Examining distress among Saudi paramedics in responding to traumatic events: A mixed-methods study.

INTRODUCTION: Paramedics are critical in providing timely medical care to injured patients and responding to trauma events. However, they are often exposed to traumatic events such as death, serious injuries, and violence, which can increase their risk of developing mental health disorders. The nature of their work, including uncontrolled environments and frequent exposure to trauma, as well as the severity of the patient's conditions, all contribute to this risk. This study aims to investigate the distress experienced by Saudi paramedics in response to traumatic events. METHODS: An explanatory sequential mixed-methods approach was used to explore the experiences of distress among a sample of paramedics following traumatic events. RESULTS: The study found that the participants ranked assaults and road traffic collisions as the most concerning traumatic events. Qualitative analysis of the data revealed several themes related to the participants' experiences, including emotional well-being, violence, road traffic collisions, death, personal limitations, culture, coping strategies, and professional support. CONCLUSIONS: The study highlights the high levels of distress experienced by paramedics in response to road traffic collisions, with intrusion and avoidance symptoms being the most commonly reported.

Knowledge and willingness of schoolteachers in Jordan to perform CPR: a cross-sectional study.

OBJECTIVES: This study aimed to assess the cardiopulmonary resuscitation (CPR) knowledge and willingness of schoolteachers in Jordan. DESIGN: This was a cross-sectional study conducted using an online questionnaire. SETTING: For inclusion in this study, schoolteachers must be currently teaching at any level in schools across the country. Responses were collected from 1 April 2021 to 30 April 2021. PARTICIPANTS: All schoolteachers actively working in public or private schools were included in our study. PRIMARY AND SECONDARY OUTCOME MEASURES: Continuous variables were summarised as means and SD, whereas categorical variables were reported as frequencies and percentages (%). A χ2 test for independence, independent sample t-tests and analysis of variance were used appropriately. A p-value less than 0.05 was used to determine statistical significance. RESULTS: A total of 385 questionnaires were eligible for analyses. Only 14.5% of the participants received CPR training and overall correct knowledge answers were 18.8% of the total score. Those participants with previous CPR training had higher mean knowledge scores (2.34 vs 1.15, p<0.001). Trained participants were also more likely to provide hands-only CPR to various patient groups than untrained participants (p<0.05). Participants were more willing to provide standard CPR to family members than hands-only CPR (p<0.001), but more willing to provide hands-only CPR to friends (p<0.001), students (75.1% vs 58.2%, p<0.001), neighbour (p<0.001), stranger (p=0.001) and patient from the opposite gender (p<0.001). CONCLUSIONS: Schoolteachers in Jordan possess limited knowledge of CPR. However, the study participants showed a positive attitude towards performing CPR. The study revealed that they were more inclined to provide hands-only CPR than standard CPR. Policymakers and public health officials can take advantage of these findings to incorporate CPR training programmes for schoolteachers, either as a part of their undergraduate studies or as continuing education programmes with an emphasis on hands-only CPR.

Ten-Year Comparison of Medication Complications Rates in Public and Private Hospitals in Victoria, Australia.

Medication errors occur as a result of failure in the treatment process at any point in the healthcare system. This is a retrospective study aimed at determining the rates of medication-related errors over a 10-year period in hospitals in Victoria, Australia. From 2009 to 2019, the overall rate for adverse drug events, accidental poisoning and undetermined intent were 86.15, 1.3 and 0.17 per 10,000 hospital separations, respectively. Medication complications occurred more in public hospitals. Adverse drug events account for less than 1% of all hospital separations. Medication errors contributing factors should be investigated in out of hospital environment.

What impact does maths anxiety have on university students?

BACKGROUND: Maths anxiety is defined as a feeling of tension and apprehension that interferes with maths performance ability, the manipulation of numbers and the solving of mathematical problems in a wide variety of ordinary life and academic situations. Our aim was to identify the facilitators and barriers of maths anxiety in university students. METHOD: A scoping review methodology was used in this study. A search of databases including: Cumulative Index of Nursing and Allied Health Literature, Embase, Scopus, PsycInfo, Medline, Education Resources Information Centre, Google Scholar and grey literature. Articles were included if they addressed the maths anxiety concept, identified barriers and facilitators of maths anxiety, had a study population comprised of university students and were in Arabic or English languages. RESULTS AND DISCUSSION: After duplicate removal and applying the inclusion criteria, 10 articles were included in this study. Maths anxiety is an issue that effects many disciplines across multiple countries and sectors. The following themes emerged from the included papers: gender, self-awareness, numerical ability, and learning difficulty. The pattern in which gender impacts maths anxiety differs across countries and disciplines. There was a significant positive relationship between students' maths self-efficacy and maths performance and between maths self-efficacy, drug calculation self-efficacy and drug calculation performance. CONCLUSION: Maths anxiety is an issue that effects many disciplines across multiple countries and sectors. Developing anxiety toward maths might be affected by gender; females are more prone to maths anxiety than males. Maths confidence, maths values and self-efficacy are related to self-awareness. Improving these concepts could end up with overcoming maths anxiety and improving performance.

The Correlation between Mathematics Anxiety, Numerical Ability and Drug Calculation Ability of Paramedic Students: An Explanatory Mixed Method Study.

INTRODUCTION: Numeracy is the ability to reason and to apply simple numerical concepts. Numerical and drug calculation skills are essential for patient safety. Health-care providers who perform drug calculation in their work required good math skills, especially numerical ability. The aims of this study were to explore the relationship between numerical ability, math anxiety and drug calculation performance and to explore the factors that contribute to drug calculation ability among paramedic students. METHODS: A sequential explanatory mixed-method approach that included a paper-based questionnaire followed by face-to-face interviews was used in this study. The participants completed a 30-minute survey that is composed of demographics, the 10-item Mathematics Anxiety Rating Scale (MARS), a 12-question numerical ability test (NAT) and a 9-question drug calculation ability test (DCAT) and then were invited for a structured interview. RESULTS: The mean MARS scores were higher for the second-year students than the third students. The NAT and DCAT scores for the third-year students were higher than the second-year students. There was a significant difference in the mean drug calculation ability test scores (DCAT) (t (106) = 2.13, p = 0.035 and Cohen's d = 0.43 between males (5.05 (2.32)) and females (4.03 (2.43))). Math education prior joining the university (beta = 0.862, p = 0.030) made the strongest unique contribution when controlling for the other variables followed by numerical ability (beta =0.25, p <0.001). The themes that emerged from the interviews included the impact of technology, classmates' impact, mathematics competence and the mental block. CONCLUSION: Drug calculation is fundamental in paramedic practice. It is affected by the numerical ability of the students and is negatively and indirectly impacted by mathematics anxiety. Modifications of a paramedic program curriculum can improve student's ability to think critically and to overcome medication dosage problems.

Challenges Faced by Female Healthcare Professionals in the Workforce: A Scoping Review.

BACKGROUND: The number of women entering the medical and healthcare workforce globally has increased in the past several decades. Women have many roles and positions in healthcare organizations, hospitals and healthcare education settings. Although there has been an increase in the number of women, female workers continue to face many workplace challenges. This scoping review aimed to explore the challenges female healthcare professionals face in the workforce. METHODS: A scoping review utilizing Arksey and O'Malley's six-step framework was undertaken to identify and map available literature addressing challenges faced by female healthcare professionals in the workforce. The databases searched included Embase, EmCare, Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Business Source Complete (BSC). Additional searches were performed using Google Scholar, Trove and grey literature. RESULTS: The initial search yielded 2455 publications (Medline n=369; EmCare n=276; Embase n=612; CINAHL n=1088; Business Source Complete n=109; mixed grey literature n=1). After removal of duplicates, 1782 citations remained. Abstract and title screening reduced the field to 36 publications, following which full-text reviews were conducted. Consensus was reached on 16 publications for final review. After analyzing the articles, three themes were identified: i) family responsibilities, ii) workplace environment and iii) stereotyping. CONCLUSION: Findings confirm that female healthcare professionals face circumstances that may affect their family lives, as well as factors relating to the workplace environment and stereotypes. Implementing strategies such as reduced work hours, flexible timing and part-time work can support women in the workplace, which then enhances and supports gender equality in healthcare organizations.

Eculizumab in paediatric atypical haemolytic uraemic syndrome: Lessons learned from a single-centre experience in the United Arab Emirates.

AIM: Atypical haemolytic uraemic syndrome (aHUS) is a debilitating condition that can cause significant morbidity and mortality in children if not adequately and promptly treated. This report shares real-world data on the use of eculizumab in children with aHUS. METHODS: We report our experience with the use of eculizumab in 14 children with aHUS. RESULTS: The median age at aHUS diagnosis was 12 months (range: 2-108 months), with six (42.9%) patients presenting in infancy and six (42.9%) being males. Eculizumab therapy was associated with haematological and thrombotic microangiopathy responses in 14 (100%) and 13 (92.9%) patients after a median of 9 days (range: 7-12 days) and 9.5 days (range: 7-14 days), respectively. None of the six patients who were previously treated with plasma therapy required any further infusions. Of the six patients who previously required dialysis, only one patient continued to do so and eventually received a renal transplant. The median time to ≥25% decrease in serum creatinine level in the remaining patients was 16 days (range: 14-21 days), and estimated glomerular filtration rate increased from a median of 17-101 mL/min/1.73 m2 . The safety profile was similar to that reported in the literature, and 10 patients continue to receive therapy, with 3 being on the drug for 4 or more years. CONCLUSION: Our study adds to the growing body of evidence highlighting the efficacy and safety of eculizumab for the management of children with aHUS.

Simulation experiences of paramedic students: a cross-cultural examination.

BACKGROUND: Simulation-based education is an important part of paramedic education and training. While accessing clinical placements that are adequate in quality and quantity continues to be challenging, simulation is being recognized by paramedic academics as a potential alternative. Examining students' satisfaction of simulation, particularly cross-culturally is therefore important in providing feedback to academic teaching staff and the international paramedic community. OBJECTIVE: This study aimed to compare simulation satisfaction among paramedic students from universities in Australia and Jordan. METHODS: A cross-sectional study using a paper-based English version of the Satisfaction with Simulation Experience Scale was administered to paramedic students from all year levels. RESULTS: A total of 511 students participated in this study; 306 students (60%) from Australia (Monash University) and 205 students (40%) from Jordan (Jordan University of Science and Technology). There were statistically significant differences with large effect size noted in all three original factors between Australian and Jordanian students: debrief and feedback (mean =38.66 vs mean =34.15; P<0.001; d=0.86), clinical reasoning (mean =21.32 vs mean =18.28; P<0.001; d=0.90), and clinical learning (mean =17.59 vs mean =15.47; P<0.001; d=1.12). CONCLUSION: This study has demonstrated that simulation education is generally well received by students in Australia and Jordan although Australian students reported having higher satisfaction levels then their Jordanian counterparts. These results provide important data for paramedic educators involved in simulation-based education and training in Australia and Jordan and pave the way for other cross-cultural examinations to be explored.

Stable pediatric kidney transplant recipients run higher urine indoleamine 2, 3 dioxygenase (IDO) levels than healthy children.

Immune cells utilize the IDO enzymatic conversion of trp to kyn to determine T-cell activation vs. anergy/apoptosis. In prior studies, urine IDO levels were higher in rejecting renal allografts than in stable state. However, urine IDO levels in healthy subjects or children are unknown. As a corollary to a larger longitudinal and prospective study of serum and urine IDO levels for transplant immune monitoring, here, we analyzed the difference between urine IDO levels in stable post-transplant vs. healthy children. IDO levels were measured by tandem mass spectrometry and expressed as kyn/trp ratios. We compared one-time urine samples, from 34 well children at general pediatric clinics, to the first-month post-transplant urine samples from 18 children, while in stable state (no acute rejection or major infection event in next 30 days). Urine kyn/trp ratios were significantly higher in stable children in first-month post-kidney transplant (median 16.6, range 3.9-44.0) vs. healthy children (median 9.2, range 3.51-17.0; p = 0.0057 by nonparametric Mann-Whitney test). Higher urine IDO levels even with stable transplant suggest a continuous ongoing low-grade allorecognition/inflammatory process. Our data also provide baseline urine IDO levels in healthy subjects for use in future studies.

Verification of association of elevated serum IDO enzyme activity with acute rejection and low CD4-ATP levels with infection.

BACKGROUND: Both acute rejection (AR) and major infection events (MIE) can reduce long-term allograft survival. We assessed the simultaneous efficacy of serum and urine biomarker indoleamine 2,3-dioxygenase (IDO) enzyme activity and peripheral blood CD4-ATP levels for AR and MIE association, respectively. METHODS: We prospectively tested 217 blood and 167 urine serial samples, collected monthly for 12 months after transplantation from 29 consecutive children receiving a kidney transplant. The indoleamine 2,3-dioxygenase activity was assessed by mass spectrometry assays using the ratio of product L-kynurenine (kyn) to substrate tryptophan (trp). Kyn/trp ratios and blood CD4 T-cell ATP levels were correlated with AR, MIE, or stable group (no events) in the next 30 days. RESULTS: Using absolute cutoffs and allocating to samples to AR, MIE, or stable group, mean serum kyn/trp ratios were significantly elevated in the group that experienced AR (P=0.0007). Similarly, peripheral blood CD4-ATP levels were significantly lower in the group experiencing MIE (P=0.0351). Urine kyn/trp ratios and blood tacrolimus levels were not different between AR and stable groups. Within-subject analyses, accounting for repeated measures in subjects, also showed that, over time, serum kyn/trp ratios were higher before AR (P=0.031) and blood CD4-ATP levels were lower before MIE (P=0.008). CONCLUSIONS: These results from our pilot discovery group suggest that a panel of biomarkers together can predict overimmunosuppression or underimmunosuppression. Further independent validation in a multicenter cohort is suggested.

Missed viral surveillance testing visits associate with full blown viral diseases in children receiving kidney transplants.

Surveillance testing for major viral infections such as CMV, EBV, and BKV early in their natural history course may allow for early intervention and prevention of FBVD, but the testing is expensive and optimal interval/frequency are uncertain. At our center we initiated routine monthly viral surveillance for CMV, EBV, and BKV in July 2008 for the first 12 months post-transplant. Here, we retrospectively analyzed for outcome of the patients who missed three or more surveillance tests in the first 12 months post-transplant vs. those who did not. Of 21 patients, five missed three or more surveillance tests. Two of those five developed FBVD (one BKV nephropathy and one EBV-PTLD). None of the 16 patients with more regular surveillance testing developed FBVD. The incidence of viral replication was similar in both groups. The odds ratio for FBVD if viral surveillance tests were missed was 23.57 (p-value of 0.047). In this small group of contemporaneous patients on identical immunosuppression, those patients who missed regular viral surveillance were more likely to develop FBVD. Prospective randomized trials to confirm the benefit of regular viral testing are recommended.

Immune biomarker panel monitoring utilizing IDO enzyme activity and CD4 ATP levels: prediction of acute rejection vs. viral replication events.

Infections have become as important an event as acute rejection posttransplant for long-term allograft survival. Less invasive biomarkers tested so far predict risk for one event or the other, not both. We prospectively tested blood and urine monthly for 12 months posttransplant from children receiving a kidney transplant. The IDO enzyme pathway was assessed by MS assays using the ratio of product l-kyn to substrate trp. Kyn/trp ratios and blood CD4 T-cell ATP levels were correlated with acute rejection or major infection events or stable group (no events) in the next 30 days. The 25 subjects experienced six discrete episodes of acute rejection in five subjects and 16 discrete events of major infection in 14 subjects (seven BK viruria, six cytomegaloviremia, one EB and cytomegaloviremia, and two transplant pyelonephritis). Mean serum kyn/trp ratios were significantly elevated in the group that experienced acute rejection (p = 0.02). Within-subject analyses revealed that over time, urine kyn/trp ratios showed an increase (p = 0.01) and blood CD4-ATP levels showed a decrease (p = 0.007) prior to a major infection event. These pilot results suggest that a panel of biomarkers together can predict over- or under-immunosuppression, but need independent validation.