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Doc number: P331

Background Paramedics are routinely exposed to shift work. Existing research shows that shift work exposure is associated with adverse mental and physical health outcomes. However, the current understanding of the impact of commencing shift work in a paramedic role on health is limited. This can be addressed by recruiting new paramedics before they commence shift work, and conducting regular follow-ups of potential biological, psychological and social changes. The present study aimed to examine changes in biological, psychological and social factors relative to pre-shift work baseline in a cohort of paramedics commencing intern employment with an Australian ambulance service. Method and analysis This observational, mixed-methods, longitudinal study aims to recruit 40 interns from one Australian ambulance service. Data collection will occur at baseline (standard day schedule for initial training), and subsequently at three months, six months, nine months and twelve months, to measure biological, psychological and social changes relative to baseline measurements. Changes in cardiometabolic markers (cholesterol, triglycerides, fasting glucose), microbiome (self-collected stool samples), sleep and physical activity (actigraphy) will be measured. Interns will also complete a battery of self-report questionnaires, sleep diaries and qualitative interviews to explore various psychological and social variables over time. Statistical analyses will be conducted using mixed effects regression, specifying a random effect of subject on the intercept, allowing participants to vary according to individual baseline levels, as well as tracking progress over time, appropriately accounting for serial correlation. Qualitative study components will be analysed via coding and thematic analysis procedures. Discussion The present study protocol is a comprehensive outline of the observational study planned. The study will allow for greater knowledge of any changes in biological, psychological and social factors during a 12-month transition to shift work. The findings from the proposed study will have implications for the development of strategies to support early-career shift workers.

Purpose: To review the problem of increasing cases of syphilis as a communicable disease and to review different presentations of syphilis and to discuss treatment guidelines. Data sources: Extensive review of worldwide scientific literature on the epidemiology, diagnosis, and treatment of syphilis. Conclusions: Syphilis is an infectious sexually transmitted disease, which may have devastating consequences. Previously declining rates have led to complacency in prevention and diagnosis. Primary prevention includes education regarding safer sexual practices. Secondary prevention includes early identification via screening and treatment. Implications for practice: Syphilis is a contagious disease that has devastating consequences if not diagnosed and treated. Providers should keep ever vigilant in its identification. Specifically, it should be considered when evaluating all symptom‐less dermatological lesions.

Evidence-based practice requires clinicians to review current literature for evidence-based information that demonstrates solutions for clinical problems. The daunting process of navigating extensive electronic publication sources, including citation databases, guidelines, and clinical proceedings, can feel much like finding a needle in the proverbial haystack. Knowing where to get information and strategically maneuvering search terms, Boolean operators, and available delimiters requires investment in learning how they work and then skillful deployment. Time spent in learning the systems is gained back by executing a well-honed search that yields citations that are appropriate for the clinical problem. Search terms and use of effective investigative tools focus the search and produce a comprehensive listing of references. The purpose of this article was to detail the steps in completing a comprehensive literature search when focused on a clinical question. Location of pertinent literature, the multiple characteristics of citation databases and instruction on how to use them, as well as how to manage the located citations are included.

This study found a low infection rate (3.1%) in occupationally related lacerations sutured by an on site nurse practitioner in a meat-packing plant where a high infection rate might be expected. This is compared to an overall infection rate of 1% to 30% of all sutured wounds cited in other studies. This review suggests that worksite availability of a nurse practitioner with expertise in suturing and aseptic technique is correlated to a low infection rate. Findings suggest that prophylactic antibiotics do not preclude good wound care, but may still be merited in wounds at high risk of subsequent infection. Infected wounds may cost anywhere from $2,000 to $150,000 per case depending on severity, in addition to other hidden costs. Clearly a decrease in the morbidity of wound care is significant in terms of decreased cost.

1. A nurse practitioner managed health unit for a meat packing/rendering company demonstrates a practice model for providing quality, cost effective health care to a specific population. 2. To gain management support for wellness and health promotion programs, unit cost effectiveness was demonstrated. 3. This model demonstrates success in the use of the nurse practitioner to provide care to a population that traditionally does not seek preventive or early health care.