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Papers by James Pearce
A document analysis of clinical guidelines for the paramedic management of obstetric and neonatal presentations in Australian and New Zealand ambulance services
Paramedicine, 2024
Introduction: Paramedics receive varying levels of training in obstetric presentations. In high-r... more Introduction: Paramedics receive varying levels of training in obstetric presentations. In high-risk, low-frequency cases, clinical guidelines should support clinicians to deliver optimal care. This study analysed publicly available clinical guidelines for obstetric presentations published by ambulance services in Australia and Aotearoa New Zealand to determine consistency of clinical guidance and adherence to nationally recognised standards for the development and reporting of evidence-based guidelines.
Method: Guidelines were sourced from publicly available websites of Australian and Aotearoa New Zealand ambulance services. The text was imported into a custom data collection frame which focused on five predefined specific obstetric presentations. Data were extracted and measured against nationally and internationally recognised best practice standards.
Results: Nine independent sets of clinical guidelines were included in the analysis. There was wide variation in the clinical guidance provided and scope of practice. Aspects were found to be absent, inconsistent, not supported by evidence or having potential to cause harm. None were consistent with recognised Australian best practice standards for guideline development in the areas of referencing and grading of evidence.
Conclusion: This study found substantial inconsistency of clinical guidance, highlighted conflicting and inadequate advice, and assessed the safety of advice provided when compared to best practice standards and evidence-based recommendations. Sustained effort to improve ambulance service clinical guidance regarding obstetric presentations is warranted.
Focus on Health Professional Education: A Multi-Professional Journal, 2024
Introduction: Ambulance service clinical placements are fundamental to paramedicine student educa... more Introduction: Ambulance service clinical placements are fundamental to paramedicine student education, but the quality and safety of these placements can be highly variable. Inspired by positive results from a nursing facilitator model, this study reports on a collaboration between an Australian university and ambulance service that introduced a paramedic clinical facilitator for undergraduate paramedic students during their ambulance clinical placements. This article describes the experiences of a clinical facilitator model for paramedicine students and their preceptors during the study period.
Methods: This study follows an exploratory qualitative research methodology. After implementation of the paramedic clinical facilitator model, two focus groups with paramedicine student participants and two semi-structured interviews with their paramedic preceptors were conducted. Intimate observations were recorded in a reflexive logbook by the facilitator, which was kept for data analysis. Purposive sampling was used to recruit participants, and thematic analysis was used to code data and conceptualise themes.
Results: Three broad overarching themes were conceptualised from the data: 1) increased educational opportunities, 2) improved clinical placement management and 3) greater student support and welfare. Both paramedicine students and paramedic preceptors felt that the paramedic clinical facilitator model improved the quality of ambulance clinical placements for undergraduate paramedicine students.
Conclusion: This study suggests that a paramedic clinical facilitator model improved the safety and quality of ambulance clinical placement experience for paramedicine students and preceptors. Universities and ambulance services could consider implementing a paramedic facilitator model for ambulance clinical placements in their local contexts.
JBI Database of Systematic Reviews & Implementation Reports, 2017
Background
Global cerebral ischemia occurs due to reduced blood supply to the brain. This is com... more Background
Global cerebral ischemia occurs due to reduced blood supply to the brain. This is commonly caused by a cessation of myocardial activity associated with cardiac arrest and cardiac surgery. Survival is not the only important outcome because neurological dysfunction impacts on quality of life, reducing independent living. Magnesium has been identified as a potential neuroprotective agent; however, its role in this context is not yet clear.
Objectives
The objective of this review was to present the best currently available evidence related to the neuroprotective effects of magnesium during a period of global cerebral ischemia in adults with cardiac arrest or cardiac surgery.
Inclusion criteria
Types of participants
The current review considered adults aged over 18 years who were at risk of global cerebral ischemia associated with cardiac arrest or cardiac surgery. Studies of patients with existing neurological deficits or under the age of 18 years were excluded from the review.
Types of intervention(s)/phenomena of interest
The intervention of interest was magnesium administered in doses of at least of 2 g compared to placebo to adult patients within 24 hours of cardiac arrest or cardiac surgery.
Types of studies
The current review considered experimental designs including randomized controlled trials, non-randomized controlled trials and quasi-experimental designs.
Outcomes
The outcome of interest were neurological recovery post-cardiac arrest or cardiac surgery, as measured by objective scales, such as but not limited to, cerebral performance category, brain stem reflexes, Glasgow Coma Score and
independent living or dependent living status. To enable assessment of the available data, neuroprotection was examined by breaking down neurological outcomes into three domains – functional neurological outcomes, neurophysiological outcomes and neuropsychological outcomes.
Search strategy
The search strategy aimed to find both published and unpublished studies between January 1980 and August 2014, utilizing the Joanna Briggs Institute (JBI) three-step search strategy. Databases searched included PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Australian Clinical Trials Register, Australian and New Zealand Clinical Trials Register, Clinical Trials, European Clinical Trials Register and ISRCTN Registry.
Uploads
Papers by James Pearce
Method: Guidelines were sourced from publicly available websites of Australian and Aotearoa New Zealand ambulance services. The text was imported into a custom data collection frame which focused on five predefined specific obstetric presentations. Data were extracted and measured against nationally and internationally recognised
best practice standards.
Results: Nine independent sets of clinical guidelines were included in the analysis. There was wide variation in the clinical guidance provided and scope of practice. Aspects were found to be absent, inconsistent,
not supported by evidence or having potential to cause harm. None were consistent with recognised Australian best practice standards for guideline development in the areas of referencing and grading of evidence.
Conclusion: This study found substantial inconsistency of clinical guidance, highlighted conflicting and inadequate advice, and assessed the safety of advice provided when compared to best practice standards and evidence-based recommendations. Sustained effort to improve ambulance service clinical guidance regarding obstetric presentations is warranted.
Methods: This study follows an exploratory qualitative research methodology. After implementation of the paramedic clinical facilitator model, two focus groups with paramedicine student participants and two semi-structured interviews with their paramedic preceptors were conducted. Intimate observations were recorded in a reflexive logbook by the facilitator, which was kept for data analysis. Purposive sampling was used to recruit participants, and thematic analysis was used to code data and conceptualise themes.
Results: Three broad overarching themes were conceptualised from the data: 1) increased educational opportunities, 2) improved clinical placement management and 3) greater student support and welfare. Both paramedicine students and paramedic preceptors felt that the paramedic clinical facilitator model improved the quality of ambulance clinical placements for undergraduate paramedicine students.
Conclusion: This study suggests that a paramedic clinical facilitator model improved the safety and quality of ambulance clinical placement experience for paramedicine students and preceptors. Universities and ambulance services could consider implementing a paramedic facilitator model for ambulance clinical placements in their local contexts.
Global cerebral ischemia occurs due to reduced blood supply to the brain. This is commonly caused by a cessation of myocardial activity associated with cardiac arrest and cardiac surgery. Survival is not the only important outcome because neurological dysfunction impacts on quality of life, reducing independent living. Magnesium has been identified as a potential neuroprotective agent; however, its role in this context is not yet clear.
Objectives
The objective of this review was to present the best currently available evidence related to the neuroprotective effects of magnesium during a period of global cerebral ischemia in adults with cardiac arrest or cardiac surgery.
Inclusion criteria
Types of participants
The current review considered adults aged over 18 years who were at risk of global cerebral ischemia associated with cardiac arrest or cardiac surgery. Studies of patients with existing neurological deficits or under the age of 18 years were excluded from the review.
Types of intervention(s)/phenomena of interest
The intervention of interest was magnesium administered in doses of at least of 2 g compared to placebo to adult patients within 24 hours of cardiac arrest or cardiac surgery.
Types of studies
The current review considered experimental designs including randomized controlled trials, non-randomized controlled trials and quasi-experimental designs.
Outcomes
The outcome of interest were neurological recovery post-cardiac arrest or cardiac surgery, as measured by objective scales, such as but not limited to, cerebral performance category, brain stem reflexes, Glasgow Coma Score and
independent living or dependent living status. To enable assessment of the available data, neuroprotection was examined by breaking down neurological outcomes into three domains – functional neurological outcomes, neurophysiological outcomes and neuropsychological outcomes.
Search strategy
The search strategy aimed to find both published and unpublished studies between January 1980 and August 2014, utilizing the Joanna Briggs Institute (JBI) three-step search strategy. Databases searched included PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Australian Clinical Trials Register, Australian and New Zealand Clinical Trials Register, Clinical Trials, European Clinical Trials Register and ISRCTN Registry.