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59 results

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  • Consensus Standard for Evidence Integration into EMS Education and High-Stakes Testing

  • Christopher B. Gage, Mark Terry, Kim D. McKenna, Jonathan R. Powell, Megan Hollern, Matt Ozanich, Christopher T. Richards, Christian Martin-Gill, Ashish R. Panchal
  • Journal:
    Prehospital and Disaster Medicine / Volume 38 / Issue 3 / June 2023
    Published online by Cambridge University Press:
    04 May 2023, pp. 338-344
    Print publication:
    June 2023
    • Article
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  • Background:

    Incorporating emerging knowledge into Emergency Medical Service (EMS) competency assessments is critical to reflect current evidence-based out-of-hospital care. However, a standardized approach is needed to incorporate new evidence into EMS competency assessments because of the rapid pace of knowledge generation.

    Objective:

    The objective was to develop a framework to evaluate and integrate new source material into EMS competency assessments.

    Methods:

    The National Registry of Emergency Medical Technicians (National Registry) and the Prehospital Guidelines Consortium (PGC) convened a panel of experts. A Delphi method, consisting of virtual meetings and electronic surveys, was used to develop a Table of Evidence matrix that defines sources of EMS evidence. In Round One, participants listed all potential sources of evidence available to inform EMS education. In Round Two, participants categorized these sources into: (a) levels of evidence quality; and (b) type of source material. In Round Three, the panel revised a proposed Table of Evidence. Finally, in Round Four, participants provided recommendations on how each source should be incorporated into competency assessments depending on type and quality. Descriptive statistics were calculated with qualitative analyses conducted by two independent reviewers and a third arbitrator.

    Results:

    In Round One, 24 sources of evidence were identified. In Round Two, these were classified into high- (n = 4), medium- (n = 15), and low-quality (n = 5) of evidence, followed by categorization by purpose into providing recommendations (n = 10), primary research (n = 7), and educational content (n = 7). In Round Three, the Table of Evidence was revised based on participant feedback. In Round Four, the panel developed a tiered system of evidence integration from immediate incorporation of high-quality sources to more stringent requirements for lower-quality sources.

    Conclusion:

    The Table of Evidence provides a framework for the rapid and standardized incorporation of new source material into EMS competency assessments. Future goals are to evaluate the application of the Table of Evidence framework in initial and continued competency assessments.

Spirituality and Psychiatry
  • 2nd edition
  • Edited by Christopher C. H. Cook, Andrew Powell
  • Published online:
    07 October 2022
    Print publication:
    20 October 2022
  • Spirituality and Psychiatry addresses the crucial but often overlooked relevance of spirituality to mental well-being and psychiatric care. This updated and expanded second edition explores the nature of spirituality, its relationship to religion, and the reasons for its importance in clinical practice. Contributors discuss the prevention and management of illness, and the maintenance of recovery. Different chapters focus on the subspecialties of psychiatry, including psychotherapy, child and adolescent psychiatry, intellectual disability, forensic psychiatry, substance misuse, and old age psychiatry. The book provides a critical review of the literature and a response to the questions posed by researchers, service users and clinicians, concerning the importance of spirituality in mental healthcare. With contributions from psychiatrists, psychologists, psychotherapists, nurses, mental healthcare chaplains and neuroscientists, and a patient perspective, this book is an invaluable clinical handbook for anyone interested in the place of spirituality in psychiatric practice.

  • Treatment exposures stratify need for echocardiographic screening in asymptomatic long-term survivors of hematopoietic stem cell transplantation

  • Seth J. Rotz, Adam Powell, Kasiani C. Myers, Michael D. Taylor, John L. Jefferies, Adam Lane, Javier A. El-Bietar, Stella M. Davies, Christopher E. Dandoy, Thomas D. Ryan
  • Journal:
    Cardiology in the Young / Volume 29 / Issue 3 / March 2019
    Published online by Cambridge University Press:
    12 February 2019, pp. 338-343

  • We sought to define the prevalence of echocardiographic abnormalities in long-term survivors of paediatric hematopoietic stem cell transplantation and determine the utility of screening in asymptomatic patients. We analysed echocardiograms performed on survivors who underwent hematopoietic stem cell transplantation from 1982 to 2006. A total of 389 patients were alive in 2017, with 114 having an echocardiogram obtained ⩾5 years post-infusion. A total of 95 patients had echocardiogram performed for routine surveillance. The mean time post-hematopoietic stem cell transplantation was 13 years. Of 95 patients, 77 (82.1%) had ejection fraction measured, and 10/77 (13.0%) had ejection fraction z-scores ⩽−2.0, which is abnormally low. Those patients with abnormal ejection fraction were significantly more likely to have been exposed to anthracyclines or total body irradiation. Among individuals who received neither anthracyclines nor total body irradiation, only 1/31 (3.2%) was found to have an abnormal ejection fraction of 51.4%, z-score −2.73. In the cohort of 77 patients, the negative predictive value of having a normal ejection fraction given no exposure to total body irradiation or anthracyclines was 96.7% at 95% confidence interval (83.3–99.8%). Systolic dysfunction is relatively common in long-term survivors of paediatric hematopoietic stem cell transplantation who have received anthracyclines or total body irradiation. Survivors who are asymptomatic and did not receive radiation or anthracyclines likely do not require surveillance echocardiograms, unless otherwise indicated.

  • Chapter 11 - Genocide

  • from Part I - Problems Related to Health, Safety, and Security
  • Edited by A. Javier Treviño, Wheaton College, Massachusetts
  • Book:
    The Cambridge Handbook of Social Problems
    Published online:
    16 March 2018
    Print publication:
    22 March 2018, pp 173-196

  • Summary

    Genocide is a political concept designed to guarantee cultural groups a right to life comparable to that guaranteed to individuals by human rights. Its meaning is essentially contested and ranges from restricted definitions which focus on deliberate physical extermination of ethnic or racial groups to broader definitions which include systematic cultural destruction and/or the annihilation of political and social groups. Genocide can be found throughout human history, and it has been practiced by groups of all cultural and ideological orientations. In the modern era, genocide has been implemented by socialist, fascist, and liberal governments and by Western and non-Western states. Contemporary theories of genocide focus on the interaction of power struggles involving processes of class, gender, culture, and social psychology. Effective prevention will require going beyond armed humanitarian intervention to address the fundamental procedures by which nation-states handle cultural difference.

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