Descriptive Analysis of Trauma Admission Trends before and during the COVID-19 Pandemic.

INTRODUCTION: Traumatic injuries are a significant global health concern, with profound medical and socioeconomic impacts. This study explores the patterns of trauma-related hospitalizations in the Lublin Province of Poland, with a particular focus on the periods before and during the COVID-19 pandemic. AIM OF THE STUDY: The primary aim of this research was to assess the trends in trauma admissions, the average length of hospital stays, and mortality rates associated with different types of injuries, comparing urban and rural settings over two distinct time periods: 2018-2019 and 2020-2021. METHODS: This descriptive study analyzed trauma admission data from 35 hospitals in the Lublin Province, as recorded in the National General Hospital Morbidity Study (NGHMS). Patients were classified based on the International Classification of Diseases Revision 10 (ICD-10) codes. The data were compared for two periods: an 11-week span during the initial COVID-19 lockdown in 2020 and the equivalent period in 2019. RESULTS: The study found a decrease in overall trauma admissions during the pandemic years (11,394 in 2020-2021 compared to 17,773 in 2018-2019). Notably, the average length of hospitalization increased during the pandemic, especially in rural areas (from 3.5 days in 2018-2019 to 5.5 days in 2020-2021 for head injuries). Male patients predominantly suffered from trauma, with a notable rise in female admissions for abdominal injuries during the pandemic. The maximal hospitalization days were higher in rural areas for head and neck injuries during the pandemic. CONCLUSIONS: The study highlights significant disparities in trauma care between urban and rural areas and between the pre-pandemic and pandemic periods. It underscores the need for healthcare systems to adapt to changing circumstances, particularly in rural settings, and calls for targeted strategies to address the specific challenges faced in trauma care during public health crises.

The Impact of Script Concordance Testing on Clinical Decision-Making in Paramedic Education.

This study investigates the effectiveness of the Script Concordance Test (SCT) in enhancing clinical reasoning skills within paramedic education. Focusing on the Medical University of Lublin, we evaluated the SCT's application across two cohorts of paramedic students, aiming to understand its potential to improve decision-making skills in emergency scenarios. Our approach, informed by Van der Vleuten's assessment framework, revealed that while the SCT's correlation with traditional methods like multiple-choice questions (MCQs) was limited, its formative nature significantly contributed to improved performance in summative assessments. These findings suggest that the SCT can be an effective tool in paramedic training, particularly in strengthening cognitive abilities critical for emergency responses. The study underscores the importance of incorporating innovative assessment tools like SCTs in paramedic curricula, not only to enhance clinical reasoning but also to prepare students for effective emergency responses. Our research contributes to the ongoing efforts in refining paramedic education and highlights the need for versatile assessment strategies in preparing future healthcare professionals for diverse clinical challenges.

Adapting to a Pandemic: Web-Based Residency Training and Script Concordance Testing in Emergency Medicine During COVID-19.

OBJECTIVE: The coronavirus disease (COVID-19) pandemic necessitated alternative methods to ensure the continuity of medical education. Our study explores the efficacy and acceptability of a digital continuous medical education initiative for medical residents during this challenging period. METHODS: From September to December 2020, 47 out of 60 enrolled trainee doctors participated in this innovative digital Continuous Medical Education (CME) approach. We utilized the Script Concordance Test to bolster clinical reasoning skills. Three simulation scenarios, namely Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS), and European Paediatric Life Support (EPLS), were transformed into interactive online sessions via Zoom™. Participant feedback was also collected through a survey. RESULTS: Consistent Script Concordance Testing (SCT) scores among participants indicated the effectiveness of the online training module. Feedback suggested a broad acceptance of this novel training approach. However, discrepancies observed between formative SCT scores, and summative Multiple-Choice Questions (MCQ) assessments highlighted areas for potential refinement. CONCLUSIONS: Our findings showcase the resilience and adaptability of medical education amidst challenges like the global pandemic. The success of methodologies such as SCT, endorsed by prestigious bodies like the European Resuscitation Council and the American Heart Association, suggests their potential in preparing health care professionals for emergent situations. This research offers valuable insights for shaping future online CME strategies.

Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness.

The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March-30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.

Post-Traumatic Stress Disorder among Polish Healthcare Staff in the Era of the COVID-19 Pandemic.

INTRODUCTION: The COVID-19 pandemic has brought many adverse phenomena, particularly in the area of health for both individuals and society as a whole. Healthcare staff also suffered dire consequences. AIM: The aim of this study was to assess whether the COVID-19 pandemic increased the risk of post-traumatic stress disorder among healthcare professionals in Poland. MATERIAL AND METHOD: The survey was conducted between 4 April 2022 and 4 May 2022. The study applied the Computer Assisted Web Interview (CAWI) technique using the standardised Peritraumatic Distress Inventory (PDI) questionnaire. RESULTS: The average score obtained by the respondents on the PDI was 21.24 ± 8.97. There was a statistically significant difference between the average PDI score obtained based on the gender of the subject (Z = 3.873, p = 0.0001.) The score obtained amongst nurses was statistically significantly higher compared to the paramedic group (H = 6.998, p = 0.030). There was no statistically significant difference between the average PDI score obtained based on the age of the participants (F = 1.282, p = 0.281), nor with their length of service (F = 0.934, p = 0.424). A total of 82.44% of the respondents received 14 PDI points, the cut-off point indicating the risk of PTSD that was adopted in the study. It was concluded that 6.12% of respondents did not require intervention (<7 PDI score); 74.28% of respondents needed further follow-up for PTSD and a reassessment of the PDI approximately 6 weeks after the initial testing; and 19.59% required coverage for PTSD prevention and mitigation (>28 PDI score). CONCLUSIONS: The study has shown a high risk of post-traumatic stress disorder among healthcare professionals in Poland. This risk is related to the gender of the respondents, with an indication of a higher risk of PTSD among women. The results have also shown a correlation between increased risk of post-traumatic stress disorder and occupation, with nurses being the most affected group. In contrast, no association has been found in terms of age and length of service for an increase in the risk of PTSD, following exposure to trauma in relation to healthcare services during the COVID-19 pandemic.

The Prevalence of Depression Symptoms and Their Socioeconomic and Health Predictors in a Local Community with a High Deprivation: A Cross-Sectional Studies.

Depression is a heterogeneous and etiologically complex psychiatric syndrome thatshows a strong sexual dimorphism and often impacts people with a low socioeconomic status (SES). The aim of the study was to estimate the occurrence of depression symptoms in a local community with a high deprivation rate, the example being the inhabitants of the JanówLubelski County in eastern Poland. A cross-sectional study was carried out on 3752 people aged between 35 and 64. The prevalence of depression symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9) scale. In the screening for depression symptoms in the entire population we studied, the risk of depression symptoms was 16.1% (n = 605), with women having a significantly higher mean score than men (p < 0.001). Significant predictors associated with the achievement of 10 points and more in the PHQ-9 assessment in the case of women and men were: living alone, education and having comorbidities. Moreover, female participants living in rural areas were significantly more likely to exhibit depression symptoms, whereas smoking was a significant predictor of depressive symptoms in men. It was observed that in the case of obese women, the chance of being in the higher category of the PHQ-9 assessment was 1.41 times higher than in women with normal body weight. However, in the case of men, an increase in age by one year increased the chance of being in a higher category by 1.02 times. Moreover, the odds of falling into a higher category, as assessed by the PHQ-9 questionnaire, among men who drink alcohol more than once a week was 1.7 times higher than in men who do not drink or consume alcohol occasionally. Summarising the results of studies conducted in a local community characterised by a high deprivation rate, socioeconomic and health variables related to SES significantly impacted the incidence of depression, but they differ in terms of gender.

Relationship between Serum Kallistatin and Afamin and Anthropometric Factors Associated with Obesity and of Being Overweight in Patients after Myocardial Infarction and without Myocardial Infarction.

Extensive clinical and epidemiological evidence has linked obesity to a broad spectrum of cardiovascular disease (CVD), including coronary disease, heart failure, hypertension, cerebrovascular disease, atrial fibrillation, ventricular arrhythmias, and sudden death. In addition, increasing knowledge of regulatory peptides has allowed an assessment of their role in various non-communicable diseases, including CVD. The study assessed the concentration of kallistatin and afamin in the blood serum of patients after a myocardial infarction and without a cardiovascular event, and determined the relationship between the concentration of kallistatin and afamin and the anthropometric indicators of being overweight and of obesity in these groups. Serum kallistatin and afamin were quantified by ELISA tests in a cross-sectional study of 160 patients who were divided into two groups: study group (SG) (n = 80) and another with no cardiovascular event (CG) (n = 80). Serum kallistatin concentration was significantly higher in the SG (p < 0.001), while the level of afamin was significantly lower in this group (p < 0.001). In addition, a positive correlation was observed in the SG between the afamin concentration and the waist to hip ratio (WHR), lipid accumulation product (LAP) and the triglyceride glucose index (TyG index). In the CG, the concentration of kallistatin positively correlated with the LAP and TyG index, while the concentration of afamin positively correlated with all the examined parameters: body mass index (BMI), waist circumference (WC), hip circumference (HC), waist to hip ratio (WHtR), visceral adiposity index (VAI), LAP and TyG index. Serum kallistatin and afamin concentrations are associated with the anthropometric parameters related to being overweight and to obesity, especially to those describing the visceral distribution of adipose tissue and metabolic disorders related to excessive fatness.

The Relationship Between the Metabolic Syndrome and the Place of Residence in the Local Community on the Example of the Janów Lubelski District in Eastern Poland: A Population-Based Study.

PURPOSE: The aim of this study was to estimate the incidence concerning metabolic syndrome (MetS) in a local community with a low socioeconomic status and a medium and high cardiovascular risk on the example of residents of Janów Lubelski district, eastern Poland. The second goal of the research was to analyze the relationship between residence and the occurrence of MetS. METHODS: We conducted a cross-sectional study of 4040 people living in eastern Poland. A group of 3046 people with medium and high cardiovascular risk was selected among the respondents and included in further analyzes. The research adopted the definition criteria proposed by the National Cholesterol Education Program - Third Adult Treatment Panel (NCEP ATP III) to implement diagnostic evaluation of MetS. RESULTS: It was observed that metabolic syndrome was significantly more frequent among the inhabitants of rural areas (40.56%; n=810) compared to those living in the city (35.27%; n=370) p=0.005. Among the inhabitants of rural areas, the percentage of people with elevated glucose levels was significantly higher, fasting blood glucose (FGB) p<0.001, elevated blood pressure (HBP) p<0.001, elevated serum triglycerides (TGs) p=0.01, and abnormal waist circumference (WC) p=0.003 compared to urban inhabitants. After adjusting for potential confounding variables (age, education, smoking, marital status, and level of physical activity), in both women and men, the odds of developing metabolic syndrome were approximately 30% higher in rural areas compared to urban residents (women: odds ratio (OR)=1.25, 95% confidence intervals (CI)=1.01-1.56; men: OR=1.30, 95% CI=1.01-1.67). CONCLUSION AND RECOMMENDATIONS: A higher incidence of metabolic syndrome was observed among respondents living in rural areas than those living in cities. Similarly, across the gender strata, metabolic syndrome is more commonly diagnosed among men and women living in rural areas. Healthcare workers, especially in rural areas, should engage in education, prevention, and the promotion of a healthy lifestyle.

Transitioning to Web-Based Learning in Basic Life Support Training During the COVID-19 Pandemic to Battle the Fear of Out-of-Hospital Cardiac Arrest: Presentation of Novel Methods.

Ongoing training in the area of basic life support aims to encourage and sustain the willingness to act in out-of-hospital cardiac arrest situations among first aiders. The contribution of witnesses and first aiders has diminished rapidly, as suspicion associated with the COVID-19 pandemic has risen. In this paper, we present teaching methods from the medical education field to create a new teaching-learning process for sustaining the prehospital involvement of first aiders and encourage new first aiders. The most important benefit-improving outcomes-can be achieved by introducing a variety of teaching-learning methods and formative assessments that provide participants with immediate feedback to help them move forward in the basic life support course. The new reality of web-based learning that has been introduced by the pandemic requires an innovative approach to traditional training that involves techniques and methods that have been proven to be useful in other fields.

Mind the gap: The integration of anatomy course contents with basic procedural skills.

OBJECTIVES: This study investigated the value of procedural skill acquisition in low-fidelity simulation labs for students entering a clinical setting during the mandatory one-month nursing internship. METHODS: We conducted a course that combined gross anatomy knowledge with the teaching of simple procedural skills. We analysed 299 students' opinions and then compared them with their assessment outcomes. RESULTS: The survey results showed general satisfaction of students with the simulation-based course. Regarding the role of procedural labs as an adequate enhancement for traditional anatomy labs, students considered the basic procedural skills course as a strong alternative for traditional anatomy lectures and labs. Moreover, a comparison of participants' pre- and post-course answers indicated a significant increase in their anatomy knowledge. CONCLUSIONS: This study thus indicated a positive perception of students about a course that employed innovative educational measures. In this way, the positive impact of teaching anatomical knowledge through basic procedures was noted.

The Severity of Traumatic Stress Associated with COVID-19 Pandemic, Perception of Support, Sense of Security, and Sense of Meaning in Life among Nurses: Research Protocol and Preliminary Results from Poland.

The COVID-19 pandemic can not only affect physical health, but also mental health, resulting in sleep problems, depression, and traumatic stress. Our research investigates the level of posttraumatic stress, perceived social support, opinions on positive and negative consequences of the pandemic, sense of security and sense of meaning among nurses in the face of this new and not fully understood global epidemiological phenomenon. For this purpose, computer-assisted web interviews were conducted between May 1 and May 15, 2020. Participating nurses completed the following research tools: The Impact Event Scale-Revised (IES-R), The Multidimensional Scale of Perceived Social Support (MSPSS), The Changes in Outlook Questionnaire (CIOQ), The Safety Experience Questionnaire (SEQ) and The Meaning in Life Questionnaire (MLQ). Three hundred and twenty-five nurses of an average age of 39.18 ± 11.16 years and working throughout Poland joined the study. The average overall IES-R score in the study group was 1.78 ± 0.65. Among the dimensions of traumatic stress, the highest score was obtained in the "avoidance" dimension was 1.86 ± 0.73. Amongst participating nurses, the highest support rates were provided by significant others (22.58 ± 5.22). Higher average scores were noted among participants in the subscale measuring positive psychological changes (18.56 ± 4.04). The mean MLQ score was 5.33 ± 0.87. A slightly higher result was observed in the subscale "presence" (5.35 ± 1.14). The results of the research implemented during the period of severe psychological pressure associated with the COVID-19 pandemic provided information on symptoms of traumatic stress in the examined group of nurses. Their sense of security has been lowered and accompanied by an intensified reflection on issues concerning security. However, their current sense of meaning in life remains higher than the tendency to searching for it. The surveyed nurses received individual support mostly from significant others (i.e., other than family and friends). They see positive changes resulting from painful experiences related to the COVID-19 pandemic, which can be characterized by adaptation in the form of post-traumatic growth.

Protective antigen domain 4 of Bacillus anthracis as a candidate for use as vaccine for anthrax.

Existing research for using the protective antigen (PA) of Bacillus anthracis as a vaccine component shows that protection against anthrax may be obtained using fragments of this protein. The aim of the research is to check whether the selected protein fragment of the protective antigen (domain 4) encoded by an appropriate nucleotide sequence of gene pag of B. anthracis, was expressed in the bacterial system of E. coli. In order to examine the selected sequence of the pag gene, a PCR reaction and a highly effective TOPO cloning strategy were used, followed by purification of the recombinant proteins and their detection by a western-blot method. In the planning of the PA4 antigen expression a higher level of effectiveness in production of small protein - domain 4 - was anticipated. As a result, the 139 amino acids protein fragment of B. anthracis PA (domain 4) was isolated. The research may have found the basis for in vivo research aimed at finding potential anthrax vaccine components.

Self-reported occupational blood exposure among paramedics in Poland: a pilot study.

Introduction. Paramedics are at risk of occupational blood exposure, increased by the immediacy of provided treatment. However, the issue has not been acknowledged to date by any research in Europe. Methods. This research aimed at assessing occupational blood exposure among paramedics in Poland. Respondents represented 21 Polish medical institutions. Their participation was voluntary and anonymous. Paramedics were provided with a self-directed job-specific questionnaire adapted to Polish conditions from an original US version. Results. 118 paramedics participated in the study from institutions constituting the National Emergency Medical System in Poland; including ambulance crews, Helicopter Emergency Medical Services and emergency department employees. Occupational exposure was reported by 18.64% of respondents and the main route of exposure was needlestick events. Conclusions. There is a further need to improve education among paramedics concerning the threat of being infected with blood-borne pathogens through all existing routes. Our findings point to the problem as being hidden and considered a shameful issue.

Translation of learning objectives in medical education using high-and low-fidelity simulation: Learners' perspectives.

OBJECTIVES: The mastering of learnt procedures by medical students is triggered by numerous elements, including the ability to understand educational goals for specific tasks. In this study, the authors investigated the processes for identifying learning objectives set forth by medical students and the possibility of the chosen simulation fidelity influencing this ability in Basic Clinical Skills and Elderly Medicine courses at the Medical University of Lublin. METHODS: A total of 121 medical students assessed the extent to which learning objectives were implemented in two courses with high- and low-fidelity simulation. Using an online survey with closed-ended questions, a list of learning objectives assigned to the courses was sent to participants. The authors evaluated how the courses were generally assessed in terms of their substantive value and general applicability. The Spearman rank correlation (Spearman's rho), χ2, and descriptive statistics were used for investigating research problems. RESULTS: Students correctly identified established learning objectives embedded in the courses and positively assessed both courses. Participants' affirmative opinions were related to the high substantive value of both courses. CONCLUSIONS: Teachers and course creators could benefit from students' feedback about the clarity of learning objectives. The application of some of their ideas would promote a student-centred approach in medical simulation. This approach could be considered input for task selection and optimisation of learning.

Risk indicators for road accident in Poland for the period 2004-2017.

OBJECTIVE: The aim of the research was to assess the prevalence, effects and risk factors for motor vehicle accidents (MVA) in the years 2004-2017 in Poland. METHOD: We merged secondary data from the Prevention and Analysis Office of Road Traffic Headquarters of Police and Central Statistical Office of Poland. RESULTS: Our results suggest that several thousand people are killed on Polish roads annually, and tens of thousands are injured. Road crashes represent the leading cause of death for Polish men up to 44 years of age. The most common causes of road crashes in Poland include failure to comply with the road traffic rules and low driving skills. We also found drivers who poorly assessed road situations, roads characterized by a lack of adequate road infrastructure, and many vehicles in poor condition. Road crashes have become a significant public health and social problem globally. Drivers caused most MVA in Poland in the years 2004-2017, whereas the underlying cause was inadequate speed regarding the road traffic condition as well as not respecting the right-of-way. Despite various measures that are being taken to improve safety on Polish roads, the number of the dead and wounded as a result of road accidents is still high and the losses to the society are considerable as well. CONCLUSION: It is necessary to continue multidirectional actions to improve safety on the roads in Poland resulting in a systematic increase in the level of road traffic security.

Brucella - Virulence Factors, Pathogenesis and Treatment.

Brucellae are Gram-negative, small rods infecting mammals and capable of causing disease called brucellosis. The infection results in abortion and sterility in domestic animals (sheeps, pigs, rams etc). Especially dangerous for humans are: Brucella melitensis, Brucella suis, Brucella abortus, and Brucella canis that trigger unspecific symptoms (flu-like manifestation). Brucella rods are introduced via host cells, by inhalation, skin abrasions, ingestion or mucosal membranes. The most important feature of Brucella is the ability to survive and multiply within both phagocytic and non-phagocytic cells. Brucella does not produce classical virulence factors: exotoxin, cytolisins, exoenzymes, plasmids, fimbria, and drug resistant forms. Major virulence factors are: lipopolysaccharide (LPS), T4SS secretion system and BvrR/BvrS system, which allow interaction with host cell surface, formation of an early, late BCV (Brucella Containing Vacuole) and interaction with endoplasmic reticulum (ER) when the bacteria multiply. The treatment of brucellosis is based on two-drug therapy, the most common combinations of antibiotics are: doxycycline with rifampicin or fluoroquinolones with rifampicin. Currently, also other methods are used to disrupt Brucella intracellular replication (tauroursodeoxycholic acid or ginseng saponin fraction A).

Evaluation of tourniquet application in a simulated tactical environment.

BACKGROUND: Application of a tourniquet in a tactical environment is implemented in two ways: the so-called self-aid, which is the application of a tourniquet by the injured, and the so-called buddy aid, which is the application of a tourniquet by the person provide aid. This study aimed to test the quality of tourniquet use in a simulated situation, close quarter battle. METHODS: The study involved 24 injured operators and 72 operators in the whole simulation, implying 12 sections of six individuals. To validate the application of tourniquets, the recommendations of the Committee of Tactical Combat Care of the Injured were used, and ultrasound with Doppler function was employed to assess the hemodynamic effect of applying tourniquets. RESULTS: Native flow was observed in 15 operators; in three people, a trace flow was noticed, whereas in six people, a full flow was observed. No significant difference was found between the qualities of tourniquet application by the operators themselves compared with those of tourniquet application by another person. The median distance of tourniquet application from the armpit was 9.5 cm for self-aid and buddy aid. In 16 participants the outer arrangement of tourniquets was observed, and in only eight participants tourniquets were correctly located on the internal part of the arm. In 18 participants, tourniquets were not correctly prepared for use in the tactical environment, whereas in only six participants, they were correctly prepared. Most operators with a negative ultrasound flow revealed negative distal observed pulse (DOP). Positive DOP occurred in the majority of operators with full ultrasound flow. CONCLUSION: The application of tourniquets poses a challenge even in case of specialized units; therefore, there is a need to provide regular training for implementing that procedure.

Acute respiratory distress syndrome (ARDS) in the course of influenza A/H1N1v infection--genetic aspects.

Influenza is a contagious respiratory disease caused by viruses belonging to the family Ortomyxoviridae. Among the influenza viruses type A, B and C, the A type virus shows the most pathogenic potential. Its surface receptor glycoproteins, hemagglutinin (HA) and neuraminidase (NA), are characterized by high antigenic variation, thus a host organism cannot develop permanent resistance. The case is described of a male patient with severe acute respiratory distress syndrome in the course of influenza A/N1H1v infection, confirmed by virological molecular analysis. During diagnostic procedures based on the MSSCP genotyping it was observed that the WHO recommended RT-PCR kits and/or procedure of sample collection from patients for molecular investigation could lead to false positive A/H1N1 pandemic strain detection because of the co-amplification during the RT-PCR fragments of the human genome.