Student perceptions of adverse health events during ambulance clinical placements

This pilot study intended to augment current literature in the clinical placement field by investigating the frequency and nature of adverse health events experiences by paramedic students undertaking ambulance clinical placements. Supports accessed post event were also reviewed. A purposive sample of fifty-six paramedic students completed the questionnaire. The results indicate that a number of students experience adverse health events while on clinical placement, with fourteen cases of verbal abuse, one case of physical abuse, nine cases of sexualised behavior and seven cases of psychological distress reported. While some case related incidents were flagged by ambulance services and followed up by peer support, students did not initiate any formal support processes themselves. Moreover, no student filed a formal report regarding any of the incidents raised. The results of this pilot study require further investigation. In the interim, the benefits of clinical placements must be weighed against their risks, and processes put in place to minimize the risk to students undertaking clinical placements.

Assessing risk post intervention for an acute coronary syndrome: a review of the risk assessment tools and their development

Considerable variability in survival rate after an acute myocardial infarction exists and accurate risk stratification is of significant importance. The American College of Cardiology and the American Heart Association has recommended early risk stratification using several clinical risk scoring instruments to identify high risk patients. The aim of this paper is to identify secondary cardiovascular risk scoring instruments that could be utilized at the time of intervention for acute coronary syndromes and compare their psychometric properties as they were developed. A search using Medline, Cumulative Index to Nursing and Allied Health Literature and the Psychology and Behavioral Sciences Collection data-bases identified studies published between January 1990 and January 2010 used to measure risk after intervention for acute coronary syndrome. Four validated secondary risk prediction scoring instruments were identified for comparison.Secondary risk prediction scoring instruments for the acute coronary syndrome patient population are evidence based, valid and reliable. Use of the instruments by cardiac focused clinicians will aid in the determination of treatment strategies, and estimation of short and long term events and mortality.

Mapping the ill disciplined? Spatial analyses and historical change in the post-war film industry

As part of a broad disciplinary shift, from a focus on measuring the value and meaning of cultural artefacts to understanding the import of cultural flows, humanities researchers are increasingly turning to other disciplines and disciplinary practices to inform their research. For film scholars, rather than providing a reading of specific media texts and their qualities there is an increasing focus on the contextual events that shape and formulate cinema practice. This chapter is an example of how cross-disciplinary relationships, for example between Cinema Studies, Geospatial Science, Statistics and the Creative Arts can uncover new research questions and test methodologies across uncharted disciplinary terrain. It also offers an opportunity to reflect on some of the key assumptions around collaborative research, through its reorganization of academic spaces and “sites” of knowledge.

Examining adverse events after intensive care unit discharge : outcomes from a pilot questionnaire

Adverse events are common in acute clinical settings but little is known about these events occurring after Intensive Care discharge. This study aimed to develop a reliable and valid tool for exploring clinicians’ opinions of factors associated with post-Intensive Care adverse events. A convenience sample of Australian Intensive Care Liaison Nurses was invited to complete and appraise a questionnaire using structured guidelines. Content validity and internal consistency were assessed.

Twelve Intensive Care Liaison Nurses completed the questionnaire. Cronbach?s alpha coefficient showed high internal consistency for the questionnaire; all 24 items on the questionnaire had coefficients greater than 0.852. The content validity index of the questionnaire overall was 0.76.

The post-Intensive Care adverse events questionnaire demonstrated reliability and validity. It is a tool that can be used to explore clinicians? opinions of factors associated with these events. The tool is important as it facilitates further insight into the causes of post-Intensive Care adverse events.

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis

Introduction: While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the Post-Anaesthetic Care Unit. These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether use of PACT will i) enhance the recognition and response to patients at risk of deterioration in PACU; ii) improve documentation for handover from PACU nurse to ward nurse; iii) result in improved patient outcomes; and iv) reduce health care costs.

Methods and analysis: A prospective, non-randomised, pre- and post-implementation design comparing: (i) patients (n=750) who have surgery prior to the implementation of the PACT and (ii) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre- and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as odds ratios with the corresponding 95% confidence intervals.

Conclusion: This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce health care costs.

Using clinical trial data and linked administrative health data to reduce the risk of adverse events associated with the uptake of newly released drugs by older Australians: a model process

BACKGROUND: The study was undertaken to evaluate the contribution of a process which uses clinical trial data plus linked de-identified administrative health data to forecast potential risk of adverse events associated with the use of newly released drugs by older Australian patients. METHODS: The study uses publicly available data from the clinical trials of a newly released drug to ascertain which patient age groups, gender, comorbidities and co-medications were excluded in the trials. It then uses linked de-identified hospital morbidity and medications dispensing data to investigate the comorbidities and co-medications of patients who suffer from the target morbidity of the new drug and who are the likely target population for the drug. The clinical trial information and the linked morbidity and medication data are compared to assess which patient groups could potentially be at risk of an adverse event associated with use of the new drug. RESULTS: Applying the model in a retrospective real-world scenario identified that the majority of the sample group of Australian patients aged 65 years and over with the target morbidity of the newly released COX-2-selective NSAID rofecoxib also suffered from a major morbidity excluded in the trials of that drug, indicating a substantial potential risk of adverse events amongst those patients. This risk was borne out in post-release morbidity and mortality associated with use of that drug. CONCLUSIONS: Clinical trial data and linked administrative health data can together support a prospective assessment of patient groups who could be at risk of an adverse event if they are prescribed a newly released drug in the context of their age, gender, comorbidities and/or co-medications. Communication of this independent risk information to prescribers has the potential to reduce adverse events in the period after the release of the new drug, which is when the risk is greatest.Note: The terms 'adverse drug reaction' and 'adverse drug event' have come to be used interchangeably in the current literature. For consistency, the authors have chosen to use the wider term 'adverse drug event' (ADE).

Post-crisis: rebuilding a company, a reputation, a community

It is well recognised that when an organisation experiences a crisis caused by a natural disaster,publics are less likely to apportion responsibility to that organisation. This contrasts with crisesinvolving events such as product tampering, accidents or management transgressions where thelevel of organisational control is perceived or judged to be greater (Coombs, 2000, p. 86). In 2012,biomedical company Gambro’s manufacturing plant, based in Medolla, a small town of 6000 in theModena region of Italy, was hit by a devastating series of earthquakes. Damage to the plant hadsignificant and immediate impact for employees, customers and other key stakeholders, as operationsceased in the wake of the earthquakes.This chapter will reflect on Gambro’s crisis management response and their crisis communicationstrategies in response to the earthquakes and the ensuing rumours. An analysis ofGambro’s crisis response shows they acted to counteract stakeholder concerns and leveragewell-established stakeholder relationships. As Coombs (2000, 2006, 2007a, 2007b) makes clear,relationships are central to effective crisis management, and, although stakeholders often view anatural disaster as being removed from the organisation’s responsibility, this concession may not exist in a prolonged recovery period or where the stakeholders face a life or death outcome. Thesewere the very conditions Gambro faced. So, a relational approach can add depth to the attributionalanalysis of such a crisis (Coombs 2000, p. 86). To extend the analysis of crises caused bynatural disaster and Gambro’s crisis response, the chapter will also examine crisis communicationstrategies of similar disaster case studies.The international medical-technical company Gambro, headquartered in Sweden, has 13 productionfacilities in more than 90 countries, and employs more than 8000 people worldwide. Gambrohas operated in the Medolla region of Emilia-Romagna since the early 1960s.

Image-encounters with the techno-mediated other: Regarding post-election Iran on Youtube

In June 2009 large-scale public demonstrations on the streets of Tehran followed Mahmoud Ahmadinejad’s controversial claiming of victory in the Republic’s most recent election. As the scale of the unrest rapidly escalated, foreign journalists were expelled from the country and unprecedented numbers of Iranian journalists were imprisoned (Sreberny and Khiabany 176). Observers outside of Iran learned of the events as Iranians on the streets embraced image production and distribution as a central component of their protest. Evading the attempts of the regime to control media coverage of the post-election violence, Iranians uploaded rough footage, still images, and blog entries, seeking to make real their experiences for the international community. A stream of citizen-produced footage of mass demonstrations, beatings and deaths was relayed to the world at large via Internet-based social networking channels and mobile phones. This paper takes a series of images from the mediated turmoil in Iran as a prism through which to consider the problem of what it is that such images make real for distant observers.