Fit for duty: The health status of New South Wales Paramedics

IntroductionParamedics are health care workers who respond to medical emergencies. Paramedics exhibit high rates of injury and illness with markers of poor health. The aims of this study were to explore the self-reported health status of paramedics in New South Wales, Australia, and to compare it with that of the Australian general population and to examine paramedics’ attitudes towards exercise.MethodsIn 2015, paramedics employed by NSW Ambulance were invited to complete a web-based survey composed of the Medical Outcomes Survey Short Form 36 (SF-36), measures of attitudes towards exercise and demographic information. Normative comparator data for the Australian general population (BMI and SF-36 scores) were sourced from the Household Income Labour Dynamics in Australia 2015 survey.ResultsOf the approximately 3,300 paramedics invited to participate, 747 completed the survey (507 male, 240 female).  Mean age and mean years of service were 41.5 ± 9.5 (SD) and 13.6 ± 9.0 respectively. Male paramedics scored higher than females (p<0.001) in the Vitality domain of the SF-36, and regional paramedics had a higher General Health domain score than metropolitan paramedics (p<0.05). Regional male paramedics had higher BMIs than their metropolitan counterparts (28.04 kg/m2 ± 3.99 vs. 26.81 kg/m2 ± 4.67, p = 0.001). Compared to the Australian population, paramedics scored higher in the Physical Function domain (p<0.001) but lower in summary scores for mental and physical health (p<0.001). Paramedics’ BMIs were slightly higher than the general population (27.10 ± 4.30 kg/m2 vs. 26.47 ±5.42, p<0.001). Paramedics reported lack of time, family commitments, and lack of motivation and in regional postings: distance to fitness facilities and shift patterns as barriers to exercise.ConclusionsParamedics scored lower on the SF-36 than the general population, which can indicate a lower health-related quality of life.  High BMI and low SF-36 scores may be related to a perceived inability to engage in regular exercise. Increasing BMI can be associated with the development of markers of poor health. Attention is needed to ensure that paramedics are “fit for duty”.  Ambulance management should foster innovative health promotion programs and paramedics need to recognise and value good health

The effect of 5, 10, and 20 repetition maximums on the recovery of voluntary and evoked contractile properties

Maximal strength training has been reported to emphasize neural adaptations. The main objective of this study was to detect differences in muscle activation between 5, 10, and 20 repetition maximum (RM) sets. Fourteen subjects performed elbow flexion with 5, 10, and 20RM. Subjects were tested for maximum isometric force (maximal voluntary contraction [MVC]), twitch amplitude (peak twitch [Pt]), time to peak twitch (TPT), half relaxation time (1/2 RT), electromyography (EMG), and muscle activation (interpolated twitch). Subjects were tested preexercise and 30 seconds, 1, 2, and 3 minutes postexercise. There were no significant differences in MVC, muscle activation, or antagonist/agonist EMG after 5, 10, or 20RM. However, greater RM did have a greater detrimental effect on twitch properties than fewer RM. Peak twitch was significantly (p = 0.004) less (32.08%) for the 20 than for the 5RM, whereas TPT shortened (p < 0.05) by 7.3 and 11.1% with 10 and 20RM vs. 5RM, respectively. Half relaxation time at 20RM was shortened (p < 0.05) by 20.6 and 25.4% compared with that at 5 and 10RM, respectively. MVC, muscle activation, and temporal twitch properties did not recover within 3 minutes of recovery. In conclusion, whereas 5RM did not produce greater muscle inactivation, twitch contractile properties were affected to a greater degree by a higher number of RM

Comparing maximal mean and critical speed and metabolic powers in elite and sub-elite soccer

The quantification of maximal mean speed (MMS), maximal mean metabolic power (MMP met), critical speed (CS) and critical metabolic power (CP met) was conducted over full A-League (elite) and National Premier League (NPL; sub-elite) seasons. Comparisons were made between levels of soccer competition and playing positions (i. e. centre backs, full backs, central midfielders, wide midfielders and strikers). A symmetric moving average algorithm was applied to the GPS raw data using specific time windows (i. e. 1, 5, 10, 60, 300 and 600 s) and maximal values were obtained. Additionally, these maximal values were used to derive estimates of CS and CP met. Maximal mean values, particularly during smaller time windows (i. e. 1 and 5 s), were greater in A-League match play. Only MMP met1 was identified as being consistently different between competitions (P = \u3c 0.001 – 0.049) in all playing positions. Significance was only observed in CS (P = 0.005) and CP met (P = 0.005) of centre backs between competitions. Centre backs were identified as the least energy demanding playing position. The present findings suggests that both maximal mean and critical analyses are suitable alternatives to common absolute distance and speed assessments of match running performance during competitive matches. © 2020 Georg Thieme Verlag KG StuttgartNew York

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine