bluuebunny/crossref_metadata_2025_split huggingface dataset:
A10 Those in peril on the sea: the maritime work of the UK military SAR
Authors: Dykes L , Thomas M , Hird J 
Published: October 2011

BackgroundAt any time, thousands of people are at sea around the UK. We wished to ascertain the nature of maritime emergencies attended by UK military (Royal Air Force/Royal Navy) SAR helicopters.MethodsAll UK military SAR “medrescues” 1 January 2009–13 March 2010 were entered onto a database. Clinical scenarios were extracted from winchmen's reports. Acuity was estimated using the Manchester Triage Score.ResultsOf 907 SAR medrescues during the 15.5-month audit period, 172 (19%) were maritime.Mean age of casualty 44 years (range 16–87); 90% male.Of 130 reports with vessel type noted, 28% of casualties were from fishing boats, 20% military ships; 12% dive boats, 11% passenger ferries/cruise ships and 10% oil rigs. The remainder were on boats ranging from small pleasure craft to oil tankers, plus one surfer.The aircraft was able to land on the vessel in 13% of the 168 jobs where this information was recorded, mainly oil-rigs and military ships. The remaining 87% were winched aboard the aircraft.7% of cases were diving-related emergencies; 53% medical/surgical and 40% trauma (including drowning/near-drowning).151/172 cases had sufficient information to enable estimation of Manchester Triage category: 66/151 (44%) were category 1 or 2 and 77/151 (51%) category 3. Only 8/151 (5%) were category 4. None were category 5.ConclusionMedical emergencies at sea are surprisingly diverse, with a wide variety of major and minor injuries & illnesses. This series ranges from diving emergencies, major trauma, an elderly cruise ship passenger with a ruptured AAA, and obstetric emergencies. Our data are retrospective and the MTS is not designed for prehospital use, but most maritime cases attended by RAF/RN SAR helicopters appear to be genuinely urgent. Lives would be at risk without the service, which features both winching capability & a technician or HPC-registered paramedic on board.
A12 Patient priorities and decision-making about using 999 EMS? A review of the literature
Authors: Coleman P , Turner J 
Published: October 2011

BackgroundAgainst a background of increasing demands for emergency ambulances in the UK, there are ongoing concerns about the proportion of users (between 30% and 52%) who are transported to EDs inappropriately or unnecessarily. Less attention has been paid to understanding the factors that influence patients' decisions to use, delay, or not to use an emergency ambulance.Aims and ObjectivesTo summarise what is known about patient priorities and decision-making around 999 EMS use, we carried out a rapid review of the literature.MethodsWe initiated searches of MEDLINE from 1996 to the present using a series of MESH terms linking patient self-reports of utilisation of health care AND emergency ambulance. The strategy yielded 84 potential items. To identify recent papers, we limited publications to prospective surveys of user views published after 1999. Eleven papers were reviewed. Two of these were from the UK.ResultsThe papers divided into two broad categories: (1) users who delayed contacting an emergency ambulance in medical emergencies, and (2) users whose presenting condition did not require an emergency transportation to an ED. Patients struggled to distinguish the symptoms of a serious medical emergency from a less serious need. Underestimating the progression of symptoms, guilt or potential embarrassment around requesting an ambulance was associated with inappropriate delayed contact or non-use. Other recurring themes associated with use and non-use were: someone else making or sharing the decision, gender, pain, coping strategies, ease of access to other transport and resources, previous experience of the health problem or ambulance use.ConclusionsFurther patient-centred research is required in the UK to increase understanding of the important factors that influence decisions about whether to use an emergency ambulance or not.
A13 The SAR side: the medical work of UK military search & rescue
Authors: Thomas M , Hird J , Dykes L 
Published: October 2011

IntroductionSea King SAR helicopters are a familiar sight to UK mountain users, mariners and fans of TV's “Highland Emergency”! However, their medical activity is not routinely analysed. We wished to assess the nature of cases attended and the equipment/drugs/skills utilised by SAR winchmen, to ensure the applicability of winchman training programmes.MethodFollowing every military SAR call-out (RAF/Royal Navy) a formal report is sent to SAR Force Headquarters. These reports for incidents 1 January 2009–31 December 2009 were scrutinised and data extracted.ResultsThere were 767 jobs involving medical activity in the 1-year period (plus 31 body recoveries).Age 6 months–98 years (mean 43, median 42); 71% maleTrauma 57%, Medical 42%, Chemical 1%: some had combined problems.169/798 (21%) were jointly managed with other agencies (eg, ambulance; Mountain Rescue; Maritime & Coastguard Agency; RNLI)19% of jobs were at sea; 13% involved >1 casualtyDuring the 1-year period, winchmen performed 5 needle thoracocenteses, 15 intubations, 181 cannulations, and applied 105 limb splints and 9 pelvic splints.63/767 (8%) were given IV fluids; 92 (12%) received morphine.Winchmen cared for 30 casualties given drugs by other providers including midazolam, intranasal diamorphine, pethidine and ketamine.59 casualties had a documented GCS of 8 or less including 44 in cardiac arrest.Of the 470 trauma cases (25% of which had fallen from height), 41% had lower limb injuries, 28% possible neck/spinal/back injury, 26% head/facial injuries and 8.5% chest injuries. Of the medical problems, 17% had chest pain, 15% neurological/vascular, 10% abdominal problems, 4% O&G and 4% “medical paeds”.ConclusionRAF/RN winchmen deal with a wide variety of cases, of all ages. Considering that, typically, 70% of the 70 winchmen at any time are qualified paramedics (the remainder are technician-level) advanced skills are used moderately frequently.
A15 A case study framework for design and evaluation of a national project to improve prehospital care of myocardial infarction and stroke
Authors: Essam N , Davy Z , Shaw D , Spaight A , Siriwardena A N 
Published: October 2011

BackgroundCardiovascular disease (CVD) affects 1.8% of the population annually, 0.9% with stroke and 0.8% with coronary heart disease. People suffering from CVD often present acutely to ambulance services with symptoms of acute myocardial infarction or stroke. Early and effective treatment prevents death, improves long term health and reduces future disability.ObjectiveOur aim is to develop a rational approach for informing the design and evaluation of a national project for improving prehospital care of myocardial infarction and stroke: the Ambulance Services Cardiovascular Quality Initiative (ASCQI), the first national improvement project for prehospital care.MethodsWe will use a case study methodology initially utilising an evaluation logic model to define inputs (in terms of resources for planning, implementation and evaluation), outputs (in terms of intended changes in healthcare processes) and longer-term outcomes (in terms of health and wider benefits or harms), whether intended or incidental and in the short, medium or long term.ResultsWe will present an evaluation logic model for the project. This will be expanded to show the analytical techniques which we will use to explain how and why the project achieves its outcomes. This includes times series analyses, pattern matching, cross case syntheses and explanation building to inform an explanatory logic model. We will discuss how this model will be useful in determining the data that will need to be collected during the course of the project to inform the detailed explanation of how and why the project delivered its outcomes.ConclusionThe case study approach will enable us to evaluate the impact of this collaborative project in constituent ambulance services as well as the initiative as a whole. It will enable us to show whether and to what extent the project has had an impact, but also how and why this has happened.
A2 The potential and pitfalls of anonymised data linkage for follow-up of patient outcomes in prehospital emergency care research
Authors: Sánchez A , Snooks H , Cheung I , Williams C , Jones K 
Published: October 2011

BackgroundDue to the nature of collection, storage and retrieval of data in emergency prehospital care, following up patient outcomes can be challenging. Data are often of poor quality, data structures within which they are housed complex and difficult to interrogate, and outcome data can be owned by various providers of care. Issues of ethics, consent and research/information governance further complicate matters. The Secure Anonymised Information Linkage (SAIL) databank is currently pioneering a system that collects routine social and heath records from numerous providers and assembles them within one structure that allows patient data to be stored, linked, accessed and analysed for research purposes without the need for individual (identifiable) personal data.MethodsThis system was tested within a cluster Randomised Controlled Trial (RCT) in prehospital emergency care. The Support and Assessment for Fall Emergency Referrals 1 (SAFER 1) trial, is designed to evaluate the use of computerised clinical decision support software to assist paramedics to assess and decide care for older people who have fallen, for whom an ambulance has been called. Primary and secondary outcomes utilise follow-up measures from the ambulance service; hospital trusts (A&E and inpatients) and from the ONS (deaths). Eligible patients are identified from ambulance dispatch and on-scene clinical records and are then tracked anonymously via SAIL to follow-up these outcomes.ResultsThe initial matching rate was high at 89% (66/74). Details of unmatched patients were returned for further checking and, where possible, supplementation with identifiers. Results of second stage matching are currently pending.ConclusionsThe unmatched cases are a result of poor quality of dispatch/on-scene data. Lengthy information governance processes within SAIL and a time lag until data are available have meant that follow-up data have not yet been provided. Risk of non-provision within the study period is now being assessed by the study and SAIL teams. Anonymised data linkage offers an attractive alternative to lengthy processes of consent and follow-up of identifiable outcomes across NHS providers. On the question of whether it works within the constraints of an externally funded RCT—the jury is still out.
A3 Identifying barriers and facilitators to improving prehospital care of asthma: views of ambulance clinicians
Authors: Shaw D , Knowles S , Siriwardena A N 
Published: October 2011

BackgroundIn 2008/2009 there were nearly 80 000 emergency hospital admissions for asthma. Current UK guidelines emphasise the importance of evidence-based prehospital assessment and treatment of asthma for improving patient outcomes and reducing hospitalisation, morbidity and mortality. National benchmarking of ambulance clinical performance indicators for asthma have revealed important unexplained variations in care across ambulance services. Little research has been undertaken to understand the reasons for poor levels of care.ObjectiveThe aim of this study was to gather data on ambulance clinicians' perceptions and beliefs around prevailing and best practice for management of asthma. This was used to identify the factors which prevent or enable better asthma care in ambulance services.MethodsWe used a phenomenological qualitative approach, which addresses how individuals use their experiences to make sense of their world, focusing on participants' lived experiences of care delivery for asthma. We used focus groups of ambulance clinicians to gather data on barriers and facilitators to better asthma care. Recordings and notes were taken, transcribed and then analysed using QSR NVivo 8. A coding framework was developed based on a priori concepts but with emergent themes added during the analysis.ResultsTwo focus groups were conducted with eight and five participants respectively. A number of preliminary themes and subthemes were identified. The study identified issues relating to clarity of ambulance guidelines, conflicts between training and guidance, misconceptions about the importance of objective assessment and over reliance on non-objective assessment. Some practitioners believed that hospital staff were not interested in prehospital peak flow assessments.ConclusionOur findings will inform improved systems of care for asthma and the effect on indicators will be measured using time series methods. This approach could be used more widely to improve management of specific clinical conditions where quality of care is demonstrated to be suboptimal.
A5 Characteristics of ambulance category B calls
Authors: Turner J , Bjarkoy M 
Published: October 2011

BackgroundOne of the key recommendations of the 2005 policy document “Taking Healthcare to the patient” was that the category B 19-min response standard be replaced with more clinically focused performance measures. Before developing these new measures a clear description of the nature and type of calls within category B was needed in order to understand the case-mix of this group. We have conducted a descriptive observational study of category B ambulance calls.MethodsThe study was conducted in two parts. First, a national survey of all ambulance services in England was conducted requesting information on total number of category B calls for 1 year (2007/2008) and the numbers allocated to each AMPDS dispatch category. Secondly, we obtained 2 months of category B call dispatch records and scanned anonymised clinical patient record data from one ambulance service. This information was used to describe clinical acuity and frequency of clinical assessment and interventions.ResultsNational survey—7/11 ambulance services returned data. We found that 50% of the total category B call volume is accounted for by 5 of the 32 main dispatch categories. Diabetic problems and falls were the main categories.Analyses of clinical data—After removing duplicate records 26 882 cases were used. A quarter (25%) of cases had no assessment or intervention other than basic vital sign measurement, 50% had additional clinical assessment but no intervention and 25% required an intervention. The most frequent intervention was oxygen administration. Only 10% of cases required drugs, airway management or other procedures.ConclusionsCategory B calls comprise a population of patients without time dependant conditions and response time is therefore a poor indicator of the quality of care for this patient group.
A6 Left bundle branch block: simplified Sgarbossa criteria applied to prehospital ECGs
Authors: Viner A , Mclean S , Fitzpatrick D , Flapan A 
Published: October 2011

IntroductionIn patients presenting with chest pain, the presence of Left Bundle Branch Block (LBBB) on the ECG may obscure the diagnosis of acute myocardial infarction (AMI). Patients with LBBB caused by AMI are shown to benefit significantly from rapid provision of reperfusion therapy, yet evidence suggests this is often underprovided. Difficulties in the identification of AMI in these patients is the most commonly cited reason.AimsTo determine whether the application of the simplified Sgarbossa criteria to undifferentiated chest pain patients presenting with ECG changes of LBBB, transmitted during the prehospital phase of care, will be positively predictive of a discharge diagnosis of AMI.Methods785 ECGs were reviewed retrospectively and categorised based on their features. Those displaying LBBB and complete patient data were evaluated using the simplified Sgarbossa criteria and a decision made as to whether the patient had suffered AMI, a process which was blind peer reviewed. Results of cardiac biomarkers were traced and the diagnosis of AMI confirmed or refuted.ResultsOf the 785 ECGs reviewed and categorised 56 (7.1%) displayed the features of LBBB and 18 were eligible for inclusion in the study. The sensitivity and specificity of the Sgarbossa criteria were 50% and 75% respectively. Inter-observer reliability was κ=0.93 (almost perfect).ConclusionDespite excellent inter-observer agreement, the Sgarbossa criteria is too insensitive to be implemented in clinical practice as it cannot be relied upon to identify correctly, patients who have suffered AMI. Instead, diagnosis and management should proceed according to clinical judgement with reperfusion therapy administered following evaluation of risk verses benefit.
A9 Temperature variation in pre hospital environments
Authors: Black S , Allen K 
Published: October 2011

IntroductionResearch from outside the UK has demonstrated that the temperature variation experienced in pre hospital emergency vehicles can exceed the recommended limits of drug companies and may be outside the operating restrictions set down by medical device manufacturers. This study aimed to engage ambulance clinicians in research by participating in a longitudinal study measuring the temperature in a variety of emergency service vehicles and mediation storage facilities. The study used data loggers capable of recording temperatures up to extreme levels at routine intervals. These were placed in variety of environments to monitor the temperature variation in both pre hospital vehicles and static sites such as drug cupboards.MethodsMeasurement was phased over 2 years, covering both the summer and winter periods to capture seasonal differences in the minimum and maximum temperatures experienced. Data loggers were placed in a range of vehicles, from emergency ambulances to rapid response cars where the location of drug storage facilities differ. Comparisons are drawn between vehicles which spent time garaged and those that were not. Temperature loggers were placed within ambulance drug bags and also attached to equipment housing within the vehicle to establish the temperature variation which may affect the operation of medical devices.ResultsResults show a wide variation in temperatures, from −7.5°C to over 30°C some of which were sustained for periods of several hours. More variation was observed in vehicles than in static sites such as station drug stores.ConclusionAlthough this project did not look at the pharmacological degradation of emergency drugs, the variation in temperature found has implications which may impact on the efficacy of pre hospital medications and for the operating efficiency of medical devices.
Forearm muscle size, strength, force, and power in relation to pQCT-derived bone strength at the radius in adults
Authors: Lorbergs Amanda L. , Farthing Jonathan P. , Baxter-Jones Adam D.G. , Kontulainen Saija A. 
Published: October 2011

We aimed to examine the relationship between forearm muscle cross-sectional area (MCSA), muscle force, or rate of torque development (RTD) and 2 estimated radius bone strength indices — compressive bone strength index (BSI) at the wrist and strength strain index in torsion (SSIp) at the shaft — in healthy middle-aged males and females. Distal (4%) and shaft (65%) sites of nondominant forearms were scanned using peripheral quantitative computed tomography (pQCT) in a sample of 48 adults (mean age ± SD, 49.4 ± 2.4 y) to obtain estimated bone strength indices and MCSA. Muscle force, measured by grip dynamometry and wrist flexion RTD, was obtained using an isokinetic dynamometer. Hierarchical linear regressions, adjusted for weight, explained 27% and 36% of the BSI variance at the 4% site in males and premenopausal females, respectively (p < 0.05). At the radius shaft, weight explained 26% (p < 0.05) and 83% (p < 0.01) of SSIp variance. The unique variance of BSI explained by MCSA was 16% in males (p < 0.05) and 31% in females (p < 0.01). Grip force predicted variance in SSIp in males (p < 0.01) and BSI in females (p < 0.05). RTD did not explain any variance in BSI or SSIp. Body weight was the only significant predictor (p < 0.05) of SSIp in females. Although forearm muscle size and grip strength are associated with estimates of radius bone strength at midlife, this relationship appears to be sex dependent. The differences observed between muscle size and strength properties and bone strength at distal and shaft sites of the radius suggest a property-, sex-, and site-specific relationship between muscle and bone in the forearm.
Brentuximab Vedotin (SGN-35)
Authors: Katz Jessica , Janik John E. , Younes Anas 
Published: October 2011

AbstractBrentuximab vedotin (SGN-35) is an antibody-drug conjugate (ADC) directed against the CD30 antigen expressed on Hodgkin lymphoma and anaplastic large cell lymphoma. SGN-35 consists of the cAC10 chimerized IgG1 monoclonal antibody SGN30, modified by the addition of a valine-citrulline dipeptide linker to permit attachment of the potent inhibitor of microtubule polymerization monomethylauristatin E (MMAE). In phase II trials, SGN-35 produced response rates of 75% in patients with Hodgkin lymphoma (n = 102) and 87% in patients with anaplastic large cell lymphoma (n = 30). Responses to SGN-35 might be related not only to the cytotoxic effect due to release of MMAE within the malignant cell but also to other effects. First, SGN-35 may signal malignant cells through CD30 ligation to deliver an apoptotic or proliferative response. The former would amplify the cytotoxicity of MMAE. A proliferative signal delivered in the context of MMAE intoxication could enhance cell death. Second, the efficacy of SGN-35, particularly in Hodgkin lymphoma, might be attributed to its effect on the tumor microenvironment. Diffusion of free MMAE from the targeted tumor cells could result in a bystander effect that kills the normal supporting cells in close proximity to the malignant cells. The elimination of T regulatory cells that inhibit cytotoxic effector cells and elimination of cells that provide growth factor support for Hodgkin/Reed–Sternberg cells could further enhance the cytotoxic activity of SGN-35. Here we review the biology of SGN-35 and the clinical effects of SGN-35 administration. Clin Cancer Res; 17(20); 6428–36. ©2011 AACR.
Polo-like Kinase 1 Inhibitors and Their Potential Role in Anticancer Therapy, with a Focus on NSCLC
Authors: Medema René H. , Lin Chia-Chi , Yang James Chih-Hsin 
Published: October 2011

Abstract
Cytotoxic platinum-doublet chemotherapy that includes antimitotic agents is a current standard of care in advanced non–small cell lung cancer (NSCLC). Microtubule-targeting antimitotics, taxanes, and Vinca alkaloids are effective anticancer therapeutics that affect both dividing and nondividing cells. A new generation of antimitotic agents that target regulatory proteins—mitotic kinases and kinesins—has the potential to overcome the limitations related to the role of tubulin in nondividing cells that are associated with traditional antimitotics. This review concentrates on Polo-like kinase 1, a key regulator of mitosis, outlines a rationale for its development as an anticancer target, and discusses data from preclinical and clinical studies of Plk1 inhibitors with a particular focus on NSCLC. Clin Cancer Res; 17(20); 6459–66. ©2011 AACR.