bluuebunny/crossref_metadata_2025_split huggingface dataset:
REVOLUTION IN PPI OR REVOLT? A MEETING OF MINDS OR A CLASH OF OPINIONS
Authors: Irving Andy , Broadway-Parkinson Andrea , Marsh Maggie , Fall Dan 
Published: May 2015

BackgroundThe PhOEBE (Pre-Hospital Outcomes for Evidence Based Evaluation) research programme aims to develop new ways of measuring how well ambulance services meet the needs of the patients who call them and the quality of the care they provide. Measuring how services are performing is important as it allows us to monitor if standards are being maintained, assess what works well and identify problems early so improvements can be made. The first stages of our programme have focused on identifying the range of possible measures and from these narrowing it down to a small number that we will then develop in more detail.MethodsA Delphi survey was planned for PPI and ‘experts’ to score how useful they thought each potential measure was. At the outset of the survey preparation, the PhOEBE PPI group highlighted concerns regarding the accessibility of the method for a lay audience. Alternative means of involving patient and public views were considered. The PPI reference group co-designed a more interactive and accessible consensus event open to a wider PPI audience in order to consider those measures favoured by the Delphi expert panel. The event included presentations, small group discussions facilitated by the PhOEBE PPI ref group and electronic voting.ResultsOf the thirty one measures presented nine were voted as most relevant and important from a lay perspective.ConclusionThis event not only provided the project with valuable information about which of our potential measures are considered important but also demonstrated that a PPI led initiative can enhance a lay audience's understanding of ambulance service performance issues. Despite some challenges in communication the event proved the PPI ref group as valued research collaborators. We continue to develop a more proactive PPI-led model of involvement capable of meeting the needs of the PhOEBE programme.
ARE PREHOSPITAL TREATMENT OR CONVEYANCE DECISIONS AFFECTED BY AN AMBULANCE CREW'S ABILITY TO ACCESS A PATIENT'S HEALTH INFORMATION? A UK SURVEY
Authors: Zorab Ollie , Robinson Maria , Endacott Ruth 
Published: May 2015

BackgroundA shift from a predominantly emergency service, towards one where a wide range of conditions are managed and treated on scene presents numerous challenges for ambulance services and clinicians. The effective management of a broad range of patients and conditions in the ambulance setting will have an impact on other parts of the health service including emergency departments and primary care.MethodsA two part online survey was distributed to operational staff working for a regional UK ambulance service. Clinicians were asked to report their experiences of accessing patient information and making decisions about patient management based on four hypothetical patient scenarios.ResultsA survey of clinical staff (n=302) revealed that overall, 285 (94.4%) of respondents felt that they had been unable to access health information about a patient that they were caring for, whilst 274 (90.7%) felt that this lack of information had led to a less appropriate care pathway being selected and the majority (246/81.5%) felt that information was easier to access during working hours on weekdays. Sources that respondents use when trying to access a patient's health information were mainly the patient's General Practitioner (n=294, 94.7%). Hospital Discharge and GP Summaries were the two pieces of information which respondents considered as helpful sources of information.ConclusionsDecisions regarding the most appropriate care for patients presenting to the ambulance service are best informed by access to accurate and complete health information and records. An understanding of patients' pre-existing medical conditions, recent treatments and health information is needed for the selection of the most appropriate care; this information is often difficult to obtain in the ambulance service setting.
A SYSTEMATIC REVIEW OF RAPID ACCESS MODELS OF CARE AND THEIR EFFECTS ON DELAYS IN EMERGENCY DEPARTMENTS
Authors: Evans Bridie Angela , Porter Alison , Gammon Becky , Mayes Robert Harris , Poulden Mark , Rees Nigel , Snooks Helen , Toghill Alun , Wells Bridget , Whitfield Richard 
Published: May 2015

BackgroundPressure on emergency departments (EDs) sometimes results in handover delays for patients who arrive in ambulances, leading to operational disruption to the ambulance service and ED, and poorer patient experience. Some EDs have adopted models of care to provide rapid access for emergency patients to senior clinical staff.MethodsWe carried out a systematic review of studies describing the operation of a senior clinician-led rapid assessment team in an ED whose purpose was to streamline receiving, treating and discharging patients. We examined research papers published in English 2004–2014, searching eight electronic databases. We used a pre-defined data extraction framework and assessed papers for quality. We used narrative synthesis to analyse and synthesise the data on the characteristics of these models and their impact on patient flow.ResultsWe identified 628 potentially eligible studies, of which 13 met the inclusion criteria for the review. Most were uncontrolled before and after studies (n=8); two were randomised controlled trials and two were controlled studies. The majority of models shared common characteristics, in addition to being led by senior clinicians: the patient was initially seen by a triage nurse, assessment and treatment occurred simultaneously with triage or followed quickly, and assessment and triage took place within a designated area of the ED. A wide range of outcome measures was collected. All studies which described effects on waiting times reported a reduction, generally across all patient groups. Seven studies reported that patients treated under the model spent less time in the ED between registration and discharge (up to 54% less in one study), with a range of impacts noted on other ED patients. Five studies reported that fewer patients left the ED without being seen. Five studies reported positive feedback from staff.ConclusionsThe review suggests that rapid access models in the ED may have benefits for patients, though evidence is still limited.
CAN WE REDUCE EMERGENCY HOSPITAL ADMISSIONS THROUGH EFFECTIVE SOCIAL CARE FOR OLDER PEOPLE?
Authors: Porter Alison , Morrison-Rees Sian 
Published: May 2015

BackgroundAppropriate social care delivered at the right time can potentially maintain health and delay or avoid the need for health care interventions such as emergency hospitalisation. We describe a study, currently underway in Wales, which examines whether there is an association between the implementation from 2008 of policy aimed at reducing emergency hospital admissions among people with long term conditions and a change in provision of local authority-supported social care for people aged 65 and over.MethodsThis observational study of routine data employs mixed methods for data collection and analysis. We are using interrupted time series analyses (January 2006 to December 2012) to study overall trends in the use of social care and unplanned use of secondary care across Wales, and to examine the relationship between the two. We are examining how this relationship varies between local authority areas; over time; and by the type of care received, and the cost of care delivered. Within one case study area, we are using the SAIL database to link anonymously health and social care data, to examine service use at an individual level in the 65+ age group. We are using interviews with local authority data managers to explore the feasibility of extending this data linkage model to the whole of Wales.ResultsAnalysis is currently underway on all-Wales data. Linkage of social services data with health data within the case study area is complete (91% match rate), and analysis will begin shortly. We have completed the majority of interviews.ConclusionsThere is potential to use routine data to examine the use of social care and the interaction with use of health care.
IMPROVING OUTCOMES FROM OUT OF HOSPITAL CARDIAC ARREST: THE CARDIAC ARREST INDIVIDUAL REGISTRY AND OUTCOMES PROGRAMMES (CAIRO)
Authors: Benger Jonathan , Voss S , Thomas M 
Published: May 2015

BackgroundA cardiac arrest occurs when the heart stops beating suddenly. It is one of the most extreme medical emergencies. 60,000 people suffer an out of hospital cardiac arrest (OHCA) in the UK each year, with resuscitation attempted in less than half, and less than 10% surviving to hospital discharge. The Cardiac Arrest Individual Registry and Outcomes (CAIRO) Programme includes a comprehensive patient registry: the CAIRO database. This registry will allow us to confidentially link data from different sources to track each cardiac arrest patient from their initial collapse through to hospital discharge and, with the patient's consent, subsequently in the community through follow-up assessments of progress.Aims and ObjectivesTo determine whether it is feasible to set up the CAIRO database in this patient population, by linking sources of routinely collected data.To chart the patient pathway and estimate the completeness of the data obtained from routine data sourcesConditional on sufficient data being available to allow meaningful analysis;Objective 1To compare the survival to hospital discharge, ICU stay, complications and neurological outcomes in patients in whom the arterial oxygen concentration in the first 24 hours following cardiac arrest was or was not maintained between 60 mm Hg to 200 mm Hg.Objective 2To compare the survival to hospital discharge of patients who were or were not transported or transferred to a cardiac care centre within 12 hours of the cardiac arrest.Objective 3To compare the survival to 1-year of patients who underwent coronary angiography within 8 hours of the cardiac arrest or more than 8 hours after the cardiac arrest.Objective 4To compare the healthcare resource use to 1-year of patients who were or were not within 5 miles of the receiving heart attack centre when they had an OHCA.
REDUCING OVERTRIAGE AND UNDERTRIAGE RATES OF PELVIC FRACTURES AND UNNECESSARY PELVIC BINDER APPLICATIONS IN MAJOR TRAUMA PATIENTS
Authors: Trebilcock Hannah 
Published: May 2015

BackgroundData has been collected from suspected major trauma patient clinical records since the launch of the major trauma system in the South West in April 2012. In an internal report it was identified that 50% of overtriaged suspected major trauma patients were attributed to a suspected pelvic fracture. The National Consensus Statement on the Pre-Hospital Management of Pelvic Fractures provided a flow diagram depicting the appropriate application of the pelvic binder.MethodAn audit was conducted looking at all suspected major trauma patients from April 2012–March 2013. Two groups were selected for the audit. Group 1 consisted of the overtriaged patients where a SAM splint had been applied. Group 2 consisted of the undertriaged patients identified by TARN as having a pelvic fracture where no binder was applied. The flow diagram sited in the consensus statement was retrospectively applied to both groups of patients to confirm whether following the criteria would result in more accurate pelvic binder applications.ResultsIn group 1, after applying the criteria specified in the flow diagram, there was a 15% reduction in unnecessary pelvic binder applications. In group 2 73% of the patients required a pelvic binder in accordance with the flow diagram criteria. Thus reducing the number of patients both over and under triaged with a pelvic fracture.ConclusionsApplying the flow diagram criteria has shown to improve accuracy of appropriate pelvic binder applications in suspected major trauma patients. The flow diagram has been summarised into four key points and included in a new Trust Clinical Guideline for pelvic injury. A follow up audit will be conducted looking at the same groups of patients in the year following publication of the guideline to analyse whether accuracy of pelvic binder applications has increased.
PRE-HOSPITAL PAIN ASSESSMENT AND MANAGEMENT: A QUALITY IMPROVEMENT (QI) APPROACH
Authors: Lynde Jessica , Zorab Ollie 
Published: May 2015

BackgroundPain presents regularly in a range of medical and traumatic conditions. Ongoing monitoring for STEMI, limb fractures and major trauma, as well as audits on paediatric care have all indicated, however, that adequate pain management is not yet universal.Involvement in the ASCQI project demonstrated the benefits of using QI methods to engage with clinicians, to identify barriers to providing evidence-based care and possible solutions. A QI approach was thus employed to tackle obstacles to optimal pain management, as part of the ASCQI Impact study.MethodTrust clinicians were invited to join a Clinical Webchat, an online forum, to discuss pain assessment techniques and pain relief, including non-pharmacological methods. Clinicians shared their experiences and suggestions, and were guided by questions using audit evidence to provoke discussion. A thematic analysis of the Webchat transcript informed recommendations for clinical managers and trainers.Results11 clinicians took part in the Webchat, with representation from the Clinical Development and Audit teams. Participants agreed with the value of the existing pain scales to assist in titrating pain relief interventions. However, concerns that patients may over-estimate their pain meant clinicians use supplementary observations. Potential alternative methods were suggested for assessing pain. Practical issues with Entonox were uncovered, and the adequacy of the current formulary was questioned. It was accepted that non-pharmacological techniques were often overlooked, and innovative suggestions around use of distraction and combining analgesia with immobilisation emerged.Recommendations included publicity around overlooked techniques; auditing pain management for specific groups; tackling localised and practical barriers to providing exemplary care; and further QI work exploring complementary pain assessment methods.ConclusionThe Clinical Webchat is a novel QI method that can engage geographically-dispersed clinicians on a pre-prepared topic. Useful, generalisable information, added to audit findings, informed recommendations that could provide real and sustained improvements in patients' experience.
DOES CURRENT PRE-HOSPITAL CARE FOR PATIENTS AT THE END OF THEIR LIFE REFLECT BEST PRACTICE GUIDANCE?
Authors: Shaw Joanna , Fothergill Rachael , Murphy-Jones Georgina 
Published: May 2015

IntroductionThe end of life care good practice guide encourages organisations to enable terminally ill patients to be cared for and die outside of hospital. Ambulance services play a critical role in achieving this goal, however little guidance exists for ambulance crews.MethodTo determine the current levels of care provided, a retrospective review was conducted of 50 end of life care records. Findings were communicated to staff with a questionnaire to determine levels of confidence caring for these patients (61 responded); prior to a prospective review of a further 30 records.ResultsOnly 4% of patients had out-of-hours information registered with the ambulance service. 48% were attended out-of-hours and their wishes were unknown. 38% of crews consulted with the patients' GP/palliative care team to determine whether the patient had a plan for their end of life. 88% of patients were conveyed (27% to a hospice and 73% to A&E). 53% of survey respondents were not confident treating this patient group. Respondents identified training needs, specifically on: alternative care pathways, evidence of terminal illness and DNA-CPR orders. Pain and discomfort was considered for 83% of patients, with subsequent action taken for 73%. Patients' wishes were not documented for 79%, however the patient's diagnosis and prognosis was clear for 97%. Referrals to A&E, a hospice or to the patient's GP/palliative care team were felt to be appropriate to the patient's presenting complaint for 93%.ConclusionCrews are not able to access out-of-hours information for end of life patients and are therefore not always aware of the patient's wishes. The care provided to the majority of patients was good, but the questionnaire showed most respondents were not sufficiently confident when treating end of life patients. Further work is needed to ensure crews are able to determine patients' wishes and training could increase confidence treating this patient group.
IMPROVING PRE-HOSPITAL PAEDIATRIC PAIN MANAGEMENT
Authors: Shaw Joanna , Fothergill Rachael , Virdi Gurkamal 
Published: May 2015

IntroductionPain is one of the most frequently reported symptoms to UK ambulance services and pain management is a known area for improvement. This is especially true for paediatric patients who may not be able to communicate their levels of pain as effectively as adults.MethodA criterion-based retrospective clinical audit evaluated pain assessment and management for children less than 12 years old who reported a suspected fracture. To determine how pain assessments could be improved, an investigation of pain assessment methods used in other areas of the NHS was undertaken. A laminated card was produced and distributed to all clinicians for use when assessing pain in children. The card contains an amended version of the Wong-Baker faces to help clinicians assess and monitor paediatric patients' levels of pain with a reminder of the analgesic options available for children. Paediatric pain assessment and pain management was re-audited following introduction of the card.ResultsPrior to introduction of the card, the data showed paediatric pain management as a considerable area of concern for the ambulance service. A pain assessment was undertaken for 64% of patients. When a pain assessment was undertaken, and the child reported they were in pain, only 23% of patients received pharmacological pain relief. The introduction of the card resulted in great improvements. A pain assessment was documented for 96% of patients, representing an improvement of 32% from the original audit. When analgesia was indicated, it was administered to 66% of patients, an improvement of 43%. Despite this improvement, pain was still not managed effectively for 34% of patients.ConclusionFurther improvement is required to ensure every paediatric patient has their pain assessed and managed effectively. The laminated card has been redesigned and distributed, in conjunction with a pain training strategy. In addition, further analgesic options for paediatric patients have been investigated.
BETTER TOGETHER? AMBULANCE STAFF VIEWS OF HUMAN FACTORS IN RESUSCITATION
Authors: Miller Joshua 
Published: May 2015

BackgroundResearch into the care of cardiac arrest patients outside of hospital is limited. Evidence from hospital settings suggests that human factors including both technical and non-technical skills and performance may impact on care. This study sought staff views from a UK ambulance service aiming to investigate areas for improvement in resuscitation performance.MethodsVolunteer ambulance staff responded to an open invitation to complete an anonymous internet-based survey. The survey used a mixture of closed questions, Likert-scaled answers and free text to explore staff views on resuscitation performance. Quantitative responses were presented graphically, and free text answers arranged by theme.Results111 staff responded to the survey. The results demonstrated that staff see effective teamwork as desirable in out-of-hospital resuscitation, but that this is not always the case currently. Staff felt more confident about practical skills such as cannulation and chest compression delivery. Difficulties were noted in: poor communication between staff members; inconsistent identification and nomination of leaders; low staff confidence in peri- and post-cardiac arrest conversations with relatives; and insufficient staff numbers on scene.ConclusionsThe findings demonstrate poor staff confidence in several non-technical skills, including teamwork and communication. Limitations of the survey included lack of recording of training received—where this has shifted in recent years from in-service to higher education routes—and missing demographic data.However, the findings provide specific areas for improvement activity. This has already included best practice slides displayed in ambulance stations, and proposals for identification wristbands, a role-based work standard to reduce task omission and duplication, and a policy to send higher numbers of rescuers to cardiac arrest cases.
Kissing-Y stenting for endovascular treatment of complex wide necked bifurcation aneurysms using Acandis Acclino stents: results and literature review
Authors: Brassel Friedhelm , Melber Katharina , Schlunz-Hendann Martin , Meila Dan 
Published: May 2015

IntroductionY-configured stent assisted coiling is a promising therapeutic option to ensure safe coil embolization and preserve the affected arteries in complex wide necked aneurysms. We present our experience with self-expanding Acandis Acclino stents for the treatment of complex aneurysms using the kissing-Y technique.MethodsWe retrospectively reviewed seven patients with seven complex aneurysms (three anterior communicating artery (AcomA), two middle cerebral artery, one basilar artery/superior cerebellar artery, and one vertebral artery/posterior inferior cerebellar artery) who were treated with the kissing-Y technique by stent assisted coiling from June 2013 to July 2014, with follow-up until January 2015. DSA follow-up was up to 17 months, with a mean follow-up period of 10 months. Six patients were treated electively and one in the acute phase of a subarachnoid hemorrhage. In all cases, closed cell Acandis Acclino stents were used. We evaluated procedural complications, clinical outcomes, and mid term angiographic follow-up. Additionally, a literature review is provided.ResultsIn all patients, stents were successfully placed and implanted. One patient developed a periprocedural thromboembolic complication not directly related to the stents. No other periprocedural or postprocedural complications were encountered. Follow-up examinations showed stable and total occlusion of all coiled aneurysms.ConclusionsThe results of our study show that the kissing-Y technique using closed cell Acandis Acclino stents followed by coil embolization is a feasible treatment option for selected complex bifurcation aneurysms.