Limited data to support improved outcomes after community paramedicine intervention: A systematic review.

BACKGROUND: Community paramedicine (CP) leverages trained emergency medical services personnel outside of emergency response as an innovative model of health care delivery. Often used to bridge local gaps in healthcare delivery, the CP model has existed for decades. Recently, the number of programs has increased. However, the level of robust data to support this model is less well known. OBJECTIVE: To describe the evidence supporting community paramedicine practice. DATA SOURCES: OVID, PubMed, SCOPUS, EMBASE, Google Scholar-WorldCat, OpenGrey. STUDY APPRAISAL AND SYNTHESIS METHODS: Three people independently reviewed each abstract and subsequently eligible manuscript using prespecified criteria. A narrative synthesis of the findings from the included studies, structured around the type of intervention, target population characteristics, type of outcome and intervention content is presented. RESULTS: A total of 1098 titles/abstracts were identified. Of these 21 manuscripts met our eligibility criteria for full manuscript review. After full manuscript review, only 6 ultimately met all eligibility criteria. Given the heterogeneity of study design and outcomes, we report a description of each study. Overall, this review suggests CP is effective at reducing acute care utilization. LIMITATIONS: The small number of available manuscripts, combined with the lack of robust study designs (only one randomized controlled trial) limits our findings. CONCLUSIONS: Initial studies suggest benefits of the CP model; however, notable evidence gaps remain.

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis.

OBJECTIVES: Intravenous dextrose aids in the resolution of ketosis in dehydrated patients not tolerating oral glucose and is often recommended in this clinical scenario. Our aim was to determine whether the addition of dextrose to intravenous rehydration solutions results in decreased hospital admissions or other clinically important benefits among dehydrated children or adults. METHODS: MEDLINE, EMBASE, Web of Science, SCOPUS, and the Cochrane Library were searched by a medical librarian from inception through November 2017. The inclusion criteria were randomized controlled trials comparing dextrose containing intravenous solutions with intravenous solutions without dextrose in patients being treated for dehydration, and not already hospitalized. RESULTS: The database and bibliographies search identified 1,472 unique citations. Only two trials (N = 333) met the inclusion criteria. Both compared normal saline with solutions of dextrose in normal saline. There was no statistically significant difference in admission rates (relative risk = 0.83; 95% confidence interval = 0.62 to 1.10) or revisits (relative risk = 0.54; 95% confidence interval = 0.24 to 1.22). Heterogeneity was low (I2 = 0). No other outcome results were eligible for pooling, but neither study found differences in any clinical outcomes. No adverse events were reported in either trial. CONCLUSIONS: The addition of dextrose to intravenous saline has not been shown to improve clinical outcomes in dehydrated children presenting to the emergency department with gastroenteritis, but the confidence intervals around the estimate of effect are wide and include the possibility of substantial benefit.

OBJECTIF: Les perfusions de dextrose aident à neutraliser la cétose chez les patients en état de déshydratation qui ne tolèrent pas la prise orale de glucose, et le traitement est souvent recommandé dans ces situations cliniques. L'étude visait donc à déterminer si l'adjonction de dextrose aux solutions de réhydratation intraveineuse se traduisait par une réduction du nombre d'hospitalisations ou offrait d'autres avantages cliniques importants chez les enfants et les adultes. MÉTHODE: Une recherche a été menée dans les bases de données MEDLINE, EMBASE, SCOPUS, la plateforme Web of Science et la bibliothèque Cochrane Library par un bibliothécaire spécialisé dans le domaine médical, depuis leur mise sur pied jusqu'à novembre 2017. Les critères de sélection consistaient en la recherche d'essais à répartition aléatoire, dans lesquels étaient comparées des solutions de perfusion additionnées de dextrose à celles n'en contenant pas chez les patients externes, traités pour de la déshydratation. RÉSULTATS: La recherche documentaire dans les bibliographies et les bases de données a permis de relever 1472 citations uniques; toutefois, 2 essais (n = 333) seulement satisfaisaient aux critères de sélection. Dans les deux cas, on comparait des solutions physiologiques salées à des solutions physiologiques salées additionnées de dextrose. Il n'est ressorti aucun écart significatif en ce qui concerne le taux d'hospitalisation (taux relatif [TR] = 0,83; intervalle de confiance [IC] à 95% = 0,62­1,10) ou de reconsultation (TR = 0,54; IC à 95% = 0,24­1,22). Quant à l'hétérogénéité, elle était faible (I2 = 0). Aucun autre résultat ne se prêtait à une mise en commun, mais il ne s'est pas dégagé non plus de différence entre les deux études à l'égard de quelque résultat clinique que ce soit. Enfin, aucun événement indésirable n'a été signalé dans l'un ou l'autre des essais. CONCLUSION: L'adjonction de dextrose aux solutions physiologiques salées ne s'est pas traduite par une amélioration des résultats cliniques chez les enfants en état de déshydratation, traités au service des urgences pour une gastroentérite; toutefois, les intervalles de confiance entourant l'estimation des effets sont larges et pourraient comporter des avantages importants.

A University-Wide Collaborative Effort to Designing a Makerspace at an Academic Health Sciences Library.

This article describes the planning and development of a 3D printing makerspace at an academic health sciences library. At the start of 2015, a new library Technology Team was formed consisting of a team leader, an emerging technologies librarian, and a library systems analyst. One of the critical steps in the development of the proposal and with the planning of this project was collaborating and partnering with different departments and units outside the library. These connections helped shape the design of the makerspace.

Pathways to the first contact with specialist mental health care.

OBJECTIVE: To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care. METHOD: One hundred and forty-six consecutive Australian-born, Asian and Arabic-speaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed. RESULTS: An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the help-seeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English fluency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals. CONCLUSIONS: The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.