bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pairing regression and configurational analysis in health services research: modelling outcomes in an observational cohort using a split-sample design
Authors: Miech Edward J , Perkins Anthony J , Zhang Ying , Myers Laura J , Sico Jason J , Daggy Joanne , Bravata Dawn M 
Published: June 2022

BackgroundConfigurational methods are increasingly being used in health services research.ObjectivesTo use configurational analysis and logistic regression within a single data set to compare results from the two methods.DesignSecondary analysis of an observational cohort; a split-sample design involved randomly dividing patients into training and validation samples.Participants and settingPatients who had a transient ischaemic attack (TIA) in US Department of Veterans Affairs hospitals.MeasuresThe patient outcome was the combined endpoint of all-cause mortality or recurrent ischaemic stroke within 1 year post-TIA. The quality-of-care outcome was the without-fail rate (proportion of patients who received all processes for which they were eligible, among seven processes).ResultsFor the recurrent stroke or death outcome, configurational analysis yielded a three-pathway model identifying a set of (validation sample) patients where the prevalence was 15.0% (83/552), substantially higher than the overall sample prevalence of 11.0% (relative difference, 36%). The configurational model had a sensitivity (coverage) of 84.7% and specificity of 40.6%. The logistic regression model identified six factors associated with the combined endpoint (c-statistic, 0.632; sensitivity, 63.3%; specificity, 63.1%). None of these factors were elements of the configurational model. For the quality outcome, configurational analysis yielded a single-pathway model identifying a set of (validation sample) patients where the without-fail rate was 64.3% (231/359), nearly twice the overall sample prevalence (33.7%). The configurational model had a sensitivity (coverage) of 77.3% and specificity of 78.2%. The logistic regression model identified seven factors associated with the without-fail rate (c-statistic, 0.822; sensitivity, 80.3%; specificity, 84.2%). Two of these factors were also identified in the configurational analysis.ConclusionsConfigurational analysis and logistic regression represent different methods that can enhance our understanding of a data set when paired together. Configurational models optimise sensitivity with relatively few conditions. Logistic regression models discriminate cases from controls and provided inferential relationships between outcomes and independent variables.
819 What can you teach in 15 minutes? A pilot study of ‘just-in-time’ teaching in a paediatric emergency department
Authors: Tomlinson Patrick 
Published: June 2022

Aims/Objectives/BackgroundThe Emergency Department (ED) is a busy environment due to shift patterns and high acuity, which can make arranging formal teaching sessions difficult. We proposed daily ’15-minute Hot Topic Teaching’ sessions with feedback questionnaires used to evaluate these. The aim of this study was to assess the effectiveness of daily ’15-minute Hot Topic Teaching’ sessions in a Paediatric Emergency Department.Methods/DesignA daily teaching programme was designed and implemented in a busy tertiary Paediatric Emergency Department. The teaching sessions were performed for 15 minutes at 1 pm on Monday to Friday for all clinical ED staff members. Following each teaching session, participants completed a feedback questionnaire to evaluate the teaching session. This assessed the ‘overall rating of the teaching session’, ‘change in confidence in application of knowledge’, and ‘the rating of how appropriate the length of the teaching session was’.Results/ConclusionsOverall, 200 questionnaire feedbacks were completed. The average rating for the teaching sessions was 9.07/10 (0 being ‘very poor’ and 10 being ‘excellent’). The participants’ confidence in application of knowledge improved on average from 5.44/10 before the session to 8.04/10 following it (0 being ‘no confidence’ and 10 being ‘very confident’). The teaching session length was reported as ‘about right’ by 92%, with 8% stating they were either ‘too long’ or ‘too short’. ED clinical staff attending included doctors (47.5%), Advanced Nurse Practitioners (19.5%), nursing staff (12%), Physician Associates (9.5%), Health Case Assistants (3%), and ‘other’ members including medical students, nursing students and paramedic students (8.5%).This study shows that daily 15-minute teaching sessions are an effective way of delivering teaching in a busy Paediatric Emergency Department to a wide variety of clinical staff. The sessions have improved confidence and knowledge in a variety of topics and are an appropriate length of time, making them ideal for use in Emergency Departments.
787 Evaluation of the role of anal tone and perianal sensation examination in the assessment of suspected cauda equina syndrome
Authors: Lopez Carlos Curtis , Berg Andrew , Clayton Bethan , Siddique Irfan , Carrasco Roberto , Horner Daniel , Angus Michelle 
Published: June 2022

Aims/Objectives/BackgroundCauda equina syndrome (CES) can present with a varied constellation of clinical signs and symptoms, which together with the time sensitive nature of the condition and risk of catastrophic clinical outcome, presents a significant challenge to those assessing patients with this suspected diagnosis. Anal tone is commonly tested during initial assessment using a digital rectal examination (DRE). This study aims to evaluate the diagnostic value of anal tone and perianal sensation assessment in patients with suspected CES and report modern prevalence data on CES within a neurosciences centre.Methods/DesignConsecutive patients with suspected CES presenting over a three-year period to the Emergency Department (ED) of a busy tertiary centre were included in the study. History and examination findings, documented in the ED notes, were assessed and these variables were correlated with the presence or absence of cauda equina compression on subsequent magnetic resonance imaging (MRI).Results/ConclusionsOut of 1005 patients with suspected CES, 117 (11.6%) had MRI confirmed cauda equina compression (MRI +ve CES). 35% of MRI +ve patients and 31% of MRI -ve patients had reduced anal tone. Using univariate and multivariable logistic regression analyses, no associations were found between abnormal anal tone and MRI +ve CES for patients of all ages. The univariate logistic regression analysis identified altered perianal sensation to be significantly associated with MRI +ve CES in patients ≤ 42 years old. This association was no longer present when an adjusted multivariable logistic regression was performed.The prevalence of MRI +ve CES was 11.6%. Our findings suggest that the clinical finding of reduced anal tone has no demonstrable diagnostic value for those with suspected CES, either in itself or in combination with other clinical findings. Further studies are needed to confirm the diagnostic efficacy of assessing perianal sensation in this context.
1148 Harnessing a student network to support validation of the patient reported experience measure for over 65s attending the ED (PREM-ED 65+): Initial findings from a novel collaborative project
Authors: Graham Blair , Smith Jason , Nelmes Pam , Latour Jos 
Published: June 2022

Aims/Objectives/BackgroundPREM-ED 65+ is an 83-item patient experience questionnaire for over-65s attending the ED. The final development stage will confirm psychometric properties in the real-world. Following recent successes of trainee-led collaborative studies, intercalated Urgent/Emergency Care students (University of Plymouth) were invited to participate in this study as student site investigators (SSIs).We aim to outline this collaborative project and report challenges and successes encountered so far.Methods/DesignA cross-sectional study was designed to administer PREM-ED 65+ to eligible patients upon discharge. Students were invited to review the protocol/SSI role at outset. Senior faculty agreed to their participation; timetable conflicts were avoided. NHS and University ethics were obtained.Thirty- two students within 19 EDs volunteered to become SSIs (64% of the cohort). All underwent training. Existing mentors were co-recruited as site PIs. Commencement—planned January 2021—was delayed until Mid-May due to administrative reasons.ResultsData collection is ongoing. Currently, twenty-two SSIs across 16 sites have recruited 272 participants in five weeks (median= 16 patients/site(R3—45); 10 accruals/SSI(R2—20)). Completion of all 83-items is near- perfect (97.8%). Sixty-four (23.5%) participants consented to a retest survey.Average respondent age is 77 years (R65—100) with more females (58.6%). No differences in arrival mode or complaint type has been observed. Participant LOS is commonly >4 hours (51.3%) with very few treated within an hour (3.3%).Per-item analysis will commence once the minimum sample (300) is achieved. Redundant items will be excluded; structural and criterion validity, and test- retest reliability will be assessed for remaining items.Student feedback will be sought to evaluate the SSI role.ConclusionsThe student network has made an essential contribution. The efficiency of the collaborative model has mitigated significant commencement delay. Concerns such as conflicts with the academic programme have been allayed through involving students and faculty in design, and proactively arranging supervision and communication.
781 Drone delivered defibrillators (The 3D Project): a simulation study
Authors: Smith Christopher M , Sheehan Anthony , Rees Nigel , Powell Carl 
Published: June 2022

Aims/Objectives/BackgroundCardiopulmonary resuscitation (CPR) and defibrillation can double survival from out-of-hospital cardiac arrest. Members of the public can perform both before the arrival of the ambulance service, but they currently use a public-access Automated External Defibrillator (AED) in around only 5% of out-of-hospital cardiac arrests.There are several barriers in getting an AED to a patient’s side promptly. One means of overcoming these barriers may be to deliver AEDs using Unmanned Aerial Vehicles (‘drones’). In this study we aimed to create a technologically feasible solution for drone-delivered defibrillation, and to investigate how easily a bystander performing CPR could use a drone-delivered AED.Methods/DesignWe developed a drone capable of flying an AED and lowering it to the ground via winch between July and September 2020 and tested the mechanism in October 2020. On 9thJuly 2021, we will conduct simulated cardiac arrests in an outdoor controlled test environment. Twenty participants will find a simulated patient, call an experienced 999 call-handler from Welsh Ambulance Service NHS Trust, and start CPR. Once cardiac arrest is confirmed during the 999 call a drone will take off, reach hovering altitude and lower the AED to the ground on-scene. The call-handler will alert the participant, who will then leave the patient to retrieve and attach the AED.Hands-off CPR time is the primary outcome. Secondary outcomes are: time taken to reach the drone, recover the AED and apply it; usability of drone-delivered AEDs (using a questionnaire adapted from the System Usability Scale); and an exploration of participant behaviours by review of audio (999 calls) and video of the simulation.Results/ConclusionsWe will determine what additional burden there is for a lone bystander after introducing a drone-delivered AED to a simulated cardiac arrest scenario. This will inform future work developing protocols for drone delivery of AEDs in clinical trials.
1074 Ottawa Ankle rules cannot be safely used to rule out ankle fractures in patients who present ≥10 days post-injury
Authors: Anderson Richard , Green Amy , Davies Rhianna , Dew Lindsey , Harrison Mark 
Published: June 2022

Aims/Objectives/BackgroundThe Ottawa ankle rules (OAR) have been validated as a highly sensitive tool to rule out ankle fractures and reduce need for radiography. However, datasets validating OAR to date have excluded patients presenting ≥10 days post-injury and there is a need to ascertain if OAR can be safely used to rule out ankle fractures in this population.Methods/DesignPatients presenting with ankle injuries to an emergency department (ED) in England between June 2015 and November 2020 were identified retrospectively through a clinical-coding search. Patient records were used to confirm the number of days between injury and presentation; those who presented ≥10 days post-injury were included for further analysis. Data was collected from ED documentation including region of pain, bony tenderness and weight-bearing status. OAR were used to categorise patients as ‘Ottawa-positive’, ‘Ottawa-negative’ or insufficient documentation. It was recorded whether the patient underwent radiography and whether the formal radiograph report confirmed a clinically-significant fracture. Patients who didn’t undergo radiography and didn’t subsequently re-present were deemed not to have a fracture. Data collected for each patient was checked and agreed by two authors.Results/Conclusions6782 patients presented with ankle injuries, of which 126 patients presented ≥10 days post-injury. Of these 126 patients, 9 were Ottawa-positive, 90 were Ottawa-negative and 27 patients had insufficient documentation. 85 patients underwent radiography and 19 were found to have clinically-significant fractures. Of these fracture patients, 4 were Ottawa-positive and 15 were Ottawa-negative.Within our dataset, OAR demonstrated a sensitivity of 21.05%, specificity 93.75%, PPV 44.40% and NPV 83.30%. Using Fishers exact test, p=0.0658. OAR demonstrate poor sensitivity and cannot be safely used to rule out ankle fractures in patients who present ≥10 days post-injury. However, due to the p-value and low power there may be a risk of type 2 error and a larger study may prove otherwise.
1107 Real-world deployment of point-of-care SARS-CoV-2 testing in the emergency department admission pathway can support the safe, accurate and rapid diagnosis of COVID-19
Authors: Gunawardena Ramith , Merrick Blair , Gettings Holly , Douthwaite Sam , Nebbia Gaia , Webber Kay , Edgeworth Jonathan , Batra Rahul , Harrison Hooi-Ling 
Published: June 2022

Aims/Objectives/BackgroundPatients admitted to hospital via the emergency department (ED) need to be separated by SARS-CoV-2 infection status to prevent transmission. Using clinical criteria alone is not feasible due to the range of symptoms and asymptomatic spread. Turnaround time of laboratory PCR assays (~6–24 hrs) hinders patient movement through the hospital with pressure on side-rooms pending results and exposure risk if unsuspected cases are moved into bays. Lateral flow devices (LFD) can provide a rapid diagnosis and aid patient movement. This implementation study aimed to assess the accuracy and safety of LFDs within an ED during a high-prevalence period.Methods/DesignTwo rapid point-of-care tests (POCT) were introduced during December 2020: Cobas®-Liat® system (Roche Diagnostics) is a 20-minute assay comparable to laboratory PCR (in-house validation), and LFDs. Symptomatic patients with a positive LFD were cohorted on a ‘red’ ward. Asymptomatic patients with a negative result were allocated an ‘amber’ ward, pending lab PCR. Where there were discrepancies between results and symptoms; a Liat® was performed.The LFDs were validated by PCR swabs to determine true positive and false negative (FN) rates and to minimise fallout via contact tracing. The PCR cycle threshold (CT) values were recorded to evaluate the LFD sensitivity and specificity. Results were collected between December 2020-March 2021.Results/ConclusionsComparing LFD with PCR results, the sensitivity and specificity were 70.7% and 99.1%. LFD FNs had higher CT values (≥25), indicating the beginning or end of infection – unlikely infectious. One period of false positives during lower prevalence revealed a faulty batch. During the study period 90% of patients left the ED with a virological diagnosis.We conclude that POCT can aid the diagnosis of COVID-19 in the ED when combined with existing laboratory-based PCR algorithms. We demonstrate a safe and effective use of POCT in the ED which could be replicated across other centres.
750 Is higher-level trauma centre care associated with better outcomes in patients injured by low-energy trauma? A systematic review
Authors: Tonkins Michael , Bradbury Daniel , Bramley Paul , Sabir Lisa , Wilkinson Anna , Lecky Fiona 
Published: June 2022

Aims/Objectives/BackgroundGlobally, trauma is a significant cause of morbidity and mortality globally. In high-income countries the demographic of major trauma is changing. Trauma patients are becoming older, more likely to have multiple comorbidities, and are being injured by low-energy mechanisms, chiefly ground-level falls. It is unknown whether existing trauma systems are equipped for the optimum management of these patients. Therefore, a systematic review was performed to investigate the association between higher-level trauma centre care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma.Methods/DesignA pre-registered systematic review of all major subject databases and grey literature archives supplemented by targeted manual searching was conducted in January 2021. Where necessary study authors were contacted. In the presence of study heterogeneity a narrative synthesis was pre-specified.Abstract 750 Box 1Level 1:capable of providing total care for every aspect of injury, from prevention to rehabilitation. Level 1 centres are responsible for providing leadership in education, research, and system planning.Level 2:capable of providing initial definitive care except for particularly complex or specialised injuries.Level 3:capable of providing prompt assessment, resuscitation, stabilisation and transfer of patients when required.Level 4:provides advanced trauma life support in remote areas where no higher level of care is available.In the United Kingdom, ‘major trauma centres’ would be equivalent to a Level 1 or 2 trauma centre, and ‘trauma units’ equivalent to a Level 3 trauma centre.Results/ConclusionsOf 2,898 potentially eligible unique records, three observational studies were included. Overall the studies’ risk of bias was moderate-to-serious due to potential residual confounding and selection bias. All studies compared outcomes among adults injured by ground-level falls who were treated in American College of Surgeons (ACS) verified trauma centres in the USA. The studies demonstrated divergent results, with one demonstrating improved outcomes in level 3 or 4 trauma centres (Observed:Expected Mortality 0.973, 95%CI 0.971–0.975), one demonstrating improved outcomes in level 1 trauma centres (Adjusted Odds Ratio 0.71, 95%CI 0.56–0.91), and one demonstrating no difference between level 1 or 2 and level 3 or 4 trauma centre care (Adjusted Odds Ratio 0.91 (0.80–1.04).There is currently no clear evidence for the efficacy of major trauma centres in caring for adult patients injured by a ground-level fall. Further studies at lower risk of bias and studies conducted outwith the USA are required.
Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair
Authors: Tanaka Tetsu , Kavsur Refik , Spieker Maximilian , Iliadis Christos , Metze Clemens , Brachtendorf Birthe M , Horn Patrick , Zachoval Christian , Sugiura Atsushi , Kelm Malte , Baldus Stephan , Nickenig Georg , Westenfeld Ralf , Pfister Roman , Becher Marc Ulrich 
Published: June 2022

ObjectiveA sizeable proportion of patients with secondary mitral regurgitation (SMR) do not receive guideline-directed medical therapy (GDMT) for heart failure (HF). We investigated the association between the use of GDMT and mortality in patients with SMR who underwent transcatheter edge-to-edge repair (TEER).MethodsWe retrospectively analysed patients with SMR and a left ventricular ejection fraction of <50% who underwent TEER at three centres. According to current HF guidelines, GDMT was defined as triple therapy consisting of beta-blockers, renin–angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs). Patients were divided into two groups: GDMT and non-GDMT groups. We calculated the propensity scores and carried out inverse probability of treatment weighting (IPTW) analyses to compare 2-year mortality between the two groups.ResultsOf 463 patients, 228 (49.2%) were treated with GDMT upon discharge. IPTW-adjusted Kaplan-Meier curve showed patients with GDMT had a lower incidence of mortality than those without GDMT (19.8% vs 31.1%, p=0.011). In IPTW-adjusted Cox proportional hazards analysis, GDMT was associated with a reduced risk of 2-year mortality (HR: 0.58; 95% CI: 0.35 to 0.95; p=0.030), which was consistent among clinical subgroups. Moreover, patients with GDMT had a higher rate of left ventricular reverse remodelling at 1 year after TEER than those without GDMT.ConclusionGDMT, defined as triple therapy consisting of beta-blockers, RAS inhibitors and MRAs, was associated with a reduced risk of 2-year mortality after TEER for SMR. Optimisation of medical therapy is crucial to improve clinical outcomes in patients undergoing TEER for SMR.
Noticing people, discounts and non-tobacco flavours in e-cigarette ads may increase e-cigarette product appeal among non-tobacco-using young adults
Authors: Chen-Sankey Julia , Jeong Michelle , Wackowski Olivia A , Unger Jennifer B , Niederdeppe Jeff , Bernat Edward , Bansal-Travers Maansi , Moran Meghan , Kennedy Ryan David , Broun Aaron , Hacker Kiana , Choi Kelvin 
Published: June 2022

IntroductionYoung adults new to tobacco (including e-cigarettes) are at an increased risk of e-cigarette use after e-cigarette exposure. This study examined the association between noticing e-cigarette advertising features and perceived product appeal among non-tobacco-using young adults.MethodsA sample of non-tobacco-using young adults (ages 18–29 years; n=1993) completed an online survey in 2021. We content analysed visible features from 12 e-cigarette ads that represented commonly used e-cigarette brands. Participants viewed the ads and clicked on the areas of the ads that drew their attention. Participants reported e-cigarette product appeal for each ad, including ad liking, product curiosity and use interest. We used generalised estimating equations to examine within-person associations between noticing specific ad features and reporting each and any type of product appeal, adjusting for noticing other features and participant characteristics.ResultsNoticing people, discounts, non-tobacco (menthol and mint/fruit) flavours, positive experience claims or product images was positively associated with having any e-cigarette product appeal. Noticing discounts or mint/fruit flavours was also positively associated with e-cigarette use interest. In contrast, noticing nicotine warnings or smoking cessation claims was negatively associated with ad liking and product curiosity.ConclusionsAttention to several e-cigarette ad features (eg, people, discounts, non-tobacco flavours) was associated with increased e-cigarette product appeal, whereas attention to nicotine warnings and smoking cessation claims was associated with reduced appeal among non-tobacco-using young adults. Restricting appeal-promoting features while strengthening the effects of nicotine warnings and smoker-targeted claims in e-cigarette ads may potentially reduce e-cigarettes’ overall appeal among this priority population.