bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of telephone health mentoring in community-recruited chronic obstructive pulmonary disease on self-management capacity, quality of life and psychological morbidity: a randomised controlled trial
Authors: Walters Julia , Cameron-Tucker Helen , Wills Karen , Schüz Natalie , Scott Jenn , Robinson Andrew , Nelson Mark , Turner Paul , Wood-Baker Richard , Walters E Haydn 
Published: September 2013

ObjectivesTo assess benefits of telephone-delivered health mentoring in community-based chronic obstructive pulmonary disease (COPD).DesignCluster randomised controlled trial.SettingTasmanian general practices: capital city (11), large rural (3), medium rural (1) and small rural (16).ParticipantsPatients were invited (1207) from general practitioner (GP) databases with COPD diagnosis and/or tiotropium prescription, response rate 49% (586), refused (176) and excluded (criteria: smoking history or previous study, 68). Spirometry testing (342) confirmed moderate or severe COPD in 182 (53%) patients.RandomisationBy random numbers code, block stratified on location, allocation by sequentially numbered, opaque and sealed envelopes.InterventionHealth mentor (HM) group received regular calls to manage illness issues and health behaviours from trained community health nurses using negotiated goal setting: problem solving, decision-making and action planning. Control: usual care (UC) group received GP care plus non-interventional brief phone calls.OutcomesMeasured at 0, 6 and 12 months, the Short Form 36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ, primary); Partners In Health (PIH) Scale for self-management capacity, Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies-Depression (CES-D) questionnaire, Post-Traumatic Stress Disorder Checklist, Satisfaction with life and hospital admissions (secondary).Results182 participants with COPD (age 68±8 years, 62% moderate COPD and 53% men) were randomised (HM=90 and UC=92). Mixed model regression analysis accounting for clustering, adjusting for age, gender, smoking status and airflow limitation assessed efficacy (regression coefficient, β, reported per 6-month visit). There was no difference in quality of life between groups, but self-management capacity increased in the HM group (PIH overall 0.15, 95% CI 0.03 to 0.29; knowledge domain 0.25, 95% CI 0.00 to 0.50). Anxiety decreased in both groups (HADS A 0.35; 95% CI −0.65 to −0.04) and coping capacity improved (PIH coping 0.15; 95% CI 0.04 to 0.26).ConclusionsHealth mentoring improved self-management capacity but not quality of life compared to regular phone contact, which itself had positive effects where decline is generally expected.
THE 3MG TRIAL: A RANDOMISED CONTROLLED TRIAL OF INTRAVENOUS OR NEBULISED MAGNESIUM SULPHATE VERSUS PLACEBO IN ADULTS WITH SEVERE ACUTE ASTHMA
Authors: Gray A , Goodacre S , Cohen J , Braidburn M , Benger J , Coats T 
Published: September 2013

Objectives & BackgroundPrevious studies suggest intravenous or nebulised magnesium sulphate may improve respiratory function in patients with acute asthma. We aimed to determine whether intravenous or nebulised MgSO4improve symptoms of breathlessness and reduce the need for hospital admission in adults with severe acute asthma.MethodsIn a double-blind, placebo-controlled trial, we enrolled adults with severe acute asthma at emergency departments of 34 UK hospitals. We excluded patients with life-threatening features. Allocated participants received IV MgSO4(2 g in 20 min) or nebulised MgSO4(3×500 mg doses in 1 h)+standard therapy, or placebo+standard therapy. We assessed two primary outcome measures in all participants according to treatment group: the proportion of patients admitted to hospital within 7 days and breathlessness measured on a 100 mm VAS in the 2 h after initiation of treatment. We adjusted for multiple testing. Study registration no:ISRCTN04417063.Results1109 patients were recruited (Jul 2008 to Jun 2012). 261 (79%) of 332 patients allocated nebulised MgSO4were admitted to hospital, as were 285 (72%) of 394 patients allocated intravenous MgSO4and 281 (78%) of 358 controls. Breathlessness was assessed in 296 (89%) patients allocated nebulised MgSO4, 357 (91%) patients allocated intravenous MgSO4, and 323 (90%) controls. Rates of hospital admission did not differ between patients treated with either form of MgSO4compared with controls or each other. Change in VAS breathlessness did not differ between active treatments and control, but change in VAS was greater for patients in the intravenous MgSO4group than the nebulised MgSO4group (5.1 mm, 0.8 to 9.4; p=0.019). Intravenous or nebulised MgSO4did not significantly decrease rates of hospital admission and breathlessness compared with placebo: intravenous MgSO4was associated with an odds ratio of 0.73 (95% CI 0.51 to 1.04; p=0.083) for hospital admission and a change in VAS breathlessness of 2.6 mm (−1.6 to 6.8; p=0.231) compared with placebo; nebulised MgSO4was associated with an odds ratio of 0.96 (0.65 to 1.40; p=0.819) for hospital admission and a change in VAS breathlessness of −2.6 mm (−7.0 to 1.8; p=0.253) compared with placebo.ConclusionThese data suggest nebulised MgSO4has no role in the management of severe acute asthma in adults and at best suggest only a limited role for intravenous MgSO4in the ED.
CAN AMBULANCE DATA BE USED TO REDUCE COMMUNITY VIOLENCE? EXPLORATORY RECORD LINKAGE STUDY
Authors: Boyle A , Ariel B , Weinborn C 
Published: September 2013

Objectives & BackgroundEmergency Department information sharing with Community Safety Partnerships and the Police is well established, Emergency Department Data about the location, time of assault and weapon type is shared with the police to support targetted policing and licensing decisions. It is not established whether ambulance data, which routinely collects automated location and time data, provides additional information to police and emergency department data. We aimed to find out what proportion of ambulance call outs to assault was not recorded by the police or the emergency department services.MethodsWe compared routine, anonymous aggregate data from the police and ambulance service about calls for service to violent crime in Peterborough, England in 2011–2012. We used two methods of identifying matches. The first is ‘hotspotting' which uses spatio-temporal methods to identify clusters. The second is by manually matching individual cases in time and location.Results775 calls for service were made to the ambulance service to victims of assault. 347 (49%) of these cases were transported to hospital. 3,997 calls for police service to victims of violence were made in the same time period. The demographic and temporal characteristics of the two lists were similar. Between 125 and 204 cases could be matched, depending on case definition.ConclusionThe ambulance service is responding to many victims of community violence that are not recorded by the police and probably not recorded by the emergency department. Ambulance data has potential to inform licensing and targetted policing. It is not proven whether this will reduce community violence.
DEATH AND SERIOUS INJURY CAUSED BY STABBING IN ENGLAND AND WALES 2000–2010
Authors: Davies M , Lecky F 
Published: September 2013

Objectives & BackgroundFollowing a spate of high profile murders there is concern that injuries and deaths caused by knives is increasing in England and Wales, especially within the teenage population. Excluding police and Home Office statistics, there are few UK studies examining Emergency Department data.MethodsA retrospective analysis was performed of stab injuries from the Trauma Audit and Research Network (TARN) database (2000-2010), the largest national registry of serious injuries. Data were analysed to determine temporal trends in the prevalence of stab injuries and demographic characteristics of those injured. The UK Office of National Statistics provided data on deaths by stabbing.ResultsOf 102,562 cases in the TARN database, 3052 (3%) were due to stabbing. There were 2755 men and 297 women with a median age of 28 and 33 years respectively. The median NISS was 18 with a mortality rate of 6.5% in men and 7.7% in women. The highest rate of stabbings as a proportion of all injuries was submitted from London (7.8%), with the South East submitting the least (1.5%). 92% resided in urban areas, 90% were due to assault and 36% presented to the ED between 00.00-08.00. Following a peak in the middle of the decade, serious stab injuries are falling. ONS data recording death from stabbing also follows this pattern, mainly due to a fall in homicides.ConclusionBoth from TARN and ONS data, the rate of death and serious injury from stab wounds rose in the middle of the last decade but since 2006 is falling. Stabbings account for a low proportion of overall injury deaths and hospitalised trauma patients. The vast majority are due to assault and affect young men in urban areas, particularly London, the North East and the North West. Accidental death from stabbing is rare although suicide using sharp implements, particularly amongst older men, is perhaps more common than previously thought.
PREDICTION OF UNSUCCESSFUL TREATMENT IN PATIENTS WITH SEVERE ACUTE ASTHMA: AN ANALYSIS FROM THE 3MG TRIAL
Authors: Gray A , Goodacre S , Braidburn M , Cohen J , Benger J , Coats T 
Published: September 2013

Objectives & BackgroundClinical assessment can be used to identify which patients with acute asthma are at risk of unsuccessful initial treatment. We aimed to determine, using data from the 3MG trial, which elements of clinical assessment predict unsuccessful treatment, defined as needing critical care or any unplanned additional treatment.MethodsWe analysed data from a large multicentre trial (the 3Mg trial). Adults with severe acute asthma underwent standardised clinical assessment, including peak expiratory flow rate (PEFR), up to two hours after initiation of treatment. Standard care was provided other than blinded random allocation to trial treatment or placebo. Patients were followed up by record review up to 30 days. Unsuccessful treatment was defined as needing (1) critical care or (2) critical care or any unplanned additional treatment within seven days of presentation. Logistic regression was used to identify predictors and derive a prediction model for each outcome.ResultsOut of 1084 patients analysed, 81 (7%) received critical care and 157 (14%) received critical care or unplanned additional treatment. Baseline PEFR (p=0.017), baseline heart rate (p<0.001), other serious illness (p=0.019), PEFR change (p=0.015) and heart rate change (p<0.001) predicted need for critical care. Baseline PEFR (p=0.010), baseline heart rate (p<0.001), baseline respiratory rate (p=0.017), other serious illness (p=0.023), PEFR change (p=0.003) and heart rate change (p=0.001) predicted critical care or additional unplanned treatment. Models based on these characteristics had c-statistics of 0.77 and 0.69 respectively.ConclusionPEFR, heart rate and other serious illness are the best predictors of unsuccessful treatment, but models based on these variables provide only modest predictive value.
EMERGENCY CARE HANDOVER (ECHO STUDY) ACROSS CARE BOUNDARIES–THE NEED FOR JOINT DECISION-MAKING AND CONSIDERATION OF PSYCHOSOCIAL HISTORY
Authors: Sujan M , Chessum P T , Rudd M , Fitton L , Inada Kim M , Spurgeon P , Cooke M W 
Published: September 2013

Objectives & BackgroundHandover in emergency care is an important patient safety issue and has particular problems due to different environmental, professional, organisational and cultural backgrounds. Previous work as focussed on the standardisation of handover content (including use of checklists), relatively little is known about the verbal behaviours that shape handover conversations. This study looks at both the content of the handover and the verbal behaviours during different types of handovers around the emergency department.MethodsThree handovers were studied: ambulance service to ED in ‘Resuscitation’ and ‘Majors’ areas and referrals to acute medicine. They were audio recorded in three NHS emergency departments. Handover conversations were segmented into utterances. Frequency counts for content and language forms were derived for each type of handover using Discourse Analysis. Verbal behaviours were identified using Conversation Analysis.Results203 handover conversations were analysed. Handover conversations involving ambulance services were mainly descriptive (60%–65% of utterances), unidirectional and focused on patient's clinical presentation (75%–80%). Referrals entailed more bidirectional conversation focused on the decision to admit and immediate care needs. Across all types of handover, only 1.5%–5% of handover conversation content related to the patient's social and psychological status and needs.ConclusionHandover may entail both descriptive (aimed at information transfer) and collaborative (aimed at joint decision-making) elements. Standardisation of handover needs to accommodate collaborative aspects with their greater variability according to the individual situation, and should incorporate communication of information relevant to the patient's social and psychological needs to establish appropriate care arrangements at the earliest opportunity.
ALCOHOL ATTENDANCE WITHIN THE EMERGENCY DEPARTMENT
Authors: Kelly G , Crick J , Hall T 
Published: September 2013

Objectives & BackgroundHow much does alcohol contribute to the demands on the Emergency Department (ED)? York is a popular tourist destination, particularly amongst hen and stag parties. But a quarter of the resident population have previously been identified as higher risk drinkers. So therefore, how much does alcohol contribute to the pressures on York ED? Additionally, clinical coding of alcohol within the ED is anecdotally unreliable. How true is this? We therefore undertook an alcohol needs assessment within York ED looking at general demographics, reasons for attendance and evidence of alcohol linked to the attendance. We also looked at the discrepancy between how much the ED was paid for these patients by commissioners and the actual cost to the acute trust.MethodsWe randomly selected 1 week per quarter in 2011 and hand searched every ED record for evidence of alcohol-related attendance. We also included patients for whom it was felt alcohol was highly likely although not directly mentioned. We undertook a concordance assessment around the alcohol question and achieved 94%.ResultsThe 4 randomly selected weeks amounted to a 5,704 patient sample, 7.2% of the total number of attendances in 2011.9.8% of attendances were alcohol-related (553 patients)Between 21:00 and 09:00, this rose to 19.7%Alcohol was involved in 45% of mental health attendancesThe alcohol group was heavily over-represented in the patients removed by police (100%), refusing treatment (55%) and leaving prior to their treatment (41%)10.3% of alcohol-related attendees remained in the ED for >4hours compared with 5.9% of non-alcohol-related attendees62.8% of alcohol-related attendees were living within the City of York18% of all ambulance journeys were due to alcoholAlthough 553 patients had evidence of alcohol in their attendance, it was only coded as such in 46 computer recordsIf these figures are extrapolated to cover the annual patient population, the discrepancy between what the commissioners pay and the true cost of these patients is £552,431ConclusionAlcohol poses a disproportionate burden on York Emergency Department and Yorkshire Ambulance Service. With pressures on staffing, the 4 hour standard and ambulance turnaround times at an all-time high, how different would the ED be if the alcohol burden were reduced? This needs assessment fuels the argument for an 'invest to save' attitude to reduce alcohol-related attendance.
A PILOT PROJECT TARGETING FREQUENT ATTENDERS AT THE EMERGENCY DEPARTMENT WITH MEDICALLY UNEXPLAINED SYMPTOMS
Authors: Baker M , Stallard J , Gibson S 
Published: September 2013

Objectives & BackgroundWe identified that there is a cohort of people who attend our Emergency Department (ED) extremely frequently (>24 times per year) or who have frequent admissions (>12 per year). Analysing hospital clinical records identified that in many cases medically unexplained symptoms (MUS) drive the frequent presentation. The needs of these patients were not being met by a traditional dualistic approach in which people are seen in either physical or mental health settings. Indeed, despite frequent medical investigations/treatments, their symptoms persist, their problems are not resolved, they frequently complain and they keep coming back. This carries risk and distress for the patients, and heavy use of resources for the hospitals involved.MethodsEach month we looked at attendance data for the previous 3 months (this identified people who in an acute phase of repeat presentations). By accessing patients clinical records we determined the main factors which appeared to drive their frequent attendance and admissions and identified those who presented with MUS. Care plans were developed and each patient was contacted and offered weekly Cognitive Behavioural Therapy (CBT) sessions to help them manage their symptoms. This was part of a case management approach in which coordinated, multidisciplinary reviews were undertaken resulting in an individualised care plan.ResultsThus far the pilot has seen a reduction in attendances at ED for 100% of patients included in study (N=20). Crucially, all now attend less than once per month. In total 245 attends were saved after the CBT interventionsConclusionProviding a psychological intervention to this patient cohort is effective in reducing hospital costs by containing the most frequent attenders. CBT and care plans have reduced attendance to under once per month and subsequently reduced medical interventions and prescribing costs.
LYRICA NIGHTS–RECREATIONAL PREGABALIN ABUSE IN AN URBAN EMERGENCY DEPARTMENT
Authors: Millar J , Sadasivan S , Weatherup N , Lutton S 
Published: September 2013

Objectives & BackgroundSince ‘legal highs' emerged as drugs of abuse in the UK, Emergency Physicians have battled to keep up with the latest drug craze. Whilst many of these drugs present with recognisable toxidromes, the effect of new compounds or medications cannot be readily predicted. In Belfast, we have witnessed a recent increase in the number of patients presenting after recreational abuse of Pregabalin (Lyrica). Patients, state that the medication induces a state similar to drunkenness, hence the street name ‘Budweiser's’. To our knowledge this is the first case series detailing the recreational abuse of Pregabalin, a drug which has become popular in primary care.MethodsWe conducted a one year review of all patients presenting to our department after recreational drug abuse. Those who admitted to Pregabalin usage were identified and case notes were reviewed.ResultsBetween 02/12–02/13, 10 patients presented to our ED following recreational Pregabalin abuse. All were aged between 20 and 35 years of age. Dosages ranged from 500–1400 mg. Six patients presented with seizures (5 of which were ‘first' seizures). Two patients required intubation and ventilation and were admitted to the ICU. In total, nine patients were admitted for a minimum of 24 hours, whilst one patient discharged against advice.ConclusionEmergency Physicians should be aware of the current use of Pregabalin as a recreational drug. Patients are either taking tablets whole or cutting and snorting them. 60% of patients in this case series presented to the ED with seizures and 20% required ICU admission. We recommend that patients who present with potential Lyrica toxicity should be admitted for observation with the treating physician being mindful of the potential for seizure activity.
TACKLING KNIFE CRIME–A JOINT VENTURE BETWEEN ED AND POLICE IN REDBRIDGE TO IDENTIFY PATTERNS OF ATTENDANCE OF DOMESTIC VIOLENCE VICTIMS
Authors: Ahsan S , Leung J Y , Hicks D 
Published: September 2013

Objectives & BackgroundRedbridge Tackling Knife Crime Programme was an initiative run between Redbridge Safer Communities Partnership, a London-based police force and Barking, Havering and Redbridge University Hospital Trust. It comprised of data collection resulting in the analysis of types of assault, locations, demographics of both assailant and victim and were police informed. Domestic violence (DV) was identified as a category of assault. The inspiration came from the 1996 ‘Cardiff-model’–the Violence Prevention Group shared ED assault data with its police force. The outcome led to enhanced effectiveness of the police in managing alcohol-related violence. The TKAP aim is it identify DV locations and patterns, otherwise unknown to police by improved intelligence gathered through ED data. As a result police deployment can reflect areas of need and allow police to compare their own figures allowing a more informed service for DV victims.MethodsThe patient recording system, Symphony, was adjusted to accommodate data vital for intelligence gathering. Parameters recorded included arrival in ED, assault date and time, location, were the police called, number of attackers, relationship to the victim, body part assaulted, object if any used, or body part and was this a repeat assault. If the assailant was either a family member, spouse or partner the assault is identified as DV.ResultsThe 10-month data collection identified 221 patients as DV out of the 2011 total figure of assault victims from TKAP. ED data showed 66% were female and 24% were male, differing from police data which shows 83% as female. The majority of females were aged 18–44 years at 74%, with males aged 35–59 years at 58% and 29% between 1–25 years. For both male and female, 5% were under 16 years old.ConclusionData identified a significant number of female assault patients who were DV victims were repeat victims and had not called the police. Overall figures acknowledged some DV victims treated in ED were not involved in the data collection. This is attributed to the victim refusing to implicate the assailant. Those that participated had the most significant injuries–suggesting they were subject to extended cycles of abuse and were reaching out for help.Resultswill be used to implement police enforcement activities and prevention work, hence improving safe-guarding.