Early diagnosis of haemorrhagic shock (HS) might be difficult because of compensatory mechanisms. Clinical scoring systems aimed at predicting transfusion needs might assist in early identification of patients with HS. The Shock Index (SI) - defined as heart rate divided by systolic BP - has been proposed as a simple tool to identify patients with HS. This systematic review discusses the SI's utility post-trauma in predicting critical bleeding (CB). We searched the databases MEDLINE, Embase, CINAHL, Cochrane Library, Scopus and PubMed from their commencement to 1 September 2013. Studies that described an association with SI and CB, defined as at least 4 units of packed red blood cells (pRBC) or whole blood within 24 h, were included. Of the 351 located articles identified by the initial search strategy, five met inclusion criteria. One study pertained to the pre-hospital setting, one to the military, two to the in-hospital setting, and one included analysis of both pre-hospital and in-hospital values. The majority of papers assessed predictive properties of the SI in ≥10 units pRBC in the first 24 h. The most frequently suggested optimal SI cut-off was ≥0.9. An association between higher SI and bleeding was demonstrated in all studies. The SI is a readily available tool and may be useful in predicting CB on arrival to hospital. The evaluation of improved utility of the SI by performing and recording at earlier time-points, including the pre-hospital phase, is indicated.

Patient or visitor perpetrated workplace violence (WPV) has been reported to be a common occurrence within the ED. No universal definition of violence or recording of such events exists. In addition ED staff are often reluctant to report violent incidents. The true incidence of WPV is therefore unclear. This systematic review aimed to quantify WPV in EDs. The association of WPV to drug and alcohol exposure was explored. The databases MEDLINE, Embase, PsycInfo and the Cochrane Library were searched from their commencement to 10 March 2016. MeSH terms and text words for ED, violence and aggression were combined. A meta-analysis was conducted on the primary outcome variable-proportion of violent patients among total ED presentations. A secondary meta-analysis used studies reporting on proportion of drug and alcohol affected patients occurring within the violent population. The search yielded a total of 8720 records. A total of 7235 were unique and underwent abstract screening. A total of 22 studies were deemed relevant according to inclusion and exclusion criteria. Retrospective study design predominated, analysing mainly security records and incident reports. The rates of violence from individual studies ranged from 1 incident to 172 incidents per 10 000 presentations. The pooled incidence suggests there are 36 violent patients for every 10 000 presentations to the ED (95% confidence interval 0.0030-0.0043). WPV in the ED was commonly reported. There is wide heterogeneity across the study methodology, definitions and rates. More standardised recording and reporting may inform preventive measures and highlight effective management strategies.

BackgroundPeer-assisted learning (PAL) is used throughout all levels of healthcare education. Lack of formalised agreement on different PAL programmes may confuse the literature. Given the increasing interest in PAL as an education philosophy, the terms need clarification. The aim of this review is to 1) describe different PAL programmes, 2) clarify the terminology surrounding PAL, and 3) propose a simple pragmatic way of defining PAL programmes based on their design.MethodsA review of current PAL programmes within the healthcare setting was conducted. Each programme was scrutinised based on two aspects: the relationship between student and teacher, and the student to teacher ratio. The studies were then shown to fit exclusively into the novel proposed classification.ResultsThe 34 programmes found, demonstrate a wide variety in terms used. We established six terms, which exclusively applied to the programmes. The relationship between student and teacher was categorised as peer-to-peer or near-peer. The student to teacher ratio suited three groupings, named intuitively ‘Mentoring’ (1:1 or 1:2), ‘Tutoring’ (1:3–10), and ‘Didactic’ (1:>10). From this, six novel terms – all under the heading of PAL – are suggested: ‘Peer Mentoring’, ‘Peer Tutoring’, ‘Peer Didactic’, ‘Near-Peer Mentoring’, ‘Near-Peer Tutoring’, and ‘Near-Peer Didactic’.ConclusionsWe suggest herein a simple pragmatic terminology to overcome ambiguous terminology. Academically, clear terms will allow effective and efficient research, ensuring furthering of the educational philosophy.

Resuscitation of patients presenting with hemorrhagic shock after major trauma has evolved to incorporate multiple strategies to maintain tissue perfusion and oxygenation while managing coagulation disorders. We aimed to study changes across time in long-term outcomes in patients with major trauma. A retrospective observational study in a single major trauma center in Australia was conducted. We included all patients with major trauma and massive blood transfusion within the first 24 h during a 6-year period (from 2006 to 2011). The main outcome measures were Glasgow Outcome Score-Extended (GOSE) and work capacity at 6 and 12 months. There were 5,915 patients with major trauma of which 365 (6.2%; 95% confidence interval [95% CI], 5.6 - 6.8) received a massive transfusion. The proportion of major trauma patients receiving a massive transfusion decreased across time from 8.2% to 4.4% (P < 0.01). There were statistically significant trends toward lower volumes of red blood cell transfusion and higher ratios of fresh-frozen plasma to red blood cells (P < 0.01). Among massively transfused patients, there was no significant change in measured outcomes during the study period, with a persistent 23% mortality in hospital, 52% unfavorable GOSE at 6 months, and 44% unfavorable GOSE at 12 months. Massive transfusion was independently associated with unfavorable outcomes at 6 months after injury (adjusted odds ratio, 1.56; 95% CI, 1.05 - 2.31) but not at 12 months (adjusted odds ratio, 0.85; 95% CI, 0.72 - 1.01). A significant reduction in massive transfusion rates was observed. Unfavorable long-term outcomes among patients receiving a massive transfusion after trauma were frequent with a substantial proportion of survivors experiencing poor functional status 1 year after injury.

BackgroundSearch filters aid clinicians and academics to accurately locate literature. Despite this, there is no search filter or Medical Subject Headings (MeSH) term pertaining to paramedics. Therefore, the aim of this study was to create two filters to meet to different needs of paramedic clinicians and academics.MethodsWe created a gold standard from a reference set, which we measured against single terms and search filters. The words and phrases used stemmed from selective exclusion of terms from the previously published Prehospital Search Filter 2.0 as well as a Delphi session with an expert panel of paramedic researchers. Independent authors deemed articles paramedic-relevant or not following an agreed definition. We measured sensitivity, specificity, accuracy and number needed to read (NNR).ResultsWe located 2102 articles of which 431 (20.5%) related to paramedics. The performance of single terms was on average of high specificity (97.1% (Standard Deviation 7.4%), but of poor sensitivity (12.0%, SD 18.7%). The NNR ranged from 1 to 8.6. The sensitivity-maximising search filter yielded 98.4% sensitivity, with a specificity of 74.3% and a NNR of 2. The specificity-maximising filter achieved 88.3% in specificity, which only lowered the sensitivity to 94.7%, and thus a NNR of 1.48.ConclusionsWe have created the first two paramedic specific search filters, one optimised for sensitivity and one optimised for specificity. The sensitivity-maximising search filter yielded 98.4% sensitivity, and a NNR of 2. The specificity-maximising filter achieved 88.3% in specificity, which only lowered the sensitivity to 94.7%, and a NNR of 1.48. A paramedic MeSH term is needed.Electronic supplementary materialThe online version of this article (10.1186/s12911-017-0544-z) contains supplementary material, which is available to authorized users.

Background: Empathy is a difficult characteristic to define, teach and assess; the 'nebulous' properties of empathic behaviour often means that educators fail to incorporate the explicit teaching and assessment of empathy within the curriculum. One solution suggested is that teaching empathy in an interprofessional education setting is an effective educational approach in developing empathic behaviours. Method: Student participants from Monash University, Deakin University, University of South Australia, and Edith Cowan University completed a self-reporting survey package pre and post two-hour empathy workshop consisting of the Jefferson Scale of Empathy -Health Profession -Student version (JSE-HP-S). Results: A total of 293 students from 12 different medical and health care professions participated in the empathy workshops. The majority of participants were from Monash University n = 230 (78 %), the nursing profession n = 59 (20 %), < 26 years of age n = 215 (73 %) and enrolled in first year studies n = 123 (42 %). Using a paired t-test repeated measure self-reported empathy levels improved at p < 0.0001, mean 114.34 vs. 120.32 (d = 0.22). Conclusion: This project has shown that self-reported empathy levels have been shown to statistically improve following DVD simulation-based workshops.

Introduction Although paramedicine is an integral element of healthcare systems, there is a lack of universal consensus on its definition. This study aimed to derive a global consensus definition of paramedicine. Methods Key attributes pertaining to paramedicine were identified from existing definitions within the literature. Utilising text analysis, common attribute themes were identified and six initial domains were developed. These domains formed the basis for a four-round Delphi study with a panel of 58 global experts within paramedicine to develop an international consensus definition. Results Response rates across the study varied from 96.6% (round 1) to 63.8% (round 4). Participant feedback on appropriate attributes to include in the definition reflected the high level of specialized clinical care inherent within paramedicine, and its status as an essential element of healthcare systems. In addition, the results highlighted the extensive range of paramedicine capabilities and roles, and the diverse environments within which paramedics work. Conclusion Delphi methodology was utilized to develop a global consensus definition of paramedicine. This definition is as follows: paramedicine is a domain of practice and health profession that specialises across a range of settings including, but not limited to, emergency and primary care. Paramedics work in a variety of clinical settings such as emergency medical services, ambulance services, hospitals and clinics as well as non-clinical roles, such as education, leadership, public health and research. Paramedics possess complex knowledge and skills, a broad scope of practice and are an essential part of the healthcare system. Depending on location, paramedics may practice under medical direction or independently, often in unscheduled, unpredictable or dynamic settings. We believe that the generation and provision of this consensus definition is essential to enable the further development and maturation of the discipline of paramedicine.

No abstract