Subjectivity About Turnover Intention Among Male Nurses in South Korea: A Q-Methodological Study

Purpose

Around the world, male nurses face a variety of difficulties within clinical settings; accordingly, a large number of male nurses consider changing their occupation. In particular, male nurses in a number of Asian countries with a Confucian heritage experience difficulties. Thus, the purpose of this study was to explore individual differences in turnover intention among male nurses in one such country, South Korea, and on that basis to suggest concrete strategies for reducing turnover among male nurses in Confucian cultures.

日本患者图书馆概述

基于“阅读”在患者康复过程中的重要作用,介绍了日本患者图书馆的历史、现状、服务形式、服务业务、服务对象以及人才培养方法,相关团体和个人的积极带动,以推动我国医院患者图书馆的建立和发展。     

Airway ultrasound for the confirmation of endotracheal tube placement in cadavers by military flight medic trainees – A pilot study

Objective

Confirming correct endotracheal tube (ETT) placement is a key component of successful airway management. Ultrasound (US) as a tool for the confirmation of ETT placement has been investigated in the hospital setting but not in the pre-hospital setting. We hypothesized that after a short educational session, military flight medic trainees would be able to accurately identify ETT placement in a cadaver model.

现代医学主要困境的重要根源与出路

现代医学在迅猛发展、取得巨大成就的同时,正面临着一些困境和难题。人们在不断反思后发现,长期对医学的片面认识是现代医学面临一系列困境和难题的根源之一;探寻走出现代医学困境的根本出路之一,就是消除公众对医学和健康的片面认识,其关键就是重塑医学人才多维视野能力和素质。这既是走出现代医学困境、促进医学模式转变、满足人们健康需求日益增长的客观需要,也是未来医学人才培养的必然要求。     

The feasibility of implementing an evidence-based physical training program during a Canadian Armed Forces basic infantry course

ObjectivesDetermine the feasibility of implementing an evidence-based training program compared to a control during a basic infantry training course, and compare their effectiveness on measures of injuries and associated burdens.DesignProspective, cohort, feasibility study.MethodsInfantry candidates awaiting course between 01-April-2019 and 31-March-2020 were invited to participate while those releasing from the military, awaiting occupational transfer or having >5 medical employment limitation days were excluded. Consenting participants were allocated to an infantry course prospectively scheduled to host either the evidence-based program or a control. The evidence-based program adapted modified physical training strategies from previous studies reporting reduced injuries in recruits and was supervised by certified fitness professionals, while the control was at the discretion of infantry instructors.ResultsWith the exception of intervention duration which was limited due to operational factors, all feasibility outcomes were met including a recruitment rate of 171/203 = 84.2% and an intervention adherence of 126/144 = 87.5%. Stakeholders reported that the evidence-based program implementation was feasible, posing a manageable demand on resources without compromising operations. Evidence-based program participants reported 68% fewer overuse musculoskeletal injuries, 296 fewer medical employment limitation days and 11 fewer attritions than control participants.ConclusionsAn evidence-based training program is feasible to implement on a basic infantry training course, and results in fewer musculoskeletal injuries, medical employment limitation days and attrition. Given these results, this program should be generalizable for a full experimental trial, and may be scaled for intermediate/advanced infantry and/or other combat occupation courses to promote an evolution towards evidence-based training.     

Sex and occupation are salient factors associated with lateral ankle sprain risk in military tactical athletes

ObjectivesTo assess the risk of lateral ankle sprain (LAS) in male and female tactical athletes across different military occupations in the US military.DesignRetrospective cohort.MethodsThe Defense Medical Epidemiology Database was queried for the number of individuals with ICD-9 diagnosis codes 845.00 (sprain of ankle, unspecified) and 845.02 (calcaneofibular ligament sprain) on their initial encounter from 2006 to 2015. Relative risk (RR) and chi-square statistics were calculated assessing sex and occupational category on LAS risk.Results272,970 enlisted males (27.9 per 1000 person-years), 56,732 enlisted females (34.5 per 1000 person-years), 24,534 male officers (12.6 per 1000 person-years), and 6020 female officers (16.4 per 1000 person-years) incurred a LAS. Enlisted females in all occupational groups were at significantly higher risk for LAS than their male counterparts (RR 1.09–1.68; p < 0.001), except for Engineers (p = 0.15). Female officers had consistently higher risk for LAS in all occupational groups (RR 1.10–1.42; p < 0.001) compared with male officers, except Ground/Naval Gunfire (p = 0.23). Contrasted with Infantry, enlisted tactical athletes in the Special Operations Forces, Mechanized/Armor, Aviation, Maintenance, and Maritime/Naval Specialties were at lower risk (RR 0.38?0.93; p < 0.001), Artillery, Engineers, and Logistics Specialties were at higher risk (RR 1.04–1.18; p < 0.001), and Administration, Intelligence, and Communications were no different (p = 0.69). Compared with Ground/Naval Gunfire officers, Aviation officers were at significantly lower risk (RR, 0.75; p < 0.001), and Engineers, Maintenance, Administration, Operations/Intelligence, and Logistics officers were at higher risk (RR, 1.08–1.20; p < 0.001).ConclusionsSex and military occupation were salient factors associated with LAS risk.     

Effect of Physician Delegation to Other Healthcare Providers on the Quality of Care for Geriatric Conditions

The quality of care of older adults in the United States has been consistently shown to be inadequate. This gap between recommended and actual care provides an opportunity to improve the value of health care for older adults. Prior work from the Assessing Care of Vulnerable Elders (ACOVE) investigators first defined, and then sought to improve, clinical practice for common geriatric conditions. A critical component of the ACOVE intervention for practice improvement was an emphasis on the delegation of specific care processes, but the independent effect of delegation on the quality of care has not been evaluated. This study analyzed the pooled results of prior ACOVE projects from 1998 to 2010. Totaled, these studies included 4,776 individuals aged 65 and older of mixed demographic backgrounds and 16,204 ACOVE quality indicators (QIs) for three geriatric conditions: falls, urinary incontinence, and dementia. In unadjusted analyses, QI pass probabilities were 0.36 for physician‐performed tasks, 0.55 for nurse practitioner (NP)‐, physician assistant (PA)‐, and registered nurse (RN)‐performed tasks; and 0.61 for medical assistant– and licensed vocational nurse–performed tasks. In multiply adjusted models, the independent pass‐probability effect of delegation to NPs, PAs, and RNs was 1.37 (P = .05). These findings suggest that delegation of selected tasks to nonphysician healthcare providers is associated with higher quality of care for these geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions in older adults.     

应用2014西雅图心电图判读标准筛查部队心血管高危患者的可行性研究

目的：探讨部队心血管高危患者筛查方法,以减少高强度军事训练中急性心血管事件乃至猝死的发生。方法采用问卷调查、查体、12导联心电图和心脏彩色多普勒超声综合筛选法对参加军事训练的320名官兵进行健康体检。分别依据2014西雅图心电图判读标准(西雅图组)、美国心脏学会(AHA)标准(AHA 组)以及二者综合判断(综合组),进行心血管高危患者筛查。比较各组筛查敏感性、特异性及阳性预测值、阴性预测值,并绘制受试者工作特征(ROC)曲线,计算曲线下面积。结果西雅图组和综合组筛查敏感性高于 AHA 组,且西雅图组筛查特异性高于其余两组,差异均有统计学意义(P <0．05);阳性预测值西雅图组较高,阴性预测值综合组较高。西雅图组、综合组 ROC 曲线下面积均高于 AHA 组,差异均有统计学意义(P <0．05)。结论采用2014西雅图心电图判读标准预测部队心血管高危患者优于 AHA 标准,联合应用两种方法有助于提高筛查的敏感性。