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Evaluating the effectiveness of Transcendental Meditation on mental health and resilience of paramedicine students – a randomised controlled pilot study
Paramedics worldwide have a higher prevalence of PTSD, anxiety, and depression than the general population. Paramedicine students predominately enter the profession without preventative techniques to manage stress, depression and fatigue. The objective of this study was to examine the effect of Transcendental Meditation (TM) on the well-being and resilience of paramedicine students. A pilot randomised control trial (RCT) spanning 4 weeks assessed the efficacy of TM on paramedicine students (
n
= 5) compared to a control group (
n
= 5). A set of questionnaires were distributed pre- and post-intervention to determine the effect of TM. Post-intervention, TM participants had significantly higher results in mental clarity (t = 3.347,
p
= 0.010), trait resilience (t = 2.630,
p
= 0.030), lower stress (t=-3.667,
p
= 0.008), and less depression, (t=-2.617,
p
= 0.035) with large effect sizes, as well as less fatigue (
Z
=-2.060,
p
= 0.039) than the control group. A significant negative relationship between stress and trait resilience was found. This is the first international study to examine the effect of TM on the well-being and resilience of paramedicine students. The findings suggest that students who undertook TM had reduced levels of stress, depression, fatigue, and increased mental clarity and trait resilience post TM intervention compared to the control group.
This trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12625000240448 on 03/04/2025. Available at https//www.anzctr.org.au/Trial/Registration/TrialReview.aspx? id=389,147&isReview=true.
Journal Article
Adult education and health
Along with a broad overview of concepts and strategies in the field, Adult Education and Health includes illustrative practical examples from a variety of contexts and a helpful glossary of key terms. It will be a useful resource for professionals and academics in many areas, including community health education, health policy, First Nations health, and the education of health professionals.\"--pub. desc.
Book
Teaching the National Institutes of Health Stroke Scale to Paramedics (E-Learning vs Video): Randomized Controlled Trial
Prompt and accurate identification of stroke victims is essential to reduce time from symptom onset to adequate treatment and to improve neurological outcomes. Most neurologists evaluate the extent of neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics, the first healthcare providers to usually take care of stroke victims, has proven unreliable. This might be, at least in part, due to the teaching method. The video used to teach NIHSS lacks interactivity, while more engaging electronic learning (e-learning) methods might improve knowledge acquisition.
This study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics.
A randomized controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed with paramedics working in Geneva, Switzerland. A registration number was not required as our study does not come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847), which issued a \"Declaration of no objection.\" Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and quiz completion, user satisfaction regarding the learning method, user perception of the course duration, and probability the user would recommend the course to a colleague.
The study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method in the e-learning group (90% vs 37%, P=.002). Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between groups (25 vs 38 minutes, P=.12).
Use of an e-learning module shows promising results in teaching the NIHSS to paramedics.
Journal Article
Impact of an e-learning module on personal protective equipment knowledge in student paramedics: a randomized controlled trial
Background
Prehospital professionals such as emergency physicians or paramedics must be able to choose and adequately don and doff personal protective equipment (PPE) in order to avoid COVID-19 infection. Our aim was to evaluate the impact of a gamified e-learning module on adequacy of PPE in student paramedics.
Methods
This was a web-based, randomized 1:1, parallel-group, triple-blind controlled trial. Student paramedics from three Swiss schools were invited to participate. They were informed they would be presented with both an e-learning module and an abridged version of the current regional prehospital COVID-19 guidelines, albeit not in which order. After a set of 22 questions designed to assess baseline knowledge, the control group was shown the guidelines before answering a set of 14 post-intervention questions. The e-learning group was shown the gamified e-learning module right after the guidelines, and before answering post-intervention questions. The primary outcome was the difference in the percentage of adequate choices of PPE before and after the intervention.
Results
The participation rate was of 71% (98/138). A total of 90 answer sets was analyzed. Adequate choice of PPE increased significantly both in the control (50% [33;83] vs 25% [25;50],
P
= .013) and in the e-learning group (67% [50;83] vs 25% [25;50],
P
= .001) following the intervention. Though the median of the difference was higher in the e-learning group, there was no statistically significant superiority over the control (33% [0;58] vs 17% [− 17;42],
P
= .087). The e-learning module was of greatest benefit in the subgroup of student paramedics who were actively working in an ambulance company (42% [8;58] vs 25% [− 17;42],
P
= 0.021). There was no significant effect in student paramedics who were not actively working in an ambulance service (0% [− 25;33] vs 17% [− 8;50],
P
= .584).
Conclusions
The use of a gamified e-learning module increases the rate of adequate choice of PPE only among student paramedics actively working in an ambulance service. In this subgroup, combining this teaching modality with other interventions might help spare PPE and efficiently protect against COVID-19 infection.
Journal Article
Randomized controlled trial of asynchronous vs. synchronous online teaching formats: equal knowledge after training, greater acceptance and lower intrinsic motivation through asynchronous online learning
Background
The growing importance of online education in recent years has led to an increased focus on implementing and optimizing online learning formats. This study investigated how a lecture delivered in an asynchronous or synchronous online teaching format affects acceptance, intrinsic motivation and knowledge levels after training. The results can be used to optimize online education by identifying format-specific advantages and adapting them to learners’ needs.
Methods
All the Styrian paramedics (
N
= 5910) were invited to participate in the study and randomly assigned to one of two groups. A total of 1044 participants completed the trial, with one group receiving asynchronous training via a learning platform (
N
= 545) and the other group participating in synchronous training via webinars (
N
= 499) providing the same content. After completing a two-hour psychiatric emergency course, the participants were invited to complete a multiple-choice test and a survey assessing acceptance, preferences and intrinsic motivation. Linear regression, t tests and mediation analyses were conducted.
Results
The asynchronous training format was significantly more accepted (
p
<.001) and preferred overall. The participants’ preferences depended significantly on the type of learning format (
p
<.001). The synchronous learning format fostered greater intrinsic motivation (
p
=.001) and greater perceived autonomy (
p
<.001) but also a higher level of perceived pressure/tension (
p
=.003). The analysis revealed no significant difference in test results (
p
=.449) or perceived competence between the groups (
p
=.420). Furthermore, the difference in intrinsic motivation was fully mediated by perceived autonomy.
Conclusions
There are different advantages and disadvantages to providing a lecture via webinar or online learning platform. Both formats are equally effective in terms of knowledge levels after training, highlighting the importance of adapting teaching strategies to learners’ preferences.
Journal Article
Building patient safety culture by using interprofessional simulation with nursing, paramedic and emergency telecommunication students: A mixed-methods research study
The aim of this study was to investigate student attitudes toward interprofessional education and collaborative practice and their perceptions of simulation design elements after participating in an interprofessional simulation educational activity.
Patient safety continues to be an international healthcare priority. However, critical incidents to patients continue to persist due to poor communication between professionals and poor teamwork.
A mixed methods design.
The study sample consisted of Bachelor of Nursing (n=81), Paramedic (n=38) and Emergency Telecommunication (n=11) students randomized into interprofessional groups. Following the interprofessional learning experience, students completed two standardized self-reporting instruments, Students Perceptions of Interprofessional Clinical Education, National League for Nursing Simulation Design Scale and open-ended questions of their perceptions on teamwork and collaboration, communication skills, transfer of care and patient safety.
Students in each program reported high scores for attitudes toward the importance of teamwork and collaborative practice. There were significant differences in scores between programs for the ranking factors ‘Teamwork and Team-Based Practice’ (BN=4.74 SD 0.72, PM=4.66 SD 0.81, ET=4.95 SD 0.15 *; p = 0.00005) and ‘Roles & Responsibilities’ (BN=3.78 SD 1.12, PM=3.55 SD 0.92, ET=4.67 SD 0.85*; p= 0.012). Themes included: communication and collaboration in teamwork; roles, responsibilities and leadership; patient-centred care and safety; and emotional dynamics and professional growth.
An interprofessional simulation is an effective strategy to practice teamwork and collaboration and communication skills during transfer of care. Ensuring earlier education of roles and responsibilities during transfer of care needs review as do strategies for structured handover communication tools.
Journal Article
Implementing community-based perinatal care: results from a pilot study in rural Pakistan
This pilot study investigated the feasibility of delivering a package of community-based interventions for improving perinatal care using lady health workers (LHWs) and traditional birth attendants (Dais) in rural Pakistan.
The intervention was implemented in four of eight village clusters (315 villages, total population 138,600), while four served as a comparison group. The LHWs in intervention clusters received additional training focused on essential maternal and newborn care, conducted community education group sessions, and were encouraged to link up with local Dais. The intervention was delivered within the regular government LHW programme and was supported by the creation of voluntary community health committees.
In intervention villages, there were significant reductions from baseline in stillbirth (from 65.9 to 43.1 per 1000 births, P < 0.001) and neonatal mortality rates (from 57.3 to 41.3 per 1000 live births, P < 0.001). The proportion of deliveries conducted by skilled attendants at public sector facilities also increased, from 18% at baseline to 30%, while the proportion of home births decreased from 79% to 65%. A household survey indicated a higher frequency of key behaviours (e.g. early and exclusive breastfeeding, delayed bathing and cord care) in intervention villages.
The improved stillbirth and neonatal mortality rates observed indicate that community health workers (i.e. LHWs and Dais) can be effective in implementing a community and outreach package that leads to improved home care practices by families, increased care-seeking behaviour and greater utilization of skilled care providers. These preliminary observations require confirmation in an adequately powered trial.
Journal Article
The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity
To date, the benefit of prehospital advanced life-support programs on trauma-related mortality and morbidity has not been established
The Ontario Prehospital Advanced Life Support (OPALS) Major Trauma Study was a before-after systemwide controlled clinical trial conducted in 17 cities. We enrolled adult patients who had experienced major trauma in a basic life-support phase and a subsequent advanced life-support phase (during which paramedics were able to perform endotracheal intubation and administer fluids and drugs intravenously). The primary outcome was survival to hospital discharge.
Among the 2867 patients enrolled in the basic life-support (n = 1373) and advanced life-support (n = 1494) phases, characteristics were similar, including mean age (44.8 v. 47.5 years), frequency of blunt injury (92.0% v. 91.4%), median injury severity score (24 v. 22) and percentage of patients with Glasgow Coma Scale score less than 9 (27.2% v. 22.1%). Survival did not differ overall (81.1% among patients in the advanced life-support phase v. 81.8% among those in the basic life-support phase; p = 0.65). Among patients with Glasgow Coma Scale score less than 9, survival was lower among those in the advanced life-support phase (50.9% v. 60.0%; p = 0.02). The adjusted odds of death for the advanced life-support v. basic life-support phases were nonsignificant (1.2, 95% confidence interval 0.9-1.7; p = 0.16).
The OPALS Major Trauma Study showed that systemwide implementation of full advanced life-support programs did not decrease mortality or morbidity for major trauma patients. We also found that during the advanced life-support phase, mortality was greater among patients with Glasgow Coma Scale scores less than 9. We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.
Journal Article
C-MAC compared with direct laryngoscopy for intubation in patients with cervical spine immobilization: A manikin trial
The aim of this study was to compare C-MAC videolaryngoscopy with direct laryngoscopy for intubation in simulated cervical spine immobilization conditions.
The study was designed as a prospective randomized crossover manikin trial. 70 paramedics with <5years of medical experience participated in the study. The paramedics attempted to intubate manikins in 3 airway scenarios: normal airway without cervical immobilization (Scenario A); manual inline cervical immobilization (Scenario B); cervical immobilization using cervical extraction collar (Scenario C).
Scenario A: Nearly all participants performed successful intubations with both MAC and C-MAC on the first attempt (95.7% MAC vs. 100% C-MAC), with similar intubation times (16.5s MAC vs. 18s C-MAC). Scenario B: The results with C-MAC were significantly better than those with MAC (p<0.05) for the time of intubation (23 s MAC vs. 19 s C-MAC), success of the first intubation attempt (88.6% MAC vs. 100% C-MAC), Cormack-Lehane grade, POGO score, severity of dental compression, device difficulty score, and preferred airway device. Scenario C: The results with C-MAC were significantly better than those with MAC (p<0.05) for all the analysed variables: success of the first attempt (51.4% MAC vs. 100% C-MAC), overall success rate, intubation time (27 s MAC vs. 20.5 s C-MAC), Cormack-Lehane grade, POGO score, dental compression, device difficulty score and the preferred airway device.
The C-MAC videolaryngoscope is an excellent alternative to the MAC laryngoscope for intubating manikins with cervical spine immobilization.
Journal Article