Undergraduate paramedic students and interpersonal communication development: a scoping review.

The objective of this review is to examine the current literature related to interpersonal communication skill development within undergraduate paramedicine. Interpersonal communication is a vital paramedic skill, with evidence demonstrating it leads to improved patient outcomes and satisfaction and reduces medical errors. Interpersonal communication is a core capability set by paramedicine regulatory bodies, and it is the responsibility of accredited universities to ensure graduates are ready for industry and possess all required skills and attributes. In order to be included in this scoping review, all articles were required to meet a pre-determined 'population, concept, context' (PCC) framework. The population was undergraduate paramedic students within the context of their undergraduate paramedicine programs, and the concept was interpersonal communication education/teaching/training. In June 2021, a search was conducted using CINAHL, Medline, Emcare and ERIC. The articles had to be written in English and published between 2011 and 2021 and non-research sources were excluded. 176 articles were identified in this search and after screening for duplicates and relevancy, 15 articles were found to be eligible. The literature highlighted 4 key themes, including graduate perception of 'work readiness', and a variety of learning experiences including alternative work integrated learning (WIL), interactions with specific patient groups and professional learning experiences. The literature demonstrated that interpersonal communication skills are fostered through human interactions, WIL and simulation, within undergraduate paramedicine programs. Findings from the literature review indicate that practising communication through human interactions, afford an increase in confidence, awareness of ability and empathy, and an increased awareness of preconceived biases. Intraprofessional and interprofessional simulation teaching methods demonstrate the potential to build students confidence in communication and awareness of what is required to function well in a team.

Mental health training programs for community pharmacists, pharmacy staff and students: A systematic review.

BACKGROUND: Primary care is often the first point of contact for people living with mental disorders. Community pharmacists, pharmacy staff and students are increasingly being trained to deliver mental health care. However, there is still a gap in the literature exploring the characteristics of all available mental health training programs and their components and their influence on pharmacists, pharmacy staff and students' outcomes. OBJECTIVES: To summarize the evidence evaluating mental health training programs completed by community pharmacists, pharmacy staff and students. More specifically, to explore the components of mental health training programs and identify those that facilitate significant improvements in outcomes. METHODS: A systematic review was conducted following the Cochrane handbook and reported according to PRISMA guidelines. A search for published literature was conducted in three databases (PubMed, Scopus, and Web of Science) in July 2021. Eligible studies were included if they described and evaluated the impact of mental health training programs delivered to community pharmacists, pharmacy staff and pharmacy students regardless of design or comparator. The methodological quality of included studies was appraised using both the NIH quality assessment, to evaluate studies with an uncontrolled pre-post design, and the Cochrane EPOC risk of bias assessment, to evaluate studies with a controlled (randomized and non-randomized) study design. RESULTS: Thirty-three studies were included. Most of the identified mental health training programs contained knowledge-based components and active learning activities. Changes in participants' attitudes, stigma, knowledge, confidence and skills were frequently assessed. An extensive range of self-assessment and observational instruments used to evaluate the impact of the training programs were identified. Positive improvements in participants' attitudes, knowledge and stigma were frequently identified following participation in training programs. CONCLUSIONS: This systematic review highlights the importance of mental health training programs in increasing pharmacists', pharmacy staff and pharmacy students' skills and confidence to deliver mental health care in community pharmacy. Future research should build upon this basis and further focus on finding the most efficient measures to evaluate these training programs and assess their long-term effectiveness, allowing comparison between programs.

Testing the impact of interpersonal regulatory fit on empathy, helping intentions, and prosocial behaviour.

Similarity with others in need regarding various attributes [e.g., social group membership] has been shown to increase individuals' empathic responses, willingness to help and prosocial behaviour. We tested whether a subtle similarity, namely of observers' and targets' self-regulatory orientation in terms of a promotion or prevention regulatory focus [i.e., interpersonal regulatory fit], would entail similar effects. Interpersonal regulatory [mis]fit was conveyed through focus-congruent or -incongruent emotional reactions which targets, facing distressing situations, expressed. We predicted that when observer participants' regulatory focus fits with targets' negative emotional reaction [i.e., promotion focus-dejection or prevention focus-agitation], they would be more likely to express empathy, willingness to help, and to engage in prosocial behaviour towards this target compared to conditions of misfit. Five studies relied on observers' chronic regulatory focus [Study 1, 3, & 4] and situationally induced regulatory focus [Study 2 & 5] and presented different distressing scenarios with targets conveying focus [in]congruent negative emotions. Inconsistent results emerged across the studies, which indicated misfit, fit and no effects. Study characteristics did not suggest a moderator explaining these inconsistent findings. An internal meta-analysis across all studies indicated that overall there was no evidence of either a fit or a misfit effect. This work sheds light on the technical challenges of exploring relations between subtle interpersonal regulatory [mis]fit and prosocial reactions. Implications for future research are discussed, including the importance of creating stronger interpersonal [mis]fit experiences by means of incorporating descriptions of distressed targets' hindered goal pursuits as well as negative reactions.

A qualitative exploration of mental health services provided in community pharmacies.

The burden of mental health problems continues to grow worldwide. Community pharmacists', as part of the primary care team, optimise care for people living with mental illness. This study aims to examine the factors that support or hinder the delivery of mental health services delivered in Australian community pharmacies and proposes ideas for improvement. A qualitative study was conducted comprising focus groups with community pharmacists and pharmacy staff across metropolitan, regional, and rural areas of New South Wales, Australia. Data were collected in eight focus groups between December 2020 and June 2021. Qualitative data were analysed using thematic analysis. Thirty-three community pharmacists and pharmacy staff participated in an initial round of focus groups. Eleven community pharmacists and pharmacy staff participated in a second round of focus groups. Twenty-four factors that enable or hinder the delivery of mental health services in community pharmacy were identified. Participant's perception of a lack of recognition and integration of community pharmacy within primary care were identified as major barriers, in addition to consumers' stigma and lack of awareness regarding service offering. Suggestions for improvement to mental health care delivery in community pharmacy included standardised practice through the use of protocols, remuneration and public awareness. A framework detailing the factors moderating pharmacists, pharmacy staff and consumers' empowerment in mental health care delivery in community pharmacy is proposed. This study has highlighted that policy and funding support for mental health services is needed that complement and expand integrated models, promote access to services led by or are conducted in collaboration with pharmacists and recognise the professional contribution and competencies of community pharmacists in mental health care. The framework proposed may be a step to strengthening mental health support delivered in community pharmacies.

Art and knowing in health management education.

Presented is a case illustrating connections between art, learning and the mobilization of knowledge. As part of an assessment task in a postgraduate degree, a student made a painting about her experiences with workplace harassment and bullying in the surgical ward that she managed. I interviewed this student and made my own artworks to better understand her workplace and learning experiences. We then discussed our respective artworks and recorded those conversations. These data suggest that art-making can create powerful learning experiences, change attitude to health management practice, make connections and generate productive conversations within a healthcare organization, and mobilize knowledge. The paper responds to the question: Can art be 'paradigm-shifting' and therefore hold potential for creating a 'good' or better health service? It also reflects on the use of art in health service research more generally, especially in an era considered by some to be 'postparadigmatic.'

The impact of a needs-based model of care on accessibility and quality of care within children's mental health services: A qualitative investigation of the UK i-THRIVE Programme.

BACKGROUND: The i-THRIVE Programme is a needs-based model of care, based on the THRIVE Framework, that is being implemented across the United Kingdom with the aim of improving outcomes for children and young people's mental health and wellbeing. This study aimed to investigate the impact that this programme has on accessibility and quality of care, as viewed by key stakeholders. METHODS: Interviews with professionals and service users were conducted during the implementation of the THRIVE Framework in four sites of one mental health and community service provider. RESULTS: Three themes are identified: 'impact of needs-based groupings on referral', 'impact of collaborative and interagency approach' and 'impact of i-THRIVE on clinical practice'. Findings suggest that accessibility was seen to be promoted through the integration of a needs-based approach, flexible re-referral, signposting and information sharing, the use of goal-orientated interventions and collaboration over risk and treatment endings. Shared decision making was perceived to improve the experience of care for young people, as was interagency working. Goal-focused interventions and upfront discussion of treatment endings were seen to help clinicians manage expectations and discharge but could also compromise effectiveness and engagement. Obstacles to impact were resistance to interagency working and a shortage of resources across the system. CONCLUSIONS: i-THRIVE is a promising approach with the potential to facilitate the accessibility and quality of mental health care. However, a tension exists between enhancing accessibility and quality of care, which points towards the importance of outcome and satisfaction monitoring. Obstacles to impact point to the importance of a whole-system approach supported by sufficient resources across the locality.

Correction and repair: a comparative analysis of a boy with ASD interacting with a parent and with an ABA trainer.

Applied Behaviour Analysis (ABA) is a widely used therapeutic intervention for children with autism spectrum disorder (ASD) yet there has been little research into the interactional organization of ABA sessions. We report a comparative case study of two interactions in which the same child, a 12-year-old boy with ASD, interacts with his father and interacts with an Applied Behaviour Analysis (ABA) trainer. Both interactions occur at home and are drawn from a small corpus (2 h) of children with ASD in domestic settings. Drawing on CA to delineate the sequential relationships between the actions of the adult participant and the child, we present a quantitative and microstructural analysis of 156 directive sequences in order to examine the similarities and differences between the two interactions. We first show that the rate of the production of directives is higher in the ABA session. The analysis then demonstrates the applicability of Schegloff, Jefferson and Sacks' (1977) treatment of repair in conversation to some problems that occur in how the child responses to adults' directives. However, we show that whilst some correction-initiations target problems with hearing, speaking, and understanding, some target substantive problems. We identify a practice, explicating an error, whereby correction-initiations are expanded to point out the nature of the error. This practice can show that the correction-target is being construed as a substantive error. In such cases, the correction-initiation is not a subtype of repair-initiation in the sense of Schegloff, Jefferson and Sacks' (1977) analysis of repair.

Clients' experiences of shared decision making in an integrative psychotherapy for depression.

Mental health and general health care research has shown that practitioners can facilitate patient involvement in shared decision making (SDM) and that the approach can benefit patients who wish to take part in decisions around their care. Yet patient experiences of SDM within a psychotherapy context have been little researched. This study examined how clients experienced SDM in a collaborative-integrative psychotherapy. A grounded theory approach used interpersonal process recall interviewing and supplementary semi-structured interviews to investigate 14 clients' experiences of SDM in pluralistic psychotherapy for depression. Verbatim transcripts were coded into 819 meaning units across six categories containing 13 subcomponents that comprised a single, core category. The six categories were (a) experiencing decisions as shared, (b) psychotherapists supporting clients to become more active in the decision-making process, (c) both parties presenting and recognizing expert knowledge, (d) clients felt recognized as an individual and accommodated for by their psychotherapist, (e) clients felt comfortable engaging with the decision-making process, and (f) daunting for clients to be asked to take part in decision discussions. A core category emerged of "Psychotherapists encourage client participation and progressively support clients to provide information and contributions towards shared treatment decisions that could be led equally, or marginally more by one party." Such support was particularly useful when clients had difficulty contributing as part of decision discussions. Client preferences for SDM change across clients and across decisions, highlighting the importance of practitioners remaining flexible to individual clients when using the approach.

An Alternative Pedagogy for the Teaching of Anatomy and Physiology Beyond the Classroom.

This article was migrated. The article was marked as recommended. Valuing Indigenous culture is a requirement for teaching at the Charles Sturt University and we enact this on the Port Macquarie and dubbo campuses through the principles of Indigenous pedagogy/andragogy (IP). In this paper we share our experiences of IP-inspired learning activities, in particular our use of the 8 Aboriginal Ways of Learning ( Yunkaporta, 2009), to increase student engagement with anatomy and physiology and support the retention of Indigenous students in their first year of university study. Indeed, we propose that this approach will increase the educational success of all students.

Lemierre's Syndrome - A rare cause of disseminated sepsis requiring multi-organ support.

Lemierre's syndrome is a rare complication of acute pharyngitis characterised by septicaemia with infective thrombophlebitis of the internal jugular vein, most commonly due to Fusobacterium necrophorum. It characteristically affects healthy young adults causing persistent pyrexia and systemic sepsis presenting several days after an initial pharyngitis. Septic emboli seed via the bloodstream to distant sites including the lung, joints, skin, liver, spleen and brain. Prolonged antimicrobial therapy is required and admission to intensive care common. This once rare condition is increasing in incidence but awareness amongst clinicians is low. We present a classic case in a young man who developed multi-organ failure requiring intensive care support and describe the epidemiology, pathophysiology, microbiology, clinical features and management of the disease.

Portraying Reflexivity in Health Services Research.

A model is proposed for supporting reflexivity in qualitative health research, informed by arguments from Bourdieu and Finlay. Bourdieu refers to mastering the subjective relation to the object at three levels-the overall social space, the field of specialists, and the scholastic universe. The model overlays Bourdieu's levels of objectivation with Finlay's three stages of research (pre-research, data collection, and data analysis). The intersections of these two ways of considering reflexivity, displayed as cells of a matrix, pose questions and offer prompts to productively challenge health researchers' reflexivity. Portraiture is used to show how these challenges and prompts can facilitate such reflexivity, as illustrated in a research project.

Implementation of evidence-based practice: A naturopath perspective.

Evidence-based practice (EBP), an approach to clinical practice that places emphasis on the use of best available research evidence for decision-making, has been adopted broadly in clinical practice. As a patient-focused approach, EBP promotes the spirit of inquiry. It can also facilitate consistency of care across professional boundaries, and clarify the directions of research. However, over-emphasis on systematic reviews and randomised control trials as the "gold standard" for evidence is a major limitation of EBP as it is being practised today. There are also objections to EBP based on epistemological grounds. Complementary and alternative medicine (CAM) therapies often fare unfavourably under the scrutiny of EBP due to the lack of research and inherent differences in healing ideology. Naturopathy is a unique form of CAM, based on both traditional and scientific knowledge. We argue that there is no conflict between naturopathy and EBP. EBP can be adopted as a useful approach to assimilate scientific evidence in naturopathic practices. However, naturopaths need to reconcile tensions between traditional and scientific knowledge in their choice of treatment remedies, while adhering to the naturopathic principles of healing, to benefit the patients. They must also maintain their emphasis on clinical expertise, and also patient preferences and values, in clinical decision-making.

Gearing up to a new activity: how teachers use object adjustments to manage the attention of children with autism.

Children with autism have characteristic difficulties with joint attention. In educational settings, this can present a challenge when directing a child's attention to new objects and activities. Drawing on videotaped interactions between teachers and two children with autism recorded in Finland, we use conversation analysis to examine how teachers manage such transitions during one-to-one teaching. We show how adjusting material objects can be used to manage the child's engagement and how these adjustments can escalate into more conspicuous actions so as to direct the child's attention. Rather than examining participants' use of communicational objects, we are instead concerned with practices that use task-related objects. We thereby offer an empirically grounded account of the interactional practices involved in achieving joint attention through the objects themselves.

Estimating the gaze of a virtuality human.

The aim of our experiment is to determine if eye-gaze can be estimated from a virtuality human: to within the accuracies that underpin social interaction; and reliably across gaze poses and camera arrangements likely in every day settings. The scene is set by explaining why Immersive Virtuality Telepresence has the potential to meet the grand challenge of faithfully communicating both the appearance and the focus of attention of a remote human participant within a shared 3D computer-supported context. Within the experiment n=22 participants rotated static 3D virtuality humans, reconstructed from surround images, until they felt most looked at. The dependent variable was absolute angular error, which was compared to that underpinning social gaze behaviour in the natural world. Independent variables were 1) relative orientations of eye, head and body of captured subject; and 2) subset of cameras used to texture the form. Analysis looked for statistical and practical significance and qualitative corroborating evidence. The analysed results tell us much about the importance and detail of the relationship between gaze pose, method of video based reconstruction, and camera arrangement. They tell us that virtuality can reproduce gaze to an accuracy useful in social interaction, but with the adopted method of Video Based Reconstruction, this is highly dependent on combination of gaze pose and camera arrangement. This suggests changes in the VBR approach in order to allow more flexible camera arrangements. The work is of interest to those wanting to support expressive meetings that are both socially and spatially situated, and particular those using or building Immersive Virtuality Telepresence to accomplish this. It is also of relevance to the use of virtuality humans in applications ranging from the study of human interactions to gaming and the crossing of the stage line in films and TV.

Factors influencing the successful integration of ambulance volunteers and first responders into ambulance services.

This study identifies the factors associated with the successful integration of ambulance volunteers and first responders into major ambulance services in Australia and New Zealand and then proposes a model of volunteer management for ambulance services. All ten members of the Australasian Council of Ambulance Authorities completed a questionnaire describing their volunteer and first-responder staff, their numbers and deployment, and the management and integration of volunteers within their respective organisations. Eight senior managers responsible for ambulance volunteers and first responders from six States of Australia and one region of New Zealand subsequently participated in semistructured interviews. Analysis of interview transcripts and publicly available data revealed facilitative factors associated with strong, vibrant ambulance volunteer systems. These facilitative factors are commitment to volunteer models of service delivery; a degree of management decentralisation and volunteer input into decision-making; commitment of resources towards the volunteer model; and the organisational integration of volunteers into the ambulance service. The proposed facilitative model of volunteer management developed aims to encourage the adoption of positive and innovative strategies to improve the integration of ambulance volunteers and first responders in ambulance services. The model consists of four components: leadership; integrative processes; resource commitment; and relative autonomy. The first three of these relate directly to the organisation, while the fourth concerns the volunteers themselves. If these approaches were replicated more widely, a viable and effective volunteer emergency health response system could be established in those areas where it is uneconomic or impractical to provide a salaried ambulance service staffed with professionally qualified paramedics.

Using conversation analysis to explore the recurrence of a topic in the talk of a boy with an autism spectrum disorder.

Some higher functioning individuals with autism spectrum disorders (ASDs) are reported to produce perseverative talk, especially around 'special interests'. Topic perseveration is a form of pragmatic impairment captured in Prizant and Rydell's (1993) continuum of unconventional verbal behaviour in autism. Although widely reported, there is little systematic empirical research into this phenomenon. This paper considers the utility of Conversation Analysis in developing knowledge in this area, drawing upon data involving a boy with an ASD interacting with a researcher and a mobile robot platform. Although a frequency analysis of the boy's talk on a single topic may suggest that it is perseverative in nature, in a sequential analysis of both talk and non-spoken activities this study aims to show how these may be interactionally-embedded. It is suggested that, in considering the interactional salience of apparently perseverative talk, it can be useful to explore the participation framework in which the topic is revisited.

Residents' satisfaction with multi-purpose services.

AIM: To establish a system for measuring resident satisfaction in multi-purpose services, benchmarking and performance improvement. SETTING: Six multi-purpose services in rural New South Wales were involved in the project. DESIGN: Residents were surveyed and the results benchmarked. Benchmarking included a comparison of results along with an exploration of work processes across participating sites. This preceded quality improvement activities conducted by individual multi-purpose services. Resident surveys were repeated and staff and managers interviewed. OUTCOMES: Benchmarking was a useful method for identifying performance leaders and enabling the dissemination of better practice. The majority of staff members were comfortable with the PDSA (Plan, Do, Study, Act) quality improvement cycle to guide their improvement efforts. The ability of staff to complete quality improvement cycles was related to the management styles of their supervisors. Resident satisfaction was related to the understanding and confidence of staff. CONCLUSION: A resident satisfaction survey can provide the direction for effective quality improvement activities. Benchmarking results with other sites not only empowers staff members at those sites recognised as leaders, but can also stimulate dissemination of leading practice. Management styles which empower staff enhance their ability to implement quality improvement projects.

Two forms of spoken repetition in a girl with autism.

BACKGROUND: The talk of persons with autistic spectrum disorders (ASD) often features distinctive forms of repetition (echophenomena). Although often characterized as meaningless or inappropriate, there is evidence that such practices can sometimes have communicative functions. AIMS: To investigate the interactional organization of repetition practices found in the talk of an adolescent girl with an ASD. METHODS & PROCEDURES: As part of a project examining the interactional practices of children with ASD, we video-recorded 6 hours of activity in a school classroom for severe learning difficulty (SLD) children. This paper considers instances of repeated talk produced by a class pupil, 'Helen'. The analysis involved assembling a collection of examples of the repeated talk which were then transcribed in detail. Conversation Analysis was used to explore the sequential contexts in which they occur and precisely how they are produced. OUTCOMES & RESULTS: Two forms of repetition occur very frequently in Helen's talk: first, repeats of turn-final lexical items from another speaker's immediately before talk (prior-turn repeats, a form of immediate echolalia), and second, repeats of the first item within a turn such that a turn is produced consisting entirely of repeated items (within-turn repeats). The latter appears to be a form of palilalia (repeats of one's own prior talk) that has not been widely reported in ASD. The prior turn repeats follow other speaker's initiating actions (e.g. questions) that are addressed specifically to Helen and make a response from her relevant. Helen apparently uses these to demonstrate that she has nevertheless heard, and is orienting to, that prior turn. Within-turn repeats are tied to and bounded by the accomplishment of non-vocal activities, e.g. handing an object to a co-participant, such that the repetitions cease when the object has reached its recipient. The two forms of repetition frequently co-occur to display on-going engagement with a recipient's prior turn. CONCLUSIONS: Although Helen has limited verbal resources she is more interactionally competent than this may initially suggest. We propose that these repetition practices may constitute an adaptation to interacting with a limited lexicon. We discuss the relevance of Conversational Analysis for understanding autistic children's pragmatic competence, and the implications for remediation and further research.

Exhaled nitric oxide increases following admission for intravenous antibiotics in children with cystic fibrosis.

BACKGROUND: Lack of standardisation for the measurement of exhaled nitric oxide (NO) (FENO) has resulted in conflicting data in cystic fibrosis (CF). The aim of this study was to assess whether FENO is a useful non-invasive marker of lung disease in CF by assessing the effect of intravenous (IV) antibiotics on FENO. METHODS: FENO was measured on line, according to recently published ERS/ATS guidelines, using a chemiluminescence analyser together with pulmonary function in 14 CF children prior to and following a course of IV antibiotics. RESULTS: There was a significant improvement in mean (S.E.M.) % FEV1 from 60.0 (6.3) to 68.0 (5.4) (P < 0.05) and mean (S.E.M.) % FVC from 66.3 (5.5) to 75.1 (4.9) (P < 0.01). FENO increased significantly from median (range) 5.8 (2.0-14.3) to 9.2 ppb (0.8-25.1) (P < 0.05). There was no correlation between FE(NO) and lung function. Subgroup analysis on those with chronic Pseudomonas aeruginosa infection (n = 6) demonstrated no significant change in FENO. CONCLUSIONS: Using a flow of 50 ml/s, FENO increases following admission for IV antibiotic treatment in children with CF but does not correlate with lung function. It is not a useful marker of lung diseases in CF, which has implications for clinical practice.