Introduction: Prison officers undergo a high amount of work-stress and consequently suffer from burnout, which is detrimental to their health, the organization and the inmates. There are no studies conducted on burnout of prison officers in Sri Lanka, partly due to the non-availability of a validated scale. Objectives: To validate the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) for assessing burnout among prison officers working in Sri Lankan prisons Methods: A cross-sectional validation study was carried out among a representative sample of 267 correctional and rehabilitation officers working in the Colombo Remand Prison and Colombo New Magazine Prison, selected through probability-proportionate-to-sample size and random sampling methods. The Sinhala-translated MBI-HSS was judgmentally validated and pre-tested prior to administration. Confirmatory factor analysis (CFA) was performed using LISREL 9.3 software to assess the construct validity of MBI-HSS. The presence of job-related neurasthenia in participants, diagnosed by a psychiatrist was taken as the gold standard to assess the criterion validity. Internal consistency and test-retest methods were used to assess the reliability. Results: A three-factor model with items 6, 13, 16 and 22 of the instrument deleted, was identified as the model best fitting the data during CFA, achieving the best goodness of fit parameters (RMSEA=0.0748;  2 =185.2, p=0.001;  2 /df=1.4; CFI=0.974; NNFI=0.97; GFI=0.985; SRMR=0.056). Clinical burnout was seen in 32.6% of the sample. According to the cutoff values achieved through receiver operating characteristics (ROC) curves for burnout and its three sub-scales of emotional exhaustion, depersonalization and diminished personal accomplishment, the sensitivity and specificity were 94.3% & 87.8%; 82.8% & 80.6%; 72.4% & 73.9%; and 77% & 77.2%, respectively. The reliability of the tool was satisfactory. Conclusions: Translated and validated MBI-HSS was found to be a valid and reliable tool for assessing burnout among Sri Lankan prison officers. Using it during their medical examinations is recommended.

Background: High work demands and low work resources predispose employees to occupational burnout. Burnout of Sri Lankan prison officers has not been studied previously. Prison guards and prison rehabilitation officers are the staff categories who come into regular and direct contact with prison inmates. Aim: The study aimed to describe the prevalence of burnout and its three sub-domains in Sri Lankan prison officers and to explore the personal and work-related correlates of their burnout. Methods: An institution-based cross-sectional study was carried out in 2017, among 1803 prison officers including 1683 prison guards and 120 prison rehabilitation officers working in 32 prison institutions island-wide. Prison guards were selected using multi-stage stratified sampling, while all the eligible Rehabilitation Officers were included. Self-administered, translated and validated Sinhala version of the Maslach Burnout Inventory – Human Services Survey and a self-developed questionnaire on correlates were used for collecting data. Results: The response rate was 98.53%. Majority of the participants were male (88%) and currently married (80.6%). True prevalence of burnout was 31.1% (95%CI:22.1-40.1). More than one third (37.8% - 95%CI:28.3–47.3) were suffering from diminished personal accomplishment, while over one fourth were suffering from emotional exhaustion (28.6% - 95%CI:19.7–37.5) and depersonalization (26.9% - 95%CI:18.2–35.6). Feeling overburdened by housework (OR–3.9,95%CI:1.6-9.3), working in closed prisons (OR–5.4,95%CI:1.3–21.7), remand prisons (OR–4.9,95%CI:1.2–19.3) and work camps (OR–6.7,95%CI:1.6–28.4), perceived difficulty in shift work (OR–2.4,95%CI:1.4–4.0) and in taking leave (OR–2.8,95%CI:1.5–5.4), work overload (OR–2.1,95%CI:1.1–3.7), poor relationship with colleagues (OR–10.6,95%CI:1.1–103.3) and with families of inmates (OR–4.7,95%CI:1.4–16.0), poor welfare facilities (OR–3.8,95%CI:1.6–8.7) and job dissatisfaction (OR:14.3,95%CI:4.4–46.8) were associated with a higher risk for burnout. Conclusion: Burnout among prison officers is a significant issue requiring prompt interventions including basic and in-service trainings focusing on stress management.

Background We aimed to synthesize the qualitative experiences of patients, their family members, and ambulance staff involved in the prehospital management of acute pain in adults and generate recommendations to improve the quality of care. Methods A systematic review was conducted following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines. We searched from inception to June 2021: MEDLINE, CINAHL Complete, PsycINFO and Web of Science (search alerts were screened up to December 2021). Articles were eligible for inclusion if they reported qualitative data and were published in the English language. The Critical Appraisal Skills Program for qualitative studies checklist was used to assess risk of bias, thematic synthesis was performed on included studies and recommendations for clinical practice improvement were generated. Results Twenty‐five articles were included in the review, representing over 464 patients, family members, and ambulance staff from 8 countries. Six analytical themes and several recommendations to improve clinical practice were generated. Strengthening the patient–clinician relationship by building trust, promoting patient empowerment, addressing patient needs and expectations, and providing a holistic approach to pain treatment is key to improving prehospital pain management in adults. Shared pain management guidelines and training across the prehospital and emergency department intersection should improve the patient journey. Conclusion Interventions and guidelines that strengthen the patient‐clinician relationship and span the prehospital and emergency department phase of care are likely to improve the quality of care for adults suffering acute pain in the prehospital setting.

Context Medical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides opportunities to manage acutely unwell patients in the prehospital environment, not usually offered as part of formal undergraduate medical education. There are few previous studies describing activities or experiences of MSFRs or exploring the potential educational benefits. We aimed to investigate the activity of MSFRs and explore their experiences, particularly from an educational perspective. Methods We used a mixed methods design, combining quantitative analysis of ambulance dispatch data with qualitative semi-structured interviews of MSFRs. Dispatch data were from South Central and East Midlands Ambulance Service NHS Trusts from 1st January to 31st December 2019. Using propensity score matching, we compared incidents attended by MSFRs with those attended by other Community First Responders (CFRs) and ambulance staff. We interviewed MSFRs from five English (UK) medical schools in those regions about their experiences and perceptions and undertook thematic analysis supported by NVivo 12. Results We included 1,939 patients (median age 58.0 years, 51% female) attended by MSFRs. Incidents attended were more urgent category calls (category 1 n = 299, 14.9% and category 2 n = 1,504, 77.6%), most commonly for chest pain (n = 275, 14.2%) and shortness of breath (n = 273, 14.1%). MSFRs were less likely to attend patients of white ethnicity compared to CFRs and ambulance staff, and more likely to attend incidents in areas of higher socioeconomic deprivation (IMD – index of multiple deprivation) (p < 0.05). Interviewees (n = 16) consistently described positive experiences which improved their clinical and communication skills. Conclusion MSFRs’ attendance at serious medical emergencies provide a range of reported educational experiences and benefits. Further studies are needed to explore whether MSFR work confers demonstrable improvements in educational or clinical performance.