bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neutropenic diets to prevent cancer infections: updated systematic review and meta-analysis
Authors: Sonbol Mohamad Bassam , Jain Tania , Firwana Belal , Hilal Talal , Deleon Thomas , Murad Angela , Murad M Hassan , Khera Nandita 
Published: April 2019

IntroductionMultiple studies have questioned the benefit of neutropenic diets in decreasing infections in patients with cancer, but recent surveys showed that such diets are still prescribed. In this study, we sought to evaluate the effectiveness of neutropenic diet in decreasing infection and mortality in neutropenic patients with cancer with neutropenia. This review is an update of a previously published systematic review.Materials and methodsWe searched different databases to identify comparative studies that investigated the effect of neutropenic diet compared with regular diet in neutropenic adults and children with cancer. We conducted random‐effects meta‐analyses using the Der‐Simonian and Laird method to pool treatment effects from included studies. Outcomes of interest were mortality, bacteremia/fungemia, major infections, quality of life, and the composite outcome for neutropenic fever and/or infection.ResultsWe included six studies (five randomised) with 1116 patients, with 772 (69.1%) having underwent haematopoietic cell transplant. There was no statistically significant difference between neutropenic diet and regular diet in the rates of major infections (relative risk [RR] 1.16; 95% CI 0.94 to 1.42) or bacteremia/fungemia (RR 0.96; 95% CI 0.60 to 1.53). In haematopoietic cell transplant patients, neutropenic diet was associated with a slightly higher risk of infections (RR 1.25; 95% CI 1.02 to 1.54). No difference in mortality was seen between neutropenic diet and regular diet (RR 1.08, 95% CI 0.78 to 1.50).ConclusionThere is currently no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer. Patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the U.S. Food and Drug Administration.
PP12 New ‘nature of call’ telephone screening tool, employed prior to nhs pathways triage, can accurately identify those later treated for out of hospital cardiac arrest: analysis of sensitivity and specificity using routine ambulance service data
Authors: Green Jonathan , Ewings Sean , Wortham Richard , Walsh Bronagh 
Published: April 2019

BackgroundA new pre-triage emergency medical call screening tool, Nature of Call (NoC), has been introduced into UK ambulance services which employ the NHS Pathways (NHSP) triage system. Its current function is to provide a rapid sieve, differentiating between patients who may need treatment for Out-of-Hospital Cardiac Arrest (OHCA), and therefore require immediate ambulance dispatch, and all other calls, for which ambulance dispatch is withheld whilst further triage is undertaken.ObjectiveTo evaluate the accuracy of NoC in identifying patients with potentially treatable OHCA or peri-arrest conditions.MethodsStudy of diagnostic accuracy. The sample was a retrospective cohort of consecutive calls to a UK ambulance service, taken over a four-month period. Sensitivity and specificity were determined, comparing allocated priority dispositions with an OHCA Treatment Registry. Context was supplied by the evaluation of subsequent categorisation by NHSP. The accuracy of the combined NoC and NHSP allocations was also investigated.ResultsA total of 1 87 419 emergency calls were received. Of these, 71 373 were allocated both NoC and NHSP priority dispositions and were associated with electronic Patient Clinical Records. 590 (0.8%) of these patients received treatment for OHCA. NoC, sensitivity=77.6% (95% CI 74.1 to 80.8); specificity=86.9% (95% CI 86.6 to 87.1). NHSP, sensitivity=79.2% (95% CI 75.7 to 82.2); specificity=93.4% (93.2 to 93.6). NoC and NHSP combined, sensitivity=84.1% (95% CI 80.9 to 86.8); specificity=95.0% (95% CI 94.8 to 95.3).ConclusionsNoC and subsequent NHSP call categorisation each achieved relatively high sensitivity for the identification of treated OHCA, predicting similar groups of registry patients (although 6% were identified by NoC alone). Overall accuracy was enhanced when NoC and subsequent NHSP Results were combined. The unidentified group of treated OHCA patients (16%) present a challenge to the current dispatch system which relies on the early recognition of patients who may require treatment for OHCA.
PP13 The NHS pathways (NHSP) medical call triage system and new ‘nature of call’ telephone screening tool, employed prior to NHSP, can accurately identify high acuity patients: analysis of sensitivity and specificity using routine ambulance service data
Authors: Green Jonathan , Ewings Sean , Wortham Richard , Walsh Bronagh 
Published: April 2019

BackgroundThe NHS Pathways (NHSP) medical call triage system is employed by UK ambulance services. One function is to identify a broad category of ‘high-acuity calls’, distinguishing them from those that do not require an emergency response. A new pre-triage screening tool, Nature of Call (NoC), designed to augment NHSP could be employed as a rapid initial sieve of broad acuity.ObjectivesTo identify the accuracy of NHSP (and NoC) in recognising patients who require an emergency ambulance response (and therefore those who may not).MethodsDiagnostic accuracy. The sample is a retrospective cohort of consecutive calls, over a 4 month period, to a UK ambulance service. Sensitivity and specificity were determined, comparing allocated NoC and NHS Pathways priority dispositions with a composite reference standard comprised of administered medications, procedures, observations and clinical impressions associated with high-acuity, as recorded on ambulance electronic Patient Clinical Records.ResultsA total of 1 87 408 emergency calls were received. Of these, 71 373 were allocated both NoC and NHSP priority dispositions and were associated with electronic Patient Clinical Records. 40 997 (57%) of these patients met the high-acuity reference criteria. NHSP, sensitivity=98.1% (95% CI 98.0 to 98.2); specificity=5.9% (95% CI 5.6 to 6.1). NoC, sensitivity=84.0% (95% CI 83.7 to 84.4); specificity=26.5% (95% CI 26.0 to 27.0).ConclusionsNHSP is effective in identifying high-acuity patients (as is NoC). Sensitivity analysis therefore supports the this function of NHSP and NoC/NHSP to inform initial ambulance dispatch decisions, particularly if NoC categorisation is reviewed in the light of subsequent NHSP triage. However, both systems appear to achieve high sensitivity by also allocating most low-acuity calls to high-acuity categories. This significantly restricts operational application. Only one quarter of low-acuity calls are allocated the lowest priority category by NoC and one-in-seventeen by NHSP, severely restricting the group likely to be considered for alternative care pathways.
PP15 Non-technical skills in the delivery of ambulance service telephone advice
Authors: O’Hara Rachel , Bishop-Edwards Lindsey , Knowles Emma , O’Cathain Alicia 
Published: April 2019

BackgroundAround 10% of calls to ambulance services in England are resolved over the phone (referred to as telephone advice or hear and treat). These calls are generally dealt with by clinicians following initial call-handler assessment. A systematic review concluded that telephone advice is a safe alternative for patients categorised as low priority but recommended the need to understand the skills required. Our research explores the non-technical skills (cognitive, social and personal) required.MethodsNon-participant observation of telephone advice in three ambulance services involved 40 hours of observation per service, (total n=27 clinicians and 20 call-handlers) and semi-structured interviews with clinicians (n=7), call-handlers (n=7) and managers (n=3). A framework approach and NVIVO qualitative data analysis software were used to analyse the data.FindingsSituation awareness was a necessary skill in gathering information by telephone. Strategies included visualisation, attending to tone of voice and listening to Background noise. Decision making skill was needed to select an appropriate course of action. For clinicians this involved reference to prior experience and risk judgement that the available information supported a safe decision. Call-handlers were more reliant on computerised triage systems. Communication skill required rephrasing technical questions, providing reassurance and assertiveness in managing expectations. Call-handlers had less discretion to rephrase computerised scripts. Personal resources were required to manage role demands that included dealing with high call volumes, task conflict and difficult conversations with callers expecting an ambulance response.ConclusionsThe findings have implications for the recruitment, training and ongoing development of call-handlers and clinicians involved in the delivery of telephone advice. There is scope for further research to provide a more detailed understanding of non-technical skills in the delivery of telephone advice to ensure the consistent delivery of appropriate and safe care that is acceptable to patients.
PP16 Modelling of patient outcomes after emergency treatment for out-of-hospital cardiac arrest by paramedics and community first responders
Authors: D Smith Murray , Norman John , Niroshan Siriwardena A , Spaight Robert 
Published: April 2019

BackgroundPatient outcomes for out-of-hospital-cardiac-arrest (OHCA) should include shorter term response resulting from care delivered by first aiders (CFR) and emergency services as well as any longer term response achieved following handover into hospital care. We construct statistical models of: Return of Spontaneous Circulation while under emergency care (ROSC), and Discharge Alive from hospital (DA).MethodsData on 15,103 OHCA patients aged 4+weeks from East Midlands Ambulance Service NHS Trust were gathered across a 3 year period April 2014 – March 2017. Both outcomes were represented by binary variables (yes=1, no=0). Duration variables: waiting time (WT; time from 999 to emergency service arrival at the patient’s side), total treatment time (TOT; time from emergency service arrival to patient handover at hospital), time to ROSC (TtoR; time from emergency service arrival to first ROSC achieved). Statistical analyses were to be conducted on complete records (2825 patients) and involve fitting of a bivariate probit model to the joint outcome (ROSC, DA) and a probit model to the conditional outcome (DA|ROSC=1).ResultsCFR attendance had no statistically significant influence on either patient outcome.Patient outcomes worsened as wait time (WT) increased, but was insignificant versus no effect.Total treatment time (TOT) was significant; with positive influence on ROSC occurrence the longer that time period (estimate >0, p=0.036), but worsening the chance of longer term survival DA (estimate <0, p<0.001).Time to ROSC (TtoR) was the key driver in the DA|ROSC=1 model (estimate <0, p<0.001), evidencing the better the chances of longer term survival DA the sooner ROSC is achieved.ConclusionsOur Results show that OHCA patient outcomes depend crucially on the quality of clinical care provided by the emergency services. Next steps include the need to gather granular data evidencing the pre-hospital care that is administered to patients by paramedics and community first responders.
PP18 Implementation of electronic patient clinical records in ambulances in the UK: a national survey
Authors: Williams Victoria , LaFlamme-Williams Yvette , McNee Katie , Morgan Heather , Morrison Zoe , WW Potts Henry , Shaw Debbie , Siriwardena Niro , Snook Helen , Spaight Rob , Porter Alison 
Published: April 2019

BackgroundThe roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances.Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage.MethodsWe carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction.The interviews were transcribed and thematically analysed, by three members of the research team.ResultsWe completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care.Reported benefits of ePCR were largely associated with improved data management for audit and record keeping. Potential improvements to patient care were discussed, but tended to be associated with future planned developments.ImplicationsImplementation of ePCR has proved challenging with wide variation in use between ambulance services. Progress has been erratic, rather than linear, demonstrated by difficulties that services experienced putting ePCR into practice. There is potential for ambulance services in the earlier stages of implementation to learn from the experiences of others.
02 Women’s experience of unplanned out-of-hospital birth in paramedic care
Authors: Flanagan Belinda , Lord Bill , Reed Rachel , Crimmins Gail 
Published: April 2019

BackgroundParamedics assess, treat and transport labouring women who require intrapartum care in the out-of-hospital setting, yet very little is known about the experiences of mothers who birth whilst being supported by paramedics. Internationally, the healthcare literature describes predisposing factors, clinical risk and maternal and neonatal clinical outcome. However, there is little quality research available that explores the care provided by paramedics or that describes the views of women with recent experience of birth involving paramedic care.MethodsThrough narrative inquiry this study utilised a feminist approach to explore the experiences of women who birth in paramedic care, their care needs, and the physical, emotional and psychosocial issues surrounding these cases.Results22 narrative interviews with women who birthed in paramedic care in Australia within the last 5 years were undertaken. This identified a series of factors that contributed to the planned hospital birth occurring in the out-of-hospital setting. The Results identified the themes: Birth Knowledge, The Birth Experience and Reflections on Birth. Women in this study began their story by discussing previous birth experience and their knowledge and personal beliefs concerning the birth process. Women described their previous interactions with maternity care providers and issues that caused them to delay attending hospital. Specific to the birth event, women reported feeling empowered, confident and exhilarated during the birth. However, they also identified concerns with paramedics not providing privacy, having poor interpersonal skills, a lack of consent for procedures, feeling judged and issues related to bonding.ConclusionThis study identified a series of factors that contribute to the planned hospital birth occurring in the out-of-hospital setting. Women described various deficiencies in the antenatal and intrapartum care received by maternity services in Australia. Women also described opportunities for improvement in the care provided by paramedics, specifically deficiencies in technical and non-technical skills.
PP20 Exploring the knowledge, attitudes, and behaviour of the general public to responding to out-of-hospital cardiac arrest
Authors: Dobbie Fiona , Clegg Gareth , Marie MacKintosh Anne , Bauld Linda 
Published: April 2019

BackgroundBystander Cardio-Pulmonary Resuscitation (CPR) is a key determinant of survival after Out-of-Hospital Cardiac Arrest (OHCA) but is performed at only around half of OHCA in UK. This study collected data to inform a social marketing strategy to address the barriers to responding to OHCA.MethodsA representative sample (n=1027) of Scottish adults aged 16 and over were included in a general population face-to-face omnibus survey in 2015.ResultsWe identified three factors associated with knowledge, experience, and attitudes toward bystander CPR.Age –the older a person is, the less likely they were to be CPR trained and show willingness to be CPR trained. They were also more likely to have had CPR training more than five years previously and be the least confident to administer bystander CPR. These findings are particularly relevant considering that most OHCA happen in the homes of older people.Social grade– people in professional managerial and non-manual occupations were more likely than those in manual, unskilled occupations and long-term unemployed people to be CPR trained and be more confident to administer CPR if talked through by a call handler.Working status –people who were working were more likely to be CPR trained, be trained more recently and show higher levels of confidence to administer CPR. Barriers cited for not administering CPR were not having the skills or confidence to give CPR, fear of making things worse or of being sued.ConclusionsFuture social marketing strategies to improve bystander CPR should address the barriers to administering CPR by building confidence and addressing myths/fears.
PP22 Sandpiper wildcat project – saving lives after out-of-hospital cardiac arrest in rural grampian
Authors: Fickling Keri , Clegg Gareth , Jensen Keith , Donaldson Lorna , Laird Colville , Bywater Dave 
Published: April 2019

BackgroundRecent analysis shows a higher risk of death after Out of Hospital Cardiac Arrest (OHCA) for patients who lived in rural areas of UK in casemix adjusted comparison with urban areas. Sandpiper Wildcat is an action research project aiming to increase survival rates through the implementation of a novel network of trained responders in rural Grampian.MethodsAfter using historic data to identify 50 locations with poor response times but significant numbers of OHCA we established teams of trained volunteer responders equipped with automatic external defibrillators (AED 3, Zoll) and Vehicle Locator Systems. Responders were trained and made available for dispatch to OHCA by ambulance control. In addition to real time CPR quality feedback the AED 3 also records ECG, compression metrics and audio of the incident for analysis and debrief.ResultsAround 500 responders were successfully trained and deployed in 53 rural locations during the first 6 months. They were mobilised to 109 OHCA, arriving on scene an average of 7 min (−15 to 48 mins) before Scottish ambulance service resources. Analysis of metrics from defibrillator downloads showed high quality resuscitation. In addition there were many reports of significant ‘added value’ to patients, families and Scottish Ambulance Service staff as a result of Sandpiper Wildcat responders’ attendance. Responders replied overwhelmingly positively to debrief questions ‘did you feel of value at scene’ and ‘do you feel you made a difference’, all indicated that they would be willing to respond again.ConclusionsSandpiper Wildcat project has reduced the response time to OHCA in rural Grampian and increased the number of responders at each OHCA. Responders have delivered high quality BLS and provided assistance to SAS personnel. Further analysis will examine the spread and sustainability of this approach in rural UK and the longer term impact on clinical outcomes.
PP23 Linking pre-hospital out-of-hospital cardiac arrest data to in-hospital outcomes in order to improve the ‘chain of survival’
Authors: Halbesma Nynke , Clegg Gareth , Bijman Laura , Lynch Ellen , Clarke Scott , Bywater David 
Published: April 2019

BackgroundA first step to improving outcomes after Out-of-hospital cardiac arrest is to measure the performance of the local ‘Chain of Survival’. Ambulance services routinely report the number of OHCA where resuscitation is attempted, but lack access to outcome data such as survival to hospital discharge. Our novel data linkage project has been developed to inform the implementation of UK’s strategy for OHCA and provide insight into both short- and long-term patient outcomes.MethodsScottish Ambulance Service data was used to identify OHCA incidents where resuscitation was attempted between 2011–2015. OHCA incidents were then probabilistically matched to a range of administrative datasets based on Community Health Index (CHI) linkage. The data were stored and accessed through a Safe Haven where it was used to determine baseline characteristics of the ‘Chain of Survival’ in UK.ResultsAround 3,000 OHCA cases per year were identified with around 6.2% survival to hospital discharge. Of all cases 73.2% could be linked with other datasets such as hospital data (SMR01 and intensive care data), deaths data and SPARRA (comorbidities). This resulted in a rich dataset including a range of demographics, survival and clinical performance measures. Logistic regression models showed that a higher age, male gender and living in a socially deprived area are associated with a higher risk of an OHCA. Higher age and living in a rural or socially deprived area are also associated with an increased mortality risk.ConclusionsOur data set the scene for the implementation of UK’s Strategy for OHCA providing insight into the performance of whole ‘Chain of Survival’. It offers the opportunity to identify priority areas for improvement and track impact of strategy implementation.