Spatial-time analysis of cardiovascular emergency medical requests: enlightening policy and practice

Background: Response time to cardiovascular emergency medical requests is an important indicator in reducing cardiovascular disease (CVD) -related mortality. This study aimed to visualize the spatial-time distribution of response time, scene time, and call-to-hospital time of these emergency requests. We also identified patterns of clusters of CVD-related calls. Methods: This cross-sectional study was conducted in Mashhad, north-eastern Iran, between August 2017 and December 2019. The response time to every CVD-related emergency medical request call was computed using spatial and classical statistical analyses. The Anselin Local Moran's I was performed to identify potential clusters in the patterns of CVD-related calls, response time, call-to-hospital arrival time, and scene-to-hospital arrival time at small area level (neighborhood level) in Mashhad, Iran. Results: There were 84,239 CVD-related emergency request calls, 61.64% of which resulted in the transport of patients to clinical centers by EMS, while 2.62% of callers (a total of 2218 persons) died before EMS arrival. The number of CVD-related emergency calls increased by almost 7% between 2017 and 2018, and by 19% between 2017 and 2019. The peak time for calls was between 9 p.m. and 1 a.m., and the lowest number of calls were recorded between 3 a.m. and 9 a.m. Saturday was the busiest day of the week in terms of call volume. There were statistically significant clusters in the pattern of CVD-related calls in the south-eastern region of Mashhad. Further, we found a large spatial variation in scene-to-hospital arrival time and call-to-hospital arrival time in the area under study. Conclusion: The use of geographical information systems and spatial analyses in modelling and quantifying EMS response time provides a new vein of knowledge for decision makers in emergency services management. Spatial as well as temporal clustering of EMS calls were present in the study area. The reasons for clustering of unfavorable time indices for EMS response requires further exploration. This approach enables policymakers to design tailored interventions to improve response time and reduce CVD-related mortality.This study was financially sponsored by Mashhad University of Medical Sciences (Project grant: 980861)

The Status of Clinical Supervision in Midwifery Education: Perspective of Midwifery Clinical Teachers and Students in Tehran University of Medical Sciences

Introduction: Implementation of clinical supervision of student training could bring about high standards in patient care. The purpose of this study was to determine the status of clinical supervision in midwifery education from the perspective of midwifery clinical teachers and students in Tehran University of Medical Sciences. Methods: This descriptive cross-sectional study was performed on 90 midwifery students in different field internship training units and 25 midwifery clinical teachers who were selected through census method. Data collection tool was the 15-item, 5-point Likert scale CCTEI standardized questionnaire. The data were analyzed using independent t-test, chi-square and ANOVA. Results: A total of 80 student questionnaires and 20 clinical teacher questionnaires were analyzed. The status of clinical supervision in midwifery education was evaluated as average with the mean score 52.5 out of 75. There was a significant difference between the views of clinical teachers and students about the status of clinical supervision such that the clinical teachers evaluated it at a high level with the mean score 60.3 (SD=5.07) while the students evaluated it at an average level with the mean score 46.2 (SD=9.94). The statuses of clinical supervision were significantly different in different clinical arrangements. Conclusion: This difference between the views of clinical teachers and students about the status of clinical education could be due to students’ needs such that the students needed more training in diagnostic skills which is not fully provided by clinical teachers. Since clinical supervision is a teacher-student interaction, further research is recommended to account for these different views