bluuebunny/crossref_metadata_2025 huggingface dataset:
Identify the best evidence for school and student improvement
Authors: Thessin Rebecca A.
Published: November 2015

Empowering teachers to use data effectively as part of a process of instructional improvement calls for schools and districts to engage in systematic collection and analysis of evidence as part of an ongoing school improvement cycle. In research and practice, the author has identified four steps school leaders — supported by central office -- must take in order to launch and implement this work effectively and sustain it over time to lead to improvement. Identify a clear instructional focus to which all teachers can align their work; Lead a schoolwide improvement process that facilitates ongoing learning as part of a plan, do, study, act cycle; collect and analyze multiple types of evidence from teachers and students to enhance instruction; and build a strong team to lead the work of improvement in professional learning.
Under the Law
Authors: Underwood Julie
Published: November 2015

The U.S. Constitution does not guarantee the right to an education for undocumented immigrants, but a string of U.S. Supreme Court decisions restricts states’ ability to deny resident children access to public education. But the landmark ruling in Plyler v. Doe, which pave the way for undocumented immigrant children to access public school, could be overturned or narrowed by the current U.S. Supreme Court.
Backtalk
Authors: Stitzlein Sarah M.
Published: November 2015

Advice for parents who want to affect change in their schools: Raise consciousness; build solidarity and coalitions; employ a broad, open platform; clearly articulate principles; put forward a solution; employ a strategy consistent with their ends; question the purposes of schools; and Embody publicness.
Parenteral Nutrition Is One of the Most Significant Risk Factors for Nosocomial Infections in a Pediatric Cardiac Intensive Care Unit
Authors: Netto Roberta , Mondini Matteo , Pezzella Chiara , Romani Lorenza , Lucignano Barbara , Pansani Laura , D'argenio Patrizia , Cogo Paola
Published: November 2015

Background: Nosocomial infections (NIs) are associated with significant morbidity and mortality and increased healthcare costs. We aimed to assess the NI epidemiology and associated risk factors in a pediatric cardiac intensive care unit (PCICU). Materials and Methods: Prospective observational study on 1106 patients admitted to a PCICU from January 1, 2012, to October 31, 2013. NIs were defined and recorded weekly by a multidisciplinary team. Independent risk factors for NIs were assessed by logistic regression analysis in the overall cohort, in cardiac surgical patients, and in those who had cardiopulmonary bypass (CPB). Results: Ninety‐two patients (8.3%) had NIs. Overall mortality was 2% but 8.3% in children with NIs (P < .001). The most frequent NIs were pneumonia (19.6%), bacteremia of unknown origin (16.3%), and catheter‐associated bloodstream infection (14.1%) caused mainly by Staphylococcus aureus and Pseudomonas aeruginosa. In the overall cohort, independent risk factors for NIs were number of days of parenteral nutrition (PN), days of invasive and noninvasive ventilation, ward before PCICU admission, and days of PCICU stay; in the cardiac surgical patients, the risk factors were days of PN and days of invasive and noninvasive ventilation; in children who had undergone CPB, the risk factors for NIs were days of PN, delayed sternal closure, reintervention, length of CPB, younger age, and days of invasive ventilation. Conclusion: Mortality was significantly higher in patients with NIs. The use of PN was one of the most significant predictors for NIs in the overall cohort of PCICU patients, cardiac surgical patients, and those who required CPB.
Accuracy of intracranial pressure monitoring: systematic review and meta-analysis
Authors: Zacchetti Lucia , Magnoni Sandra , Di Corte Federica , Zanier Elisa R. , Stocchetti Nino
Published: November 2015

Introduction

Intracranial pressure (ICP) measurement is used to tailor interventions and to assist in formulating the prognosis for traumatic brain injury patients. Accurate data are therefore essential. The aim of this study was to verify the accuracy of ICP monitoring systems on the basis of a literature review.

Methods

A PubMed search was conducted from 1982 to 2014, plus additional references from the selected papers. Accuracy was defined as the degree of correspondence between the pressure read by the catheter and a reference “real” ICP measurement. Studies comparing simultaneous readings from at least two catheters were included. Drift was defined as the loss of accuracy over the monitoring period. Meta-analyses of data from the studies were used to estimate the overall mean difference between simultaneous ICP measurements and their variability. Individual studies were weighted using both a fixed and a random effects model.

Results

Of 163 articles screened, 83 compared two intracranial catheters: 64 reported accuracy and 37 drift (some reported both). Of these, 10 and 17, respectively, fulfilled the inclusion criteria for accuracy and zero drift analysis. The combined mean differences between probes were 1.5 mmHg (95 % confidence interval (CI) 0.7–2.3) with the random effects model and 1.6 mmHg (95 % CI 1.3–1.9) with the fixed effects model. The reported mean drift over a long observation period was 0.75 mmHg. No relation was found with the duration of monitoring or differences between various probes.

Conclusions

This study confirms that the average error between ICP measures is clinically negligible. The random effects model, however, indicates that a high percentage of readings may vary over a wide range, with clinical implications both for future comparison studies and for daily care.
The course of diaphragm atrophy in ventilated patients assessed with ultrasound: a longitudinal cohort study
Authors: Schepens Tom , Verbrugghe Walter , Dams Karolien , Corthouts Bob , Parizel Paul M. , Jorens Philippe G.
Published: November 2015

Introduction

Mechanical ventilation and the effect of respiratory muscle unloading on the diaphragm cause ventilator-induced diaphragmatic dysfunction (VIDD). Atrophy of the diaphragmatic muscle is a major part of VIDD, and has a rapid onset in most animal models. We wanted to assess the clinical evolution and risk factors for VIDD in an adult intensive care unit (ICU) by measuring diaphragm thickness using ultrasound.

Method

We performed a single-centre observational cohort study, including 54 mechanically ventilated patients. The right hemidiaphragm was measured daily at the zone of apposition on the midaxillary line.

Results

Mean baseline thickness was 1.9 mm (SD ± 0.4 mm), and mean nadir was 1.3 mm (SD ± 0.4 mm), corresponding with a mean change in thickness of 32 % (95 % CI 27–37 %). Length of mechanical ventilation (MV) was associated with the degree of atrophy, whereas other known risk factors for muscle atrophy in an ICU were not. The largest decrease in thickness occurred during the first 72 hours of MV.

Conclusions

Diaphragm atrophy occurs quickly in mechanically ventilated patients and can accurately be monitored using ultrasound. Length of MV, as opposed to other variables, is associated with the degree of atrophy.

Clinical trial registration

Clinicaltrials.gov NCT02299986. Registered 10/11/2014
Gathered by Invention: Additive Forms and Inference in Gascoigne’s Poesy
Authors: Heffernan Megan
Published: November 2015

From the perspectives of both literary form and the history of the book, volumes of gathered poetry illustrate the fundamental incoherence of handpress-era texts. This essay considers the flexible web of connections in poetic miscellanies as an imaginative response to that basic disorder. Reading the organization of two editions of George Gascoigne’s work, it explores the dynamic exchanges between poems and commercial textual features and finds in those feedback loops an ambitious projection of the larger form of the book. Far from a simple or inherent unity, this paratactic structure uses poetry to span the physical juxtapositions of books made by diverse agents of the press. By forging an inferential engagement with the design of the volume, Gascoigne resisted a system of publication bent on dispersing his writing and folded nonauthorial devices into the most elemental workings of poetic form.
Suspended Judgments: Skepticism and the Pact of Fictionality in Cervantes’s Picaresque Novellas
Authors: Fuchs Barbara
Published: November 2015

While Cervantes’s playfulness with perspectivism and his skepticism in Don Quijote have been abundantly noted, the skepticism of the Novelas ejemplares is equally striking. Examining the tension between exemplarity and skepticism—the one offering models for behavior that presume belief, the other encouraging instead a productive doubt—suggests that Cervantes advances a fully engaged fictionality as an alternative to the exemplary text. In particular, “Rinconete y Cortadillo” and the dyad of “El casamiento engañoso/El coloquio de los perros” show that the picaresque allows him to probe a broader readerly skepticism, extending beyond irony to epistemological questions of the truth of narratives and how they might be assessed.
Boy Meets Camera: Christopher Isherwood, Sergei Tretiakov, and the Queer Potential of the First Five-Year Plan
Authors: Salton-Cox Glyn
Published: November 2015

Reading Christopher Isherwood’s Berlin Stories (1935–39) through an important debate in the Marxist aesthetics of the period between Sergei Tretiakov and Georg Lukács, this article argues that Isherwood’s famous statement “I am a camera” should be reimagined as a declaration of radical antihumanism with key implications for both Marxist and queer theory. In so doing, it proposes that Isherwood’s literary praxis of self-instrumentalization advances a definition of the human that refuses both property ownership and heterosexual monogamy. In light of this new reading, Isherwood’s place in the leftist and queer canons must be reconstituted, as should the relationship between certain strains of Soviet Marxism and queer writing of the period. Far from a lukewarm socialist in his youth who later became a middlebrow bourgeois figure in gay literature, Isherwood offers a queer Marxist contribution to radical literary history; reading him through Tretiakov reveals, moreover, a striking cultural-historical possibility: the queer potential of the First Five-Year Plan (1928–32).
Trans Intelligentsia
Authors: Davy Zowie
Published: November 2015

Katie Herzog's Transtextuality (Senate Bill 48), an installation “depicting 48 portraits of transgender men and women of letters,” took on the mammoth task of displaying portraits of trans pioneers who represent transgender intelligentsia. The celebration of her Western “sitters” is an impressive display, and their academic work has no doubt contributed vast and wide-reaching insights into mine and the lives of some of my trans sisters, brothers, and others. However, her wall of fame, while potentially innocent in its creation, neglects the class, ethnicity/race, sexuality, and other situational aspects of trans writers' lives that may have impacted the performative aspects of knowledge production about (trans) gender beyond the Western imaginary. Although this trans celebration may feel subversive because it challenges the status quo of those whose knowledge counts vis-à-vis cisgender people, we must be constantly drawn to ask, does the subversion suppress others?
Eunuchs Online
Authors: Handy Ariel B. , Johnson Thomas W.
Published: November 2015

The Eunuch Archive (EA) is an online community of individuals who identify as a eunuch or have strong interests in castration. The Eunuch Archive contains various discussion forums ranging from safe castration methods to the physical and psychological impact of androgen deprivation. The EA also contains fictional stories written by EA members, which potentially help both the authors and readers work through extreme castration ideations. “Eunuch” as a gender identity is not limited to the online world. There have been at least ten annual gatherings of EA members, as well as a growing acceptance of eunuchs throughout the world (though still minimal). Many countries are now beginning to offer a third gender as a valid gender identity. Preserving information on sites such as the EA along with other trans* dedicated materials can lead to better understanding of the development of gender identities and can also help individuals who desire emasculation but not necessarily feminization to better understand their gender identity and its history. Preserving the EA fills a gap in trans* archives that has previously been unexplored.
Metagenomic Chromosome Conformation Capture (3C): techniques, applications, and challenges
Authors: Liu Michael , Darling Aaron
Published: November 2015

We review currently available technologies for deconvoluting metagenomic data into individual genomes that represent populations, strains, or genotypes present in the community. An evaluation of chromosome conformation capture (3C) and related techniques in the context of metagenomics is presented, using mock microbial communities as a reference. We provide the first independent reproduction of the metagenomic 3C technique described last year, propose some simple improvements to that protocol, and compare the quality of the data with that provided by the more complex Hi-C protocol.
A protocol to examine vision and gait in Parkinson’s disease: impact of cognition and response to visual cues
Authors: Stuart Samuel , Galna Brook , Lord Sue , Rochester Lynn
Published: November 2015

Background

Cognitive and visual impairments are common in Parkinson’s disease (PD) and contribute to gait deficit and falls. To date, cognition and vision in gait in PD have been assessed separately. Impact of both functions (which we term ‘visuo-cognition’) on gait however is likely interactive and can be tested using visual sampling (specifically saccadic eye movements) to provide an online behavioural measure of performance. Although experiments using static paradigms show saccadic impairment in PD, few studies have quantified visual sampling during dynamic motor tasks such as gait.

This article describes a protocol developed for testing visuo-cognition during gait in order to examine the: 1) independent roles of cognition and vision in gait in PD, 2) interaction between both functions, and 3) role of visuo-cognition in gait in PD.

Methods

Two groups of older adults (≥50 years old) were recruited; non-demented people with PD (n=60) and age-matched controls (n=40). Participants attended one session and a sub-group (n=25) attended two further sessions in order to establish mobile eye-tracker reliability. Participants walked in a gait laboratory under different attentional (single and dual task), environmental (walk straight, through a door and turning), and cueing (no visual cues and visual cues) conditions. Visual sampling was recorded using synchronised mobile eye-tracker and electrooculography systems, and gait was measured using 3D motion analysis.

Discussion

This exploratory study examined visuo-cognitive processes and their impact on gait in PD. Improved understanding of the influence of cognitive and visual functions on visual sampling during gait and gait in PD will assist in development of interventions to improve gait and reduce falls risk. This study will also help establish robust mobile eye-tracking methods in older adults and people with PD.
THE DEVELOPMENT OF PEASANT (FARMER) ECONOMY IN TERMS OF IMPORT SUBSTITUTION
Authors: Гарафутдинова  , Garafutdinova Alfiya
Published: November 2015

The article is dedicated to the development of peasant (farmer) households. The article describes the analysis of the achieved level of production efficiency at the present stage in the (peasant) farms.
METHODOLOGICAL APPROACHES TO ASSESSMENT OF THE RELATIONSHIP OF AGRICULTURAL PRODUCTION AND RURAL SOCIAL INFRASTRUCTURE
Authors: Мухаметгалиев  , Mukhametgaliev Farit , Файзрахманов  , Fayzrakhmanov Dzhaudat , Гайнутдинов  , Gaynutdinov Ilgizar , Ситдикова  , Sitdikova Landysh
Published: November 2015

The article provides an overview of the main methodological approaches to the study and evaluation of the relationship of agricultural production efficiency and the development of rural social infrastructure, investigates the features of the effect of the level of rural social infrastructure development on the level of agricultural production development, offers a system of effective performance of agricultural production and a set of indicators, characterizing the level of rural social infrastructure development and having impact on the development of agricultural production.
MEDIUM AND SMALL ENTERPRISES OF AGRICULTURE, FORESTRY, FISHERY AND HUNTING SECTORS OF REGIONAL ECONOMY OF THE REPUBLIC OF TATARSTAN
Authors: Хасанов  , Khasanov Ilgizar
Published: November 2015

The sector of agriculture, forestry, fishery and hunting takes a significant share of the regional economy of the Republic of Tatarstan and the Russian national economy. The status of agriculture, forestry, fishery and hunting sectors of the regional economy is satisfactory. Nowadays, in conditions of economic sanctions against Russia, the government and corporate financial support of agriculture, forestry, fishery and hunting sectors of the regional economy of the country should be strengthened.
MEGA-REGULATOR IN SEARCH FOR CONVERGENT MODEL FROM THE FISCAL POLICY BALANCE AND REGULATION ON FINANCIAL MARKETS TO STIMULATING THE ECONOMY
Authors: Карпова  , Karpova Natalya , Хаялеева  , Khayaleeva Chulpan , Абрамкин  , Abramkin Stanislav
Published: November 2015

In modern world the development of economic processes requires the balanced efforts to ensure the stability of the markets, in general, and financial markets, in particular. The development of the financial markets is influenced by the development of economic systems and vice versa. In this connection, the issues on adequate evolution of financial supervision are very important. The article highlights the problems and issues of the mega-regulator activity in Russia in the context of world experience of active fiscal policy and the regulation of financial markets. The prospects, problems and risks of possible options were discussed. A conceptual vision of development nature of the financial markets mega-regulation, as the immanent institution in the social and economic system, was stated.
Method activation end date in the past. direction:re
Authors: Гараев  , Garaev Razil , Зубарев  , Zubarev Sergey , Ганиев  , Ganiev Azat , Сержанов  , Serzhanov Igor , Шайхутдинов  , Shaykhutdinov Farit , Шайхразиев  , Shaykhraziev Shamil
Published: November 2015

The article examines the impact of growing space on productive features and quality properties of quality of spring wheat seeds of Ekada 70 variety.
EFFICIENCY OF PRE-SOWING TREATMENT OF COMMON SPRUCE SEEDS WITH SUCH FERTILIZERS AS “BIOPLANT FLORA”, “GUMAT” AND NITROGEN FERTILIZATION
Authors: Сабиров  , Sabirov Ayrat
Published: November 2015

The article presents the results of 4-year field studies to identify the efficiency of pre-sowing treatment of common spruce seeds with drugs “Gumat” and “Bioplant Flora”, as well as the introduction of various nitrogen fertilizers for growing seedlings. The studies were conducted in 2008-2011 on sandy loam, sod-podzolic soil of basic forest nursery “Training and experimental suburban forestry”, which is located in the Kama climatic zone of the Republic of Tatarstan. Studies have found that pre-sowing seed soaking by drugs increases the productivity of standard seedlings, an application of nitrogen fertilizer has a positive effect on biometrics (diameter of trunks at the root collar, height and etc.) of common spruce seedlings.
Coordinating Complex Work: Knowledge Networks, Partner Departures, and Client Relationship Performance in a Law Firm
Authors: Briscoe Forrest , Rogan Michelle
Published: November 2015

The mobility of individual managers has long presented a problem for firms in knowledge-intensive industries. Shifting to more complex work often reduces the importance of a single individual’s knowledge for the firm’s exchange relationships because complex work requires inputs from a broader set of the firm’s members. Although complex work decreases the likelihood that a single individual can shift the exchange relationship to another firm, we propose that it increases the vulnerability of the firm’s performance to departures of those individual managers who act as coordinators of knowledge. This leads us to focus on how the internal knowledge network formed to maintain each relationship can compound or mitigate the loss of a coordinating manager. Using original data on client relationships from a law firm, we examine the effect of internal knowledge networks and lead partner departures on the performance of the relationships. Supporting our argument, we find that the negative performance effect of a lead partner departure is greater when the network has high knowledge heterogeneity and involves more experts and lower when the network has high cohesion.

This paper was accepted by Jesper Sørensen, organizations.
Old age and people on the autism spectrum: a focus group perspective
Authors: Barber Chris
Published: November 2015

Until recently, the focus of many within the ‘autism service industry’ has been on children and young adults who are on the autism spectrum where ‘service transition’ usually refers specifically to the transition from children to adult service provision. This article explores ‘service transition’ from the opposite end of the age scale, that of old age, and incorporates the views of older adults who are on the autism spectrum. In order to design and provide a service that is ‘fit for purpose’, training of health professionals and consulting with people on the autism spectrum is crucial.
Conducting a pilot study: case study of a novice researcher
Authors: Doody Owen , Doody Catriona M
Published: November 2015

Pilot studies play a vital role in health research, but are often misused, mistreated and misrepresented. A well-conducted pilot study with clear aims and objectives within a formal framework ensures methodological rigour, can lead to higher-quality research and scientifically valid work that is publishable and can benefit patients and health service delivery. A pilot study contributes valuable information to assist researchers in the conduct of their study. Conducting a pilot study provides the researcher with the opportunity to develop and enhance the skills necessary before commencing the larger study. By conducting a pilot the researcher obtains preliminary data, can evaluate their data-analysis method and clarify the financial and human resources required. This article presents an overview of pilot studies, why they are conducted, what to consider when reporting pilot studies and the authors' experience of conducting a pilot study. To conduct a successful study, researchers need to develop their skills, choose the right methods and carefully plan for all aspects of the process.
Preventing lower back pain for dental nurses
Authors: Valachi Bethany
Published: November 2015

In this article, Bethany Velachi discusses how to maintain optimal musculoskeletal health. The right ergonomic equipment, exercising and stretching all play a part in keeping healthy in the dental practice
Writing for publication. Part 4: using appropriate evidence
Authors: Fowler John
Published: November 2015

This series is designed to help you, the dental nurse, write for professional publication. This article discusses how to use previously published articles to support your statements
Palliative and end-of-life decision-making in dementia care
Authors: Mitchell Gary
Published: November 2015

This paper will highlight some of the pertinent issues associated with palliative and end-of-life decision-making in relation to dementia. To achieve this, the author will consider why there is disparity in relation to shared decision-making practices across non-malignant disease through exploration of models of disease trajectories. The author will then go on to highlight how people living with dementia, a non-malignant disease, have a human right to receive palliative care and be an active agent in the shared decision-making process about their future and care preferences. The challenges of shared decision-making in dementia care will be discussed along with some implications for nursing practice. The aim of this paper is to provide nurses, practising across all settings, with an overview of the fundamental importance of timely palliative and end-of-life shared decision-making in dementia care.
Automatic detection of acute kidney injury: a national approach
Authors: Selby Nicholas , Hill Robert , Fluck Richard ,   On behalf of the NHS England Think Kidneys acute kidney injury programme
Published: November 2015

Following a national patient safety alert regarding the standardisation of the early indication of acute kidney injury (AKI), there has been a drive to encourage an automated system in acute hospitals to detect changes in serum creatine concentration. In this article, Nick Selby et al describe an ambitious plan to capture data on the incidence and outcomes of AKI.
A case of acute kidney injury secondary to an inappropriate dose of vancomycin
Authors: Chai Mee Onn , Coleman Adrian
Published: November 2015

Mrs KM was admitted to hospital with an itchy, painful rash, and was diagnosed with stage 2 acute kidney injury (AKI). Mee Onn Chai and Adrian Coleman describe the progression of this case of AKI development secondary to the administration of an inappropriate dose of vancomycin.
Past, present and future: education and collaboration
Authors: Jenkins Karen , Wells Louise
Published: November 2015

In this month's article, Karen Jenkins and Louise Wells give kidney care professionals an overview of the work of the British Renal Society from its conception in the late 1980s to today. The article outlines some of the society's major achievements over the years, and highlights its passion for person-centred multiprofessional working across all disciplines in kidney care.
Opportunities for research and innovation in acute kidney injury
Authors: Lumsdon Angela
Published: November 2015

Acute kidney injury (AKI) is a significant patient safety challenge for health professionals. Alongside the drive to improve care pathways for prevention, management and follow-up of this life-changing condition, high-quality research is also required to improve its diagnosis, stratification and management. Angela Lumsdon discusses some major studies in the area of AKI.
Eminent researchers report that mid-life health checks are ineffective
Authors: Biela Chris
Published: November 2015

Serious questions have recently been raised with regard to the efficacy of the NHS Health Check programme, for people aged 40–75 years. In particular, Capewell et al (2015) reported that a health spend of £450 million is a waste of money and resources. Chris Biela discusses their challenging paper.
Pre-hospital paediatric seizures: midazolam versus diazepam
Authors: Broughton William
Published: November 2015

This literature review aims to scope the current evidence for use of diazepam and midazolam for managing seizures in children, with particular focus on pre-hospital management. Many emergency departments now use buccal midazolam as first-line treatment for managing paediatric seizures, while ambulance services continue to use diazepam via the rectal (PR) or intravenous (IV) route.

This review concludes that the evidence for the continued use of diazepam by ambulance services should be reconsidered if we are to provide the best standard of care for our paediatric patients—and move our treatment in line with best practice, and what is considered the norm in a hospital setting.
Increasing objectivity in the assessment of interpersonal skills and attitude
Authors: Tanner Kieron
Published: November 2015

The concept of failure to fail has become more widely discussed in paramedic practice over recent years; however, it has been observed that on occasion mentors and managers experience challenges around the non-practical components of paramedic practice. Consideration has been given to identifying those elements of practice which can be more challenging to encapsulate, with the aim of providing objective feedback and where necessary set pass/fail standards. A non-practical skills matrix has been developed for consideration by those responsible for the development of ambulance staff and students.

The proposal encourages qualities of the burgeoning concept of distributive leadership, incorporates elements of the document Towards a New Model of Leadership for the NHS ( Department of Health (DH), 2013a ), and having been mindful of the NHS response to the failings of Mid-Staffordshire and the findings of both Lord Francis’ and the Health Ombudsman ( Parliamentary and Health Service Ombudsman, 2011 ; DH, 2013b ), it responsibly aims to aid in the implementation of aspects of the recommendations capturing the current drive towards improved demonstrable compassion in UK care delivery.
O2 outlines commitment to the next generation of emergency services communications
Authors: D'Arcy Billy
Published: November 2015

Billy D'Arcy, managing director, Public Sector Business at O2 Telefonica, guides us through the next generation of emergency services (ES) communications and explains why O2 is dedicated to building trusted partnerships with all the ES.
AAA conference sees Keith Willett call for more evidence-based research in HEMS
Authors: Quaile Alistair
Published: November 2015

Alistair Quaile, editor, Journal of Paramedic Practice, gives an overview of this year's Association of Air Ambulances National Conference and Awards of Excellence, held on 17 November at the Millenium Gloucester Hotel, London.
An integrated ABCDE approach to managing medical emergencies using CRM principles
Authors: Logarajah Sri , Alinier Guillaume
Published: November 2015

Background:

There is increasing recognition of the vital role of non-technical skills in managing medical emergencies. An ABCDE approach has been very successful in training healthcare professionals in technical skills. Using a similar structure is likely to enhance successful application of their non-technical counter parts in clinical practice whether it is in the hospital or pre-hospital setting.

Aim and Methods:

To further promote safe patient care, teaching and learning aids currently used to implement crisis resource management skills, non-technical skills and human factors were identified and grouped in a way that facilitates memorisation.

Results:

Tools are available in the form of lists, tables and algorithms to identify behavioural markers of different components of non-technical skills and aspects of crisis resource management (CRM) and human factors. They require the need to memorise a list of items or a checklist. We have successfully used a visual aid representing these key CRM principles as a radial diagram, combined with a flow chart representing ABCDE approach for technical skills. Grouping them together in a format to embed in memory, combined with a visual aid representing the application nature of the principles, is likely to complement the existing tools in matching the learning style of more healthcare professionals. This inherently promotes the more widespread use of the principles, and hence has the potential to enhance patient safety.

Conclusions:

The proposed radial diagram, alongside the mnemonic alphabetical grouping, can be used to introduce the CRM principles and to provide effective feedback. This mnemonic is likely to help embed the CRM principles and enable recall in clinical practice to increase patient safety. The effectiveness of this aid could be tested using simulation of medical emergencies while training multiprofessional teams.
Delivering enhanced safety, productivity and experience: early results from a frequent caller management system
Authors: Smith Daniel P , McNally Angela
Published: November 2015

Inappropriate frequent use of services can be a challenge for private and public sector organisations throughout the world. Whether related to satisfaction and experience, difficulties accessing alternative and more appropriate services, or unrealistic expectations, organisations must develop innovative ways of ensuring the challenge is effectively managed. If successful, organisations could enjoy increased productivity and user satisfaction. Services provided by the NHS must provide timely health care to those in need, but ignoring the challenge of inappropriate use leads to inefficiencies, poor patient experience and clinically unsafe environments. In response, integrated care systems are being developed across the NHS to develop services that are both appropriate and accessible within local communities. Ambulance services are employing a number of different techniques to tackle the issue of inappropriate or frequent use of 999 to access health care. This article examines the challenges associated with frequent 999 callers, shares the experiences of a pilot project in the North West Ambulance Service, and considers the future strategic development of frequent caller management systems for the NHS.
Sophisticated technology for sophisticated emergency medical services
Authors: Callsen Chris
Published: November 2015

Chris Callsen discusses the introduction of planning and system-management technologies, which have enabled EMS services to effectively plan for increasing response volumes, changes in health care infrastructure and a growing service area.
A comparison of paramedic practice with that of an emergency care practitioner
Authors: Dixon Matthew , Gaisford Matthew
Published: November 2015

This article, following on from the previous article by Gaisford (2014) , set out to further quantify the day-to-day work of the modern ambulance service. A particular focus was given to the comparison of emergency care practitioner (ECP) and paramedic practice. Non-patient-identifiable audit data from two consecutive years of practice was analysed and compared, looking in particular at the rates the different clinicians treated patients at scene and referred to specialist units. Seven specific categories of presenting complaint were analysed in depth to illustrate where and why the ECP was performing better than the paramedic at treating patients in the community. The audit of the data showed that in all areas the ECP sends less patients to the emergency department than the paramedic; this was found to be due to both the enhanced range of skills and interventions the ECP has available to him/her as well as the greater level of clinical reasoning and knowledge possessed by the ECP.
Potential use of amiodarone to treat new-onset AF in the pre-hospital setting
Authors: Brown Philip
Published: November 2015

Incidence of atrial fibrillation (AF) is high, it is the most prevalent arrhythmia in the UK, Europe and the USA ( Naccarelli et al, 2009 ; Davis et al, 2012 ; Dagres et al, 2013 ) and is associated with significant morbidity, high risk of stroke and mortality ( Cottrell, 2012 ). Clinical guidance from the National Collaborating Centre for Chronic Conditions (NCCCC) (2006) and the National Institute for Health and Care Excellence (NICE) (2006) supports clinicians working in primary and hospital-based emergency care, but not those working in pre-hospital care. Updated guidance from NICE (2014) highlights the importance of providing rapid, personalised, evidence-based care, yet does not provide any guidance for pre-hospital clinicians responding to emergency presentations of AF. Paramedics have knowledge and experience of identifying AF, possess antiarrhythmic, anticoagulant and anti-platelet medications as part of their formulary and possess the necessary skills for obtaining intravenous access.

This article reviews the national guidance and available best-evidence to provide safe treatment to patients presenting with new-onset AF and considers areas that merit further research.
Intra-cardiac arrest thrombolysis in the pre-hospital setting: four cases worth considering
Authors: Hitt Andy , Pateman Jane
Published: November 2015

Background:

It has been estimated that over 400 000 people have an out-of-hospital cardiac arrest (OHCA) annually in the United States and Europe combined, of whom fewer than 10% survive to hospital discharge. In up to 70% of cases OHCA is caused by underlying acute coronary disease or pulmonary embolism, and as such the benefits of thrombolytic therapy during resuscitation attempts have been explored without there being a clear conclusion. This paper presents a case series of four victims of OHCA who received thrombolysis, with adjunctive antithrombotic therapy, in the pre-hospital phase of their treatment. Three of these were attended by a critical care paramedic (CCP)—a paramedic with advanced training in emergency care—who received online physician support. The other victim was attended by paramedics and a physician who is experienced in pre-hospital emergency care.

Discussion:

Although there is much debate about the efficacy of routine administration of thrombolytic therapy during OHCA, cases such as those featured in this paper indicate a need for clinicians to consider the merits of pre-hospital thrombolysis (PHT) based on individual patient characteristics and the circumstances leading to their presenting condition.

Conclusions:

Lives can be saved with the timely administration of intra-arrest PHT but candidates should be selected with great care. This may be best delivered in systems where clinicians at scene are supported by expert medical advice, allowing clinicians to recognise and treat this small but important group of survivors.
A clinical review of the indications for, and subsequent implementation of, a pilot pre-hospital sepsis pathway within NWAS
Authors: Butterworth Daniel
Published: November 2015

Aim:

Review the clinical evidence for, and introduce a modified ‘Red Flag’ sepsis screening tool, treatment pathway and associated education package into a pilot site within the North West Ambulance Service NHS Trust (NWAS) and evaluate its impact.

Methods:

Retrospective application of a modified ‘Red Flag’ sepsis screening tool to 259 hospital confirmed cases of sepsis to evaluate the current identification and treatment of sepsis within NWAS. A subsequent prospective pilot launch of the tool within central Manchester in collaboration with Salford Royal Foundation Trust and Central Manchester Foundation Trust hospital emergency departments, collecting and analysing 100 cases of suspected sepsis in which the screening tool has been utilised.

Results:

The modified ‘Red Flag’ sepsis tool was found to be highly sensitive when applied retrospectively. Only 46% of confirmed severe sepsis cases were found to show hypotension (systolic BP <90 mmHg) pre-hospital. In the pilot, complete analysis of Systemic Inflammatory Response Syndrome (SIRS) criteria and a suspicion and documentation of sepsis increased from 15% to 94%. Compliance with a bundle of care in suspected severe sepsis cases increased from 10% to 90%.

Conclusions:

The introduction of a modified ‘Red Flag’ screening tool significantly improved pre-hospital sepsis identification and treatment within the pilot site. Paramedics were able to give fluid boluses to normotensive patients in suspected severe sepsis safely without adverse incident.
RCEM conference places health and wellbeing of clinicians at heart of sessions
Authors: Sanders-Page Alex
Published: November 2015

Alex Sanders-Page, hazardous area response team paramedic, South Western Ambulance Service Foundation Trust, summarises the key messages for paramedics at the Royal College of Emergency Medicine Scientific Symposium 2015.
Falls assessment and prevention in older people: an evaluation of the Crisis Response Service
Authors: Pyer Michelle , Campbell Jackie , Ward Alison , Knights Ashley , Jones Janice
Published: November 2015

The elderly population of the world is growing, with increasing trends of older people falling and accessing emergency services. The Crisis Response Falls Service in Northamptonshire (UK) was designed to identify health and social care needs, promote independence and limit the impact of falls. This paper presents the findings of an evaluation of the service. A mixed-method approach was applied, drawing on the views of service users (via a survey and telephone interviews) and reviewing existing East Midlands Ambulance Service NHS Trust (EMAS) data with routinely collected data from the service.

A decrease in the numbers of patients conveyed to hospital following a fall was observed. Best estimates of financial calculations suggest savings. High levels of patient satisfaction were achieved; patients felt treated with dignity and staff were considered friendly, approachable and well-informed. First responder services can provide positive impacts for those who fall in the community. The development and impact of the CRS shows the importance of evidence-based client centred training to inform the approaches taken to supporting those who fall, and the impact of a strong values based approach on the experiences of patients.
Community first responders: improving access to defibrillation in cardiac arrest
Authors: Weir Alan
Published: November 2015

The benefits of early CPR and defibrillation together have shown to potentially increase rates of survival following out-of-hospital cardiac arrest considerably. Alan Weir looks at the implementation of community first responder and public access defibrillation schemes for improving access to care for patients in cardiac arrest.
HART communications: current capability and future options
Authors: Price James
Published: November 2015

James Price, chair of the Hazardous Area Response Team (HART) National Operations Group and HART manager for West Midlands Ambulance Service NHS Foundation Trust, explains the communications systems the teams employ.
Airway management in UK ambulance services: results of the National Ambulance Service Airway Management Audit
Authors: Gregory Pete , Kilner Tim , Arnold-Jones Sally
Published: November 2015

Aim:

To establish the range of airway devices provided to ambulance staff employed by the UK NHS ambulance services, which level of practitioner is allowed to use which device or intervention, and what the main factors were in the purchasing decisions taken.

Methods:

Medical directors from all 14 UK NHS ambulance services were invited to participate in an anonymous, web-based survey of emergency airway management equipment provided within their service and which grades of practitioner were authorised to use the equipment they provided. Additionally, they were asked for the main reasons for the purchase of the selected equipment.

Results:

All 14 ambulance services completed the survey questionnaire. A range of clinical grades is now employed by UK ambulance services although there is inconsistency in both title and skill set. All services provide a range of airway equipment, but there is no common inventory across UK ambulance Trusts. Nearly all staff were authorised to use some of the basic equipment, but wider variations appear with more complex or sophisticated techniques. In particular there appears to be significant gaps in advanced equipment and those authorised to use it in respect of children.

Conclusions:

The range of airway equipment and those authorised by ambulance services to undertake airway management interventions appears to be evolving. It is of concern that there remains an apparent lack of standardisation of the range of airway equipment provided by UK NHS ambulance services.
Length of professional education of paramedics and nurses at community colleges in the Northeast United States
Authors: Phelps Scott
Published: November 2015

Aim:

To determine if the professional bodies of knowledge of paramedics and nurses are roughly equivalent for each discipline at the point of primary licensure.

Methods:

A list was compiled of all paramedic education programmes in the Northeast US states of Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey and Pennsylvania. Each programme was then surveyed to identify those institutions that offered college credit for their paramedic education programme and also had an associate's degree nursing programme. Northeast paramedic education programmes that were not accredited by the Commission on Accreditation of Allied Health Education Programs were then identified that offered college credit for their paramedic education programme and also had an associate's degree nursing programme.

Results:

In total, 23 colleges in the Northeast United States had both paramedic and registered nursing education programmes offered for college credit. Paramedic education required a mean of 41 credits compared to a mean of 37 credits for nursing education.

Conclusions:

While paramedics are less likely to have a college degree than registered nurses, their specific professional education programmes are equivalent. Further research is required to establish if the paramedic body of knowledge is both deep and complex enough that it is unsafe for non-paramedic registered nurses to be functioning in the pre-hospital environment.
Pain: highlighting the law and ethics of pain relief in end-of-life patients
Authors: Parkinson Martin
Published: November 2015

As the world of palliative medicine is rapidly becoming a fixture in the pre-hospital field of practice, this article looks to explore the ethical and legal issues surrounding pain relief for end-of-life patients by paramedics.

Particular attention is focused on the moral and ethical principles of care as proposed by Beauchamp and Childress (2008) , as well as the legal aspects of care as set out by the European Court of Human Rights. Through the use of law cases, this article looks to demonstrate precedence for practice, as well as the implications that arise thereof.

This article concludes that, although many aspects are still a grey area for paramedics, the depth of law cases, alongside the moral arguments, show that providing paramedics act with the best interests of the patient at heart and work within a multi-disciplinary team, the administration of analgesia to prevent suffering can be legally and ethically proven.
A review of a self-prescribed medication regime in undiagnosed diabetes
Authors: Sheridan Samantha
Published: November 2015

The purpose of this review is to critically analyse how a single pathology can influence a patient's susceptibility to either beneficial or adverse effects of a self-imposed medication regime. The benefits and risks of polypharmacy, from self-medicating and substance misuse will also be considered. The review will also focus on the challenges posed by patients suffering with concurrent illness, identifying problems encountered and proposing tailored solutions while evaluating current evidence.
The rapid rise of The Larrey Society
Authors: Davis David
Published: November 2015

The Larrey Society is the first cross-sector ‘think tank’ established to help shape the future policy of emergency medical services. David Davis, the society's founder outlines some of the campaigns initiated in the six months since the society's inception, as well as future plans in the pipeline.