Exposição a radiações ionizantes em cirurgia ortopédica num hospital público de Lisboa.

RESUMO - A monitorização individual dos trabalhadores (dosimetria individual) é obrigatória (Decreto Regulamentar n.o 9/90, de 19 de Abril) para os profissionais de saúde que desempenham funções com risco de exposição à radiação X, quando classificados como categoria A. Apesar disso, a exposição a radiações ionizantes é frequentemente pouco, ou mesmo nada, valorizada pelos profissionais de saúde. O presente estudo, realizado no contexto de intervenções cirúrgicas de ortopedia, teve por objectivos: • avaliar a dose de radiação em diferentes zonas durante as cirurgias ortopédicas; • estimar a dose de exposição a radiações ionizantes dos profissionais de saúde, em função das suas posições, predominantemente adoptadas durante o acto cirúrgico; • sensibilizar os profissionais de saúde para a utilização correcta da dosimetria individual e para a adopção das medidas de protecção radiológica. A avaliação do risco foi efectuada através de: 1) medições preliminares com recurso a um fantoma colocado a 50 cm e a 100 cm do eixo central do feixe de radiação e em direcções de 45°, 90° e 135°; 2) medições durante uma cirurgia ortopédica em «localizações » correspondentes às gónadas, ao cristalino e às mãos dos profissionais de saúde intervenientes na cirurgia (ortopedistas, enfermeiros instrumentistas); 3) medições ao nível do topo da mesa (posição do anestesista) e ao nível do comando do equipamento emissor de raios X (técnico de radiologia); 4) determinação do tempo de utilização dos raios X durante as cirurgias ortopédicas; 5) cálculo da estimativa do número anual de cirurgias ortopédicas realizadas, com base nos registos existentes. Assumindo a não utilização de aventais plúmbeos os valores máximos medidos foram de 2,5 mSv/h (ao nível das gónadas), de 0,6 mSv/h ao nível do cristalino e de 1 mSv/ h ao nível das mãos dos ortopedistas e dos enfermeiros instrumentistas (que se situavam próximo do feixe de raios X, a 50 cm do feixe de radiação). A estimativa de exposição anual (dose equivalente) para os profissionais que operam junto ao feixe de radiação X foi de: • Ortopedistas — 20,63 a 68,75 mSv (gónadas), 4,95 a 16,50 mSv (cristalino) e 8,25 a 27,50 mSv (mãos); • Enfermeiros instrumentistas — 130,63 a 151,25 mSv (gónadas), 31,35 a 36,30 mSv (cristalino) e 52,25 a Os profissionais que ocupam posições mais afastadas do feixe (por exemplo: anestesistas) terão doses de radiação mais reduzidas, embora estas possam ainda ser importantes ao nível das gónadas na zona do topo da mesa (anestesista). Conclui-se que a exposição profissional em blocos operatórios pode implicar, em cirurgia ortopédica, a sujeição a níveis de exposição consideráveis, o que permite classificar estes profissionais de categoria A, justificando a utilização obrigatória (e correcta de acordo com as recomendações) da dosimetria individual e a adopção de medidas de protecção radiológica, tantas vezes negligenciadas.

Level of compliance in contact lens wearing medical doctors in Nepal

PURPOSES: To determine the level of compliance and major non-compliant behaviors in contact lens (CL) wearing medical doctors (MDs) and to compare it with age matched CL wearing normal subjects with no medical background (NS). METHODS: Thirty-nine current CL wearing MDs, who were prescribed CLs in Nepal Eye Hospital, Kathmandu, Nepal, between 2007 and 2011, were interviewed on ten modifiable compliant behaviors regarding lens care and maintenance. The level of compliance and the rate of non-compliance for each behavior were determined and compared with NS. RESULTS: Level of compliance was good, average and poor in 35.9%, 48.7% and 15.4% of MDs, respectively. There was no significant difference in compliance between MDs and NS (p=0.209). Level of compliance was not associated with age, gender and duration of lens wear (p>0.05). Compliance rate varied according to different behaviors, achieving a good compliance level of 95% for hand hygiene, avoidance of water contact and not sleeping with lenses. There was poor compliance for topping up solution (53.8%) and lens case replacement (15.4%). CONCLUSION: About one third of MDs had a good level of compliance. Level of compliance and compliance rate of different behaviors were similar in MDs and NS. Periodic lens case replacement was the most neglected behavior in CL wearers for this region.

Promoting hospital-based smoking cessation services at major Swiss hospitals: a before and after study.

Whether a 1-year nationwide, government supported programme is effective in significantly increasing the number of smoking cessation clinics at major Swiss hospitals as well as providing basic training for the staff running them. We conducted a baseline evaluation of hospital services for smoking cessation, hypertension, and obesity by web search and telephone contact followed by personal visits between October 2005 and January 2006 of 44 major public hospitals in the 26 cantons of Switzerland; we compared the number of active smoking cessation services and trained personnel between baseline to 1 year after starting the programme including a training workshop for doctors and nurses from all hospitals as well as two further follow-up visits. At base line 9 (21%) hospitals had active smoking cessation services, whereas 43 (98%) and 42 (96%) offered medical services for hypertension and obesity respectively. Hospital directors and heads of Internal Medicine of 43 hospitals were interested in offering some form of help to smokers provided they received outside support, primarily funding to get started or to continue. At two identical workshops, 100 health professionals (27 in Lausanne, 73 in Zurich) were trained for one day. After the programme, 22 (50%) hospitals had an active smoking cessation service staffed with at least 1 trained doctor and 1 nurse. A one-year, government-supported national intervention resulted in a substantial increase in the number of hospitals allocating trained staff and offering smoking cessation services to smokers. Compared to the offer for hypertension and obesity this offer is still insufficient.

Underreporting of needlestick and sharps injuries among healthcare workers in a Swiss University Hospital.

OBJECTIVES: To determine 1) rates of needlestick and sharps injuries (NSSIs) not reported to occupational health services, 2) reasons for underreporting and 3) awareness of reporting procedures in a Swiss university hospital. MATERIALS AND METHODS: We surveyed 6,367 employees having close clinical contact with patients or patient specimens. The questionnaire covered age, sex, occupation, years spent in occupation, history of NSSI during the preceding twelve months, NSSI reporting, barriers to reporting and knowledge of reporting procedures. RESULTS: 2,778 questionnaires were returned (43.6%) of which 2,691 were suitable for analysis. 260/2,691 employees (9.7%) had sustained at least one NSSI during the preceding twelve months. NSSIs were more frequent among nurses (49.2%) and doctors performing invasive procedures (IPs) (36.9%). NSSI rate by occupation was 8.6% for nurses, 19% for doctors and 1.3% for domestic staff. Of the injured respondents, 73.1% reported all events, 12.3% some and 14.6% none. 42.7% of doctors performing invasive procedures (IPs) underreported NSSIs and represented 58.6% of underreported events. Estimation that transmission risk was low (87.1%) and perceived lack of time (34.3%) were the most common reasons for non-reporting. Regarding reporting procedures, 80.1% of respondents knew to contact occupational health services. CONCLUSION: Doctors performing IPs have high rates of NSSI and, through self-assessment that infection transmission risk is low or perceived lack of time, high rates of underreporting. If individual risk analyses underestimate the real risk, such underreporting represents a missed opportunity for post-exposure prophylaxis and identification of hazardous procedures. Doctors' training in NSSI reporting merits re-evaluation.

Hospital admission counts and rates for injuries in Republic of Ireland, Northern Ireland, England, Scotland and Wales

Number of hospital discharges and age-standardised discharge rates for emergency hospital admissions for injury by sex and type of injury for the following regions and year:Republic of Ireland 2006Northern Ireland 2006England 2006/07Scotland 2006/07Wales 2006 Numbers and rates are based on official hospital statistics from each region. All regions use International Classification of Disease (ICD) version 10 for hospital discharges in these years. Only emergency inpatient hospital spells with an ICD 10 code in the range S000-T739, T750-T759, T780-T789 (in any diagnostic position) and an ICD10 external cause code in the range V01-Y36 (in any diagnostic position) were included. A hospital spell is an unbroken period of time that a person spends as an inpatient in a hospital. The person may change consultant and/or specialty during a spell but is counted only once. See http://www.injuryobservatory.net/analysis-of-inpatient-admissions-data-f... for more details.

Valeur ajoutée de la supervision du médecin-assistant par un médecin de famille dans une permanence [Added value of family practitioners' supervision of junior doctors in a walk-in clinic].

The pending workforce crisis in family medicine has triggered various initiatives. This article describes the PMU-FLON walk-in clinic, a project of the Institute of General Medicine University of Lausanne. The working conditions in this clinic are close to that of a family practice. Doctors in training are supervised by family doctors who work part-time in the clinic. The objective is to improve training in the various fields of family medicine, from technical skills (improving optimal use of diagnostic tools), to integrating patients' requests in a more global patient-centered approach. This new educational model allows doctors in training to benefit from the specific approaches of different trainers. It will contribute to promoting quality family medicine in the future.

Nouveautés thérapeutiques 2008 en médecine interne hospitalière: perspective des chefs de clinique [Highlights 2008 in a university hospital-based internal medicine: the point of view from the chief residents]

Doctors must regularly adjust their patients' care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2008, such as heart failure, diabetes, COPD, and thromboembolic disease. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modem medical practice based on evidence.

Discriminant validity and test-retest reliability of a self-administered Internet-based questionnaire testing doctors' knowledge in evidence-based medicine.

Aims and objectives  This study aimed to determine the discriminant validity and the test-retest reliability of a questionnaire testing the impact of evidence-based medicine (EBM) training on doctors' knowledge and skills. Methods  Questionnaires were sent electronically to all doctors working as residents and chief residents in two French speaking hospital networks in Switzerland. Participants completed the questionnaire twice, within a 4-week interval. The discriminant validity was examined in comparing doctors' performance according to their reported EBM previous training. Proportion of agreement between both sessions of the questionnaire, Cohen's kappa and 'uniform kappa' determined its test-retest reliability. Results  The participation rate was 9.8%/7.1% to first/second session. Performance increased according to the level of doctors' previous training in EBM. The observed proportion of agreement between both sessions was over 70% for 14/19 questions, and the 'uniform kappa' was superior to 0.60 for 15/19 questions. Conclusion  The discriminant validity and test-retest reliability of the questionnaire were satisfying. The low participation rate did not prevent the study from achieving its aims.

Ordonnance de sortie d'hôpital: un défi pour la continuité des soins et la collaboration interprofessionnelle [Hospital's discharge prescription: a challenge for continuity of care and the interprofessional collaboration].

The transition between hospital and community is an interface at high risk for medication. "The Association of Family Doctors" committee in the canton of Vaud (MFVaud), together with community pharmacists' and Homecare representatives, have begun to consider the following improvements: fast and co-ordinated care providers' information; arrangements for family doctors appointments as soon as possible; awareness and education for interprofessional collaboration; more secured preparation of pill boxes; development of interprofessional means such as medication use reviews and reconciliations. In the opinion of all the experts, there is an urgent public health need to act in an interprofessional manner, even if the solutions required (especially change in professional culture and technologies) are not immediate.

Prevalence of Burnout syndrome in health professionals of an onco-hematological pediatric hospital

OBJECTIVE To identify the prevalence of Burnout Syndrome in medical professionals, nurses and nursing technicians working in an Onco-Hematological Pediatric Hospital in São Paulo. METHOD An exploratory, descriptive study with cross-sectional design and quantitative approach, with a sample of 188 health professionals. Data were collected using two self-report instruments: the Maslach Burnout Inventory (MBI-HSS) which is a biosocial data form, and a non-participant observation guide. RESULTS High depersonalization for nurses (29.8%), low job performance for physicians (27.8%), and of nursing technicians (25.5%). High scores were identified in at least two domains of Burnout in 19.2% of nurses, 16.8% of nursing technicians, and 16.6% of doctors. CONCLUSION Health professionals are highly vulnerable to each of the dimensions of Burnout syndrome - namely emotional exhaustion, alienation, and low job performance/satisfaction- in the hospital work.

The last days of dying stroke patients referred to a palliative care consult team in an acute hospital.

BACKGROUND AND PURPOSE: Needs of patients dying from stroke are poorly investigated. We aim to assess symptoms of these patients referred to a palliative care consult team, and to review their treatment strategies. METHODS: All charts of patients dying from stroke in a tertiary hospital, and referred consecutively to a palliative care consultant team from 2000 to 2005, were reviewed retrospectively. Symptoms, ability to communicate, treatments, circumstances and causes of death were collected. RESULTS: Forty-two patients were identified. Median NIH Stroke Scale on admission was 21. The most prevalent symptoms were dyspnoea (81%), and pain (69%). Difficulties or inability to communicate because of aphasia or altered level of consciousness were present in 93% of patients. Pharmacological respiratory treatments consisted of anti-muscarinic drugs (52%), and opioids (33%). Pain was mainly treated by opioids (69%). During the last 48 h of life, 81% of patients were free of pain and 48% of respiratory distress. The main causes of death were neurological complications in 38% of patients, multiple medical complications in 36%, and specific medical causes in 26%. CONCLUSIONS: Patients dying from stroke and referred to a palliative care consult team have multiple symptoms, mainly dyspnoea and pain. Studies are warranted to develop specific symptoms assessment tools in non-verbal stroke patients, to accurately assess patients' needs, and to measure effectiveness of palliative treatments.

Patients' characteristics associated with the decision of "do not attempt cardiopulmonary resuscitation" order in a Swiss hospital.

BACKGROUND: According to Swiss legislation, do not attempt cardiopulmonary resuscitation (DNACPR) order can be made at any time by patients only, unless the resuscitation is considered as futile, based on the doctors' evaluation. Little is known about how this decision is made, and which are the factors influencing this decision. METHODS: Observational, cross-sectional study was conducted between March and May 2013 on 194 patients hospitalized in the general internal medicine ward of a Swiss hospital. The associations between patients' DNACPR orders and gender, age, marital status, nationality, religion, number and type of comorbidities were assessed. RESULTS: 102 patients (53%) had a DNACPR order: 27% issued by the patient him/herself, 12% by his/her relatives and 61% by the medical team. Patients with a DNACPR order were significantly older: 80.7±10.8 vs. 67.5±15.1years in the "with" and "without" DNACPR order group, respectively, p<0.001. Oncologic disease was associated with a DNACPR order issued by the medical team (37.5% vs. 16.9% in the "with" and "without" DNACPR order group, respectively, p<0.05). Being protestant was associated with a DNACPR order issued by the patient (57.9% vs. 25.9% in the "with" and "without" DNACPR order group, respectively p<0.01). CONCLUSIONS: Over half of the patients admitted to a general internal medicine ward had a DNACPR order issued within the first 72h of hospitalization. Older age and oncologic disease were associated with a DNACPR decision by the medical team, while protestant religion was associated with a DNACPR decision by the patient.

Educational sessions in pharmacovigilance: What do the doctors think?

Background: The aim of this study was to determine physicians"opinion regarding pharmacovigilance feedback sessions. A survey was conducted in a teaching hospital, and the physicians who attended the sessions were invited to participate by filling out a structured questionnaire. All sessions included a review of adverse drug reactions identified at the hospital and information on pharmacovigilance issues (news on warnings released by regulatory agencies or drug toxicity problems identified by recently published studies in medical journals). The survey questions were related to the interest, satisfaction, and belief in the utility of the sessions. A Likert scale (0-10 points) was used to assess physicians" opinions. Findings: A total of 159 physicians attended the sessions and 115 (72.3%) participated in the survey. The mean (SD) age was 38.9 (12.1) years, and 72 (62.6%) were men. The mean (SD) scores of interest, satisfaction with the information provided, and belief in the utility of these sessions were 7.52 (1.61), 7.58 (1.46), and 8.05 (1.38) respectively. Significant differences were observed among physicians according to medical category and speciality in terms of interest, satisfaction, and belief in the utility of those sessions. Conclusions: Educational activities for physicians, such as feedback sessions, can be integrated into the pharmacovigilance activities. Doctors who attend the sessions are interested in and satisfied with the information provided and consider the sessions to be useful. Additional studies on the development and effectiveness of educational activities in pharmacovigilance are necessary.

Institutional legacies, employment and professional integration of non EU/EEA doctors in France

Internationally, policies for attracting highly-skilled migrants have become the guidelines mainly used by the Organisation for Economic Co-operation and Development (OECD) countries. Governments are implementing specific procedures to capture and facilitate their mobility. However, all professions are not equal when it comes to welcoming highly-skilled migrants. The medical profession, as a protective market, is one of these. Taking the case of non-EU/EEA doctors in France, this paper shows that the medical profession defined as the closed labour market, remains the most controversial in terms of professional integration of migrants, protectionist barriers to migrant competition and challenge of medical shortage. Based on the path-dependency approach, this paper argues that non-EU/EEA doctors' issues in France derive from a complex historical process of interaction between standards settled in the past, particularly the historical power of medical corporatism, the unexpected long-term effects of French hospital reforms of 1958, and budgetary pressures. Theoretically, this paper shows two significant findings. Firstly, the French medical system has undergone a series of transformations unthinkable in the strict sense of a path-dependence approach: an opening of the medical profession to foreign physicians in the context of the Europeanisation of public policy, acceptance of non-EU/EEA doctors in a context of medical shortage and budgetary pressures. Secondly, there is no change of the overall paradigm: significantly, the recruitment policies of non-EU/EEA doctors continue to highlight the imprint of the past and reveal a significant persistence of prejudices. Non-EU/EEA doctors are not considered legitimate doctors even if they have the qualifications of physicians which are legitimate in their country and which can be recognised in other receiving countries.

Desórdenes músculo-esqueléticos en los trabajadores asistenciales y administrativos de un hospital en Sogamoso, Boyacá, en el 2013

Objetivo: Establecer la relación de las condiciones de trabajo y salud con los desórdenes músculo-esqueléticos (DME) en los trabajadores asistenciales y administrativos de un hospital en Sogamoso, Boyacá, en el 2013. Metodología: Se llevó a cabo un estudio descriptivo con una muestra de 90 trabajadores, correspondiente al 22%, de 405 incluyendo médicos, jefes de enfermería, auxiliar de enfermería, auxiliares administrativos y profesionales administrativos. Se aplicó una encuesta para determinar las condiciones de trabajo y salud y para el análisis de los síntomas de desorden músculo esquelético, junto con la toma de estatura y peso para calcular el índice de masa corporal. En el análisis de las variables cuantitativas se utilizó medidas de tendencia central y dispersión; para las variables cualitativas se calculó frecuencias absolutas y porcentajes. Se realizó pruebas de asociación Chi cuadrado y se estimó las medidas OR crudas y ajustadas por medio de un modelo de regresión binaria logística, con sus respectivos intervalos de confianza. Resultados: La población estuvo conformada por 78 mujeres (86.7%) y 12 hombres (13.3%), con edades entre 24 y 56 años. Los cargos más representativos fueron el Auxiliar Administrativo y el Auxiliar de Enfermería con el 35.6% (32) y 38.9% (35) respectivamente. Los síntomas de DME más frecuentes se ubicaron en la espalda y en mano afectando al 58.9% (53) y 45.6% (41) respectivamente. Según el 93.3% de los participantes, el factor de riesgo biomecánico que tiene alta influencia en los DME es la realización de movimientos repetidos. Se encontró para los Médicos un Odds Ratio (OR) 4.2; de DME, mientras que para los Auxiliares Administrativos tienen un OR 2.9 y presentan mayor posibilidad de padecer DME que un Auxiliar de Enfermería.