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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A disaster is any situation or event that overwhelms local response resources&#44; and usually produces severe damage&#44; destruction and human suffering&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#8211;3</span></a> The impact of disasters is particularly severe in the field of paediatric emergency medicine&#44; as children are more vulnerable and at greater risk of experiencing dehydration&#44; infection and multiple trauma&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Therefore&#44; it is essential that paediatric emergency departments &#40;PEDs&#41; and their personnel be properly prepared to manage these situations&#44; which&#44; while infrequent&#44; can result in substantial morbidity and mortality in the population&#46; Such preparedness involves a broad range of elements&#58; availability of materials&#44; reorganisation of health care delivery&#44; training of health care staff&#8230;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Training in disaster preparedness is a must for all health care workers&#44; especially for those in emergency settings&#44; and should be incorporated in educational curricula&#44; as has been recommended by the American Medical College&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;4</span></a> A lack of specific training in disaster preparedness poses risks to the health of the general population and also to that of patient care providers&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a> There are different educational strategies and a wide variety of training programmes&#44; ranging from the Advanced Pediatric Life Support &#40;APLS&#41; to self-directed courses&#44; day-long workshops or training sessions that use simulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Several studies&#44; most of them conducted outside of Spain&#44; warn of a lack of disaster preparedness&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4&#44;6&#44;8&#44;9</span></a> In Spain&#44; many PEDs do have disaster plans in place&#44; but they are usually not up to date and are not generally known by the staff&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to analyse the efficacy of a disaster preparedness training programme in a PED&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We conducted a quasi-experimental pre-post intervention study by means of a survey of health care workers in which the training programme was the intervention&#46; The study took place in a tertiary paediatric hospital that receives approximately 100&#44;000 visits a year and is the reference hospital for patients with multiple trauma&#46; The hospital has a disaster plan &#40;DP&#41; that was updated in 2013 and the PED is equipped with a disaster kit to be opened by the staff in case the DP is activated&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The target population of our study was the collective of health care workers that regularly staffs the PED &#40;125 individuals&#41;&#44; including nursing staff &#40;nurse assistants and registered nurses &#91;RNs&#93;&#41; and doctors in the specialties of paediatric emergency medicine&#44; surgery and traumatology &#40;adjunct&#44; fellow and resident doctors&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We conducted the study over two time periods &#40;period 1&#44; before training&#44; in January 2014&#44; and period 2&#44; after training&#44; in November 2014&#41; and the training programme took place between the two &#40;April 2014&#41;&#46; Between the two periods&#44; the researchers asked the health care staff to fill out the paper-based questionnaire anonymously&#44; and no reward was offered for participating&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The training programme consisted of one theoretical session that explained the hospital&#39;s DP and two three-hour-long practical sessions in which various disaster-related clinical scenarios were discussed in small groups to put the DP into practice &#40;victim triage&#44; reorganisation of PED activity and space&#44; duties of the shift manager&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The questionnaire was written in Spanish and based on the published literature&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> and comprised 20 multiple-answer questions &#40;Appendix 1&#41;&#46; It included&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Demographic data of the health care worker &#40;sex&#44; age&#44; professional category&#44; years worked in the emergency department&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Five theoretical questions about the external disaster plan&#44; the disaster kit&#44; and the duties of the shift manager&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Ten practical questions that presented clinical situations in disaster scenarios requiring the application of the DP and that assessed aspects such as victim triage&#44; the reorganisation of space in the PED&#44; staff duties and recruitment&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Two personal questions that asked about the perceived importance of the training and whether the respondent felt prepared to respond to a disaster&#46;</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">To score the answers for the ten practical questions&#44; each correct answer was graded with one point and each incorrect answer with zero points&#44; which were added up to obtain the total score for practical knowledge &#40;minimum score&#44; 0&#59; maximum score&#44; 10&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">We collected 110 questionnaires in period 1 &#40;88&#37; response rate&#41; and 80 in period 2 &#40;64&#37; response rate&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic data of the respondents&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Sixty percent of the staff that filled out the questionnaire in period 1 had never undergone disaster training of any kind&#46; Eighty percent of respondents in period 2 had completed the questionnaire in period 1&#46; Of all period 2 respondents&#44; 71&#46;3&#37; had attended the theoretical session and 43&#46;8&#37; had participated in the practical sessions&#46; Thirty percent of respondents in period 2 had completed the full training&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Following the training programme&#44; we observed significant differences in the awareness of the existence of a DP &#40;77&#46;1&#37; vs&#46; 95&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; having read the DP &#40;24&#46;5&#37; vs&#46; 67&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and knowing where to find the DP &#40;52&#46;77&#37; vs&#46; 73&#46;8&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Concerning the disaster kit&#44; we also observed a significant increase in the number of staff that were aware of its existence &#40;53&#46;6&#37; vs&#46; 72&#46;5&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41; and that knew where to find it in the PED &#40;33&#46;6&#37; vs&#46; 72&#46;7&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; after the training&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">When it came to the responsibilities of the shift manager&#44; 33&#46;6&#37; of the health care workers knew them in period 1&#44; compared to 72&#46;7&#37; in period 2 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We did not observe a significant improvement in the mean score obtained in the practical questions from period 1 to period 2 &#40;5&#46;8&#47;10 vs&#46; 6&#46;1&#47;10&#41;&#46; We also did not find a statistically significant difference between the answers given in each period for any of the 10 practical questions when we analysed each of them separately&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The staff felt better prepared to face a disaster after participating in the training programme &#40;15&#46;5&#37; vs&#46; 41&#46;8&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and 98&#46;8&#37; stated that training on this subject is important&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Based on the results of the study&#44; the training programme succeeded in improving certain knowledge areas in the staff&#44; mostly concerning theoretical aspects of the DP&#46; However&#44; the application of this theoretical knowledge to the proposed clinical scenarios did not improve&#44; so the results we obtained were not entirely satisfactory&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">This may be due to various factors&#46; On the one hand&#44; the time elapsed between training and the survey was six months&#44; so participants may have forgotten some of what they had learned&#59; on the other hand&#44; less than half of the staff attended the practical sessions and those that did not were unable to put the DP into practice&#59; last of all&#44; the training programme did not include simulation exercises&#44; such as drills in the PED or virtual simulations&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Although the studies published to date have yet to identify the most effective training strategy&#44; most disaster readiness courses recommend the performance of practical sessions with drills&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">7&#44;9&#44;12</span></a> Such drills should be performed on a regular basis&#44; as on one hand they consolidate the knowledge of the staff&#44; and on the other help identify areas for improvement in the DP of the facility&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">3&#44;7&#44;9</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The health care workers in our sample stated that training in disaster preparedness is important&#44; which was consistent with the findings of other authors&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4&#44;6&#44;9</span></a> Health care staff usually have limited experience in disasters due to the low frequency of such occurrences&#44; and usually want a combination of didactic and experiential training that includes simulations or drills&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4&#44;9</span></a> In fact&#44; the recommended coursework in paediatric disaster medicine in the United States comprises five components and includes experiential learning&#58; preparedness&#44; knowledge of the response system&#44; triage&#44; treatment&#44; mental health needs of victims and local training&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In addition to the limitations inherent in any survey-based study&#44; our assessment of the outcomes of the training programme may be biased for lack of a control group consisting of individuals with no training&#46; We also were unable to compare the performance of the staff that participated in the training programme with that of staff that did not participate&#44; as the surveys were filled out anonymously&#46; Furthermore&#44; the survey has not been validated&#44; so its results must be interpreted with caution&#46; Last of all&#44; the high dropout rate between the two periods may be a significant source of bias&#44; as the interest in disaster training of respondents in period 2 is probably greater&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">To conclude&#44; the implementation of a specific training programme on disaster preparedness improved some of the knowledge of health care workers&#44; but was not associated with an improvement in answers given to hypothetical clinical situations they were presented with&#46; Therefore&#44; training needs to be improved&#44; incorporating simulations or drills&#44; and giving incentives for staff participation&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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              "titulo" => "Metodolog&#237;a"
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          "titulo" => "Introduction"
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    "fechaRecibido" => "2015-05-15"
    "fechaAceptado" => "2015-07-21"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec726531"
          "palabras" => array:3 [
            0 => "Disaster medicine"
            1 => "Training programme"
            2 => "Questionnaire"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec726532"
          "palabras" => array:3 [
            0 => "Medicina de cat&#225;strofes"
            1 => "Formaci&#243;n"
            2 => "Encuestas"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to evaluate the effectiveness of a disaster preparedness training programme in a Paediatric Emergency Department &#40;PED&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A quasi-experimental study was conducted using an anonymous questionnaire that was distributed to health care providers of a PED in a tertiary paediatric hospital&#46; The questions concerned the disaster plan &#40;DP&#41;&#44; including theoretical and practical aspects&#46; Questionnaires were distributed and completed in January 2014 &#40;period 1&#41; and November 2014 &#40;period 2&#41;&#46; The disaster training programme includes theoretical and practical sessions&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 110 questionnaires were collected in period 1&#44; and 80 in period 2&#46; Almost three-quarters &#40;71&#46;3&#37;&#41; of PED staff attended the theoretical sessions&#44; and 43&#46;8&#37; attended the practical sessions&#46; The application of this training programme significantly improved knowledge about the DP&#44; but no improvement was observed in the practical questions&#46; PED staff felt more prepared to face a disaster after the training programme &#40;15&#46;5&#37; vs&#46; 41&#46;8&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The training programme improved some knowledge about the disaster plan&#44; but it has not improved responses in practical situations&#44; which may be due to the low attendance at practical sessions and the time between the training programme and the questionnaires&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
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            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar la eficacia de un programa formativo sobre cat&#225;strofes en un Servicio de Urgencias Pedi&#225;tricas &#40;SUP&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio cuasiexperimental mediante encuestas dirigidas al personal sanitario del SUP de un hospital pedi&#225;trico de tercer nivel&#46; Se eval&#250;an aspectos te&#243;ricos y pr&#225;cticos del plan de cat&#225;strofes &#40;PC&#41;&#46; Las encuestas son cumplimentadas en 2 periodos &#40;periodo 1&#44; enero del 2014&#44; y periodo 2&#44; noviembre del 2014&#41;&#44; entre los cuales se realiza una formaci&#243;n con sesiones te&#243;ricas y situaciones cl&#237;nicas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se recogen 110 encuestas en el periodo 1 y 80 en el periodo 2&#46; El 71&#44;3&#37; del personal asiste a las sesiones te&#243;ricas y el 43&#44;8&#37; a las pr&#225;cticas&#46; Tras la formaci&#243;n&#44; aumenta significativamente la proporci&#243;n del personal que conoce el PC y el &#171;kit&#187; de cat&#225;strofes&#46; En cuanto a los aspectos pr&#225;cticos&#44; no se observa mejor&#237;a en las respuestas a las situaciones cl&#237;nicas planteadas&#46; El personal se siente m&#225;s preparado para afrontar una cat&#225;strofe despu&#233;s del programa formativo &#40;15&#44;5&#37; vs&#46; 41&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La aplicaci&#243;n de una formaci&#243;n sobre cat&#225;strofes ha mejorado algunos conocimientos del personal&#44; pero no ha mejorado las respuestas en las situaciones cl&#237;nicas planteadas&#44; posiblemente influenciado por la baja asistencia a las sesiones pr&#225;cticas y el tiempo transcurrido entre la formaci&#243;n y la encuesta&#46;</p></span>"
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            "titulo" => "Metodolog&#237;a"
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          2 => array:2 [
            "identificador" => "abst0035"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Parra Cotanda C&#44; Rebordosa Mart&#237;nez M&#44; Trenchs Sainz de la Maza V&#44; Luaces Cubells C&#46; Impacto de un programa de formaci&#243;n de cat&#225;strofes en el personal sanitario&#46; An Pediatr &#40;Barc&#41;&#46; 2016&#59;85&#58;149&#8211;154&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Previous presentations&#58; This study was presented as an oral communication at the XX Reuni&#243;n Anual de la Sociedad Espa&#241;ola de Urgencias de Pediatr&#237;a&#59; April 16&#8211;18&#44; 2015&#59; Bilbao&#44; Spain&#46; It has not been published before and it is not under consideration by any other editorial board&#46;</p>"
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            "etiqueta" => "Appendix 1"
            "titulo" => "Survey on disasters"
            "identificador" => "sec0030"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period 1<br>Pre training&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period 2<br>Post training&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Female sex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96 &#40;87&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 &#40;85&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Median 33 years &#40;IQR&#44; 28&#8211;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Median 34 years &#40;IQR&#44; 28&#8211;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Years worked in Emergency dept</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Median 4 years &#40;IQR&#44; 2&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Median 7 years &#40;IQR&#44; 3&#8211;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Professional category</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adjunct physician&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;21&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;26&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Resident physician&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;31&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;26&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Registered nurse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;31&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;28&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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