bluuebunny/crossref_metadata_2025 huggingface dataset:
The Evaluation of Joint Mobilization Dosage on Ankle Range of Motion in Individuals With Decreased Dorsiflexion and a History of Ankle Sprain
Authors: Meyer Jennifer E. , Rivera Matthew J. , Powden Cameron J.
Published: September 2020

Context: Mulligan’s Mobilization with Movement (MWM) is a common intervention used to address dorsiflexion range of motion (DFROM) impairments. However, the treatment dosage of MWMs varies within the literature. Objective: The aim of this study was to examine the effect of serial MWM application on DFROM. Design: Repeated-measures cohort. Setting: A Midwestern University and the surrounding community. Participants: A total of 18 adults (13 females; age = 29 [12.87] y; DFROM = 30.26° [4.60°]) with decrease dorsiflexion (<40°) participated. Inclusion criteria consisted of a history of ≥1 ankle sprain, ≥18 years old, no lower-extremity injury in the last 6 months, and no history of foot/ankle surgery. Intervention: Participants completed a single data collection session consisting of 10 individual sets of MWMs. Main Outcome Measures: DFROM was taken at baseline and immediately after each intervention set (post 1, post 2, … post 10). DFROM was measured with a digital inclinometer on the anterior aspect of the tibia during the weight-bearing lunge test with the knee straight and knee bent. Analysis of variances examined DFROM changes over time. Post hoc analysis evaluated sequential pairwise comparisons and changes from baseline at each time point. Results: Analysis of variance results indicated a significant time main effect for weight-bearing lunge test with knee bent (P < .001) and a nonsignificant effect for weight-bearing lunge test with knee straight (P < .924). Post hoc analysis indicated improvements in the weight-bearing lunge test with knee bent at each timepoint compared with baseline (P < .005). Post 2 improved compared with post 1 (P = .027). No other pairwise sequential comparisons were significant (P > .417). Conclusions: MWMs significantly improved acute knee bent DFROM and indicated that after 2 sets of MWMs, no further DFROM improvements were identified. Future research should investigate the lasting effects of DFROM improvements with variable MWM dosages.
A machine learning approach to define antimalarial drug action from heterogeneous cell-based screens
Authors: Ashdown George W. , Dimon Michelle , Fan Minjie , Sánchez-Román Terán Fernando , Witmer Kathrin , Gaboriau David C. A. , Armstrong Zan , Ando D. Michael , Baum Jake
Published: September 2020

Machine learning is applied to high-throughput microscopy images of malaria parasites to define antimalarial drug mode of action.
Magnetic Hamiltonian parameter estimation using deep learning techniques
Authors: Kwon H. Y. , Yoon H. G. , Lee C. , Chen G. , Liu K. , Schmid A. K. , Wu Y. Z. , Choi J. W. , Won C.
Published: September 2020

Deep learning can provide a better complementary link between the theoretical models and experimental results in magnetism.
A magnetically actuated microrobot for targeted neural cell delivery and selective connection of neural networks
Authors: Kim Eunhee , Jeon Sungwoong , An Hyun-Kyu , Kianpour Mehrnoosh , Yu Seong-Woon , Kim Jin-young , Rah Jong-Cheol , Choi Hongsoo
Published: September 2020

A magnetically controlled microrobot is used for an artificial neural network by connecting neural clusters.
Many functionally connected loci foster adaptive diversification along a neotropical hybrid zone
Authors: Lewis James J. , Van Belleghem Steven M. , Papa Riccardo , Danko Charles G. , Reed Robert D.
Published: September 2020

Many genes associate with the adaptive diversification of red warning coloration in neotropical
Heliconius
butterflies.
The prefusion structure of herpes simplex virus glycoprotein B
Authors: Vollmer B. , Pražák V. , Vasishtan D. , Jefferys E. E. , Hernandez-Duran A. , Vallbracht M. , Klupp B. G. , Mettenleiter T. C. , Backovic M. , Rey F. A. , Topf M. , Grünewald K.
Published: September 2020

Elusive, pharmacologically relevant conformation of the herpesvirus fusion protein is revealed by a multi-methodological approach.
Arctic mid-winter phytoplankton growth revealed by autonomous profilers
Authors: Randelhoff Achim , Lacour Léo , Marec Claudie , Leymarie Edouard , Lagunas José , Xing Xiaogang , Darnis Gérald , Penkerc’h Christophe , Sampei Makoto , Fortier Louis , D’Ortenzio Fabrizio , Claustre Hervé , Babin Marcel
Published: September 2020

Despite polar night and thick sea ice, algae can grow in the wintertime Arctic Ocean.
Herpes Simplex Virus 1 (HSV-1) 0ΔNLS Live-Attenuated Vaccine Protects against Ocular HSV-1 Infection in the Absence of Neutralizing Antibody in HSV-1 gB T Cell Receptor-Specific Transgenic Mice
Authors: Gmyrek Grzegorz B. , Filiberti Adrian , Montgomery Micaela , Chitrakar Alisha , Royer Derek J. , Carr Daniel J. J.
Published: September 2020

The role of CD8+T cells in antiviral efficacy using a live-attenuated virus as the vaccine is complicated by the humoral immune response. In the case of the herpes simplex virus 1 (HSV-1) 0ΔNLS vaccine, the correlate of protection has been defined to be primarily antibody driven. The current study shows that in the near absence of anti-HSV-1 antibody, vaccinated mice are protected from subsequent challenge with wild-type HSV-1 as measured by survival. The efficacy is lost following depletion of CD8+T cells. Whereas increased survival and reduction in virus replication were observed in vaccinated mice challenged with HSV-1, cornea pathology was mixed with a reduction in neovascularization but no change in opacity. Collectively, the study suggests CD8+T cells significantly contribute to the host adaptive immune response to HSV-1 challenge following vaccination with an attenuated virus, but multiple factors are involved in cornea pathology in response to ocular virus challenge.
Deglacial Kankakee Torrent, source to sink
Authors: Curry B. Brandon , Kehew Alan E. , Antinao Jose Luis , Esch John , Huot Sebastien , Caron Olivier J. , Thomason Jason F.
Published: September 2020

The last-glacial megaflood Kankakee Torrent streamlined hills and the remarkably straight backslope of the Kalamazoo moraine (Lake Michigan lobe of the Laurentide ice sheet) in southwestern Michigan. Flooding ensued as proglacial Lake Dowagiac overflowed across remnants of the Lake Michigan lobe at the position of the inner margin of the Kalamazoo moraine as glacial debris and ablating ice were pinned against Portage Prairie. Proglacial Lake Dowagiac developed in the Dowagiac River valley as the lobe retreated to form the Valparaiso moraine. A minimum age of the Kankakee Torrent (18.7 ± 0.6 k.y. B.P) is indicated by the weighted mean value of six optically stimulated luminescence ages determined from quartz sand in glaciofluvial sediment on the Kalamazoo moraine (Lake Michigan and Saginaw lobes). This value is consistent with tighter age control based on radiocarbon ages of tundra plants within silty sediment forming ice-walled lake plains and in a torrent-scoured lake basin (Oswego channel) in Illinois. Crosscutting relationships of well-dated moraines indicate the Kankakee Torrent occurred sometime between 19.7 and 18.9 calibrated (cal.) k.y. B.P. as it skirted the south margin of the Valparaiso Morainic System.
Genetic landscape of congenital disorders in patients from Southeast Asia: results from sequencing using a gene panel for Mendelian phenotypes
Authors: Wei Heming , Lai Angeline , Tan Ee Shien , Koh Mark Jean Aan , Ng Ivy , Ting Teck Wah , Thomas Terrence , Cham Breana , Lim Jiin Ying , Kam Sylvia , Goh Chew Yin Jasmine , Lin Grace , Brett Maggie , Chan Derrick , Jamuar Saumya Shekhar , Tan Ene-Choo
Published: September 2020

Objective

To test the utility and diagnostic yield of a medical-exome gene panel for identifying pathogenic variants in Mendelian disorders.

Methods

Next-generation sequencing was performed with the TruSight One gene panel (targeting 4813 genes) followed by MiSeq sequencing on 216 patients who presented with suspected genetic disorders as assessed by their attending physicians.

Results

There were 56 pathogenic and 36 likely pathogenic variants across 57 genes identified in 87 patients. Causal mutations were more likely to be truncating and from patients with a prior clinical diagnosis. Another 18 promising variants need further evaluation for more evidence to meet the requirement for potential upgrade to pathogenic. Forty-five of the 92 clinically significant variants were novel.

Conclusion

The 40.3% positive yield compares favourably with similar studies using either this panel or whole exome sequencing, demonstrating that large gene panels could be a good alternative to whole exome sequencing for quick genetic confirmation of Mendelian disorders.
Enhanced Recovery after Intensive Care (ERIC): study protocol for a German stepped wedge cluster randomised controlled trial to evaluate the effectiveness of a critical care telehealth program on process quality and functional outcomes
Authors: Adrion Christine , Weiss Bjoern , Paul Nicolas , Berger Elke , Busse Reinhard , Marschall Ursula , Caumanns Jörg , Rosseau Simone , Mansmann Ulrich , Spies Claudia
Published: September 2020

Introduction

Survival after critical illness has noticeably improved over the last decades due to advances in critical care medicine. Besides, there is an increasing number of elderly patients with chronic diseases being treated in the intensive care unit (ICU). More than half of the survivors of critical illness suffer from medium-term or long-term cognitive, psychological and/or physical impairments after ICU discharge, which is recognised as post-intensive care syndrome (PICS). There are evidence-based and consensus-based quality indicators (QIs) in intensive care medicine, which have a positive influence on patients’ long-term outcomes if adhered to.

Methods and analysis

The protocol of a multicentre, pragmatic, stepped wedge cluster randomised controlled, quality improvement trial is presented. During 3 predefined steps, 12 academic hospitals in Berlin and Brandenburg, Germany, are randomly selected to move in a one-way crossover from the control to the intervention condition. After a multifactorial training programme on QIs and clinical outcomes for site personnel, ICUs will receive an adapted, interprofessional protocol for a complex telehealth intervention comprising of daily telemedical rounds at ICU. The targeted sample size is 1431 patients. The primary objective of this trial is to evaluate the effectiveness of the intervention on the adherence to eight QIs daily measured during the patient’s ICU stay, compared with standard of care. Furthermore, the impact on long-term recovery such as PICS-related, patient-centred outcomes including health-related quality of life, mental health, clinical assessments of cognition and physical function, all-cause mortality and cost-effectiveness 3 and 6 months after ICU discharge will be evaluated.

Ethics and dissemination

This protocol was approved by the ethics committee of the Charité—Universitätsmedizin, Berlin, Germany (EA1/006/18). The results will be published in a peer-reviewed scientific journal and presented at international conferences. Study findings will also be disseminated via the website (www.eric-projekt.net).

Trial registration number

ClinicalTrials.gov Registry (NCT03671447).
Public health programmes to promote mental health in young people: a systematic integrative review protocol
Authors: Wickramasinghe Nuwan Darshana , Samarutilake Nelum , Wettasinghe Mihiri Chami , Feiler Julie , Morgan Antony , Kousoulis Antonis A , Van Bortel Tine
Published: September 2020

Introduction

In light of the ever-growing mental health disease burden among young people worldwide, we aim to systematically review the global literature to identify the public health programmes targeted at promoting mental health and well-being in young people, the reported/anticipated mental health-related outcomes of the implemented public health programmes and the reported facilitators and barriers in relation to the implementation of those public health programmes.

Methods and analysis

A comprehensive literature search will be carried out in the following electronic bibliographic databases: MEDLINE, EMBASE, PsycINFO, Scopus, ASSIA, Web of Science, Global Health, AMED, Health Source and The Cochrane Library. Further, a manual search of the reference lists of eligible studies and reviews will be carried out. The search strategy will include combinations of three key blocks of terms, namely: ‘young people’, ‘mental health’ and ‘public health programme’, using database-specific subject headings and text words. Two reviewers will independently screen, assess data quality and extract data for synthesis. Disagreements at any stage will be resolved by consensus with the involvement of a third reviewer. Given the anticipated methodological pluralism of the potential eligible studies, we will provide a narrative synthesis of the findings on public health programmes aimed at promoting the mental health and well-being of young people according to identified thematic areas. Furthermore, a narrative synthesis of the reported facilitators and barriers in relation to the implementation of public health programmes will be provided.

Ethics and dissemination

Given that the review findings will be focused on understanding the breadth and depth of the global research into public health programmes to promote mental health in young people with a particular emphasis on the facilitators and barriers of programmatic implementation, the findings will be of great value to inform future interventions, programmes and approaches to promote mental health and well-being of young people worldwide.

PROSPERO registration number

CRD42018099551.
Rehabilitation nursing for motor functional recovery of acute ischaemic stroke: study protocol for a randomised controlled trial
Authors: Wang Jianmiao , Chen Yuanyuan , Zhang Yuping , Li Mei , Jin Jingfen
Published: September 2020

Introduction

Stroke is the second-leading cause of death and disability in the world, and patients with stroke often suffer from functional impairments and need rehabilitation. Notably, there is much evidence that rehabilitation can lead to better mortality and morbidity outcomes. The evidence for the effectiveness of rehabilitation nursing, however, is limited. Thus, this study seeks to explore whether rehabilitation nursing is not inferior to usual rehabilitation for motor functional recovery in patients with acute ischaemic stroke.

Methods and analysis

We will conduct an assessor-blinded parallel randomised controlled trial of patients who meet the inclusion criteria after stratification by weighted corticospinal tract lesion load. The experimental group will receive rehabilitation nursing by trained and qualified nurses (seven consecutive days, two sessions per day, 30 min each session). The control group will receive usual rehabilitation provided by therapists (seven consecutive days, two sessions per day, 30 min each session). The primary outcome measures are the Motor Assessment Scale, the Fugl-Meyer Assessment and the Action Research Arm Test. The secondary outcome measures are the modified Rankin Scale, the modified Barthel Index and the National Institute of Health Stroke Scale. Primary and secondary outcome assessment will be performed before and after the intervention, and secondary outcome be assessed at 4 and 12 weeks follow-up. We will recruit 224 patients within a period of 12–18 months from a hospital in southeastern China.

Ethics and dissemination

The study was approved by the Human Research Ethics Committee from the corresponding author’s hospital (approval Number is Ethical Review Study No. 2018 - 112). Peer-reviewed journals and presentations at national and international conferences will be used to disseminate the results.

Trial registration number

NCT03702452.
Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators
Authors: Gidlow Christopher J , Ellis Naomi J , Cowap Lisa , Riley Victoria A , Crone Diane , Cottrell Elizabeth , Grogan Sarah , Chambers Ruth , Clark-Carter David
Published: September 2020

Objectives

Quantitatively examine the content of National Health Service Health Check (NHSHC), patient–practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators.

Design

RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation.

Setting and participants

Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40–74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients’ age, gender and ethnicity.

Methods

Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management.

Results

173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8–38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01–12.48 vs QRISK2 M=7.44%, CI: 5.29–9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44–3.97 vs QRISK2=2.35%, CI: 1.89–2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92–42.17).

Conclusions

There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences.

Trial registration number

ISRCTN10443908.
Patterns of prescription opioid use in Swiss emergency department patients and its association with outcome: a retrospective analysis
Authors: Woitok Bertram K , Büttiker Petra , Ravioli Svenja , Funk Georg-Christian , Exadaktylos Aristomenis K , Lindner Gregor
Published: September 2020

Objectives

We aimed to clarify the prevalence, indications, analgesic comedications and complications of prescription opioid use in patients presenting to a large emergency department (ED).

Design

Retrospective chart review.

Setting

Large, interdisciplinary ED of a public hospital.

Participants

All patients aged ≥18 years presenting between 1 January 2017, and 31 December 2018, with documentation on medication were included.

Interventions

None.

Primary and secondary outcome measures

Prevalence rates for prescription opioid use and its indication. Prevalence of analgesic comedications in prescription opioid users. Hospitalisation rate, 72 hours ED reconsultation rate, 30-day rehospitalisation rate, in-hospital mortality.

Results

A total of 26 224 consultations were included in the analysis; 1906 (7.3%) patients had prescriptions for opioids on admission to the ED. The main indications for opioid prescriptions were musculoskeletal disease in 1145 (60.1%) patients, followed by neoplastic disease in 374 (19.6%) patients. One hundred fifty-four (8.2%) consultations were directly related to opioid intake, and 50.1% of patients on opioids also used other classes of analgesics. Patients on prescription opioids were older (76 vs 62 years, p<0.0001) and female individuals were over-represented (58 vs 48.9%, p<0.0001). Hospitalisation rate (78.3 vs 49%, p<0.0001), 72 hours ED reconsultation rate (0.8 vs 0.3%, p=0.004), 30-day rehospitalisation rate (6.2 vs 1.5%, p<0.0001) and in-hospital mortality (6.3 vs 1.6%, p<0.0001) were significantly higher in patients with opioid therapy than other patients. In 25 cases (1.3%), admission to the ED was due to opioid intoxication.

Conclusions

Daily prescription opioid use is common in patients presenting to the ED. The use of prescription opioids is associated with adverse outcomes, whereas intoxication is a minor issue in the studied population.
Community paramedicine—cost–benefit analysis and safety with paramedical emergency services in rural areas: scoping review protocol
Authors: Elden Odd Eirik , Uleberg Oddvar , Lysne Marianne , Haugdahl Hege Selnes
Published: September 2020

Introduction

Community paramedicine models have been developed around the world in response to demographic changes, healthcare system needs and reforms. The traditional role of the paramedic has primarily been to provide emergency medical response and transportation of patients to nearby medical facilities. As a response to healthcare service gaps in underserved communities and the growing professionalisation of the workforce, the role of community paramedicine has evolved as a new model of care. A community paramedicine model in one region might address other healthcare needs than a model in another region. Various terms are also in use for community paramedicine providers, with no consensus on the definition for community paramedics, although the definition used by the International Roundtable on Community Paramedicine has been widely accepted. We aimed to examine the current knowledge and possibly identify gaps in the research/knowledge base for cost–benefit analysis and safety concerning community paramedicine in rural areas using a scoping review methodology.

Methods and analysis

This scoping review will follow the methodology developed by Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. In October 2020, we will search electronic databases (MEDLINE via PubMed, CINAHL, Cochrane and Embase) and the reference lists of key studies to identify studies for inclusion. The selection process is in two steps. First, two reviewers will independently screen identified articles for title and abstracts and, second, perform a full-text review of eligible studies for inclusion. Studies focusing on community paramedicine in rural areas, which include cost–benefit analysis or safety evaluation, will be included.

Ethics and dissemination

The data used are available from publicly secondary sources, therefore this study will not require ethical review. The results will be disseminated through peer-reviewed publication.
Serum 25-hydroxyvitamin D level in relation to weight change and the risk of weight gain in adults of normal weight at baseline: the Norwegian HUNT cohort study
Authors: Heitz Adaline , Mai Xiao-Mei , Chen Yue , Sun Yi-Qian
Published: September 2020

Objective

We sought to investigate the relationship of serum 25-hydroxyvitamin D (25(OH)D) level with weight change and the risk of weight gain in an adult population who had normal weight at baseline and were followed up for 11 years.

Design

A population-based prospective cohort study.

Setting

Nord-Trøndelag, Norway.

Participants

The study included 1501 adults who participated in the second and third surveys of the Nord-Trøndelag Health Study (HUNT2 (1995–1997) and HUNT3 (2006–2008)) and had a normal body mass index ≥18.5 and <25.0 kg/m2 at baseline.

Primary and secondary outcome measures

Relative weight change (%) was calculated as ((HUNT3 weight−HUNT2 weight)/HUNT2 weight×100). Relative annual weight change (%) was calculated as (relative weight change/follow-up years×100). Clinical weight gain was defined as relative weight change ≥5% over the 11 years, while annual weight gain was defined as relative annual weight change >1.25%.

Methods

Multiple regression models were used to estimate adjusted coefficients for the relative annual weight change and risk ratios (RRs) for the risk of clinical weight gain and of annual weight gain.

Results

Each 25 nmol/L increase in season-standardised serum 25(OH)D level at baseline was associated with a reduction of 0.05% (95% CI −0.11 to 0.01) for relative annual weight change, a 10% (RR 0.90, 95% CI 0.82 to 0.97) reduced risk of clinical weight gain, and a 19% (RR 0.81, 95% CI 0.65 to 1.00) reduced risk of annual weight gain. A statistically significant trend was evident for the risk of clinical weight gain when 25(OH)D levels were treated as a categorical variable (p=0.006).

Conclusions

The findings suggested an inverse association of serum 25(OH)D level with the risk of clinical weight gain in adults who had normal weight at baseline over 11 years’ follow-up.
Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study
Authors: Apanga Paschal Awingura , Kumbeni Maxwell Tii , Ayamga Emmanuel Awine , Ulanja Mark B , Akparibo Robert
Published: September 2020

Objective

To assess the prevalence and factors associated with modern contraceptive (CP) use among women of the reproductive age.

Design

Cross-sectional study.

Setting

We used data from the Multiple Indicator Cluster Surveys (MICSs) from 20 African countries collected between 2013 and 2018.

Participants

Data on 1 177 459 women aged 15–49 years old.

Methods

Multivariable logistic regression was used to identify factors associated with modern CP use, while controlling simultaneously for independent variables, and accounting for clustering, stratification and sample weights from the complex sampling design. We used random effects meta-analysis to pool adjusted estimates across the 20 countries.

Results

The overall prevalence of modern CP use was 26% and ranged from 6% in Guinea to 62% in Zimbabwe. Overall, injectable (32%) was the most preferred method of CP, followed by oral pill (27%) and implants (16%). Women were more likely to use a modern CP if they: had a primary (adjusted prevalence odds ratios (aPORs): 1.68, 95% CI: 1.47 to 1.91)) or secondary/higher education (aPOR: 2.16, 95% CI: 1.80 to 2.59) compared with women with no formal education; had no delivery in the last 2 years (aPOR: 3.89, 95% CI: 2.76 to 5.47) compared with women who delivered in the last 2 years; were aged 25–34 years (aPOR: 1.33, 95% CI: 1.20 to 1.47) compared with women aged 15–24 years; were of middle-income status (aPOR: 1.25, 95% CI: 1.11 to 1.39) or rich (aPOR: 1.53, 95% CI: 1.27 to 1.84) compared with poor women and had two or more antenatal care visits compared with women without a visit. Perceived domestic violence was not associated with modern CP use (aPOR: 0.98, 95% CI: 0.92 to 1.05).

Conclusion

Our findings are relevant in a global context, particularly in the African region, and improve our understanding on relevant factors essential to increasing modern CP use.
BET 1: Esmolol—a novel adjunct to the ACLS algorithm?
Authors: King Christine , McKenzie Casey , Saikaley Kyle
Published: September 2020

A short-cut review of the available medical literature was carried out to establish whether esmolol was an effective treatment for patients in cardiac arrest. After abstract review, two papers were found to answer this clinical question using the detailed search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is insufficient research addressing this question to know whether esmolol is a potential treatment for cardiac arrest.
BET 2: The accuracy of self-reported penicillin allergies in adults
Authors: Wakeling Sonja , Alavian Sara
Published: September 2020

A short-cut review of the available medical literature was carried out to establish the proportion of patients who self-report an allergy to penicillin have a true penicillin allergy. After abstract review, four papers were found to answer this clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that many adults who self-report a penicillin allergy are probably not allergic to penicillin antibiotics.
Abstracts from international emergency medicine journals
Authors: Production EMJ
Published: September 2020

EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
PP14  Improving access to, and experience of, ambulance care for eastern european migrants: a paramedic interview study
Authors: Phung Viet-Hai , Asghar Zahid , Matiti Milika , Siriwardena Niro
Published: September 2020

Background

The UK has experienced significant immigration from Eastern Europe following European Union (EU) expansion in 2004. Lincolnshire is a predominantly rural county in the East Midlands region of the UK with a large Eastern European migrant population requiring healthcare, including urgent ambulance care. The Equality Act 2010 requires public bodies such as health services to provide access to high quality healthcare, while the Equality Delivery System seeks to ensure that NHS organisations comply with the legislation. This study aimed to explore the perceptions and experiences of ambulance staff attending Eastern European migrants in Lincolnshire.

Methods

Qualitative semi-structured interviews were conducted with 15 ambulance staff at locations across Lincolnshire. Purposive and maximum variation sampling ensured that participants were knowledgeable about Eastern European migrants’ use of ambulance care and covered a range of demographic characteristics. The data were analysed using framework analysis.

Results

Difficulty in accessing professional interpreters meant that some patients relied instead on family members. Some Eastern European migrants brought back foreign language medication, which ambulance staff could not understand. It was common for patients to not be registered with GPs because they were temporarily resident, did not understand how the UK healthcare system worked or preferred to go to their home country for treatment. By not registering with GPs, patients were sometimes transported to the Emergency Department for primary care conditions.

Conclusions

The practical recommendations for service delivery improvements may be valuable for service providers and could be incorporated into future protocols. These include: having a glossary of key terms in Eastern European languages; simple packs explaining how and when to use the ambulance service translated into different languages where necessary; encouraging patients to register with GPs; and face-to-face meetings where the ambulance service inform the Eastern European communities about how to use their services.
PP18  Preventing burnout amongst healthcare professionals – preliminary findings of a case analysis of yorkshire ambulance service
Authors: Powell Catherine , Lord Kathryn , Fylan Beth , Breen Liz
Published: September 2020

Background

In order to deliver safe and effective healthcare to patients the NHS needs to create a good working environment for its staff. Healthcare professionals report high levels of physical and mental illness which can be related to their work. In particular, work-related stress can result in poor retention rates in healthcare organisations and poor staff wellbeing impacts on patients’ experiences and care quality. As such there is a need to focus on the health and wellbeing of NHS staff. Our key aim is to understand how 999 call handlers working within Yorkshire Ambulance Service (AS) experience burnouts and how these can be reduced based on job and personal resilience mechanisms.

Our objectives are the following:

Explore the triggers of burnout amongst call handlers working within Yorkshire AS.

Examine the resources available on the job to reduce the frequency and impact of burnouts.

Explore personal resources available to mitigate the risk of burnouts.

Methods

A qualitative study design was used. 18 AS staff were interviewed via telephone (72% female). Thematic analysis of the data was applied as per standard steps.

Results

Preliminary findings suggest that the sources of burnout are related to role perceptions, job norms, and intensity of the role. Job resources to reduce frequency and impact of burnout may hinge on resource availability, individual appreciation and motivations, and job preparation. The personal resources that AS staff possess to reduce frequency and impact of burnout can include developing protective strategies, having time with others and time alone, and self-care and recovery.

Conclusions

Findings suggest that AS staff have developed techniques to prevent and/or manage burnout yet require more support to increase their resilience to prevent burnout.
02  The role of feedback and follow up in ambulance services: a qualitative interview study
Authors: Wilson Caitlin , Janes Gillian , Lawton Rebecca , Howell Anne-Marie , Benn Jonathan
Published: September 2020

Background

International studies have shown that the feedback that ambulance staff receive lacks structure, relevance, credibility and routine implementation (Cash, 2017; Morrison, 2017). Research from psychology and implementation science suggests that feedback can change professional behaviour, improve clinical outcomes and positively influence staff mental health (Ivers, 2012; Michie and Williams, 2003). The aim of this study was to explore the experience of ambulance staff regarding current feedback provision and their views on how feedback impacts on patient safety, staff wellbeing and professional development.

Methods

A qualitative study conducted as part of a wider study of work-related wellbeing in ambulance staff. 25 semi-structured interviews with prehospital staff in a clinical role from a UK ambulance service sampled using theoretical sampling. Theoretically-informed thematic analysis using psychological theory linked to the self-motives framework for feedback-seeking behaviour.

Results

Study participants viewed current feedback provision as inadequate and consistently expressed a desire for increased feedback. Participants raised concerns that inadequate feedback could negatively impact on patient safety by preventing learning from mistakes. Enhancing feedback provision was suggested to improve patient safety by supporting professional development and clinical decision-making, through facilitating reflection, knowledge acquisition and professional behaviour change. Similarly, participants thought that enhanced feedback could improve staff wellbeing by enabling closure and encouraging intra-professional dialogue and peer-support. The self-motives framework was useful in interpreting personal and professional motivators for feedback-seeking behaviour within the data.

Conclusions

In accordance with previous research in this area, this study highlights prehospital clinicians’ strong desire for feedback. Furthermore, it suggests that enhancing prehospital feedback could improve patient safety by enriching clinical decision-making and supporting professional development, as well as promote staff wellbeing. Findings from this initial study will be used to guide a PhD programme to address this evidence gap.
PP20  Paramedic identification and referral of patients in the last year of life: a stakeholder interview study
Authors: Kirby Kim , Black Sarah , Goodwin Laura , Pocock Lucy , Proctor Alyesha , Richardson Sally , Stonehouse Joanne , Taylor Hazel , Voss Sarah , Benger Jonathan
Published: September 2020

Background

Patients are approaching End of Life when they are likely to die within the next 12 months. Quality in End of Life Care is variable and identifying patients in the End of Life phase is challenging, particularly in those people with diagnoses other than cancer. Many patients accessing the ambulance service are in the last year of their lives and the role of ambulance services in recognising patients approaching the end of their lives is often overlooked. Patients who are End of Life should be offered advanced care planning.

Research Question

What are stakeholders’ views on a paramedic screening and referral intervention aimed at improving care planning in patients in the last year of life?

Methods

A qualitative study using semi-structured telephone interviews conducted with 17 stakeholders to investigate stakeholders’ views on:

the utility of a paramedic screening and referral tool

the likely impact of a paramedic screening and referral tool

Preliminary Results

All staff groups:

Increasing advanced care planning would be advantageous for patients

Patients with non-malignant conditions are not readily recognised as End of Life.

Paramedics should use the Gold Standards Framework Proactive Identification Guidance to identify patients in the last year of life.

The proposed intervention has the potential to reduce unnecessary hospital admissions and unnecessary resuscitation.

Specific staff groups:

GPs: Concerns about additional workload.

GPs: The intervention is useful for patients who may ‘fall under the radar’.

GPs and ED doctors: Concerns about the need for paramedics to have sensitive communication skills.

Paramedics and GPs: A dedicated End of Life lead or team would be advantageous.

Conclusions

The introduction of an end of life screening and referral tool into paramedic practice is a welcome intervention and will have a positive impact on patients at the end of life. GPs expressed concern about capacity to manage referrals.
PP21  Perceptions and experiences of employee mental health support: a cross-sectional survey of UK ambulance service staff
Authors: Johnston Sasha , Wild Jennifer , Sanderson Kristy , Kent Bridie
Published: September 2020

Background

Mental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, staff experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. To identify whether organisational support meets staff needs, this research explored the perceptions and experiences of staff working in a large ambulance trust covering the south west of England.

Methods

Between September and October 2018, ambulance staff were invited to complete an online questionnaire, which assessed demographics, work-related stressful life events, related psychological impact assessed by the avoidant subscale of Weiss and Marmar’s Impact of Event Scale-Revised, mental ill health sickness absence during the previous 12 months, perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time-to-talk at work.

Results

Over 11% (N=540) of the workforce responded. The majority reported experiencing work-related stressful life events (n=444; 82%), that were associated with subsequent avoidant symptoms. Avoidant symptom severity peaked between six-months to five-years after an event (F(5,438) = 2.4,p=0.03), was associated with repeated exposure (F(4,439) = 2.9,p=0.01) and to sickness absence. A fifth of participants reported mental ill health sickness absence (21.6%), a third of which was not disclosed as related to mental health. Content analysis identified stigma, fear, as well as embarrassment, as barriers to disclosure and help-seeking. Perceptions and experiences of organisational support were significantly correlated (r(195) =0.46,p<0.001) and positive.

Conclusions

Symptoms associated with work-related stressful life events can persist for years among ambulance staff. Given the association between organisational support and mental wellbeing, it is possible that an intervention, such as mandatory time-to-talk, supported at an organisation level could improve wellbeing among ambulance staff. Such an intervention needs to be evaluated in future research.
PP24  Does a paramedic practitioner self-tasking dispatch model benefit their self-sufficiency in patient management? A cross sectional study
Authors: Cotterill Liam , Halter Mary
Published: September 2020

Background

Paramedic Practitioner (PP) scope of practice is not comprehensively understood by Emergency Operations Centre (EOC) staff and tasking may be suboptimal. In one UK ambulance trust in November 2018, one PP team was enabled to remotely monitor live incidents and, alongside some continued EOC-dispatch, to self-task to incidents they judged would benefit from their additional knowledge and skills. Evidence on self-tasking benefit was found from helicopter emergency services only.

Methods

A retrospective cross-sectional study was utilised to evaluate the impact on self-sufficiency - defined as incidents completed by a PP without the need for further ambulance resources - and conveyance rates of PPs utilising a ‘self-tasking’ dispatch model. PP-completed shift reports were collected over a 6-month period from ten PPs working in one trust locality. Excluded cases: Category-1 calls, healthcare professional calls, PP referrals and back-up requests originating from on-scene ambulance clinicians. Descriptive statistics were used to compare rates of self-sufficiency and conveyance between self-tasked and EOC-dispatched incidents.

Results

Shift reports detailing 964 incidents were analysed; 705 were self-tasked and 259 were EOC-tasked. PPs showed a statistically significant increase in self-sufficiency when utilising the self-tasking method of dispatch compared to EOC initiated dispatch (88% self-tasked versus 72% EOC-tasked, χ240.4, df 1, p<0.01). There was also an increased non-conveyance rate self-tasking compared to EOC-led tasking (64% versus 56%, χ25.3, df 1, p<0.05).

Conclusions

PPs appear to find it easier to identify incidents suited to their scope to be self-sufficient than EOC staff. This study is a small-scale evaluation in one site, does not adjust for confounders, and does not constitute a direct comparison of the two models. There remains a need for more rigorous research on this topic, though this evaluation suggests that there may be benefits to be gained from PPs self-tasking.
PP25  Does unguided cardio-pulmonary-resuscitation in copenhagen achieve high quality recommendations?
Authors: Lyngby Rasmus Meyer , Nikoletou Dimitra , Folke Fredrik , Quinn Tom
Published: September 2020

Background

Survival from out-of-hospital cardiac arrest (OHCA) is associated with the quality of cardio-pulmonary-resuscitation (CPR). The European Resuscitation Council (ERC) and American Heart Association (AHA) define high quality CPR as compression depth of 5–6 centimeters, compression rate of 100–120 compressions/minute, full recoil (>400 milliseconds) after each compression and a hands-on time (compression fraction) of at least 60% (ERC) or 80% (AHA). The aim of this study was to investigate if unguided CPR performed by Copenhagen Emergency Medical Services (EMS) met these recommendations.

Method

From October throughout December 2018, OHCA data were collected from ambulances within the Capital Region of Denmark using Zoll X-series defibrillator (without CPR feedback dashboard or metronome). Only cases where EMS performed CPR were included. Data was uploaded to a central database and extracted to EXCEL for descriptive statistics and preliminary results.

Results

EMS CPR was performed in 330 cases of which 252 were available for analysis. Mean (SD)compression depthwas 5.6±1.7 centimeters,compression ratewas 110±9.8 compressions/minute,release velocitywas 410±125.1 milliseconds,compression quality(correct compression depth + correct compression rate) was 13.8% andcompression fractionwas 69.7%.

Conclusion

The quality of EMS-delivered CPR, unguided by feedback or metronome, was within recommendations for compression depth, compression rate and release velocity. CPR fraction was between ERC and AHA guidelines. Compression quality, which is not included in ERC/AHA recommendations, did not reach the manufactures recommended >60%. Further work is ongoing to evaluate the effect of adding real-time feedback to guide EMS CPR.
PP26  Knowledge, attitudes and practices of UK paramedics regarding pharmacology and the legal, management and administration aspects of medicines: a cross-sectional online quantitative survey
Authors: Laws Samantha , Halter Mary , Wang Chao
Published: September 2020

Background

Changes in the paramedic profession have seen an increased range of medicines available within UK ambulances services. However, poor practice in medicines management has been identified by the Care Quality Commission. Literature in this area is sparse. This study aimed to determine the perceived knowledge, attitudes and practices of paramedics regarding pharmacology and the legal and regulatory issues of medicines management and administration.

Methods

The study utilised a cross-sectional survey design, administering an anonymous online survey to all (approximately 1000) paramedics within one UK NHS ambulance trust. The survey focused on paramedic knowledge on pharmacology, legal supply and administration; self-assessment of knowledge and confidence related to medicine management and administration; and personal characteristics. The primary outcome was percentage of (pre-determined) correct answers.

Results

251 responses were received. The mean percentage of correct answers was 79.0% (SD 10.0), with variation by question observed, from 34.7 to 97.2% correct responses. A higher correct knowledge was associated with: higher self-rated confidence, lower self-reported knowledge, being less likely to report errors and higher education-based initial route into the paramedic profession.

Conclusion

This single-site UK-based survey highlighted variation in medicines knowledge amongst self-selecting paramedic respondents. The results indicate a need for medicines-specific further education for all paramedics, particularly those who have not experienced longer formal education entry routes, integrating a focus on confidence and self-perceived knowledge, and enhancing and embedding integrated improvement strategies. Further research is required with larger, multi-site samples, and to evaluate the impact of education packages developed.