ABSTRACT
BACKGROUND: The NVVC guideline on ST-elevation myocardial infarction forms the basis for the regional prehospital triage (PHT) project in Zuidoost Brabant. In this project diagnosis and treatment strategies are determined in the ambulance. AIM: To summarise quality assessment and clinical results after one year. METHODS: We evaluated the protocol and patient record form, the patient's call, assignment of tasks, diagnosis, treatment, time intervals, information to hospitals, cooperation and data transmission. Time delays were compared with time delays in a regional dry run before the start of the project and with time delays reported in the literature. RESULTS: Patients still wait over one hour before seeking medical attention. The GP received the majority (65%) of patient calls. In half of all cases (51%), GPs call the ambulance centre only after they have seen the patient. When the patient calls the ambulance centre (35%), information to the GP is either prompt or absent. In 77% of calls to 112 it remains unclear whether the GP was informed at all. The treatment strategy was correct in 97% of cases. Time between symptoms and call decreased in comparison with our local preliminary investigation. Quality assessment after one year shows protocol deviations that are either logical procedural improvements or correctable flaws with no substantial negative influence. CONCLUSION: Short-term clinical results are good, but structured follow-up is needed to reduce mortality in the long term, especially after thrombolysis. A guideline is a snapshot of a dynamic process. The PHT project allows rapid adaptations to be made to new paradigms.
ABSTRACT
When conducting research on burnout, it may be difficult to decide whether one should report results separately for each burnout dimension or whether one should combine the dimensions. Although the multidimensionality of the burnout concept is widely acknowledged, for research purposes it is sometimes convenient to regard burnout as a unidimensional construct. This article deals with the question of whether and when it may be appropriate to treat burnout as a unidimensional variable, and presents a decision rule to distinguish between people high and low in burnout. To develop a guideline for obtaining a dichotomous measure of burnout, the scores on the Utrecht Burnout Scale (UBOS) of 44 well functioning individuals were compared with the scores of 29 individuals diagnosed as suffering from burnout. Based on these data, the authors recommend the "exhaustion + 1" criterion for research in non-clinical populations. Following this criterion, individuals can be considered as burnt out when they report, compared to a norm group, high emotional exhaustion, in combination with high depersonalisation or low personal accomplishment. The criterion may be used to estimate the percentage in a sample of individuals in a state of burnout.
