Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study

INTRODUCTION@#The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety.@*METHODS@#A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR).@*RESULTS@#We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR.@*CONCLUSION@#Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.

Factors Associated With Delayed Ambulance Response Time In Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan

@#Ambulance response time is one of the key performance of ambulances services. The objective of this study is to determine the factors associated with delayed ambulance response time in Hospital Universiti Sains Malaysia (HUSM). This was a cross sectional study conducted in Department of Emergency Medicine, Hospital Universiti Sains Malaysia (EDHUSM) between January 2016 to January 2017. A total of 300 ambulance calls were included in our analysis. Data were collected by ambulance paramedic using validated ambulance form. All ambulance forms with missing data were excluded from this study. Of the 300 ambulance calls within the study periods, 254 cases (84.7%) were determined to have delayed ambulance response time. Current ambulance response time is 14 minutes with interquartile range of 5 minutes. Factors which showed significant association delayed ambulance response time include distance from hospital, location, type of emergency and ambulance mechanism. The odd of delayed ambulance response time by every increase in distance unit was 1.59 (95% CI, 1.37 to 1.85). For location type, the odd of delayed ambulance response time for public location as compared to road was 0.13 (95% CI, 0.04 to 0.45). For ambulance mechanism, the odd of delayed ambulance response time for beacon type as compared to siren type was 0.22 (95% CI, 0.01 to 0.69). Further intervention should be initiated based on our findings to improve current ambulance response time.

Use of hyperbaric oxygen therapy (HBOT) in chronic diabetic wound - A randomised trial

@#Introduction: The purpose of this study was to investigate the effect of hyperbaric oxygen therapy (HBOT) towards diabetic foot ulcer (DFU) patients in addition to the standard wound care management. Methods: Fifty-eight diabetic patients with ulcers at Wagner Grade 2 and above involved in this study after presented at two study centres of tertiary teaching hospitals. The assigned patients received conventional wound care with additional HBOT given at 2.4 ATA for 90 minutes. Patients in the control group who received conventional wound care only were treated and observed for 30 days. The progress of wound healing was observed and measured at day 0, 10, 20 and 30 of study. The data collected were analysed using SPSS software (ver. 22) to study the association of HBOT towards healing of the diabetic foot ulcers. Results: Repeated Measures ANOVA analysis with Greenhouse-Geisser correction indicated that the means of wound size over time points (Day 0, 10, 20 and 30) among patients under HBOT group were statistically significantly different [F(1,61)=30.86, p<0.001)] compared to conventional therapy group. Multiple logistic regression analysis showed that HBOT group has nearly 44 times higher odds to achieve at least 30% wound size reduction within the study period (95%CI: 7.18, 268.97, p<0.001). Conclusion: The results obtained in this study indicated that as an adjunctive therapy to conventional wound care, HBOT affected the rate of healing in diabetic foot ulcers significantly in terms of wound size reduction when compared to administering the conventional wound care alone.

The Record-Setting Flood of 2014 in Kelantan: Challenges and Recommendations from an Emergency Medicine Perspective and Why the Medical Campus Stood Dry

Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a ‘tsunami-like disaster’. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated.

The Pattern of Death Related to Trauma Cases Presented to The Emergency Department of A Tertiary University Hospital

Trauma is an ever increasing problem and it is the leading cause of morbidity and mortality in the under 40s age group. The main purpose of this study is to determine the pattern of death related to trauma cases presenting to the emergency department (ED) of a university hospital. This was a retrospective analysis of 75 consecutive trauma case records at a university hospital for a one year period. The most common cause of deaths is motor vehicle crashes. The mean score for the injury severity score (ISS) and revised trauma score (RTS) on arrival to the ED among the succumbed patients were 27.8 (s.d 8.6) and 5.7 (s.d 1.1) respectively. 58.7% of deaths occurred within 48 hours after the admission. Less than 50% of studied patients were still alive beyond 45 hours post admission and less than 10% still alive beyond 11 days. Our analysis also showed that 28% (n=21) and 56% (n=41) of the studied sample had a probability of survival between 50% to 75% and more than 75% respectively upon arrival based on the initial vital signs in the ED and the trauma and injury severity score (TRISS) methodology. Overall, we observed similar injury mechanisms, demographics and causes of death compare to other studies. The figures from this study, mandate further exploration of preventive issues and management improvements that should be applied not only to the current trauma system, but also to the health care system in general.