Designing emergency ambulances for the 21st century.

BACKGROUND: In 2005 the Department of Health set out a vision for the provision of future ambulance services with an increasing range of quality mobile healthcare services for patients with urgent and emergency care needs. This paper describes a scoping study funded by the National Patient Safety Agency and Ambulance Service Association to investigate the short and longer term requirements of future emergency ambulances. METHOD: Four stakeholder workshops were held to explore the wishes, concerns and preferences of the clinicians, operational staff and manufacturers about the future provision of ambulance services and problems and possible solutions relating to ambulance design and use. Incident reports relating to ambulance design and use were reviewed from three national and international databases. RESULTS: Nine design challenges were identified: access/egress; space and layout; securing people and equipment in transit; communication; security, violence and aggression; hygiene; equipment; vehicle engineering; patient experience. These were validated at the national UK ambulance conference (AMBEX 2006) with a rating questionnaire. CONCLUSION: The results are being used in the development of a national specification for future UK emergency ambulances.

Uniforms: a comparative evaluation of tunic tops.

AIM: The aim of this study was to produce a recommendation for selection of a tunic top for female nurses, based on previously established ergonomic criteria. METHOD: Four tunic top designs were evaluated using functional tests, including anthropometry, body-part discomfort charts, product feature questionnaires and comparative ranking. A convenience sample of nurses from one trust wore the tunics during the study tests. The trial draws heavily on previous research on nurses' uniforms and applies ergonomic criteria to tunic top design. RESULTS: The researchers were not able to identify on optimum design using the results of the trial. The tunics compared were relatively restrictive, with one tunic being identified as the least restrictive of the four. CONCLUSION: The researchers are now taking this initiative forward in a participatory ergonomics project with nursing staff to try to produce a uniform design that will meet functional ergonomic criteria. Prototypes will be evaluated using the protocol from this trial.

Flashbacks among soldiers discharged as unfit who abused more than one drug.

Of 280 soldiers discharged from military service in 1971 as unfit, 207 reported the heavy use of at least one drug (most of these abused more than one drug) and 146 (52%) reported having flashbacks. Most flashbacks were of a simple visual nature, but repeat "trips," complex subjective experiences, and persistent difficulties in concentration were often reported. The prevalence and severity of flashbacks increased with drug use, particularly with hallucinogens and marijuana. Because psychological, social, and physiological factors may all contribute to flashback phenomena, other populations need to be studied to determine the extent to which these findings can be generalized.

Drug refusal in schizophrenia and the wish to be crazy.

The extremes of drug compliance were studied in two groups of schizophrenics: 29 habitual drug-refusers who invariably discontinued medication only to be readmitted several months later, and 30 drug-complier patients who habitually came in for their refills or injections of antipsychotic medication. The drug-refusers experienced the resurgence of an ego-syntonic grandiose psychosis after they discontinued medication. The habitual compliers, in contrast, developed decompensations characterized by such dysphoric affects as depression, anxiety, virtual absence of grandiosity, and some awareness of illness. The refusal of these chronic schizophrenics to take their medication could not be attributed to social isolation, paranoid diagnosis, or secondary gain. A discriminant function analysis showed grandiosity to be the most powerful discriminating variable between the two groups. We interpret these findings to mean that some schizophrenics may prefer an ego-syntonic grandiose psychosis to a relative drug-induced normality.

Adopting new models for continuity of care: the ward as mini-mental-health-center.

Several years ago the staff of a traditional psychiatric ward in a Veterans Administration hospital began trying to provide continual care for their former inpatients after they left the hospital. Nursing assistants conducted basic-skills groups and other groups in board-and-care homes; staff members made themselves available to former inpatients and theri families, roommates, or board-and-care sponsors through a 24-hour telephone service and home visits; and a day-care program and follow-up groups for the ward's outpatients were set up. Later the staff establiched additional day-care and follow-up programs in a downtown satellite unit. In a recent three month period, patients made a total of 4488 visits to the satellite and hospital programs. The preceding paper discusses some of the theoretical considerations on which this program and other alternatives to traditional care are based.

Personality factors associated with frequency of marijuana use.

A number of personality and style-of-life variables were found to be significantly related to frequency of marijuana use, in a study of 1215 students on the University of California, Los Angeles, campus. Compared with the non-user, in composite the typical marijuana-user is somewhat depressed, more inclined to doubt his emotional adjustment. He likes to take risks and seeks stimulation; he has strong political opinions; he believes in punishment for law-breakers, but he is more likely to question it. He is not religious; he is less well identified with parents, and he has a lower opinion of their marital adjustment. He is not decisive about career goals; he is a fine arts or liberal arts major. He uses alcohol, sometimes in combination with marijuana; he first tried marijuana after entering college and is not increasing his use. The typical marijuana-user in the sample uses it infrequently, twice a month or less often, and is not likely to be using other drugs. The frequent user probably uses other drugs.