Benjamin Clubbs Coldron

Objectives: Understanding the factors that influence avoidable and unavoidable hospital conveyance, including rurality and distance from hospital for diabetes-related metabolic problems is important and will help to inform guidelines and develop policy for emergency services including paramedic and ambulance staff. This study compared the impact of degree of rurality, and other factors on conveyance rates across rural and urban areas in Scotland. Methods: Using a national retrospective five-year dataset from the Scottish Ambulance Service we conducted a univariate, bivariate and multivariable analysis of factors influencing conveyance to hospital for people with diabetes-related metabolic complications. The analysis focused on rurality using a national standardised classification, initial blood glucose level, type and complexity of treatment at the scene, day of the week or time of day, paramedic attendance, time spent at the scene and the distance to the nearest hospital as potentially significant factors. Results: Conveyance rates were highest for those experiencing hyperglycaemia (82%), for those under 20yr (69%) or over 80yr (64%), and for females (58%). Rates were lower for longer time spent at the scene and the longer the distance to hospital from the scene. Probability of conveyance was more likely with increasing age, with glucose levels in the normal or higher range and less likely for males, and if there was a paramedic in attendance. There was no association of degree of rurality with probability of conveyance. Conclusions: Conveyance to hospital following ambulance callouts for diabetes metabolic complications is related to predictable factors. The presence of a paramedic is associated with lower probability of conveyance. Rurality does not appear to be associated with increased probability of higher conveyance rates.

In this article, the authors identify and explore the phenomenon of consumer cyborgification and ask what the legal and ethical implications of this emerging trend are. They consider whether fundamental legal principles, concepts, and assumptions in various EU acts and directives are adequate to address these challenges or whether these need to be reassessed in light of novel forms of vulnerability. They also ask what alternatives might be suggested. In the era of the consumer Internet of Things (IoT), consumer expectations of privacy, security, and durability are changing. While the consumer uses of the IoT often revolve around improving efficiency (e.g., of the body, the home, the car) and enhancing experiences through datafication of our bodies and environments and personalization of services and interfaces, the power of IoT companies to influence consumer behaviours and preferences is increasing in part because the hybridization of humans and machines. Cyborgification allows our behaviours to be individually and continuously monitored and nudged in real time. Our bodies and minds are reflected back at us through data, shaping the narratives we tell about ourselves and our surroundings, and this is creating new lifeworlds and shaping our preferences, roles, and identities. This presents novel benefits, as well as risks in the potential exploitation of novel vulnerabilities. With technology under the skin, both metaphorically (in relation to products that become a sensory accessory to the body and influence the perception and physical reality of one’s body and lifeworld) and literally (in the form of microchips, cybernetic implants, and biometric sensors and actuators), cyborg consumers are more vulnerable to manipulative practices, unfair contractual terms, automated decision-making, and to privacy and security breaches. Cyborg consumers are therefore more susceptible to damage, financial and physical, caused by defective products, low-quality services, and lax cybersecurity. Law, policy, and practice must go further than merely enhancing transparency and consent processes and prohibit practices and business models that are premised on manipulating the need to anticipate and manage the working of technologies under the skin, i.e., that which undermines consumer and public interests systematically. The law needs to be agile and responsive to the changes the IoT has established in the consumer–producer relationship. Consumer laws, including the contractual/consenting process itself, must be reviewed and reimagined to ensure more robust protections.

Background: Evidence indicates that poor glycemic control is associated with increased morbidity and length of stay in hospital. There are a wide range of guidelines published, which seek to ensure safe and effective inpatient glycemic control in the hospital setting. However, the implementation of these protocols is limited in practice. In particular, the feasibility of “flash” and continuous glucose monitoring (CGM) remains untested on general wards. Method: Scoping Review. Results: If used in the general ward hospital settings, CGM and flash glucose monitoring (FGM) systems could lead to improved glycemic control, decreased length of stay, and reduced risk of severe hypoglycemia or hyperglycemia. Potential problems include lack of experience with this technology and costs of sensors. Rapid analysis of glucose measurements can facilitate clinical decision making and therapy adjustment in the hospital setting. In addition, people with diabetes may be empowered to better self-manage their condition in hospital as they have direct access to their glucose data. Conclusions: More studies are required in which the feasibility, benefits and limitations of FGM and CGM in non–intensive care unit hospital settings are elucidated. We need evidence on which types of hospital wards might benefit from the introduction of this technology and the contexts in which they are less useful. We also need to identify the types of people who are most likely to find FGM and CGM useful for self-management and for which populations they have the most benefit in terms of clinical outcomes and length of stay.

Aim: To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into interventions that might reduce avoidable hospital admissions.Methods: A national retrospective data set including 30 999 diabetes‐related callouts from the Scottish Ambulance Service was utilized covering a 5‐year period between 2013 and 2017. The relationship between diabetes‐related hospital conveyance and seven potential risk factors was analysed. Independent variables included: age, gender, deprivation, paramedic attendance, treatment at the scene, first blood glucose measurement and day of the week.Results: In Scotland, hyperglycaemia was associated with a higher number of people being conveyed to hospital than hypoglycaemia (49.8% with high blood glucose vs. 39.3% with low glucose, P ≤ 0.0001). Treatment provided in pre‐hospital care was associated with reduced conveyance rates (47.3% vs. 58.2% where treatment was not administered, P ≤ 0.0001). Paramedic attendance was also associated with reduced conveyance to hospital (51.4% vs. 59.5% where paramedic was not present, P ≤ 0.0001). Paramedic attendance in hyperglycaemic cases was associated with significantly reduced odds of conveyance (odds ratio 0.52, P ≤ 0.001).Conclusions: A higher rate of conveyance associated with hyperglycaemic cases indicates a need for more resources, education and training in this area. Higher conveyance rates were also associated with no paramedic being present and no treatment being administered. This suggests that paramedic attendance may be crucial in reducing avoidable admissions. Developing and validating protocols for pre‐hospital services and treatment may help to reduce hospital conveyance rates.

There has been a recent surge of interest in recovery, co‐production in care and political inclusion for persons with mental health difficulties (Voorberg et al. 2015.) This has revealed a need for principles based on robust theoretical and empirical enquiry to guide practices that enhance political participation in institutional settings. This need is likely to be felt in any jurisdiction that has ratified the UNCRPD and therefore the concern is internationally relevant. This paper offers, based on empirical research, a set of principles that mental health nurses and other practitioners might apply when making decisions as to what types of political participation are appropriately facilitated during mental health treatment. It also provides examples of implementation approaches observed and a critique of practice based on individualised notions of autonomy.