Antioxidant enzymes, occupational stress and burnout in workers of a prehospitalary emergency service.

BACKGROUND: Reactive oxygen species (ROS) play an important role in many diseases and aging. Scavenging enzymes represent one of several natural defence mechanisms against ROS-induced damage. Superoxide dismutase (SOD) and catalase are enzymes that are involved in antioxidant defence. Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. OBJECTIVES: To determine the activity of two antioxidant enzymes, SOD and catalase, and their variation according to demographic and occupational variables in workers of a prehospitalary emergency service, and to analyse the relationship between antioxidant enzyme activities and burnout 111 healthy workers of a prehospitalary emergency service were surveyed. METHODS: SOD activity was analysed by the Minami and Yoshikawa method. Catalase activity was measured by the method of Aebi. To measure burnout, the Maslach Burnout Inventory was used. RESULTS: No significant variations with respect to sex were detected in SOD and catalase activities and levels of burnout. Significant differences in SOD activity between the control group and workers of a prehospitalary emergency service (P<0.001) were found. SOD activity was higher in workers on night and evening shifts (P<0.001). These workers also obtained higher scores in burnout subscales, but without statistical significance.     

Gender and occupational role differences in work-related post-traumatic stress symptoms,burnout and global functioning in emergency healthcare workers

ObjectivesTo explore gender and occupational role impact on work-related Post-Traumatic Stress Symptoms, Post-Traumatic Stress Disorder, burnout and global functioning in a sample of emergency healthcare workers.DesignA cross-sectional study.Participants/setting126 healthcare workers of the Emergency Department, including Intensive Care Unit, Emergency Room and Emergency Medicine, of a major University Hospital in central Italy were recruited.Main outcome measuresParticipants were assessed by means of the: Trauma and Loss Spectrum-Self Report (TALS-SR) to explore Post-Traumatic Stress Spectrum Symptoms, Professional Quality of Life (ProQOL) Scale to assess Compassion Satisfaction, Burnout and Compassion Fatigue and Work and Social Adjustment Scale (WSAS) to measure global functioning.ResultsThe present findings showed females were more prone to develop Post-Traumatic Stress Symptoms, particularly re-experiencing (p = .010) and hyperarousal (p = .026) symptoms and medical doctors reporting higher Burnout (p < .001) and lower Compassion Satisfaction (p = .009) mean scores than nurses. Higher levels of functioning impairment emerged amongst medical doctors rather than nurses, in both social (p = .029) and private (p = .020) leisure activities. Linear correlations highlighted relationships between the TALS-SR, ProQOL and WSAS scores. Finally, medical doctor status was significantly associated with lower Compassion Satisfaction (p = .029) and higher Burnout (p = .015).ConclusionOur results highlight high post-traumatic stress symptoms and burnout levels in emergency healthcare workers with a relevant impact of female gender and occupational role, supporting the need for preventive strategies, also in light of the current COVID-19 pandemic.     

Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service

Background

Hypoxemia may occur during rapid sequence intubation (RSI). This study establishes the incidence of this adverse event in patients intubated by physicians in a helicopter emergency service in Norway.

Methods

This was a prospective, observational study of all RSIs performed by helicopter emergency service physicians during a 12-month period. Hypoxemia was defined as a decrease in Spo₂ values to below 90% or a decrease of more than 10% if the initial Spo₂ was less than 90%.

Results

A total of 122 prehospital intubations were performed during the study period. Spo₂ data were available for 101 (82.8%) patients. Hypoxemia was present in 11 (10.9%) patients.

Conclusions

Prehospital, RSI-related hypoxemia rates in this study are lower than reported rates in similar studies and are comparable with in-hospital rates. Prehospital RSI may accordingly be considered a safe procedure when performed by experienced physicians with appropriate field training.     

Initial emergency medical dispatching and prehospital needs assessment: a prospective study of the Swedish ambulance service.

OBJECTIVES: To evaluate the setting of priorities and patients' need for the ambulance service. METHODS: A prospective, consecutive study was conducted during a 6-week period. The ambulance staff completed a questionnaire assessing each patient's need for prehospital care. In addition to the questionnaire, data were extracted from the ambulance medical records for each case. RESULTS: The study included 1977 ambulance assignments. The results show that there is a substantial safety margin in the priority assessments made by the emergency medical dispatch operators, where the ambulance staff support the safety margin for initial priorities, despite the lack of at-the-scene confirmation. At-the-scene assessments indicated that 10% of all patients had potentially life-threatening conditions or no signs of life, but the advanced life support units were not systematically involved in these serious cases. The results even showed that one-third of the patients for whom an ambulance was assigned did not need the ambulance service according to the assessment made by the ambulance staff. CONCLUSION: Using the criteria-based dispatch protocol, the personnel at the emergency medical dispatch centres work with a safety margin in their priority assessments for ambulance response. Generally, this 'overtriage' and safety margin for initial priority settings were supported as appropriate by the ambulance staff. According to the judgement of the ambulance staff, one-third of all the patients who were assigned an ambulance response did not require ambulance transport.     

Effect of physician-staffed helicopter emergency medical service on blunt trauma patient survival and prehospital care.

OBJECTIVE: The aim of the study was to assess the immediate and long-term effect of a helicopter emergency physician giving advanced life support on-scene compared with conventional load and go principle in urban and rural settings in treating blunt trauma patients. METHODS: In a retrospective study, 81 blunt trauma patients treated prehospitally by a physician-staffed helicopter emergency medical service were compared with 77 patients treated before the era of the helicopter emergency medical service. The data were collected in the prehospital and hospital files and a questionnaire was sent to the survivors 3 years after the trauma. RESULTS: The physicians treated the patients more aggressively (gave drugs, intubated and cannulated) and had the patients transported directly to a university hospital. The given treatment did not delay arrival at the hospital. No statistically significant difference was found, but a trend (P = 0.065) to lower survival in the helicopter emergency medical service group. Almost half of the deaths in the helicopter emergency medical service group and none in the control group, however, occurred in the emergency department. No difference was found 3 years later between the groups in the health-related quality of life or decrease in the income owing to the accident. CONCLUSION: The physicians treated the patients more aggressively, but it did not delay the arrival at the hospital. A beneficial effect of this aggressive treatment or direct transport to a university hospital could not be seen in the immediate physiological parameters or later health-related quality of life. The physician-staffed helicopter emergency medical service was not beneficial to blunt trauma patients in this setting.     

Duration and type of prehospital emergency therapy.

Prehospital on-scene time (OST) has only been recorded sporadically and has not been related to different types of therapy. In order to create a reference standard for a European emergency medical system involving field stabilization (FS) by physicians, a retrospective analysis was performed of 639 consecutive missions over 81 months in relation to the extent of therapy evaluated by the Emergency Therapy Index (ETI). An OST was not registered in ETI-0-2. The median OST in ETI-3 was 14.0 minutes, slightly increasing with mission grade to 19.5 minutes in ETI-6, and then suddenly increasing to 23.5 minutes in cases of intubation (ETI-7) and to 26.0 minutes when cardiopulmonary resuscitation was performed with subsequent admission (ETI-8). A variety of prehospital therapy is demonstrated. The study supports the view that only exceptional conditions can justify an OST exceeding 20 minutes in ETI-3-4, 24 minutes in ETI-5-6 and 33 minutes in ETI-7.     

Lipid peroxidation in stroke patients.

BACKGROUND: Paraoxonase is high-density lipoprotein (HDL)-associated esterase/lactonase implicated to play a role in the antioxidant and anti-inflammatory properties exerted by HDL. Increasing evidence support a role of free radicals and oxidative stress in neuronal damage induced by ischemia-reperfusion. The aim of this study was to further investigate the relationship between lipoprotein oxidative damage and stroke. METHODS: We compared the paraoxonase activity and levels of lipid hydroperoxides in plasma isolated from healthy subjects (n=50) and from stroke patients (n=49). Moreover, the correlations between biochemical markers and the National Institute of Health Stroke Scale (NIHSS), which is widely used to study neurological severity, were evaluated. RESULTS: Our results demonstrated, for the first time, that the activity of paraoxonase in plasma of stroke subjects was significantly lower than controls (p<0.001) and the levels of lipid hydroperoxides were significantly higher in plasma from patients (p<0.001). Moreover, using linear regression analysis, significant correlations between the activity of paraoxonase, lipid peroxidation and the severity of neurological deficit at admission were observed. CONCLUSIONS: These results provide further evidence that oxidative stress and impairment of the antioxidant system may play a role in stroke. Antioxidant activity of plasma may be an important factor providing protection from neurological damage caused by stroke-associated oxidative stress.     

急诊手术室护士疲劳症状调查及干预措施分析

目的：研究急诊手术室护士的职业压力状况,寻求缓解或排除其压力的方法。方法：采用量表法来客观表达急诊手术室护士身心受压的情况。结果：经过适当干预,急诊手术室护士抑郁自评量表、焦虑自评量表、护士职业压力源量表和护士疲劳综合征量表评分明显降低,有统计学差异。结论：护理管理中应充分重视应对手术室护士的职业压力,采取合理的干预措施,营造一个融洽、和谐的工作环境,促其身心健康发展。     

院前急救在医学中的作用

现代医学进步的一个显著标志是急危重患者救治水平的提高,同时衡量一个医院的整体医疗水平,往往也是看其危重患者的处理结果。国际上先进国家建立了急救医疗服务体系(EMSS)即将院前急救-急诊室急救-24 h救治形成一个完整体系[1]。这是急救医学的一大进步,是社会发展的必然趋势。院前急救是     

Delayed mobilization of the emergency physician in prehospital missions.

A retrospective analysis of 118 prehospital missions involving vitally important therapy (anaesthesia or resuscitation with admission) was carried out. Primary mobilization of the emergency physician (EP) (i.e. before arrival of the rescue ambulance) was carried out by the alarm dispatch centre in only 36% of these missions. In the 74 missions utilizing secondary alarm (i.e. request for the EP after the arrival of the ambulance), detrimental delay of 8 minutes or more was found in 30%. In two of the 27 missions of cardiopulmonary resuscitation with subsequent admission, the physician was only mobilized after the patient developed cardiac arrest during unescorted transport although acute myocardial infarction had been suspected prior to transport. The observations suggest that an improved assessment of possible involvement of an EP is necessary, both at the alarm central and the emergency site. Moreover, continued monitoring (quality control) of this delay is necessary.     

急诊科护士职业创伤后应激障碍的调查研究

[目的]了解长沙市三级综合性医院急诊科护士创伤后应激障碍水平.[方法]采用整群抽样法选取调查长沙市7所三级综合性医院的急诊科护士,调查问卷包括基本情况调查表和创伤后应激障碍自评量表,对调查结果行统计学分析.[结果]长沙市三级综合性医院急诊科护士创伤后应激障碍阳性率为19.7%,年龄、健康状况、急诊护龄影响急诊科护士创伤后应激障碍水平.[结论]长沙市三级综合性医院急诊科护士创伤后应激障碍水平较高.作为管理者要关心和爱护护士,提高管理水平;作为急诊科护士,更应不断提高心理承受能力,有意识地调节好身心状态.     

Lipid peroxidation and antioxidant status in experimental diabetes.

Oxidative stress is currently suggested as a mechanism underlying diabetes. The present study was designed to evaluate the oxidative stress related parameters in streptozotocin-induced diabetes in rats using different complementary approaches: susceptibility to in vitro oxidation (lipid peroxidation induction in liver homogenate, red blood cells hemolysis), blood antioxidant status (total antioxidant capacity by two approaches), and plasma isoprostane measurement, a new marker of lipid peroxidation in vivo. We have shown that induced liver thiobarbituric acid reactive substances increased after 4 weeks of diabetes, in spite of increased liver vitamin E content. Red blood cells hemolysis was significantly delayed after 4 weeks of diabetes. Plasma antioxidant capacity (AOC) tended to increase after 4 weeks of diabetes and was correlated with plasma vitamin E levels. Total antioxidant activity (TAA) significantly decreased after 1 week and a significant correlation was observed with plasma albumin levels. Plasma isoprostane (8-epiprostaglandinF2alpha) concentrations were not modified significantly 1 week or 4 weeks after the induction of diabetes. Levels of vitamin E in the diet and changes in its distribution among the body seems to play an important role in the development of oxidative stress during diabetes and its consequences.     

Lipid peroxidation biomarkers for evaluating oxidative stress and assessing antioxidant capacity in vivo

Recently, the biological roles of lipid peroxidation products have received a great deal of attention not only for elucidating pathological mechanisms but also for practical clinical applications as biomarkers. In the last 50 years, lipid peroxidation has been the subject of extensive studies from the viewpoints of mechanisms, dynamics, product analysis, involvement in diseases, inhibition, and biological signaling. Lipid hydroperoxides are formed as major primary products, but they are substrates for various enzymes and they also undergo various secondary reactions. During this decade, hydroxyoctadecadienoic acid from linoleates, F₂-isoprostanes from arachidonates, and neuroprostanes from docosahexanoates have been proposed as biomarkers for evaluating oxidative stress in vivo and its related diseases. The implications of lipid peroxidation products in vivo will be briefly reviewed and their practical applications will be discussed.