The effect of a targeted clinical toxicology training intervention on the diagnostic accuracy and management of paramedics exposed to clinical simulation: a repeated measures study

John Talbot and James Coulson, 'The effect of a targeted clinical toxicology training intervention on the diagnostic accuracy and management of paramedics exposed to clinical simulation: a repeated measures study', British Paramedic Journal, 2016, Vol. 1 (1): 15-25, © The Author(s) 2016.Background – As first contact practitioners in a variety of medical emergencies, paramedics are frequently required to manage a number of toxicological emergencies. Although mortality from poisonings is low, timely and appropriate management can help to prevent subsequent sequelae such as acute coronary syndromes in cocaine toxicity, dangerous arrhythmias after tricyclic antidepressant overdose and regurgitation of gastric content following opioid poisoning. Paramedics potentially have underdeveloped knowledge of toxic syndromes (toxidromes), instead relying on heuristics and experience to manage poisoning emergencies. Moreover formal teaching of pharmacology and toxicology on paramedic undergraduate programmes is not universal, potentially leading to suboptimal management of poisoned patients. Study objectives – To evaluate baseline diagnostic accuracy and management of poisoning emergencies by undergraduate paramedics and the effect of participation in a targeted toxicological training intervention on diagnostic accuracy and management among undergraduate paramedics when assessed through clinical simulation. Methods – The research utilised a two-stage repeated measures design; following completion of a Likert scale questionnaire a cohort of final year undergraduate paramedics from the University of Northamptonshire undertook three 5-minute simulated patient scenarios on a Laerdal SimMan® programmed to display specific clinical signs; a written sheet with a brief history accompanied each scenario. The scenarios were designed to reflect current paramedic practice comprising opioid (scenario 1), tricyclic antidepressant (scenario 2) and beta blocker overdoses (scenario 3). Two weeks after completing the scenarios the cohort attended a targeted 90-minute educational intervention; a further two months later the cohort repeated the scenarios although the order in which the individual cases were encountered was changed.Peer reviewe

Towards a renewable adaptive recyclable and environmental architecture

Research in pursuit of an effective response to the demands for a sustainable architecture has lead towards the conception of a Renewable, Adaptive, Recyclable and Environmental (R.A.R.E.) building typology. The term R.A.R.E. expresses issues that have assumed central importance in the current architectural debate. This paper establishes the principles of the typology, drawing on the contents and pedagogical methods applied in a building technology academic course, at fourth year level. The R.A.R.E methodology is presented to and explored by students in the search for a definition of an innovative architecture, which is both progressive and sustainable. The unit is structured into eight subjects: Sustainable Site &amp; Climate Analysis; Flexible &amp; Adaptive Structural Systems; Renewable &amp; Environmental Building Materials; Modular Building Systems; Innovative Building Envelope Systems; Renewable &amp; Non-conventional Energy Systems; Innovative Heating, Ventilation &amp; Air Conditioning Systems; Water Collection &amp; Storage Systems. Through a holistic and integrated approach, the unit presents a comprehensive overview of these &lsquo;Sustainable Building Categories&rsquo;, so that the students can produce a guide towards the design requirements of a Renewable, Adaptive, Recyclable and Environmental (R.A.R.E.) Architecture.<br /

Recreational drug use and the emerging challenges of psychoactive substances in Malta : a case series

Introduction: Recreational drug-related hospital admissions, excluding alcohol, appeared to be relatively constant in Mater Dei Hospital (MDH), Malta’s sole public, acute general hospital. While ‘classical’ recreational drugs such as cocaine, heroin and Methylenedioxymethamphetamine (MDMA) were always seen as the main culprits, intoxications secondary to novel psychoactive substances (NPS) have recently emerged in MDH. The aim of this study was to determine the challenges of recreational drug intoxication, including NPS, in MDH. Methods: All the MDH admissions secondary to recreational drug intoxication between 2010 and 2015 were investigated. MDH clinical performance unit (CPU), hospital data files, hospital discharge letters and the hospital database software system were utilised for data collection. Intoxications associated with self-harm, trauma and lone alcohol ingestions were excluded. Results: 286 patients were admitted to MDH with recreational drug intoxication between 2010-2015, with a peak of 71 patients in 2015. 78.3% were males and the median age was 26 years. While 79% of the admissions were Maltese nationals, there was a surge in foreigner admissions, from 11.8% between 2010-2012 to 28.3% between 2013-2015 (p<0.001). Admissions occurred mostly in spring and summer, on Saturday or Sunday, and at night. 52.4% of admissions were acutely confused. Ethanol co-ingestion (40.9%) and polydrug use (39.9%) were common in these admissions. 16% needed admission to critical care. 91.3% admissions were secondary to ‘Classical’ recreational drugs, mostly heroin and cocaine. In 2015, 36.6% of admissions were secondary to NPS, mostly synthetic cannabinoids (SCRA). SCRA admissions were associated with severe sympathomimetic and neuropsychiatric features. An SCRA toxidrome mnemonic (MEET_SCRA) is proposed from the most common features of lone intoxications. Conclusion: Recreational drugs were associated with significant hospital burden, with NPS representing a new threat to MDH and Maltese public health. The toxidrome mnemonic MEET_SCRA could potentially aid in the identification of SCRA intoxications.peer-reviewe

Anterior chamber depth measurement: Experimental slit lamp method versus applanation a-scan

Accurately measuring anterior chamber depth is critical in placing an intraocular lens after cataract surgery. The current method most commonly used to measure the distance from the posterior surface of the cornea to the anterior surface of the crystalline lens is ultrasound biometry. This project explored the efficacy of a simple optical instrument to measure anterior chamber depth (ACD) compared to that of applanation A scan ultrasound. The mean ACD measured by the A scan was 3.40mm (range 2.87 to 3.87 mm) while the mean ACD measured with test instrument was 3.61mm (range 3.00 to 4.llmm). The ACD measured with the test instrument was greater in 5 of the 6 eyes when compared with the A scan. The difference ranged from .06 mm shorter to 0.44 longer (mean +0.22±0.19. At-test revealed no significant difference in the two sets of measurements with significance of 0.00

Can Peanuts Fall in Love with Distributional Semantics?

The context in which a sentence appears can drastically alter our expectations about upcoming words - for example, following a short story involving an anthropomorphic peanut, experimental participants are more likely to expect the sentence 'the peanut was in love' than 'the peanut was salted', as indexed by N400 amplitude (Nieuwland & van Berkum, 2006). This rapid and dynamic updating of comprehenders' expectations about the kind of events that a peanut may take part in based on context has been explained using the construct of Situation Models - updated mental representations of key elements of an event under discussion, in this case, the peanut protagonist. However, recent work showing that N400 amplitude can be predicted based on distributional information alone raises the question whether situation models are in fact necessary for the kinds of contextual effects observed in previous work. To investigate this question, we attempt to model the results of Nieuwland and van Berkum (2006) using six computational language models and three sets of word vectors, none of which have explicit situation models or semantic grounding. We find that the effect found by Nieuwland and van Berkum (2006) can be fully modeled by two language models and two sets of word vectors, with others showing a reduced effect. Thus, at least some processing effects normally explained through situation models may not in fact require explicit situation models

Stamped Amphora Handles from Tel Beersheba

This article publishes the 39 stamped amphora handles found during excavations conducted at Tel Beersheba between 1969 and 1976. All were found in poorly stratified contexts and so have no real stratigraphic value. They do, however, attest to the importance of Beersheba in the Rhodian economic sphere of the late Hellenistic period and add to our knowledge of Rhodesian fabricants and eponyms of the second century B.C