Impact of peer review audit on occupational health report quality

Background: In a previous report, we described the implementation of a formal process for peer review of occupational health (OH) reports and a method of assessment of the outcomes of this process. The initial audit identified that 27% of OH reports required modifications. Aims: To assess formally, following implementation of this process, if changes in practice had occurred, i.e. whether fewer deficiencies were being identified in reports. Methods: We repeated a prospective internal audit of all peer reviewed OH reports between September and November 2011. We used an abbreviated assessment form, based on questions 4–8 and 10–12 of the modified SAIL (Sheffield Assessment Instrument for Letters), with four possible outcomes: no action, no changes made to report following discussion with author, changes made without discussion with author and changes made following discussion with author. Results: One hundred seventy-three reports by 10 clinicians were audited. The audit identified a 13% reduction in OH reports requiring modifications (from 27 to 14%) compared with the previous cycle. Where modifications were required, 8% of these were related to minor typographical, spelling and grammar errors and 6% were for more complex reasons. Implementation of this process also produced a reduction in clinical complaints about OH reports from customers, from three in the preceding year to none 2 years later. Conclusions: Peer review improved the standard of OH reports and was associated with a reduction in customer complaints about reports

Trends in NHS doctor and dentist referrals to occupational health

BACKGROUND: Ill-health in doctors can affect performance and fitness to practice, and consequently patient care and safety, placing an important responsibility on National Health Service (NHS) occupational health (OH) services. Anecdotal discussions amongst NHS occupational physicians suggest an increase in the number of doctor attendances over time, with continuing focus on mental illness. AIMS: To analyse OH referrals in doctors and dentists over 3 years. METHODS: A retrospective evaluation of all doctor and dentist referrals to the OH service in one Scottish NHS board from April 2011 to March 2014, comparing this to management-reported sickness absence (SA) data held by the organization. RESULTS: We found no significant change in overall OH referrals for doctors and dentists during the evaluation period. Mental illness was the commonest referral reason in all 3 years at 32, 38 and 30%, respectively, but no significant change in mental health referrals was demonstrated within the study period. SA events significantly increased during the three study years (356, 426 and 469, respectively; P < 0.05). OH referrals for those absent from work increased significantly between Years 1 and 3 (16 and 30, respectively; P <0.05). CONCLUSIONS: SA events and OH referrals for those absent from work significantly increased between April 2011 and March 2014, but there was no commensurate (statistically significant) increase in overall OH referrals. These findings do not support anecdotal suggestions of increasing OH (or mental ill-health) attendances but can be used as a benchmark for other NHS organizations and for future trend comparisons

Differences in opinions of occupational physicians on the required competencies by field of practice: results of an international Delphi study

Background: The activities and work demands of medical professionals, including occupational physicians (OPs), fall into three categories: clinical, academic, and administrative. Work demands of an OP consist of these three categories and additional specialty specific roles and competencies. Research on the core competencies and skills required for OPs have identified high levels of consensus amongst OPs internationally, however these opinions have not been examined between areas of practice specific groups. Furthermore, it has been identified that to a large extent academics are often the group who define the skills required of OPs. The aim of this study is to compare the opinions of OPs grouped by field of practice on the common core competencies required for occupational health (OH) practice using results from an international survey. Methods: An international modified Delphi study conducted among OPs, completed in two rounds (Rating-Round 1; Ranking-Round 2) using developed questionnaires based on the specialist training syllabus of a number of countries and expert discussions. Respondents were categorised as Physician, Manager/Physician, and Academic/Physician, based on self-reported job titles and place of work. Results: There was good agreement between the Physician and Manager/Physician groups, with the Academic/Physician group deviating the most. The top three and bottom three principle domains (PDs) were in good agreement across all groups. The top three were clinically based and would be considered core OH activities. The PDs with considerable intergroup variance were Environmental Issues Related to Work Practice and Communication Skills, categories which may reflect direct relevance and relative importance to the job tasks of respective groups. Conclusion: This study demonstrated general agreement between the three occupational groups. Academic/Physician opinions deviate the most, while good agreement is depicted between the Physician and Manager/Physician groups. The findings of this study can help identify potential gaps in training requirements for OPs and be used as a stepping stone to developing training programmes that are reflective of practice and tailored for those predominantly undertaking these specific roles

Rabies post-exposure prophylaxis started during or after travel: A GeoSentinel analysis

Background Recent studies demonstrate that rabies post-exposure prophylaxis (RPEP) in international travelers is suboptimal, with only 5–20% of travelers receiving rabies immune globulin (RIG) in the country of exposure when indicated. We hypothesized that travelers may not be receiving RIG appropriately, and practices may vary between countries. We aim to describe the characteristics of travelers who received RIG and/or RPEP during travel. Methodology/Principal findings We conducted a multi-center review of international travelers exposed to potentially rabid animals, collecting information on RPEP administration. Travelers who started RPEP before (Group A) and at (Group B) presentation to a GeoSentinel clinic during September 2014–July 2017 were included. We included 920 travelers who started RPEP. About two-thirds of Group A travelers with an indication for rabies immunoglobulin (RIG) did not receive it. Travelers exposed in Indonesia were less likely to receive RIG in the country of exposure (relative risk: 0.30; 95% confidence interval: 0.12–0.73; P = 0.01). Travelers exposed in Thailand [Relative risk (RR) 1.38, 95% Confidence Interval (95% CI): 1.0–1.8; P = 0.02], Sri Lanka (RR 3.99, 95% CI: 3.99–11.9; P = 0.013), and the Philippines (RR 19.95, 95% CI: 2.5–157.2; P = 0.01), were more likely to receive RIG in the country of exposure. Conclusions/Significance This analysis highlights gaps in early delivery of RIG to travelers and identifies specific countries where travelers may be more or less likely to receive RIG. More detailed country-level information helps inform risk education of international travelers regarding appropriate rabies prevention

How femininities are shaped by religion and culture: a comparative study of beliefs on 'pollution' during childbirth and menstruation in Hinduism and Christianity

This dissertation is a qualitative study of how femininities are shaped by religion and culture. Since religion and culture is a very broad field, this study attempts to examine how femininities are shaped by notions of 'pollution' during menstruation and childbirth. These beliefs about pollution are thought to be part of religion and culture. This comparative study examines how beliefs on pollution differ in two groups of women namely Christian and Hindu women. The sample of women for this study was chosen purposefully using the snowball sampling technique. A sample of six Hindu and six Christian women who were relatively similar in terms of education and income was chosen from the Rylands/Athlone area in the Western Cape. The limited size and nature of this sample makes generalizations difficult. Individual interviews using in-depth, open-ended questions were conducted. The questions were aimed at providing insight into women's experiences of menstruation, menarche, sexual intercourse during menstruation and pregnancy, childbirth and the religious restrictions and taboos these experiences entailed. The aim was to describe women's subjective experiences of 'pollution'. The interviews were conducted in the homes of the women as this was likely to be an environment that respondents would feel comfortable in. Interviews were tape-recorded and then transcribed in order to present the findings in the respondent's own words as far as possible. It was found that Hindu women faced religious and cultural restrictions where menstruation was concerned. They did not light the lamp in their shrines at home or attend temple services until the cessation of menstruation whereupon a ritual bath was taken. During childbirth Hindu women were seen as being 'most polluted' during the first ten days after giving birth. This period of ritual impurity ended forty days after giving birth. During this time, all the women in this study did not leave the house, cook, attend temple or light the lamp as a result of this ' impure' state. After performing a ritual bath and shaving the newborn's hair, these women were reintroduced into the community. In contrast, the Christian women in this study did not face any religious or cultural restrictions during menstruation and childbirth. The Christian women were actually encouraged to attend church as soon as possible after giving birth. Beliefs about 'pollution' during menstruation and childbirth were analyzed using structural-functional theory. It was argued that 'pollution beliefs' serve various functions in society, mostly to ensure gender inferiority and male dominance. There were also differences in the Hindu and Christian respondent's views on marriage and the sex of their children. It was found that the women's experiences of menstruation and childbirth were shaped to a large extent by religion and culture. Femininities were linked to religion and culture as attitudes on 'pollution' stemming from culture affect the way women view themselves and their bodies

Comparison of competency priorities between UK occupational physicians and occupational health nurses

Objectives: The competencies required of occupational physicians (OPs) and occupational health nurses (OHNs) separately have been studied in various countries but little research has made direct comparisons between these two key occupational health (OH) professional groups. The aim of this study was to compare current competency priorities between UK OPs and OHNs. Methods: A modified Delphi study conducted among professional organisations and networks of UK OPs and OHNs. This formed part of a larger Delphi, including international OPs. It was undertaken in two rounds (round 1—‘rating’, round 2—‘ranking’), using a questionnaire based on available OH competency guidance, the literature, expert panel reviews and conference discussions. Results: In each round (rating/ranking), 57/49 and 48/54 responses were received for OPs and OHNs respectively. The principle domain (PD) competency ranks were very highly correlated (Spearman’s r=0.972) with the same PDs featuring in the top four and bottom three positions. OPs and OHNs ranked identically for the top two PDs (good clinical care and general principles of assessment and management of occupational hazards to health). Research methods was ranked lowest by both groups. Conclusions: This study has observed a high level of agreement among UK OPs and OHNs on current competency priorities. The ‘clinically focused’ competency priorities likely reflect that although OH practice will broaden in response to various factors, traditional ‘core’ OH activities will still be required. These mutually identified priorities can serve to strengthen collaboration between these groups, develop joint education/training programmes and identify common professional development opportunities

Poor adherence to South African guidelines for the tnanagement of community-acquired pneumonia

Objective. To evaluate adherence to the South African guidelines for the management of community-acquired pneumonia (CAP) and to determine whether adherence reduced length of hospital stay and mortality in patients with severe CAP. Setting. King Edward VIII Hospital, Durban.Methods. Four hundred and thirty patients with CAP were recruited between June 2000 and October 2001. Severity assessment data were collected. Severe CAP was defined by thepresence of two or more markers. Without influence from the investigators, the admitting team chose the empirical antibiotic regimen. Antibiotics administered, outcome and length of stay were analysed.Results. Two hundred and eighty-seven of 430 patients were Egible for analysis. One hundred and eighty-two patients had two or more markers of severe CAP. Fourteen of the 182 patients (8%) had initial antibiotic therapy administered according to South African guidelines and 168 (92%) did not. The mortality rate was 20% (36 patients). Accounting for sample size there was no statistically significant difference in length of stay between the two groups (14 v. 12 days, p = 1.0000, odds ratio (OR) 1.167, 95% confidence interval (CI): 0.3926 - 3.467) or in mortality rate (28.5% v. 19%, p = 0.3549, OR 1.667, 95% CI: 0.667 - 4.161).Conclusion. There was very poor adherence with South African CAP antibiotic guidelines. The sample size of patients receiving treatment according to the South African Thoracic Society (SATS) guidelines was too low to confirm confidently that adherence may have resulted in a clinical benefit

Profile of children with head injuries treated at the trauma unit of Red Cross War Memorial Children's Hospital

Objective. To describe the profile of childhood head injury patients treated in a trauma unit. Design. A retrospective record-based study. Setting. The trauma unit of the Red Cross War Memorial Children’s Hospital. Subjects. Children (under 13 years of age) presenting with head injuries between January 1991 and December 2001. Results. Of the almost 94 000 records, more than one-third were children presenting with head injuries. Fifty-nine per cent were boys, with more than half the sample under 5 years of age. The majority of children presented with superficial lacerations and abrasions, mostly affecting the scalp and skull. Injuries were mainly caused by falls from a variety of heights, and traffic-related injuries. Almost twothirds of traffic-related injuries involved children as pedestrians being struck by a motor vehicle. More than 60% of injuries occurred in or around the child’s own home. Conclusions. Head injuries in children are a significant cause of morbidity. Prevention, especially in the home and on the streets, needs urgent attention