OBJECTIVE: To explore Finnish paramedics\' perceptions of work-related performance expectations in relation to work experience, and understand how organizational socialization contributes to understanding paramedics\' performance expectations.
METHODS: A qualitative design with a deductive-inductive approach utilizing a social constructivist framework. The organizational socialization framework by Wanberg was used as the theoretical basis.
METHODS: Data were collected between May and August 2023, using group and individual interviews of newly graduated (n = 9) and experienced paramedics (n = 13). Participants were recruited via social media channels. Data were first analyzed deductively, according to constructs of the organizational socialization framework (role clarity, task mastery, and social acceptance), then inductively, using codes not utilized in the deductive phase.
METHODS: Interviewed Finnish paramedics (N = 22), both newly graduated paramedics (n = 9) and experienced paramedics (n = 13). The interviews were performed remotely and then transcribed into text.
RESULTS: Our findings showed comparable performance expectations between newly graduated and experienced paramedics, mismatches in role clarity of paramedic work, challenges in both learning and upholding professional competence, and difficulties of social acceptance into the paramedic community. There were variations in how expectations were perceived between groups, indicating that experience might partly affect how paramedics identify and manage performance expectations. The organizational socialization framework enables the contextualization of these performance expectations.
CONCLUSIONS: Paramedic work involves challenges to upholding clinical competence, aligning to a professional role, and social integration into the professional community. Our research contributes to understanding how paramedics perceive these challenges as performance expectations in different stages of their careers and how they could be managed utilizing a framework for organizational socialization. The socialization of paramedics into the workforce needs to account for these performance expectations, especially considering the changing paradigm of paramedic work, role, and societal expectations.
UNASSIGNED: No Patient or Public Contribution.

暂无摘要。

BACKGROUND: Delivering emergency care in rural areas can be challenging, but video consultation (VC) offers opportunities to make healthcare more accessible. The communication and relationship between professionals and patients have a significant impact on the patient\'s experience of safety and inclusion. Understanding the patient perspective is crucial to developing good quality healthcare, but little is known about patient experiences of emergency care via VC in a rural context. The aim of this study was to explore patient experiences of emergency care via VC in northern rural Sweden.
METHODS: Using a qualitative approach, semi- structured interviews (n = 12) were conducted with individuals aged 18-89 who had received emergency care with a registered nurse (RN) on site and VC with a general practitioner (GP). The interviews were conducted between October 2021 and March 2023 at community hospitals (n = 7) in Västerbotten County, Sweden. Interviews were analysed with content analysis.
RESULTS: The analysis resulted in main categories (n = 2), categories (n = 5) and subcategories (n = 20). In the main category, \"We were a team of three\", patients described a sense of inclusion and ability to contribute. The patients perceived the interaction between the GP and RN to function well despite being geographically dispersed. Patients highly valued the opportunity to speak directly to the GP. In the main category, \"VC was a two-sided coin\", some experienced the emergency care through VC to be effective and smooth, while some felt that they received a lower quality of care and preferred face-to-face consultation with the GP. The quality of the VC was highly dependent on the RN\'s ability to function as the hub in the emergency room.
CONCLUSIONS: Patients in rural areas perceived being included in \'the team\' during VC, however they experienced disadvantages with the system on individual basis. The nursing profession plays an important role, and a proper educational background is crucial to support RNs in their role as the hub of the visit. The GP\'s presence via VC was seen as important, but to fully enable them to fulfil their commitments as medical professionals, VC needs to be further improved with education and support from technical devices.

BACKGROUND: During the COVID-19 pandemic, patients with Alzheimer\'s disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes.
METHODS: Among 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors\' office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January-December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths - due to COVID and non-COVID causes - and changes in care use in the beneficiary\'s state of residence.
RESULTS: Increased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p < .001). Emergency/inpatient visits declined (by 9 percent, p < .001) and long-term care facility use declined, remaining 14% below the 2019 trend from June 2020 onward (p < .001). Both COVID and non-COVID deaths rose, with 231,000 excess deaths (16% above the prediction from 2019), over 80 percent of which were attributable to COVID. Excess deaths were higher among women, non-White patients, those in rural and isolated zip codes, and those with higher social deprivation index scores. States with the largest increases in primary care visits had the lowest excess deaths (correlation -0.49).
CONCLUSIONS: Older adults with ADRD had substantial deaths above pre-pandemic projections during the COVID-19 pandemic, 80 percent of which were attributed to COVID-19. Routine care increased overall due to a dramatic increase in telehealth visits, but this was uneven across states, and mortality rates were significantly lower in states with higher than pre-pandemic visits.

暂无摘要。

OBJECTIVE: This study sought to describe the 2-year evolution of the intensity and frequency of noncardiac chest pain (NCCP), NCCP-related disability and health-related quality of life in a cohort of emergency department (ED) patients. It also aimed to identify and characterize subgroups of patients who share similar NCCP trajectories.
METHODS: 672 consecutive patients with NCCP were prospectively recruited in two EDs. NCCP, physical and mental health-related quality of life and pain-related impairment were assessed at baseline and 6 months, 1 year and 2 years after the index ED visit.
RESULTS: Significant reductions in the intensity and frequency of NCCP and in NCCP-related disability were observed over time, with 58.1% of patients being considered NCCP-free at the 2-year follow-up. Four trajectories of NCCP intensity were identified through latent class growth mixture modelling: Worsening Trajectory (6.8%), Persistence Trajectory (20.5%), Limited Improvement Trajectory (13.1%) and Remission Trajectory (59.5%). Physical quality of life was significantly higher in the latter two trajectories at all assessment points. Patients in the Remission Trajectory reported a better mental quality of life and a greater decrease in NCCP-related disability over time than those in the other trajectories.
CONCLUSIONS: Over 40% of ED patients with NCCP experienced persistent biopsychosocial morbidity that warrants further clinical attention.

BACKGROUND: Three-quarters of pregnancy-related deaths occur from 1 day to 1 year after birth, and medical complications frequently occur after birth. Postpartum health concerns are often urgent, requiring timely medical care, which may contribute to a reliance on acute care. One approach to improving postpartum health is to investigate birthing parents\' accounts of acute care use in the months after birth, which is what we did in this study.
METHODS: This mixed-methods study included questionnaire responses, semi-structured interviews, and chart review of 18 English-speaking individuals who used acute care in the 90 days after birth in the southeastern United States. Interviews were conducted remotely, recorded, and professionally transcribed. Qualitative data were inductively coded to iteratively develop categories and themes with respect to contributors and barriers to postpartum acute care use.
RESULTS: Birthing parents engaged in complex decision-making processes to decide where and when to seek postpartum acute care in response to their urgent health concerns. Many described fear and uncertainty about their postpartum health. Most participants contacted a healthcare practitioner before using acute care, followed their guidance, and were treated or otherwise reassured at the acute care visit.
CONCLUSIONS: These findings suggest multilevel opportunities for strengthening healthcare systems, including better-preparing individuals for the postpartum period and structuring care to accommodate birthing parents and include their support systems. The insights from this study can inform multilevel strategies for strengthening healthcare so that birthing parents are safe and well postpartum.

BACKGROUND: Emergency medical services (EMS) systems are piloting interventions to respond to overdoses with additional services such as leave-behind naloxone and medication for opioid use disorder, but little is known about the perspectives of people who use drugs (PWUD) on these interventions being delivered by EMS during an overdose response.
METHODS: The Consolidated Framework for Implementation Research guided the development of data collection tools, the analytic strategy and the organisation of results. A community engaged method was used which included both academically trained researchers and community trained researchers who are also PWUD. This study used semi-structured interviews to gather data from 13 PWUD in King County, Washington in June 2022. Data were analysed using thematic analysis.
RESULTS: The people interviewed for this study viewed EMS distribution of leave-behind naloxone and field-based buprenorphine favourably. They viewed EMS facilitation of hepatitis C virus and HIV testing in the field less favourably and were concerned about stigmas associated with those results. Additional themes emerged regarding: the need for different approaches to post-overdose care; the need for new services, including post-overdose trauma counselling and an alternative destination to the emergency department; and the harms of law enforcement presence at overdose responses.
CONCLUSIONS: This study found strong support for leave-behind naloxone and field-initiated buprenorphine. Further training for EMS should include trauma-informed care and strategies to address burnout and increase compassion. Alternatives to the emergency department as a post-overdose destination are needed. These strategies should be considered by jurisdictions revising overdose response protocols.

暂无摘要。

OBJECTIVE: Computer vision (CV) mimics human vision, enabling computers to automatically compare radiological images from recent examinations with a large image database for unique identification, crucial in emergency scenarios involving unknown patients or deceased individuals. This study aims to extend a CV-based personal identification method from orthopantomograms (OPGs) to computed tomography (CT) examinations using single CT slices.
METHODS: The study analyzed 819 cranial computed tomography (CCT) examinations from 722 individuals, focusing on single CT slices from six anatomical regions to explore their potential for CV-based personal identification in 69 procedures. CV automatically identifies and describes interesting features in images, which can be recognized in a reference image and then designated as matching points. In this study, the number of matching points was used as an indicator for identification.
RESULTS: Across six different regions, identification rates ranged from 41/69 (59%) to 69/69 (100%) across over 700 possible identities. Comparison of images from the same individual achieved higher matching points, averaging 6.32 ± 0.52% (100% represents the maximum possible matching points), while images of different individuals averaged 0.94 ± 0.15%. Reliable matching points are found in the teeth, maxilla, cervical spine, skull bones, and paranasal sinuses, with the maxillary sinuses and ethmoidal cells being particularly suitable for identification due to their abundant matching points.
CONCLUSIONS: Unambiguous identification of individuals based on a single CT slice is achievable, with maxillary sinus CT slices showing the highest identification rates. However, metal artifacts, especially from dental prosthetics, and various head positions can hinder identification.
CONCLUSIONS: Radiology possesses a multitude of reference images for a CV database, facilitating automated CV-based personal identification in emergency examinations or cases involving unknown deceased individuals. This enhances patient care and communication with relatives by granting access to medical history.
CONCLUSIONS: Unknown individuals in radiology or forensics pose challenges, addressed through automatic CV-based identification methods. A single CT slice highlighting the maxillary sinuses is particularly effective for personal identification. Radiology plays a pivotal role in automated personal identification by leveraging its extensive image database.