To examine whether post-outbreak early-phase interventions by emergency response teams (ERTs) in long-term care facilities (LTCFs) contribute to containment with lower incidence and case-fatality ...rate of COVID-19 and analyse the required assistance.
Records from 59 LTCFs (28 hospitals, 15 nursing homes, and 16 homes) assisted by ERTs after the COVID-19 outbreak, between May 2020 and January 2021, were used for the analysis. Incidence and case-fatality rates among 6,432 residents and 8,586 care workers were calculated. The daily reports of ERTs were reviewed, and content analysis was performed.
Incidence rates among residents and care workers with early phase (<7 days from onset) interventions (30·3%, 10·8%) were lower than those with late phase (≥7 days from onset) interventions (36·6%, 12·6%) (p<0·001, p = 0·011, respectively). The case-fatality rate among residents with early-phase and late-phase interventions were 14·8% and 16·9%, respectively. ERT assistance in LTCFs was not limited to infection control but extended to command and coordination assistance in all studied facilities.
Assistance in the facility's operational governance from the early phase of an outbreak in LTCFs contributed to a significant decline in incidence rate and case fatality rate among LTCF residents and care workers in facilities.
This study aimed to compare the longitudinal change in depressive symptoms among healthcare professionals in Japan who are willing to receive novel coronavirus disease (COVID-19) vaccination and ...those who are unwilling to receive COVID-19 vaccination. The baseline survey was conducted in October 2020 (Survey time 1: T1); respondents in T1 were invited to participate in May 2021 (Survey time 2: T2). Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Group comparisons of the estimated mean of PHQ-9 score at T1 and T2 were estimated by the analysis of covariance. In T1, 597 participants (response rate: 4.4%) completed all questions. In T2, 211 participants (follow up rate: 35.3%) completed all questions. The group and time interaction effect was significant (F(1, 207)=3.9, p=0.049); depressive symptoms were worse among healthcare professionals who were unwilling to receive vaccination than among those who were willing to receive vaccination. This study showed that depressive symptoms were worse among healthcare professionals who were unwilling to receive COVID-19 vaccination than those who are willing to receive COVID-19 vaccination. This suggests that it is important to take care of healthcare professionals who are unwilling to receive vaccination to prevent mental health deterioration.
Abstract
Introduction
Disasters and accidents have occurred with increasing frequency in recent years. Primary disasters have the potential to result in mass casualty events involving crush syndrome ...(CS) and other serious injuries. Prehospital providers and emergency clinicians stand on the front lines of these patients’ evaluation and treatment. However, the bulk of our current knowledge, derived from historical data, has remained unchanged for over ten years. In addition, no evidence-based treatment has been established to date.
Objective
This narrative review aims to provide a focused overview of, and update on, CS for both prehospital providers and emergency clinicians.
Discussion
CS is a severe systemic manifestation of trauma and ischemia involving soft tissue, principally skeletal muscle, due to prolonged crushing of tissues. Among earthquake survivors, the reported incidence of CS is 2–15%, and mortality is reported to be up to 48%. Patients with CS can develop cardiac failure, kidney dysfunction, shock, systemic inflammation, and sepsis. In addition, late presentations include life-threatening systemic effects such as hypovolemic shock, hyperkalemia, metabolic acidosis, and disseminated intravascular coagulation. Immediately beginning treatment is the single most important factor in reducing the mortality of disaster-situation CS. In order to reduce complications from CS, early, aggressive resuscitation is recommended in prehospital settings, ideally even before extrication. However, in large-scale natural disasters, it is difficult to diagnose CS, and to reach and start treatments such as continuous administration of massive amounts of fluid, diuresis, and hemodialysis, on time. This may lead to delayed diagnosis of, and high on-site mortality from, CS. To overcome these challenges, new diagnostic and therapeutic modalities in the CS animal model have recently been advanced.
Conclusions
Patient outcomes can be optimized by ensuring that prehospital providers and emergency clinicians maintain a comprehensive understanding of CS. The field is poised to undergo significant advances in coming years, given recent developments in what is considered possible both technologically and surgically; this only serves to further emphasize the importance of the field, and the need for ongoing research.
The World Health Organization (WHO) and its partners established the WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Network (HEALTH EDRM RN) in 2016 to respond to ...the increasing burden of recent health emergencies and disasters. The mission of the HEALTH EDRM RN, whose secretariat is located at the WHO Kobe Centre (WKC), is to promote global research collaboration and strengthen research activities to inform policies and programs by generating new evidence to manage health risks associated with all types of emergencies and disasters. With the strong support and involvement of all WHO regional offices, the HEALTH EDRM RN now works with more than 200 global experts and partners to pursue its mission. The first Core Group Meetings of the HEALTH EDRM RN were held on 17-18 October 2019, and concluded with the HEALTH EDRM RN-activity priorities to (1) promote operational research to better meet the needs of emergency- and disaster-exposed individuals and communities and efforts to translate science to policies and programs and (2) strengthen the research capacity of the Health EDRM community. In collaboration with the Japanese Association for Disaster Medicine, the WKC held a workshop on 21 February 2020, in which 20 Japanese experts from different research fields participated to further discuss these two points. This paper summarizes the discussion at the workshop.
Objectives
Translation of the Professional Fulfillment Index (PFI) into Japanese would be more useful than the currently developed scales for appropriately measuring burnout and professional ...fulfillment in healthcare professionals. This study aimed to develop the Japanese version of the PFI and examine its internal consistency, structural validity, and convergent validity in healthcare professionals.
Methods
Healthcare professionals in Japan were recruited online. The survey was conducted from October to November 2022. Internal consistency was tested using Cronbach's α. Structural validity was tested using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Convergent validity was tested using Pearson's correlation coefficients, which were calculated between each score of the PFI scale and burnout (the Japanese Burnout Scale: JBS), depressive symptoms (the Patient Health Questionnaire‐9), and QOL (the General Health Questionnaire‐12).
Results
The Cronbach's alpha was .91 in professional fulfillment, .80 in burnout: work exhaustion, .90 in burnout: interpersonal disengagement, and .89 in burnout: total score. Confirmatory factor analysis demonstrated a modest fit, and EFA yielded a three‐factor structure the same as the original PFI. The all three subscales and total score of burnout were significantly correlated with the scores of all the scales (p < .001; e.g., burnout: work exhaustion correlated emotional exhaustion in JBS, r = .71).
Conclusions
The Japanese version of the PFI demonstrated acceptable high internal consistency, structural validity, and convergent validity of the scale with a three‐factor structure the same as in the original PFI. The Japanese version of PFI proved to be reliable and valid for use in healthcare professionals.
Objectives: This study aimed to investigate the relationship between clinical decision for the novel coronavirus disease 2019 (COVID-19) patients and post-traumatic stress symptoms (PTSS) among ...healthcare professionals during the COVID-19 pandemic. Methods: Japanese healthcare professionals were recruited. The survey was conducted from May 21 to June 18, 2021. PTSS was assessed by the Impact of Event Scale-Revised. Items about the experience of clinical decision for COVID-19 patients and other independent variables were originally developed from previous studies. Univariate and multiple linear regression analyses were used to examine the association of independent variables and PTSS. Results: 515 (3.9%) healthcare professionals completed all questions. Among them, 172 (33.4%) had experienced clinical decision for COVID-19 patients. Multiple linear regression analysis showed that clinical decision for COVID-19 patients (B=3.32, 95% CI 1.41–5.24; p<0.01), as well as fear of getting a COVID-19 infection (B=2.15, 95% CI 0.32–3.98; p=0.02), were significantly associated with PTSS in the adjusted model. Conclusions: The study showed that clinical decision might be a very serious factor related to PTSS among healthcare professionals during the COVID-19. Clinical decision for patients with COVID-19 has a high experience rate and was considered to be a serious experience among healthcare professionals during the pandemic. As a countermeasure for the mental health of healthcare professionals during the COVID-19, it is important for healthcare professionals to take countermeasures for clinical decision for patients with COVID-19.
The Great East Japan Earthquake of March 11, 2001 left around 20,000 dead or missing. Previous studies showed that rescue workers, as well as survivors, of disasters are at high risk for ...posttraumatic stress disorder (PTSD). This study examined the predictive usefulness of the Peritraumatic Distress Inventory (PDI) among rescue workers of Disaster Medical Assistance Teams (DMATs) deployed during the acute disaster phase of the Great East Japan Earthquake.
In this prospective observational study, the DMAT members recruited were assessed 1 month after the earthquake on the PDI and 4 months after the earthquake on the Impact of Event Scale-Revised to determine PTSD symptoms. The predictive value of the PDI at initial assessment for PTSD symptoms at the follow-up assessment was examined by univariate and multiple linear regression analysis. Of the 254 rescue workers who participated in the initial assessment, 173 completed the follow-up assessment. Univariate regression analysis revealed that PDI total score and most individual item scores predicted PTSD symptoms. In particular, high predictive values were seen for peritraumatic emotional distress such as losing control of emotions and being ashamed of emotional reactions. In multiple linear regression analysis, PDI total score was an independent predictor for PTSD symptoms after adjusting for covariates. As for covariates specifically, watching earthquake television news reports for more than 4 hours per day predicted PTSD symptoms.
The PDI predicted PTSD symptoms in rescue workers after the Great East Japan Earthquake. Peritraumatic emotional distress appears to be an important factor to screen for individuals at risk for developing PTSD among medical rescue workers. In addition, watching television for extended period of time might require attention at a time of crisis.
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