ABSTRACT
Background: The “work style reform of physicians” is due to come into effect in April 2024. Cardiovascular surgery involves many life-saving surgeries after hours, and it is expected to be difficult to achieve the upper limit (level A) of 960 h per year and less than 100 h per month for overtime work. In 2021, there were five full-time cardiovascular surgeons, four of whom were responsible for performing emergency surgery for acute aortic dissection in our facility. The ability to provide emergency surgical care with any two-person combination increases the flexibility of staffing for routine surgery or after-hours on-call. The working environment and surgical outcomes of acute aortic dissection under this system are reported, and changes in work style in cardiovascular surgery are discussed. Methods: The surgical outcomes of 39 cases of acute aortic dissection requiring emergency open heart surgery at this hospital during the one-year period from January to December 2021 were investigated. The number of cases (and first assistants) performed by five full-time surgeons were 7(13), 9(6), 12(3), 11(7) and 0(10), respectively. In addition, there were 8 cases of acute aortic dissection requiring urgent stent graft treatment during the same period. The emergency response rate for emergency patients (including those other than acute aortic dissection) was 100% during the same period. Results: The age was 69 years (median), 48.7% were female, 92.3% were Stanford type A, of which 22.2% were DeBakey type II. Shock vital 20.5%, malperfusion 30.8%. The surgical procedures included TAR in 19 cases, PAR in 8 cases, HAR in 12 cases (including 2 Bentall). Concomitant operations were AVR in 5 cases, CABG in 2 cases, TEVAR in 1 case, lower limb arterioplasty in 2 cases and right hemispherectomy in 1 case. Operating time 400 min (median), extracorporeal circulation time 194 min (median), cardiac arrest 108 min (median), selective cerebral perfusion time 125 min (median), lower body circulation arrest 46 min (median). Hospital mortality 7.7%, stroke 12.8%, delayed paraparesis 2.6%. Ventilation time was 1 day (median), hospital stay 23 days (median), 64.1% were discharged at home. Working Environments: 12-13 on-calls per month. Maximum yearly overtime work is 480.5 h with full overtime pay. Exemptions from working after night shift were also possible. Conclusions: The surgical outcomes of acute aortic dissection at our hospital were acceptable. Not having a fixed surgeon enabled a flexible emergency response, and increased the flexibility of staffing for routine surgery and on-call, and was considered to enable both a change in working style and surgical safety while meeting the needs of the community.
ABSTRACT
Cardiovascular diseases (CVDs) contribute to most of the potentially preventable burden through early risk assessment. Nurse-led CVD risk assessment is an effective strategy to address the human resource crisis for CVD prevention. An interventional study was conducted in medicine wards of a tertiary care hospital in North India to train nurses in CVD risk assessment and its communication. All bedside nurses (n = 30) of selected wards were enrolled and trained in CVD risk assessment and communication using WHO/ISH risk prediction charts. Once fully trained, each nurse enrolled patients (>40 years of age) from their respective wards to assess and communicate CVD risk. To calculate the reliability of risk assessment, investigator simultaneously assessed CVD risk with nurses. The mean age of nurses was 32.07 ± 6.31 years. The results revealed that training significantly increased the knowledge of nursing personnel (P < 0.001). There was perfect inter?rater reliability agreement (Cohen’s k = 0.929) between nurses and investigators while assessing CVD risk. Nurses demonstrated good communication skills. The study concluded that nurses can be trained successfully in CVD risk assessment and communication. The study recommends the task shifting of CVD risk assessment to nurses after providing proper training
ABSTRACT
Purpose : Recently, the Japanese government has promoted reform of working practices. The working environment of medical professionals was no exception. In the present study, we investigated the current working environment and issues of cardiovascular surgeons, who are supposed to be working in one of the most demanding circumstances in Japan. Methods : In December 2018, the Japanese Society for Cardiovascular Surgery (JSCVS) sent a questionnaire to all JSCVS members via the internet to obtain basic data on the working environment including working hours, working items, income, and the issues to be solved for cardiovascular surgeons in Japan. Results : The JSCVS received responses from 634 cardiovascular surgeons (response rate 17%, 589 males/38 females). Respondents were primarily mid-career surgeons in their age of 40 s and 50 s. Four hundred seventy-three respondents (75.5%) and 176 respondents (28.2%) answered that they worked an average of 60 and 80 h a week, respectively. In addition, 249 respondents (40.4%) reported receiving no allowance for on-call work during off hours, after midnight, or on a holiday, while 345 respondents (56.6%) reported receiving no allowance for emergency surgery during off hours, after midnight, or on a holiday. Conclusion : Over 75% of cardiovascular surgeons reported being overworked without receiving an appropriate amount of income. Along with the reform of working style being made for the Japanese people, improving the working environment of cardiovascular surgeons is also an urgent matter to maintain healthcare for cardiovascular disease. Facilitating understanding of the issue by the Japanese people is of the utmost importance for the JSCVS.
ABSTRACT
Aims: To describe the stepwise implementation and roll out of Community ART Groups (CAG) in Mozambique. Study Design: Descriptive study Place and Duration of Study: Mozambique, between February 2008 and December 2011. Methodology: Description of the stepwise implementation of a model for Anti-Retroviral Therapy (ART) delivery based on the principles of peer support and self-management. The program data on CAG were obtained through a chart review and routine datacollection. Results: To overcome patient reported barriers to monthly drug refills for ART the Tete Provincial Directorate of Health and Médecins Sans Frontières developed a communitybased ART model or patient-centered model, through peer support groups named CAG. The first CAG commenced in 2008, in rural health facility catchment areas, where members of CAG shared transport costs to overcome distances to the ART clinics. In 2009, lessons learnt were exported in Tete province and CAG model was launched in semi-urban contexts to decrease time spent in the clinics. In 2011, retention rates as high as 97,5 % convinced a joint task force that included Ministry of Health and major partners to pilot the CAG strategy on a national scale. Conclusion: To respond to staggering attrition rates Ministry of Health in Mozambique and partners piloted an innovative patient-centered model for HIV care and exported good practices from local to provincial and national level. Success of scale up will depend on the collaboration and interaction between policymakers, donors, health-managers, caregivers, communities, and patients.