• Mixed methods in pre-hospital research: understanding complex clinical problems

      Whitley, Gregory; Munro, Scott; Hemingway, Pippa; Law, Graham Richard; Siriwardena, Aloysius; Cooke, Debbie; Quinn, Tom (2020-12-01)
      Healthcare is becoming increasingly complex. The pre-hospital setting is no exception, especially when considering the unpredictable environment. To address complex clinical problems and improve quality of care for patients, researchers need to use innovative methods to create the necessary depth and breadth of knowledge. Quantitative approaches such as randomised controlled trials and observational (e.g. cross-sectional, case control, cohort) methods, along with qualitative approaches including interviews, focus groups and ethnography, have traditionally been used independently to gain understanding of clinical problems and how to address these. Both approaches, however, have drawbacks: quantitative methods focus on objective, numerical data and provide limited understanding of context, whereas qualitative methods explore more subjective aspects and provide perspective, but can be harder to demonstrate rigour. We argue that mixed methods research, where quantitative and qualitative methods are integrated, is an ideal solution to comprehensively understand complex clinical problems in the pre-hospital setting. The aim of this article is to discuss mixed methods in the field of pre-hospital research, highlight its strengths and limitations and provide examples. This article is tailored to clinicians and early career researchers and covers the basic aspects of mixed methods research. We conclude that mixed methods is a useful research design to help develop our understanding of complex clinical problems in the pre-hospital setting. Abstract published with permission.
    • The use and impact of 12-lead electrocardiograms in acute stroke patients: a systematic review

      Munro, Scott F.S.; Cooke, Debbie; Kiln-Barfoot, Valerie; Quinn, Tom (2018-04)
    • The use of prehospital 12-lead electrocardiograms in acute stroke patients

      Cooke, Debbie; Joy, Mark; Quinn, Tom (2018-04)
      AIM Emergency medical services (EMS) play a vital role in the recognition, management and transportation of acute stroke patients. UK guidelines recommend clinicians consider performing a prehospital 12-lead electrocardiogram (PHECG) in patients with suspected stroke , but this recommendation is based on expert consensus, rather than robust evidence. The aim of this study was to investigate the association between PHECG and modified Rankin scale (mRS). Secondary outcomes included in-hospital mortality, EMS and in-hospital time intervals and rates of thrombolysis received. Method A multicentre retrospective cohort study was undertaken. The data collection period spanned from 29/12/2013 – 30/01/2017. Participants were identified through secondary analysis of hospital data routinely collected as part of the Sentinel Stroke National Audit Programme (SSNAP) and linked to EMS clinical records (PCRs) via EMS incident number. Results PHECG was performed in 558 (48%) of study patients. PHECG was associated with an increase in mRS (aOR 1.44, 95% CI: 1.14 to 1.82, p=0.002) and in-hospital mortality (aOR 2.07, 95% CI: 1.42 to 3.00, p=0.0001). There was no association between PHECG and administration of thrombolysis (aOR 0.92, 95% CI: 0.65 to 1.30, p=0.63). Patients who had a PHECG recorded spent longer under the care of EMS (median 49 vs 43 min, p=0.007). No difference in times to receiving brain scan (Median 28 with PHECG vs 29 min no PHECG, p=0.14) or thrombolysis (median 46 min vs 48 min, p=0.82) were observed. Conclusion This is the first study of its kind to investigate the association between PHECG and functional outcome in stroke patients attended by EMS. Although there are limitations in Abstracts BMJ Open 2018;8(Suppl 1):A1–A34 A5 Trust (NHS). Protected by copyright. on September 3, 2019 at Manchester University NHS Foundation http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2018-EMS.14 on 16 April 2018. Downloaded from regard to the retrospective study design, the findings challenge current guideline recommendations regarding PHECG in patients with acute stroke. https://bmjopen.bmj.com/content/bmjopen/8/Suppl_1/A5.3.full.pdf 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: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.14