bluuebunny/crossref_metadata_2025_split huggingface dataset:
Counselling for physical activity, life-space mobility and falls prevention in old age (COSMOS): protocol of a randomised controlled trial
Authors: Edgren Johanna , Karinkanta Saija , Rantanen Taina , Daly Robin , Kujala Urho M , Törmäkangas Timo , Sievänen Harri , Kannus Pekka , Heinonen Ari , Sipilä Sarianna , Kannas Lasse , Rantalainen Timo , Teittinen Outi , Nikander R 
Published: September 2019

IntroductionThe most promising way to promote active life years in old age is to promote regular participation in physical activity (PA). Maintaining lower extremity muscle function with good balance has been associated with fewer falls and the need of help from others. This article describes the design and intervention of a randomised controlled trial (RCT) investigating the effectiveness of a health and PA counselling programme on life-space mobility and falls rates in community-dwelling older adults at the Health Kiosk and/or Service Centre.Methods and analysisCommunity-dwelling men and women (n=450) aged 65 years and over with early phase mobility limitation will be recruited to a 24-month RCT with a 24-month follow-up. Participants will be randomly allocated into either a health and PA counselling group (intervention) or relaxation group (control intervention). All participants will receive five group specific face-to-face counselling sessions and 11 phone calls. The counselling intervention will include individualised health counselling, strength and balance training, and guidance to regular PA. The control group will receive relaxation exercises. Outcomes will be assessed at baseline, 12, 24 and 48 months. Primary outcomes are average life-space mobility score and falls rates. Life-space mobility will be assessed by a validated questionnaire. Falls rates will be recorded from fall diaries. Secondary outcomes are data on fall-induced injuries and living arrangements, number of fallers, fracture risk, mean level of PA, physical performance, quality of life, mood, cognition, balance confidence and fear of falling. Data will be analysed using the intention-to-treat principle. Cost-effectiveness of the programme will be analysed. Ancillary analyses are planned in participants with greater adherence.Ethics and disseminationEthical approval was obtained from the Ethics Committee of the Tampere University Hospital (R15160). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences.Trial registrationISRCTN65406039; Pre-results.
Pulmonary embolism following complex trauma: UK MTC observational study
Authors: Glover Thomas E , Sumpter Joanna E , Ercole Ari , Newcombe Virginia F J , Lavinio Andrea , Carrothers Andrew D , Menon David K , O’Leary Ronan 
Published: September 2019

ObjectivesTo describe the incidence of pulmonary embolism (PE) in a critically ill UK major trauma centre (MTC) patient cohort.MethodsA retrospective, multidataset descriptive study of all trauma patients requiring admission to level 2 or 3 care in the East of England MTC from 1 November 2014 to 1 May 2017. Data describing demographics, the nature and extent of injuries, process of care, timing of PE prophylaxis, tranexamic acid (TXA) administration and CT scanner type were extracted from the Trauma Audit and Research Network database and hospital electronic records. PE presentation was categorised as immediate (diagnosed on initial trauma scan), early (within 72 hours of admission but not present initially) and late (diagnosed after 72 hours).ResultsOf the 2746 trauma patients, 1039 were identified as being admitted to level 2 or 3 care. Forty-eight patients (4.6%) were diagnosed with PE during admission with 14 immediate PEs (1.3%). Of 32.1% patients given TXA, 6.3% developed PE compared with 3.8% without TXA (p=0.08).ConclusionThis is the largest study of the incidence of PE in UK MTC patients and describes the greatest number of immediate PEs in a civilian complex trauma population to date. Immediate PEs are a rare phenomenon whose clinical importance remains unclear. Tranexamic acid was not significantly associated with an increase in PE in this population following its introduction into the UK trauma care system.
PP11 Relationship between hospital characteristics and survival outcomes in out of hospital cardiac arrest (OHCA) patients treated and transported by yorkshire ambulance service (YAS)
Authors: Platt Anthony 
Published: September 2019

BackgroundThere is mounting evidence that post resuscitation care, should include early angiography and primary percutaneous coronary intervention (PPCI) in OHCA where a cardiac cause is suspected. In Yorkshire, the ambulance service can transport patients with a return of spontaneous circulation (ROSC), directly to a regional PPCI unit, if their ECG shows ST elevation myocardial infarction (STEMI) and the PPCI units accept. The aim of this study was to evaluate transport decisions, hospital characteristics and outcome in the form of 30 day survival rates of post-ROSC patients with presumed cardiac aetiology.MethodsOHCA patient care records (PCRs) between January and July 2017 were reviewed. Patients were eligible for inclusion if they were: an adult non-traumatic OHCA: achieved ROSC on scene, and were transported to hospital. Descriptive statistics were used to analyse the data.Results478 patients met the inclusion criteria. 361/478 (75.6%) patients had an ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a PPCI unit. 40/88 (45.5%) of referrals made were accepted by PPCI. Patients taken directly to PPCI were most likely to survive to 30 days (25/39, 53.8%). 34/126 (27.0%) patients survived to 30 days after transport to an emergency department (ED) at a PPCI- capable hospital, and 50/310 (16.1%) survived if taken to ED at a non-PPCI capable hospital.ConclusionWork is required to ensure post-ROSC patients receive a 12 lead ECG, and those with STEMI are referred to PPCI, as survival was greatest in this group. 30 day survival was better for patients taken to ED at a hospital with PPCI facilities, than an ED at a general hospital. Discussion needs to take place between YAS and the relevant hospitals in the region to ensure patients are transported to the appropriate destination.
PP12 An evaluation of the role of SCAS in the attendance to call-outs and the transport to hospital of older people with dementia
Authors: Lofthouse-Jones Chloe , Pocock Helen , King Phil , Jadzinski Patryk , England Ed , Taylor Sarah , Cavalier Julian , Fogg Carole 
Published: September 2019

BackgroundOur previous work has shown that 35% of ambulance attendances by SCAS are to people aged 75 and over; 17% of these have dementia. The research literature suggests that older people with cognitive impairment/dementia experience longer stays, or die, in hospital. It is unclear whether factors such as call time or availability of social care impact conveyance rates. The aim of this study was to explore the impact of out-of-hours call-outs and social care provision on ambulance conveyance rates for people aged ≥75 years, including patients with dementia.MethodsFor this service evaluation, electronic records for patients aged ≥75 years attended by SCAS were extracted over one year. The proportion of conveyed patients according to a dementia record, out-of-hours call, time of year, triage grade, social care provision and indices of deprivation were calculated. Univariate and multivariate analyses identified factors which may influence conveyance.ResultsA total of 111,548 electronic records were included, 16.5% with dementia. 63.7% of calls resulted in conveyance (59.1% with dementia). Conveyances reduced in out-of-hours periods for all patients. 13.6% more patients living alone and 16.5% more patients living with family were conveyed to hospital if there was no care package in place. Adjusted for other factors, having a care package reduced the risk of conveyance in older people living alone by 36% (Odds ratio 0.64, 95% Confidence interval 0.62–0.67).ConclusionsAvailability of social care and time of call appear to be important determinants of conveyance in older people, both in those with and without dementia. More research is needed to improve needs assessments and local referral services and pathways.
PP19 Use and impact of the pre-hospital 12-lead electrocardiogram in the primary PCI era (PHECG2): mixed methods study protocol
Authors: Gavalova Lucia , Halter Mary , Snooks Helen , Gale Chris , Weston Clive , Watkins Alan , Munro Scott , Davies Glenn , Hampton Chelsey , Driscoll Timothy , Quinn Tom 
Published: September 2019

BackgroundThe pre-hospital 12-lead electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS). Prior research found PHECG was associated with improved 30-day survival, but a third of ACS patients under EMS care did not have PHECG. Such patients tended to be female, older and/or with comorbidities. This previous study was undertaken when thrombolytic treatment was the main treatment for ST segment elevation myocardial infarction (STEMI); practice has since shifted to a predominant interventional strategy – primary percutaneous coronary intervention (pPCI). Moreover, the previous study relied solely on data collected by the Myocardial Ischaemia National Audit Project (MINAP), which does not include information on symptoms, EMS personnel gender, and other factors that may influence decision-making. The PHECG2 study addresses the following research questions: a) Is there a difference in 30-day mortality and reperfusion between those who do and do not receive PHECG? b) Has the proportion of eligible patients who receive PHECG changed since the introduction of pPCI networks? c) Are patients that receive PHECG different from those that do not in social and demographic factors, and in pre-hospital clinical presentation? d) What factors do EMS clinicians report as influencing their decision to perform PHECG?MethodsExplanatory sequential Quan-Qual mixed methods study comprising 4 Work Packages (WPs): WP1 a population based, linked data analysis of MINAP from 2010–2017 (n=510,000); WP2 retrospective chart review of EMS records from 3 EMS; WP3 focus groups with personnel from 3 EMS. WP4 will synthesise findings from WP1-3.ConclusionsGaining an understanding into the clinical and non-clinical factors influencing EMS clinicians’ decisions to record PHECG will enable us to develop (and later test through a randomised trial) an intervention to improve PHECG uptake and patient outcomes following an ACS event.
PP20 A retrospective service evaluation of the presentation of anaphylaxis to a UK ambulance service
Authors: Groom Nicholas , Taylor Sarah , England Ed , Pocock Helen , Deakin Charles D 
Published: September 2019

BackgroundThere is a lack of data relating to frequency and presentation of anaphylaxis to the ambulance service in England. Little research exists relating to the patients’ self-treatment of anaphylaxis and there is an absence of evidence to evaluate the impact of self-administered adrenaline, there is a need to describe this patient group to evaluate any potential to develop their care.MethodsRetrospective data were collected from the electronic patient records of a single NHS ambulance service serving a population of approximately four million. Records between 1stApril 2017 and 31stMarch 2018 were included where a diagnosis of anaphylaxis was recorded. Gender, age, incident location, allergy history, were summarised to identify any trends in presentation. The frequency of patient self-administration, as well as ambulance administration, of adrenaline was also included for analysis to determine any correlation.Results326 records were included in the analysis. The mean, median and modal patient ages were 34, 29 and 20 respectively. Patient ages ranged from six months to 95 years. Patients were 65% female, 35% male and 59% of incidents occurred at home. 76% of patients reported having a known allergy with food being the most common allergen (44%). Peak times for calling 999 were midday and 6pm. 35% of patients had self-administered adrenaline. 52% received ambulance-administered adrenaline. The doses of self-administered adrenaline ranged from 0–3 doses and ambulance administered adrenaline ranged from 0–8 doses. Patients who self-administered adrenaline were less likely to receive further adrenaline from the ambulance service. No correlation was found between the number of self-administered doses and ambulance administered doses.ConclusionPatient demographics such as age, gender and allergies were consistent with two previous small-scale studies. This study suggests that early self-administration of adrenaline is beneficial. Opportunities for improvements in data recording as well as patient education were identified.
03 Opioid overdose death in wales from 2012 to 2015: a linked data autopsy study
Authors: Jones Matthew , Watkins Alan , Bulger Jenna , John Ann , Snooks Helen , Bradshaw Ceri , Fuller Gordon 
Published: September 2019

BackgroundOpioids account for more fatalities by overdose than any other drug. Fatal opioid overdose is a growing public health problem, with incidence rising in western countries especially. We sought to describe the deaths, sociodemographic characteristics, and service usage patterns of decedents of opioid overdose in Wales.MethodsWe carried out a retrospective cross-sectional analysis of opioid related deaths in Wales identified from Office for National Statistics data between 01/01/2012 and 31/12/2015, in Wales, UK.Routine data were captured from Office of National Statistics (ONS), the Welsh Demographic Service and National Health Service datasets for the preceding three years and linked using a deterministic algorithm. Demographic, socioeconomic, clinical and service use characteristics were detailed using descriptive statistics.ResultsThe majority of opioid overdose deaths (n=312) occurred at home (n=253, 81.09%) and were accidental (n=262, 83.97%). A third (31.09%) involved heroin as the main object of injury (n=97). Decedents were mostly male (n=228, 73.1%) and lived in socioeconomically deprived (lacking in material and social opportunities and/or resources) areas at the time of their death (n=199, 63.75%). The majority of decedents changed address at least once during the 36 month observation period prior to death (n=169, 53.85%), but rarely moved far geographically (e.g. were resident in more than two postcode areas). The majority of decedents visited the emergency department (n=227, 72.76%), were admitted to hospital (n=199, 63.78%) – usually for mental health problems – and were recorded at least one General Practitioner episode (n=258, 82.69%) during the observation period. A minority of decedents used drug treatment services (n=72, 23.08%).ConclusionsOpioid overdose deaths occur most commonly secondary to heroin use. Decedents demonstrate a peripatetic lifestyle and are rarely engaged with drug treatment services. Frequent contact with unscheduled care providers might present a target for preventative interventions.
OP6 A qualitative study on conveyance decision-making during emergency call outs to people with dementia: The HOMEWARD project
Authors: Voss Sarah , Kirby Kim , Brandling Janet , Benger Jonathan 
Published: September 2019

ObjectivesAmbulance staff are increasingly required to make complex decisions as to whether they should convey a patient to hospital or ‘see and treat’ at the scene. Dementia can be a significant barrier to the assessment of pain and injury. However, to our knowledge no research has specifically examined the process of decision-making by ambulance staff in relation to people with dementia. This qualitative study was designed to investigate the factors influencing the decision-making process during ambulance calls to older people with dementia.MethodsThis qualitative study used a combination of observation, interview and document analysis, to investigate the factors influencing the decision-making process during ambulance calls to older people with dementia. A researcher worked alongside ambulance crews in the capacity of observer and recruited eligible patients to participate in case studies. Data were collected from observation notes of decision-making during the incident, patient care records and post incident interviews with participants, and analysed thematically.ResultsFour main themes emerged from the data concerning the way that paramedics make decisions in people with dementia: Physical Condition; the key factor influencing paramedics’ decision-making was the physical condition of the patient. Cognitive Capacity; most of the participants preferred not to remove patients with a diagnosis of dementia from surroundings familiar to them, unless they deemed it absolutely essential. Patient Circumstances; this included the patient’s medical history and the support available to them. Professional Influences; paramedics also drew on other perspectives to inform their decision-making.ConclusionThe preference for avoiding unnecessary conveyance for patients with dementia, combined with difficulties in obtaining an accurate patient medical history and assessment, mean that decision-making can be especially challenging. Further research is needed to find reliable ways of assessing patients and accessing information to support conveyance decisions for ambulance calls to people with dementia.
PP8 Trauma and the obesity epidemic: a systematic review of the impact of obesity on trauma mortality and morbidity
Authors: Mayer Simon , Lahiri Sumitra , Rowles Joseph 
Published: September 2019

BackgroundTrauma and obesity are both current global epidemics. A simple way to measure the body habitus of patients, to identify the overweight or obese is via the internationally recognized calculation of body mass index (BMI). The primary aim of this systematic review is to assess the mortality rate of those patients with a BMI>30 kg/m2in relation to traumatic injury and secondly to assess the effect of those patients with BMI>30 kg/m2upon the length of stay in hospital with regards to traumatic injury.MethodA systematic review of the literature was conducted via an internet search of databases and hand searching of references in identified publications from 1stJanuary 1990 to 17thFebruary 2018. Data was extracted from identified publications to include odds ratios of mortality and total length of stay in hospital (days) for patients with a BMI>30 kg/m2from included studies when compared to patients with a BMI <24.9 kg/m2.ResultsA total of 23 studies met the inclusion criteria. 32, 378 patients were admitted to hospital with a BMI>30 kg/m2and recorded injury severity score (ISS). Data collated identified BMI>30 kg/m2OR 1.66 (95% CI 0.75 – 4.2) vs BMI <24.9 kg/m2OR 0.93 (95% CI 0.82–1.5) to suffer mortality. ISS, BMI>30 kg/m2–19.93 vs 22.3 respectively. Furthermore, those categorised as BMI>30 kg/m2have 3.78 additional days in the hospital compared to those defined as normal weight.ConclusionThis systematic review presents a strong relationship of increased mortality and complications in trauma patients with BMI>30 kg/m2. Complications are suggestive of those who have a BMI>30 kg/m2are more likely to suffer detrimental effects following trauma predominantly due to pre-existing unknown co-morbidities. Although, the direct relationship between obesity, trauma and mortality is not fully understood at present and requires more research.
A Multicenter, Scan-Rescan, Human and Machine Learning CMR Study to Test Generalizability and Precision in Imaging Biomarker Analysis
Authors: Bhuva Anish N. , Bai Wenjia , Lau Clement , Davies Rhodri H. , Ye Yang , Bulluck Heeraj , McAlindon Elisa , Culotta Veronica , Swoboda Peter P. , Captur Gabriella , Treibel Thomas A. , Augusto Joao B. , Knott Kristopher D. , Seraphim Andreas , Cole Graham D. , Petersen Steffen E. , Edwards Nicola C. , Greenwood John P. , Bucciarelli-Ducci Chiara , Hughes Alun D. , Rueckert Daniel , Moon James C. , Manisty Charlotte H 
Published: September 2019

Background:
Automated analysis of cardiac structure and function using machine learning (ML) has great potential, but is currently hindered by poor generalizability. Comparison is traditionally against clinicians as a reference, ignoring inherent human inter- and intraobserver error, and ensuring that ML cannot demonstrate superiority. Measuring precision (scan:rescan reproducibility) addresses this. We compared precision of ML and humans using a multicenter, multi-disease, scan:rescan cardiovascular magnetic resonance data set.

Methods:
One hundred ten patients (5 disease categories, 5 institutions, 2 scanner manufacturers, and 2 field strengths) underwent scan:rescan cardiovascular magnetic resonance (96% within one week). After identification of the most precise human technique, left ventricular chamber volumes, mass, and ejection fraction were measured by an expert, a trained junior clinician, and a fully automated convolutional neural network trained on 599 independent multicenter disease cases. Scan:rescan coefficient of variation and 1000 bootstrapped 95% CIs were calculated and compared using mixed linear effects models.

Results:

Clinicians can be confident in detecting a 9% change in left ventricular ejection fraction, with greater than half of coefficient of variation attributable to intraobserver variation. Expert, trained junior, and automated scan:rescan precision were similar (for left ventricular ejection fraction, coefficient of variation 6.1 [5.2%–7.1%],
P
=0.2581; 8.3 [5.6%–10.3%],
P
=0.3653; 8.8 [6.1%–11.1%],
P
=0.8620). Automated analysis was 186× faster than humans (0.07 versus 13 minutes).

Conclusions:

Automated ML analysis is faster with similar precision to the most precise human techniques, even when challenged with real-world scan:rescan data. Assessment of multicenter, multi-vendor, multi-field strength scan:rescan data (available at
www.thevolumesresource.com
) permits a generalizable assessment of ML precision and may facilitate direct translation of ML to clinical practice.
Observations of Island Wakes at High Rossby Numbers: Evolution of Submesoscale Vortices and Free Shear Layers
Authors: Chang Ming-Huei , Jan Sen , Liu Chih-Lun , Cheng Yu-Hsin , Mensah Vigan 
Published: September 2019

AbstractOceanic vortex evolution on the lee side of Taiwan’s Green Island (~7 km in diameter), where the Kuroshio flows at a speed of 1–1.5 m s−1, is observationally examined and compared to theories and the preceding results of laboratory experiments. In the near wake, recirculation occurs with a relative vorticity of ζ ~ 20f (where f is the planetary vorticity) and subsequently sheds at a combination of periods resulting from the tidal oscillations and the intrinsic time scale of eddy evolution. The tidal oscillations are the predominant processes. Our analysis suggests that an island positioned in the Kuroshio with periodic and cross-stream tidal excursions is analogous to a cross-stream oscillating cylinder. Consequently, the shedding period of the vortex is synchronized to a tidal period occurring close to the intrinsic period. The free shear layer, which is characterized by an ~30f relative vorticity band (2 km wide) and a wavy thermal front, develops between the Kuroshio and recirculation. The frontal wave occurring over a time period of 0.5–2 h resembles Kelvin–Helmholtz instability corresponding to high Re values. For the far wake, repeated cross-wake surveys suggest that cyclonic and anticyclonic vortices are alternatively present at a period close to the period of M2 tides in agreement with near-wake measurements. Repeated along-wake surveys reveal a cyclonic eddy shedding downstream at a speed of 0.35 m s−1, 1/3 of the upstream current speed, from the near wake. In comparing our observations with the results of previous water tank experiments, an Re value of O(103) for the submesoscale wake regime is expected.