The latest medical research on Paramedicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about paramedicine gathered by our medical AI research bot.

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The actual status of hospitals as COVID-19 vaccination Clinic in China and safety monitoring of inactivated vaccine: a cross-sectional study.

Disaster Prevention & Management

The outbreak has had a devastating impact, and efforts are underway to speed up vaccination. The study's objective was to describe the clinical characteristics of the COVID-19 vaccination clinic in the Second People's Hospital of Fujian Province, China. Meanwhile, We monitored all the vaccine recipients to evaluate adverse reactions.

A cross-sectional study was done at the COVID-19 Vaccination Clinic, the Second People's Hospital of Fujian Province, China. We systematically collected Clinical data from the COVID-19 vaccination clinic between March 11 and November 11, 2021, including the type of vaccine, number of doses, gender, age, educational level, occupational category, adverse reactions, etc. Investigators will contact vaccine recipients via phone call or WeChat message to record the negative responses. Lastly, this report covers data through 8 months, so it will be better to Evaluate the Safety of two inactivated COVID-19 vaccines from China (BBIBP-CorV (Beijing Institute of Biological Products, Beijing, China) and CoronaVac (Sinovac Life Sciences, Beijing, China)).

The results indicated that the Second People's Hospital of Fujian Province received a total of 64,602 COVID-19 vaccines from March 11 to November 11, 2021, including 34,331 (53.14%) first doses, 29,245 (45.27%) second doses, and 1,026 (1.59%) third doses. This study found the highest proportion in other personnel (38.69% at the first dose, 38.75% at the second dose, and 2.44% at the third dose), who were mainly retirees. People with higher levels of education are more likely to be vaccinated against COVID-19 during the early stages of vaccine rollout. In terms of age stratification, the highest proportion was found among people aged 18-49 (BBIBP-CorV: first dose 61%, second dose 62.6%, and third dose 76.8%; Corona Vac: first dose 66.1%, double dose 63.6%, and third dose 75.5%), followed by those over 60. The common adverse reactions were mainly local and systemic, and there were some differences between the two inactivated vaccines (P<0.05).

This is the first study to analyze the actual status of hospitals as COVID-19 vaccination clinics in China. The hospital has focused on vaccinating citizens and the initial rollout of vaccines to ensure any safety issues are identified. More citizens are willing to vaccinate in hospitals because of the uncertain safety of the available vaccines and adverse reactions. The good news is that vaccine-related severe adverse events have not been found in the hospital vaccination clinic. The Safety of BBIBP-CorV and Corona Vac is relatively high.

Neighborhood Association, Peer Communication, and Self-Assistance Behaviors Against Disaster Among Individuals With Spinal Cord Injury.

Disaster Prevention & Management

Individuals with spinal cord injuries (SCIs) are vulnerable in case of disaster, and it is unknown how they can prepare themselves for such events. This study explored factors associated with self-assistance behaviors against disasters.

An internet-based cross-sectional survey was conducted in Japan. The participants were 70 individuals with SCI in a self-help group in Japan. Self-assistance behaviors against disaster were defined in terms of personal network, escape, information, essential items, disaster drill participation, and list registration. After identifying significant variables through binary analyses, logistic regression analysis was conducted to adjust for age and sex.

Neighborhood association and peer communication significantly predicted list registration (AOR:2.97; 95% CI:1.05 - 8.40; P = 0.04; AOR:2.79, 95% CI:1.00-7.74, P = 0.05). However, no significant factor was found in relation to other self-assistance behaviors against disasters.

Belonging to a neighborhood association and having communication with peers could help individuals with SCI register on a list for assistance during disaster. To promote self-assistance behaviors against disasters, access to neighborhood associations, and opportunities for peer communication should be increased.

Application of Telerehabilitation for Older Adults During the COVID-19 Pandemic: A Systematic Review.

Disaster Prevention & Management

The employment of telerehabilitation in different disciplines, particularly in the rehabilitation of older adults, has grown significantly across the world. In the wake of the COVID-19 outbreak, a chance has arisen to improve the user experience and to draw attention to the advantages of utilizing this service. The current research aimed to evaluate the investigations that utilized telerehabilitation to assist elderly people during the COVID-19 pandemic.

Systematic searches of papers published between September 1, 2019 and 1 December, 2021 were conducted in PubMed, Cochran Library, Web of Science, Scopus, Science Direct, and ProQuest databases. The author narrowed down the list of articles by using search terms. Ultimately, publications from the COVID-19 period were studied for their perspectives on the employment of telerehabilitation among the elderly population. The whole process was supervised by two investigators at the same time.

In total, 2529 articles were included in the first search. Five articles were chosen for further assessment based on the careful consideration of their titles, abstracts, and full texts. Cross-sectional, feasibility, case, and interventional studies comprised 20%, 20%, 20%, and 40% of the papers, respectively. The studies were carried out in Brazil, the United States, Germany, Japan, and South Korea and involved using telerehabilitation for elderly individuals, identification of crucial manifestations and impairments, improving physical function in this population, and ensuring their happiness.

Using a digital strategy for rehabilitation should be regarded as a means of overcoming the field's obstacles. As a result, legislators and rehabilitation groups should consider the employment of telerehabilitation for the elderly population during the COVID-19 pandemic.

A Medical Nebulizer as a Substitute for the OSHA-Approved Nebulizer for Qualitative Fit testing of Respirators During the Respiratory Infectious Pandemics: An Experimental Feasibility Study.

Disaster Prevention & Management

The qualitative fit testing procedure would be challenging due to severe shortages, high cost, and unavailability of commercial fit test kits in the marketplaces during pandemics of respiratory infectious diseases. Assessment of alternatives for commercial fit test kits to be prepared for emergencies is critically required. This study aimed to investigate the feasibility of an alternative of the Accumed NF60 nebulizer for the OSHA-approved Allegro one.

Thirty-two participants were randomly allocated to six filtering facepiece respirators (FFRs). They were qualitatively fit tested by both manual Allegro and automated Accumed NF60 nebulizers.

There was no statistically significant difference between the Allegro and Accumed NF60 nebulizers by passing rates. The odds for passing fit testing using the Accumed NF60 nebulizer was similar to that of the Allegro one [OR=1.0, 95% CI (0.58-1.74)].

The Accumed NF60 nebulizer could be used as a cost-benefit substitute for the standard fit test nebulizers in the pandemic situation where there is a shortage and difficulty of access. It is more convenient, decreases the time investment, and reduces the contact stress in the operators' hands as it does not require squeezing the nebulizer bulb frequently. The test solutions' preparation and fit testing procedures on many personnel are more straightforward, efficient, and hygienic than the Allegro one.

University students' risk perception, protective measures, and general health during the COVID-19 pandemic in Turkey.

Disaster Prevention & Management

This study aimed to investigate university students' risk perception, protective measures, and general health during the COVID-19 pandemic in Turkey.

The research sample consisted of 1920 university students. The data were collected through an online questionnaire.

56.6% of the students considered their risk of being infected with the COVID-19. The number of measures taken by students was lower than expected. Students' increased anxiety perceived individual risk level, insufficient social support perceptions, and their perceptions of the current pandemic more serious than previous epidemics affect the number of measures they take.Students had sleep and study problems, and suicidal thoughts in the social isolation period. Sex, studying in medicine, anxiety related to COVID-19, feeling unconfident in coping with pandemic, social support, were determined to be risk factors regarding general health, sleep and study problems, and suicidal thought.

The results of the study showed that the measures taken by university students were insufficient and the precautions were affected by many factors. It was determined that their health was adversely affected by the pandemic. University administrations and decision-makers should consider the risk factors to improve the students' experiences in such pandemics and emergencies.

Development of an index to assess Covid-19 hospital care installed capacity in the 450 Brazilian Health Regions.

Disaster Prevention & Management

The article seeks to assess the Brazilian health system ability to respond to the challenges imposed by the Covid-19 pandemic by measuring the capacity of Brazilian hospitals to care for Covid-19 cases in the 450 Health Regions of the country during the year 2020. Hospital capacity refers to the availability of hospital beds, equipment, and human resources.

We used longitudinal data from the National Register of Health Facilities (CNES) regarding the availability of resources necessary to care for patients with Covid-19 in inpatient facilities (public or private) from January to December 2020. Among the assessed resources are health professionals (certified nursing assistants, nurses, physical therapists, and doctors), hospital beds (clinical, intermediate care, and intensive care units), and medical equipment (CT scanners, defibrillators, ECG monitors, ventilators, and resuscitators). In addition to conducting a descriptive analysis of absolute and relative data (per 10,000 users), a synthetic indicator named Installed Capacity Index (ICI) was calculated using the multivariate principal component analysis technique to assess hospital capacity. The indicator was further stratified into value ranges to understand its evolution.

There was an increase in all selected indicators between January and December 2020. It was possible to observe differences between the Northeast and North regions and the other regions of the country; most Health Regions presented low ICI. The ICI increased between the beginning and the end of 2020, but this evolution differed among Health Regions. The average increase in the ICI was more evident in the groups that already had considerably high baseline capacity in January 2020.

It was possible to identify inequalities in the hospital capacity to care for patients affected by Covid-19 in the Health Regions of Brazil, with a concentration of low index values in the Northeast and North of the country. As the indicator increased throughout the year 2020, inequalities were also observed. The information here provided may be used by health authorities, providers, and managers in planning and adjusting for future Covid-19 care and in dimensioning the adequate supply of hospital beds, health care professionals, and devices in Health Regions to reduce associated morbidity and mortality. We recommend that the ICI continue to be calculated in the coming months of the pandemic to monitor the capacity in the country's Health Regions.

Survival Evaluation of Hospitalized COVID-19 Patients with Cox Frailty Approach.

Disaster Prevention & Management

The survival cox analysis is becoming more popular in time to-event data analysis. When there are unobserved/unmeasured individual's factors, then the results of this model may not be reliable. So, this study aimed to determine the factors associated with covid-19 patient's survival time with considering frailty factor.

This study conducted at one of the hospitals in Iran. So that, hospitalized patients with confirmed COVID-19 were included. Epidemiological, clinical, laboratory and outcome data on admission were extracted from electronic medical records. Gamma-frailty Cox model was used to identify the effects of the risk factors.

360 patients with COVID-19 enrolled in the study. The median age was 74 years (IQR 61-83); 903 (57·7%) were men and 661 (42·3%) were women, the mortality rate was 17%. The cox frailty model showed that there is at least a latent factor in the model (P = 0.005). Age and platelet count were negatively associated with the length of stay, while red blood cell count was positively associated with the length of stay of patients.

The frailty cox model indicates that in addition to age, the frailty factor is a useful predictor of survival in coved-19 patients.

A framework for nursing practice in rural and remote Canada.

Rural and Remote Health

Despite the increased understanding of Canadian rural and remote nursing practice in the past two decades, a synthesis of nursing frameworks to guide practice has been missing from the literature. In this article, the process undertaken to develop a nursing practice framework is described. The purpose of the project was to integrate existing rural and remote nursing evidence into a framework to guide rural nursing practice; inform the actions of rural communities, other health professionals, educators, policymakers and regulators; and support the health of Canadian residents who live in rural and remote areas.

Two consultants (DE, JK) worked with the Canadian Association for Rural & Remote Nursing (CARRN) Executive to plan and implement a process to develop a rural and remote nursing framework. An external advisory group, representing regulated nurses, and six expert rural nursing researchers were invited to critique project outcomes. A focused international review of the literature was conducted to determine which rural nursing frameworks existed. Electronic database platforms (ProQuest and the Cumulative Index of Allied Health Literature and Medline) were searched, with literature limited to English-only articles. Each article was analyzed to determine relevant key components and elements.

The literature review generated 22 full-text articles that were analyzed and synthesized into five main categories: larger society/determinants of health, role of place/the rural or remote context, rural and remote peoples/communities, rural and remote nursing, and health outcomes. A draft document describing the creation of the framework and two different graphic designs of the framework were developed, then sent to the advisory group for critique. All critiques were reviewed and the document was revised as appropriate. The framework design, which used concentric circles to depict relationships between the five identified categories, was selected by a majority of the advisory group reviewers as being representative of their practice and experience.

It is envisioned that, by using the framework, practicing nurses can identify the tightly woven interconnections within the rural context affecting the health of their clients. Nursing assessments and practice can then be strengthened from consideration of the framework. Nursing programs with dedicated rural nursing content potentially could incorporate the rural and remote nursing practice framework document into classroom and clinical discussions. Due to resource and time restrictions, Indigenous and Francophone nurses were not part of the framework discussions, nor were community members living in rural or remote Canada. Ongoing critique from relevant rural groups will be beneficial for future input and revisions. CARRN is developing a knowledge mobilization strategy to begin this process.

A systematic review and qualitative analysis of geriatric models of care for rural and remote populations.

Rural and Remote Health

Much is known about the healthcare needs of rural and remote communities; however, understanding how to best deliver geriatric models of care in these settings has received less attention. The purpose of this systematic review was to identify necessary key components of existing models of geriatric care serving rural or remote populations.

A systematic literature review was conducted using MEDLINE, CINAHL and EMBASE databases to identify articles that described models of geriatric care serving rural or remote populations. A qualitative case study and key component analysis approach was used to identify necessary model components.

Eight articles were included. We identified eight distinct components that may improve the successful delivery of models of geriatric care serving rural or remote populations. Environmental assessments were done in six of eight models. Model integration with the local healthcare system, local provider leadership, and local provider education in geriatrics were present in five of eight models. Three of eight models used high-risk screening principles and included geriatrician consultation. One model described active community engagement, and one used telemedicine.

Future geriatric care delivery models designed to serve rural or remote populations are encouraged to use an evidence-based framework based on eight distinct model characteristics found in the literature that aim to support the ideal provision of effective and accessible geriatric medical care.

Terrorist Attacks Against Performing Arts Venues: Global Trends and Characteristics Spanning 50 Years.

Prehosp Disaster Med

In fostering community and culture through entertainment in shared spaces, performing arts venues have also become targets of terrorism. A greater understanding of these attacks is needed to assess the risk posed to different types of venues, to inform medical disaster preparedness, to anticipate injury patterns, and to reduce preventable deaths.

A search of the Global Terrorism Database (GTD) was conducted from the year 1970 through 2019. Using pre-coded variables for target/victim type and target subtype, attacks involving "business" and "entertainment/cultural/stadium/casino" were identified. Attacks targeting performing arts venues were selected using the search terms "theater," "theatre," "auditorium," "center," "hall," "house," "concert," "music," "opera," "cinema," and "movie." Manual review by two authors was performed to confirm appropriateness for inclusion of entries involving venues where the primary focus of the audience was to view a performance. Descriptive statistics were performed using R (version 3.6.1).

A total of 312 terrorist attacks targeting performing arts venues were identified from January 1, 1970 through December 31, 2019. Two-hundred nine (67.0%) attacks involved cinemas or movie theaters, 80 (25.6%) involved unspecified theaters, and 23 (7.4%) specifically targeted live music performance venues. Two-hundred thirty-four (75.0%) attacks involved a bombing or explosion, 50 (16.0%) damaged a facility or infrastructure, and 17 (5.4%) included armed assault. Perpetrators used explosives in 234 (75.0%) attacks, incendiary weapons in 50 (16.0%) attacks, and firearms in 19 (6.1%) attacks. In total, attacks claimed the lives of 1,307 and wounded 4,201 persons. Though fewer in number, attacks against music venues were responsible for 29.4% of fatalities and 35.0% of those wounded, and more frequently involved the use of firearms. Among 95 attacks falling within the highest quartile for victims killed or wounded (>two killed and/or >ten wounded), 83 (87.4%) involved explosives, seven (7.4%) involved firearms, and three (3.2%) involved incendiary methods.

While uncommon, terrorist attacks against performing arts venues carry the risk for mass casualties, particularly when explosives and firearms are used.

Making Space to Save Lives: A Critical Role for the Hospitalist During Mass Casualty Incidents.

Disaster Prevention & Management

An effective hospital response to mass casualty incidents (MCIs) requires rapid mobilization of personnel capable of caring for critically ill trauma patients and availability of resuscitation resources.

Hospitals facing an MCI wrestle with the challenge of immediately adjusting their overextended clinical operations to resuscitate a large number of rapidly arriving patients without compromising the care of existing patients.

Hospitalists are well positioned to add significant value by off-loading the emergency department (ED) given their broad clinical expertise. We describe our institution's protocol to generate immediate and sustained surge capacity by integrating our hospitalist service into MCI response.

Our protocol details the safe and rapid transfer of care of existing ED patients to hospitalist teams to make ED staff and space available to care for incoming MCI patients.


Disaster Prevention & Management

The COVID-19 pandemic has seen health systems adapt and change in response to local and international experiences. This paper describes the experiences and learnings by the Central Adelaide Local Health Network (CALHN) in managing a campaign style, novel public health disaster response.

Disaster preparedness has focussed on acute impact, mass casualty incidents. In early 2020 CALHNs largest hospital the Royal Adelaide Hospital (RAH) was appointed as the state primary COVID-19 adult receiving hospital. Between the period of 1st February 2020 when the first COVID-19 positive patient was admitted, through to 31st December 2020 the RAH had admitted 146 inpatients with COVID-19, 118 admitted to our hospital in the home service, 18 patients admitted to Intensive Care and four patients died whilst inpatients. During this time CALHN has sustained an active (physical and virtual) Network Incident Command Centre (NICC) supported by a Network Incident Management Team (NIMT).

This paper describes our key lessons learnt in relation to the management of a campaign style disaster response including the importance of disaster preparedness, fatigue management and communication. Also described were the challenges of operating in a command model and the role of exercising and education and an overview of our operating rhythm, how we built capability and lessons management.

Undertaking a longer duration disaster response, relating to the COVID-19 pandemic has shown that whilst traditional disaster principles still are important there are many nuances that need to be considered to retain a proportionate response. Our key lessons have revolved around the key tenants of disaster management, communication, capability, and governance.