To cannulate or not to cannulate? Variation, appropriateness and potential for reduction in cannulation rates by ambulance staff

Background: Peripheral intravenous (IV) cannulation is a key intervention in the prehospital setting, but inappropriate use may cause unnecessary pain, distress or risk of infection. The aim of this study was to examine the rate and appropriateness of prehospital cannulation and the relative importance of factors associated with increased likelihood of cannulation. Design and setting: Cross-sectional survey of patients transported in Lincolnshire, East Midlands Ambulance Service. Methods: Retrospective non-identifiable data for September 2006 were extracted. Clinical conditions were classified according to whether they warranted, did not warrant or were uncertain as to the need for cannulation. Other potential indications for cannulation including IV drug administration, reduced consciousness, systolic hypotension, respiratory depression and haemorrhage were combined to determine whether cannulation was indicated. Other variables were investigated as predictors of cannulation. The method of analysis was agreed at the outset. Results: Paramedics cannulated 14.6% (1295/8866) of patients. IV drug administration, clinical indication, reduced conscious level, respiratory depression and hypotension were associated with greater likelihood of cannulation (p,0.001). Cannulation was more likely in older patients but was not associated with gender, haemorrhage or hypoglycaemia. Multivariate logistic regression showed IV drug administration as the strongest predictor of cannulation. Cannulation rates varied threefold by ambulance station (mean 13.4%, 5.8% to 19.0%). It was estimated that 202 (15.6%) of the cannulations performed could potentially have been avoided. Conclusion: Rates of cannulation were higher than previous studies with wide variations between ambulance stations. 15.6% of cannulations performed could have been avoided, thus reducing pain, distress and other potential complications such as thrombophlebitis, extravasation and infection. The generalisability of this study was limited by use of a single site, short duration and dependence on accurate retrospective data. The data demonstrating wide variations suggest that there may be scope for consideration of interventions to reduce cannulation rates

The New Kid on the Block for Small Business Success: Ethics?*

"By the year 2000, small businesses will be the major growth machine of the U.S. economy, providing a multitude of benefits in the forms of personal independence, financial rewards, and economic dynamism" (Anwar & Stahlecker, 1989). Small businesses now account for 40% of the GNP and create approximately 70% of the new jobs in the U.S ., yet the majority' of all small businesses fail  within a few  short years (Polansky ).The most common reasons given for these failures are management incompetence, poor or no planning and the inability to secure financing. For the first time, however, a study of factors important to success of small business places ethics in the workplace high on the list

Exploring Psychology and Nursing Students Perceptions of Disgust

Practitioners can often experience feelings of disgust when exposed to malodorous wounds and this can manifest by facial expression, involuntary gagging and vomiting. This study reports on an investigation to measure a group of psychology and nursing students (n = 158) perceptions of disgust using three previously validated tools: The Disgust Scale-Revised and the Perceived Vulnerability to disease Scale. Method: Data were collected via anonymous on line survey of 158 psychology and nursing students at two Universities in the UK between June and July 2015. Results: Statistical analysis of the data revealed that the majority of the sample were female (97.3%) with nursing students being more resilient to disgust. Disgust scores diminished with increasing age. Psychology students are more sensitive to actual and perceived vulnerability to disease. Levels of perceived vulnerability falls with increasing age. Discussion: Nursing students undertake 50% of their pre-registration programme in clinical practice where they may have been exposed to potentially disgust provoking situations that may sensitize them to such situations. It is unclear whether their disgust diminishes because they become more tolerant, or accustomed to such situations or to other factors. Previous and repeated exposure to situations provoking disgust may however, explain why nursing student responses differ to their psychology counterparts. Conclusions: Nursing students are disgusted less easily than psychology students; although all individuals become slightly more tolerant to certain issues over time. Psychology students are significantly more sensitive to actual and perceived vulnerability to disease than nursing students. Perceived vulnerability falls with increasing age. In order to fully examine the impact of gender on disgust more research is required with a purposive sample

A Study of the Knowledge and Use of Hospice by Health Care Professionals in Omaha

The primary objective of this study was to conduct a needs assessment for the Omaha Hospice Organization which would determine the knowledge and/or use of hospice concepts and programs by health care professionals

Development and pilot of clinical performance indicators for English ambulance services

Introduction: There is a compelling need to develop clinical performance indicators for ambulance services in order to move from indicators based primarily on response times and in light of the changing clinical demands on services. We report on progress on the national pilot of clinical performance indicators for English ambulance services. Method: Clinical performance indicators were developed in five clinical areas: acute myocardial infarction, cardiac arrest, stroke (including transient ischaemic attack), asthma and hypoglycaemia. These were determined on the basis of common acute conditions presenting to ambulance services and in line with a previously published framework. Indicators were piloted by ambulance services in England and results were presented in tables and graphically using funnel (statistical process control) plots. Results: Progress for developing, agreeing and piloting of indicators has been rapid, from initial agreement in May 2007 to completion of the pilot phase by the end of March 2008. The results of benchmarking of indicators are shown. The pilot has informed services in deciding the focus of their improvement programme in 2008 and 2009 and indicators have been adopted for national performance assessment of standards of prehospital care. Conclusion: The pilot will provide the basis for further development of clinical indicators, benchmarking of performance and implementation of specific evidencebased interventions to improve care in areas identified for improvement. A national performance improvement registry will enable evaluation and sharing of effective improvement methods as well as increasing stakeholder and public access to information on the quality of care provided by ambulance services

Exploring the Impact of Targeted Distribution of Free Bed Nets on Households Bed Net Ownership, Socio-Economic Disparities and Childhood Malaria Infection Rates: Analysis of National Malaria Survey Data from three Sub-Saharan Africa countries.

The last decade has witnessed increased funding for malaria control. Malaria experts have used the opportunity to advocate for rollout of such interventions as free bed nets. A free bed net distribution strategy is seen as the quickest way to improve coverage of effective malaria control tools especially among poorest communities. Evidence to support this claim is however, sparse. This study explored the effectiveness of targeted free bed net distribution strategy in achieving equity in terms of ownership and use of bed nets and also reduction of malaria prevalence among children under-five years of age. National malaria indicator survey (MIS) data from Angola, Tanzania and Uganda was used in the analysis. Hierarchical multilevel logistic regression models were used to analyse the relationship between variables of interest. Outcome variables were defined as: childhood test-confirmed malaria infections, household ownership of any mosquito net and children's use of any mosquito nets. Marginal effects of having free bed net distribution on households with different wealth status were calculated. Angolan children from wealthier households were 6.4 percentage points less likely to be parasitaemic than those in poorest households, whereas those from Tanzania and Uganda were less likely to test malaria positive by 7 and 11.6 percentage points respectively (p < 0.001). The study estimates and present results on the marginal effects based on the impact of free bed net distribution on children's malaria status given their socio-economic background. Poorest households were less likely to own a net by 21.4% in Tanzania, and 2.8% in Uganda, whereas both poorer and wealthier Angolan households almost achieved parity in bed net ownership (p < 0.001). Wealthier households had a higher margin of using nets than poorest people in both Tanzania and Uganda by 11.4% and 3.9% respectively. However, the poorest household in Angola had a 6.1% net use advantage over children in wealthier households (p < 0.001). This is the first study to use nationally representative data to explore inequalities in bed net ownership and related consequences on childhood malaria infection rates across different countries. While targeted distribution of free bed nets improved overall bed net ownership, it did not overcome ownership inequalities as measured by household socioeconomic status. Use of bed nets was disproportionately lower among poorest children, except for Angola where bed net use was higher among poorest households when compared to children in wealthier households. The study highlights the need for malaria control world governing bodies and policy makers to continue working on finding appropriate strategies to improve access to effective malaria control tools especially by the poorest who often times bears the brunt of malaria burden than their wealthier counterparts

SANTPEN’s SoTL Journey: Building and Using a SoTL Approach Across Institutions

In the current higher education environment, providing high quality teaching and learning experiences to students has moved beyond desirable to essential. Quality improvement takes many forms, but one core aspect to ensure sustainable improvement is the development of a culture of scholarship of teaching and learning (SoTL). Developing such an institutional culture is surprisingly challenging yet essential to improving the status of teaching in higher education (HE), being successful in teaching and learning awards and grants, and, improving the student experience. The Australian Government’s Promoting Excellence Network initiative funds networks to foster collaboration between HE institutions to improve outcomes in national learning and teaching award and grant programs. Supported by this funding, the South Australian / Northern Territory Promoting Excellence Network (SANTPEN), a grouping of six institutions, formed. Bringing together a diverse network of institutions, similar only by virtue of geographic location is challenging. This paper describes the first three years of SANTPEN’s journey from the context of our own development with the concept of SoTL and how we applied this to build a culture of SoTL in and between our institutions. It also demonstrates how a modest budget can be put to effective use to benefit those immediately involved, institutional objectives and the aims of the national funding body. We provide evidence of this effectiveness and conclude with our collective aspirations for the future of SANTPEN and other likeminded and funded networks

Longitudinal patterns of antidepressant prescribing in primary care in the UK: comparison with treatment guidelines

The objective of this study was to determine whether patients beginning therapy on the most common tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) differed in their likelihood of having antidepressant treatment that was consistent with recommended treatment guidelines in the UK. An analytical file constructed from a large general practitioner medical records database (DIN-LINK) from the UK for the years 1992-97 was constructed. A total of 16 204 patients with a new episode of antidepressant therapy who initiated therapy on one of the most often prescribed TCAs (amitriptyline, dothiepin, imipramine and lofepramine) or SSRIs (fluoxetine, paroxetine and sertraline) were analysed. A dichotomous measure was defined to indicate whether subjects were prescribed at least 120 days of antidepressant therapy at an adequate average daily dose within the first 6 months after initiation of therapy. Only 6.0% of patients initiating therapy on aTCA and 32.9% of patients initiating therapy on a SSRI were prescribed antidepressant treatment that was consistent with treatment guidelines. After controlling for observable characteristics, patients who initiated therapy on a SSRI were much more likely (odds ratio=7.473, p<0.001) to have a prescribed average daily dose and duration consistent with recommended treatment guidelines within the first 6 months of initiating therapy than were patients who initiated therapy on a TCA. These findings suggest that initial antidepressant selection is an important determinant of whether the subsequent course of treatment is consistent with current national guidelines for the treatment of depression in the UK.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68732/2/10.1177_026988119901300204.pd

Assessment of energy and nutrient intakes among undergraduate students attending a University in the North of England

Unhealthy diets are typical of university students and are often thought to be unrepresentative of the general population. The main aim was to determine the energy and nutrient intakes of a large cohort of undergraduate university students; and to compare to gender-specific dietary reference values (DRVs) and nutrient data from the general population. Methodology: Data was collected from 639 university students aged 18–24 years who completed 4-day diet diaries. The energy and nutrient intake was determined and percentage energy values calculated and compared with dietary reference values (DRVs) and the National Diet and Nutrition Survey (NDNS) and Family Food Statistics. Logistic regression methods were used to identify micronutrients functioning as predictors of exceeding DRVs. Results: Energy intakes were lower than the DRV. The percentage total energy values for protein, fat, saturated fat and carbohydrate exceeded DRVs but the percentage energy from alcohol was below the maximum 5%. The DRVs were met for vitamin C, thiamin, and sodium/salt. Iron and calcium intakes were met in males but not in females. Intakes for fibre and vitamin A were below the DRV. Student data was comparable to the NDNS, with the exception of alcohol, fibre, vitamin A, calcium and sodium/salt, which were all lower than the NDNS. Conclusions: This study contradicts the stereotypical assumption that students are following a high energy, fat, saturated fat, total sugars, salt and alcohol diet compared with the general population