Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature

BACKGROUND: Increasing demand on the UK emergency services is creating interest in reviewing the structure and content of ambulance services. Only 10% of emergency calls have been seen to be life-threatening and, thus, paramedics, as many patients’ first contact with the health service, have the potential to use their skills to reduce the demand on Emergency Departments. This systematic literature review aimed to identify evidence of paramedics trained with extra skills and the impact of this on patient care and interrelating services such as General Practices or Emergency Departments. METHODS: International literature from Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and grey literature from 1990 were included. Articles about any prehospital emergency care provider trained with extra skill(s) beyond their baseline competencies and evaluated in practice were included. Specific procedures for certain conditions and the extensively evaluated UK Emergency Care Practitioner role were excluded. RESULTS: 8724 articles were identified, of which 19 met the inclusion criteria. 14 articles considered paramedic patient assessment and management skills, two articles considered paramedic safeguarding skills, two health education and learning sharing and one health information. There is valuable evidence for paramedic assessing and managing patients autonomously to reduce Emergency Department conveyance which is acceptable to patients and carers. Evidence for other paramedic skills is less robust, reflecting a difficulty with rigorous research in prehospital emergency care. CONCLUSIONS: This review identifies many viable extra skills for paramedics but the evidence is not strong enough to guide policy. The findings should be used to guide future research, particularly into paramedic care for elderly people

Identification of Novel Pesticides for Use against Glasshouse Invertebrate Pests in UK Tomatoes and Peppers

To inform current and future pesticide availability to glasshouse vegetable growers, the current project trialled more than twenty products, including existing industry standards, against four key pests of glasshouse tomatoes and bell peppers. These included experimental conventional chemical pesticides as well as alternative biopesticide and biorational products based on phytochemicals, microbials and physically-acting substances. The results suggest that certain biopesticide products, particularly botanicals, provide good levels of pest control, with the same being true of experimental conventional chemical pesticides not yet recommended for use against these pests on these crops. Efforts are on-going to ensure that results of the current project translate to industry benefit via new pesticide approvals

Exploring psychological peritraumatic risk factors and safety behaviours as key mechanisms in the onset and maintenance of PTSD; a Systematic Review and Meta-Analysis

Background After Post-Traumatic Stress Disorder (PTSD) was first conceptualised in 1980, decades of valuable research have contributed to the development of cognitive theories and evidence-based treatments, which are used as front-line treatments in NHS services in line with NICE guidance. However, there are some elements of the cognitive model which are under-researched, such as the role of safety behaviours in the development and maintenance of PTSD. Research is also yet to provide clarity on the role of psychological peritraumatic risk factors for PTSD in adults. Method This portfolio contains two systematic reviews and meta-analyses. The first review concerns the relationship between safety behaviours and PTSD in adults, and includes six studies (n = 628). The second review explores peritraumatic risk factors for PTSD in adults, and includes 63 studies (n=20,335). Results The first paper regarding safety behaviours yielded a large effect r=0.62, supporting the idea that engaging in safety behaviours is associated with the development and/or maintenance of PTSD in adults. Regarding the second paper, peritraumatic subjective threat and peritraumatic dissociation yielded moderate estimates of population effect size (r=.39, r=.39), and peritraumatic data-driven processing yielded a small estimated population effect size (r=.26). Both studies were affected by high levels of heterogeneity. Each paper discusses the outcome of moderator analyses, limitations, clinical implications and suggestions for future research. Conclusion Overall, there were a small number of studies available for inclusion in the first review, despite safety behaviours forming an important part of the cognitive model for over twenty years. While the findings are in line with the Ehlers and Clark model (2020), more research is needed to clarify the directionality of the relationship. The second meta-analysis highlighted the need for more studies to investigate the predictive risk of a wider range of peritraumatic emotions e.g. guilt, shame, anger and disgust

Rock fisher behaviours and perceptions regarding drowning risk assessed by direct observation and self-report: a public awareness campaign evaluation

Issue addressed: Participants engaged in rock fishing are at risk of drowning. Following coronial investigation of fatalities, a 3-year safety campaign targeting rock fishers was developed in Victoria, Australia. Key campaign messages were wearing lifejackets, not fishing alone, and checking sea and weather conditions. The reported study provides results from a campaign evaluation. Methods: Evaluation by self-report and direct observation of safety attitudes and behaviours was undertaken pre-and during campaign. Data collections were as follows: (a) online survey of rock fishers recruited from panels, social media and rock fishing networks (n = 350) and (b) rock fisher direct observation and self-report at selected Victorian rock fishing platforms (n = 282; n = 58, respectively). Results: Safety message recall was reported by 51.7% of rock fishers surveyed online though far fewer recalled campaign key messages. No effect on key safety behaviours or attitudes were detected for fishers on platforms during campaign. Never wearing a lifejacket was reported by 31.8% online, 60.3% at platforms and observed for 97.4%. From direct observation, most participants did not fish alone and checked conditions on arrival. Conclusion: Campaign evaluation measures showed mixed outcomes. Irrespective, most rock fishers carry high drowning risk through failure to wear lifejackets. Legal mandating of lifejackets for identified high-risk platform is being introduced for Victoria, although careful evaluation is required to detect unanticipated outcomes. Informing future campaign evaluation, complementary methods highlight likely bias in self-reporting through faulty recall or social desirability. So what?: Future campaigns require innovative or novel design, over longer duration,to capture attention and change rock fisher behaviours

Thoughts about talk in romantic relationships: Similarity makes for attraction (and happiness, too)

Abstract OnlyThis current study assessed whether heterosexual dating partners are similar in their values about communication and how well such similarities predict partners’ attraction to one another and satisfaction with their relationship. Participants were 135 couples who described themselves as “seriously involved”; and had been dating for an average of 15 months. They completed a version of Burleson and Samter's (1990) Communication Functions Questionnaire, which assesses the value placed on several distinct communication skills and activities, and multiple measures of interpersonal attraction and relationship satisfaction. Correlational analyses indicated that partners’ evaluations of communication skills and activities were not significantly related. However, degree of similarity in couples’ communication values was moderately related to the assessments of attraction and satisfaction, demonstrating that partners with similar communication values were more attracted to one another and more satisfied with their relationship. In particular, similarities in the value placed on affectively oriented forms of communication such as ego support, comforting, and conflict management were significantly associated with indices of partner attraction and relationship satisfaction. Subsidiary analyses indicated that the similarities in couples’ communication values were not due to convergence (the tendency to become more similar over time). The results are discussed in terms of how cognitive similarities, especially those directly implicated in the conduct of a relationship, may contribute to the health and well being of that relationship

Using a realistic evaluation approach to explore how alternative education programs support children who are at risk of school exclusion to remain in mainstream education

The research uses a Realistic Evaluation approach (Pawson and Tilley, 1997) to begin to identify and refine shared programme theories that underpin alternative education programmes (AEPs) that support children who are at risk of school exclusion to remain in mainstream school. A Realist Synthesis (Pawson, 2006) of the relevant literature begins to identify programme theories underpinning the AEPs’ approach. Realist interviews (Pawson and Tilley, 1997) with a range of stakeholders, including education practitioners, children and a parent who have experience of one Local Authority AEP, are used to refine the programme theories identified. Supportive programme outcomes included: increasing parental engagement, promoting an effective school environment and promoting skills and resilience in the young person. Programme context conditions and mechanisms are identified as promoting the achievement of these outcomes. The bio-ecological theory (Bronfenbrenner, 2005) provided a model that located one potential analytic framework which identifies the purpose of the programme as ‘facilitating change in the child’s ecological context systems to enable a more supportive environment for reintegration’. These embryonic programme theories and the RE approach are discussed in light of how they can enable practitioners to develop a clearer understanding of how AEPs, and other education programmes, can effectively support children

Dieting, Restraint, and Disinhibition Predict Women\u27s Weight Change over 6 y

Background: Although disinhibited eating is positively associated with higher weight in women, it is not known whether restrained eating and dieting moderate the influence of disinhibited eating on weight change. Objective: The objective was to investigate over 6 y the interactive effects of restrained and disinhibited eating and self-reported dieting to lose weight as predictors of weight gain in women. Design: Data were collected from non-Hispanic white women (n = 163) every 2 y. Height and weight were measured in triplicate. Dietary restraint and disinhibition were assessed by using the Eating Inventory. Participants were also asked if they were “currently dieting to lose weight.” Multilevel modeling was used to examine change in weight as a function of time-invariant and time-varying predictors, including dietary restraint, dietary disinhibition, and self-reported dieting. Results: After covariates were adjusted for, growth curve models showed that within-person increases in restraint over time were associated with concurrent decreases in weight and that higher levels of restraint moderated the positive association between dietary disinhibition and weight. Women who reported dieting at study entry were heavier at study entry and gained more weight over time than did nondieters. Finally, a significant interaction between restraint, disinhibition, and dieting showed that restraint moderated the effect of disinhibition on weight differently in nondieters than in dieters. Conclusions: Increasing levels of dietary restraint may be beneficial in moderating weight by attenuating the positive association between disinhibition and weight in dieting women. An understanding of weight and weight change requires examination of the interactive effects of restraint, disinhibition, and dieting