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There are few rigorously conducted clinical trials assessing specific therapy for non-septic bursitis. First-line treatments of non-septic bursitis include NSAIDs, aspiration, and injection therapy with corticosteroids and local anesthetics. Patients receiving oxaprozin showed improved overall function scores on a variety of measures. Results for periarticular inflammation other than bursitis are similar to the findings for bursitis. For patients with shoulder bursitis, oral corticosteroids provide early improvement over placebo, but treatment benefit is lost after the first few weeks of therapy. Many corticosteroids have demonstrated effectiveness for injection of subacromial inflammation. For trochanteric bursitis, studies investigating intrabursal injection of corticosteroids have found efficacy similar to that reported for other bursal injection sites. One long-recognized medication-related etiology of subacromial inflammation is the use of protease inhibitors: indinavir and lamivudine. Given the obvious risks in altering these medication regimens, the ED provider should reduce dosages only after consultation with patients' physicians.
The purpose of this study was to evaluate stress levels in emergency medical services personnel across the United States.
Confidential, 20-question survey tool, Medical Personnel Stress Survey-Abbreviated (MPSS-R). A total score of 50 indicates average stress levels. A score of 12.5 on the subset measurements of somatic distress, job dissatisfaction, organizational stress, and negative attitudes towards patients indicates average levels of stress. Data were analyzed using ANOVA and t-test.
A total of 658 of 3,000 emergency medical technicians (EMTs) (22%) completed the survey. The mean value of 69.3±6.3 for the total stress scores was very high Mean values for the subset scores were: somatic distress = 19.6±3.3; organizational stress = 17.3±2.4; job dissatisfaction = 17.0±2.6; negative attitudes towards patients = 15.5±2.3. Characteristics predicting higher stress were EMT-basic (A) licensure, basic life support (BLS) only service provider, volunteer status, new employee working in a small EMS organization, and providing service to a small town.
Stress levels in EMS personnel were very high, were manifested primarily as somatic distress, secondarily as organizational stress and job dissatisfaction, and lastly as negative patient attitudes. Stress levels and subset manifestations of occupational stress among EMS personnel varied depending on gender, marital status, age, level of training and function, on salaried or volunteer status, length of time as an EMT, and size of the organization, city, and population served. Care should be taken to address stresses peculiar to individual EMS system needs.
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