Holistic Person-Centered Care in Radiotherapy: Protocol for a Scoping Review.

BACKGROUND: Several types of health care professionals are responsible for the care of patients with cancer throughout their engagement with the health care system. One such type is the radiotherapist. The radiotherapist not only administers treatment but is also directly involved with the patient during treatment. Despite this direct contact with the patient, the narrative tends to focus more on technical tasks than the actual patient. This task-focused interaction is often due to the highly sophisticated equipment and complex radiotherapy treatment processes involved. This often results in not meeting the psychosocial needs of the patient, and patients have acknowledged noncompliance and delayed treatment as a result. OBJECTIVE: The scoping review aims to explore, chart, and map the available literature on holistic person-centered care in radiotherapy and to identify and present key concepts, definitions, methodologies, knowledge gaps, and evidence related to holistic person-centered care in radiotherapy. METHODS: This protocol was developed using previously described methodological frameworks for scoping studies. The review will include both peer-reviewed and gray literature regarding holistic, person-centered care in radiotherapy. A comprehensive search strategy has been developed for MEDLINE (Ovid), which will be translated into the other included databases: Scopus, CINAHL (EBSCO), MEDLINE (PubMed), Embase (Elsevier), Cochrane Library, and the Directory of Open Access Journals. Gray literature searching will include Google (Google Books and Google Scholar), ProQuest, the WorldWideScience website, the OpenGrey website, and various university dissertation and thesis repositories. The title and abstract screening, full-text review, and relevant data extraction will be performed independently by all 3 reviewers using the Covidence (Veritas Health Innovation) software, which will also be used to guide the resolution of conflicts. Sources selected will be imported into ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) for analysis, which will consist of content analysis, narrative analysis, and descriptive synthesis. Results will be presented using narrative, diagrammatic, and tabular formats. RESULTS: The review is expected to identify research gaps that will inform current and future holistic, person-centered care in radiotherapy. The review commenced in November 2023, and the formal literature search was completed by the end of February 2024. Final results are expected to be published in a peer-reviewed journal by 2025. CONCLUSIONS: The findings of this review are expected to provide a wide variety of strategies aimed at providing holistic, person-centered care in radiotherapy, as well as to identify some gaps in the literature. These findings will be used to inform future studies aimed at designing, developing, evaluating, and implementing strategies toward improved holistic, person-centered care in radiotherapy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51338.

Physical restraint within the prehospital Emergency Medical Care Environment: A scoping review.

Background: Psychomotor agitation and aggressive behaviour (AAB) have the potential to occur in any healthcare setting, including those in which Emergency Medical Services (EMS) operate. This scoping review aimed to examine the available literature on physical restraint of patients within the prehospital setting and to identify guidelines and their effectiveness, safety to patients and health care practitioners and strategies relating to physical restraint when used by EMS. Methods: We performed our scoping review using the methodological framework described by Arksey and O'Malley augmented by that of Sucharew and Macaluso. Several steps guided the review process: identification of the research question, eligibility criteria, information sources (CINAHL, Medline, Cochrane and Scopus), search, selection and data collection, ethical approval, collation, summarizing and reporting on the results. Results: The population of interest, in this scoping review was prehospital physically restrained patients, however, there was a reduced research focus on this population in comparison to the larger emergency department. Conclusion: The limitation of informed consent from incapacitated patients may relate to the lack of prospective real-world research from previous and future studies. Future research should focus on patient management, adverse events, practitioner risk, policy, and education within the prehospital setting.

Use of global rating scales and checklists in clinical simulation-based assessments: a protocol for a scoping review.

INTRODUCTION: Assessment in health sciences education remains a hotly debated topic, with measures of competency and how to determine them in simulation-based assessments enjoying much of the focus. Global rating scales (GRS) and checklists are widely used within simulation-based education but there is a question regarding how the two strategies are used within clinical simulation assessment. The aim of this proposed scoping review is to explore, map and summarise the nature, range and extent of published literature available relating to the use of GRS and checklists in clinical simulation-based assessment. METHODS: We will follow the methodological frameworks and updates described by Arksey and O'Malley, Levac, Colquhoun and O'Brien, and Peters, Marnie and Tricco et al and will report using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We will search PubMed, CINAHL, ERIC, Cochrane Library, Scopus, EBSCO, ScienceDirect, Web of Science, the DOAJ and several sources of grey literature. We will be including all identified sources published in English after 1 January 2010 that relate to the use of GRS and/or checklists in clinical simulation-based assessments. The planned search will be conducted from 6 February 2023 to 20 February 2023. ETHICS AND DISSEMINATION: An ethical waiver was received from a registered research ethics committee and findings will be disseminated through publications. The overview of literature the produced will help to identify knowledge gaps and inform future research on the use of GRS and checklists in clinical simulation-based assessments. This information will be valuable and useful for all stakeholders that are interested in clinical simulation-based assessments.

Workplace violence against paramedic personnel: a protocol for a scoping review.

INTRODUCTION: There is evidence to suggest that violence against paramedic personnel is increasing. Several authors report adverse effects linked to exposure to workplace violence. There remain gaps in the knowledge related to specific aspects of workplace violence experienced by paramedics in the prehospital setting. METHODS AND ANALYSIS: This scoping review will consider evidence relating to workplace violence against paramedic personnel. All types of evidence will be considered, including quantitative and qualitative studies, systematic reviews, opinion papers, grey literature, text and papers as well as unpublished materials. This scoping review will be designed and conducted in accordance with the JBI methodology for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews will guide the reporting process. Sources will include ERIC, Scopus, PubMed, CINAHL, Cochrane Library, ScienceDirect, Web of Science, Sabinet and the DOAJ as well as OpenGrey (https://opengrey.eu/). All sources published in English will be considered for inclusion and no date limit will be applied. The searching of the databases will begin 16 January 2023 and will be concluded by 30 January 2023. Three independent reviewers will conduct the study selection and data extraction process. In the event of disagreement related to a particular source, this will be resolved by discussion. The findings of the proposed review will be presented in a narrative style that uses diagrams and tables for reporting. ETHICS AND DISSEMINATION: This scoping review will use published literature available in the public domain and will involve no participants, meaning that ethical approval is not required. The findings of the proposed review will be published in topic relevant peer-reviewed journals and will be presented at associated conferences.

Simulation debriefing: a perspective from emergency medical care students at three South African Higher Education Institutions.

INTRODUCTION: simulation-based learning (SBL) is an educational technique that is used to create lifelike experiences within a controlled setting. Feedback and debriefing have been described as most important components in healthcare simulation. Providing feedback or debriefing loses its efficacy if it is not performed correctly. The results of poor feedback or debriefing practice may negatively affect future student performance. It is important to identify both positive and negative current practice so as to better understand the potential effects on student learning. There is a paucity of evidence relating to debriefing within the resource-constrained environment. METHODS: a cross-sectional design collected data using a purpose-designed, paper-based questionnaire that was validated using a pilot study. We collected data from three South African higher education institutions (HEI) offering emergency medical care qualifications. Questionnaires were distributed on-site at each HEI by an academic staff member and were returned to the researchers via courier. Participants were recruited from the second, third and fourth academic years of study. Responses were captured manually and imported into Microsoft Excel for analysis. RESULTS: we collected 153 completed questionnaires from three South African Higher Education Institutions (HEIs). Student perceptions of debriefing practices were generally positive. There were general feelings of psychological safety and an understanding between students and facilitator related to why debriefing took place. Linking debrief and learning outcomes was perceived as making debriefing meaningful to students. Question-asking techniques by facilitators were mixed, but were generally asked in a manner that encouraged self-reflection. Peer-led debriefing was perceived as good practice and a single facilitator was preferred to multiple facilitators. CONCLUSION: several strategies related to effective feedback and debriefing were identified by the student participants as already being employed by facilitators. The potentially negative effect of multiple facilitators was highlighted by participants who indicated that they preferred a single debriefer for the entire academic year. Peer-led debriefing was perceived as a positive practice and has a number of advantages and disadvantages that should be considered and mitigated by the facilitator.

The variables perceived to be important during patient handover by South African prehospital care providers.

INTRODUCTION: High-acuity patients are typically transported directly to the emergency centre via ambulance by trained prehospital care providers. As such, the emergency centre becomes the first of many physical transition points for patients, where a change of care provider (or handover) takes place. The aim of this study was to describe the variables perceived to be important during patient handover by a cohort of South African prehospital care providers. METHODS: A purpose-designed questionnaire was used to gather data related to prehospital emergency care provider opinions on the importance of certain patient variables. RESULTS: We collected 175 completed questionnaires from 75 (43%) BAA, 49 (28%) ANA, 15 (9%) ECT, 16 (9%) ANT and 20 (11%) ECP respondents. Within the ten handover variables perceived to be most important for inclusion in emergency centre handover, five were related to vital signs. Blood pressure was ranked most important, followed by type of major injuries, anatomical location of major injuries, pulse rate, respiration rate and patient history. These were followed by Glasgow Coma Score, injuries sustained, patient priority, oxygen saturations and patient allergies. CONCLUSION: This study has provided some interesting results related to which handover elements prehospital care providers consider as most important to include in handover. More research is required to correlate these findings with the opinions of emergency centre staff.

For the students, by the students: Student perceptions of low cost medical moulage in a resource-constrained environment.

INTRODUCTION: Simulation-based learning affords participants the opportunity to practice high-acuity, low-incidence situations without risk to the patient. The realism of a simulated scenario is often referred to as fidelity. High levels of fidelity imply high levels of realism. One method of enhancing fidelity is the use of moulage. Commercially available moulage kits and professionally applied moulage are often expensive and therefore not practical in the resource-constrained environment. Cost-effective alternatives are required for the resource-constrained environment. METHODS: Students at a South African university used readily available, low cost materials to apply self-constructed, low cost moulage for a bandaging practical. A cross sectional design used a purpose-designed, validated questionnaire to gather data related to face and content validity of the self-constructed moulage. Frequency analysis formed the cornerstone of Likert-type quantitative data analysis. An open-ended question afforded participants the opportunity to express their own opinions related to the moulage experience. RESULTS: The results revealed that there was both high face validity and high content validity of the self-constructed moulage. Participants found the activity enjoyable and a generally positive learning experience. The self-constructed moulage was realistic and added to the fidelity of the scenario. Participant confidence was improved and their engagement in the learning activity was enhanced. Participants found the self-constructed, low-cost moulage more realistic that commercial products that they had been exposed to. CONCLUSION: The use of low-cost, self-constructed moulage is a feasible and economically viable means of enhancing fidelity within the resource-constrained simulation setting. This technique is not necessarily limited to emergency medical care and can be used in other areas of healthcare simulation.

The effect of physical exertion in chemical and biological personal protective equipment on physiological function and reaction time.

OBJECTIVES: The primary objective of this study was to describe and compare changes in heart rate, venous pH, venous partial pressure of carbon dioxide (pCO(2)), venous bicarbonate level, lactate level, oxygen saturation (SpO(2)), and tympanic membrane (TM) temperature occurring in a group of healthy volunteers during 20 minutes of physical exertion, both with and without chemical and biological personal protective equipment (PPE). A further aim was to establish whether any significant prolongation of reaction time occurred after physical exertion in chemical and biological PPE, compared to baseline values without the protective equipment. METHODS: Nineteen highly fit volunteers were subjected to a baseline reaction time test and measurement of physiological variables. They were then subjected to physical exertion on a treadmill: once while wearing a short-sleeved t-shirt, shorts, and running shoes and once while wearing chemical and biological PPE. Repeat measurements of the physiological variables were made after 10 and 20 minutes of physical exertion in both groups, after which repeat reaction time tests were conducted. RESULTS: Results showed that physical exertion of 20 minutes undertaken by highly fit volunteers wearing PPE resulted in a higher heart rate response and TM temperature compared with control measurements. Decreased venous pH and increased venous pCO(2) were also observed during exertion in the PPE group. Although differences in these variables between the control and PPE groups were statistically significant, they were not of clinical relevance in the sample of volunteers studied. No significant difference in reaction time before and after exertion in PPE was identified. CONCLUSIONS: This study did not identify any effect of 20 minutes of heavy exercise in highly fit volunteers wearing level C chemical and biological PPE on reaction time. Heart rate response and TM temperature were higher during exertion in PPE. These differences, along with other physiological alterations observed, were not of clinical relevance. Further studies using arterial blood gas analysis and a more accurate measure of core body temperature are needed to better assess the physiological effect of this level and duration of exercise on subjects wearing similar PPE. Other aspects of cognition also require investigation under these conditions, in order to assess their effect on patient and rescuer safety.