lip contusion with four cases and the sport that experienced more injuries was basketball with three cases. [source] Extreme altitude mountaineering and Type 1 diabetes; the Diabetes Federation of Ireland Kilimanjaro ExpeditionDIABETIC MEDICINE, Issue 9 2001K. Moore Abstract Aims To examine the effects of extreme altitude mountaineering on glycaemic control in Type 1 diabetes, and to establish whether diabetes predisposes to acute mountain sickness (AMS). Methods Fifteen people with Type 1 diabetes and 22 nondiabetic controls were studied during the Diabetes Federation of Ireland Expedition to Kilimanjaro. Daily insulin requirements, blood glucose estimations and hypoglycaemic attacks were recorded in diaries by the people with diabetes. The performance of blood glucose meters at altitude was assessed using standard glucose solutions. Symptoms of acute mountain sickness were recorded daily by people with diabetes and by the nondiabetic controls using the Lake Louise Scoring Charts. The expedition medical team recorded the incidence of complications of altitude and of diabetes. The final height attained for each individual was recorded by the expedition medical team and verified by the expedition guides. Results The final altitude ascended was lower in the diabetic than the nondiabetic group (5187 ± 514 vs. 5654 ± 307 m, P= 0.001). The mean daily insulin dose was reduced from 67.1 ± 28.3,32.9 ± 11.8 units (P < 0.001), but only 50% of recorded blood glucose readings were within the target range of 6,14 mmol/L. There were few hypoglycaemic attacks after the first two days of climbing. Both blood glucose meters tested showed readings as low as 60% of standard glucose concentrations at high altitude and low temperatures. The Lake Louise questionnaires showed that symptoms of AMS occurred equally in the diabetic and nondiabetic groups. There were two episodes of mild diabetic ketoacidosis; two of the diabetic group and three of the nondiabetic group developed retinal haemorrhages. Conclusions People with Type 1 diabetes can participate in extreme altitude mountaineering. However, there are significant risks associated with this activity, including hypoglycaemia, ketoacidosis and retinal haemorrhage, with the additional difficulties in assessing glycaemic control due to meter inaccuracy at high altitude. People with Type 1 diabetes must be carefully counselled before attempting extreme altitude mountaineering. Diabet. Med. 18, 749,755 (2001) [source] V.A.C.® Therapy in the management of paediatric wounds: clinical review and experienceINTERNATIONAL WOUND JOURNAL, Issue 2009Mona Baharestani ABSTRACT Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure® (V.A.C.® Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C.® Therapy System. [source] Primary care mental health: a new frontier for psychologyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 3 2009William B. Gunn Abstract The medical system in this country is divided into primary care and specialty care. Mental health is for the most part a specialty service dependent on referrals, often from primary care providers. The authors propose a new model where psychologists work in collaboration with primary care medical teams. This integrated, coordinated model enables psychologists to help patients they would not otherwise see in a mental health system. Examples of patients in this category are seniors, those with somatizing disorders, and those experiencing the challenges of dealing with a chronic illness. This model also enables psychologists to provide consultation to the medical teams. In this article, the authors discuss the world of the primary care medical team and present the rationale for integration or collaboration. They describe the barriers to collaborative practices and ways to overcome these barriers. Finally, they present practical strategies that psychologists can use on a regular basis to increase their collaboration with primary care. These strategies can be used by those who work in colocated practices as well as those who work in separate locations. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1,18, 2009. [source] Applying lessons from China's Wenchuan earthquake to medical rescue following the Yushu earthquakeJOURNAL OF EVIDENCE BASED MEDICINE, Issue 2 2010Shaolin Deng A 7.1-magnitude earthquake hit China's Qinghai province,4000 meters above sea level, on April 14, 2010, just 702 days after Wenchuan Earthquake. As of 12:00 on April 19, the death toll stood at 1706, with 256 missing and 12,128 injured. West China Hospital (WCH), a regional state-level hospital of the Ministry of Health, sent a medical team with relief supplies within the first hour after Yushu earthquake and the team rushed to Yushu in the first day participating golden seventy-two hours rescue effort. The second day after Yushu earthquake, medical apparatuses and drugs valued at 5 million RMB were delivered to the rescue site and the second batch of medical team were positioned. Within 33 hours of the earthquake, 102 people, including 93 with earthquake-related injuries and 9 armed police with severe altitude sickness, were send to WCH by air in four batches. WCH organized its medical rescue efforts based on first-hand experience with medical rescue following Wenchuan earthquake, a series of evidence-based diagnosis and treatment standards, and "four concentration principles," namely concentrating the wounded, experts, resources, and treatments. Of the 93 cases with earthquake-related injuries, 54 were seriously wounded, and in the five days immediately following the earthquake, 58 underwent operations and none died. The experience learned from Wenchuan earthquake have been used, improved and sublimated more rapidly, appropriately, and effectively in the Yushu earthquake medical rescue. [source] Bispectral index during cardiopulmonary resuscitation: a poor indicator of recovery.ANAESTHESIA, Issue 2 2010Two very different cases Summary We report two cases of massive intra-operative bleeding during lung transplantation requiring emergency cardiopulmonary bypass. In both cases the bispectral index dropped to 0, remained low for around 30 and 90 min respectively, and then returned to values consistent with a usual anaesthetic state (around 40). At the time bispectral monitoring provided some reassurance to the medical team about the adequacy of the resuscitation. However, this proved misleading since postoperative neurological recovery was favourable in one case but not in the other. [source] The clinical psychologist's role in the OOKP clinic.ACTA OPHTHALMOLOGICA, Issue 2009A one year review OOKP Surgery places complex Physical and Psychological demands on patients. Attention to Psychological factors is likely to facilitate good outcome and improve Quality of Life. This presentation outlines an innovative addition to the OOKP service at Sussex Eye Hospital, Brighton UK, incorporating a Clinical Psychologist as a member of the OOKP medical team. It will describe the first year's work including a study which has identified four subgroups of patients presenting for OOKP and the psychological needs of each group. The presentation describes how the service aims to address the particular psychological needs of these patient groups from assessment to psychological follow up. The presentation will also include a summary of a second Qualitative Interview study looking at patients' reports of their experiences of undergoing OOKP from a bio-psychosocial perspective. The National Health Service, UK seeks to use patient experience and feedback to shape clinical services and the implications of the outcomes of the research for the service will be discussed. [source] Screening for cervical cancer among Israeli lesbian womenINTERNATIONAL NURSING REVIEW, Issue 4 2009M. Ben-Natan rn Background:, The proportion of lesbian women who contract the human papilloma virus may reach 13% or even 21%; however, lesbian women were found to receive Pap smear tests less often or less regularly. Aim:, To explore factors influencing lesbian women to undergo Pap smear tests and to determine whether the Health Belief Model (HBM) is able to predict whether lesbian women would be willing to undergo the test. Method:, This is a correlational quantitative study guided by the HBM. A convenience sample of 108 Israeli lesbian women was recruited from local events in the lesbian community in the city of Tel Aviv, Israel. Data were collected using a self-administered questionnaire. Findings:, Findings indicate that only 22.2% of the women had undergone Pap smear tests in the past, but a slightly higher proportion, 30.8%, intended to be tested during the next year. Older women were found to be more compliant with the test. Model-based factors affecting actual testing were perceived benefits and barriers. Factors affecting women's intention to be tested were perceived susceptibility, perceived benefits and general health motivation. Conclusions:, Effective strategies for nurses promoting cervical cancer screening among lesbians should address ways to improve familiarity with Pap smear tests, raise physicians' awareness of offering the test to lesbians and emphasize the importance of women-based medical teams. [source] Primary care mental health: a new frontier for psychologyJOURNAL OF CLINICAL PSYCHOLOGY, Issue 3 2009William B. Gunn Abstract The medical system in this country is divided into primary care and specialty care. Mental health is for the most part a specialty service dependent on referrals, often from primary care providers. The authors propose a new model where psychologists work in collaboration with primary care medical teams. This integrated, coordinated model enables psychologists to help patients they would not otherwise see in a mental health system. Examples of patients in this category are seniors, those with somatizing disorders, and those experiencing the challenges of dealing with a chronic illness. This model also enables psychologists to provide consultation to the medical teams. In this article, the authors discuss the world of the primary care medical team and present the rationale for integration or collaboration. They describe the barriers to collaborative practices and ways to overcome these barriers. Finally, they present practical strategies that psychologists can use on a regular basis to increase their collaboration with primary care. These strategies can be used by those who work in colocated practices as well as those who work in separate locations. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1,18, 2009. [source] Insights into creation and use of prescribing documentation in the hospital medical recordJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2005Mary P. Tully PhD MRPharmS Abstract Rationale, aims and objectives, Extraction of prescribing data from medical records is a common, albeit flawed, research method. Yet little is known about the processes that result in those data. This study explores the creation and use of prescribing documentation in the medical record, from the perspective of the hospital doctors who both create and use it. Methods, Thirty-six hospital doctors were purposively selected for qualitative interviews, giving a maximum variability sample of grades of doctors across the range of major medical specialty areas and medical teams at a large teaching hospital in England. Results, The findings suggest a number of reasons why hospital doctors fail to record prescribing decisions in the medical record. There was no set standard, record keeping was not formally taught and the hurried environment of the ward gave little time for documentation. The doctors also acknowledged that there was no need for completeness, as colleagues would be able to ,fill in the gaps' via an inferential process. ,Assumptions ,were ,made ,and ,although ,this ,was ,not ,seen ,as ,ideal, it was recognized as necessary if work was to be done efficiently. Conclusion, These results reinforce the suggestion that, despite the large number of potential users, the medical record is created for those with the right privileged knowledge. This has profound implications for those without that insider knowledge who are using medical records for research purposes. Funding, This work was funded by a North West Regional National Health Service Postdoctoral Fellowship. [source] Epidemiology of Skin Diseases in School Children: A Study from Northern IndiaPEDIATRIC DERMATOLOGY, Issue 6 2003D.N.B., Sunil Dogra M.D. Low socioeconomic status, malnutrition, overcrowding, and poor standards of hygiene are important factors accounting for the distribution of skin diseases in developing countries such as India. In order to estimate the burden and relative frequency of dermatologic diseases among children in the community, we measured the point prevalence of skin conditions in 12,586 Indian school children ages 6,14 years. The overall point prevalence of one or more identifiable/apparent skin conditions was 38.8%. Of those studied, 3786 children (30%) had only one skin disease, 765 (6%) had two, and 336 (2.7%) had three skin pathologies. The most common skin conditions and their respective point prevalences were skin infections (11.4%), pityriasis alba (8.4%), dermatitis/nonspecific eczemas (5.2%), infestations (5.0%), disorders of pigmentation (2.6%), keratinization disorders (mostly keratosis pilaris) (1.3%), and nevi/hamartomas (1.1%). This study shows that skin conditions are common in children and about one-third of them are affected at any given time. The finding that more than 85% of the disorders can be grouped into fewer than eight categories is important in designing training programs for medical teams involved in the delivery of primary health care services in developing countries such as India, where about one-third of the population is less than 15 years of age. [source] Synergy and sustainability in rural procedural medicine: Views from the coalfaceAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2010Andrew Swayne Abstract Objective:,The practice of rural and remote medicine in Australia entails many challenges, including a broad casemix and the remoteness of specialist support. Many rural practitioners employ advanced procedural skills in anaesthetics, surgery, obstetrics and emergency medicine, but the use of these skills has been declining over the last 20 years. This study explored the perceptions of rural general practitioners (GPs) on the current and future situation of procedural medicine. Design:,The qualitative results of data from a mixed-method design are reported. Free-response survey comments and semistructured interview transcripts were analysed by a framework analysis for major themes. Setting:,General practices in rural and remote Queensland. Participants:,Rural GPs in Rural and Remote Metropolitan Classification 4,7 areas of Queensland. Main outcome measure:,The perceptions of rural GPs on the current and future situation of rural procedural medicine. Results:,Major concerns from the survey focused on closure of facilities and downgrading of services, cost and time to keep up skills, increasing litigation issues and changing attitudes of the public. Interviews designed to draw out solutions to help rectify the perceived circumstances highlighted two major themes: ,synergy' between the support from medical teams and community in ensuring ,sustainability' of services. Conclusions:,This article presents a model of rural procedural practice where synergy between staff, resources and support networks represents the optimal way to deliver a non-metropolitan procedural service. The findings serve to remind educators and policy-makers that future planning for sustainability of rural procedural services must be broad-based and comprehensive. [source] | |||||||||||||||||||