Mass shootings incidents occur with increasing frequency over time. Studying these cases proved that, despite their diversity, several common features could be taken into account in the early detection and possible prevention of certain future cases. Accepting that such incidents may occur anywhere and anytime, societies need to be prepared for their more effective response. Informing citizens about the best way to react to a mass shooting event is considered crucial and essential. The "Run-Hide-Fight" guideline/directive seems to be the most appropriate guideline given to the public. Proper training, of both the Suppression Forces and the emergency medical care providers, is considered of utmost importance. The role of the Incident Commander, regarding the incident management, as well as the external bleeding control of the injured people, are factors of paramount importance in trying to mitigate the casualties from such an incident. The alertness of both citizens and organizations/structures may lead to early detection of potential perpetrators and thereby averting a mass shooting incident. To achieve increased survival and a reduced number of casualties from a mass shooting event it is vital proper education be present at all levels. The response to a mass shooting event should be imprinted in an Emergency plan. Such a plan should have been decided and made, by the Security and Suppression Forces, the Healthcare Institutions, and the Public Safety Answering Point.
Introduction: Public interest in burnout has grown recently in developed countries, as has media coverage. Burnout has been a topic of scientific research in recent years for psychologists and sociologists alike. They have published numerous articles on the identification and classification of burnout syndrome. The medical staff is quite exposed to burnout because they often experience strong emotions such as the desire to treat or save their patients, fear of failure, occasional failures in the treatment of diseases. Materials and methods: This study aims to highlight the impact of the burnout syndrome in the Emergency Department of the Central Military Emergency Hospital during the COVID-19 pandemic, by conducting a comparative study based on the results of a questionnaire applied to the medical staff before and during the COVID-19 pandemic. Results: The study interviewed 65 participants aged between 20 and 60 years. They had to anonymously answer 16 questions marked with scores from 1 to 4. Comparing the results highlighted by the questionnaire, applied before the COVID-19 period, with those obtained in the questionnaire applied between May and June 2020, we noticed an increase in the level of burnout in all categories interviewed during the pandemic. Conclusions: In conclusion, the high level of contagiousness and the lack of a vaccine or treatment against SARS-CoV2 infection are additional concerns for burnout syndrome among healthcare professionals.
Isolation and quarantine during the Covid-19 pandemic affected the lifestyle and daily functioning of the population around the world, leading to social, psychological, and economic changes which further multiplied the stress related to the threat of coronavirus contagion by adding financial, relational, academic, professional and mental health vulnerabilities. To assess the impact of isolation and quarantine over the quality of life in the Romanian population, we conducted a Web-based survey focused on the evaluation of stress level, perception of lifestyle changes, communication patterns, mental health, major concerns, perception of one’s future, but also on the preferred coping strategies that people have used to deal with the isolation stress. The answers were collected during one month and the results for the first 2 weeks of quarantine/isolation were compared with the results after one month of such regimen. Several recommendations based on the survey results analysis were formulated regarding possible strategies for decreasing the impact of stress factors over the general population and specific, vulnerable groups.
Medical personnel is constantly exposed to a variety of stressful events, starting from work overloading, to threats to one's own health or personal integrity, disruptions in personal relationships due to high stress in the professional environment, continuous need to keep in touch with the advances of medical science and therapeutic guidelines etc. Structured evaluation of work-related stress disorders (WRSD) is important both for screening purposes in a vulnerable population like the medical personnel, and for the monitoring of the overall status evolution during individual or organizational interventions. Beside burnout syndrome, major depressive episodes, anxiety disorders, acute stress reactions, posttraumatic stress reactions, substance use disorders, adjustment disorders are also included in the category of WRSD. A specific instrument has been designed for the purpose of screening for WRSD in this specific population, i.e. the Work-related Stress Inventory for Medical Personnel, structured as a 20 items, self-administered instrument (WRSIMP-20). This inventory evaluates three main dimensions- (1) mood symptoms and somatic equivalents, (2) work and professional environment- related discomfort, and (3) interpersonal relationship-associated distress. The results of online administration of WRSIMP- 20 in 81 health care workers and 52 individuals not related in any way to health care professions (control group) were consistent with the premises, as this inventory has been proven valid for the targeted population. Larger trials and test-retest evaluation are needed in order to complete the psychometric properties of WRSIMP-20, but this instrument seems promising in the detection of individuals vulnerable to WRSD.
Chronic pelvic pain syndrome (CPPS) presents a diagnostic challenge due to its multifactorial nature, often involving urological, gynecological, and psychological components. This study focuses on the effectiveness of prophylactic phytotherapy in preventing CPPS recurrence, aiming to mitigate symptoms and psychosocial impact. The study includes 74 patients following a six-month treatment regimen with Graminex, Seronoa Repens, Curcuma Longa, and Acediboswellic ke-to-acetyl-11. Symptom assessment employs the IPSS and NIH-CPSI questionnaires, conducted at 3, 6, 8, 9, and 12 months. Patients exhibit significant improvements in IPSS scores, with maintenance of treatment impact observed at 3, 6, and 9 months. Interruption of therapy leads to symptom recurrence, but upon resumption, responses are more effective. The third group, under observation for three months, reports positive outcomes. Both IPSS and NIH-CPSI scores show a consistent impact on urinary symptoms and pelvic pain, indicating the therapy's effectiveness. The study demonstrates a concordance in the positive effects of phytotherapy across different age groups, emphasizing its efficacy in alleviating urinary symptoms and pelvic pain in CPPS patients. Symptom remission or improvement in quality of life is reported, with a notable tropism for symptom reduction in the cold season. Patient adherence to treatment is high, and even after treatment interruption, resumed therapy yields significant improvements. The observed benefits include the absence of pelvic pain, dysuria, and enhanced sexual competence, contributing to an overall improvement in the quality of life for patients with CPPS.
With recent advances in the understanding of psoriatic disease, it is increasingly considered a systemic inflammatory condition rather than limited to the skin and joints. A variety of biologics are available today for the treatment of psoriasis, but with them, characteristics such as rapidity of onset, long-term efficacy, safety profile, and effects on comorbidities differ. We designed an observational, non-interventional, retrospective study of patients with severe psoriasis receiving biologic treatment with IL-17 inhibitors and aimed to investigate the correlations between etiopathogenic factors and the efficacy and persistence of these therapies in a group of psoriasis patients from Romania. Study results show that patients treated with ixekizumab had better persistence and high adherence compared to those treated with secukinumab. In this study, ixekizumab demonstrated lower risks of non-persistence, discontinuation, and switching and a higher likelihood of high adherence compared with secukinumab. This study contributes to the understanding of the persistence of anti-IL17 biologic therapies in psoriasis and the factors that may influence it.
This review explores the trajectory of photoplethysmography (PPG) technology from its inception in 1934 to its integration into smart devices in 2013. While PPG has proven effective in estimating left ventricular ejection time (LVET) and distinguishing between hypertensive and normotensive patients, challenges persist. The need for a robust mathematical model to explain physiological behaviors, address calibration protocols, and handle waveform variability is emphasized. Despite limitations, PPG is on the cusp of achieving clinical-grade confidence, particularly in estimating blood pressure and tracking vasomotor states. Integration into wearable devices is a prominent trend, with major companies exploring applications for improved health monitoring. Open-source databases and the availability of physiological data aim to enhance understanding, paving the way for universally accepted protocols. As PPG advances, it holds promise for personalized healthcare, revolutionizing treatment evaluations and preventive measures. However, potential disagreements over protocols may impede progress. Nevertheless, the technology's potential to remotely monitor cardiovascular markers could reduce physicians' workload for routine tasks. PPG stands as a beacon for the future of noninvasive cardiovascular assessment.
The harmful effects of smoking cigarettes on human health are well documented; thus various smoking cessation methods have been assessed and new options are currently under development to provide a “better’ alternative to the “worse” one, namely smoking. However, no ideal method of ending or replacing conventional smoking has been developed so far, and actually, none of them has been proven entirely effective or safe. The laxity, or rather the absence of regulations in the first decade of existence of electronic nicotine delivery systems (ENDS) allowed their use with prohibited substances instead of nicotine or other substances with detrimental effect, with the emergence of a severe syndrome - e-cigarette and vaping-associated lung injury (EVALI), whose treatment required even lung transplantation in young people without any prior underlying lung disease. This narrative review aims to provide a brief overview of concerns about medical issues associated with e-cigarette use, particularly cardiovascular and respiratory panels. We organized the data in several micro-sections varying from practical aspects of understanding ENDS to clinical issues. To combat tobacco addiction, electronic cigarettes are increasingly widely accepted. A global regulatory framework is required to prevent the emergence of an illicit e-cigarette business with detrimental impacts on health.
Background: Duct to mucosa Pancreatico-gastrostomy (DMPG) is a method for reconstruction of pancreatic mass following pancreaticoduodenectomy (PD). There are still controversies about the benefits of this surgical technique compared to the old ones. Objectives: This study aimed to evaluate the long-term outcomes of DMPG reconstruction following PD operation. Method: Through a prospective observational setting, 164 patients, undergoing PD surgery, with diagnosed pancreatic head or peri-ampullary cancer, were enrolled. A pylorus-preserving PD and DMPG were done for all patients to reconstruct the pancreatic mass. Patients were followed up to a mean of 21.06±14.12 months. Demographic data, risk factors, tumoral staging, and postoperative follow-up data were collected for the analytic study. Results: The mean survival of the patients was 21.06±14.23 months after surgery. DGE (delayed gastric emptying) (34.75%), pancreatic fistula (21.34%), bile duct fistula (7.31%), and hemorrhage (5.5%) were recorded as the most important complication in patients. Some post-operative complications were significantly observed in patients with diabetes mellitus (pancreatic fistula, increased amylase, and DGE), Smokers (bile duct fistula, hemorrhage, and increased Amylase), and the elders (bile duct fistula) (p-value <0.05). Conclusions: Although our results indicate that DMPG reconstruction is a safe technique, our findings did not confirm the priority of this method over the older techniques.
Resilience refers to the means and ability to deal with adverse conditions. Resilience is defined as the ability of the system to recover easily after disturbances and changes in the system and the ability of the organization to respond quickly to them. The resilient system can withstand environmental pressures so that it can provide optimal performance in critical situations. Resilience in the use of healthcare services is related to reducing vulnerability to shocks caused by natural disasters and increasing adaptive capacity due to improved measures and opportunities. Considering the importance of evaluation, monitoring, and planning to improve user resilience against accidents, spatial evaluation and redefinition of the use of health and medical services to prepare a comprehensive model for measuring the resilience of hospitals against accidents and calamities Naturally, at the top of which is the coronavirus epidemic, it is necessary. The aim of the current study is a comprehensive review of the factors influencing the redefinition of the spatial pattern of therapeutic uses in big cities at the time of the emergence of a pandemic disease with a resilience approach. It is expected that the managers and decision-makers of the country's health field can use the results of the present research for better planning.
