scholarly journals Applying Hospital Evidence to Paramedicine: Issues of Indirectness, Validity and Knowledge Translation

CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 281-285 ◽  
Author(s):  
Blair Bigham ◽  
Michelle Welsford
Keyword(s):  
Emergency Medicine ◽  
Economic Evaluation ◽  
Best Practices ◽  
Resource Availability ◽  
Hospital Care ◽  
Critical Appraisal ◽  
Scientific Evidence ◽  
Hospital Setting ◽  
Hospital Environment ◽  
Mobile Environment

AbstractThe practice of emergency medicine (EM) has been intertwined with emergency medical services (EMS) for more than 40 years. In this commentary, we explore the practice of translating hospital based evidence into the prehospital setting. We will challenge both EMS and EM dogma—bringing hospital care to patients in the field is not always better. In providing examples of therapies championed in hospitals that have failed to translate into the field, we will discuss the unique prehospital environment, and why evidence from the hospital setting cannot necessarily be translated to the prehospital field. Paramedicine is maturing so that the capability now exists to conduct practice-specific research that can inform best practices. Before translation from the hospital environment is implemented, evidence must be evaluated by people with expertise in three domains: critical appraisal, EM, and EMS. Scientific evidence should be assessed for: quality and bias; directness, generalizability, and validity to the EMS population; effect size and anticipated benefit from prehospital application; feasibility (including economic evaluation, human resource availability in the mobile environment); and patient and provider safety.

scholarly journals Animal assisted interventions in the children's hospital: protocol for a scoping review

2021 ◽  
Vol 3 ◽  
pp. 74
Author(s):  
Rachel Howe ◽  
Sandra Nicholson ◽  
Attracta Lafferty ◽  
Carmel Davies ◽  
Diarmuid Stokes ◽  
...  
Keyword(s):  
Scoping Review ◽  
Scientific Evidence ◽  
Companion Animals ◽  
Hospital Setting ◽  
Evidence Base ◽  
Hospital Environment ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Review Protocol ◽  
Long Term Impact

The introduction of Animal Assisted Interventions (AAIs) in healthcare is relatively common; however, their actual effectiveness and long-term impact are not so well known, especially in relation to the children’s hospital setting.  It is important to plot where and why animal interventions take place but also to focus on how the human animal bond impacts on children in a children’s hospital setting.  Family members, including companion animals, are important supports which help children to relax and give them a sense of familiarity to navigate the busy and stressful hospital environment.  The scoping review of the literature proposed will explore the scientific evidence base for AAIs in children’s hospitals and will map results prior to undertaking a full scale research project.   Arksey and O’Malley’s framework guided by the Joanna Briggs Institute will frame this review protocol.  Appendices are used to ensure transparency of methods. The protocol is presented in narrative style to demonstrate flow, fluency, and appeal to wider readership.

scholarly journals Projeto terapêutico singular durante estágio em ambiente hospitalar: relato docente

2021 ◽  
Vol 11 (34) ◽  
pp. 203-211
Author(s):  
Luiza Cremonese ◽  
Laísa Xavier Schuh ◽  
Camila Nunes Barreto ◽  
Fernanda Quevedo Alves ◽  
Oclaris Lopes Munhoz ◽  
...  
Keyword(s):  
Scientific Evidence ◽  
Hospital Setting ◽  
Disease Process ◽  
Rio Grande ◽  
Teaching Experience ◽  
Practical Experience ◽  
Hospital Environment ◽  
Care Practice ◽  
Rio Grande Do Sul ◽  
Hospitalized Elderly

Relatar a experiência docente de utilização do Projeto Terapêutico Singular em ambiente hospitalar durante o estágio supervisionado do 10º semestre do Curso de Bacharel em Enfermagem. Trata-se de um relato de experiência de docentes de uma Universidade do interior do Rio Grande do Sul a partir da vivência prática da utilização do PTS em cenário hospitalar. A solicitação para realização do PTS ocorreu na disciplina de Assistência de Enfermagem ao Adulto e Idoso Hospitalizado, do Curso de Graduação em Enfermagem. O PTS possibilitou que o discente conseguisse organizar melhor suas ideias e proposições de cuidado alicerçado em evidências científicas, culminando em maior associação teórica e prática. O PTS é uma tecnologia capaz de auxiliar na interpretação do processo saúde-doença, fortalece a autonomia e preparo do acadêmico para realizar discussões de casos e proposições de soluções de problemáticas pertinentes à prática assistencial, fortalecendo seu pensamento crítico-reflexivo no cuidado de enfermagem.Descritores: Educação Superior, Enfermagem, Estágio Clínico. Singular therapeutic project during internship in hospital environment: teaching reportAbstract: To report the teaching experience of using the Singular Therapeutic Project in a hospital environment during the supervised internship of the 10th semester of the Bachelor of Nursing Course. It is an account of the experience of professors at a University in the interior of  Rio Grande do Sul from the practical experience of using PTS in a hospital setting. The request to perform the PTS occurred in the discipline of Nursing Assistance to Adult and Hospitalized Elderly, from the Nursing Undergraduate Course. The PTS enabled the student to better organize his ideas and care propositions based on scientific evidence, culminating in a greater theoretical and practical association. The PTS is a technology capable of assisting in the interpretation of the health-disease process, it strengthens the academic autonomy and preparation to carry out case discussions and propositions of solutions to problems relevant to the care practice, strengthening their critical-reflective thinking in nursing care.Descriptors: Education, Higher, Nursing, Clinical Clerkship. Proyecto terapéutico singular durante las prácticas en un entorno hospitalario: informe docenteResumen: Informar la experiencia docente de la utilización del Proyecto Terapéutico Singular en el ámbito hospitalario durante la pasantía supervisada del 10º semestre de la Licenciatura en Enfermería. Es un relato de la experiencia de profesores de una Universidad del interior de Rio Grande do Sul a partir de la experiencia práctica de utilizar PTS en un entorno hospitalario. La solicitud para realizar el PTS se dio en la disciplina de Asistencia de Enfermería al Adulto y Anciano Hospitalizado, de la Licenciatura en Enfermería. El PTS permitió al alumno organizar mejor sus ideas y propuestas de cuidado basadas en la evidencia científica, culminando en una mayor asociación teórica y práctica. El PTS es una tecnología capaz de asistir en la interpretación del proceso salud-enfermedad, fortalece la autonomía académica y la preparación para la realización de discusiones de casos y propuestas de soluciones a problemas relevantes para la práctica asistencial, fortaleciendo su pensamiento crítico-reflexivo en el cuidado de enfermería.Descriptores: Educación Superior, Enfermería, Prácticas Clínicas.

scholarly journals Animal assisted activities in the children's hospital: protocol for a scoping review

2020 ◽  
Vol 3 ◽  
pp. 74
Author(s):  
Rachel Howe ◽  
Sandra Nicholson ◽  
Attracta Lafferty ◽  
Carmel Davies ◽  
Diarmuid Stokes ◽  
...  
Keyword(s):  
Scoping Review ◽  
Scientific Evidence ◽  
Companion Animals ◽  
Hospital Setting ◽  
Hospital Environment ◽  
Children's Hospital ◽  
Human Animal Bond ◽  
Children’S Hospital ◽  
Review Protocol ◽  
Actual Effectiveness

The introduction of animal interventions in healthcare are relatively common; however, their actual effectiveness and longer term findings are not so well known or published, especially in relation to the children’s hospital setting.  It is important to plot where and why animal interventions take place but also to focus on how the human animal bond impacts on children, their parents and staff in a children’s hospital setting.  Family members, including companion animals, are important supports which help children to relax and give them a sense of familiarity to navigate the busy and stressful hospital environment.  The scoping review of the literature proposed will explore the scientific evidence for animal assisted activities (AAA) in children’s hospitals and will map results prior to undertaking a full scale research project.   Arksey and O’Malley’s framework guided by the Joanna Briggs Institute will frame this review protocol.  Appendices are used to ensure transparency of methods. The protocol is presented in narrative style to demonstrate flow and fluency and appeal to wider readership.

Pre-hospital care for the anaesthetist

2017 ◽  
Author(s):  
Nicholas Crombie ◽  
G. Boukes Eindhoven ◽  
Bert Dercksen
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Critically Ill ◽  
Hospital Care ◽  
Medical Specialty ◽  
Hospital Environment ◽  
Exciting Area

Pre-hospital care is arguably the newest medical specialty having evolved from the introduction of portable defibrillators in the 1970s to the advanced critical care and interventions delivered today. The specialty draws heavily on anaesthesia and emergency medicine along with an understanding of and familiarity with the pre-hospital environment and infrastructure. Rather than being an expansive text on the specialty, this chapter sets out the history, the challenges, and the practice of pre-hospital care relevant to anaesthetists. The inclusion of pre-hospital care in the Oxford Textbook of Anaesthesia further reinforces the point that this exciting area of medicine has moved from the peripheries into an established and important component of the care of the critically ill.

Pre-hospital care

2018 ◽  
Author(s):  
Oliver Harrison
Keyword(s):  
Emergency Medicine ◽  
Hospital Care ◽  
General Medical Council ◽  
Training Programme ◽  
Hospital Environment ◽  
Medical Council ◽  
Building Site ◽  
Acute Medicine ◽  
Town Centre ◽  
Hospital Teams

Many doctors are attracted to pre-hospital emergency medicine (PHEM) because of the variety of challenges that it presents. With limited time and resources, the doctor is expected to assess and treat a range of medical and traumatic pathologies in patients of any age, without delaying transport to the most appropriate location for definitive care. This must be done in spite of what is usually a suboptimal environment, e.g. in a ditch at the roadside, on a rainy building site, or in a crowded town centre. Recognizing the limitations of what can be achieved on scene is a key skill that must be balanced against the increasing range of lifesaving interventions at the disposal of pre-hospital teams. While PHEM has been practised by a variety of doctors for many years, it has only recently gained General Medical Council (GMC) subspecialty recognition. A formal training programme may now be undertaken by trainees with base specialties of acute medicine, anaesthetics, emergency medicine, and intensive care medicine, leading to a dual certificate of completion of training. The challenging nature of the pre-hospital environment, the high-risk nature of the interventions that can be undertaken, and the lack of availability of immediate assistance on scene mean that PHEM is a service delivered by consultants and senior trainees. Medical students and foundation doctors who may be interested in PHEM training should seek to spend time in the above mentioned acute specialties, as well as looking for opportunities to observe alongside some of the services that operate nationally. The following questions represent a small selection of the range of scenarios that may be faced by a PHEM practitioner on a day-to-day basis.

scholarly journals Delivering Community Emergency Medicine during the COVID-19 pandemic: the Physician Response Unit

2021 ◽  
Vol 38 (5) ◽  
pp. 371-372
Author(s):  
Rich Carden ◽  
Bill Leaning ◽  
Tony Joy
Keyword(s):  
Emergency Medicine ◽  
Emergency Care ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Response Unit ◽  
Care Services ◽  
Vulnerable Patients ◽  
Palliative Care Services ◽  
Alternative Solutions ◽  
Physician Response

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model, working closely with community, hospital and pre-hospital services. In response to the pandemic, the PRU has been able to rapidly introduce novel pathways designed to support local emergency departments (EDs) and local emergency patients. The pathways are (1) supporting discharge from acute medical and older people’s services wards into the community; (2) supporting acute oncology services; (3) supporting EDs; (4) supporting palliative care services. Establishing these pathways have facilitated a number of vulnerable patients to access patient-focussed and holistic definitive emergency care. The pathways have also allowed EDs to safely discharge patients to the community, and also mitigate some of the problems associated with trying to maintain isolation for vulnerable patients within the ED. Community Emergency Medicine models are able to reduce ED attendances and hospital admissions, and hence risk of crowding, as well as reducing nosocomial risks for patients who can have high-quality emergency care brought to them. This model may also provide various alternative solutions in the delivery of safe emergency care in the postpandemic healthcare landscape.

scholarly journals SARS-CoV-2 detection status associates with bacterial community composition in patients and the hospital environment

Microbiome ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Clarisse Marotz ◽  
Pedro Belda-Ferre ◽  
Farhana Ali ◽  
Promi Das ◽  
Shi Huang ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Rna Virus ◽  
Bacterial Community Composition ◽  
Hospital Setting ◽  
Amplicon Sequencing ◽  
Hospital Environment ◽  
Rrna Gene ◽  
Sequence Variant ◽  
Care Providers ◽  
Single Amplicon

Abstract Background SARS-CoV-2 is an RNA virus responsible for the coronavirus disease 2019 (COVID-19) pandemic. Viruses exist in complex microbial environments, and recent studies have revealed both synergistic and antagonistic effects of specific bacterial taxa on viral prevalence and infectivity. We set out to test whether specific bacterial communities predict SARS-CoV-2 occurrence in a hospital setting. Methods We collected 972 samples from hospitalized patients with COVID-19, their health care providers, and hospital surfaces before, during, and after admission. We screened for SARS-CoV-2 using RT-qPCR, characterized microbial communities using 16S rRNA gene amplicon sequencing, and used these bacterial profiles to classify SARS-CoV-2 RNA detection with a random forest model. Results Sixteen percent of surfaces from COVID-19 patient rooms had detectable SARS-CoV-2 RNA, although infectivity was not assessed. The highest prevalence was in floor samples next to patient beds (39%) and directly outside their rooms (29%). Although bed rail samples more closely resembled the patient microbiome compared to floor samples, SARS-CoV-2 RNA was detected less often in bed rail samples (11%). SARS-CoV-2 positive samples had higher bacterial phylogenetic diversity in both human and surface samples and higher biomass in floor samples. 16S microbial community profiles enabled high classifier accuracy for SARS-CoV-2 status in not only nares, but also forehead, stool, and floor samples. Across these distinct microbial profiles, a single amplicon sequence variant from the genus Rothia strongly predicted SARS-CoV-2 presence across sample types, with greater prevalence in positive surface and human samples, even when compared to samples from patients in other intensive care units prior to the COVID-19 pandemic. Conclusions These results contextualize the vast diversity of microbial niches where SARS-CoV-2 RNA is detected and identify specific bacterial taxa that associate with the viral RNA prevalence both in the host and hospital environment.

scholarly journals The Implementation of Active Environmental Surveillance in a Veterinary Referral Hospital Setting

2020 ◽  
Vol 41 (S1) ◽  
pp. s409-s409
Author(s):  
Emily Feyes ◽  
Dixie Mollenkopf ◽  
Thomas Wittum ◽  
Dubraska Diaz-Campos ◽  
Rikki Horne
Keyword(s):  
Veterinary Medicine ◽  
Hospital Setting ◽  
Ohio State University ◽  
Hospital Environment ◽  
State University ◽  
Environmental Surveillance ◽  
University College ◽  
Animal Contact ◽  
Contact Surfaces ◽  
The Ohio State University

Emily Feyes, The Ohio State University College of Veterinary Medicine; Dixie Mollenkopf, The Ohio State University College of Veterinary Medicine; Thomas Wittum, The Ohio State University College of Veterinary Medicine; Dubraska Diaz-Campos, The Ohio State University College of Veterinary Medicine; Rikki Horne, The Ohio State University College of Veterinary MedicineBackground: The Ohio State University College of Veterinary Medicine (OSU-CVM) Antimicrobial Stewardship Working Group (ASWG) uses monthly environmental surveillance to understand the effectiveness of our veterinary medical center (VMC) infection control and biosecurity protocols in reducing environmental contamination with multidrug resistant organisms. Monthly surveillance allows us to monitor trends in the recovery of these resistant organisms and address issues of concern that could impact our patients, clients, staff, and students. Methods: The OSU-CVM ASWG collects samples from >100 surfaces within the companion animal, farm animal, and equine sections of our hospital each month. Sampling has been continuous since January 2018. Samples are collected from both human–animal contact and human-only contact surfaces using Swiffer electrostatic cloths. These samples are cultured for recovery of Salmonella spp, extended-spectrum cephalosporin-resistant Enterobacteriaceae, carbapenemase-producing Enterobacteriaceae (CPE), and methicillin-resistant Staphylococcus spp. Results: The recovery of these antibiotic resistant target organisms is low in the environment of our hospital. Recovery from human-only contact surfaces (19.8%) is very similar to recovery from human–animal contact surfaces (25.5%). We commonly recover Enterobacteriaceae (E.coli, Klebsiella spp, and Enterobacter spp) that are resistant to extended-spectrum cephalosporins (496 of 2,016; 24.6%) from the VMC environment. These antibiotic-resistant indicator bacteria are expected in a veterinary hospital setting where use the of β-lactam drugs is common. Recovery of both Salmonella spp and CPE has remained very low in our hospital environment over the past 19 months: 16 of 2,016 (0.7%) for Salmonella and 15 of 2,016 (0.8%) for CPE. Discussion: The active environmental surveillance component of our antimicrobial stewardship program has allowed us to reduce the threat of nosocomial infections within our hospital and address environmental contamination issues before they become a problem. Our consistently low recovery of resistant organisms indicates the effectiveness of our existing cleaning and disinfection protocols and biosecurity measures. Due to the nature of our patient population, we do expect to find resistant organisms in the patient-contact areas of the hospital environment. However, our similar rates of resistant organisms from human-only surfaces (eg, computer keyboards, door handles, telephones, and Cubex machines) indicates a need to improve our hand hygiene practices. These data are now supporting the implementation of a new hand hygiene campaign in our veterinary hospital.Funding: NoneDisclosures: None

scholarly journals A Structured Curriculum for Interprofessional Training of Emergency Medicine Interns

2019 ◽  
Vol 21 (1) ◽  
pp. 149-151 ◽  
Author(s):  
Ashley Rider ◽  
Tiffany Anaebere ◽  
Mariko Nomura ◽  
David Duong ◽  
Charlotte Wills
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Interprofessional Education ◽  
Hospital Setting ◽  
Scope Of Practice ◽  
Registered Nursing ◽  
Interprofessional Training ◽  
Before And After ◽  
Team Based Care ◽  
Improve Health

Interprofessional education (IPE) has been shown to improve health outcomes and patient satisfaction. IPE is now represented in the Accreditation Council for Graduate Medical Education’s emergency medicine (EM) milestones given the team-based nature of EM. The Highland Allied Health Rotation Program (H-AHRP) was developed by residents to enhance and standardize IPE for EM residents in a single hospital setting. H-AHRP was incorporated into the orientation month for interns starting in the summer of 2016. EM interns were paired with emergency department preceptors in registered nursing (RN), respiratory therapy (RT), pharmacy (PH), laboratory (LAB), and social work (SW) in either a four-hour shadowing experience (RN, RT, PH) or lecture-based overview (LAB, SW). We conducted a survey before and after the program. Overall, the EM interns reported an improved understanding of the scope of practice and day-to-day logistics after working with the preceptors. They found the program helpful to their future as physicians and would recommend it to other residencies. The H-AHRP program allows for the early incorporation of IPE into EM training, enhances interns’ understanding of both the scope and logistics of their colleagues, and is a well-received effort at improving team-based care.

An alternative model of pre-hospital care for 999 patients who require non-emergency medical assistance

2017 ◽  
Vol 6 (2) ◽  
pp. 99-103 ◽  
Author(s):  
Joanna M. Blodgett ◽  
Duncan Robertson ◽  
David Ratcliffe ◽  
Kenneth Rockwood
Keyword(s):  
Hospital Care ◽  
Critical Appraisal ◽  
Systems Of Care ◽  
Healthcare Services ◽  
Limited Evidence ◽  
Content Type ◽  
Potential Benefits ◽  
Increasing Demand ◽  
Alternate Routes ◽  
Emergency Medical Assistance

Purpose With the increasing demand on ambulance services, paramedics are tasked to arrange as much out of hospital care as possible, to develop integrated systems of care and work with hundreds of different providers – all in the 15 minutes allocated for assessment. A UK ambulance trust is navigating and leading much of this work as one of the first trusts to implement a general practitioner referral policy as an alternate to direct conveyance. The paper aims to discuss this issue. Design/methodology/approach Here the authors discuss the referral scheme, examine the limited evidence available and discuss what is needed to influence prospective success of implementing this scheme in other trusts. Findings Limited evidence for these schemes are described, however there is a clear gap in critical appraisal and methodologically rigorous evidence needed to implement these schemes in other ambulance schemes. Originality/value In order to facilitate collaboration of healthcare services and to minimize the burden of increasing numbers of patients, communication and discussion of alternate routes of care is crucial. This viewpoint piece is one of the first to emphasize the potential benefits of such schemes.

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