Student compliance with taught indications for intravenous cannulation during clinical learning

Abstract: One of the guiding principles behind the teaching and performance of a medical intervention is to “firstly do no harm”. Gaining access to a patient’s circulatory system for the purposes of administering fluid and / or medications is commonly achieved through a procedure that involves piercing the skin with a needle and inserting a cannula into a vein. Whilst intravenous (IV) cannulation remains a relatively common procedure, routinely performed by a number of health care professionals, it has the potential to create unintended adverse effects. Subjecting patients to medical procedures in the absence of a clearly established need may be considered an unethical form of “overtreatment”. Conversely, failing to perform an intervention when it is clearly indicated is equally undesirable. For this reason, it is important that medical professionals and educators ensure a real need or indication for IV cannulation exists prior to the performance of the procedure by students. The University of Johannesburg (UJ) is one of four higher education institutions in South Africa that currently offer a four-year professional bachelor degree in emergency medical care. Intravenous cannulation is a clinical procedure that is taught in the second year of study. The didactic approach followed at the UJ is to firstly teach and assess theoretical knowledge and understanding relating to the procedure with regard to the technique, indications, risks and benefits. The procedure is then demonstrated, practiced and assessed in a simulated environment making use of an intravenous trainer (medium fidelity manikin). Thereafter students are required to demonstrate performance of the procedure a set number of times on real patients. Whilst this naturally creates a desire in students to perform IV cannulation when the opportunity presents itself, as mentioned above, seeking clear indications for the performance of the procedure is essential to prevent unnecessary exposure of patients to potential adverse effects. The Department of Emergency Medical Care at the UJ currently teaches four indications for intravenous cannulation in the pre-hospital setting which are well supported by literature. These include: a) the administration of intravenous fluid in an effort to reverse hypovolaemic and associated dehydrated states, b) administration of intravenous medications, c) securing intravenous access in the case of acutely-ill, high-acuity “priority 1” or “code red” patients and d) obtaining blood samples/specimens for further laboratory testing. The authors aimed to assess the extent to which emergency medical care students may have been establishing IV access on patients during the course of their clinical learning without a clear indication

Underlying barriers to referral to paediatric palliative care services: knowledge and attitudes of healthcare professionals in a paediatric tertiary care centre in the United Kingdom

Referrals to children’s palliative care services typically occur late in the illness trajectory, with many children who would benefit not referred at all. Previous studies report health care professionals’ (HCPs) assessment of various parent-related factors as barriers to referral. We conducted a cross-sectional survey of HCPs working in a paediatric tertiary care hospital in the United Kingdom, with an established paediatric palliative care team, to explore staff perceptions of barriers, knowledge and attitudes, with the aim of developing interventions to increase patient access to palliative care services. Survey respondents evidenced good knowledge of the principles of palliative care in closed questions, but their attitudes expressed in open-text questions and reported reasons to refer to a palliative care service demonstrated an association of palliative care with death and dying. We suggest that the association of palliative care with end of life may be a modifiable factor relevant to late and non-referral and deserving of further investigation and attention in education and training

Not fitting in and getting out : psychological type and congregational satisfaction among Anglican churchgoers in England

Listening to the motivations reported by individuals for ceasing church attendance and becoming church leavers, Francis and Richter identified high on the list the sense of "not fitting in". Drawing on psychological type theory, several recent studies have documented the way in which some psychological types are over-represented in church congregations and other psychological types are under-represented. Bringing these two observations together, the present study tested the hypothesis that church congregations have created type-alike communities within which individuals displaying the opposite type preferences are more likely to feel marginalised and to display lower levels of satisfaction with the congregations they attend. Data were provided by 1867 churchgoers who completed a measure of psychological type, together with measures of frequency of attendance and congregational satisfaction. These data confirmed that congregations were weighted towards preferences for introversion, sensing, feeling and judging, and that individuals displaying the opposite preferences (especially intuition, thinking and perceiving) recorded lower levels of congregational satisfaction. The implications of these findings are discussed for promoting congregational retention by enhancing awareness of psychological type preferences among those who attend

Self-Sacrifice and the Transformation of the Hero

The literary notion of a hero is often steeped in great deeds, such as vanquishing the monster, completing Herculean tasks, or protecting the innocent from harm. The medium of the comic book also provides numerous tales of self-sacrifice that add weight to the legitimacy of a hero and their contribution to a particular society or cause. This article will consider certain themes within the self-sacrificing hero narrative in order to gain further insight into this phenomenon and will draw inspiration from Greek and Norse mythology as well as the Superhero genre within comics and film. Finally, this article will consider the cyclical nature of the hero’s journey and the importance of continual heroic rebirth in sustaining their legacy for new generations of comic book readers and film audiences. What does their sacrifice mean when the hero and even their universe is reborn at a later date

Body odor quality predicts behavioral attractiveness in humans

Growing effort is being made to understand how different attractive physical traits co-vary within individuals, partly because this might indicate an underlying index of genetic quality. In humans, attention has focused on potential markers of quality such as facial attractiveness, axillary odor quality, the second-to-fourth digit (2D:4D) ratio and body mass index (BMI). Here we extend this approach to include visually-assessed kinesic cues (nonverbal behavior linked to movement) which are statistically independent of structural physical traits. The utility of such kinesic cues in mate assessment is controversial, particularly during everyday conversational contexts, as they could be unreliable and susceptible to deception. However, we show here that the attractiveness of nonverbal behavior, in 20 male participants, is predicted by perceived quality of their axillary body odor. This finding indicates covariation between two desirable traits in different sensory modalities. Depending on two different rating contexts (either a simple attractiveness rating or a rating for long-term partners by 10 female raters not using hormonal contraception), we also found significant relationships between perceived attractiveness of nonverbal behavior and BMI, and between axillary odor ratings and 2D:4D ratio. Axillary odor pleasantness was the single attribute that consistently predicted attractiveness of nonverbal behavior. Our results demonstrate that nonverbal kinesic cues could reliably reveal mate quality, at least in males, and could corroborate and contribute to mate assessment based on other physical traits

Guilty Plea Revocation, Constitutional Waiver, and the Charter: A Guilty Plea Is Not A Trap

The entry of a guilty plea has significant constitutional ramifications. It relieves the Crown of its obligation to prove the elements of an offence beyond a reasonable doubt and constitutes a waiver by the accused of various rights including the right to put the Crown\u27s case to the test of a trial, the right to confront Crown witnesses through cross-examination and the right to remain silent in relation to the determination of legal guilt. In light of these constitutional dimensions, the article considers an issue which has received little academic attention: the revocation of a guiltyplea. The authorassesses the existing Canadian common law revocation rule, which he finds to be incompatible with the values expressed in the Canadian Charter of Rights and Freedoms owing to its narrow scope, uncertainty, and discretionary nature. He also considers the rule developed within the American federal court system as a possible alternative to the Canadian approach. The author proposes a revised revocation rule which provides for the withdrawal of a guilty plea where the accused can prove on a balance of probabilities that the guilty plea was either uninformed or involuntary, and which further allows for revocation at any time priorto sentencing unless the Crown can demonstrate that significant prejudice would result from revocation. The author counters the view that the decision to deny the revocation of a guilty plea should be subject to deference on appeal

Improved performance of marron using genetic and pond on using genetic and pond management strategies

Marron (Cherax tenuimanus) are the highest valued freshwater crayfish farmed in Australia. This project addressed the need to increase the profitability of commercial marron farms by improving growth rates and pond management strategies.https://researchlibrary.agric.wa.gov.au/fr_frcr/1002/thumbnail.jp

A randomised feasibility study to investigate the impact of education and the addition of prompts on the sedentary behaviour of office workers

Abstract Background Office workers have been identified as being at risk of accumulating high amounts of sedentary time in prolonged events during work hours, which has been associated with increased risk of a number of long-term health conditions. There is some evidence that providing advice to stand at regular intervals during the working day, and using computer-based prompts, can reduce sedentary behaviour in office workers. However, evidence of effectiveness, feasibility and acceptability for these types of intervention is currently limited. Methods A 2-arm, parallel group, cluster-randomised feasibility trial to assess the acceptability of prompts to break up sedentary behaviour was conducted with office workers in a commercial bank (n = 21). Participants were assigned to an education only group (EG) or prompt and education group (PG). Both groups received education on reducing and breaking up sitting at work, and the PG also received hourly prompts, delivered by Microsoft Outlook over 10 weeks, reminding them to stand. Objective measurements of sedentary behaviour were made using activPAL monitors worn at three time points: baseline, in the last 2 weeks of the intervention period and 12 weeks after the intervention. Focus groups were conducted to explore the acceptability of the intervention and the motivations and barriers to changing sedentary behaviour. Results Randomly generated, customised prompts, delivered by Microsoft Outlook, with messages about breaking up sitting, proved to be a feasible and acceptable way of delivering prompts to office workers. Participants in both groups reduced their sitting, but changes were not maintained at follow-up. The education session seemed to increase outcome expectations of the benefits of changing sedentary behaviour and promote self-regulation of behaviour in some participants. However, low self-efficacy and a desire to conform to cultural norms were barriers to changing behaviour. Conclusions Prompts delivered by Microsoft Outlook were a feasible, low-cost way of prompting office workers to break up their sedentary behaviour, although further research is needed to determine whether this has an additional impact on sedentary behaviour, to education alone. The role of cultural norms, and promoting self-efficacy, should be considered in the design of future interventions. Trial registration This study was registered retrospectively as a clinical trial on ClinicalTrials.gov (ID no. NCT02609282 ) on 23 March 2015