U.S. Military Veterans’ Attitudes and Perceptions of Mental Healthcare

The purpose of this research project is to measure whether U.S. military veterans experience any stigma related to mental healthcare and if this is associated with age, length of service, and military branch. U.S. military veterans are a high-risk group for developing mental illnesses. It is believed social stigma and personal attitudes, perceptions and beliefs of mental healthcare may influence whether a veteran will pursue mental healthcare. This cross-sectional study was conducted as an online survey via Qualtrics resulting in 75 total responses. 21 responses were excluded from the analysis due to incompletion or failure to pass the consciousness-awareness test question. The survey included a general demographics questionnaire following a brief mental health history and mental healthcare experience of the respondent. The end of the survey presented 9 reflective statements where the respondent’s answer on a 5-point scale of “strongly agree” to “strongly disagree” would reflect either positive or negative attitudes towards mental healthcare. 13.6% of respondents agreed with statements which described negative attitudes and perceptions of mental healthcare and 76.4% of respondents agreed with statements which described positive attitudes and perceptions of mental healthcare; 10.1% of respondents were indifferent. No statistically significant correlations were found between the variables presented in the research question

Implementation of computerised clinical decision support (CCDS) in a prehospital setting: Processes of adoption and impact on paramedic role and practice.

TitleImplementation of computerised clinical decision support (CCDS) in a prehospital setting: processes of adoption and impact on paramedic role and practiceAimTo examine the adoption of CCDS by paramedics, including the impact of CCDS on paramedic role and practice.MethodsSystematic review of CCDS in emergency care followed by a cluster-randomised controlled trial (C-RCT) of CCDS with a qualitative component involving 42 paramedics at two study sites.Results19/20 studies identified for inclusion in the systematic review were from the Emergency Department setting, with no studies from prehospital care. The focus of the studies was on process of care (19/20) rather than patient outcomes (5/20). Positive impacts were reported in 15/19 (79%) process of care studies. Only two patient outcome studies were able to report findings (one positive, one negative). Results relating to CCDS implementation were reported as an ad hoc response to problems encountered. In this C-RCT paramedics used CCDS with 12% of eligible patients (site one: 2%; site two: 24%). Intervention paramedics were twice as likely to refer patients to a falls service as those in the control group (usual care) (relative risk = 2.0; 95% Cl 1.1 to 3.7) although conveyance rates were unaltered (relative risk = 1.1; 95% Cl 0.8 to 1.5) and episode of care was unchanged (-5.7 minutes; 95% Cl -38.5 to 27.2). When CCDS was used patient referral to falls services was three times as likely (relative risk = 3.1; 95% Cl 1.4 to 6.9), and non-conveyance was twice as likely (risk = 2.1; 95% Cl 1.1 to 3.9) and overall episode of care fell by 114 minutes (95% Cl from 77.2 to 150.3). Reasons given for not using CCDS included technical problems, lack of integration, it was not sophisticated enough to influence decision making. Paramedics adapted when and how they used CCDS to suit context and patient condition.ConclusionThere is little existing evidence in relation to CCDS use in the emergency care setting, and the prehospital emergency care setting in particular. Studies of CCDS undertaken in emergency departments have shown benefit, particularly in relation to process of care. The C-RCT found that CCDS use by paramedics was low, particularly at site one, but use was associated with higher rates of patient referral and non-conveyance, and shorter episodes of care. There were encouraging signs that CCDS can support a new decision making role for paramedics. The study provides useful lessons for policy makers, practitioners and researchers about the potential benefits of CCDS and the challenges to adoption of new technology in emergency prehospital care

Emergency Medicine Society of South Africa guidelines for the training and credentialing in emergency point-of-care ultrasound

This is the second guideline from the Emergency Medicine Society of South Africa (EMSSA) on the use of emergency point-of-care ultrasound in South Africa. It supersedes and replaces the guidelines produced in 2009. This document contains information on the changes from the 2009 guidelines and details of the training and credentialing processes recommended by EMSSA. It also contains detailed information on the curricula of the Core Emergency Point-of-Care Ultrasound and Advanced Emergency Point-of-Care Ultrasound courses

The effectiveness of pilates exercise in people with chronic low back pain: A systematic review

OBJECTIVE:To evaluate the effectiveness of Pilates exercise in people with chronic low back pain (CLBP) through a systematic review of randomised controlled trials (RCTs). DATA SOURCES:A search for RCTs was undertaken using Medical Search Terms and synonyms for "Pilates" and "low back pain" within the maximal date range of 10 databases. Databases included the Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Medline; Physiotherapy Evidence Database; ProQuest: Health and Medical Complete, Nursing and Allied Health Source, Dissertation and Theses; Scopus; Sport Discus; Web of Science. STUDY SELECTION:Two independent reviewers were involved in the selection of evidence. To be included, relevant RCTs needed to be published in the English language. From 152 studies, 14 RCTs were included. DATA EXTRACTION:Two independent reviewers appraised the methodological quality of RCTs using the McMaster Critical Review Form for Quantitative Studies. The author(s), year of publication, and details regarding participants, Pilates exercise, comparison treatments, and outcome measures, and findings, were then extracted. DATA SYNTHESIS:The methodological quality of RCTs ranged from "poor" to "excellent". A meta-analysis of RCTs was not undertaken due to the heterogeneity of RCTs. Pilates exercise provided statistically significant improvements in pain and functional ability compared to usual care and physical activity between 4 and 15 weeks, but not at 24 weeks. There were no consistent statistically significant differences in improvements in pain and functional ability with Pilates exercise, massage therapy, or other forms of exercise at any time period. CONCLUSIONS:Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise. Future research should explore optimal Pilates exercise designs, and whether some people with CLBP may benefit from Pilates exercise more than others

The development of theory-informed participant-centred interventions to maximise participant retention in randomised controlled trials

Acknowledgements We would like to thank all of the participants who volunteered their time to contribute to this study. We would also like to thank all of the teams linked to the host trials we worked with to help identify potential participants. Funding This research is funded by the Chief Scientist Office of the Scottish Government’s Health and Social Care Department [HIPS/16/46]. KG held a Medical Research Council UK Methodology Fellowship during the delivery of this project [MR/L01193X/1]. The publication was supported through a Health Research Board Trials Methodology Research Network award. MDW acknowledges support from the NIHR Newcastle Biomedical Research Centre. MW acknowledges support from the NIHR Imperial Biomedical Research Centre (BRC). The Health Services Research Unit, Institute of Applied Health Sciences (University of Aberdeen), is core-funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no involvement in study design, collection, analysis and interpretation of data, reporting or the decision to publish.Peer reviewedPublisher PD

Systematic Techniques to Enhance rEtention in Randomised controlled trials:the STEER study protocol

Funding: This research is funded by the Chief Scientist Office of the Scottish Government’s Health and Social Care Department (HIPS/16/46). This manuscript is supported by an Institutional Strategic Skills Award (Women’s returner award held by KG) at the University of Aberdeen which is funded by the Wellcome Trust.Peer reviewedPublisher PD

Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial

Background: Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS) software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services. Methods/Design: Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial. Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders. The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically. Discussion: Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services. In conclusion this complex emergency care trial will provide rigorous evidence on the clinical and cost effectiveness of CCDS for paramedics in the care of older people who have fallen

Is music enriching for group-housed captive chimpanzees (Pan troglodytes)?

Many facilities that house captive primates play music for animal enrichment or for caregiver enjoyment. However, the impact on primates is unknown as previous studies have been inconclusive. We conducted three studies with zoo-housed chimpanzees (Pan troglodytes) and one with group-housed chimpanzees at the National Centre for Chimpanzee Care to investigate the effects of classical and pop/rock music on various variables that may be indicative of increased welfare. Study one compared the behaviour and use of space of 18 animals when silence, classical or pop/rock music was played into one of several indoor areas. Overall, chimpanzees did not actively avoid the area when music was playing but were more likely to exit the area when songs with higher beats per minute were broadcast. Chimpanzees showed significantly fewer active social behaviours when music, rather than silence, was playing. They also tended to be more active and engage in less abnormal behaviour during the music but there was no change to either self-grooming or aggression between music and silent conditions. The genre of music had no differential effects on the chimpanzees’ use of space and behaviour. In the second study, continuous focal observations were carried out on three individuals with relatively high levels of abnormal behaviour. No differences in behaviour between music and silence periods were found in any of the individuals. The final two studies used devices that allowed chimpanzees to choose if they wanted to listen to music of various types or silence. Both studies showed that there were no persistent preferences for any type of music or silence. When taken together, our results do not suggest music is enriching for group-housed captive chimpanzees, but they also do not suggest that music has a negative effect on welfare

Implementation and use of computerised clinical decision support (CCDS) in emergency pre-hospital care: a qualitative study of paramedic views and experience using Strong Structuration Theory

Computerised clinical decision support (CCDS) has been shown to improve processes of care in some healthcare settings, but there is little evidence related to its use or effects in pre-hospital emergency care. CCDS in this setting aligns with policies to increase IT use in ambulance care, enhance paramedic decision-making skills, reduce avoidable emergency department attendances and improve quality of care and patient experience. This qualitative study was conducted alongside a cluster randomised trial in two ambulance services of the costs and effects of web-based CCDS system designed to support paramedic decision-making in the care of older people following a fall. Paramedics were trained to enter observations and history for relevant patients on a tablet, and the CCDS then generated a recommended course of action which could be logged. Our aim was to describe paramedics' experience of the CCDS intervention and to identify factors affecting its implementation and use. We invited all paramedics who had been randomly allocated to the intervention arm of the trial to participate in interviews or focus groups. The study was underpinned by Strong Structuration Theory, a theoretical model for studying innovation based on the relationship between what people do and their context. We used the Framework approach to data analysis. Twenty out of 22 paramedics agreed to participate. We developed a model of paramedic experience of CCDS with three domains: context, adoption and use, and outcomes. Aspects of context which had an impact included organisational culture and perceived support for non-conveyance decisions. Experience of adoption and use of the CCDS varied between individual paramedics, with some using it with all eligible patients, some only with patients they thought were 'suitable' and some never using it. A range of outcomes were reported, some of which were different from the intended role of the technology in decision support. Implementation of new technology such as CCDS is not a one-off event, but an ongoing process, which requires support at the organisational level to be effective. ISRCTN Registry 10538608 . Registered 1 May 2007. Retrospectively registered