The Journal of Medicine, Law & Public Health

A Systematic Review of the Efficacy of Full-Scale Simulation Exercises in Enhancing Hospital Disaster Preparedness

2024-04-28T22:51:48-07:00

Introduction:

A full-scale simulation exercise is a comprehensive drill designed to replicate a real-world emergency scenario, thereby identifying the strengths and weaknesses in current practices. The overarching goal is to enhance healthcare system resilience through improved protocols, as highlighted in this systematic review tailored for researchers. The study aims specifically to assess the impact of full-scale simulations on enhancing hospital disaster plans.

Methodology:

Following PRISMA guidelines, this systematic review investigates the impact of full-scale simulation exercises on hospital disaster preparedness. The focus was on hospital staff involved in disaster and emergency preparedness training. The primary intervention was the execution of full-scale simulation exercises, and our research included various study designs, including randomised controlled trials and observational study designs. A comprehensive electronic database search was conducted, spanning PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials, from inception until October 9, 2023. The risk of bias was assessed using NIH tools.

Results:

The literature search yielded 2398 results, with 28 publications finally included in the systematic review. Summarising a broad range of disaster preparedness simulation exercises with a specific focus on full-scale simulation (FSS), the studies consistently demonstrated a positive impact on participants' skills, as well as identifying safety issues in hospital settings. Moreover, they revealed that simulations effectively addressed crucial areas for improvement in disaster response, including communication breakdowns, equipment deficiencies, and flaws in emergency plans. The studies utilised a multidimensional approach to evaluation metrics, encompassing non-technical skills, communication, teamwork, decision-making, and operational readiness. The exercises varied in duration from 30 minutes to multi-day simulations, covering a diverse range of disaster scenarios, such as mass casualties, viral epidemics, large aviation accidents, and terrorist attacks.

Conclusion:

Full-scale simulation exercises are a preparatory learning tool to test facility and staff readiness for complex emergencies. This systematic review focused on the different exercise scenarios used to address critical aspects of disaster response such as communication breakdowns, equipment deficiencies, and flaws in emergency plans. The scenarios and their duration were varied, and involved a multidimensional approach to evaluation. Such exercises enhance critical thinking and problem-solving skills, increase familiarity with potential emergencies, and build confidence in making judgments in real-world situations. In our opinion, there is a need for further programs that align simulation exercises with community resources for better preparedness in the face of public health disasters.

Evaluating Patient Satisfaction With Nurse-Led Wound Care Services

2024-03-25T02:05:30-07:00

Background:

The increasing incidence of chronic wounds, combined with the high number of patients requiring hospital services, has led to the concept of nurse-led wound care clinics to support general practitioners in the treatment and management of wounds.

Aim:

This study aims to assess patients’ perception of, and satisfaction with, wound care services in a tertiary healthcare setting in Riyadh, Saudi Arabia.

Methods:

The study utilised a cross-sectional descriptive design and was conducted between September 2022 and October 2023, and data were collected via a client satisfaction questionnaire (CSQ-8).

Results:

Our findings revealed very positive responses overall. Considered together (response options 4 and 3), a majority of respondents (91.3%) rated the quality of service they received as “excellent” or “good”, and 85.6% reported receiving the kind of service they wanted. Regarding overall satisfaction, 92.5% of respondents reported being “very satisfied” or “mostly satisfied” with the overall service they received.

Conclusion:

This study reveals positive patient satisfaction with overall wound care services. However, there remains weakness in certain areas. This could be understood in more detail by conducting a qualitative study, so that action maybe taken to further improve the quality of healthcare services provided to patients.

Exercise Capacity and Fatigue in Post-COVID-19 Patients

2024-02-20T22:25:09-08:00

Background:

While many researchers have investigated the influence of COVID-19 on fatigue and quality of life, its impact on exercise capacity has been little considered. It is therefore our aim to examine the impact of COVID-19 on exercise capacity and fatigue among individuals who have recovered from the virus.

Methods:

A cross-sectional study was conducted at the outpatient physical therapy department of a tertiary hospital and Primary health care center. The study comprised 116 participants divided into two groups: a normative group composed of individuals who had not been infected with COVID-19 in the past three months, and a control group consisting of those who had contracted COVID-19 within the preceding three months. The one-minute sit-to-stand test (1STST) was carried out to assess exercise capacity, following which fatigue was measured using the validated Arabic version of the Fatigue Severity Scale (FSS).

Results:

Of the 116 participants enrolled in this study, 76 (65.5%) were in the normative group and 40 (34.5%) in the control group. Following the intervention, the mean FSS score differed significantly between the normative (26.6; SD 10.9) and the control group (36.9; SD 14.8); p-value < 0.001, with participants in the control group reporting higher levels of weariness than those in the normative group. Moreover, as measured by 1STST, the median number of sit-to-stand repetitions completed by participants in the normative group (21.0) was considerably greater than that of the control group (20.0); p-value = 0.025.

Conclusion:

Participants in the control group reported higher levels of fatigue and demonstrated lower exercise capacity than those in the normative group.

The Impact of Involving a Senior Emergency Physician in the Triage Process

2024-03-10T04:13:37-07:00

BACKGROUND:

Emergency Department (ED) overcrowding has been demonstrated in several studies to be associated with undesirable effects such as longer waiting times, reduced patient satisfaction, and, most importantly, poor patient outcomes. Furthermore, long waiting times for walk-ins result in more complaints and patient dissatisfaction than illness management itself, with the majority of issues arising as a result of real and perceived waiting periods before being seen by the doctor.

AIM:

We set out to investigate whether introducing a senior emergency physician into the triage system would reduce waiting time, door-to-decision time, and door-to-doctor time, as well as increase patient satisfaction across the ED.

METHOD:

This was an interventional pre-post study that utilised retrospective data to evaluate the effect on ED throughput of triage by senior emergency physicians. We aimed to measure its impact on waiting time, door-to-decision time, and door-to-doctor time, along with ED patient satisfaction.

RESULTS:

Patient satisfaction, the overall assessment of treatment received during the visit, increased, from 74.975 to 77.425, and the likelihood of patients recommending the ED increased from 71.36 to 75.21. Operational metrics revealed a considerable drop in door-to-decision time (admit or discharge) of 46 minutes and 3 seconds, as well as a 1 minute and 21 second reduction in time from door to doctor (arrival to first provider).

CONCLUSION:

The mixed results hint at an effective but iterative process of enhancing patient flow and experience in the ED through senior physician triage.

Coercive Vaccination Policy in Nigeria: Legal Perspectives

2024-03-29T12:40:23-07:00

Background: In December 2021, the Nigerian federal government declared a compulsory COVID-19 immunisation for all employees of government. This declaration by the government has been viewed by some Nigerians as a contravention of the fundamental rights of Nigerian citizens.

Aim: This study was aimed at identifying the human rights concerns surrounding vaccination mandates from the perspective of legal practitioners in Nigeria.

Methods: This study was a cross-sectional study that used a semi-structured self-administered questionnaire to interview legal practitioners practicing in Uyo, Nigeria. The survey focused on identifying human right concerns surrounding vaccination mandates.

Results: One hundred and five legal practitioners participated in the study. Data analysis revealed that 79 (75.2%) of our respondents agreed that vaccination mandates to prevent an epidemic is well within the powers of the state, while 97 (92.4%) asserted that the Nigerian constitution gives the state authority to enact health laws including quarantine and vaccination laws to protect its citizens. According to 59% (n=62) of our respondents, the only exception to a mandatory vaccination is an offer of apparent or reasonably certain proof to the state’s board of health that the vaccination would seriously impair health or probably cause death.

Conclusion: In the opinion of majority of the legal practitioners interviewed, the Nigerian constitution gives the state the power to implement measures established by legislation to protect the health of her citizens. Thus, coercive vaccination policies by the state to protect the public from an epidemic outbreak of a disease which threatens the safety of citizens may be legally binding on the citizens.