The latest medical research on Paramedicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about paramedicine gathered by our medical AI research bot.

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ASSESSMENT OF VULNERABILITY TO THE COVID-19 PANDEMIC IN THE CENTRAL AFRICAN SUB-REGION.

Disaster Prevention & Management

This study aimed at examining the vulnerability of Central Africa to the Covid-19 pandemic.

Demographic, health and socio-economic indicators were used to describe the vulnerability.

According to demographic indicators, populations appear younger than in Europe, Asia and North America, where evidence showed a higher lethality of Covid-19 and a higher frequency of hospitalization among the elderly. This highlights the protective effect of the age structure of the Central African populations. There is a significant vulnerability of their populations resulting from high morbidity and a considerable deficit in health care. Poverty indicators are not in their favour for a sustainable implementation of effective pandemic control measures. Very low literacy rates in some countries, misinformation and belief in conspiracy theory could affect the community involvement in the response. Several countries are weakened by other humanitarian crises, including; conflicts and other epidemics. The early easing in lockdown restrictions in certain countries could worsen the situation.

This Sub-region, where the largest proportion of the population lives in poverty, poor sanitary conditions, conflicts and humanitarian crises, the questions of standards of prevention could appear to them as luxurious idea relegated to the background. Central African Countries need financial and logistic support for a sustainable effective response. These observations could be easily extrapolated to other Sub-Saharan sub-regions.

Evaluation of postgraduate rural medical training programs and implications for rural workforce development: a systematic review.

Rural and Remote Health

Providing postgraduate rural training programs has been recognised as central for successful recruitment and retention of medical workforce. While there have been many documented cases of rural training program development, documented program outcome evaluations are few. This review investigated how postgraduate training and educational programs for rural and remote medicine are evaluated worldwide. Through the use of a systematic review, the study explored three questions: 'What are the outcomes of postgraduate rural and remote training programs worldwide?', 'How are the program evaluations conducted?' and 'What evaluation models and approaches are used in evaluating the effectiveness of these training programs?'

A qualitative synthesis was undertaken of evaluations of postgraduate rural training programs published in the English language in medical education journals. The study involved pooling quantitative and mixed-methods research data and findings from qualitative studies, which were aggregated, integrated and interpreted. PubMed, PsycINFO, ERIC and Web of Science databases were searched to identify studies that satisfy the search criteria.

Of the 1297 articles identified through the database search, 26 studies were included in the analysis. Most of the evidence from the studies consists of descriptive studies with some longitudinal tracking programs and cohort studies. Nine themes were identified: practice location after training completion; training location and decentralised model; educational aspects; incentives, political contexts and regulations; personal, social and cultural issues; professional development; rural orientation and community engagement; support system; and gender and racial issues. Key outcomes were analysed and cross-validated against the 2020 WHO guideline on health workforce development, attraction, recruitment and retention in rural and remote areas. These studies' most frequent evaluation methods were surveys, followed by interviews, questionnaires and secondary data from existing databases. Methodological characteristics, the relationship between rural background and program outcomes, and implications for decentralised training, telehealth and tele-assessment during the COVID-19 pandemic are discussed. Analysis from the key outcomes suggests evaluation as a strategy to uncover outcomes in postgraduate rural and remote training and medical education.

Regardless of the similar outcomes, the program evaluations implemented and the robustness of evidence vary across programs and medical schools. The absence of solid evaluation designs and their alignment to the program objectives will lessen the strengths of evidence. Better quality research and evaluation design, objective settings, qualitative inquiry to uncover the contexts, and developing appropriate indicators and benchmarks for monitoring and evaluating strategies must be considered during program development and implementation.

Responding to the 'thin' markets of rural and remote disability services. Quantitative and spatial analysis is part of the picture.

Rural and Remote Health

Policymakers, funding bodies and service provider agencies require objective indicators to ensure quality, equity and access. We sought to depict t...

Feasibility of using telephone interviews and internet-based message services during the COVID-19 pandemic in rural Sri Lanka: experiences of the Rajarata Pregnancy Cohort.

Rural and Remote Health

The COVID-19 pandemic has challenged population health researchers to use remote data collection methods to avoid face-to-face interaction. A prope...

The Policy Gap and Inefficiency in Public Volunteers' Response to Assist the Hospitals After Natural Disasters in Iran: A Grounded Theory Methodology.

Disaster Prevention & Management

This study aims to explore a public volunteer's hospital response model in natural disasters in Iran.

This study employed grounded theory using the Strauss and Corbin 2008 method and data analysis was carried out in three steps, namely open, axial, and selective coding. The present qualitative study was done using semi-structured interviews with 36 participants who were on two levels and with different experiences in responding to emergencies and disasters as "public volunteers" and "experts". National and local experts were comprised of professors in the field of disaster management, hospital managers, Red Crescent experts, staff and managers of Iran Ministry of Health and Medical Education.

The main concept of the paradigm model was "policy gap and inefficiency" in the management of public volunteers, which was rooted in political factions, ethnicity, regulations, and elites. The policy gap and inefficiency led to chaos and "crises over crises." Overcoming the policy gap will result in hospital disaster resilience. Meanwhile, the model covered the causal, contextual, and intervening conditions, strategies, and consequences in relation to the public volunteers' hospital response phase.

The current public volunteers' hospital in Iran suffered from the lack of a coherent, comprehensive, and forward-looking plan for their response. The most important beneficiaries of this paradigm model will be for health policy-makers, to clarify the main culprits of creating policy gap and inefficiency in Iran and other countries with a similar context. It can guide the decision-makings in upstream documents on the public volunteers. Further research should carried out to improve the understanding of the supportive legal framework, building the culture of volunteering, and enhancing volunteers' retention rate.

Limited utility of self-made oxygen generators assembled from everyday commodities during the COVID-19 pandemic.

Disaster Prevention & Management

The current COVID-19 pandemic has aggravated pre-existing oxygen supply gaps all over the world. In fact, oxygen shortages occurred in affluent are...

COVID-19 fosters social accountability in medical education.

Rural and Remote Health

The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems. Traditionally, structural issues with health pro...

Culturally sensitive care of Misak Indigenous patients with rheumatoid arthritis in Colombia.

Rural and Remote Health

To describe and understand the attitudes, cultural knowledge, and therapeutic practices of the Misak people concerning rheumatoid arthritis (RA), inscribed in an emergent culturally sensitive healthcare model along with the indigenous community and health professionals, following a respectful and empathic relational contact approach to the inter-ethnic encounter.

A qualitative study that used ethnographic methods using observation techniques and in-depth interviews was carried out in the Misak community, Colombia, by a multidisciplinary team (rheumatology, physiotherapy, and anthropology). A thematic analysis based around the concept of explanatory models (EMs) was carried out.

Researchers interviewed 20 patients with RA, 12 traditional healers, and 5 health professionals. The following themes were identified: (1) the traditional healers are allowed to practice only if the community recognizes their vocation; (2) two types of EM were observed: Misak community EM related to conception of RA and its treatment, shared by patients and the traditional healers; and biomedical EM. The interaction of the two types is still a healthcare challenge that requires articulating to achieve better clinical outcomes for patients.

The EMs of RA care identified in the Misak community are focused on both the patients and the traditional healers. However, this predominant EM and the biomedical EM of RA care need to be brought closer together to contribute to the construction of a unifying model of a culturally sensitive care.

Decision-Making During a Disaster-Scenario Tabletop Exercise by Prelicensure Student Nurses - A Replication Study.

Disaster Prevention & Management

"Determine which clients to recommend for discharge in a disaster situation" is a Registered Nurse Activity Statement on the National Council Licensing Exam test plan. The activity statement raised the nursing education research question: could senior student nurses transfer their learning to a novel circumstance, with a high degree of risk, making decisions using patient assessments and determining resource needs? A study with a descriptive quantitative approach was designed with 2 aims. The first was to describe students' transfer of learning for basic disaster and medical-surgical knowledge and make recommendations for patient dispositions. The second aim was to describe students' attitudes about their transfer of learning during the tabletop exercise.

A researcher-designed disaster-scenario tabletop exercise and 3 instruments with subject-matter-expert feedback captured participants' decisions. Eligible senior student nurses volunteered to participate in the replicated study that was extended to 2 universities. Participant decisions and attitude responses were statistically analyzed.

Descriptive and difficulty index statistics described students' transfer of learning for basic disaster and medical-surgical topics, patient disposition recommendations, and attitudes. The cut-score for optimal transfer of learning was difficulty index (DI) ≤ .49.

Students had positive attitudes and transferred learning to most decisions. Decision DIs ≤ .49 were remediated.

It's not one size fits all: a case for how equity-based knowledge translation can support rural and remote communities to optimize virtual health care.

Rural and Remote Health

People living in rural and remote British Columbia (BC) in Canada experience complex barriers to care, resulting in poorer health outcomes compared to their urban counterparts. Virtual healthcare (VH) can act as a tool to address some of the care barriers, including reducing travel time, cost, and disruptions to people's lives. Conversely, VH can exacerbate inequities through unique difficulties in rural implementation, such as a lack of access to necessary infrastructure (eg internet), social supports, and technological capacity (eg devices and literacy).

The impacts of the COVID-19 pandemic induced a rapid shift to VH, providing new opportunities for health care while simultaneously highlighting and exacerbating inequities for people living in rural and remote settings. Equity-informed knowledge translation processes can help address these concerns. This commentary reports on an equity-informed knowledge translation process engaged by a diverse group of health researchers, community members, and practitioners in BC.

Informed by equity principles from the Canadian Coalition for Global Health Research, this knowledge exchange and translation process led to the co-creation of two practical tools: a set of VH appointment tip sheets and an open access report. Through stakeholder engagement and literature consultation, VH appointments were found to have many benefits for those in rural and remote communities, including expanding access to basic and specialized health services. However, some hesitation was noted when relying solely on these modes of care, as they can lack relationality, clarity, and time to process medical information. The tip sheets resulting from this process are an interactional-level tool developed to address this concern and optimize VH appointments, for rural patients and care providers. They offer the respective stakeholder group insights on how to actively prepare for and participate in inclusive virtual care. On a systems level, there is a continually echoed need for equity-based processes to ensure that VH is striking the balance of meeting rural health needs without exacerbating inequities. Additionally, incorporating the voices of rural and remote community members is essential. To help address this gap, an open-access report was compiled to serve as a small-scale example of integrating rural voices with existing literature to recommend systems-level adjustments. Overall, VH holds promise as an effective tool for addressing inequities experienced by those living in rural areas. To maximize this potential, rural and remote stakeholders must be proactively engaged and listened to throughout the processes of considering, planning, and implementing shifts in the utilization of VH options.

Patient and carer experiences of pain care in an Australian regional comprehensive cancer care setting: a qualitative study.

Rural and Remote Health

Pain is a common and distressing symptom in people living with cancer that requires a patient-centred approach to management. Since 2010, the Australian Government has invested heavily in developing regional cancer centres to improve cancer outcomes. This study explored patient and carer experiences of care from a regional cancer centre with specific reference to cancer pain management.

A qualitative approach was used with semi-structured telephone interviews. Participants were outpatients at a regional cancer centre in New South Wales who had reported worst pain of 2 or more on a 0-10 numerical rating scale, and their carers. Questions explored experiences of pain assessment and management, and perceptions of how these were affected by the regional setting. Researchers analysed data using a deductive approach, using Mead and Bower's (2000) framework of factors influencing patient-centred care.

Eighteen telephone interviews were conducted with 13 patients and 5 carers. Participants perceived that living in a regional setting conferred advantages to the patient-centredness of care via influences at the levels of professional context, the doctor-patient relationship, and consultation. These influences included established and ongoing relationships with a smaller number of care providers who were members of the community, and heightened accessibility in terms of travel/parking, flexible appointments, and ample time spent with each patient. The first of these factors was also perceived to contribute to continuity of care between specialist and primary care providers. However, one negative case reported disagreement between providers and a difficulty accessing specialist pain services. Several participants also reported a preference, and unmet need, for non-pharmacological rather than pharmacological pain management.

While much research has focused on lack of services and poorer outcomes for people with cancer in rural areas, the Australian regional setting may offer benefits to the patient-centredness of cancer pain management and continuity of care. More research is needed to better understand the benefits and trade-offs of cancer care in regional versus urban settings, and how each can learn from the other. An unmet need for non-pharmacological rather than pharmacological pain management is among the most consistent findings of qualitative studies of patient/carer preferences across settings.

'Inclusive' health systems increase healthy life expectancy.

Rural and Remote Health

This article attempts to investigate whether inclusive health systems increase societal welfare, with the latter expressed through estimates of healthy life expectancy (HLE).

The analysis uses publicly available data by the Organisation for Economic Co-operation and Development and explores the relationship of HLE at the age of 65 years (HLE_65) with four variables that are representative of institutional inclusivity or extractiveness of health systems.

Results indicate that HLE_65 is positively associated with healthcare system institutional inclusivity as expressed in terms of the share of public healthcare expenditure and the spending on preventive care. HLE_65 is inversely associated with the strength of extracting characteristics of the system, such as the market power of physicians and the share of specialists in the total number of physicians.

In this light, the development of health policies that aim to strengthen inclusive institutions, such as the focus on prevention, financial protection and primary care, could have a significant positive impact in collective welfare and social cohesion - especially for populations in rural, remote and less developed parts of the world.