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In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

Background: Quality of life is a core concern for cancer patients, which can be negatively affected by illness-related death anxiety; yet understanding of how to appropriately target psycho-oncological interventions remains lacking. We aimed to explore experiential acceptance in cancer patients, and whether acceptance – as an alternative to avoidant coping – was related to and predictive of better quality of life and death anxiety outcomes.

Methods: We used a longitudinal, quantitative design with a follow-up after three months. Seventy-two participants completed a questionnaire-battery measuring illness appraisals, acceptance and non-acceptance coping-styles, quality of life, and death anxiety; 31 participants repeated the battery after three months.

Results: Acceptance was an independent explanatory and predictive variable for quality of life and death anxiety, in the direction of psychological health. Acceptance had greater explanatory power for outcomes than either cancer appraisals or avoidant response styles. Avoidant response styles were associated with greater death anxiety and poorer quality of life.

Conclusions: The findings support the role of an accepting response-style in favourable psychological outcomes, identifying a possible target for future psychological intervention. Response styles that might be encouraged in other therapies, such as active coping, planning, and positive reframing, were not associated with beneficial outcomes.

The purpose of this study is to present a comprehensive knowledge mapping and an in-depth analysis of pro-environmental travel behaviour research to better understand the global trend in this field that have emerged between 2000 and 2021.

In this study, a visual analysis of 187 scholarly articles between the year 2000 and 2021 related to pro-environmental travel behaviour (PETB) is presented. Using the knowledge mapping based on CiteSpace it presents the current research status, which contains the analysis of collaboration network, co-citation network, and emerging trends.

The results revealed that the PETB is an emerging topic, which has an increased number of publications in recent years. Though the collaboration network between scholars is dispersed, some countries exert stronger collaboration network. Researchers from England, USA and China have worked more on this topic comparatively. “Pro-environmental norm” is found to be the major concern in regard to PETB, and the theory of planned behaviour (TPB) is the most common theory used by the scholars around the world. Ten articles with the highest citations are found to be the most valuable articles. COVID-19, value orientation, negative spillover, carbon footprints, biospheric and adolescent are some of the latest keywords based on the past two years' literature review, all of which have huge research potential in the future.

This study is among the pioneers to shed some light on the current research progress of PETB by using a bibliometric analysis to provide research directions for scholars. Moreover, this study utilized latest data from 2000 to 2021. The studies which are published before and during the pandemic are also incorporated.