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

Illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh: A cross-sectional study.

BACKGROUND:Despite recognition that palliative care is an essential component of any humanitarian response, serious illness-related suffering continues to be pervasive in these settings. There is very limited evidence about the need for palliative care and symptom relief to guide the implementation of programs to alleviate the burden of serious illness-related suffering in these settings. A basic package of essential medications and supplies can provide pain relief and palliative care; however, the practical availability of these items has not been assessed. This study aimed to describe the illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh. METHODS AND FINDINGS:Between November 20 and 24, 2017, we conducted a cross-sectional study of individuals with serious health problems (n = 156, 53% male) and caregivers (n = 155, 69% female) living in Rohingya refugee camps in Bangladesh, using convenience sampling to recruit participants at the community level (i.e., going house to house to identify eligible individuals). The serious health problems, recent healthcare experiences, need for medications and medical supplies, and basic needs of participants were explored through interviews with trained Rohingya community members, using an interview guide that had been piloted with Rohingya individuals to ensure it reflected the specificities of their refugee experience and culture. The most common diagnoses were significant physical disabilities (n = 100, 64.1%), treatment-resistant tuberculosis (TB) (n = 32, 20.5%), cancer (n = 15, 9.6%), and HIV infection (n = 3, 1.9%). Many individuals with serious health problems were experiencing significant pain (62%, n = 96), and pain treatments were largely ineffective (70%, n = 58). The average age was 44.8 years (range 2-100 years) for those with serious health problems and 34.9 years (range 8-75 years) for caregivers. Caregivers reported providing an average of 13.8 hours of care per day. Sleep difficulties (87.1%, n = 108), lack of appetite (58.1%, n = 72), and lack of pleasure in life (53.2%, n = 66) were the most commonly reported problems related to the caregiving role. The main limitations of this study were the use of convenience sampling and closed-ended interview questioning. CONCLUSIONS:In this study we found that many individuals with serious health problems experienced significant physical, emotional, and social suffering due to a lack of access to pain and symptom relief and other essential components of palliative care. Humanitarian responses should develop and incorporate palliative care and symptom relief strategies that address the needs of all people with serious illness-related suffering and their caregivers

Forced Smoking Abstinence: Not Enough for Smoking Cessation

Importance: Millions of Americans are forced to quit smoking as they enter tobacco-free prisons and jails, but most return to smoking within days of release. Interventions are needed to sustain tobacco abstinence after release from incarceration. Objective: To evaluate the extent to which the WISE intervention (Working Inside for Smoking Elimination), based on motivational interviewing (MI) and cognitive behavioral therapy (CBT), decreases relapse to smoking after release from a smoke-free prison. Design: Participants were recruited approximately 8 weeks prior to their release from a smoke-free prison and randomized to 6 weekly sessions of either education videos (control) or the WISE intervention. Setting: A tobacco-free prison in the United States. Participants: A total of 262 inmates (35% female). Main Outcome Measure: Continued smoking abstinence was defined as 7-days point-prevelance abstinence validated by urine cotinine measurement. Results: At the 3-week follow-up, 25% of the participants in the WISE intervention (31 of 122) and 7% of the control participants (9 of 125) continued to be tobacco-abstinent (odds ration [OR], 4.4; 95% CI, 2.0-9.7). In addition to the intervention, Hispanic ethnicity, a plan to remain abstinent, and being incarcerated for more than 6 months were all associated with increased likelihood of remaining abstinent. In the logistical regression analysis, participants randomized to the WISE intervention were 6.6 times more likely to remain tobacco abstinent at the 3-week follow up than those randomized to the control condition (95% CI, 2.5-17.0). Nonsmokers at the 3-week follow-up had an additional follow-up 3 months after release, and overall 12% of the participants in the WISER intervention (14 of 122) and 2% of the control participants (3 of 125) were tobacco free at 3 months, as confirmed by urine cotinine measurement (OR, 5.3; 95% CI, 1.4-23.8). Conclusions and Relevance: Forced tobacco abstinence alone during incarceration has little impact on postrelease smoking status. A behavioral intervention provided prior to release greatly improves cotinine-confirmed smoking cessation in the community. Trial Registration: clinicaltrials.gov Identifier: NCT0112258

Impacts of Increased Atmospheric CO2 on Ocean Chemistry and Ecosystems

Lead Partner: National University of Ireland Galway. Project Partner: Marine InstituteOcean pH is a function of the seawater carbonate system, which is a function of both the influx of CO2 from the atmosphere and the resulting concentration of CO2 in the water (i.e. pCO2). Uptake of anthropogenic carbon dioxide from the atmosphere is reducing ocean pH; a phenomenon referred to as ocean acidification. It is estimated that there has been a decrease of 0.1 pH units in the surface waters of the world’s oceans since the start of the industrial revolution with a reduction of 0.3 – 0.5 forecast by 2100. There is growing concern over the potential consequences of ocean acidification for marine ecosystems and the services they provide for mankind. This project was aimed at enabling the capability and developing the expertise within Ireland to measure and quantify the flux of CO2 into (or out of) the ocean; to monitor seasonal trends in pCO2 and CO2 fluxes; to determine the current baseline state and variability of the carbonate system; and to evaluate the potential impact of future changes on ecosystems with the ultimate aim of contributing to more informed policy development.This project (Grant-Aid Agreement No. SS/CC/07/001(01)) was carried out under the Sea Change strategy with the support of the Marine Institute and the Marine Research Sub-Programme of the National Development Plan 2007–2013. Support was also provided by NUI Galway College Fellowship and by the EPA Fellowship 2006-PhD-AQ-2.Funder: Marine Institut

Politics, policies, and patient care: Rehabilitation therapists' experiences during the COVID-19 Pandemic

The year 2020 represents a historically turbulent period for the United States marked by the COVID-19 pandemic, a contentious political season, and heightened awareness of racism among citizens. This intersection of medicine, politics, and social unrest generated a demanding clinical environment for healthcare workers, including understudied groups such as physical therapists, occupational therapists, and speech-language pathologists. This descriptive qualitative study focused on experiences and perspectives of clinical rehabilitation therapists working in inpatient rehabilitation and acute-care units from September to November, 2020. Thirteen participants completed individual, semi-structured interviews focused on clinical practice and coping strategies. The analysis included a multi-step, inductive process. Four interconnecting factors chronicling participants' experiences emerged: sociopolitical, institutional, hospital unit, and personal. Stressors and buffers were noted that further shaped individual experiences. Utilization of an ecological framework provided a way to recognize the impact of a complex range of social and environmental factors affecting participants' experiences on personal and professional levels. Awareness of rehabilitation therapists' experiences enriches understanding of the pandemic's effect on healthcare workers and presents clinical implications for healthcare systems to promote therapist well-being

A Lockpick's Guide to dataARC: Designing Infrastructures and Building Communities to Enable Transdisciplinary Research

The North Atlantic Biocultural Organization (NABO) community initiated dataARC to develop digital research infrastructures to support their work on long-term human-ecodynamics in the North Atlantic. These infrastructures were designed to address the challenges of sharing research data, the connections between those data and high-level interpretations, and the interpretations themselves. In parallel, they were also designed to support the reuse of diverse data that underpin transdisciplinary synthesis research and to contextualise materials disseminated widely to the public more firmly in their evidence base. This article outlines the research infrastructure produced by the project and reflects on its design and development. We outline the core motivations for dataARC's work and introduce the tools, platforms and (meta)data products developed. We then undertake a critical review of the project's workflow. This review focuses on our understanding of the needs of stakeholder groups, the principles that guided the design of the infrastructure, and the extent to which these principles are successfully promoted in the current implementation. Drawing on this assessment, we consider how the infrastructure, in whole or in part, might be reused by other transdisciplinary research communities. Finally, we highlight key socio-technical gaps that may emerge as structural barriers to transdisciplinary, engaged, and open research if left unaddressed

Manual / Issue 7 / Alchemy

Manual, a journal about art and its making. Alchemy. The seventh issue. Manual 7 (Alchemy) prompts the unexpected and emergent to manifest. To engage as an alchemist/artist is to be the perpetual student of the present moment, to synthesize culture, so-called science, and the implications of existential borders into a discipline that is repeatable, a practice. Art and alchemy are not singular, unified pursuits. Their practitioners are trans-disciplinary, disjointed, and solitary in their practice, and their labor and the ordering of their lives become porous, overlaid in the pursuit of other-than or beyond-dominant modes of understanding. Alchemy and art are not about finding resolution, but building the capacity for curiosity, formulating questions that invest fields of knowledge with possibility, prompting the unexpected and emergent to manifest. —Bryan McGovern Wilson, from the introduction to Issue 7: Alchemy Softcover, 76 pages. Published 2016 by the RISD Museum. Manual 7 (Alchemy) contributors include Markus Berger, Rachel Berwick, Stephen S. Bush, CA Conrad, Florence Friedman, Doreen Garner, Michael Grugl, Kate Irvin, Mimi Leveque, Dominic Molon, Douglas R. Nickel, Emily J. Peters, Elizabeth A. Williams, Bryan McGovern Wilson, and Diming Stella Zhong.https://digitalcommons.risd.edu/risdmuseum_journals/1033/thumbnail.jp

The evolution of cellular deficiency in GATA2 mutation.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageConstitutive heterozygous GATA2 mutation is associated with deafness, lymphedema, mononuclear cytopenias, infection, myelodysplasia (MDS), and acute myeloid leukemia. In this study, we describe a cross-sectional analysis of 24 patients and 6 relatives with 14 different frameshift or substitution mutations of GATA2. A pattern of dendritic cell, monocyte, B, and natural killer (NK) lymphoid deficiency (DCML deficiency) with elevated Fms-like tyrosine kinase 3 ligand (Flt3L) was observed in all 20 patients phenotyped, including patients with Emberger syndrome, monocytopenia with Mycobacterium avium complex (MonoMAC), and MDS. Four unaffected relatives had a normal phenotype indicating that cellular deficiency may evolve over time or is incompletely penetrant, while 2 developed subclinical cytopenias or elevated Flt3L. Patients with GATA2 mutation maintained higher hemoglobin, neutrophils, and platelets and were younger than controls with acquired MDS and wild-type GATA2. Frameshift mutations were associated with earlier age of clinical presentation than substitution mutations. Elevated Flt3L, loss of bone marrow progenitors, and clonal myelopoiesis were early signs of disease evolution. Clinical progression was associated with increasingly elevated Flt3L, depletion of transitional B cells, CD56(bright) NK cells, naïve T cells, and accumulation of terminally differentiated NK and CD8(+) memory T cells. These studies provide a framework for clinical and laboratory monitoring of patients with GATA2 mutation and may inform therapeutic decision-making.Lymphoma and Leukaemia Research British Society of Hematology Bright Red George Walker Trust Wellcome Trus

The human syndrome of dendritic cell, monocyte, B and NK lymphoid deficiency

Human immunodeficiency syndrome with loss of DCs, monocytes, and T reg cells; preservation of Langerhans cells; associated loss of BM multilymphoid progenitors; and overproduction of Flt3 ligand