bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poised for take-off – research activities within a hospice collaborative
Authors: Leung Joanne 
Published: August 2016

BackgroundFour adult hospices within one region are working in partnership as a Hospice Collaborative (the Collaborative), the Collaborative has sought strategic funding for a research practitioner to support research activities since late 2015. To further develop the embryonic research work in the locality, the Collaborative is anticipated to build partnerships with external organisations to exchange professional knowledge and expertise (Hospice UK, 2013).AimsTo support and develop research activities across the CollaborativeTo identify opportunities to work in partnership with external organisationsMethodMembers of an existing local research group provide expertise from various backgrounds, including primary care services, universities and research institutes. This research group has fostered partnerships between the Collaborative and external organisations to exchange expertise, information and knowledge in palliative and end-of life care.ResultsAn initial collaborative work can be demonstrated by the planned art workshop between one of the hospices within the Collaborative and a local university, to explore the latent thoughts and feelings about death and dying with patients and carers. Other planned collaboration works include organising a research design workshop to aid hospice staff with their fundamental research skills. The recruitments of the NIHR Portfolio studies and potential organic collaborative projects are expected to rise across the Collaborative, resulting from research ideas being circulated amongst the research group.ConclusionThrough the continuing research development of hospice staff in the locality, it is expected that the research activities will continue to grow across the Collaborative as well as between external organisations.ReferenceHospice UK.Future needs and preferences for hospice care: challenges and opportunities for hospices. A working paper of the Commission into the Future of Hospice Care; 2013https://www.hospiceuk.org/docs/default-source/default-document-library/future-needs-and-preferences-for-hospice-care-challenges-and-opportunities-for-hospices.pdf. Accessed May 29, 2016
Responding 24/7: an evaluation of urgent admission requests to the hospice
Authors: Downham Esther , Carduff Emma , Whyte Graham 
Published: August 2016

IntroductionProvision of 24/7 palliative care is a national priority. Hospices endeavour to respond to the palliative care needs of patients and families timeously, though resources are limited.AimThis study aimed to evaluate urgent admission requests to the hospice, via the on-call doctor.MethodsData on time of call; reason for and source of referral (GPs, community nurses, patients and families); whether the patient was known to the hospice; and details about the decision to admit were collected prospectively over three months.ResultsThere were 131 admissions to the hospice. Fifty-seven requests for urgent admission were recorded, the majority for symptom control (n = 34). Thirty-eight (67%) were considered appropriate requests - defined as patients with specialist palliative care needs that could not be met elsewhere. Twenty (53%) appropriate requests were admitted the same day, and 10 (26%) the following. Eight patients (21%) were not admitted because of bed or staff shortages; four were directed to the acute sector as an alternative place of care.Nineteen (33%) requests were not accepted, mostly because they were considered clinically inappropriate. However, six (11%) were provided with support and advice which enabled patients to remain in their current setting.ConclusionsThere is a need for direct access to a specialist palliative care doctor as this service is frequently used. Most appropriate requests for urgent admission were admitted within one day, suggesting a responsive service. Education for healthcare professionals is needed to ensure appropriate hospice referral, enabling patients to achieve their preferred place of care.ReferencesPalliative and end of life care Priority Setting Partnership. Putting patients, carers and clinicians at the heart of palliative and end of life care research: The James Lind Alliance; 2015Ritchie L. Pulling together: transforming urgent care for the people of Scotland. Edinburgh, UK: Scottish Government; 2015
Out of hours palliative care support across boundaries: a review of the 24 hour advice line for south east wales from marie curie hospice cardiff and the vale
Authors: Osborn Hannah , Hayes Jo 
Published: August 2016

IntroductionMarie Curie Hospice Cardiff and Vale runs a 24 hour specialist palliative care telephone advice line for patients, relatives and healthcare professionals covering the whole of South East Wales. It supports the fully established 7/7 Clinical Nurse Specialist (CNS) palliative care service across Wales. This is managed by staff nurses on the inpatient unit, coordinating with the relevant hospital or community CNS to provide ongoing support and follow up, with medical advice provided by the on call palliative medicine consultant.MethodA retrospective review of 12 months advice calls April 2015–16.ResultsA total of 521 calls were recorded with an average of 43.4 calls per month. Only 135 of these were from patients previously known to Marie Curie. 35.6% of calls were from relatives, 5% from patients, 10.9% from ward nurses, 4% from DNs, 14% from GPs, 14.8% from hospital doctors, and 13.1% from clinical nurse specialists. The majority of patients were based in the community setting (66%) compared to inpatient (30%). Most popular type of advice required was symptom control, other types included psychological support, practical advice and medication queries. The calls were average length of 9.53 minutes (79.1 hours in 12 months), with the majority of calls falling over the weekend period.ConclusionThis review demonstrates that Marie Curie Hospice Cardiff and the Vale is working collaboratively with other organisations in the area to extend support and advice to patients, relatives and healthcare professionals beyond its usual patient population 24/7.
Making sense of advanced cancer: using narrative at the end of life to identify information and supportive care needs
Authors: Baker Nicky , Armour Kathy , Redwood Sabi , Meystre Chantal , Dawson Angus 
Published: August 2016

IntroductionNarrative research methods are widely used in social sciences to gain insight into illness experiences and social constructions of health. Qualitative analysis of narrative interviews are increasingly utilised to improve knowledge of individuals’ unmet needs at the end of life. However, use of storytelling to understand concepts of hope and meaning has been relatively underexplored in palliative care settings.AimsExplore the experiences of hospice patients with advanced cancer and their close relatives, and the impact of these on cancer beliefs.MethodsSemi-structured interviews were conducted with 14 patients with breast, bowel or lung cancer in the last weeks or months of life, and their close family members. The social science literature and theory of narrative coherence guided qualitative analysis using a constant comparison method.ResultsPatient narratives followed a pattern of initial confusion and chaos at the time of diagnosis which later transcended to accounts focused on creating sense, hope and meaning. Leaving a legacy was an important part of fostering hope in the face of acceptance of dying. In contrast, narratives from relatives were dominated by persistent chaos, exemplified by a sense of helplessness and fear. Diagnostic delays, awareness of their own mortality and perceptions of ‘feeling out of the loop’ exacerbated these negative experiences, which frequently resulted in cancer fatalism and information avoidance.ConclusionNarrative analysis of individuals’ stories can facilitate development of client-centred palliative care services. Case studies are presented that demonstrate important points at which information provision and supportive care could be improved.
Are there too few women presenting at emergency medicine conferences?
Authors: Carley Simon , Carden Richard , Riley Rebecca , May Natalie , Hruska Katrin , Beardsell Iain , Johnston Michelle , Body Richard 
Published: August 2016

IntroductionThere is a perception that women are under-represented as speakers at emergency medicine (EM) conferences. We aimed to evaluate the ratio of male to female speakers and the proportion of presenting time by gender at major international EM conferences.MethodsConference programmes of the major English-speaking EM conferences occurring from 2014 to 2015 were obtained. The number of presentations, the gender of the speaker and the duration of each presentation were recorded.ResultsWe analysed eight major EM conferences. These included 2382 presentations, of which 29.9% (range 22.5%–40.9%) were given by women. In total, 56 104 min of presentations were analysed, of which 27.6% (range 21%–36.7%) were delivered by women. On average, presentations by women were 95 s shorter than presentations by men (23 vs 21 min 25 s).ConclusionsMale speakers exceed female speakers at major EM conferences. The reasons for this imbalance are likely complex and multifactorial and may reflect the gender imbalance within the specialty.
PERCEIVED AREAS FOR FUTURE INTERVENTION AND RESEARCH ADDRESSING CONVEYANCE DECISIONS AND POTENTIAL THREATS TO PATIENT SAFETY: STAKEHOLDER WORKSHOPS
Authors: O'Hara Rachel , Johnson Maxine , Hirst Enid , Weyman Andrew , Shaw Deborah , Mortimer Peter , Newman Chris , Storey Matthew , Turner Janette , Mason Suzanne , Quinn Tom , Shewan Jane , Siriwardena A Niroshan 
Published: August 2016

BackgroundAs part of a study examining systemic influences on conveyance decisions by paramedics and potential threats to patient safety, stakeholder workshops were conducted with three Ambulance Service Trusts in England. The study identified seven overarching systemic influences: demand; priorities; access to care; risk tolerance; training, communication and resources. The aim of the workshops was to elicit feedback on the findings and identify perceived areas for future intervention and research. Attendees were also asked to rank the seven threats to patient safety in terms of their perceived importance for future attention.MethodsA total of 45 individuals attended across all the workshops, 28 ambulance service staff and 17 service user representatives. Discussions were audio-recorded, transcribed and thematically analysed. A paper based paired comparison approach was used to produce an ordinal ranking to illustrate the relative prioritisation of issues. Analysis included testing for internal consistency and between-rater agreement for this relatively small sample.FindingsThe two highest ranking priorities were training and development, as well as access to care. The areas for intervention identified represent what attendees perceived as feasible to undertake and relate to: care options; cross boundary working; managing demand; staff development; information and feedback; and commissioning decisions. Perceived areas for research specifically address conveyance decisions and potential threats to patient safety. 17 areas for research were proposed that directly relate to six of the systemic threats to patient safety.ConclusionsFeedback workshops were effective in the validation of findings as well as providing an opportunity to identify priorities for future interventions and research. They also facilitated discussion between a variety of Ambulance Service staff and service user representatives. Ongoing collaboration between members of the research team has enabled some of the research recommendations to be explored as part of a mutually agreed research agenda.
COMPLICATIONS ASSOCIATED WITH SUPRAGLOTTIC AIRWAY USE IN AN URBAN AMBULANCE SERVICE: A CASE SERIES
Authors: Edwards Tim 
Published: August 2016

BackgroundCurrent resuscitation guidelines deemphasise the role of endotracheal intubation (ETI) in cardiac arrest. Although supraglottic airways (SGA) are increasingly used in the management of prehosptial cardiac arrest, there is limited data relating to adverse events in practice.MethodsCases reported to an ambulance service medical directorate involving adverse events associated with SGA use in cardiac arrest were logged from April 2014–October 2015. Prehospital clinical notes were reviewed to determine patient demographics, details of adverse events, clinical course and patient disposition.ResultsA total of 6 cases were reported. All patients were male and aged between 35–83 years. The majority of cases (n=4) were associated with a history of choking and the supraglottic device was removed to facilitate ETI due to poor ventilation. In all these cases, laryngoscopy revealed the presence of food obscuring the glottis which was removed under direct vision. None of these patients presented in a shockable rhythm and 3 experienced sustained return of spontaneous circulation. In another case, insertion of the supraglottic airway resulted in traumatic avulsion of teeth necessitating direct removal under laryngoscopy. This patient presented in ventricular fibrillation following chest pain and achieved ROSC at the scene. The final case involved a 35 years male with an extensive history of deliberate self-harm who received ventilation via SGA throughout the resuscitation attempt. A plastic bag was found compacted into the airway at post mortem.ConclusionsThe majority of adverse events associated with SGA use in cardiac arrest related to airway obstruction following choking. ROSC in a number of these patients suggests this may have been a reversible cause of cardiac arrest. Future guidelines should emphasise the need for laryngoscopy to exclude foreign body airway obstruction prior to SGA insertion in appropriate cases.
STAKEHOLDER ENGAGEMENT IN THE DESIGN OF A NOVEL PRE-HOSPITAL ACUTE STROKE ASSESSMENT
Authors: Lally Joanne , McClelland Graham , Exley Catherine , Ford Gary , Price Christopher 
Published: August 2016

BackgroundOutcomes for stroke patients can be improved by rapid identification and assessment, but delays commonly occur due to the availability of clinical information and brain imaging. We sought to develop a novel paramedic-led intervention to reduce scene to needle time for stroke patients suitable for thrombolysis.MethodsOver 12 months we undertook group interviews and consultation in North East England, North West England and Wales involving patient representatives (n=20), paramedics, emergency department and stroke service hospital staff (n=100). The primary aim was to understand the impact of organisational boundaries, service pressures and traditional professional roles upon a new paramedic approach to stroke assessment. Secondly, to develop a clinical trial protocol for later evaluation of the proposed new paramedic approach. All interviews were digitally recorded, transcribed and analysed using open then focussed coding.ResultsParticipant feedback supported an intervention which transgressed organisational and professional boundaries.Modifications were made following participant views about logistical, ethical and governance issues:▸ The protocol was changed to reflect operational barriers restricting paramedics taking patients directly to the CT scan room.▸ Participants advocated obtaining research consent after admission in order to address concerns over treatment delays, and supported a trial protocol which allowed data collection from patients that died before consent was feasible.▸ Paramedics would provide additional information at patient handover directly to the stroke team or A&E staff rather than attempt to convey more during pre-notification.ConclusionsFollowing the interviews significant alterations were made to the intervention and protocol in order to improve trial feasibility, acceptability and data quality. This emphasizes the importance of engaging with ambulance services, other clinical teams and patients during the development of pre-hospital research protocols.
PRE-HOSPITAL TRAUMA RESEARCH…MAKING IT HAPPEN
Authors: Reeves Emma , Mitchell Natalie 
Published: August 2016

BackgroundThe Brain Biomarker after Trauma Cohort Study (BBATS) investigates potential biomarkers in traumatic brain injury, for guiding diagnosis, prognosis and treatment of brain injury. It has been running for 19 months. Blood samples must be obtained within 60 minutes (i.e. the ‘Golden Hour’) of traumatic injury. The National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC) trauma research team recruit patients at the scene of injury. This requires extensive collaboration with the ambulance service in order to achieve maximum recruitment in this cohort of patients.MethodsMedical Emergency Response Incident Team (MERIT) training was conducted at the Queen Elizabeth Hospital, Birmingham (QEHB) and the West Midlands Ambulance Service by means of audio-visual presentations and group discussions. Awareness of the study in the Emergency Department (ED) of QEHB was ensured by regular training sessions with relevant staff. Ready-made blood bottle packs were delivered to the MERIT air ambulance base. The trauma research nursing team were available 24 hours a day, attending all trauma activations in ED. Delivery of quarterly interim results and recruitment progress is fed back to the ambulance team and ED staff.ResultsTrauma research nurses screened 481 patients for eligibility into BBATS. 72 (15%) were recruited within the first 19 months and of these only 42% were recruited during working hours, Monday to Friday 09:00–17:00. 409 patients did not meet inclusion criteria. Only 3 patients declined enrolment.ConclusionsPre-hospital enrolment of trauma patients into BBATS has been successfully undertaken through coordinated activity between the SRMRC trauma research nursing team and pre-hospital practitioners. However a large proportion of screened trauma patients are not recruited due to lack of blood sample during the ‘Golden Hour’. Achieving research in the pre-hospital setting is possible with clear infrastructure and collaboration established from the outset.
TRANSIENT ISCHAEMIC ATTACK 999 EMERGENCY REFERRAL (TIER): FEASIBILITY TRIAL
Authors: Rees Nigel , Bulger Jenna , Dewar Richard , Edwards Adrian , Evans Bridie , Moore Chris , Porter Alison , Seagrove Anne , Sewell Bernadette , Snooks Helen , Watkins Alan , Whitmann Shirley , Ali Khalid , Ford Gary , Pryce Alan , Quinn Tom 
Published: August 2016

BackgroundStudies demonstrate TIA patients are at risk of further TIAs, stroke and death. TIA incidence is unknown, however estimated at 35 per 100,000 people annually in the UK, costing approximately £7 billion. Many TIA patients call 999, are assessed, stabilised and conveyed to Emergency Department (ED). Rapid assessment of TIA severity and risk and intervention is emerging as the new standard for TIA care leading to alternative pathways with direct referral to specialist services. However, uncertainties exist over this new model of care.We will develop and assess feasibility of paramedic assessment and referral of low-risk TIA patients directly to TIA clinic for early review, thus providing timely specialist review without: adverse consequences; inconvenience of ED attendance; unnecessary cost to the NHS.MethodsThis feasibility trial is designed to test the methods of a pragmatic cluster randomised trial with a qualitative component. To develop the treatment protocol, training and referral processes, working with clinicians/stakeholders, we will conduct:– survey across UK ambulance services to find referral pathways for low-risk TIA patients– systematic review of TIA prehospital care– paramedic focus groups pre-implementationThen:– randomise paramedics (intervention/control)– recruit patients– interview patients, key clinicians and service managers– collect routine data– hold paramedic focus groups post-implementationWe will:– measure uptake and compliance with treatment protocols– validate TIA assessment tool– analyse qualitative data– pilot recruitment processes– test data collection methods– estimate key outcomes effect size to inform full trial sample size calculationResultsWill inform full trial development using criteria: intervention acceptability to practitioners and patients; trial design feasibility; outcome data completeness.Conclusions▸ If indicated, full trial conducted▸ If not, but positive results – advise intervention development for immediate implementation▸ If not, but negative results – advise delivery of intervention should cease.
NON RANDOMISED CONTROL STUDY OF THE EFFECTIVENESS OF A NOVEL PAIN ASSESSMENT TOOL FOR USE BY PARAMEDICS
Authors: Iqbal Mohammad , Spaight P Anne , Kane Ros , Asghar Zahid , Siriwardena A Niroshan 
Published: August 2016

BackgroundEighty percent of patients presenting to ambulance services present with pain. Pain is sometimes inadequately assessed and treated. Effective pain management can improve patient outcomes and experience. Previous qualitative research suggested that numerical verbal pain scores, usually used to assess pain in the ambulance setting, were poorly understood. We developed a new tool, the ‘Patient Reported Outcome Measure for Pain Treatment’ (PROMPT), to address this need. Initial testing showed that PROMPT had reliability and (face, content and predictive) validity. We aimed to investigate the effectiveness of PROMPT.MethodsWe used a non-randomised control group design in adult patients with chest pain or injury treated by intervention paramedics using PROMPT compared with control paramedics following usual practice for pain outcomes (reduction in pain score, use of analgesia). Routine data from electronic patient records were used to measure outcomes. We collected baseline rates of outcomes in patients treated by intervention and control paramedics, in a seven month period one year previously, to adjust for secular trends. The study was conducted in East Midlands Ambulance Service. We used regression analysis to compare groups for differences in pain score change and use of analgesics correcting for baseline rates and demographic differences.ResultsTwenty-five intervention paramedics used PROMPT (of 35 who were trained in its use) treating 300 patients over a seven month period. Data for these and 848 patients treated by 106 control paramedics were entered into SPSS and STATA12 for analysis. Mean reductions in pain score ( p<0.001) and use of analgesics was significantly greater (p<0.001) in patients managed by paramedics using PROMPT compared with those receiving usual care after adjusting for patient age, sex, clinical condition and baseline rates.ConclusionUse of the PROMPT resulted in greater reductions in pain score and increased use of analgesics compared with usual care.