Atrial fibrillation (AF) is the most prevalent sustained arrhythmia managed in emergency departments, and the already high prevalence of this arrhythmia is increasing in Spain. This serious condition associated with increased mortality and morbidity has a negative impact on patient quality of life and the functioning of the health care system. The management of AF requires consideration of diverse clinical variables and a large number of possible therapeutic approaches, justifying action plans to coordinate the work of several medical specialties in the interest of providing appropriate care and optimizing resources. This consensus statement brings together recommendations for emergency department management of AF based on available evidence adapted to special circumstances. The statement was drafted by a multidisciplinary team of specialists from the Spanish Society of Emergency Medicine (SEMES), the Spanish Society of Cardiology (SEC), and the Spanish Society of Thrombosis and Hemostasis (SETH). Strategies for stroke prophylaxis, measures to bring heart rate and heart rhythm under control, and related diagnostic and logistic issues are discussed in detail.
La fibrilación auricular (FA) es la arritmia sostenida de mayor prevalencia en los servicios de urgencias (SU), y en España presenta una frecuentación elevada y creciente. Esta arritmia es una enfermedad grave, que incrementa la mortalidad y asocia una relevante morbilidad e impacto en la calidad de vida de los pacientes y en el funcionamiento de los servicios sanitarios. La diversidad de aspectos clínicos a considerar y el elevado número de opciones terapéuticas posibles justifican la implementación de estrategias de actuación coordinadas entre los diversos profesionales implicados, con el fin de incrementar la adecuación del tratamiento y optimizar el uso de recursos. Este documento, realizado por un grupo multidisciplinario de expertos en arritmias cardiacas miembros de la Sociedad Española de Medicina de Urgencias y Emergencias, la Sociedad Española de Cardiología y la Sociedad Española de Trombosis y Hemostasia, recoge las recomendaciones para el manejo de la FA en los SU hospitalarios, basadas en la evidencia disponible y adaptadas a las especiales circunstancias de los mismos. En él se analizan con detalle las estrategias de profilaxis tromboembólica, control de frecuencia y control del ritmo, y los aspectos logísticos y diagnósticos relacionados.

Workplace violence in healthcare settings is alarmingly common and represents significant financial and human cost. The aim of this scoping review was to identify and summarize evidence on strategies to prevent and/or manage workplace violence in healthcare settings. Searches were limited to evidence-based clinical practice guidelines and systematic reviews published between 2015 and 2021. Multiple databases were searched and screened. Quality of the included guidelines and reviews was also assessed. Three guidelines and 33 systematic reviews were included. Both the Occupational Safety and Health Administration 2015 and Registered Nurses\' Association of Ontario 2019 guidelines provided useful recommendations for building a comprehensive prevention program. Evidence-based risk assessment, prevention and management, and education and training are all central components. Regular reassessment and adjustment is required. Included reviews (n = 33) were grouped into five main categories: violence toward nurses (n = 10); violence toward healthcare workers in general (n = 8); violence in the emergency department (n = 5); violence related to mental health (n = 5); and measurement related to workplace violence (n = 5). Multicomponent interventions were often more effective than those applied in isolation. We found consistent support for certain strategies including education and training, post-incident debriefing, multidisciplinary rapid response teams, and environmental modifications; however, the strength of evidence and certainty of conclusions were limited across reviews. This scoping review found that strong leadership that cultivates and enforces a culture of inclusivity, support, and respect is a prerequisite for a successful workplace violence prevention program. Rigorous comparative effectiveness research testing interventions are needed.

BACKGROUND: Research shows that the most typical response to client violence has been to implement policies that safeguard social workers at their workplaces. This article examined, through a document analysis, the international norms for the protection of social workers. The goal of the document analysis was to inform policy development in South Africa against client violence.
METHODS: The researchers found, selected, analysed, and synthesised 17 international policies, frameworks, protocols, guidelines, and legislative frameworks using the applied thematic analysis (ATA) approach. The data was analysed at three levels, and open coding yielded 18 codes.
RESULTS: The codes were refined into three main themes and subthemes related to protecting social workers from client violence: (1) employers inspired a culture of safety and security within the work-environment, (2) social workers prioritised their safety by using their clinical skills, and (3) actively implementing initiatives to ensure the safety of social workers.
CONCLUSIONS: The research highlighted social work safety while providing services at an office, visiting sites, or traveling. Examining these practicalities provided valuable data that can inform policy development processes in different countries.

In order to implement a systems-level Emergency Medical Services (EMS) workplace violence intervention, input from end users was critically needed. We convened the two-day Stress and Violence in fire-based EMS Responders (SAVER)\" Systems Checklist Consensus Conference (SC3) using methods from meeting science (i.e., ThinkLets) to comprehensively and efficiently gather feedback from stakeholders on the completeness and utility of the draft checklist that would comprise the intervention.
ThinkLets, a codified facilitation technique was used to aid brainstorming, convergence, organization, evaluation, and consensus building activities on the SAVER Systems Checklist among 41 national stakeholders during a two-day conference. A qualitative and quantitative process evaluation was conducted to measure the effectiveness of conference procedures. To verify checklist feasibility results from the conference, a second feasibility assessment was conducted with the four implementation sites.
The quantitative conference evaluation results indicated most participants viewed the conference process favorably. Emergent themes reflecting on conference effectiveness and suggestions for improvements are described. The re-evaluation of the checklist\'s feasibility completed by the SAVER study sites confirmed prior feasibility findings. SAVER study sites cast 45.5% of votes on checklist items to be most feasible, 34.9% as less feasible, and 19.6% as extremely difficult. Practical Applications: Multidisciplinary collaboration between public health, occupational health psychology, and meeting science led to the development of the SAVER Systems Checklist. The checklist underscores important needs for EMS policy and training development critical to responder safety as identified and supported by over 41 diverse subject matter experts. The incorporation of a widely used meeting science method, ThinkLets, into public health intervention design proved an effective and well-received approach to bring assessment, evaluation, and consensus to the SAVER Systems Checklist. These methods may hold benefit for other industries and disciplines that may not be familiar with such facilitation and consensus-building techniques.

Workplace violence has potentially high prevalence, in addition to positive correlation with risk of physical and mental disorders, absenteeism, high turnover rates, impaired productivity and poorer organizational climate. Workplace violence is embedded in the work routine, while its manifestations are heterogeneous and vary according to the local culture, work activities and organization. The scientific evidence for the efficacy of interventions to reduce the prevalence of violent incidents is insufficient to ground general recommendations applicable to any occupational activity. Consensus among organizational actors about notions, relevance, prevalence and risk factors associated with workplace violence, based on epidemiological mappings, is necessary, given the subjective and cultural nature of this problem, and also to enable organizational actors to jointly design pilot solutions. This approach is based on methods used in experimental studies and seeks to promote greater adherence to changes.
Violência em ambiente de trabalho potencialmente ocorre em prevalência importante, com associação de risco positiva para adoecimento físico e mental, absenteísmo, aumento de rotatividade, diminuição da produtividade e piora do clima organizacional. A expressão da violência no trabalho é incrustada no cotidiano profissional e heterogênea na cultura, atividade e organização de trabalho locais. Há insuficiência de evidências científicas que atestem a eficácia das intervenções em reduzir a prevalência dos eventos de violência de forma a permitir recomendações generalizáveis para qualquer atividade de trabalho. A natureza subjetiva e cultural do problema torna necessária a criação de um consenso com os membros da empresa quanto aos conceitos, importância, prevalência e fatores de risco da violência ocupacional a partir da apresentação do mapeamento epidemiológico. O desenho conjunto de soluções piloto pelos membros da empresa surge após esse consenso. Essa abordagem segue a metodologia dos estudos experimentais sobre o tema e busca promover maior aderência a mudanças.

This consensus report summarizes the negative impact of work-related psychosocial factors and job stressors on the health and wellbeing of shift workers. Psychosocial factors may (a) directly affect work schedules or (b) mediate or moderate relationships between work schedules, circadian factors, and health. In this paper, prominent psychosocial models (e.g. Job Strain and Effort-Reward Imbalance) are used to help assess detrimental effects, including pathophysiologic outcomes. Several studies indicate the psychosocial environment can be more problematic for shift workers compared to regular day workers. This is likely due to shift worker\'s experiencing greater risks of low job control, high physical work demands, lower support from supervisors, and greater levels of over-commitment. Workplace violence is another frequently encountered psychosocial stressor for shift workers more likely to be in regular contact with the general public, such as police officers, security personnel, professional drivers, and other service employees being at elevated risk. A large body of literature confirms night and irregular shift schedules increase risk for injury. Non-diurnal schedules can trigger and worsen such incidents, especially under unsafe conditions. The problem of workplace violence for shift workers, in terms of severity and consequences, is probably underestimated, especially when present among other occupational stressors. Practical considerations and recommendations for action to mitigate the detrimental effects of psychosocial stressors on night and shift workers are presented.