Near peer teaching is becoming increasingly popular within healthcare education. The experiences and effects of near-peer teaching upon the near-peer teachers' academic performance are poorly understood. In order to address this, the objective of this study was to examine whether a near-peer teaching program improved the overall clinical unit scores of undergraduate paramedic near-peer teachers. Students in their final year of an undergraduate paramedic, or nursing/paramedic degree were given the opportunity to volunteer as near-peer teachers for a first year clinical skills unit. The overall unit scores in a final year clinical unit of 74 students involved in the near-peer teaching program were compared with a randomly selected sample not involved. 74 students participated in this study as near-peer teachers between 2011-2013 (n=23 in 2011, n=18 in 2012, n=33 in 2013). In each year, the median clinical unit grade of participating near-peer teachers was significantly higher than that of the students not involved in the near-peer teaching program when examined using a Mann-Whitney U Test (71 vs 67, p=0.006 in 2011; 76 vs 72, p=0.007 in 2012; 75 vs 71, p=0.004 in 2013). This study has demonstrated that participation in a near-peer teaching program can result in improved overall clinical unit grades for undergraduate paramedic near-peer teachers. This study has added objective data to the variety of subjective information evaluating the effects of near-peer teaching upon the teachers themselves.

Burnout is common among clinical specialties and has implications on the residents' wellbeing and mental health. Evidence suggests that optimism and burnout are correlated, but research has not focused on the applicability to medical residents. The objective of the study was to define burnout in residents and correlate it with optimism. Methods The authors conducted a correlational, prospective cross-sectional study using self-reported single item burnout (1-10) and Life Oriented Test-Revised (LOT-R) (0-24) survey instruments among residents of neurosurgery, neurology, internal medicine, family medicine and emergency medicine at a community-based hospital. Residents were asked to fill out the survey once in the 2018 academic year and once again in the 2019 academic year. Burnout and optimism scores were correlated and compared across subgroups for each year.

Papilledema is a swelling of the optic disc secondary to elevated intracranial pressure (ICP). We analyzed 79 peer-review journal articles and provided a concise summary of the etiology, epidemiology, pathophysiology, clinical presentation, evaluation, natural history, differential diagnosis, treatment, and prognosis of papilledema. Only studies written in English with the full text available were included. Although many etiologies of papilledema exist, idiopathic intracranial hypertension is the most common and, thus, a large focus of this review.

IntroductionPaediatric patients comprise a reasonable minority of paramedic workload, but cases involving children often evoke anxiety and discomfort. Subsequent feelings of low confidence and self-efficacy have been linked with a reluctance to initiate treatment and possibly, poorer care. It is unknown to what extent these apprehension-producing perceptions are held by paramedics and what educational strategies can improve them. This study aims to fill this gap by reporting on a scoping review that examined and mapped the effectiveness of educational interventions on improving paramedic perceptions of caring for paediatric patients.MethodsArksey and O’Malley’s scoping methodology was used. CINAHL, AMED, EMBASE, MEDLINE and PsychINFO databases were searched, alongside several networks and grey literature services. The search strategy was validated by a subject research-librarian. Two reviewers independently reviewed retrieved articles against inclusion and exclusion criteria determined in advance.ResultsSeventeen articles were included in the review, comprising six conference abstracts, one letter to the editor and 10 journal articles. These articles were categorised into three themes: identifying educational needs and preferences, novel education programs and evaluating education delivery methods.ConclusionParamedics feel uncomfortable treating paediatric patients and desire more paediatric training, particularly simulation and exposure to children. There is insufficient evidence to demonstrate superior effectiveness of any particular training program. While the most effective education delivery method is unclear, it seems web-based learning can be as effective as traditional teaching. The efficacy of existing pre-established paediatric training programs needs to be investigated, alongside paediatric education in the initial training curriculum. Further research, particularly from outside the United States of America, is needed to identify and develop the most effective educational intervention to improve paramedic confidence with paediatric patients.

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Methamphetamine or “meth” is a sympathomimetic amine of the amphetamine-type substances (ATS) class with an extremely high potential for abuse. Illicitly abused neurostimulants like cocaine and meth predispose patients to the aneurysmal formation with reported rupture at a younger age and in much smaller sized aneurysms. However, very rapid growth of aneurysm within less than 2 weeks with methamphetamine abuse is very rarely observed or reported. In this report, we present a patient with repeated and recurrent meth abuse who demonstrated rapid growth of a pericallosal aneurysm over the period of less than two weeks. The pathophysiology of stroke related to meth and ATS abuse is multifactorial with hypertension, tachycardia, and vascular disease postulated as major mechanisms. The rapid growth of an aneurysm has a high risk of aneurysmal rupture and SAH, which is a neurosurgical emergency and therefore warrants careful consideration and close monitoring. This case confirms the dynamic temporal effects of methamphetamine use on intracranial vessels and this specific neurostimulants association to rapid aneurysmal formation. In light of vascular pathologies the possibility of drug-induced pseudoaneurysm should also be considered in young patients with history of meth abuse.

Background: The novel severe acute respiratory syndrome coronavirus 2 is responsible for over 83 million cases of infection and over 1.8 million deaths since the emergence of the COVID-19 pandemic. Because COVID-19 infection is associated with a devastating mortality rate and myriad complications, it is critical that clinicians better understand its pathophysiology to develop effective treatment. Cumulative evidence is suggestive of cerebral aneurysms being intertwined with the hyperinflammatory state and hypercytokinemia observed in severe COVID-19 infections. Case Description: In case example 1, the patient presents with chills, a mild cough, and sore throat. The patient develops high-grade fever of 39.8° C, decreased oxygen saturation of 93% on room air, and an extensive spontaneous subarachnoid hemorrhage (SAH) in the basal cisterns from a ruptured left posterior communicating artery aneurysm. In case example 2, the patient presents with a positive PCR test for COVID-19 2 weeks prior with spontaneous SAH and found to have a large multilobulated bulbous ruptured aneurysm of the anterior communicating artery. Both patients’ symptoms and high-grade fever are consistent with hypercytokinemia and a hyperinflammatory state, with elevated granulocyte colony-stimulating factor, inducible protein-10, monocyte chemoattractant protein-1, M1P1A, and tumor necrosis factor-α inflammatory mediators found to be elevated in COVID-19 intensive care unit admissions. Conclusion: COVID-19 effect on cerebral aneurysms requires future studies to clearly delineate correlation, however, hypercytokinemia and a hyperinflammatory state are strongly implicated to cause degenerative vascular changes that may predispose patients to cerebral aneurysm formation, change in size or morphology, and resultant aneurysm rupture.