bluuebunny/crossref_metadata_2025_split huggingface dataset:
Point-of-care diagnostic technology in paediatric ambulatory care: a qualitative interview study of English clinicians and stakeholders
Authors: Raymond Meriel Elizabeth , Bird Chris , van Hecke Oliver , Glogowska Margaret , Hayward Gail 
Published: June 2022

Point-of-care (POC) tests have the potential to improve paediatric healthcare. However, both the development and evaluation of POC technology have almost solely been focused on adults. We aimed to explore frontline clinicians’ and stakeholders’ current experience of POC diagnostic technology in children in England; and to identify areas of unmet need.Design, setting and participantsQualitative semistructured telephone interviews were carried out with purposively sampled participants from clinical paediatric ambulatory care and charity, industry and policymaking stakeholders. The interviews were audio-recorded, transcribed and analysed thematically.ResultsWe interviewed 19 clinicians and 8 stakeholders. The main perceived benefits of POC tests and technologies were that they aided early decision-making and could be convenient and empowering when used independently by patients and families. Clinicians and stakeholders wanted more POC tests to be available for use in clinical practice. Most recognised that play and reward are important components of successful POC tests for children. Clinicians wanted tests to give them answers, which would result in a change in their clinical management. Detecting acute serious illness, notably distinguishing viral and bacterial infection, was perceived to be an area where tests could add value. POC tests were thought to be particularly useful for children presenting atypically, where diagnosis was more challenging, such as those less able to communicate, and for rare serious diseases. Many participants felt they could be useful in managing chronic disease.ConclusionsThis exploratory study found that clinicians and stakeholders supported the use of diagnostic POC technology in paediatric ambulatory care settings in England. Some existing tests are not fit for purpose and could be refined. Industry should be encouraged to develop new child-friendly tests tackling areas of unmet need, guided by the preferred characteristics of those working on the ground.
Social innovations to increase health coverage: evidence from a crowdsourcing contest in Ghana
Authors: Dako-Gyeke Phyllis , Asampong Emmanuel , Opoku-Mensah Kwabena , Tabong Philip Teg-Nefaah , Awor Phyllis , Tucker Joseph D 
Published: June 2022

ObjectivesDespite progress made to expand access to health service in Ghana, inequities still exist. Social innovations have been developed as community-engaged solutions to decrease inequities.MethodsIn partnership with a multistakeholder group, our social innovation team organised a crowdsourcing contest to identify health innovations in Ghana. Informed by a WHO-Special Programme for Research and Training in Tropical Diseases framework, we organised a six-stage crowdsourcing challenge.ResultsIn all, 13 innovations were received in the contest, while 2 innovations were rejected after initial screening. The 11 innovations were reviewed by a panel of four independent expert judges. Inter-rated reliability index (kappa) was 0.86. Following the review of the average score, five top innovations were recognised. These submissions can be put into three main themes: technology and strengthening (eg, mHealth for cervical cancer screening, video directly observed therapy), inclusiveness and reaching the marginalised (people with disability and infertility) and data utilisation for project improvement (seasonal calendar to reduce morbidity and mortality of children under 5 for malaria, diarrhoea and pneumonia).ConclusionIn conclusion, this study shows that solutions to local problems exist. Therefore, policymakers, the government and development partners should support the scale-up of such innovations.
Description of global innovative methods in developing the WHO Community Engagement Package
Authors: Bayugo Yolanda Vargas , Labarda Meredith , Cruz Jose Rene Bagani , Mier-Alpaño Jana Deborah , Tiangco Pauline Marie Padilla , Oyene Ukam Ebe , Omoleke Semeeh Akinwale , Ulitin Allan , Ong Jr Alberto , Fajardo Marvinson See , Echavarria Maria Isabel , Alger Jackeline , Mathanga Don , Msiska Barwani Khaura , Ekwunife Obinna Ikechukwu , Nwaorgu Obioma , Abella Lizcano Lorena , Gomez Quenguan Natalia , Nieto Anderson Claudia Ivette , Beltran Briana Yasmin , Carcamo Rodriguez Elsy Denia , Núñez Eduardo Salomón , Nkosi-Kholimeliwa Vera , Mwafulirwa-Kabaghe Glory , Juban Noel 
Published: June 2022

ObjectivesDevelopment of a Community Engagement Package composed of (1) database of community engagement (CE) experiences from different contexts, (2) CE learning package of lessons and tools presented as online modules, and (3) CE workshop package for identifying CE experiences to enrich the CE database and ensure regular update of learning resources. The package aims to guide practitioners to promote local action and enhance skills for CE.Setting and participantsThe packages were co-created with diverse teams from WHO, Social Innovation in Health Initiative, UNICEF, community practitioners, and other partners providing synergistic contributions and bridging existing silos.MethodsThe design process of the package was anchored on CE principles. Literature search was performed using standardised search terms through global and regional databases. Interviews with CE practitioners were also conducted.ResultsA total of 356 cases were found to fit the inclusion criteria and proceeded to data extraction and thematic analysis. Themes were organised according to rationale, key points and insights, facilitators of CE and barriers to CE. Principles and standards of CE in various contexts served as a foundation for the CE learning package. The package comprises four modules organised by major themes such as mobilising communities, strengthening health systems, CE in health emergencies and CE as a driver for health equity.ConclusionAfter pilot implementation, tools and resources were made available for training and continuous collection of novel CE lessons and experiences from diverse socio-geographical contexts.
Prevalence of muscle imbalance and its potential influence on injury among female acrobatic dancers
Authors: Smith Devenney , Noorbhai Habib 
Published: June 2022

ObjectiveThe purpose of this study was to determine the prevalence of muscle imbalance among young adolescent acrobats (n=15) and if there was a potential link to injury.MethodsIsokinetic strength of the lower extremity, isometric strength of the trunk, and flexibility of both the trunk and lower extremity were assessed. Pearson correlation (r) and χ2correlation tests were performed on all explanatory variables.ResultsSignificant correlations were found between isokinetic peak torque of the quadriceps and hamstrings (p=0.000) and the plantar flexors and dorsiflexors (p=0.000) on both sides, along with plantar flexor dominance (p=0.000). Non-significant findings were seen when identifying dominance between the quadriceps and hamstrings (p=0.933) as well as when correlating peak torque and flexibility of the lower extremity (right hamstrings: p=0.668, left hamstrings: p=0.338, right quadriceps: p=0.171, left quadriceps: p=0.707, right plantar flexors: p=0.282, left plantar flexors: p=0.382, right dorsiflexors: p=0.297 and left dorsiflexors: p=0.393).ConclusionAcrobats demonstrated noticeably high ranges of flexibility, and the most common injury site was found to be the ankle. However, these mentioned injuries were not all due to acrobatic participation. The limited sample size warrants extensive research with a larger sample size to further verify or dispute the results found in this study. Muscle imbalances found within this population could increase the risk of injury.
1134 A comparison of the aerogen vibrating mesh nebuliser versus a standard jet nebuliser to deliver bronchodilators in moderate to severe asthma in the emergency department
Authors: Abdalla Mohamed , ElKhodiar Samer , Perez Fabiola Sevilla , Wong Rebecca , Austin Helena , Rau Clovis , Patterson Michael , Garcia Bobby , Leal Tania , Murphy Ciara , Ceris Tuckey , Walton Harriet 
Published: June 2022

Aims/Objectives/BackgroundNebulised bronchodilators provide effective therapy for patients with Asthma. We sought to investigate the effectiveness of vibrating mesh nebuliser(VMN) when compared to a standard jet nebuliser(JN) in patients with moderate-to-severe asthma presenting to the Emergency Department (ED). we compared time to discharge from ED, drug delivery, and rate admission when using VMN technology compared to the JN.Methods/DesignA prospective, single-centre, non-blinded study comparing the efficacy of the VMN (Aerogen Solo) against the current standard jet nebuliser (JN)(Cirrus2 Nebuliser) to deliver nebulised Salbutamol (2.5 mg) in moderate to severe adult asthma within the ED. Patients requiring bronchodilator therapy were allocated for each arm to receive medications via the VMN, or by standard JN. Patients were managed by emergency physicians according to the joint BTS guidance. The primary endpoint was time to discharge from ED (mins) after initial physician assessment, while among the secondary endpoints examined were Salbutamol dose (mg), and rate of discharge from ED (binary). Time to discharge & salbutamol dose were summarized via the Median (IQR), and a nonparametric Mann-Whitney U test was applied to derive a p-value for the comparison. The mean (SD) was also tabulated. The rate of admission for each arm was calculated, and compared using a chi-squared test.Results/Conclusions124 patients completed the study. Time to discharge and salbutamol dose, were significantly lower in those patients treated with VMN showing a statistical significance (p=0.003 and p=0.023 respectively).VMN time to discharge: Mean (SD) 136.44 mins (89.50). VMN salbutamol dose 7.58 mg; In comparison to those treated in the JN arm. JN time to discharge: Mean (SD) 175.31 mins (97.15) JN salbutamol: 9.69 mg. No Statistical Significance for the rate of admission.Treatment with a VMN led to a significant reduction in both the median length of stay and the requirement for bronchodilators in the ED.
984 Evaluation of the effectiveness of a Welsh Physician Response Unit (PRU) at reducing ED footfall;identifying the rates and reasons for ED attendance after discharge at the scene by a PRU
Authors: Andrew Fiona , Morley Kosta 
Published: June 2022

Aims/Objectives/BackgroundThe Aneurin Bevan University Health Board (ABUHB) Physician Response Unit (PRU) aims to alleviate the pressure on its emergency departments (EDs) through the provision of physician-led community emergency medicine. An increasingly common prehospital model, the PRU brings the ED doctor to the patient with the aim of reducing the number of 999-callers requiring an ED visit. However, with no published ED follow-up studies amongst UK PRU services, how can physicians and commissioners ensure that PRU discharge in the community is synonymous with a prevented ED attendance?This study aims to be the first to follow up and identify the proportion of patients attending the ED within 7 days of discharge by a PRU and to establish the factors associated with attendance.Methods/DesignPilot retrospective observational analysis of 3 months of adult patients discharged by the ABUHB PRU in 2020. ED database searches identified patients attending the ED within 7 days of discharge. Patients were contacted for a scripted telephone satisfaction survey and responses alongside demographics were analysed for associations with ED attendance through odds ratios (OR), relative risk (RR) and Pearson’s chi-squared tests.Results/ConclusionsThe 7-day ED attendance rate was 11.7% (12 out of 103 patients). Two thirds presented due to continued symptoms. Nine patients were admitted. Male sex was associated with an increased likelihood of ED attendance (OR=4.067, 95% CI 1.134–14.587, p=0.023) alongside being in the 40–50 and 51–61 age groups (RR 3.93; 95% CI 1.153–13.327 and RR 8.25; 95% CI 3.556–19.139 respectively). The modal satisfaction rating for overall experience with the PRU was ‘very satisfied’ but no association between satisfaction level and ED attendance was identified (p=0.210) despite a 94% response rate.This study reinforces perceptions that the PRU is effective at delivering definitive care in the community whilst paving the way for future follow-up studies amongst other PRU services.
1060 All-cause presentations to emergency facilities in low-income and low-middle income Sub-Saharan African countries: a systematic review
Authors: Richardson Sarah , Luggya Tonny , Gray Alasdair , Grant Liz 
Published: June 2022

IntroductionEmergency conditions constitute a large proportion of the total global burden of disease and annual global deaths. All 10 leading causes of death in LMICs are conditions which are amenable to emergency care. Much of the research performed in the sub-Saharan African region focuses on single disease processes or particular causations, giving a skewed impression of disease burden. The lack of comprehensive information concerning emergency care delivery has stalled attempts to improve emergency care systems in LMICs.ObjectiveTo understand the current evidence base available regarding the all-cause demographics, characteristics and epidemiology of patient presentations to an emergency setting within LMIC/LIC sub-Saharan African countries.MethodsA systematic search was conducted on 23rd January 2020 of PubMed, Embase, Global Health and Google Scholar for peer reviewed literature published in English from January 2000 to January 2020 describing all-cause presentations at facility-based emergency care in Sub-Saharan LIC or LMIC countries. Articles were screened at title and full text level.Results19227 articles were screened at title level, 43 were screened at full-text level. 21 articles fit the inclusion criteria. Of 41 LMIC/LIC sub-Saharan African countries included, 31 were unrepresented due to lack of published data. Overall data quality was poor. Only 1 study fulfilled the suggested minimum core data set for emergency care surveillance. Outcome data was lacking or only partially reported in a number of papers. Chief complaints and disease categorisation reporting lacked a unified approach or reporting system making comparisons both within and between countries extremely challenging.ConclusionDespite considerable progress being made in recognising the need for integrated emergency care systems in all global regions, the data available to policy makers and system implementers remains sparse. This review demonstrates that critical investment is required to produce quality data from the current emergency systems in LMIC/LICs.
1042 Improving the accuracy of frontline clinicians in detecting SARS-COV-2 on chest X-rays using a bespoke virtual training platform
Authors: Bahra Jasdeep , Ather Sarim , Wilson Sarah , Keating Liza , Gulati Divyansh , Banerji Abhishek , Gleeson Fergus , Novak Alex 
Published: June 2022

Aims/Objectives/BackgroundThe non-specific symptoms of COVID-19 and the lack of a highly-sensitive point-of-care test make it difficult to reliably detect and diagnose in acute care settings. The early identification of COVID-19 using chest X-rays (CXR) in the Emergency Department (ED) is a crucial skill for frontline clinicians. We wanted to measure the accuracy of ED clinicians in detecting COVID-19 CXR changes and assess for improvement using an adaptive online learning module.Methods/DesignED clinicians working across five hospitals in the Thames Valley Emergency medicine Research Network (TaVERN) were recruited over six months. Participants’ reporting performance was assessed by interpreting 30 anonymised CXR via the Report and Image Quality Control (RAIQC) online platform, using an image bank which contained both COVID-19 and non-COVID-19 pathological findings. Participants subsequently completed an online training module, and repeated the assessment using different image sets. Diagnostic accuracy and speed of CXR reporting was assessed both before and after training, with results compared against radiologists. The ground truth for each case was established by consensus of three thoracic radiologists. RT-PCR results were reviewed for each case to ensure that all the COVID-19 cases were positive and all COVID-19 cases were negative.Results/ConclusionsED clinicians working in emergency departments across five hospitals in the Thames Valley Emergency Medicine Research Network (TaVERN) were recruited over a six month period. 112 clinicians completed the initial assessment. 56 clinicians completed all three training components. The initial mean accuracy for clinicians in identifying COVID-19 on chest X-rays was 43%. The mean accuracy was 57% amongst clinicians who completed all three online training components. These clinician showed improved reporting speed with mean time reduction to CXR interpretation from 69 to 50 seconds.ED clinicians do not perform well at detecting COVID-19 CXR related changes on CXR, but accuracy and speed can be improved by online training.
1114 Neutrophil to lymphocyte ratio: An added outcome predictor in spontaneous intracerebral hemorrhage
Authors: Arun KT 
Published: June 2022

ackgroundHemorrhagic stroke accounts for 10–15% of all types of strokes. It carries higher mortality and morbidity in comparison to ischemic stroke. Evidence suggests that inflammatory mechanisms are involved in the pathophysiology of brain injury due to intracranial hemorrhage. Peripheral blood neutrophil to lymphocyte ratio (NLR) has recently emerged as a reliable marker of subclinical systemic inflammation. The aim of this study was to explore the significance of Neutrophil to Lymphocyte ratio in the functional outcome of patients with hemorrhagic stroke.MethodsPatients who presented to the Emergency Department with symptoms suggestive of stroke were evaluated with CT brain to identify hemorrhagic stroke. Patients with history of trauma, coagulopathy, fever or prior cerebrovascular accidents were excluded. The Modified ICH score and NLR were estimated at the time of admission. Functional outcome was assessed with Modified Rankin score after 3 months of initial presentation by telephonic conversation. A Modified Rankin score equal to or more than 3 was categorized as poor outcome group. Receiver operating curve (ROC) was used with NLR and Modified ICH score to analyze their influence in predicting poor functional outcome.ResultsA total of 158 patients were recruited for the study. After 3 months, 107 patients were identified as the poor outcome group as per their Modified Rankin score. The mean NLR and Modified ICH score at presentation were significantly higher for the poor outcome group (6.577 and 2.83) compared to the good outcome group (2.754 and 1.49) respectively with a p value of 0.001. The cut off value of 3.2 for NLR has a sensitivity of 75% and specificity of 70% to predict poor outcome.ConclusionIn patients with hemorrhagic stroke, a higher Neutrophil to Lymphocyte ratio at presentation is associated with poor functional outcomes at 3 months.
798 Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study
Authors: Marincowitz Carl , Goodacre Steve , Stone Tony , Campbell Richard , Hasan Madina , Thomas Benjamin , Turner Janette , Pilberry Richard , Bell Fiona 
Published: June 2022

Aims/Objectives/BackgroundTo reduce the risk of spreading infection and hospitals being overwhelmed, on the 18thFebruary 2020, NHS England advised patients with suspected COVID infection to contact NHS 111 instead of attending health care providers. In March 2020, 3 million NHS 111 calls were made; a record number and double the number of the previous year. Concerns have been raised that telephone triage may not be sufficiently accurate in identifying need for emergency care.We aim to assess accuracy of telephone triage in identifying patients who need emergency care amongst those with suspected COVID-19 and identify factors which affect triage accuracy.Methods/DesignA cohort study of adults who contacted NHS 111 services provided by Yorkshire Ambulance Service between the 18thMarch 2020 and 29thJune 2020 with symptoms indicating possible COVID-19 infection was completed. Callers were linked to ONS death registrations and routine health care data collected by NHS Digital.The accuracy of triage outcome (self-care/non-urgent assessment versus ambulance/urgent assessment) was assessed for death or organ support 30 days from first contact. Multi-variable logistic regression was used to identify factors associated with risk of false negative or false positive triage.Abstract 798 Figure 1STROBE flow diagram of study population selectionAbstract 798 Table 1Performance of binary NHS 111 triage (ambulance or urgent assessment 4 hours or less) for composite outcome (death or organ support)Adverse outcome up to 30 days(3%, 2.8-3.2%)N=40, 261Adverse OutcomeNo Adverse OutcomeAmbulance/urgent assessment89015, 035Sensitivity 74.2% (71.6- 76.6%)Positive Predictive Value5.6% (5.2 - 6%)Self-care/non-urgent assessment31024, 025Specificity 61.5% (61% - 62%)Negative Predictive Value98.7% (98.6 - 98.9%)Results/Conclusions3% of the 40,261 callers experienced an adverse outcome. Self-care/non-urgent assessment was recommended for 60%, with a small but non-negligible (1.3%) risk of subsequent deterioration. Triage achieved 74.2% sensitivity (95% CI: 71.6 to 76.6%) and 61.5% specificity (61% to 62%) for the primary outcome. Multivariable analysis suggested some co-morbidities (e.g. respiratory disease) may be over-estimated, and others (e.g. diabetes) underestimated, as predictors of deterioration. Repeat contact with services appears to be an important under recognised predictor of adverse outcomes with 2 contacts (OR 1.77 95% CI: 1.14 to 2.75) and 3+ contacts (OR 4.02 95% CI: 1.68 to 9.65) associated with clinical deterioration when not provided with an ambulance/urgent clinical assessment.
809 Survey of current and former academic clinical fellows in emergency medicine in the UK
Authors: Shanahan Thomas , Barrett Liam , Body Richard , Newcombe Virginia , Fish Rebecca , Jafar Anisa 
Published: June 2022

Aims/Objectives/BackgroundAcademic emergency medicine (EM) is a young field in the United Kingdom (UK) with a small critical mass of clinical academics, who have protected time to conduct research alongside clinical duties. There is a little published information on the academic training available to emergency physicians.In the UK, academic clinical fellowships (ACFs) offer a structured opportunity for trainees to develop skills and experience in research alongside clinical training. We aimed to capture information on the prior experience of emergency medicine (EM) fellows, as well as how the ACFs were structured and the next career steps for fellows upon completion.Methods/DesignA ten-question survey was designed by the project steering committee and circulated UK wide to all current fellows in EM and those that completed the programme in the last five years. Fellows were identified by contacting programme leads in every region. Data was collected via SurveyMonkey® between 18thFebruary 2021 and 25thMarch 2021.ResultsWe approached a total of 34 EM ACFs. The survey yielded a 91% (n=31) response rate (13 current, 18 completed within 5 years). One university from Wales and ten from England have supported EM ACF schemes. 59% (n=10) of those who have completed the scheme had their clinical training extended to accommodate research time. In the remainder, fellows were expected to achieve clinical competencies in the same time as trainees who did not spend time on research. In those who had completed the ACF programme (n=18), one third of respondents are doing PhD training (n=6) and one is an academic clinical lecturer.ConclusionWe found variation in how the schemes are implemented. Future research is required to explore the experiences of those undertaking EM ACFs in more detail to identify the features of successful ACF training schemes, and whether any aspects may benefit from standardisation.