Risk Taking by Children and Seniors: Selected Sandwich Generation Caregiver’s Perceptions

Grounded theory was used to investigate the perception of risk held by 20 women in the sandwich generation and their process to evaluate risk as caregivers for both their child and senior. The impact of their risk perception was considered as it related to their actions, the child’s and senior’s ability to engage in risk taking, their independence and quality of life. Findings suggest the same risk assessment process was used to determine if the child or senior is capable of managing the risk. The independence gained by both through risk taking is supported unless safety is a factor. As the risk increases the selected sandwich generation’s control increases and the child’s and senior’s independence decreases. The selected sandwich generation views an upward trajectory for the child’s independence and a declining trajectory for the senior’s independence although their actions support the value of independence for both

When Ambulances Crash

Transporting patients to hospitals in a safe manner is a core aspect of paramedic practice within Canada. The majority of these transports are within a ground ambulance on city streets and provincial roadways. There is however an inherent danger associated with the operation of emergency vehicles

Ageism is Getting Old!

Ageism is defined as a systemic bias towards older adults because of their are. It is found across the spectrum of health care from a macro policy level down to the individual interactions of healthcare providers towards their patients

The students are our future : growing the next generation of paramedic researchers in Canada

As the paramedic discipline globally moves towards professionalisation through professional registration, higher education, and role diversification within the health service, the importance of the paramedic body of knowledge becomes more apparent. In this article we will outline our experiences with student paramedic research at Fanshawe College, and will expand on our previous reporting of this initiative

Patient Safety and Quality Improvement Education for Paramedics: The Role of the IHI Open School Chapter

In 2017, an IHI Open School Chapter was founded at Fanshawe College. This was undertaken as an additional measure to promote patient safety and quality improvement awareness among students and faculty

Maybe I\u27m not that approachable : using simulation to elicit team leaders\u27 perceptions of their role in facilitating speaking up behaviors

BACKGROUND: Simulation research that seeks to solve the problem of silence among interprofessional teams has focused almost exclusively on training subordinate team members to be more courageous and to speak up to team leaders using direct challenge scripts despite the great interpersonal cost. Consequently, the existing literature overemphasizes the responsibility of subordinate team members for speaking up and fails to consider the role and responsibilities of team leaders in sustaining silence. The purpose of this study is to identify and describe the subtle behaviors and actions of team leaders that both promote and discourage speaking up. METHODS: This study used a simulation-primed qualitative inquiry approach. Obstetricians (OB) at one academic center participated in an interprofessional simulation as an embedded participant. Five challenge moments (CM) were scripted for the OB involving deliberate clinical judgment errors or professionalism infractions. Other participants were unaware of the OB embedded participant role. Thirteen iterations were completed with 39 participants. Twelve faculty members completed a subsequent semi-structured interview. Scenarios were videotaped; debriefs and interviews were audio-recorded and transcribed verbatim. Data were analyzed using an inductive thematic approach. RESULTS: After participating in an interprofessional simulation, faculty participants reflected that being an approachable team leader requires more than simply avoiding disruptive behaviors. We found that approachability necessitates that team leaders actively create the conditions in which team members perceive that speaking up is welcomed, rather than an act of bravery. In practice, this conceptualization of approachability involves the tangible actions of signaling availability through presence, uncertainty through thinking aloud, and vulnerability through debriefing. CONCLUSIONS: By using faculty as embedded participants with scripted errors, our simulation design provided an ideal learning opportunity to prompt discussion of the subtle behaviors and actions of team leaders that both promote and discourage speaking up. Faculty participants gained a new appreciation that their actions create the conditions for speaking up to occur before critical incidents through their verbal and non-verbal communication

Driving me crazy: the effects of stress on the driving abilities of paramedic students

BackgroundPrevious research has demonstrated that stress has a negative impact on the performance of paramedics while performing medical related tasks. Acute stress has also been shown to negatively impact the driving abilities of the general population increasing the number of critical driving errors performed. No literature was discovered that discussed the effects of stress on the driving abilities of paramedics.MethodsParamedic students underwent a driving ability assessment in a driving simulator. We then exposed them to a stress inducing medical scenario. Another driving assessment was then conducted. The numbers, and types of errors were documented before and after the scenario.Results36 students participated in the study. Paramedic students demonstrated no increase in overall error rate after a stressful scenario, but demonstrated an increase in three critical driving errors; failure to wear a seatbelt (3 baseline v 10 post stress, p= 0.0087), failing to stop for red lights or stop signs (7 v 35, p= <0.0001), and losing controlling of the vehicle (2 v 11, p= 0.0052).ConclusionParamedic students demonstrated an increase in critical driving errors after a stressful simulated clinical scenario. Paramedics are routinely exposed to acute stress during the course of their working day. This stress could increase the number of critical driving errors that occur. These results reinforce the need for further research, and highlight the potential need for increased driver training and stress management education in order to mitigate the frequency and severity of driving errors made by paramedics

Strategies for incorporating patient safety education in paramedic education using the IHI Open School

IntroductionEvery year, thousands of patients die and millions are harmed by medical care provision. Paramedics care for patients in dynamic, and challenging environments every day, which creates conditions that are ideal for mistakes to occur and for harm to be caused as a result. Knowledge of patient safety is recognised as a competency for paramedics in several jurisdictions, yet general awareness among paramedics of patient safety issues remains poor. The Institute for Healthcare Improvement (IHI) Open School courses were identified as a potential solution to this identified gap. These courses have been successfully integrated into various health professions education programs in other institutions; however, no literature was discovered which discussed the integration of these courses into paramedic education.MethodsEight online courses from the 13-course IHI Basic Certificate in Quality and Safety were embedded into the curriculum of a professional issues class in a paramedic diploma program in Ontario, Canada. Courses were completed outside of classroom time over one semester, and a percentage of activity marks for the class were awarded to students on the completion of the eight courses. Students provided a copy of certificates to prove completion of training.ResultsIn this pilot program, 41 paramedic students in the class (98%) completed all 13 courses, and were awarded the IHI Basic Certificate in Quality and Safety. Students described the courses as “highly applicable to paramedicine and pre-hospital care”. In addition, students state that completing the certificate gave them knowledge of “the means by which change can be enacted”. The completion of the courses outside of class time was achievable, and feedback from students has been overwhelmingly positive. An additional 43 students are currently enrolled in the courses, with completion expected by December 2018.ConclusionThe IHI Open School courses are an easy to implement strategy for paramedics looking to gain a brief, concise education on quality and patient safety. It is our goal to integrate the IHI Open School Basic Certificate across all classes in the two-year diploma program. We hope this will lay a foundation for professional practice that is based on safe, high-quality care provision

Interleukin 2 Receptor Signaling Regulates the Perforin Gene through Signal Transducer and Activator of Transcription (Stat)5 Activation of Two Enhancers

Optimal T cell differentiation into effector cells with specialized functions requires the participation of cytokine receptor signals. In T helper cells, this process is controlled by chromatin changes and distal and proximal regulatory elements as well as specific transcription factors. Analogous events during cytotoxic T lymphocyte (CTL) differentiation remain to be identified. This process is known, however, to be crucially regulated by interleukin (IL)-2 receptor (R) signals. It is accompanied by the induction of perforin expression via a mechanism that does not entail proximal regulatory elements. In this report, transgenically expressed human perforin gene locus DNAs demonstrate that IL-2R signals target two IL-2–dependent enhancers ∼15 and 1 kilobase upstream of the promoter. The most distal enhancer may also respond to TCR signals. In transient transfections, both enhancers required two identically spaced Stat-like elements for their activation, which was abolished by expression of a dominant negative signal transducer and activator of transcription (Stat)5 molecule, whereas a constitutively active Stat5 molecule bypassed the requirement for IL-2R signals. These results provide a molecular explanation for the activation of the perforin gene during CTL differentiation and complement the analysis of animals deficient in the activation of the IL-2R Stat signaling pathway by establishing perforin as a target gene

Genome-wide analysis of regions similar to promoters of histone genes

Background: The purpose of this study is to: i) develop a computational model of promoters of human histone-encoding genes (shortly histone genes), an important class of genes that participate in various critical cellular processes, ii) use the model so developed to identify regions across the human genome that have similar structure as promoters of histone genes; such regions could represent potential genomic regulatory regions, e.g. promoters, of genes that may be coregulated with histone genes, and iii/ identify in this way genes that have high likelihood of being coregulated with the histone genes. Results: We successfully developed a histone promoter model using a comprehensive collection of histone genes. Based on leave-one-out cross-validation test, the model produced good prediction accuracy (94.1% sensitivity, 92.6% specificity, and 92.8% positive predictive value). We used this model to predict across the genome a number of genes that shared similar promoter structures with the histone gene promoters. We thus hypothesize that these predicted genes could be coregulated with histone genes. This hypothesis matches well with the available gene expression, gene ontology, and pathways data. Jointly with promoters of the above-mentioned genes, we found a large number of intergenic regions with similar structure as histone promoters. Conclusions: This study represents one of the most comprehensive computational analyses conducted thus far on a genome-wide scale of promoters of human histone genes. Our analysis suggests a number of other human genes that share a high similarity of promoter structure with the histone genes and thus are highly likely to be coregulated, and consequently coexpressed, with the histone genes. We also found that there are a large number of intergenic regions across the genome with their structures similar to promoters of histone genes. These regions may be promoters of yet unidentified genes, or may represent remote control regions that participate in regulation of histone and histone-coregulated gene transcription initiation. While these hypotheses still remain to be verified, we believe that these form a useful resource for researchers to further explore regulation of human histone genes and human genome. It is worthwhile to note that the regulatory regions of the human genome remain largely un-annotated even today and this study is an attempt to supplement our understanding of histone regulatory regions.Statistic