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Runacres J, Harvey H, O'Brien S, Halck A. Paramedics as Researchers: A Systematic Review of Paramedic Perspectives of Engaging in Research Activity From Training to Practice. J Emerg Med 2024; 66:e680-e689. [PMID: 38734546 DOI: 10.1016/j.jemermed.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/18/2023] [Accepted: 01/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND The need for a stronger evidence-base in paramedicine has precipitated a rapid development of prehospital research agendas. Paramedics are increasingly involved in research, leading to changes in their role. Yet, the integration of research responsibilities has proven to be challenging, resulting in varying attitudes and levels of engagement. OBJECTIVE This systematic review aimed to explore paramedics' views and experiences of research as researchers during training and within practice. METHODS A systematic search was performed across six databases. Qualitative empirical peer-reviewed articles that discussed paramedic perspectives on engaging with research activity were included. Of 10,594 articles identified initially, 11 were included in the final synthesis after quality appraisal. Data were extracted and subjected to narrative synthesis. RESULTS The following four themes were identified: motivation to engage, moral dilemmas, structural issues within the profession, and reflections on trial involvement. Attitudes toward research, understanding of related concepts, and the drive for patient benefit were interwoven core issues. CONCLUSIONS Research was highly valued when links to patient benefit were obvious, however, this review highlights some cultural resistance to research, particularly regarding informed consent and changes to standard practice. Paramedic research methods training should provide structured opportunities to explore concerns and emphasize the role of research in developing a high-quality evidence base to underpin safe practice. Currently, there is inadequate organizational support for paramedics to engage effectively in research activity, with minimal allocations of time, training, and remuneration. Without properly integrating research activity into the paramedic role, their capacity to engage with research activity is limited.
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Affiliation(s)
- Jessica Runacres
- Midwifery and Allied Health, Staffordshire University, Stafford, Staffordshire, UK
| | - Hannah Harvey
- Nursing and Midwifery, Birmingham City University, Birmingham, West Midlands, UK
| | - Sam O'Brien
- Midwifery and Allied Health, Staffordshire University, Stafford, Staffordshire, UK
| | - Amy Halck
- Midwifery and Allied Health, Staffordshire University, Stafford, Staffordshire, UK
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Stemerman R, Bunning T, Grover J, Kitzmiller R, Patel MD. Identifying Patient Phenotype Cohorts Using Prehospital Electronic Health Record Data. PREHOSP EMERG CARE 2021:1-14. [PMID: 33315497 DOI: 10.1080/10903127.2020.1859658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
Objective: Emergency medical services (EMS) provide critical interventions for patients with acute illness and injury and are important in implementing prehospital emergency care research. Retrospective, manual patient record review, the current reference-standard for identifying patient cohorts, requires significant time and financial investment. We developed automated classification models to identify eligible patients for prehospital clinical trials using EMS clinical notes and compared model performance to manual review.Methods: With eligibility criteria for an ongoing prehospital study of chest pain patients, we used EMS clinical notes (n = 1208) to manually classify patients as eligible, ineligible, and indeterminate. We randomly split these same records into training and test sets to develop and evaluate machine-learning (ML) algorithms using natural language processing (NLP) for feature (variable) selection. We compared models to the manual classification to calculate sensitivity, specificity, accuracy, positive predictive value, and F1 measure. We measured clinical expert time to perform review for manual and automated methods.Results: ML models' sensitivity, specificity, accuracy, positive predictive value, and F1 measure ranged from 0.93 to 0.98. Compared to manual classification (N = 363 records), the automated method excluded 90.9% of records as ineligible and leaving only 33 records for manual review.Conclusions: Our ML derived approach demonstrates the feasibility of developing a high-performing, automated classification system using EMS clinical notes to streamline the identification of a specific cardiac patient cohort. This efficient approach can be leveraged to facilitate prehospital patient-trial matching, patient phenotyping (i.e. influenza-like illness), and create prehospital patient registries.
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Affiliation(s)
- Rachel Stemerman
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
| | - Thomas Bunning
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
| | - Joseph Grover
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
| | - Rebecca Kitzmiller
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
| | - Mehul D Patel
- Received November 19, 2020 from Carolina Health Informatics Program, University of North Carolina, Chapel Hill, North Carolina (RS, RK); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (TB); Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina (JG, MDP) Revision received; accepted for publication December 1, 2020
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Lecky F, Russell W, Fuller G, McClelland G, Pennington E, Goodacre S, Han K, Curran A, Holliman D, Freeman J, Chapman N, Stevenson M, Byers S, Mason S, Potter H, Coats T, Mackway-Jones K, Peters M, Shewan J, Strong M. The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study. Health Technol Assess 2016; 20:1-198. [PMID: 26753808 DOI: 10.3310/hta20010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Reconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence - with regard to 'early neurosurgery' in this cohort - which we sought to address. METHODS Pilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of < 13 in NWAS, GCS score of < 14 in NEAS] and stable ABC, injured nearest to a NSAH were transported either to that hospital (control clusters) or bypassed to the nearest NC (intervention clusters). PRIMARY OUTCOMES recruitment rate, protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. 'Open-label' secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions. RESULTS Overall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70), with 7% (n = 20) requiring neurosurgery (craniotomy, craniectomy or intracranial pressure monitoring) but a further 18 requiring admission to an intensive care unit. An intention-to-treat analysis revealed the two trial arms to be equivalent in terms of age, GCS and severity of injury. No significant 30-day mortality differences were found (8.8% vs. 9.1/%; p > 0.05) in the 273 (159/113) patients with data available. There were no apparent differences in staff and patient preferences for either pathway, with satisfaction high with both. Very low responses to invitations to consent for follow-up in the large number of mild head injury-enrolled patients meant that only 20% of patients had 6-month outcomes. The trial-based economic evaluation could not focus on early neurosurgery because of these low numbers but instead investigated the comparative cost-effectiveness of bypass compared with selective secondary transfer for eligible patients at the scene of injury. CONCLUSIONS Current NHS England practice of bypassing patients with suspected TBI to neuroscience centres gives overtriage ratios of 13 : 1 for neurosurgery and 4 : 1 for TBI. This important finding makes studying the impact of bypass to facilitate early neurosurgery not plausible using this study design. Future research should explore an efficient comparative effectiveness design for evaluating 'early neurosurgery through bypass' and address the challenge of reliable TBI diagnosis at the scene of injury. TRIAL REGISTRATION Current Controlled Trials ISRCTN68087745. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fiona Lecky
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Wanda Russell
- Trauma Audit and Research Network, Center of Occupational and Environmental Health, Institute of Population, University of Manchester, Manchester, UK
| | - Gordon Fuller
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Graham McClelland
- Research and Development Department, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elspeth Pennington
- Research and Development Department, North West Ambulance Service, Carlisle, UK
| | - Steve Goodacre
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Kyee Han
- Research and Development Department, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Curran
- Research and Development Department, North West Ambulance Service, Carlisle, UK
| | - Damien Holliman
- Department of Neurosurgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jennifer Freeman
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Nathan Chapman
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Sonia Byers
- Research and Development Department, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Suzanne Mason
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
| | - Hugh Potter
- Potter Rees Serious Injury Solicitors LLP, Manchester, UK
| | - Tim Coats
- Department of Cardiovascular Sciences, University of Leicester/University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kevin Mackway-Jones
- Research and Development Department, North West Ambulance Service, Carlisle, UK
| | - Mary Peters
- Research and Development Department, North West Ambulance Service, Carlisle, UK
| | - Jane Shewan
- Research and Development Department, Yorkshire Ambulance Services NHS Trust, Wakefield, UK
| | - Mark Strong
- EMRiS Group, Health Services Research, School of Health and Related Research (SCHaRR), University of Sheffield, Sheffield, UK
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