bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

IntroductionStroke 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 analysisWe 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 disseminationThe 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 numberNCT03702452.
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

ObjectivesQuantitatively 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.DesignRIsk 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 participantsTwelve 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.MethodsVideo 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.Results173 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).ConclusionsThere 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 numberISRCTN10443908.
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

ObjectivesWe aimed to clarify the prevalence, indications, analgesic comedications and complications of prescription opioid use in patients presenting to a large emergency department (ED).DesignRetrospective chart review.SettingLarge, interdisciplinary ED of a public hospital.ParticipantsAll patients aged ≥18 years presenting between 1 January 2017, and 31 December 2018, with documentation on medication were included.InterventionsNone.Primary and secondary outcome measuresPrevalence 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.ResultsA 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.ConclusionsDaily 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

IntroductionCommunity 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 analysisThis 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 disseminationThe 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

ObjectiveWe 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.DesignA population-based prospective cohort study.SettingNord-Trøndelag, Norway.ParticipantsThe 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 measuresRelative 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%.MethodsMultiple 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.ResultsEach 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).ConclusionsThe 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

ObjectiveTo assess the prevalence and factors associated with modern contraceptive (CP) use among women of the reproductive age.DesignCross-sectional study.SettingWe used data from the Multiple Indicator Cluster Surveys (MICSs) from 20 African countries collected between 2013 and 2018.ParticipantsData on 1 177 459 women aged 15–49 years old.MethodsMultivariable 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.ResultsThe 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).ConclusionOur 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.
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

BackgroundThe 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.MethodsQualitative 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.ResultsDifficulty 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.ConclusionsThe 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

BackgroundIn 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.MethodsA 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.ResultsPreliminary 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.ConclusionsFindings 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

BackgroundInternational 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.MethodsA 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.ResultsStudy 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.ConclusionsIn 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

BackgroundPatients 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 QuestionWhat are stakeholders’ views on a paramedic screening and referral intervention aimed at improving care planning in patients in the last year of life?MethodsA qualitative study using semi-structured telephone interviews conducted with 17 stakeholders to investigate stakeholders’ views on:the utility of a paramedic screening and referral toolthe likely impact of a paramedic screening and referral toolPreliminary ResultsAll staff groups:Increasing advanced care planning would be advantageous for patientsPatients 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.ConclusionsThe 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.