bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interprofessional education in the care of people diagnosed with dementia and their carers: a systematic review
Authors: Jackson Marcus , Pelone Ferruccio , Reeves Scott , Hassenkamp Anne Marie , Emery Claire , Titmarsh Kumud , Greenwood Nan 
Published: August 2016

ObjectivesThis systematic review is linked to the multifaceted social, economic and personal challenges of dementia and the international recognition of the value of interprofessional education (IPE) and its influence on health and social care outcomes. This review therefore aimed to identify, describe and evaluate the impact of IPE interventions on health and social care practitioners (prequalification and postqualification) understanding of dementia, the quality of care for people with dementia and support for their carers.MethodsFollowing PRISMA guidelines, 9 databases were searched (MEDLINE, EMBASE, The Cochrane Library, PsycINFO, CINAHL Plus, Applied Social Sciences Index and Abstracts, Healthcare Management Information Consortium, ERIC and British Education Index). Narrative analysis of the findings was undertaken.DesignSystematic review.Results6 studies meeting the inclusion criteria were identified. The majority of studies were conducted in North America. Participants in 4 studies were health and social care practitioners caring for people with dementia, whereas the remaining studies focused on training graduate or undergraduate students. Diverse IPE activities with varying content, delivery mode and duration were reported. Although some studies reported more positive attitudes to interprofessional working as a result of the interventions, none reported benefits to patients or carers. The quality of the included studies varied. Overall, the evidence for the reported outcomes was considered weak.ConclusionsThis review identified 6 studies describing IPE interventions intended to improve collaborative knowledge, skills, interprofessional practice and organisational awareness of dementia and dementia care. The small number of studies, their varied nature, scope and settings combined with poor quality of evidence limits our understanding of the effectiveness of IPE on the care and support of people with dementia and their carers. Further research is required to develop the evidence base and provide robust studies to inform IPE development.Trial registration numberCRD42014015075.
Innovative approach for increasing physical activity among breast cancer survivors: protocol for Project MOVE, a quasi-experimental study
Authors: Caperchione Cristina M , Sabiston Catherine M , Clark Marianne I , Bottorff Joan L , Toxopeus Renee , Campbell Kristin L , Eves Neil D , Ellard Susan L , Gotay Carolyn 
Published: August 2016

IntroductionPhysical activity is a cost-effective and non-pharmaceutical strategy that can help mitigate the physical and psychological health challenges associated with breast cancer survivorship. However, up to 70% of women breast cancer survivors are not meeting minimum recommended physical activity guidelines. Project MOVE is an innovative approach to increase physical activity among breast cancer survivors through the use of Action Grants, a combination of microgrants (small amounts of money awarded to groups of individuals to support a physical activity initiative) and financial incentives. The purpose of this paper is to describe the rationale and protocol of Project MOVE.Method and analysisA quasi-experimental pre–post design will be used. Twelve groups of 8–12 adult women who are breast cancer survivors (N=132) were recruited for the study via face-to-face meetings with breast cancer-related stakeholders, local print and radio media, social media, and pamphlets and posters at community organisations and medical clinics. Each group submitted a microgrant application outlining their proposed physical activity initiative. Successful applicants were determined by a grant review panel and informed of a financial incentive on meeting their physical activity goals. An evaluation of feasibility will be guided by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and assessed through focus groups, interviews and project-related reports. Physical activity will be assessed through accelerometry and by self-report. Quality of life, motivation to exercise and social connection will also be assessed through self-report. Assessments will occur at baseline, 6 months and 1 year.Ethics and disseminationEthical approval was obtained from the University of British Columbia's Behavioural Research Ethics Board (#H14-02502) and has been funded by the Canadian Cancer Society Research Institute (project number #702913). Study findings will be disseminated widely through peer-reviewed publications, academic conferences, local community-based presentations, as well as partner organisations, including the Canadian Cancer Society.
Modifiable barriers to meeting care and support needs of patients with advanced chronic obstructive pulmonary disease (COPD) and their informal carers
Authors: Moore Caroline , Ewing Gail , Gardener Carole , White Patrick , Burge Peter , Mahadeva Ravi , Howson Sophie , Booth Sara , Ling Tom , Farquhar Morag ,   on behalf of the Living with Breathlessness study team
Published: August 2016

IntroductionCOPD is a progressive condition with high symptom burden. Advanced COPD management should relieve symptoms, optimise daily functioning and reduce carer burden. Our knowledge of clinician barriers and facilitators to meeting the needs of these patients and their informal carers is limited.AimTo identify modifiable barriers to meeting care and support needs of patients with advanced COPD and their carers.MethodsPurposively-sampled clinicians nominated by a population-based cohort of patients with advanced COPD participating in the Living with Breathlessness Study, took part in Longitudinal qualitative interviews on barriers and facilitators to meeting needs, and analysed using a Framework approach. Identified barriers were reviewed and recommendations to overcome them presented to stakeholders via workshop and online survey methods.ResultsIdentification and assessment of patient need, and barriers and facilitators to doing so, were largely driven by organisational and medical agendas, rather than person-centred care models. There was little evidence of clinician engagement with patients’ informal carers. There was a mismatch between clinicians’ perceptions of changes in patient need during the 18-month study duration and those of patients and carers. Clinicians felt unprepared for end-of-life care discussions and found patient readiness for these conversations difficult to assess. Clinician-identified patient, organisational and professional facilitators included trust, time and accessibility.ConclusionActioning recommendations such as stopping focusing on the challenge of prognostication as a barrier to meeting need, changing targets to incentivise person-centred care and identifying and supporting carers could improve care and support of patients and carers living with advanced COPD.This report is independent research supported by the National Institute for Health Research (Career Development Fellowship, CDF-2012-05-218). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
POST ROSC OXYGENATION STUDY
Authors: Kirby Kim , Voss Sarah , Thomas Matthew , Elder Georgina , Nolan Jerry , Benger Jonathan 
Published: August 2016

Abstracts selected through the 999 EMS Research Forum peer review process and presented orally and by poster at the ‘Making it Happen: Delivering Research in Pre-hospital Care’ Conference 2016.BackgroundThere is evidence that systematic cardiac arrest care after return of spontaneous circulation (ROSC) improves chances of survival with a good quality of life. Post cardiac arrest care is a critical component of advanced life support. It is postulated that exposing ischaemic brain tissue to significant hyperoxaemia during this period increases the possibility of oxidative injury and cellular death.This study was designed to demonstrate the feasibility of completing a cluster-randomised clinical trial to determine if oxygen therapy titrated to oxygen saturation as measured by a pulse oximeter (target SpO294–98%) for 1 hour after a sustained return of spontaneous circulation (ROSC) is superior in improving outcome following non traumatic out of hospital cardiac arrest (OHCA) in adults, compared with the use of non-titrated, 100% oxygen.MethodsParamedics were randomly allocated to one of two trial arms (100% oxygen or titrated oxygen to a target SpO2of 94–98%). The intervention was initiated in adult non-traumatic OHCA once the patient achieved a sustained (>2 minutes) ROSC. Interventions were either the administration of 100% oxygen or oxygen titrated to a target SpO2of 94–98% for 60 minutes, continued in the receiving Emergency Department if necessary.ResultsIn the intervention arm of the study, paramedics were able to titrate the inspired oxygen concentration in 72% of patients and obtain a reliable reading of oxygen saturation immediately after ROSC in 61% of patients.The assigned oxygen therapy was continued for 60 minutes after ROSC in 74% of patients for whom the intervention was initiated. Legitimate reasons for discontinuation (e.g. death) occurred in a further 11%.ConclusionThis study indicates that a future full scale trial to determine if titrated oxygen therapy is superior to 100% oxygen in improving patient outcome after non traumatic OHCA is feasible.
A CROSS-SECTIONAL SURVEY EVALUATING FACTORS AFFECTING ACCURACY AND SELF-PERCEIVED CONFIDENCE OF PARAMEDICS WHEN APPLYING THE MAJOR TRAUMA DECISION TREE
Authors: Durham Mark 
Published: August 2016

BackgroundSince 2008, Britain has been developing trauma networks, and ambulance services have been adopting triage tools to support these. So far there has been no published work on how UK paramedics use these algorithms. This study aims to evaluate factors affecting accuracy and self-perceived confidence of paramedics from one UK Ambulance Trust when applying the Major Trauma Decision Tree (MTDT).MethodsA quantitative cross-sectional survey design was used; a questionnaire sent to every paramedic within one Trust. The questionnaire asked for basic demographic data, then describing four case studies. Respondents applied the MTDT to the case studies, stating which algorithm steps (if any) they triggered, and their appropriate destination. Finally, a Likert scale explored respondent views on the MTDT. Descriptive and inferential statistics were used to look for any linked factors affecting accuracy/confidence.ResultsPopulation N=1,132, sample size n=178 (response rate=16%). Sensitivity with the MTDT was 77% (95%CI 72%–81%), specificity 61% (95% CI 56–66%). The trigger most commonly missed was patient age >56. Respondents reported transport time to MTC/TU influencing algorithm compliance.Self-perceived confidence was low. Self-reported exposure to trauma correlated positively with confidence (rs [178] =0.323,p<0.0005). Respondents' concerns about reception received from hospital staff showed significant negative correlation with confidence (rs [178] =−0.459,p<0.0005).ConclusionRespondent sensitivity was low. Paramedic concerns about transport time are prevalent and could affect sensitivity. The most commonly missed trigger was age. Future training may benefit from addressing these points.Respondents' confidence with the MTDT was low. Confidence was closely linked with exposure to trauma, and the reception anticipated from hospital staff.
SUCCESSES AND CHALLENGES IN COMMISSIONING FOR AMBULANCE NON-CONVEYANCE: THE COMMISSIONER PERSPECTIVE
Authors: Bishop-Edwards Lindsey , O'Cathain Alicia , Knowles Emma 
Published: August 2016

BackgroundAmbulance services are experiencing increasing demand for response to emergency calls. In response, they have increased the proportion of patients not conveyed to an emergency department (ED). Alternatives to transporting patients to an ED include the provision of telephone advice rather than dispatching a vehicle (‘hear and treat’), treatment at the scene (‘see and treat’) and transport to other facilities (‘see and convey elsewhere’). There is considerable variation in the rates of different types of non-conveyance, and in non-conveyance overall, between ambulance services in England. Understanding the reasons for this variation between services can help identify ways of improving service delivery across all ambulance services. Approaches to commissioning may influence the amount of non-conveyance undertaken in different ambulance services.MethodsAs part of a larger study we undertook qualitative interviews with ambulance service commissioners (or appropriate commissioning support staff) in the 10 larger ambulance services in England, to identify potential factors that may explain variation in rates of ambulance non-conveyance. 10 commissioners took part in the interviews. Telephone interviews were conducted and transcribed verbatim. Framework analysis was used to analyse the data.ResultsAmbulance commissioners reported a range of successes and challenges in relation to commissioning non-conveyance services. Successes often related to engaging, collaborative and motivational working relationships between the commissioner and the ambulance service. A range of challenges were reported including access to information to enable decision making, the scale of the geographical commissioning area, collaborative working, complexity, lack of resource and their role as quality enforcers and reporters. There was variation in how different commissioners reported their approaches to commissioning for non-conveyance.ConclusionsThese findings highlight the challenges facing commissioners. This variation in commissioning approaches will be included in a wider model of factors affecting variation in non-conveyance.
RAPID ANALGESIA FOR PREHOSPITAL HIP DISRUPTION (RAPID): A FEASIBILITY STUDY
Authors: Bulger Jenna , Seagrove Anne , Snooks Helen , Evans Bridie , Ford Simon , Pallister Ian , Guy Katy , Brown Alan , Jones Sian , Keen Leigh , Rees Nigel 
Published: August 2016

BackgroundAdequate pain relief at the point of injury and during transport to hospital is a major challenge in all acute trauma, but especially so for those with hip fractures, whose injuries are difficult to immobilise and who may be particularly sensitive to opiate analgesics. Fascia Iliaca Compartment Block (FICB), a procedure involving injection of local anaesthetic into tissues surrounding the hip, is routinely administered by doctors and nurses in Emergency Departments for patients with hip fracture, but its use has not been tested by paramedics at the scene of the patient's injury.Aim of the researchThis study aims to assess whether FICB administered by paramedics at the scene is feasible, safe and acceptable. The outcome will determined the need for a full randomised controlled trial to decide whether the procedure is effective for patients and worthwhile for the NHS.MethodsWe will recruit ten paramedics in the Swansea locality who will be trained to administer FICB. Eligible patients will be randomly allocated to FICB or usual care using sealed envelopes carried on ambulances, a method currently successfully being used by the Welsh Ambulance Service in another study – PARAMEDIC 2 (the ‘Adrenaline trial’). We will assess compliance of paramedics; pain scores; side effects; length of hospital stay; quality of life; and acceptability to patients and paramedics by conducting interviews and focus groups.OutputsWe will recommend whether a full randomised controlled trial of FICB by paramedics for hip fracture is warranted and, if so, a proposal for research funding will be submitted.This project is funded by Health and Care Research Wales, through their Research for Patient and Public Benefit funding call (1003). The views and opinions expressed are those of the authors and do not necessarily reflect those of Health and Care Research Wales or the National Health Service.
FRAILTY AS LIVED, FRAILTY AS APPLIED: EXPLORING LIVED EXPERIENCES IN OLDER PATIENTS WHO HAVE FALLEN AND CALLED 999
Authors: Robertson Duncan , Cooke Mary 
Published: August 2016

RationaleThe aim of this pilot study was to explore the personal meanings of frailty within a purposive sample of older patients who had fallen, needed an Emergency Ambulance Service response and were subsequently referred to a falls service. A systematic literature review indicated that no qualitative studies had been carried out within such a sample previously.MethodsThe qualitative methodology used Interpretative Phenomenological Analysis; which explored the essential nature of frailty as a phenomenon though a series of subjective narrative accounts generated by focused interviews. Employing a reflexive approach to the analysis allowed completion of a participant-centred and ethically sound study.ResultsAnalysis of six focused interviews with older adults provided a thick description which highlighted five themes: Adaptations to frailty, Focus on confidence as psychological frailty, A changing lifeworld-towards social frailty, Reconciling a frail future and Frailty as stigma. These themes were discussed in relation to sociological literature including theories concerning transitions from the third to fourth age, liminality and social death, frailty as stigma and frailty as lived and frailty as applied.ImplicationsThis sample of patients represented a group in transition. They occupied a liminal zone situated between the third and fourth age and while acknowledging oldness, they actively challenged biomedical assumptions of frailty through an emphasis on control and individual agency. This study enables paramedics to modulate their communications when encountering elders who reject the notion of frailty as a term applied. For service design, the results allow the voice of the patient group to be heard, so that solutions can be designed in an inclusive, rather than hierarchical fashion. Significantly, this thesis forms part of an emerging body of evidence that questions the usefulness of the term frailty as experienced by this sample of participants.
The diagnosis of adult-onset haemophagocytic lymphohistiocytosis: lessons learned from a review of 29 cases of bone marrow haemophagocytosis in two large academic institutions
Authors: Rosado Flavia G , Rinker Elizabeth B , Plummer W D , Dupont William D , Spradlin Natalie M , Reichard Kaaren K , Kim Annette S 
Published: August 2016

AimsHaemophagocytic lymphohistiocytosis (HLH) is divided into paediatric (primary) and adult (secondary) types. While paediatric-HLH has been extensively characterised, similar studies in adults are limited. This study aims to evaluate the significance of the HLH diagnostic criteria as well as other clinical parameters in adults with bone marrow evidence of haemophagocytosis.MethodsWe conducted a 10-year retrospective search of the pathology archives of two institutions for cases with bone marrow haemophagocytosis. We included those cases that fulfilled the currently established HLH diagnostic criteria. For the 29 cases that met inclusion criteria, we assessed clinical features, co-morbidities, therapy and clinical outcome. The effect of 19 clinical variables on mortality outcomes was assessed using logistic and hazard regression analyses.ResultsOf cases for which an aetiology could be identified, infectious diseases were the most common association (14 of 19, 74%). Fever and elevated ferritin were the most frequently available criteria used to establish HLH. The overall mortality rate was 61% despite HLH-specific therapy, which had been initiated in 48% of the cases. The remaining cases were treated with supportive therapy and antibiotics. The most statistically significant marker of mortality was an elevated absolute neutrophil count (ANC), a feature not typical of HLH.ConclusionsSince elevated ANC correlates with poor outcomes in sepsis, and not HLH, we postulate that many of the patients fulfilling HLH diagnostic criteria in this study likely had sepsis/systemic inflammatory response syndrome rather than HLH. Our results highlight the need to define HLH diagnostic criteria specific to the adult population.
A study in high-risk, maximally pretreated patients to determine the potential use of PCSK9 inhibitors at various thresholds of total and LDL cholesterol levels
Authors: Groves Carl , Shetty Chandrashekar , Strange Richard C , Waldron Julian , Ramachandran Sudarshan 
Published: August 2016

ABSTRACTPurpose of the studyStatins and ezetimibe reduce low-density lipoprotein cholesterol (LDL-c) and cardiovascular disease (CVD) risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors lower LDL-c by 50%–70% and might be useful in refractory patients. The National Institute for Health and Care Excellence (NICE) technology appraisal guidance (TAG) recommends use of these drugs in secondary prevention and familial hypercholesterolaemia (FH) at differing LDL-c thresholds. We have estimated the proportion of patients in whom this third-line drug might be useful.Study designWe used data from a lipid-lowering audit programme to study 72 with FH and/or CVD of 271 patients referred over 12 months who failed to achieve target total cholesterol (TC) and LDL-c levels. All 72 patients were treated with ezetimibe, and 69 cases also received statins. We used LDL-c thresholds 1.5–5.5 mmol/L to estimate how many of these refractory patients could benefit from PCSK9 inhibitors.ResultsIn 72 patients, TC and LDL-c targets were not met by 64 and 53 patients, respectively. We judged using the NICE TAG that only one patient (1.4% ezetimibe requiring and 0.4% total referrals) required a PCSK9 inhibitor.ConclusionsWe determined that the proportion of patients eligible for a PCSK9 inhibitor at various TC and LDL-c levels is modest. This may reflect the use of all available statins in UK lipid clinics often at non-daily frequency. We suggest that cost-effective use of PCSK9 inhibitors requires prescribing being restricted to clinicians working in specialised lipid clinics.
Quark–hadron duality: Pinched kernel approach
Authors: Dominguez C. A. , Hernandez L. A. , Schilcher K. , Spiesberger H. 
Published: August 2016

Hadronic spectral functions measured by the ALEPH collaboration in the vector and axial-vector channels are used to study potential quark–hadron duality violations (DV). This is done entirely in the framework of pinched kernel finite energy sum rules (FESR), i.e. in a model independent fashion. The kinematical range of the ALEPH data is effectively extended up to s = 10 GeV2 by using an appropriate kernel, and assuming that in this region the spectral functions are given by perturbative QCD. Support for this assumption is obtained by using e[Formula: see text] e[Formula: see text] annihilation data in the vector channel. Results in both channels show a good saturation of the pinched FESR, without further need of explicit models of DV.