Are we ready when needed?

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnHjúkrunarfræðingar og læknar gegna mikilvægu hlutverki í kjölfar hamfara og stórslysa en geta þó verið illa undirbúnir til slíkra starfa. Reynslubundin þekking er lítil og tækifæri til náms og þjálfunar því nauðsynleg. Íslenskar rannsóknir um efnið eru fáar ef nokkrar og því er mikilvægt að byggja upp fræðilegan grunn þar sem horft er til íslenskra aðstæðna. Tilgangur rannsóknarinnar: Að kanna viðhorf hjúkrunarfræðinga og lækna á Sjúkrahúsinu á Akureyri til viðbragðsgetu stofnunarinnar í kjölfar stórslysa og hamfara, að lýsa sýn þeirra á eigið starfshlutverk og kanna viðhorf þeirra til teymisvinnu, þjálfunar og hæfni til starfa í kjölfar stórslysa og hamfara. Rannsóknaraðferð: Notuð var eigindleg aðferð með rýnihópum. Þátttakendum (n=17) var skipt í fjóra 3-5 manna rýnihópa sem valdir voru með tilgangsúrtaki úr hópi hjúkrunarfræðinga og lækna á Sjúkrahúsinu á Akureyri. Viðtölin voru greind með eigindlegri innihaldsgreiningu. Helstu niðurstöður: Hjúkrunarfræðingar og læknar Sjúkrahússins á Akureyri hafa litla reynslu af störfum í kjölfar stórslysa og hamfara og æfingar eru fátíðar. Starfshlutverk eru ekki alltaf skýr en starfsmenn geta þurft að sinna störfum sem þeir gegna ekki venjulega. Skilgreina þarf betur hlutverk stjórnenda og þjálfa starfsmenn í það hlutverk. Hæfni til daglegra starfa nýtist til starfa í stórslysum og hamförum en nauðsynlegt er að bæta hæfni í stjórnun, samvinnu og til að vinna sérhæfð verk. Reglulegar æfingar eru mikilvægar, gjarnan í formi stórslysa- eða verkþáttaæfinga. Ályktanir: Lítil sjúkrahús þurfa að taka tillit til stærðar sinnar við gerð viðbragðsáætlana og gera í þeim greinarmun á eðli og alvarleika atburða. Hlutverk starfsmanna þarf að skýra og skilgreina og þá þarf að þjálfa. Góð almenn starfshæfni nýtist við störf í kjölfar stórslysa og hamfara en sértæka hæfni þarf að þjálfa. Þjálfun þarf að vera regluleg og hana má efla með því að tengja hana inn í daglegt starf. Sérstaka áherslu ætti að leggja á þjálfun stjórnenda sem og á þjálfun í teymisvinnu.Background: Nurses and doctors play an important role after disasters and mass casualty incidents but they are often ill prepared for those roles. Experience-based knowledge is lacking but opportunities for education and training are needed. Few if any Icelandic studies on this topic exist and it is therefore important to build a knowledge base that takes into account the Icelandic environment. Purpose: To explore the views of nurses and doctors at Akureyri Hospital on the ability of the institution to respond to mass casualty incidents and disasters. Furthermore, to capture and describe their views, regarding their professional roles’, attitudes towards teamwork, training and competence, when dealing with such incidents. Method: A qualitative focus group method was used. The members (n=17), in four focus groups of three to five members, were chosen through purposive sampling of doctors and nurses at Akureyri Hospital. The interviews were analyzed according to qualitative content analysis. Results: Nurses and doctors at Akureyri Hospital have little experience working with mass casualty incidents and disasters and training is infrequent. The perception was that their professional roles were not always clear and staff members may have to work on tasks they have no experience with. The administrative role needs to be more clearly defined and the staff needs better training. Skills in daily routines are applicable in cases of mass casualty incidents and disasters but it is necessary to improve administrative skills and teamwork. The importance of regular training of mass casualty incidents and training of skills were emphasized. Conclusion: Small hospitals need to take into account their size when organizing emergency plans and discriminate between incidents according to type and seriousness. Professional roles need to be clarified, defined and trained. Good general practice skills are useful when working with disasters and mass casualties but specific skills need to be trained. Training should be regular and can be increased by linking the training into the daily work. Particular emphasis should be on administrative training and on teamwork trainin

Early home-based recognition of anaemia via general danger signs, in young children, in a malaria endemic community in north-east Tanzania

BACKGROUND: Ethnographic studies from East Africa suggest that cerebral malaria and anaemia are not classified in local knowledge as malaria complications, but as illnesses in their own right. Cerebral malaria 'degedege' has been most researched, in spite of anaemia being a much more frequent complication in infants, and not much is known on how this is interpreted by caretakers. Anaemia is difficult to recognize clinically, even by health workers. METHODS: Ethnographic longitudinal cohort field study for 14 months, with monthly home-visits in families of 63 newborn babies, identified by community census, followed throughout April – November 2003 and during follow-up in April-May 2004. Interviews with care-takers (mostly mothers) and observational studies of infants and social environment were combined with three haemoglobin (Hb) screenings, supplemented with reports from mothers after health facility use. RESULTS: General danger signs, reported by mothers, e.g. infant unable to breast-feed or sit, too weak to be carried on back – besides of more alarming signs such as sleeping all time, loosing consciousness or convulsing – were well associated with actual or evolving moderate to severe anaemia (Hb ≤ 5–8 g/dl). By integrating the local descriptions of danger symptoms and signs, and comparing with actual or evolving low Hb, an algorithm to detect anaemia was developed, with significant sensitivity and specificity. For most danger signs, mothers twice as often took young children to traditional healers for herbal treatment, rather than having their children admitted to hospital. As expected, pallor was more rarely recognized by mothers, or primary reason for treatment seeking. CONCLUSION: Mothers do recognize and respond to symptoms and danger signs related to development of anaemia, the most frequent complication of malaria in young children in malaria endemic areas. Mothers' observations and actions should be reconsidered and integrated in management of childhood illness programmes

Capturing the Essence of Developing Endovascular Expertise for the Construction of a Global Assessment Instrument

AbstractObjectivesTo explore what characterises the development of endovascular expertise and to construct a novel global assessment instrument.DesignLiterature review and an experimental study.Materials and methodsThe literature was searched for information regarding available global rating scales (GRSs); scientific societies’ official statements on endovascular competence; and task analyses of endovascular procedures. In the experimental study, clinicians performed a video-recorded simulated iliac-artery stenting procedure. Subsequently, by using the method of retrospective verbalisation, the clinicians were interviewed while watching their performance on video commenting on key issues of the construct. Data from all sources were analysed, categorised and synthesised into a novel rating scale.ResultsAvailable GRSs primarily included technical aspects of performance, whereas the competence statements, task analyses and clinicians’ perceptions added a range of non-technical aspects. The novel rating scale SAVE (Structured Assessment of endoVascular Expertise) differs from prior scales by including issues of pre-planning; prediction of challenges; preparation of tools; management of imaging presentation; distinction of technical skills into external and internal control according to operator focus of visual attention; adaptation of strategy; clinical decision making; use of assistant; complications; inter-personal skills; and post-procedural planning.ConclusionsThe essence of developing endovascular expertise goes far beyond mere technical aspects

Maps That Represent Animals and Nature

Baš kao i na pravoj karti, svaka planina, svako jezero, svaki grad i svaki ocean nosi svoj naziv. Ali umjesto stvarnih geografskih, imena su dobili prema specifičnostima pojedine prikazane životinje – od različitih podvrsta do fiktivnih likova iz religije, književnosti, filmova. To ilustracijama daje isti učinak koji posjeduje prava karta, u smislu da možete uživati u njima s udaljenosti ili ih možete promatrati izbliza i uočiti sve detalje.Just like an actual map every mountain, every lake, every city and every ocean have all been named. But instead of geographical locations and places, they have all been named after everything relating to each animal depicted, from different subspecies to fictional characters from religion, literature, movies. This gives illustrations the same effect as a real map in the sense that you can enjoy them from a distance or you can walk up close and appreciate all the little details

Karte koje prikazuju životinje i prirodu

Just like an actual map every mountain, every lake, every city and every ocean have all been named. But instead of geographical locations and places, they have all been named after everything relating to each animal depicted, from different subspecies to fictional characters from religion, literature, movies. This gives illustrations the same effect as a real map in the sense that you can enjoy them from a distance or you can walk up close and appreciate all the little details.Baš kao i na pravoj karti, svaka planina, svako jezero, svaki grad i svaki ocean nosi svoj naziv. Ali umjesto stvarnih geografskih, imena su dobili prema specifičnostima pojedine prikazane životinje – od različitih podvrsta do fiktivnih likova iz religije, književnosti, filmova. To ilustracijama daje isti učinak koji posjeduje prava karta, u smislu da možete uživati u njima s udaljenosti ili ih možete promatrati izbliza i uočiti sve detalje

Saleability of Anti-malarials in Private Drug Shops in Muheza, Tanzania: A Baseline study in an era of assumed Artemisinin Ccombination Therapy (ACT).

Artemether-lumefantrine (ALu) replaced sulphadoxine-pymimethamine (SP) as the official first-line anti-malarial in Tanzania in November 2006. So far, artemisinin combination therapy (ACT) is contra-indicated during pregnancy by the national malaria treatment guidelines, and pregnant women depend on SP for Intermittent Preventive Treatment (IPTp) during pregnancy. SP is still being dispensed by private drug stores, but it is unknown to which extent. If significant, it may undermine its official use for IPTp through induction of resistance. The main study objective was to perform a baseline study of the private market for anti-malarials in Muheza town, an area with widespread anti-malarial drug resistance, prior to the implementation of a provider training and accreditation programme that will allow accredited drug shops to sell subsidized ALu. All drug shops selling prescription-only anti-malarials, in Muheza town, Tanga Region voluntarily participated from July to December 2009. Qualitative in-depth interviews were conducted with owners or shopkeepers on saleability of anti-malarials, and structured questionnaires provided quantitative data on drugs sales volume. All surveyed drug shops illicitly sold SP and quinine (QN), and legally amodiaquine (AQ). Calculated monthly sale was 4,041 doses, in a town with a population of 15,000 people. Local brands of SP accounted for 74% of sales volume, compared to AQ (13%), QN (11%) and ACT (2%). In community practice, the saleability of ACT was negligible. SP was best-selling, and use was not reserved for IPTp, as stipulated in the national anti-malarial policy. It is a major reason for concern that such drug-pressure in the community equals de facto intermittent presumptive treatment. In an area where SP drug resistance remains high, unregulated SP dispensing to people other than pregnant women runs the risk of eventually jeopardizing the effectiveness of the IPTp strategy. Further studies are recommended to find out barriers for ACT utilization and preference for self-medication and to train private drug dispensers

Do health systems delay the treatment of poor children? A qualitative study of child deaths in rural Tanzania.

Child mortality remains one of the major public-health problems in Tanzania. Delays in receiving and accessing adequate care contribute to these high rates. The literature on public health often focuses on the role of mothers in delaying treatment, suggesting that they contact the health system too late and that they prefer to treat their children at home, a perspective often echoed by health workers. Using the three-delay methodology, this study focus on the third phase of the model, exploring the delays experienced in receiving adequate care when mothers with a sick child contact a health-care facility. The overall objective is to analyse specific structural factors embedded in everyday practices at health facilities in a district in Tanzania which cause delays in the treatment of poor children and to discuss possible changes to institutions and social technologies. The study is based on qualitative fieldwork, including in-depth interviews with sixteen mothers who have lost a child, case studies in which patients were followed through the health system, and observations of more than a hundred consultations at all three levels of the health-care system. Data analysis took the form of thematic analysis. Focusing on the third phase of the three-delay model, four main obstacles have been identified: confusions over payment, inadequate referral systems, the inefficient organization of health services and the culture of communication. These impediments strike the poorest segment of the mothers particularly hard. It is argued that these delaying factors function as 'technologies of social exclusion', as they are embedded in the everyday practices of the health facilities in systematic ways. The interviews, case studies and observations show that it is especially families with low social and cultural capital that experience delays after having contacted the health-care system. Reductions of the various types of uncertainty concerning payment, improved referral practices and improved communication between health staff and patients would reduce some of the delays within health facilities, which might feedback positively into the other two phases of delay