Resilience in Emergency Medicine during COVID-19: Evaluating Staff Expectations and Preparedness.

INTRODUCTION: The COVID-19 pandemic brought about significant challenges for health systems globally, with medical professionals at the forefront of this crisis. Understanding their organizational expectations and well-being implications is crucial for crafting responsive healthcare environments. METHODS: Between 2021 and 2022, an online survey was conducted among 852 medical professionals across four provinces in Poland: Mazovia, Lódz, Swietokrzyskie, and Lublin. The survey tool, based on a comprehensive literature review, comprised dichotomous questions and specific queries to gather explicit insights. A 5-point Likert scale was implemented to capture nuanced perceptions. Additionally, the Post-Traumatic Stress Disorder Checklist-Civilian (PCL-C) was utilized to ascertain the correlation between workplace organization and post-traumatic stress symptoms. RESULTS: A noteworthy 84.6% of participants believed their employers could enhance safety measures, highlighting a discrepancy between healthcare workers' expectations and organizational implementations. Major concerns encompassed the demand for improved personal protective equipment (44.6%), structured debriefing sessions (40%), distinct building entrances and exits (38.8%), and psychological support (38.3%). Statistical analyses showcased significant variations in 'Avoidance' and 'Overall PTSD Score' between individuals who had undergone epidemic safety procedure training and those who had not. CONCLUSIONS: The results illuminate the imperative for healthcare organizations to remain agile, attentive, and deeply compassionate, especially during worldwide health emergencies. Despite showcasing remarkable resilience during the pandemic, medical professionals ardently seek an environment that underscores their safety and mental well-being. These findings reinforce the call for healthcare institutions and policymakers to champion a forward-thinking, employee-focused approach. Additionally, the data suggest a potential avenue for future research focusing on specific demographic groups, further enriching our understanding and ensuring a more comprehensive readiness for impending health crises.

Influence of experience, tenure, and organisational preparedness on nurses' readiness in responding to disasters: An exploration during the COVID-19 pandemic.

Background: The coronavirus 2019 (COVID-19) pandemic has placed unprecedented challenges on the nursing practice, particularly in Poland. Nurses, as crucial healthcare service providers, have faced organisational disruptions, altered working conditions, and heightened professional anxieties. Methods: We undertook a comprehensive survey across all medical centres in Lublin, Poland in 2020 to understand nurses' attitudes towards their roles and working conditions during the pandemic. This involved 470 nurses completing a questionnaire which focused on four pivotal areas: readiness to be on call in a disaster situation (even when not formally asked); willingness to work overtime in a disaster without additional compensation, preparedness to undertake health risks by caring for individuals with infectious diseases or exposure to hazardous substances, and willingness to be transferred to other departments during a disaster. Results: We found that excessive workload, fear of infection, and feelings of helplessness significantly influenced nurses' readiness to work overtime, particularly when unpaid. We also presented the ethical dilemmas that nurses encountered during the pandemic and how these dilemmas affected their decision-making processes. We further explored the impact of variables such as nurses' professional experience, tenure, and level of organisational preparedness on their readiness to respond to crisis situations. Conclusions: Gaining an understanding of nurses' perspectives is key for formulating strategies to bolster their professional engagements and resilience during crises. Addressing these issues can help build a more robust and well-prepared healthcare system that can effectively navigate future crises.

The Moral, Ethical, Personal, and Professional Challenges Faced by Physicians during the COVID-19 Pandemic.

The COVID-19 pandemic, apart from the main problems concerning the health and life of patients, sparked a discussion about physicians' moral and social professional attitudes. During a pandemic, physicians have the same ethical, moral, and medical responsibilities, however, the situation is different since they are self-exposed to a danger, which may influence their willingness to work. The problem of the professional moral attitudes of health care workers, recurring in ethical discussions, prompts us to define the limits of the duties of physicians in the event of a pandemic, hence this research aimed to assess these duties from an ethical perspective and to define their boundaries and scope. The study was conducted in May and June 2020 in the city of Lublin, covering all medical centers, and the questionnaire was completed by 549 physicians. The research was conducted in four areas: emergency standby in the event of a disaster, even if it is not requested; willingness to work overtime in the event of a disaster, even without payment; willingness to take health risks by caring for people who are infectious or exposed to hazardous substances; readiness to be transferred to other departments in the event of a disaster. Although most of the respondents declared to be agreed on personal sacrifices in the performance of professional duties, they were not prepared for a high level of personal risk when working in a pandemic. Excessive workload, its overwhelming nature, and personal risk are not conducive to readiness to work overtime, especially without pay. Research shows how important it is to respect the rights and interests of all parties involved in a pandemic. Physicians' duty to care for a patient is also conditioned by the duty to protect themselves and should not be a tool for intimidating and depersonalizing their social and professional lives.

Objective and Subjective Stress Parameters in Response to High and Low-Fidelity Simulation Activities.

Nursing graduates are required to have both excellent theoretical and practical skills that should be used during stressful emergency interventions. Since the received knowledge should be practiced to gain skills and trained to achieve competences, simulation exercises can be beneficial to even reduce the stress that each individual may face during emergency management of patients. A total of 146 first-year nursing students participated in the study, including 124 women and 22 men aged between 19 and 50 years, with a mean age of 32 years. The objective method estimated psychophysiological parameters (serum cortisol). Objective and subjective methods were used. The subjective method assessed stress experienced by students based on the standardized Stress Appraisal Questionnaire Version B for dispositional assessment. The study was conducted in the Monoprofile Medical Simulation Centre at the University of Economics and Innovation in Lublin, Poland and was approved by the University Research Ethics Committee. Both participants under and over 25 years of age showed increased levels of stress after low and high-fidelity simulations, with statistically significantly higher stress levels found for the low fidelity method. Low-fidelity simulation methods generated a greater increase in cortisol levels, indicating a higher stress level than the high-fidelity methods. The analysis of the scores obtained in the Stress Appraisal Questionnaire (KOS-B) showed that higher cortisol levels after the low-fidelity simulation reduced the subjective perception of a threat, while higher cortisol levels before the high-fidelity simulation promoted higher intellectual activity among the students. Levels of stress in the education of nursing students using low and high-fidelity methods can limit the sense of threat and activate professional task performance. The use of low and high-fidelity simulation does not generate destructive stress levels.

Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries.

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.

The importance of pre-training gap analyses and the identification of competencies and skill requirements of medical personnel for mass casualty incidents and disaster training.

BACKGROUND: Effective preparedness to respond to mass casualty incidents and disasters requires a well-planned and integrated effort by all involved professionals, particularly those who are working in healthcare, who are equipped with unique knowledge and skills for emergencies. This study aims to investigate and evaluate the level of knowledge and skills related to mass casualty and disaster management in a cohort of healthcare professionals. METHODS: A cross-sectional brief study was conducted using a validated and anonymous questionnaire, with a sample of 134 employees at a clinical hospital in Lublin, Poland. RESULTS: The findings of this study may indicate a need for standardization of training for hospitals employees. It also suggests a knowledge gap between different professional groups, which calls for adjusting such general training, to at least, the weakest group, while special tasks and mission can be given to other groups within the training occasion. CONCLUSION: Pre-Training gap analyses and identification of participants' competencies and skills should be conducted prior to training in mass casualty incidents and disasters. Such analyses provides an opportunity to develop training curriculum at various skill and knowledge levels from basic to advance. All training in mass casualty incidents and disasters should be subject to ongoing, not just periodic, evaluation, in order to assess continued competency.

Effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS - retrospective analysis of data from Almaty, Kazakhstan, 2010-2015.

INTRODUCTION: According to data from the National Centre for Prevention and Control of AIDS, in the Republic of Kazakhstan, 45.8% of patients in the symptomatic stages of HIV infection are diagnosed with tuberculosis (TB) which is the cause of death in 36% of patients infected with HIV. OBJECTIVE: The aim of the study was to conduct a retrospective analysis of the effectiveness of tuberculosis (TB) chemoprophylaxis among people living with HIV in the Republic of Kazakhstan (RK) in Central Asia. MATERIAL AND METHODS: Materials and method. A retrospective analysis of patient health status was performed for each of the 648 patients (323 in the study group and 325 in the control group) during 2010-2015. Data from outpatient treatment charts were used concerning each patient infected with HIV observed at AIDS Treatment Centres. From among the 648 patients infected with HIV, 136 were receiving isoniazid in 2010, and 187 in 2011. The control group consisted of 325 people living with HIV (PLW HIV), who did not received isoniazid during observation. RESULTS: Results. The incidence of TB in patients who underwent chemoprophylaxis did not exceed 0.555/ 100,000 population in the first year of observation. Within 5 years, the TB incidence dropped to 0. In the control group, the TB incidence rate during the first year of observation was 3.262/100,000, with a decrease to 0.364 observed in 2015. Cumulated incidence rate in 2011-2015 in the study group accounted for 1.276/100,000. In the control group, the cumulative incidence was 4.3 times higher and accounted for 5.527. A significant difference in the mortality rate due to TB in the study and control groups was observed, the share of deaths due to TB in study group was 21.6% - nearly 3 times lower than in the control group (57.0%). CONCLUSIONS: Conclusions. The effectiveness of chemoprophylaxis for TB depends on biomedical, organizational and cultural factors. The presence of HIV co-infections is a special situation. Opposite to the majority of reports, in own study, no drug-resistant forms of tuberculosis were observed in relation with chemoprophylaxis with isoniazid. In the examined population, TB chemoprophylaxis reduced the incidence and cumulative incidence of TB among PLW HIV by 3.4-4.8 times. Isoniazid chemoprophylaxis decreased 4-fold the annual and cumulative mortality due to TB.

Comparative analysis of the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS treated with isoniazid.

INTRODUCTION: The epidemic of human immunodeficiency virus has had a tremendous effect on the epidemic of tuberculosis. Together with the spread of HIV, a great increase has been observed in morbidity due to tuberculosis, both in endemic countries and in those where earlier, as a result of treatment, the frequency of occurrence of tuberculosis had decreased. In 2018, the WHO data demonstrated that the EECA region was the only region worldwide where the epidemics of HIV was still rapidly increasing. The EECA region still struggles with a serious epidemic of tuberculosis. MATERIAL AND METHODS: Materials and method. The research method applied was comparative analysis of the results of own study and studies by other researchers, concerning the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS when treated with isoniazid. RESULTS: Results. In own study, it was found that primary morbidity among patients administered isoniazid significantly decreased within 5 years. Incidence rates of primary morbidity were significantly lower than among patients who had not received isoniazid. Relevant studies conducted worldwide, in many cases differed from own study with respect to both the results and approach to the problem, by country or selection of the type of patients participating in the study. However, in all studies, isoniazid was generally a safe and well-tolerated drug, without special side-effects. CONCLUSIONS: Conclusions. All studies analyzed concerning the effectiveness of tuberculosis prophylaxis in patients with HIV/AIDS treated with isoniazid, confirmed the effectiveness of this drug. In the compared studies, applied isoniazid preventive therapy showed no difference in effectiveness according to its duration. Analyzed studies showed similar effectiveness also with respect to a decrease in mortality among patients with TB/HIV/AIDS.

Social functioning and the quality of life of patients diagnosed with schizophrenia.

INTRODUCTION: Schizophrenia to a considerably great degree impairs the social functioning of the persons affected in the spheres of interpersonal and occupational contacts, as well as self-care. It brings about serious cognitive, perceptual, motor and emotional deficits, inevitably leading to the social withdrawal of patients. This phenomenon may assume various forms, from the limitations in interpersonal relations, through narrowing these relations to only some circumstances, to the total cessation of social contacts. OBJECTIVE: The objective of the study is presentation of the most important problems related with social functioning and quality of life of patients diagnosed with schizophrenia, based on scientific studies conducted in Poland and worldwide. STATE OF KNOWLEDGE: The family of a schizophrenia patient exerts a great effect on the social functioning. While undertaking proper actions the family may become a co-therapist and significantly facilitate the patient's adjustment to life in society and his/her playing a specified role. Analysis of disorders in social functioning of patients with schizophrenia, in the context of social cognition, indicates the fact that these disorders have their source in the lack of capabilities for identification of own and other people's internal states, whereas mentalization is the essence of social cognition. CONCLUSIONS: Therapy, any psychosocial impact as well as rehabilitation, neutralizes the causes for patients' withdrawal from social life. Training of social skills is necessary which teaches patients to return to the situation when they would be able to function properly in their environment.

Impact of selected environmental factors on attendance in the Breast and Cervical Cancer Early Detection Programme in the Wielkopolska Province of Poland during 2007-2012.

Breast and cervical cancer represent a significant health and economic issue for Polish society, although if detected early, both can be cured successfully. For this reason, since 2006, according to the National Cancer Combat Programme, population-based screening programmes have been implemented, aimed at reducing the mortality and morbidity for breast and cervical cancer. The aim of this study is to determine which of the selected four environmental factors affect attendance for screening mammography and cytology. Analysis included data from questionnaires filled in during mammography by 582,959 women aged 50-69 years, and 288,142 women during cytology, aged 25-59 years, in 2007-2012 in the Wielkopolska Province of Poland. It was found that the impact of medical staff on the attendance for cytological screening was the strongest statistically significant factor (p = 0,0001). Invitation by name (p=0,001) and other factors (p= 0,0001) also affected the attendance. In the cytological screening, medical staff was the factor that had the greatest impact on attendance. Other factors, such as self-reporting, increased participation in the next screening rounds, although the factors that affect attendance changed over time. Their constant analysis is essential for the efficient and effective evaluation of screening programsme.

Evaluation of communication and acceptance of the patients by medical personnel

Background: The low level of patient satisfaction recorded in many studies and, at the same time, the level of frustration and burnout, disclosed by medics in the perception of the patient as a 'problem', incline to look for the causes of inadequate relationship between physician and patient. Objective: The aim of this study was to evaluate the level of acceptance of the patient by the medical personnel. The research problem was the acceptance level which was within the range of the communication skills of the nurses and doctors. Another aim was to discover the factors determining this level of acceptance. Material and Methods: Two methods were used in the research process: 1) a diagnostic survey regarding the medical, professional communication skills; 2) testing of professional self-esteem from the medical aspect. The study population consisted of a total of 1,244 respondents divided into the following groups: registered nurses and doctors (729), students of nursing and medical faculties (515). Results: The results of the research showed that in most cases the acceptance of the patient by the medical staff was 'conditional', which translated into the level of frustration or lack of satisfaction with their profession, and ultimately into the level of burnout. The level of patient acceptance by medical staff (unconditional acceptance), depended primarily on age, followed by their profession. However, the relationship between this acceptance and gender and work experience was statistically insignificant. Conclusions: As the method to improve this situation, the expansion of education in the field of interpersonal communication is proposed, adding issues related with both the conditional and unconditional acceptance of the patient, as well as issues regarding how to deal with the patient from the aspect of disease and the psycho-socio-spiritual area.

Evaluation of the relationship between 5-HTT and MAO gene polymorphisms, mood and level of anxiety among postmenopausal women.

OBJECTIVE: The aim of this study was to analyze how mood and anxiety level are related to the functional genetic polymorphism in the promoter region of SLC6A4 (5-HTTLPR) and the 30-bp VNTR polymorphism in the MAO A promoter region. METHODS: The study involved 272 postmenopausal women from Poland. The authors employed the State-Trait Anxiety Inventory for measuring levels of anxiety, the Mood Adjective Check List for measuring mood, and genetic tests. RESULTS: Analysis did not show any statistically significant differences in the mean levels of anxiety, and mood disorders in women in relation to genotypes of the 5-HTTLPR (SLC6A4) polymorphism and the 30-bp VNTR polymorphism in the MAO A promoter region. However, these problems were more severe among women with s/s genotype. In the case of MAO A gene polymorphism, the level of anxiety was higher in women with a 4/4 genotype. CONCLUSIONS: The study did not prove the possibility of the identification of homogeneous groups of women with an elevated risk of developing anxiety and mood disorders during the post-menopausal period. Nevertheless, it showed that respondents with s/s genotype of the 44-bp polymorphism in the 5-HTT (SLC6A4) promoter region had the highest average anxiety levels both as a state and as a trait. Furthermore, the analysis of the 30-bp VNTR polymorphism in the MAO A promoter region demonstrated slight differences in anxiety levels between the women, indicating that those with a 4/4 genotype had higher severity of anxiety symptoms.

The interaction between menstrual cycle, Tumour Necrosis Factor alpha receptors and sex hormones in healthy non-obese women--results from an observational study.

There is growing evidence that TNF-alpha and its two receptors play an important role in hormonal regulation, metabolism, inflammation and cancer. The biological effects of TNF-alpha are mediated by two receptors, p55 and p75. The aim of this study was to analyze serum concentrations of p55 and p75 and hormonal status in healthy women during the normal menstrual cycle. Eight women aged 20-22 with regular menstrual cycles were scheduled for examination on 3(rd) , 8(th) , 14(th) and 25(th) day of their menstrual cycle. We only observed a positive correlation of p75 subunit with prolactin level (correlation coefficient 0.417; p=0.0116) and negative correlation with insulin level (correlation coefficient -0.35; p=0.032) and HOMAIR insulin resistance index correlation coefficient 0.39; p=0.0185). Furthermore, a negative correlation of p55/p75 ratio with prolactin (correlation coefficient -0.42; p=0.0101) and a positive correlations of p55/p75 ratio with insulin level (correlation coefficient 0.43; p=0.008) and HOMAIR insulin resistance factor correlation coefficient 0.45; p=0.0065) were found.

Self-reported preparation of Polish midwives for independent performance of prophylactic activities within the scope of women's diseases and obstetric pathologies.

OBJECTIVE: The objective of the study is an attempt to recognize self-reported preparation of midwives for an independent performance of prophylactic activities within the scope of women's diseases and obstetric pathologies. MATERIAL AND METHODS: The study was conducted in a representative all-Polish population sample of 3,569 midwives, by the method of a diagnostic survey using a questionnaire technique. The research instrument was a questionnaire form designed by the author containing items concerning the characteristics of respondents and the object of the study, constructed based on the 5-point Liker scale. The relationships between the variables were verified using chi-square test (χ(2)) of independence. The p values p<0.05 were considered statistically significant. RESULTS: Analysis of results allows the presumption that in the opinions of midwives the majority of them are prepared for the independent performance of prophylactic activities in the area of women's diseases (84.28%) and obstetric pathologies (77.95%). However, nearly every tenth midwife, irrespective of the region of Poland where she lives, age, and participation in post-graduate training, is not prepared for an independent performance of the prevention of women's diseases. In turn, the lack of preparation for carrying out prevention of women's diseases was admitted mainly by midwives from the northern and central regions of Poland, aged 31-40, possessing post-secondary school education, who did not participate in any form of post-graduate training. CONCLUSIONS: The results of studies and analysis of the relevant literature indicate that it is necessary for midwives to improve their qualifications in the area of prophylaxis of women's diseases and obstetric pathologies through participation in various forms of post-graduate education.

The influence of passive and active moral training on medical university on changes of students' moral competence index - results from randomized single blinded trial.

INTRODUCTION AND OBJECTIVES: Human's life as well as medical professions consist of many moral dilemmas. The aim of our study was to evaluate moral competences of midwifery students during their whole university education (3 year course) based on their moral competences C-index. MATERIAL AND METHOD: We performed randomized single blinded 3-year follow-up trial of 72 midwifery students. Standard Moral Judgment Test (MJT) By Georg Lind was used accompanied by own questionnaire. Moral competences were calculated (C-index) according to Lind's methodology. Subjects were also divided into active and passive ethics training to search for differences. RESULTS: C-index varied during studies insignificant (p=0.14). Randomized groups were equal at the beginning point, no significant differences were noticed. Active ethics teaching did not increase C-index compared to controls in all measuring points (P1-P4, respectively p=0,41 and p=0,38). CONCLUSIONS: During 3 year studies at medical university moral competences measured by C-index varied insignificantly, but simultaneously the change in C-index was dependent on its value at the beginning of the trial. There was not statistically significant influence of active ethic's teaching compared to controls. Among social factors parents have strongest influence on students' morality, but growing role of Medical University in this hierarchy raises hopes for improvement in effectiveness of training in ethics.

High evaluation of medical staff by women after miscarriage during hospitalization.

The loss of a baby is a traumatic event, irrespective of the duration of pregnancy. In the present study, we attempted to recognize the opinions of women after miscarriage that needed assistance and support from the medical staff during hospitalization. The study was conducted during the period from January to June 2012 and included 303 women who miscarried and used medical care in the Lublin Region (Poland). The method of a diagnostic survey was applied using a questionnaire technique. The majority of the respondents reported that information obtained from physicians after the diagnosis of miscarriage were rather understandable (44.22%) and sufficient (41.91%). According to more than a half of respondents, after miscarriage, midwives demonstrated adequate skills (57.43%) and provided necessary informative support (52.81%). The study showed that during hospital stay the women who had experienced miscarriage evaluated in relatively high terms the physicians and midwives providing them with care. The evaluations of the attitudes of doctors and midwives increased with the women's growing needs during hospitalization. The results of the study allow the presumption that the medical staff providing care of women after miscarriage possess a relatively high level of knowledge and skills in the area of diagnostics and treatment of pregnancy terminated with miscarriage. However, it should be remembered that the constant training of doctors and midwives in the provision of emotional and psychological support is necessary.

Professional communication competences of paramedics--practical and educational perspectives.

INTRODUCTION: Dissonance between the high 'technical' competences of medical professionals, including paramedics or emergency medical technicians (EMT), and the relatively low level of patient satisfaction with care received, is a phenomenon observed in many countries. Many studies show that it occurs in the case of an inadequate interpersonal communication between medical professionals and patients. The primary goal of the presented research was evaluation of the level (study of the state) of communication competences of paramedics, and determination of the factors on which this level depends. An additional goal was analysis of the needs and educational possibilities within the existing models of education in the area of interpersonal communication provided by higher medical education institutions. METHODS: The following three methods were used: 1) documentation analysis (standards, plans and educational programmes); 2) diagnostic survey concerning professional communication competences of paramedics; 3) self-reported communication skills in emergency medical services--adjective check list. The last two instruments were subject to standardization from the aspect of reliability and validity. The study group covered a total of 105 respondents in the following subgroups: 1) professional paramedics who, as a rule, were not trained in interpersonal communication (31 respondents); paramedic students covered by a standard educational programme (54 respondents); 3) paramedic students who, in addition to a standard educational programme, attended extra courses in professional interpersonal communications (20 respondents). RESULTS: The results of studies indicate poor efficacy of shaping communication competences of paramedics based on education in the area of general psychology and general interpersonal communication. Communication competences acquired by paramedics during undergraduate education are subject to regression during occupational activity. DISCUSSION: Methods of evaluating communication competences are useful in constructing group and individual programmes focused on specific communication competences, rather than on general communication skills.