bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE JAM IN THE SANDWICH, DOWN HERE IN A&E': STAFF PERSPECTIVES ON THE IMPACT AND CAUSES OF HANDOVER DELAYS BETWEEN THE AMBULANCE SERVICE AND THE EMERGENCY DEPARTMENT
Authors: Porter Alison , Evans Bridie Angela , Gammon Becky , Mayes Robert Harris , Poulden Mark , Rees Nigel , Snooks Helen , Toghill Alun , Wells Bridget , Whitfield Richard 
Published: May 2015

BackgroundDelays to the handover of patients from ambulances to the emergency department (ED) cause operational challenges for hospitals and the ambulance service, and have attracted considerable public and policy concern. As part of a wider study of handover delays, we sought to understand the perspective of health service staff on their impact and causes, in the ED of a large teaching hospital.MethodsWe conducted semi-structured interviews with a stratified sample of key staff from the hospital and the ambulance service, including doctors (n=5); nurses (n=7); hospital based support staff (n=2); paramedics and ambulance technicians (n=12); and other ambulance service staff (n=8). All interviews were recorded and transcribed in full, then analysed using the framework approach.ResultsAll staff groups expressed concerns about the impact of crowding and handover delays on the quality of patient care, with a minority of respondents identifying clinical risk to patients. Handover delays were associated with high levels of stress for all staff groups, and in particular frustration for ambulance clinicians tied up waiting with patients outside the hospital. Delays were felt to have an impact on the relationship between professional groups. The negative impact on ambulance service performance measures was felt to be substantial.There was a high level of consensus that problems of crowding in the ED were complex, with issues right through the system. Almost all respondents identified lack of capacity elsewhere in the hospital as an immediate cause, and reflected positively on the impact of recent initiatives to improve patient flow. Batched arrival of ambulances, associated in part with shift patterns, was reported as causing knock-on delays from which it was hard to recover.ConclusionsHandover delays at the ED have a negative impact on patients, staff and health service organisations. System-wide impacts suggest that system-wide approaches to resolving delays are required.
FEASIBILITY STUDY OF A NOVEL PAIN ASSESSMENT TOOL FOR IMPROVING PREHOSPITAL PAIN MANAGEMENT
Authors: Iqbal Mohammad , Anne Spaight P , Kane Ros , Asghar Zahid , Niroshan Siriwardena A 
Published: May 2015

BackgroundPain affects 4 out of 5 patients presenting to ambulance services and is often poorly assessed and treated. Currently, patients' pain is assessed by ambulance clinicians using a numerical verbal (zero to ten) pain score (NVPS). Our previous qualitative study showed that NVPS were poorly understood by patients and that a better pain assessment tool was needed. This current study sought to develop and test a novel pain assessment tool ‘Patient Reported Outcome Measure for Pain Treatment (PROMPT)’ for feasibility of use by ambulance paramedics.MethodsThe study was conducted in the East Midlands Ambulance Service NHS Trust. We conducted secondary analysis of an existing qualitative dataset to develop a draft tool. This was revised following an expert panel review by a group of 10 experienced ambulance clinicians to assess content and face validity. The feasibility study was conducted with participating paramedics using the tool in patients presenting with pain, to determine the feasibility, reliability and validity of PROMPT; to gather initial data on its effect on prehospital pain management comparing reduction in pain score and use of analgesia compared with a baseline period using regression.ResultsEighteen paramedics, using PROMPT, collected data on pain management from 132 patients. PROMPT had high internal consistency (>0.8). There were significant reductions in pain score (p=0.027) and significantly greater use of analgesics (p<0.001) in patients when PROMPT was used compared with baseline for paramedics involved in the study after adjusting for differences in patients' age, clinical condition and pain score before treatment.ConclusionsPreliminary findings suggest that PROMPT is reliable, feasible to use, and has face, content and predictive validity. In order to evaluate the effectiveness of the tool, we are conducting a non-randomised control group study comparing pain management provided by paramedics using the tool with paramedics following their usual practice.
IMPROVING POST-RESUSCITATION CARE FOLLOWING OUT-OF-HOSPITAL CARDIAC ARREST
Authors: Lynde Jessica , Zorab Ollie 
Published: May 2015

BackgroundImproving sustained ROSC rates following out-of-hospital cardiac arrest is a key focus for ambulance services. Accordingly, a Quality Improvement (QI) project was initiated whereby an Intensive Care Society post-resuscitation care bundle of evidence-based interventions was adapted for use by pre-hospital clinicians. The objective was to introduce and embed this care bundle, in order to increase its delivery.Apr & May 2012Apr & May 2013Apr & May 2014No. of patients9610697Complete Care Bundle8.3%32.1%35.1%12—Lead ECG60%71.7%81.4%Blood Sugar43%94.3%95.9%Cooling Started49%69.8%62.9%Ventilatory Support53%52.8%73.2%Haemodynamic Support74%82.1%82.5%MethodA baseline audit of care bundle compliance was conducted in April–May 2012 to act as a pilot bundle and provide a baseline. The final care bundle, comprising five key elements, was introduced during a QI event attended by 60 clinicians in April 2013. Since then, care bundle delivery has been regularly monitored. To sustain early gains, a Post-ROSC checklist was distributed to frontline vehicles, and a QI Collaborative discussed individual elements. A defibrillator ‘aide memoire’ sticker was developed, and will be trialled using a PDSA cycle.ResultsCare bundle delivery has progressed between the pilot period, and in the two subsequent years, demonstrating the success of the QI programme in embedding these interventions. Ventilatory support has received a particular focus, and the impact on provision is marked.In future, the care bundle will be updated to reflect the latest research evidence, including new guidance on cooling. SPC charts will monitor the impact of QI activities.ConclusionThe care bundle model, alongside targeted QI activities, has proved successful in ensuring best-practice care is more routinely provided. These methods promote clinician co-production of practice development, and are adaptive to evolving clinical evidence.
DEVELOPMENT OF A PATIENT REPORTED EXPERIENCE MEASURE (PREM) FOR USE IN THE AMBULANCE SERVICE
Authors: Togher Fiona , Siriwardena Aloysius Niroshan , Windle Karen 
Published: May 2015

BackgroundNHS health policy emphasises the crucial role of patient experience as a core component of high quality care, alongside effectiveness and safety. Patient Reported Experience Measures (PREMs) measure patients' experiences with their healthcare. They are increasingly being seen as valuable for assessing patient outcomes and differences in quality between health care providers.Previous patient surveys to assess ambulance service care have not been implemented routinely or in a standardised way. This research forms part of a doctoral study to develop a PREM for use in UK ambulance services.MethodsThe study comprised three subsections:A secondary analysis of interview data exploring patients' experiences of their prehospital care.Development of questionnaire items based on those themes emerging from the secondary analysis.Semi-structured interviews with service users that explore their opinions of the questionnaire items and whether the PREM includes all aspects of the ambulance service experience that should be encompassed.ResultsThe secondary data analysis revealed specific ‘processes of importance’ to service users accessing ambulance care i.e. ‘timeliness’ and parallel ‘experiential components of care’ i.e. ‘reassurance’ that either enhanced or reduced the perception that the ‘processes of care’ were undertaken to a high standard.The key themes formed the foundation for generating the 53 item questionnaire. The interview stage is on-going and the data obtained are being used to amend the questionnaire items.ConclusionsThe construction of the PREM has incorporated the views of patients that the measure is ultimately designed for, and conforms to the concept of patient-centred care—the theoretical foundation of the research.Once completed, the PREM will enable ambulance trusts to measure differences in patient experiences, between and within organisations. This can result in positive changes to patient experience through the introduction of feedback, training and education to prehospital clinicians.
DOES DEMENTIA MATTER: IS DEMENTIA AN IMPORTANT FACTOR IN 999 CALL-OUTS TO OLDER PEOPLE?
Authors: Buswell Marina , Amado Sarah , Goodman Claire , William Julia , Fleming Jane , Lumbard Phillip , Prothero Larissa 
Published: May 2015

BackgroundCare for older people with dementia (OPWD) is a major concern across all care settings. Ambulance services are in the spotlight as pressures on emergency services and calls for admission avoidance are policy priorities. Around 1/3 of emergency call-outs are to people 75 and over, a significant proportion of whom may have dementia. There is a perception that dementia may be an issue but we do not understand how much this affects use of emergency services.MethodsWe reviewed 358 ambulance service paper-based patient care records (PCRs) to test the feasibility of using them as a source of information about ambulance service use by OPWD and, conducted critical incident reviews of 999 callouts to understand factors associated with emergency ambulance call-outs. We took our emerging findings to a stakeholder meeting where we established areas of consensus and key research questions.ResultsFifty-two (14.5%) of the PCRs reviewed had dementia recorded, this is in line with current prevalence estimates for ≥75-year-olds. However, we had to use paper PCRs as dementia recording in ePCRs is more complex.The critical incident reviews identified a wide spectrum of experience of emergency ambulance use by OPWD and their carers, from pre-diagnosis through to end-of-life scenarios.It was new for many of the stakeholders to think about the role of ambulance services in the care of OPWD. There was consensus that the contribution family and paid carers make in decision making; explaining the OPWD's needs and changed condition, is underused.ConclusionsThere is little current research that understands what ambulance clinicians are doing with respect to caring for OPWD.Research questions should focus on how communication between the person with dementia, formal/informal carers, healthcare professionals and emergency services affects the care provided for older people with dementia during and immediately after urgent care events.
Validation of ICDPIC software injury severity scores using a large regional trauma registry
Authors: Greene Nathaniel H , Kernic Mary A , Vavilala Monica S , Rivara Frederick P 
Published: May 2015

BackgroundAdministrative or quality improvement registries may or may not contain the elements needed for investigations by trauma researchers. International Classification of Diseases Program for Injury Categorisation (ICDPIC), a statistical program available through Stata, is a powerful tool that can extract injury severity scores from ICD-9-CM codes. We conducted a validation study for use of the ICDPIC in trauma research.MethodsWe conducted a retrospective cohort validation study of 40 418 patients with injury using a large regional trauma registry. ICDPIC-generated AIS scores for each body region were compared with trauma registry AIS scores (gold standard) in adult and paediatric populations. A separate analysis was conducted among patients with traumatic brain injury (TBI) comparing the ICDPIC tool with ICD-9-CM embedded severity codes. Performance in characterising overall injury severity, by the ISS, was also assessed.ResultsThe ICDPIC tool generated substantial correlations in thoracic and abdominal trauma (weighted κ 0.87–0.92), and in head and neck trauma (weighted κ 0.76–0.83). The ICDPIC tool captured TBI severity better than ICD-9-CM code embedded severity and offered the advantage of generating a severity value for every patient (rather than having missing data). Its ability to produce an accurate severity score was consistent within each body region as well as overall.ConclusionsThe ICDPIC tool performs well in classifying injury severity and is superior to ICD-9-CM embedded severity for TBI. Use of ICDPIC demonstrates substantial efficiency and may be a preferred tool in determining injury severity for large trauma datasets, provided researchers understand its limitations and take caution when examining smaller trauma datasets.
The implementation of a municipal indoor ice skating helmet policy: effects on helmet use, participation and attitudes
Authors: O'Mahony-Menton Colleen , Willmore Jacqueline , Russell Katherine 
Published: May 2015

Relevant local injury epidemiologyIn Ottawa, between 2005 and 2009 there was an annual average of 47.2 head injuries due to ice skating in children and youth (1–19 years of age) requiring a visit to the emergency department, with the highest rates among those aged 5–14 years. Between 2002 and 2007, only 6% of children were wearing a helmet during ice skating when the head injury occurred. During indoor public skating sessions, 93% of children (<10 years)—57% aged 10–12 years, 20% aged 13–17 years and 9% adults—wore helmets in the absence of a policy. Support for a helmet policy was high from public health, medical, political and community perspectives.Best practiceHelmet policies in relation to cycling have demonstrated increases in helmet use and reduction of head injuries without decreasing physical activity. However, no known studies have examined the effect of indoor ice skating helmet policy coupled with education and promotional activities on helmet use, participation and attitudes towards helmet use.ImplementationAn ice skating helmet policy for children (<11 years of age) and those with limited skating experience at indoor rinks during public skating sessions was developed, implemented and evaluated. Supportive activities such as discount coupons, promotional materials, a media launch, social marketing and staff training are described.DiscussionThe helmet policy was associated with increased helmet use for young children and for older children, youth and adults not included in the policy, without decreasing attendance to public skating sessions.
SILK flow diverter for complex intracranial aneurysms: a Canadian registry
Authors: Shankar Jai Jai Shiva , Tampieri Donatella , Iancu Daniela , Cortes Maria , Agid Ronit , Krings Timo , Wong John , Lavoie Pascale , Ghostine Jimmy , Shettar Basavraj , Ritchie Krsita , Weill Alain 
Published: May 2015

IntroductionThe SILK flow diverter (SFD) is used for the treatment of complex intracranial aneurysms. Small case series have been reported in the literature but few studies with a large number of patients have been published. We present our experience with the SFD for the treatment of intracranial aneurysms in Canada.MethodsCenters across Canada using SFDs were contacted to fill out a case report form for patients treated with an SFD in their center. Individual centers were responsible for approval from their ethics committee. Image analysis was performed by individual operators. The case report forms were collected and the final analysis was performed.ResultsA total of 92 patients were treated with SFDs in eight centers in Canada between January 2009 and August 2013. The aneurysms were located in the posterior circulation in 16 patients and in the anterior circulation in 76 patients. Most aneurysms (75%) were saccular in shape; 22% were fusiform and 3% were blister aneurysms. The size of the aneurysms varied from 2 to 60 mm with the neck varying from 2 to 60 mm. Perioperative morbidity and mortality were 8.7% and 2.2%, respectively. At the last available follow-up, 83.1% of the aneurysms were either completely or near-completely occluded. The rate of complications was higher for fusiform aneurysms (p<0.001).ConclusionsThe SFD appears to be an important tool for the treatment of complex intracranial aneurysms. Treatment outcomes and complication rates remain a problem, but should be considered in the context of available alternative interventions. Ongoing analysis of flow-diverting stents for radiographic and clinical performance is required.
Flow diversion of large internal carotid artery aneurysms with the surpass device: impressions and technical nuance from the initial North American experience
Authors: Colby Geoffrey P , Lin Li-Mei , Caplan Justin M , Jiang Bowen , Michniewicz Barbara , Huang Judy , Tamargo Rafael J , Coon Alexander L 
Published: May 2015

BackgroundFlow diversion is an important tool for treatment of cerebral aneurysms, particularly large and giant aneurysms. The Surpass flow diverter is a new system under evaluation in the USA.ObjectiveTo report our initial experience of 20 cases with the Surpass flow diverter to demonstrate its basic properties, the required triaxial delivery platform, and the methodologies used to deploy it during treatment of large internal carotid artery (ICA) aneurysmsMethodsTwenty patients with ICA aneurysms ≥10 mm with ≥4 mm neck treated as part of the Surpass IntraCranial Aneurysm Embolization System Pivotal Trial (the SCENT trial; Stryker) were included. Details of patient demographics, aneurysm characteristics, and technical procedures were collected.ResultsTwenty patients (mean age 63.3±1.3 years; range 51–72) with 20 unruptured aneurysms (mean size 13.4±0.9 mm; range 10–21 mm) were treated. For proximal access, 60% of cases had aortic arch ≥grade II, 55% had significant cervical ICA tortuosity, and 60% had cavernous ICA ≥grade II. The Surpass device was implanted in 19/20 (95%) cases. Of 19 cases, a single device was used in 18 cases (95%) and 2 devices in only 1 case (5%). Balloon angioplasty was performed in 8/19 cases (42%). Complete aneurysm neck coverage and adequate vessel wall apposition was obtained in all 19 cases.ConclusionsSurpass is a next-generation flow diverter with unique device-specific and delivery-specific features compared with clinically available endoluminal flow diverters. Our initial experience demonstrates a favorable technical profile in treatment of large and giant ICA aneurysms.Trial registration numberNCT01716117.
An Empirical Investigation on Wrapper-Based Feature Selection for Predicting Software Quality
Authors: Wang Huanjing , Khoshgoftaar Taghi M. , Napolitano Amri 
Published: May 2015

The basic measurements for software quality control and management are the various project and software metrics collected at various states of a software development life cycle. The software metrics may not all be relevant for predicting the fault proneness of software components, modules, or releases. Thus creating the need for the use of feature (software metric) selection. The goal of feature selection is to find a minimum subset of attributes that can characterize the underlying data with results as well as, or even better than the original data when all available features are considered. As an example of inter-disciplinary research (between data science and software engineering), this study is unique in presenting a large comparative study of wrapper-based feature (or attribute) selection techniques for building defect predictors. In this paper, we investigated thirty wrapper-based feature selection methods to remove irrelevant and redundant software metrics used for building defect predictors. In this study, these thirty wrappers vary based on the choice of search method (Best First or Greedy Stepwise), leaner (Naïve Bayes, Support Vector Machine, and Logistic Regression), and performance metric (Overall Accuracy, Area Under ROC (Receiver Operating Characteristic) Curve, Area Under the Precision-Recall Curve, Best Geometric Mean, and Best Arithmetic Mean) used in the defect prediction model evaluation process. The models are trained using the three learners and evaluated using the five performance metrics. The case study is based on software metrics and defect data collected from a real world software project. The results demonstrate that Best Arithmetic Mean is the best performance metric used within the wrapper. Naïve Bayes performed significantly better than Logistic Regression and Support Vector Machine as a wrapper learner on slightly and less imbalanced datasets. We also recommend Greedy Stepwise as a search method for wrappers. Moreover, comparing to models built with full datasets, the performances of defect prediction models can be improved when metric subsets are selected through a wrapper subset selector.
Investigating Two Approaches for Adding Feature Ranking to Sampled Ensemble Learning for Software Quality Estimation
Authors: Gao Kehan , Khoshgoftaar Taghi M. , Napolitano Amri 
Published: May 2015

Defect prediction is very challenging in software development practice. Classification models are useful tools that can help for such prediction. Classification models can classify program modules into quality-based classes, e.g. fault-prone (fp) or not-fault-prone (nfp). This facilitates the allocation of limited project resources. For example, more resources are assigned to program modules that are of poor quality or likely to have a high number of faults based on the classification. However, two main problems, high dimensionality and class imbalance, affect the quality of training datasets and therefore classification models. Feature selection and data sampling are often used to overcome these problems. Feature selection is a process of choosing the most important attributes from the original dataset. Data sampling alters the dataset to change its balance level. Another technique, called boosting (building multiple models, with each model tuned to work better on instances misclassified by previous models), is found to also be effective for resolving the class imbalance problem. In this study, we investigate an approach for combining feature selection with this ensemble learning (boosting) process. We focus on two different scenarios: feature selection performed prior to the boosting process and feature selection performed inside the boosting process. Ten individual base feature ranking techniques, as well as an ensemble ranker based on the ten, are examined and compared over the two scenarios. We also employ the boosting algorithm to construct classification models without performing feature selection and use the results as the baseline for further comparison. The experimental results demonstrate that feature selection is important and needed prior to the learning process. In addition, the ensemble feature ranking method generally has better or similar performance than the average of the base ranking techniques, and more importantly, the ensemble method exhibits better robustness than most base ranking techniques. As for the two scenarios, the results show that applying feature selection inside boosting performs better than using feature selection prior to boosting.