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  • On reflective practice

    Ford, Derek (2023-08)
    Derek Ford shares his experiences of reflective practice and why he now advocates for it. Abstract published with permission
  • The Effect of ambient outside temperatures on scoop stretchers

    Haley, Anthony; Gibson, Iain; Graham, Christine; Guthrie, Iain; Newins, Dominique (2024-08)
    Background: Scoop stretchers are commonly used in the prehospital care of trauma patients. Patients' clothing is often removed early in the care pathway. There may be unidentified risks if scoop stretchers are particularly cold. Aims: The primary aim of this research was to establish if there is a positive correlation between scoop temperatures and outside temperatures when this equipment is stored without access to vehicle heating. Methods: The authors recruited volunteers at ambulance locations across Scotland to measure scoop temperatures using infrared thermometers. These were compared to outside temperatures at that time. Data were subject to bivariate quantitative analysis to assess correlation strength. Findings: Results demonstrated that there was a moderate-to-strong correlation between scoop temperatures and outside temperatures (mean +3.0°C; P<0.001). There was no significant difference for other variables measured. Conclusion: Without active heating, scoop stretchers will be only marginally warmer than the outside temperature, sometimes colder than the outside temperature and sometimes below freezing point. Abstract published with permission
  • Constrained optimization for decision making in health care using Python: a tutorial

    Leung, K. H. Benjamin; Yousefi, Nasrin; Chan, Timothy; Bayoumi, Ahmed (2023-07)
  • Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries: the BE SURE study protocol

    Baghdadi, Fadi; Evans, Bridie Angela; Goodacre, Steve; John, Paul Anthony; Hettiarachchi, Thanuja; John, Ann; Lyons, Ronan A.; Porter, Alison; Safari, Solmaz; Siriwardena, Aloysius Niroshan; et al.
    INTRODUCTION: Injuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients with injuries among people from ethnic minorities in the UK. The aim of this study is to investigate what may differ for people from ethnic minorities compared with white British people when presenting with injury to ambulance and Emergency Departments (EDs). METHODS AND ANALYSIS: This mixed methods study covers eight services, four ambulance services (three in England and one in Scotland) and four hospital EDs, located within each ambulance service. The study has five Work Packages (WP): (WP1) scoping review comparing mortality by ethnicity of people presenting with injury to emergency services; (WP2) retrospective analysis of linked NHS routine data from patients who present to ambulances or EDs with injury over 5 years (2016-2021); (WP3) postal questionnaire survey of 2000 patients (1000 patients from ethnic minorities and 1000 white British patients) who present with injury to ambulances or EDs including self-reported outcomes (measured by Quality of Care Monitor and Health Related Quality of Life measured by SF-12); (WP4) qualitative interviews with patients from ethnic minorities (n=40) and focus groups-four with asylum seekers and refugees and four with care providers and (WP5) a synthesis of quantitative and qualitative findings. ETHICS AND DISSEMINATION: This study received a favourable opinion by the Wales Research Ethics Committee (305391). The Health Research Authority has approved the study and, on advice from the Confidentiality Advisory Group, has supported the use of confidential patient information without consent for anonymised data. Results will be shared with ambulance and ED services, government bodies and third-sector organisations through direct communications summarising scientific conference proceedings and publications. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. DOI
  • Reperfusion of old or new: left bundle branch block?

    Fitzpatrick, David; McLean, Scott (2010-10-01)
    Reperfusion options for patients suffering ST-elevation myocardial infarction (STEMI) have developed significantly over recent years and now include both thrombolytic therapy and primary percutaneous coronary intervention (PPCI). This system of care means that patients presenting with STEMI can be transferred directly to a heart-attack centre to receive immediate PPCI. National guidelines state that pre-hospital thrombolysis (PHT) is a crucial part of STEMI reperfusion where PPCI cannot be delivered within 90 minutes of diagnosis. There is evidence describing rates of in-hospital thrombolysis in both MI with ST elevation and MI with LBBB. There is a knowledge gap however describing treatment of MI with LBBB based upon a pre-hospital 12-lead ECG. This paper describes the challenges around PHT in the context of LBBB and offers potential solutions that may provide assistance in making the decision to undertake PHT or not. Abstract published with permission
  • Performance of a prehospital HEART score in patients with possible myocardial infarction: a prospective evaluation

    Cooper, Jamie; Ferguson, James; Donaldson, Lorna; Black, Kim; Livock, Kate; Horrill, Judith; Davidson, Elaine; Scott, Neil; Lee, Amanda; Fujisawa, Takeshi; et al. (2023-06-02)
    Introduction The History, Electrocardiogram (ECG), Age, Risk Factors and Troponin (HEART) score is commonly used to risk stratify patients with possible myocardial infarction as low risk or high risk in the Emergency Department (ED). Whether the HEART score can be used by paramedics to guide care were high-sensitivity cardiac troponin testing available in a prehospital setting is uncertain. Methods In a prespecified secondary analysis of a prospective cohort study where paramedics enrolled patients with suspected myocardial infarction, a paramedic Heart, ECG, Age, Risk Factors (HEAR) score was recorded contemporaneously, and a prehospital blood sample was obtained for subsequent cardiac troponin testing. HEART and modified HEART scores were derived using laboratory contemporary and high-sensitivity cardiac troponin I assays. HEART and modified HEART scores of ≤3 and ≥7 were applied to define low-risk and high-risk patients, and performance was evaluated for an outcome of major adverse cardiac events (MACEs) at 30 days. Results Between November 2014 and April 2018, 1054 patients were recruited, of whom 960 (mean 64 (SD 15) years, 42% women) were eligible for analysis and 255 (26%) experienced a MACE at 30 days. A HEART score of ≤3 identified 279 (29%) as low risk with a negative predictive value of 93.5% (95% CI 90.0% to 95.9%) for the contemporary assay and 91.4% (95% CI 87.5% to 94.2%) for the high-sensitivity assay. A modified HEART score of ≤3 using the limit of detection of the high-sensitivity assay identified 194 (20%) patients as low risk with a negative predictive value of 95.9% (95% CI 92.1% to 97.9%). A HEART score of ≥7 using either assay gave a lower positive predictive value than using the upper reference limit of either cardiac troponin assay alone. Conclusions A HEART score derived by paramedics in the prehospital setting, even when modified to harness the precision of a high-sensitivity assay, does not allow safe rule-out of myocardial infarction or enhanced rule-in compared with cardiac troponin testing alone. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
  • Epidemiology of emergency ambulance service calls related to COVID-19 in Scotland: a national record linkage study

    Fitzpatrick, David; Duncan, Edward; Moore, Matthew; Best, Catherine; Andreis, Federico; Esposito, Martin; Dobbie, Richard; Corfield, Alasdair; Lowe, David J (2022-01-28)
  • National before and during COVID-19 study of child emergency ambulance contacts

    Fairgray, Valerie; Fitzpatrick, David; Williams, Julia; Bowles, Kelly-Ann
  • Association between socioeconomic status and outcomes in critical care: a systematic review and meta-analysis

    McHenry, Ryan; Moultrie, Christopher; Quasim, Tara; Mackay, Daniel; Pell, Jill P (Lippincott Williams & Wilkins, 2023-03-01)
  • Treat and leave for hypoglycaemia: how are decisions made?

    Watson, A; Kelly, R; Clubbs-Coldron, B; Forbes, B; Clarke, C; Fuller, A; McConnell, D; Coates, V
  • Releasing the pressure

    Ford, Derek (MAG Online, 2023-02-02)
    In his first NQP Perspective column, Derek Ford reflects on his journey as a mature student. Abstract published with permission.
  • Factors affecting public access defibrillator placement decisions in the United Kingdom: a survey study

    Lac, Diane; Wolters, Maria K.; Leung, K. H. Benjamin; MacInnes, Lisa; Clegg, Gareth (Elsevier, 2023-01-07)
  • Data linkage to reduce severe hypoglycaemia

    Cunningham, S; Urquhart, W; Taylor, A; Neilan, L; Gillies, N.; MacDonald, N.; Chalmers, J. (2022-04)
  • What is a good mentor?

    Ford, Derek (2023-04-02)
    From the perspective of an NQP, Derek Ford offers his views of what makes a good mentor. Abstract published with permission.
  • Mathematically optimised public access defibrillator placement - fairness or accessibility?

    Leung, K.H.B.; Lac, D.; Chan, T.C.Y.; Clegg, Gareth (BMJ, 2022-05)
    Background - Mathematical optimisation can be used to maximise public access defibrillator (PAD) accessibility for out-ofhospital cardiac arrests (OHCA). It is unclear whether enforcing 'fairness' (defined as parity of PAD accessibilty) across city wards would impact resulting PAD accessibility compared to an unconstrained approach. Method We included all suspected OHCAs responded to by the Scottish Ambulance Service (SAS) in the cities of Glasgow, Edinburgh, Aberdeen, and Dundee between Jan. 2011 - Sept. 2017, and PADs registered with SAS as of Feb. 2020. We computed the accessibility (defined as within 100 m of OHCA) for existing PADs and developed a mathematical model to select locations for additional PADs under two scenarios: (1) select optimal locations across whole cities, and (2) select optimal locations distributed equally between city wards. Up to 20 additional PAD locations per ward were considered. For both scenarios, we compared PAD accessibility on out-of-sample OHCAs using McNemar's test and fairness across wards using the Nash social welfare function. Results We identified 14,674 OHCA responses and 424 existing PADs. Existing PADs were within range of 1.1% of OHCAs (0.4-2.0% per city). Optimising new PAD locations per city, regardless of wards, increased PAD accessibility to 15.4% of OHCAs (14.9-17.9% per city). Constraining an equal number of PADs in each ward resulted in accessibility loss of 0.2-1.4 percentage points depending on the quantity of PADs placed (P<0.05 for 18 of 20 cases) but improved fairness values by up to 89% for smaller quantities of PADs. Conclusion Enforcing ward-level parity when selecting optimal new PAD locations results in fairer but less accessible PADs for OHCA. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
  • The influence of significant others upon participation in cardiac rehabilitation and coronary heart disease self-help groups

    Jackson, Angela M; McKinstry, Brian; Gregory, Susan (Mark Allen Publishing, 2011-08)
    Aims: Despite identified benefits, many people do not participate in cardiac rehabilitation (CR) programmes and coronary heart disease (CHD) self-help groups when recovering from myocardial infarction (MI). Little is known about the influence of ‘significant others’ regarding participation, their role, and the significant others’ experience of rehabilitation without these resources. This article describes research aiming to explore the role of significant others in such non-participation, and their experiences and perspectives, and, from this, identify implications for policy and practice. Methods: A qualitative study was carried out in Lothian, Scotland. In-depth interviews were carried out with 27 people who had not participated in CR and/or a CHD Group after discharge from hospital 6–14 months previously following myocardial infarction, and 17 of their nominated significant others. Findings: Significant others are influential regarding their family members’/friends’ use/non-use of rehabilitation resources. However, there are important limitations upon this influence. Conclusions: Significant others should be an essential consideration in post-MI rehabilitation, as influences on rehabilitation resource participation, potentially key providers of support, and regarding their own wellbeing. Abstract published with permission.
  • A complete timeline of emergency medical response after acute stroke: are delays changing?

    Hart, SR; Tough, Dahrlene; Lee, R; Doubal, F; Mathews, T; Gray, A; Thuerey, T; Fernandes, P (2011-12)

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