Are paramedic students ready to be professional? An international comparison study

IntroductionThe last decade has seen rapid advancement in Australasian paramedic education, clinical practice, and research. Coupled with the movements towards national registration in Australia and New Zealand, these advancements contribute to the paramedic discipline gaining recognition as a health profession.AimThe aim of this paper was to explore paramedic students' views on paramedic professionalism in Australia and New Zealand.MethodsUsing a convenience sample of paramedic students from Whitireia New Zealand, Charles Sturt University and Monash University, attitudes towards paramedic professionalism were measured using the Professionalism at Work Questionnaire. The 77 item questionnaire uses a combination of binary and unipolar Likert scales (1 = Strongly disagree/5 = Strongly agree; Never = 1/Always = 5).ResultsThere were 479 students who participated in the study from Charles Sturt University n = 272 (56.8%), Monash University n = 145 (30.3%) and Whitireia New Zealand n = 62 (12.9%). A number of items produced statistically significant differences P < 0.05 between universities, year levels and course type. These included: ‘Allow my liking or dislike for patients to affect the way I approach them’ and ‘Discuss a bad job with family or friends outside work as a way of coping’.ConclusionsThese results suggest that paramedic students are strong advocates of paramedic professionalism and support the need for regulation. Data also suggest that the next generation of paramedics can be the agents of change for the paramedic discipline as it attempts to achieve full professional status.     

Is hyperchloremia associated with mortality in critically ill patients? A prospective cohort study

Purpose

The aim of the study was to determine if acid-base variables are associated with hospital mortality.

Materials and Methods

This prospective cohort study took place in a university-affiliated hospital intensive care unit (ICU). One hundred seventy-five patients admitted to the ICU during the period of February to May 2007 were included in the study. We recorded clinical data and acid-base variables from all patients at ICU admission. A logistic regression model was constructed using Sepsis-related Organ Failure Assessment (SOFA) score, age, and the acid-base variables.

Results

Individually, none of the variables appear to be good predictors of hospital mortality. However, using the multivariate stepwise logistic regression, we had a model with good discrimination containing SOFA score, age, chloride, and albumin (area under receiver operating characteristic curve, 0.80; 95% confidence interval, 0.73-0.87).

Conclusions

Hypoalbuminemia and hyperchloremia were associated with mortality. This result involving chloride is something new and should be tested in future studies.     

Interprofessional education for health science students’ attitudes and readiness to work interprofessionally: a prospective cohort study

BackgroundInterprofessional education of healthcare providers is necessary to foster collaborative practice and improve patient outcomes.ObjectiveTo examine the effectiveness of the single-session interprofessional education in improving interprofessional attitudes, increasing knowledge of healthcare professions, and improving perceived-readiness for working interprofessionally and with older adults in students in occupational therapy, physical therapy, and physician assistant graduate programs.MethodsWe used a prospective, pre–post cohort design. Fall risk evaluation for older adults was selected as the topic of the 4-hour interprofessional education session. Graduate students from three professional programs including occupational therapy (n = 20), physical therapy (n = 26), and physician assistant studies (n = 35) participated in the study, and 17 older adults aged 65 years or older volunteered for the session. Our primary outcome measure was the Interprofessional Attitudes Scale measuring interprofessional attitudes, and our secondary outcome measure was the study-specific questionnaire measuring the direct effect of our interprofessional education session.ResultsGraduate students showed significant improvements in the subscale of teamwork, roles, and responsibilities in the Interprofessional Attitudes Scale. Students also showed significant improvements in “understanding of other professions,” “perceived-readiness to work interprofessionally,” and “perceived-readiness to work with older adults” in the study-specific questionnaire. Ceiling effects were observed in most of the subscales in the Interprofessional Attitudes Scale.ConclusionThis study demonstrates that a single 4-hour interprofessional education session can improve interprofessional attitudes, knowledge of other professions, and perceived-readiness of health science graduate students to work interprofessionally and to work with older adults.     

What Are the Specific Features of Helicobacter pylori Gastritis in Children?

Children with recurrent abdominal pain and dyspeptic symptoms often present histological gastritis and Helicobacter pylori infection. No specific symptomatology has been found, however, to discriminate H. pylori positive from negative subjects. Certain differences exist in gastritis in paediatric age groups, in comparison with adults. In terms of treatment, children also form a special entity because of the long exposure time of H. pylori infection. This article describes the typical findings of H. pylori gastritis in children and discusses their significance from a clinical point of view.     

Can iridology detect susceptibility to cancer? A prospective case-controlled study

OBJECTIVE: This prospective case-control study aimed to investigate the value of iridology as a diagnostic tool in detecting some common cancers. SUBJECTS: One hundred ten (110) subjects were enrolled in the study: 68 subjects had histologically proven cancers of the breast, ovary, uterus, prostate, or colorectum, and 42 were control subjects. METHODS: All subjects were examined by an experienced practitioner of iridology, who was unaware of their gender or medical details. He was allowed to suggest up to five diagnoses for each subject and his results were then compared with each subject's medical diagnosis to determine the accuracy of iridology in detecting malignancy. RESULTS: Iridology identified the correct diagnosis in only 3 cases (sensitivity, 0.04). CONCLUSION: Iridology was of no value in diagnosing the cancers investigated in this study.     

What makes medical students receptive to interprofessional education? Findings from an exploratory case study

Interprofessional education (IPE) continues to grow as a field internationally, and therefore has become a key activity which numerous institutions have implemented around the world. A number of learner characteristics have been suggested as being important for the success of interprofessional interventions, including prior experiences, expectations, and motivations. This study sought to explore medical student engagement with IPE and the factors that affect this. Twelve final and penultimate year students took part in two focus groups to discuss previous IPE and the factors which they felt led to successful interprofessional experiences. Thematic analysis was used to interpret the data. Students were found to be receptive to the idea of IPE, but had some reservations about its current form. Students were enthusiastic about clinically relevant IPE experiences, but were put off by generic teambuilding exercises, especially those with a poor mix of professional groups. They also reported being aware of interprofessional tensions and communication issues, which they felt might be alleviated through frequent interprofessional contact at the undergraduate level. This study suggests that medical students desire realistic, clinically relevant, interprofessional experiences, with a good mix of professionals, through which they can gain more awareness of their own role and that of other professionals.     

Detection of Helicobacter pylori infection: when to perform which test?

This paper reviews current diagnostic techniques for Helicobacter pylori infection and critically questions their value under different diagnostic circumstances. As long as we do not have general treatment recommendations for H. pylori infection, endoscopy is still the basis for primary diagnosis because it assesses therapy indications. In addition, histology characterizes the gastroduodenal lesions observed and may reveal malignant diseases. New rapid urease tests from the biopsies are inexpensive, simple, and quick giving results reliably within 1 h. Culturing H. pylori from gastric samples after therapy failure and testing the strains for antimicrobial susceptibility is becoming increasingly important with higher prevalence of drug resistances. Nonendoscopic tests are more convenient to the patient. Serological tests inexpensively detect circulating IgG or IgA antibodies. However, inspite of the cost attractiveness, serology might be problematic in indicating present H. pylori infection. The tests of choice for noninvasive monitoring therapy success or failure are the 13C-urea breath test and the faecal antigen immunoassay. Both tests are also of value for first diagnosis in children when endoscopy is not indicated. In the future, serological detection of virulence factors and polymerase chain reaction with molecular fingerprinting might help to identify H. pylori strains with high pathogenicity or antibiotic resistance.     

Serum pepsinogen C: A useful marker of Helicobacter pylori eradication?

Medical treatment for Helicobacter pylori (Hp) infection is now recommended in several types of gastroduodenal disease, and its success is usually monitored by hystology. The end-points of our work were to identify the most suitable serum index of Hp eradication among pepsinogen A (PGA), pepsinogen C (PGC), PGA/PGC ratio, gastrin, and IgG anti-Hp (IGG). We studied a total of 289 Hp positive (Giemsa staining) patients, who were treated with 40 mg/day omeprazole (140 cases) or with 480 mg/day bismuth subsalicylate (149 cases) for 4 weeks. All the patients also received 1 g/day metronidazole + 2 g/day amoxycillin for the first 2 weeks of treatment. Two months after the end of therapy, the patients underwent a second endoscopy and Hp histological assessment: the infection was eradicated in 192 and still present in the remaining 97 subjects. Gastrin, PGA, PGC, and IGG were measured before and after therapy. All indices significantly decreased after therapy in eradicated patients, while PGA and gastrin significantly decreased after therapy in both eradicated and noneradicated patients, although in the latter group the variations were less pronounced. We calculated the per cent decrease of the studied indices. PGC, with a decrease of more than 25%, was found to be the most accurate biochemical index. Variation in PGC levels before and after treatment were correlated with corresponding variations in Hp bacterial load. In conclusion, between the different biochemical parameters evaluated, PGC showed the highest clinical efficiency. © 1996 Wiley-Liss, Inc.     

Intrastrain Differences in Helicobacter pylori: A Key Question in Mucosal Damage?

Helicobacter pylori causes persistent infection and inflammation in the human stomach, yet only a small fraction of infected people develop Illness. An important question is why this diversity exists in infection outcome. In recent years, there has been evidence of substantial phenotypic as well as genotypic diversity of H. pylori. Three different phenotypes — production of vacuolating cytotoxin, presence of cagA, and ability for strong PMN activation — appear to be linked to one another and to the propensity for a H. pylori strain to cause peptic ulcer disease. Further investigation in this field may help to define which infected people bear the highest risk for serious clinical consequences, and ultimately to define optimal vaccine candidates and strategies.