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BackgroundThere is an urgent need to develop prehospital research capability in order to improve the care of patients presenting to emergency medical services (EMS). The Prehospital Randomised Assessment of a Mechanical compression Device In Cardiac arrest trial, a pragmatic cluster randomised trial evaluating the LUCAS-2 device, represents the largest randomised controlled trial conducted by UK ambulance services to date. The aim of this study was to identify and analyse factors that may influence paramedic attitudes to, and participation in, clinical trials.MethodsPersonal and organisational experience from this trial was assessed by feedback from a workshop attended by collaborators from participating EMS and a survey of EMS personnel participating in the trial. A work systems model was used to explain the impact of five interwoven themes—person, organisation, tasks, tools & technology and environment—on trial conduct including gathering of high-quality data.ResultsThe challenge of training a geographically diverse EMS workforce required development of multiple educational solutions. In order to operationalise the trial protocol, internal organisational relationships were perceived as essential. Staff perceptions of the normalisation of participation and ownership of the trial influenced protocol compliance rates. Undertaking research was considered less burdensome when additional tasks were minimised and more difficult when equipment was unavailable. The prehospital environment presents practical challenges for undertaking clinical trials, but our experience suggests these are not insurmountable and should not preclude conducting high-quality research in this setting.ConclusionsApplication of a human factors model to the implementation of a clinical trial protocol has improved understanding of the work system, which can inform the future conduct of clinical trials and foster a research culture within UK ambulance services.Trial registration numberISRCTN08233942.

Background Both conventional health care providers and complementary therapists treat cancer patients. To provide effective treatment, both types of providers should to be familiar with their own as well as alternative types of treatment. Our aim was to compare how conventional health care providers (oncology doctors, oncology nurses, family physicians) and complementary therapists (acupuncturists, reflexologists, massage therapists) seek information about conventional and complementary cancer treatments. Method This analysis was conducted on the basis of feedback from 466 participants. We used self-administered questionnaires in a cross-sectional study. Results The majority of the medical doctors (96%) searched for evidence-based information regarding conventional cancer treatments. They gathered this information mostly from guidelines, which is considered best practice and is expected from Norwegian health personnel. Eighty-one percent of the nurses gather this information from evidence based resources such as UpToDate. Colleagues were asked for information by 58% of the medical doctors and 64% of the nurses. Moreover, 50% of the medical doctors and 57% of the nurses searched for evidence-based information about complementary cancer modalities. The acupuncturists gathered evidence-based information for both conventional (79%) and complementary (77%) modalities, followed by the reflexologists (54 and 54%, respectively) and massage therapists (54 and 52%, respectively). Nearly half of the acupuncturist (49%) asked a colleague for information. Conclusion To provide safe cancer care, it is important that advice about complementary modalities is based on current and evidence-based evaluations. The majority of the medical doctors and nurses in this study sought information according to evidence-based medicine regarding conventional cancer treatments, and about half of them gathered evidence-based information about complementary cancer modalities. This was also true for the complementary therapists as they gathered information about complementary and conventional treatments from evidence-based evaluations. This demonstrates that since the term evidence-based medicine was first introduced in 1991, the approach has grown extensively and both conventional and complementary providers use this approach to seek information.

Introduction: There is significant interest in allied health and the role it plays in health care for rural and remote populations. In Australia, osteopaths are allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. Workforce distribution is a significant issue for osteopathy in Australia with most practitioners centred in the metropolitan regions of Victoria and New South Wales. There is limited evidence about the role osteopathy plays in the musculoskeletal health of Australian rural and remote populations. This research sought to profile the characteristics of Australian osteopaths who practise in rural and remote settings. Methods: A secondary analysis of the Osteopathy Research and Innovation Network (ORION) data was undertaken to identify the demographic, practice and clinical management characteristics of Australian osteopaths in rural and remote settings. ORION is a practice-based research network for the Australian osteopathy profession. The ORION questionnaire comprised 27 items regarding osteopaths' characteristics. Inferential statistics were used to identify characteristics that were significantly different between Australian osteopaths practising in rural and remote settings compared to those practising in urban settings. Logistic regression was used to calculate adjusted odds ratios (AOR) relating to characteristics significantly associated with practising in a rural and remote setting. Results: Of 992 osteopaths who responded to the ORION questionnaire, 18.3% (n=172) indicated practising in a rural and remote setting. Australian osteopaths in rural and remote settings were more likely to report receiving referrals from massage therapists (AOR 2.17), send referrals to other osteopaths (AOR 1.64), and often treat patients over the age of 65 years (AOR 2.25) compared to their urban counterparts. Osteopaths in rural and remote setting were less likely to report using private health insurance claim systems (AOR 0.36) and to treat non-English-speaking patients (AOR 0.09). Conclusion: This secondary analysis identified several practitioner and practice characteristics that differ between osteopaths practising in rural and remote settings and those practising in urban settings. These findings contribute to the emerging picture of the practice of rural and remote Australian osteopaths. Further research is required to understand the role osteopaths play in rural and remote health care, and how the current data can inform workforce and health policy development.

High-quality cardiopulmonary resuscitation is a significant factor for increasing the survival rate of paediatric patients. This study is to investigate the effectiveness of finger-marker stickers for maintaining the correct compression point during simulated infant cardiopulmonary resuscitation (CPR). This crossover simulation study was conducted with 40 emergency physicians and paramedics at emergency departments of 2 tertiary hospitals. We used a remodeled infant CPR manikin developed to measure CPR quality indicators. After random coupling of participants (20 pairs), the pre-group (10 pairs) performed conventional 2-rescuer infant manikin CPR, then performed sticker-applied CPR after 1month. The post-group (10 pairs) performed the process in the opposite order. The participants placed finger-marker stickers to indicate the appropriate compression point before starting CPR. We compared accurate finger placement rates and other CPR quality indicators (compression depth, rate, complete chest recoil, and hands-off time) with and without the finger-marker sticker. All finger-marker stickers were correctly attached within 5s (4.88±1.28s) of approaching the model. There were significant differences in the rate of correct finger compression position between conventional and sticker-applied CPR (25.4% [IQRs 7.6–69.8] vs. 88.2% [IQRs 69.6–95.5], P<0.001). Results did not differ according to sex, career, and job of the participants. There were no significant differences in mean compression rate, depth, hands-off times, and rate of fully recoiled compression between the 2 groups. Finger-marker stickers can be used to maintain correct finger positioning during 2-rescuer infant manikin CPR.

Background The aim of this study was to measure chest compression decay during simulated advanced life support (ALS) in a cardiac arrest manikin model. Methods 19 paramedic teams, each consisting of three paramedics, performed ALS for 12 minutes with the same paramedic providing all chest compressions. The patient was a resuscitation manikin found in ventricular fibrillation (VF). The first shock terminated the VF and the patient remained in pulseless electrical activity (PEA) throughout the scenario. Average chest compression depth and rate was measured each minute for 12 minutes and divided into three groups based on chest compression quality; good (compression depth ≥ 40 mm, compression rate 100-120/minute for each minute of CPR), bad (initial compression depth < 40 mm, initial compression rate < 100 or > 120/minute) or decay (change from good to bad during the 12 minutes). Changes in no-flow ratio (NFR, defined as the time without chest compressions divided by the total time of the ALS scenario) over time was also measured. Results Based on compression depth, 5 (26%), 9 (47%) and 5 (26%) were good, bad and with decay, respectively. Only one paramedic experienced decay within the first two minutes. Based on compression rate, 6 (32%), 6 (32%) and 7 (37%) were good, bad and with decay, respectively. NFR was 22% in both the 1-3 and 4-6 minute periods, respectively, but decreased to 14% in the 7-9 minute period (P = 0.002) and to 10% in the 10-12 minute period (P < 0.001). Conclusions In this simulated cardiac arrest manikin study, only half of the providers achieved guideline recommended compression depth during prolonged ALS. Large inter-individual differences in chest compression quality were already present from the initiation of CPR. Chest compression decay and thereby fatigue within the first two minutes was rare.

The first book ever to bring together the best techniques from chiropractic and osteopathy, this easy-to-use guide is necessary reading for any manual therapist wishing to hone their skills, and discover related techniques that will enhance their practice. Offering practical step-by-step instruction on how to treat a full scope of musculoskeletal conditions, this duo-disciplinary guide draws on current anatomical and physiological research to bring all the most advanced and adaptive manipulation therapy techniques to your fingertips. Providing a brief history of the two central branches of manual therapy, it gives a valuable insight into how manipulation therapists can benefit from sharing ideas and integrating versatile techniques across practices, before providing clear, illustrated references for how to apply the methods on specific sections of the body. Demonstrating how to relieve common ailments, recognise contraindications and take excellent safety precautions, this is the ideal companion for practitioners and students of manipulation therapy for the whole body.

Since its beginnings in Australia in the 1890s, the Alexander Technique has become renowned as a powerful and effective antidote to the stresses and strains that modern life places upon our bodies. This introductory guide presents readers with a definitive overview of the Alexander technique which teaches us how to co-ordinate mind and body effectively so that our thinking is clarified and our movements become naturally lighter. Encompassing everything from teaching lineages to how the method works to how to find a practitioner, the book provides all the key information on the topic. It also includes a chapter on how to practise the technique at home as well as a useful resources section. Written in an engaging style and full of illustrations and photographs that demonstrate the technique, this book will be of interest to anyone considering options for treatment, as well as anyone wanting to know more about the Alexander Technique.

Découvrez enfin les bases du shiatsu et nos conseils pour améliorer votre vie. Massage relaxant aux vertus innombrables, le shiatsu permet de rééquilibrer le corps et l'esprit, tout en renforçant la force de guérison naturelle du patient. Grâce à des pressions et des étirements réalisés sur l'ensemble du corps, il agit aussi bien au niveau physique que psychologique en travaillant sur les méridiens qui parcourent le corps et dans lesquels circule l'énergie vitale. Grâce aux explications de Vera Smayan, vous découvrirez les fondements de cet art du massage et pourrez ensuite vous exercer grâce aux nombreuses illustrations et exercices proposés dans l'ouvrage. Ce livre vous donnera des informations pour: •comprendre le fonctionnement du shiatsu; •apprendre à connaître les fondements du shiatsu; •pratiquer le shiatsu. Le mot de l'éditeur: « Dans ce numéro de la collection 50MINUTES Équilibre, Vera Smayan offre une excellente introduction pour découvrir les bases du shiatsu et apprendre à se familiariser avec cette technique de massage thérapeutique. Ce faisant, elle nous ouvre les portes d'une véritable philosophie où le bien-être de l'individu est au centre de toutes les préoccupations. » Stéphanie Dagrain À PROPOS DE LA SÉRIE 50MINUTES | Équilibre La série Équilibre de la collection « 50MINUTES » présente de nombreuses thématiques et problématiques liées aux relations que nous entretenons avec nous-mêmes. Grâce aux témoignages et aux nombreuses astuces mis en lumière par nos auteurs, découvrez pas à pas les clés pour vous sentir plus épanoui et plus serein.

This book compiles the papers presented at John Bowlby Memorial Conference 2003, exploring the complex and interwoven themes of touch, attachment and the body and their emergence in clinical work. It offers a new theory of the body, and of the role of the body in psychoanalytical practice.

Mobile coronary care has been provided in Brighton by ambulance personnel without immediate help from physicians or nurses. No additional vehicles or staff were required. The capital cost of the experiment was therefore small and additional running costs were negligible. The results have been monitored by retrospective analysis of electrocardiograms recorded in the ambulance and stored on magnetic tape. In the first 12 months of operation to July 1972, 1,082 patients with suspected cardiac emergencies were carried in two vehicles. Subsequent analysis showed that 76% of these patients had acute symptoms from ischaemic heart disease or had circulatory arrest. Eighty-six per cent. of arrhythmias were diagnosed correctly by the ambulance attendants. Though only eight cases of primary ventricular fibrillation occurred during or shortly before transit all were successfully reversed, and five of these patients subsequently left hospital alive. Other benefits of the scheme have included an appreciable reduction in the median delay between onset of presenting symptoms in patients with acute myocardial ischaemia and their admission to hospital.