Paramedic-delivered teleconsultations: a grounded theory study

Objective Progression in Anglo-American models of out-of-hospital care has resulted in the development of alternative roles for paramedics, including advanced paramedics providing teleconsultations to frontline paramedics. Traditionally provided by physicians, little is known about how paramedics perceive peer-to-peer teleconsultations. This research aimed to explore paramedic perceptions of paramedic-delivered teleconsultations. Methods This investigation employed a constructivist grounded theory methodology. Six focus groups were conducted with purposive and theoretical sampling and data analyzed using open coding and continual comparative analysis. Results 33 paramedics from across British Columbia, Canada, participated in the focus groups. Seven key themes emerged during the focus groups; the perceived roles and status of paramedic specialists and physicians in healthcare, the influence of relationships and culture on clinical consultations, practicalities of out-of-hospital care and the importance of lived experience, provision of appropriate clinical advice, professional trust and respect, mentorship in out-of-hospital care and clinical governance and education requirements. This led to the development of the grounded theory paramedics increasing ownership of their profession. Conclusion Paramedics reported a number of areas in which paramedic-delivered teleconsultations provided benefits not seen with traditional physician-delivered teleconsultation model. Emergency health systems delivering an Anglo-American model of care should consider the possible benefits of paramedic-delivered teleconsultations.

Abstract 1122‐000046: A Latin American Model of the PHASES Score

Introduction : The PHASES score was developed to predict the 5‐year risk of rupture for intracranial aneurysms (IAs). However, only populations from North America, Europe, and Japan were included in the original study. As the population of origin is an item in the score, it has yet to be applied in a Latin American population. We aimed to determine the best approximation to employ this model in this previously unstudied population. Methods : We extracted the data of 848 Peruvian patients with ruptured (n = 486) and unruptured (n = 362) IAs from 2010 to 2020. According to the PHASES score, the North American and European (other than Finish), Japanese, and Finnish populations are rated with 0, 3 and 5 points, respectively. Therefore, we developed three PHASES‐derived models in which our Peruvian population is rated with 0 (Model A), 3 (Model B), and 5 (Model C) points. We compared the observed probability of each model to the expected probability reported by the original PHASES score using a scatter plot. We then compared the goodness‐of‐fit of each model using the Hosmer‐Lemeshow test in STATA version 14. Results : Nineteen percent of the patients were female. Hypertension was found in 34% of patients and 15% were >70 years. Fifty‐four percent of the aneurysms were smaller than 7mm, 25% ranged between 7 and 9.9mm, 18% were between 10 and 19.9mm, and 3% were larger than 20mm. Previous subarachnoid hemorrhage was found in 4%. The location of the aneurysms was the internal carotid artery in 4%, the middle cerebral artery in 4%, and arteries of the anterior and posterior circulation (including the anterior and posterior communicating artery) in 92%. When Model A was applied, 63% of the patients among the ruptured subgroup have an estimated 5‐year risk of rupture of <3% while 77% of the patients have an estimated risk of <3% in the unruptured subgroup. When Model B was applied, 30% of the patients among the ruptured subgroup have an estimated 5‐year risk of rupture of <3% and 42% of patients among the unruptured subgroup have an estimated risk of <3%. When Model C was applied, 96% of the patients among the ruptured subgroup have an estimated 5‐year risk of rupture of >3% while in the unruptured subgroup an estimated risk of <3% was observed only in 4% of the patients. When comparing observed to expected frequencies, model B presented a better calibration to the values reported by the original PHASES score. Additionally, the Hosmer‐Lemeshow showed Model B to have improved goodness‐of‐fit, compared to other models, although all presented adequate fit. Conclusions : We found that rating the Peruvian population with 3 points was the best approximation to the estimated risk calculated by the PHASES score to predict the 5‐year risk of rupture for IAs.

On the State of Innovative Activities of Small Enterprises in Russia

The purpose of the article is to analyze some aspects of the state of innovation in Russia, including the state of small innovative business, venture capital financing startups, the dynamics of the creation of business entities by universities and research institutes. The facts of an extremely small number of small innovative enterprises created by universities and research institutes were recorded, as well as a low level of innovative activity of small enterprises over the entire period of statistical observations, a long-term dynamics of a decrease in the share of innovative goods, works and services in 2019 by almost two times (1.7 times) compared to 2013. The presented data indicate the low effectiveness of the idea of direct copying of the American model of technology commercialization, according to which the main player here should be higher educational institutions, as it has historically developed in the United States. It was concluded that in order to create an effective model of an innovation system consisting of proactive owners of research and development results, venture funds financing startups, universities that undertake the organization of research and development for the subsequent release of results to the market, large firms financing a significant percentage of turnover in R&amp;D, in Russia there were no conditions and, unfortunately, until now there are none. The system needs to be corrected taking into account the real state of the Russian economy.The article analyzes several current competitions for the development of innovative activities held by large companies and administrations of Russian regions and makes proposals for correcting the organization of competitions.

Pick a Pocket Or Two

This book tells the full history of the British musical, from The Beggar's Opera (1728) to the present, by isolating the unique qualities of the form and its influence on the American model. To place a very broad generalization, the American musical is regarded as largely about ambition fulfilled, whereas the British musical is about social order. Oklahoma!'s Curly wins the heart of the farmer Laurey—or, in other words, the cowboy becomes a landowner, establishing a truce between the freelancers on horseback and the ruling class. Half a Sixpence, on the other hand, finds a working-class boy coming into a fortune and losing it to fancy Dans, whereupon he is reunited with his working-class sweetheart, his modest place in the social order affirmed. Anecdotal and evincing a strong point of view, the book covers not only the shows and their authors but the personalities as well—W. S. Gilbert trying out his stagings on a toy theatre, Ivor Novello going to jail for abusing wartime gas rationing during World War II, fabled producer C. B. Cochran coming to a most shocking demise for a man whose very name meant “classy, carefree entertainment.”

Medical Malpractice Liability in the United States of America in the Light of the 19th Century Origins of the American Legal System

The American model of medical malpractice liability has been the subject of lively public and scientific debate for years. This system is characterized by a large number of lawsuits against doctors and very high damages awarded in such cases. In turn, these phenomena contribute to the occurrence of so-called medical malpractice crisis. It seems that an important place in the proper understanding of the American model of physicians’ liability for medical malpractice may be the historical analysis of legal norms regulating this matter. The text claims that the modern specificity of the system of liability for medical malpractice is closely related to the development of American law in its formative period in the nineteenth century. The article indicates four features of the legal system developed at that time, which today are identified as responsible for a large number of lawsuits and high compensation in malpractice trials. These include, in particular, linking medical liability to the tort law regime, domination of the civil law dimension of liability for medical errors, the role of the jury in lawsuits for medical malpractice, and the method of remuneration of attorneys in such cases.

Grizzly bear toe amputation due to seasonal overlap with furbearer trapping in southeast British Columbia

Science and adaptive management form crucial components of the North American model of wildlife management. Under this model, wildlife managers are encouraged to update management approaches when new information arises whose implementation could improve the stewardship and viability of wildlife populations and the welfare of animals. Here we detail a troubling observation of multiple grizzly bear toe amputations in southeast British Columbia and assemble evidence to inform immediate action to remedy the issue. During the capture of 59 grizzly bears in southeast British Columbia, we noticed that four individuals (~7%) were missing some or all their toes on one of their front feet. The wounds were all well healed and linear in nature. Further opportunistic record collection revealed that this pattern of missing toes occurred beyond our study area, and that furbearer traps were responsible for toe loss. We documented a problematic seasonal overlap between the active season for grizzly bears and the fall trapping seasons for small furbearers with body grip traps and for wolves with leghold traps. Instead of opening these trapping seasons on or prior to November 1, when more than 50% of bears are still active, we recommend delaying the start of these seasons until December 1, when most bears have denned. Innovative solutions, such as narrowing trap entrances to exclude bear feet while still allowing entrance of target furbearers, have the potential to minimize accidental capture of bears but the effectiveness of these approaches is unknown. Solutions that do not involve season changes will require monitoring of efficacy and compliance to ensure success.

Developing a Model for Evaluating Patient Experience in Educational Hospitals of Mashhad University of Medical Sciences

Background: Understanding the "patient experience" is a key step in moving towards patient-centered care. The purpose of this study is to design a patient experience evaluation model to evaluate the effective components in the patient experience in hospitals of Mashhad University of Medical Sciences. Methods: This was a comparative descriptive study conducted using databases and information resources and based on a comprehensive review, and the models used in other parts of the world were extracted based on the research protocol and entered into a comparative matrix. The reliability of the extracted framework was verified using the agreement coefficient of the parties. In order to validate the model, the questions were prepared in the form of a questionnaire and validated by the specialists of Mashhad University of Medical Sciences during two-round Delphi using SPSS 16 software. Results: In this study, 10 models were obtained for evaluating patient experience in different countries, each of which was composed of several dimensions and some of them had overlap. The models included American model (8 dimensions), Swedish model (10 dimensions), British first model (7 dimensions), British second model (8 dimensions), Scotland model (6 dimensions), Hong Kong model (9 dimensions), Norway first model (6 dimensions), Norway second model (5 dimensions), India model (10 dimensions), and the model of Ethiopia (5 dimensions). The final model with 10 dimensions and 29 sub- dimensions was approved and validated. Conclusion: The results showed that the suitable pattern for Iran had 10 dimensions and 29 sub-dimensions. Among the dimensions, respect for the patient's privacy and dignity had the highest score and the way patients are discharged from the hospital had the lowest score.