Omid Shabestari

Post-traumatic stress disorder in trainee doctors with previous needlestick injuries

BACKGROUND Doctors are at particular risk of occupational needlestick injuries (NSI), and these may result in considerable acute anxiety and fear of disease transmission. AIMS To measure the prevalence of post-traumatic stress disorder (PTSD) among trainee doctors who had experienced an NSI. METHODS A questionnaire was distributed to trainee doctors starting work in a large university hospital in the UK. The survey gathered demographic information and experience of previous NSI and included questions designed to assess the presence of PTSD via the Impact of Event Scale (IES), a widely used screening tool for PTSD. The six-item version of this tool (IES-6) was used in this study. RESULTS Among the 147 doctors who participated, 80 (54%) had sustained at least one NSI during their training and 77 of these completed the IES-6 survey. Of note, 38% of injuries (30/80) were not reported to the occupational health or emergency departments. Using a cut-off level of 10 in the IES-6, 12% (9/77) of the doctors who suffered NSI during their training showed evidence of PTSD. Since the prevalence of PTSD in the general population is estimated at 3%, the odds ratio of PTSD in doctors who had NSI was 4.28 (95% confidence interval: 2.16-8.47). CONCLUSIONS NSI injury is common among doctors in training. As 12% of doctors with experience of NSI had post-traumatic stress reactions, special attention should be paid to psychological impacts of NSIs. We would recommend further prospective studies.

Analysis of the Impact of the Birmingham OwnHealth Program on Secondary Care Utilization and Cost: A Retrospective Cohort Study

BACKGROUND This study aimed to assess the impact of the Birmingham OwnHealth(®) program (a partnership among the National Health Service [NHS] Birmingham East and North, formerly Birmingham East and North PCT, as the commissioner, Pfizer Health Solutions [Tadworth, United Kingdom] as the primary contractor, and NHS Direct as a subcontractor) on the number of unscheduled secondary care spells and the cost of care for patients with long-term conditions. This article reports a retrospective cohort study conducted at the NHS Birmingham East and North. SUBJECTS AND METHODS Adults with at least 1 of 10 defined long-term conditions were eligible for inclusion. Patients in the OwnHealth program were compared with those in a matched comparison group from a population who were eligible but did not enroll in the program. The main outcome measures were the difference in the number of secondary care spells (defined as the experience between hospital admission and discharge) between the OwnHealth group and the comparison group and the difference in the cost of care (calculated from the cost of activities during secondary care spells). RESULTS The mean number of secondary care spells per person per year in the OwnHealth group was 0.61 (standard deviation [SD] 1.35) compared with 0.84 (SD 1.49) in the comparison group (p<0.0005). This constituted a 27% reduction in secondary care spells per person per year. The mean cost of secondary care spells per person per year in the OwnHealth group was

Design and validation of a questionnaire to measure the attitudes of hospital staff concerning pandemic influenza

1,305 (SD

Potentials of Web 2.0 for Diabetes Education of Adolescent Patients

3,138) compared with

NHS Blood Tracking Pilot: City University Evaluation Project

1,678 (SD

Usability evaluation of a pilot implementation of the electronic clinical transfusion management system IT specification for blood tracking.

3,485) in the comparison group (p<0.0005). DISCUSSION This difference in costs constituted a 27% reduction in utilization and 22% reduction in cost of secondary care with the OwnHealth program. CONCLUSIONS Telehealth intervention can reduce the cost of secondary care of some patients with long-term conditions.

Evaluation of alert-based monitoring in a computerised blood transfusion management system.

Summary Background and objective When pandemics lead to a higher workload in the healthcare sector, the attitude of healthcare staff and, more importantly, the ability to predict the rate of absence due to sickness are crucial factors in emergency preparedness and resource allocation. The aim of this study was to design and validate a questionnaire to measure the attitude of hospital staff toward work attendance during an influenza pandemic. Method An online questionnaire was designed and electronically distributed to the staff of a teaching medical institution in the United Kingdom. The questionnaire was designed de novo following discussions with colleagues at Imperial College and with reference to the literature on the severe acute respiratory syndrome (SARS) epidemic. The questionnaire included 15 independent fact variables and 33 dependent measure variables. A total of 367 responses were received in this survey. Results The data from the measurement variables were not normally distributed. Three different methods (standardized residuals, Mahalanobis distance and Cooks distance) were used to identify the outliers. In all, 19 respondents (5.17%) were identified as outliers and were excluded. The responses to this questionnaire had a wide range of missing data, from 1 to 74 cases in the measured variables. To improve the quality of the data, missing value analysis, using Expectation Maximization Algorithm (EMA) with a non-normal distribution model, was applied to the responses. The collected data were checked for homoscedasticity and multicollinearity of the variables. These tests suggested that some of the questions should be merged. In the last step, the reliability of the questionnaire was evaluated. This process showed that three questions reduced the reliability of the questionnaire. Removing those questions helped to achieve the desired level of reliability. Conclusion With the changes proposed in this article, the questionnaire for measuring staff attitudes concerning pandemic influenza can be converted to a standardized and validated questionnaire to properly measure the expectations and attendance of healthcare staff in the event of pandemic flu.

Formatively evaluating the importance of different aspects of an electronic blood transfusion system from the end users' point of view: a questionnaire study.

Diabetes is a very common chronic disease which produces compli-cations in almost all body organs and consumes a huge amount of the health budget. Although education has proved to be useful in diabetes management, there is a great need to improve the availability of these courses for the increasing number of diabetic patients. E-learning can facilitate this service, but the current education system should be tailored towards e-learning standards. Amongst diabetic patients, adolescents as computer natives are suggested as the best target to e-learning diabetes education. With regards to its features, Web 2.0 can be a very good technology to build a framework for diabetes education and consequent evaluation of this education.

Potential Return on Investment (RoI) on web-based diabetes education in UK.

Automation of healthcare processes is an emergent theme in the drive to increase patient safety. The Mayday Hospital has been chosen as the pilot site for the implementation of the Electronic Clinical Transfusion Management System to track blood from the point of ordering to the final transfusion. The Centre for Health Informatics at City University is carrying out an independent evaluation of the system implementation using a variety of methodologies to both formatively inform the implementation process and summatively provide an account of the lessons learned for future implementations.