Objective. To evaluate the effectiveness of a whole-foods, plant-based diet (WFPB) to reduce symptoms of osteoarthritis. Methods. Six-week, prospective randomized open-label study of patients aged 19–70 with osteoarthritis. Participants were randomized to a WFPB (intervention) or continuing current diet (control). Outcomes were assessed by mixed models analysis of participant self-assessed weekly SF-36v2 domain t scores, weekly Patient Global Impression of Change (PGIC) scales, and mean weekly Visual Analog Scale (VAS) pain assessment. Mixed models analysis also evaluated pre-post change from baseline level for standard clinical measures: weight, BMI, body temperature, pulse, and blood pressure. Results. Forty participants were randomized. Thirty-seven of them, 18 control and 19 intervention, completed the study. The intervention group reported a significantly greater improvement than the control group in SF-36v2 energy/vitality, physical functioning, role physical, and the physical component summary scale. The differences between the intervention and control PGIC scales were statistically significant over time. Intervention group improvement in VAS weekly mean was also significantly greater than that of the control group from week 2 onward. Conclusion. Study results suggest that a whole-foods, plant-based diet significantly improves self-assessed measures of functional status among osteoarthritis patients.

Caring for paediatric patients presents unique challenges to prehospital personnel who may have limited training, experience and confidence caring for children. The State of Oregon recently increased its paediatric training requirements for prehospital providers; however, little is known about the specific educational needs, barriers, and preferences of providers in this largely rural state. Objectives: the purpose of this study was to characterize the paediatric educational needs, barriers, and preferences of prehospital providers in Oregon. Methods: this was a qualitative analysis of 9 focus group discussions with a total of 64 prehospital providers from the State of Oregon. An iterative process of theme identification was used to generate themes, and then inter-rater checking was applied to confirm themes and assure inter-rater reliability. Results: participants identified a need for more paediatric training. They described knowledge gaps in assessing medically ill children, working with children with long-term medical conditions, and dealing with issues related to communication and the emotional difficulty of caring for children. Distance and cost were identified as barriers to attaining paediatric education, especially for rural providers. Other barriers included finding time for training and courses that are not designed specifically for the prehospital provider. Providers recommended increasing time spent with children during training by involving local schools and paediatricians. They recommended expanding the courses to include the areas where they felt less comfortable and increasing hands-on training opportunities. Simulation and online training were suggested as effective modalities to augment their trainings. Conclusion: our findings support previous studies that show prehospital providers feel less comfortable providing care to children.The specific barriers that our respondents identified can be related to the demographics of Oregon.To address the needs of prehospital providers in caring for children, we recommend: 1) expanding the curriculum to involve more time with children and an increased emphasis on assessing medically complicated children; 2) take measures to assure that the training is affordable and accessible to providers in different practice settings, and does not require long distance travel to attend; and 3) use online training modules and simulation to bring flexible ‘hands-on’ training to providers.

Caring for paediatric patients presents unique challenges to prehospital personnel who may have limited training, experience and confidence caring for children. These challenges exist worldwide. Specific recommendations for paediatric educational content and learning strategies are lacking. The purpose of this study was to characterize the paediatric educational needs, barriers, and preferences of prehospital providers in Oregon and to examine these findings in the context of international emergency medical services (EMS) training. This was a qualitative analysis of 9 focus group discussions with a total of 64 prehospital providers from the state of Oregon. An iterative process of theme identification was used to generate themes, and then inter-rater checking was applied to confirm themes and assure inter-rater reliability. A review of the literature was conducted to compare the paediatric training of prehospital providers in the US and the UK. Participants identified a need for more paediatric training and they described knowledge gaps in assessing medically ill children, working with children with long-term medical conditions, and dealing with issues related to communication and the emotional difficulty of caring for children. Barriers included distance and cost, especially for rural providers, as well as time for training and lack of availability of courses designed specifically for the prehospital provider. Participants recommended increasing time spent with children during training by involving local schools and paediatricians. They recommended expanding the courses to include the areas where they felt less comfortable and increasing hands-on training opportunities. Simulation and online training were suggested as effective modalities to augment their trainings. Our findings support previous studies that show prehospital providers feel less comfortable providing care to children and face barriers such as time, cost, distance, and availability of relevant paediatric education. Although identified challenges are likely related to the demographics of Oregon, providers offered suggestions that may be applicable to prehospital providers more broadly, and include: 1) spending more time with children in a variety of setting and increasing the emphasis on assessing medically complicated children; 2) assuring local, affordable and relevant paediatric training opportunities; and 3) using online training modules and simulation to bring flexible ‘hands-on training to providers. Both the challenges and recommendations from this study have potential applicability to prehospital paediatric training in the US and UK.

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