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Marincowitz C, Stone T, Bath P, Campbell R, Turner JK, Hasan M, Pilbery R, Thomas BD, Sutton L, Bell F, Biggs K, Hopfgartner F, Mazumdar S, Petrie J, Goodacre S. Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study. BMJ Qual Saf 2024; 33:375-385. [PMID: 35354665 PMCID: PMC8983415 DOI: 10.1136/bmjqs-2021-014382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/04/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess accuracy of telephone triage in identifying need for emergency care among those with suspected COVID-19 infection and identify factors which affect triage accuracy. DESIGN Observational cohort study. SETTING Community telephone triage provided in the UK by Yorkshire Ambulance Service NHS Trust (YAS). PARTICIPANTS 40 261 adults who contacted National Health Service (NHS) 111 telephone triage services provided by YAS between 18 March 2020 and 29 June 2020 with symptoms indicating COVID-19 infection were linked to Office for National Statistics death registrations and healthcare data collected by NHS Digital. OUTCOME Accuracy of triage disposition was assessed in terms of death or need for organ support up to 30 days from first contact. RESULTS Callers had a 3% (1200/40 261) risk of serious adverse outcomes (death or organ support). Telephone triage recommended self-care or non-urgent assessment for 60% (24 335/40 261), with a 1.3% (310/24 335) risk of adverse outcomes. Telephone triage had 74.2% sensitivity (95% CI: 71.6 to 76.6%) and 61.5% specificity (95% CI: 61% to 62%) for the primary outcome. Multivariable analysis suggested respiratory comorbidities may be overappreciated, and diabetes underappreciated as predictors of deterioration. Repeat contact with triage service appears to be an important under-recognised predictor of deterioration with 2 contacts (OR 1.77, 95% CI: 1.14 to 2.75) and 3 or more contacts (OR 4.02, 95% CI: 1.68 to 9.65) associated with false negative triage. CONCLUSION Patients advised to self-care or receive non-urgent clinical assessment had a small but non-negligible risk of serious clinical deterioration. Repeat contact with telephone services needs recognition as an important predictor of subsequent adverse outcomes.
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Affiliation(s)
- Carl Marincowitz
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Tony Stone
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Peter Bath
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Richard Campbell
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Janette Kay Turner
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Madina Hasan
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Benjamin David Thomas
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Laura Sutton
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Katie Biggs
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Frank Hopfgartner
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Suvodeep Mazumdar
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Jennifer Petrie
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Gard J, Howell A, Boubeta C, Corcoran H, Bell F, McMahon K. Sore throat, fever, and pancytopenia during winter. Clin Case Rep 2024; 12:e8800. [PMID: 38659496 PMCID: PMC11039805 DOI: 10.1002/ccr3.8800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Care must be taken to mitigate the effect of cognitive bias in times of frequent common presentations. The etiology of bicytopenias and pancytopenias must always be carefully investigated. Blast cells in low count B ALL may not be seen on a peripheral smear and diagnosis often requires confirmational bone marrow aspirate with flow cytometry and molecular typing.
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Affiliation(s)
- Jye Gard
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
- The Department of Paediatrics, Melbourne Medical SchoolNotre Dame UniversityWerribeeVictoriaAustralia
- The Royal Children's Hospital MelbourneParkvilleVictoriaAustralia
- The Department of Paediatrics, Melbourne Medical SchoolUniversity of MelbourneMelbourneVictoriaAustralia
| | - Amy Howell
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Claudia Boubeta
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Hannah Corcoran
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Fiona Bell
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Kathryn McMahon
- Department of PaediatricsWerribee Mercy HospitalWerribeeVictoriaAustralia
- The Department of Paediatrics, Melbourne Medical SchoolNotre Dame UniversityWerribeeVictoriaAustralia
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3
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Boyd A, Sampson FC, Bell F, Spaight R, Rosser A, Coster J, Millins M, Pilbery R. How consistent are pre-alert guidelines? A review of UK ambulance service guidelines. Br Paramed J 2024; 8:30-37. [PMID: 38445108 PMCID: PMC10910291 DOI: 10.29045/14784726.2024.3.8.4.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Aims Ambulance pre-alerts are used to inform receiving emergency departments (EDs) of the arrival of critically unwell or rapidly deteriorating patients who need time-critical assessment or treatment immediately upon arrival. Inappropriate use of pre-alerts can lead to EDs diverting resources from other critically ill patients. However, there is limited guidance about how pre-alerts should be undertaken, delivered or communicated. We aimed to map existing pre-alert guidance from UK NHS ambulance services to explore consistency and accessibility of existing guidance. Methods We contacted all UK ambulance services to request documentation containing guidance about pre-alerts. We reviewed and mapped all guidance to understand which conditions were recommended for a pre-alert and alignment with Association of Ambulance Chief Executives (AACE) and Royal College of Emergency Medicine (RCEM) pre-alert guidance. We reviewed the language and accessibility of guidance using the AGREE II tool. Results We received responses from 15/19 UK ambulance services and 10 stated that they had specific pre-alert guidance. We identified noticeable variations in conditions declared suitable for pre-alerts in each service, with a lack of consistency within each ambulance service's own guidance, and a lack of alignment with the AACE/RCEM pre-alert guidance. Services listed between four and 45 different conditions suitable for pre-alert. There were differences in physiological thresholds and terminology, even for conditions with established care pathways (e.g. hyperacute stroke, ST segment elevation myocardial infarction). Pre-alert criteria were typically listed in several short sections in lengthy handover procedure policy documents. Documents appraised were of poor quality with low scores below 35% for applicability and overall. Implications There is a clear need for ambulance services to have both policies and tools that complement each other and incorporate the same list of pre-alertable conditions. Clinicians need a single, easily accessible document to refer to in a time-critical situation to reduce the risk of making an incorrect pre-alert decision.
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Affiliation(s)
- Aimée Boyd
- South East Coast Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0003-1030-8167
| | - Fiona C Sampson
- University of Sheffield ORCID iD: https://orcid.org/0000-0003-2321-0302
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4503-1903
| | - Rob Spaight
- East Midlands Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4361-5876
| | - Andy Rosser
- West Midlands Ambulance Service University NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-5477-4269
| | - Jo Coster
- University of Sheffield ORCID iD: https://orcid.org/0000-0002-0599-4222
| | | | - Richard Pilbery
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-5797-9788
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Barrett JW, Eastley KB, Herbland A, Owen P, Naeem S, Mortimer C, King J, Foster T, Rees N, Rosser A, Black S, Bell F, Fothergill R, Mellett-Smith A, Jackson M, McClelland G, Gowens P, Spaight R, Igbodo S, Brown M, Williams J. The COVID-19 ambulance response assessment (CARA) study: a national survey of ambulance service healthcare professionals' preparedness and response to the COVID-19 pandemic. Br Paramed J 2024; 8:10-20. [PMID: 38445107 PMCID: PMC10910287 DOI: 10.29045/14784726.2024.3.8.4.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Background The COVID-19 pandemic placed significant demand on the NHS, including ambulance services, but it is unclear how this affected ambulance service staff and paramedics in other clinical settings (e.g. urgent and primary care, armed services, prisons). This study aimed to measure the self-perceived preparedness and impact of the first wave of the pandemic on paramedics' psychological stress and perceived ability to deliver care. Methods Ambulance clinicians and paramedics working in other healthcare settings were invited to participate in a three-phase sequential online survey during the acceleration (April 2020), peak (May 2020) and deceleration (September/October 2020) phases of the first wave of COVID-19 in the United Kingdom. Recruitment used social media, Trust internal bulletins and the College of Paramedics' communication channels, employing a convenience sampling strategy. Data were collected using purposively developed open- and closed-ended questions and the validated general health questionnaire-12 (GHQ-12). Data were analysed using multi-level linear and logistic regression models. Results Phase 1 recruited 3717 participants, reducing to 2709 (73%) by phase 2 and 2159 (58%) by phase 3. Participants were mostly male (58%, n = 2148) and registered paramedics (n = 1992, 54%). Mean (standard deviation) GHQ-12 scores were 16.5 (5.2) during phase 1, reducing to 15.2 (6.7) by phase 3. A total of 84% of participants (n = 3112) had a GHQ-12 score ≥ 12 during the first phase, indicating psychological distress. Participants that had higher GHQ-12 scores were feeling unprepared for the pandemic, and reported a lack of confidence in using personal protective equipment and managing cardiac arrests in confirmed or suspected COVID-19 patients. Conclusions Most participants reported psychological distress, the reasons for which are multi-factorial. Ambulance managers need to be aware of the risks to staff mental health and take action to mitigate these, to support staff in the delivery of unscheduled, emergency and urgent care under these additional pressures.
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Affiliation(s)
- Jack William Barrett
- South East Coast Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-0040-537X
| | | | - Anthony Herbland
- University of Hertfordshire ORCID iD: https://orcid.org/0000-0001-6182-4191
| | - Peter Owen
- South East Coast Ambulance Service NHS Foundation Trust
| | - Salman Naeem
- Barts Health NHS Trust ORCID iD: https://orcid.org/0000-0002-0153-1669
| | - Craig Mortimer
- South East Coast Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0001-6989-2244
| | - James King
- University of Hertfordshire ORCID iD: https://orcid.org/0000-0001-9259-0957
| | - Theresa Foster
- East of England Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-6395-0885
| | - Nigel Rees
- Welsh Ambulance Services NHS Trust ORCID iD: https://orcid.org/0000-0001-8799-5335
| | - Andy Rosser
- West Midlands Ambulance Service University NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-5477-4269
| | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0001-6678-7502
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4503-1903
| | - Rachael Fothergill
- London Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-1341-6200
| | - Adam Mellett-Smith
- London Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-6157-8979
| | | | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-4502-5821
| | - Paul Gowens
- Scottish Ambulance Service ORCID iD: https://orcid.org/0000-0002-9311-3885
| | - Robert Spaight
- East Midlands Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4361-5876
| | - Sandra Igbodo
- North West Ambulance Service NHS Trust ORCID iD: https://orcid.org/0009-0001-8290-0912
| | - Martina Brown
- South Central Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0003-3083-8958
| | - Julia Williams
- South East Coast Ambulance Service NHS Foundation Trust; University of Hertfordshire; College of Paramedics ORCID iD: https://orcid.org/0000-0003-0796-5465
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Noble AJ, Morris B, Bonnett LJ, Reuber M, Mason S, Wright J, Pilbery R, Bell F, Shillito T, Marson AG, Dickson JM. 'Knowledge exchange' workshops to optimise development of a risk prediction tool to assist conveyance decisions for suspected seizures - Part of the Risk of ADverse Outcomes after a Suspected Seizure (RADOSS) project. Epilepsy Behav 2024; 151:109611. [PMID: 38199055 DOI: 10.1016/j.yebeh.2023.109611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Suspected seizures present challenges for ambulance services, with paramedics reporting uncertainty over whether or not to convey individuals to emergency departments. The Risk of ADverse Outcomes after a Suspected Seizure (RADOSS) project aims to address this by developing a risk assessment tool utilizing structured patient care record and dispatch data. It proposes a tool that would provide estimates of an individual's likelihood of death and/or recontact with emergency care within 3 days if conveyed compared to not conveyed, and the likelihood of an 'avoidable attendance' occurring if conveyed. Knowledge Exchange workshops engaged stakeholders to resolve key design uncertainties before model derivation. METHOD Six workshops involved 26 service users and their significant others (epilepsy or nonepileptic attack disorder), and 25 urgent and emergency care clinicians from different English ambulance regions. Utilizing Nominal Group Techniques, participants shared views of the proposed tool, benefits and concerns, suggested predictors, critiqued outcome measures, and expressed functionality preferences. Data were analysed using Hamilton's Rapid Analysis. RESULTS Stakeholders supported tool development, proposing 10 structured variables for predictive testing. Emphasis was placed on the tool supporting, not dictating, care decisions. Participants highlighted some reasons why RADOSS might struggle to derive a predictive model based on structured data alone and suggested some non-structured variables for future testing. Feedback on prediction timeframes for service recontact was received, along with advice on amending the 'avoidable attendance' definition to prevent the tool's predictions being undermined by potential overuse of certain investigations in hospital. CONCLUSION Collaborative stakeholder engagement provided crucial insights that can guide RADOSS to develop a user-aligned, optimized tool.
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Affiliation(s)
- Adam J Noble
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
| | - Beth Morris
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Laura J Bonnett
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Markus Reuber
- Department of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Suzanne Mason
- Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | | | | | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | | | - Anthony G Marson
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Jon M Dickson
- Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
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Ablard S, Miller E, Poulton S, Cantrell A, Booth A, Lee A, Mason S, Bell F. Delivery of public health interventions by the ambulance sector: a scoping review. BMC Public Health 2023; 23:2082. [PMID: 37875881 PMCID: PMC10598948 DOI: 10.1186/s12889-023-16473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/08/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND With millions of unscheduled patient contacts every year and increasing call outs clustered around the most deprived communities, it is clear the ambulance sector could have a role to play in improving population health. However, the application and value of a public health approach within the ambulance sector has not been comprehensively explored. A scoping review was undertaken to explore the role of the ambulance sector in the delivery of public health interventions and what impact this has on population health and ambulance sector outcomes. METHODS A search strategy was developed on MEDLINE and translated to other major medical and health related bibliographic databases (Embase; CINAHL; HMIC; Science and Social Sciences Citation Index; Cochrane Library) to identify literature published since 2000 in OECD countries. Targeted grey literature, reference list, and citation searching was also carried out. Search results were downloaded to Microsoft Excel and screened by three reviewers according to pre-determined inclusion / exclusion criteria. Data from included studies, such as the type of activity noted within the paper, the population involved and the public health approach that was utilised, was extracted from within the paper using a data extraction form and narratively synthesised. RESULTS Fifty-two references were included in the final review (37 database searching; 9 reference list searching; 6 grey literature). Included articles were categorised according to the relevant public health domains and subdomains as articulated by the UK Faculty of Public Health: 1. Health improvement domain: Public health education and advice (Health promotion sub-domain) (n=13) Emergency Services personnel providing vaccines (Disease prevention sub-domain) (n=1) 2. Health care public health domain Paramedicine (Service delivery sub-domain) (n=30) Screening tools and referral pathways used by the ambulance sector (Service delivery sub-domain) (n=28) Health intelligence using ambulance sector data (population health management sub-domain) (n=26) Of note, some domains (e.g. health protection) returned nil results. DISCUSSION The scoping review demonstrates the breadth of public health related activities in which the ambulance sector is involved. However, an overemphasis on demand management outcomes precludes definitive conclusions on the impact of ambulance sector-led public health initiatives on public health outcomes. Future evaluations of public health initiatives should incorporate wider health system perspectives beyond the immediately apparent remit of the ambulance sector.
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Affiliation(s)
- Suzanne Ablard
- School of Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, England.
| | - Elisha Miller
- Yorkshire Ambulance Service NHS Trust Headquarters, Springhill 2 Brindley Way, WF2 0XQ, Wakefield, England
| | - Steven Poulton
- Yorkshire Ambulance Service NHS Trust Headquarters, Springhill 2 Brindley Way, WF2 0XQ, Wakefield, England
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, England
| | - Andrew Booth
- School of Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, England
| | - Andrew Lee
- School of Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, England
| | - Suzanne Mason
- School of Health and Related Research (ScHARR), The University of Sheffield, S1 4DA, Sheffield, England
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust Headquarters, Springhill 2 Brindley Way, WF2 0XQ, Wakefield, England
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Lightowler B, Hodge A, Pilbery R, Bell F, Best P, Hird K, Walker A, Snaith B. Venous blood point-of-care testing (POCT) for paramedics in urgent and emergency care: protocol for a single-site feasibility study (POCTPara). Br Paramed J 2023; 8:34-41. [PMID: 37284603 PMCID: PMC10240860 DOI: 10.29045/14784726.2023.6.8.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
The COVID-19 pandemic placed the UK healthcare system under unprecedented pressure, and recovery will require whole-system investment in innovative, flexible and pragmatic solutions. Positioned at the heart of the healthcare system, ambulance services have been tasked with addressing avoidable hospital conveyance and reducing unnecessary emergency department and hospital attendances through the delivery of care closer to home. Having begun to implement models of care intended to increase 'see and treat' opportunities through greater numbers of senior clinical decision makers, emphasis has now been placed upon the use of remote clinical diagnostic tools and near-patient or point-of-care testing (POCT) to aid clinical decision making. In terms of POCT of blood samples obtained from patients in the pre-hospital setting, there is a paucity of evidence beyond its utility for measuring lactate and troponin in acute presentations such as sepsis, trauma and myocardial infarction, although potential exists for the analysis of a much wider panel of analytes beyond these isolated biomarkers. In addition, there is a relative dearth of evidence in respect of the practicalities of using POCT analysers in the pre-hospital setting. This single-site feasibility study aims to understand whether it is practical to use POCT for the analysis of patients' blood samples in the urgent and emergency care pre-hospital setting, through descriptive data of POCT application and through qualitative focus group interviews of advanced practitioners (specialist paramedics) to inform the feasibility and design of a larger study. The primary outcome measure is focus group data measuring the experiences and perceived self-reported impact by specialist paramedics. Secondary outcome measures are number and type of cartridges used, number of successful and unsuccessful attempts in using the POCT analyser, length of time on scene, specialist paramedic recruitment and retention, number of patients who receive POCT, descriptive data of safe conveyance, patient demographics and presentations where POCT is applied and data quality. The study results will inform the design of a main trial if indicated.
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Affiliation(s)
- Bryan Lightowler
- University of Bradford ORCID iD: https://orcid.org/0000-0002-9884-6762
| | - Andrew Hodge
- The Mid-Yorkshire Hospitals NHS Trust ORCID iD: https://orcid.org/0000-0002-2632-2249
| | - Richard Pilbery
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-5797-9788
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4503-1903
| | - Pete Best
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0009-0002-7298-1138
| | - Kelly Hird
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0009-0000-1146-022X
| | - Alison Walker
- Harrogate and District NHS Foundation Trust ORCID iD: https://orcid.org/0009-0000-9235-2676
| | - Beverly Snaith
- The Mid-Yorkshire Hospitals NHS Trust ORCID iD: https://orcid.org/0000-0002-6296-0889
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Wilson C, Bell F. 'Research paramedic' and 'paramedic researcher': two different sides of the same coin. Br Paramed J 2023; 8:53. [PMID: 37284608 PMCID: PMC10240858 DOI: 10.29045/14784726.2023.6.8.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- Caitlin Wilson
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0002-9854-4289
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4503-1903
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9
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Sampson FC, Bell F, Coster JE, Miller E, Easom N. Stakeholder perspectives of piloting pre-hospital COVID-19 lateral flow testing and direct admissions pathway: exploring why well-received ideas have low uptake. Br Paramed J 2022; 7:15-25. [PMID: 36531798 PMCID: PMC9730192 DOI: 10.29045/14784726.2022.12.7.3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Introduction In January 2021, Yorkshire Ambulance Service and Hull University Teaching Hospitals implemented a pilot COVID-19 lateral flow testing (LFT) and direct admissions pathway to assess the feasibility of using pre-hospital LFTs to bypass the emergency department. Due to lower than anticipated uptake of the pilot among paramedics, we undertook a process evaluation to assess reasons for low uptake and perceived potential benefits and risks associated with the pilot. Methods We undertook semi-structured telephone interviews with 12 paramedics and hospital staff. We aimed to interview paramedics who had taken part in the pilot, those who had received the project information but not taken part and ward staff receiving patients from the pilot. We transcribed interviews verbatim and analysed data using thematic analysis. Results Participation in the pilot appeared to be positively influenced by high personal capacity for undertaking research (being 'research-keen') and negatively influenced by 'COVID-19 exhaustion', electronic information overload and lack of time for training. Barriers to use of the pathway related to 'poor timing' of the pilot, restrictive patient eligibility and inclusion criteria. The rapid rollout meant that paramedics had limited knowledge or awareness of the pilot, and pilot participants reported poor understanding of the pilot criteria or the rationale for the criteria. Participants who were involved in the pilot were overwhelmingly positive about the intervention, which they perceived as having limited risks and high potential benefits to the health service, patients and themselves, and supported future roll-out. Conclusions Ambulance clinician involvement in rapid research pilots may be improved by using multiple recruitment methods (electronic and other), providing protected time for training and increased direct support for paramedics with lower personal capacity for research. Improved communication (including face-to-face approaches) may help understanding of eligibility criteria and increase appropriate recruitment.
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Affiliation(s)
- Fiona C Sampson
- University of Sheffield ORCID iD: https://orcid.org/0000-0003-2321-0302
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4503-1903
| | - Joanne E Coster
- University of Sheffield ORCID iD: https://orcid.org/0000-0002-0599-4222
| | | | - Nicholas Easom
- Hull University Teaching Hospital NHS Trust ORCID iD: https://orcid.org/0000-0001-6413-919X
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Phung VH, Sanderson K, Pritchard G, Bell F, Hird K, Wankhade P, Asghar Z, Siriwardena N. The experiences and perceptions of wellbeing provision among English ambulance services staff: a multi-method qualitative study. BMC Health Serv Res 2022; 22:1352. [PMCID: PMC9664049 DOI: 10.1186/s12913-022-08729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
NHS ambulance service staff are at risk of poor physical and mental wellbeing because of the likelihood of encountering stressful and traumatic incidents. While reducing sickness absence and improving wellbeing support to ambulance staff is a key NHS priority, few studies have empirically documented a national picture to inform policy and service re-design. The study aimed to understand how ambulance service trusts in England deal with staff health and wellbeing, as well as how the staff perceive and use wellbeing services.
Methods
To achieve our aim, we undertook semi-structured telephone interviews with health and wellbeing leads and patient-facing ambulance staff, as well as undertaking documentary analysis of ambulance trust policies on wellbeing. The study was conducted both before and during the UK first COVID-19 pandemic wave. The University of Lincoln ethics committee and the Health Research Authority (HRA) granted ethical approval. Overall, we analysed 57 staff wellbeing policy documents across all Trusts. Additionally, we interviewed a Health and Wellbeing Lead in eight Trusts as well as 25 ambulance and control room staff across three Trusts.
Results
The study highlighted clear variations between organisational and individual actions to support wellbeing across Trust policies. Wellbeing leads acknowledged real ‘tensions’ between individual and organisational responsibility for wellbeing. Behaviour changes around diet and exercise were perceived to have a positive effect on the overall mental health of their workforce. Wellbeing leads generally agreed that mental health was given primacy over other wellbeing initiatives. Variable experiences of health and wellbeing support were partly contingent on the levels of management support, impacted by organisational culture and service delivery challenges for staff.
Conclusion
Ambulance service work can impact upon physical and mental health, which necessitates effective support for staff mental health and wellbeing. Increasing the knowledge of line managers around the availability of services could improve engagement.
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Phung VH, Pritchard G, Sanderson K, Bell F, Hird K, Wankhade P, Asghar Z, Siriwardena N. PP42 Perceptions and experiences of wellbeing provision for NHS ambulance staff: a qualitative interview study of wellbeing leads and frontline staff. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-999.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe wellbeing of ambulance staff is critical to their safety and safe care delivery. This study examined the perceptions of English NHS ambulance Trust health and wellbeing leads, and the experiences of UK ambulance staff of workplace wellbeing culture and provision.MethodsSemi-structured telephone interviews were undertaken with staff wellbeing leads for eight NHS ambulance trusts in England and with ambulance staff from three NHS ambulance trusts in England, selected to represent services with high, medium or low relative sickness absence rates. Interviews were subsequently transcribed, coded and analysed using Framework Analysis (FA).ResultsWe interviewed eight wellbeing leads and 25 frontline ambulance staff from April-November 2020. Decisions around what was included in or omitted from wellbeing policies sometimes led to conflict between wellbeing leads and their superiors. Ambulance work was perceived as inherently unhealthy because of work stress and the risk of encountering traumatic incidents. Well-being leads understood the adverse impacts of work on mental health for some staff. Ambulance staff wanted empathy, understanding and practical support from managers, but the reality did not always match these needs, because of variability in provision and experiences of health and wellbeing services, poor behaviours or attitudes from line managers, and a stigmatising rather than open organisational culture. COVID-19 not only impacted significantly on staff health and wellbeing, but also challenged how ambulance trusts support them.ConclusionsThe importance of an open organisational culture and the variable availability and experiences of interventions to support staff to stay well at work means that improvements are needed in both to ensure positive staff mental health and wellbeing. Early interventions, improved training for line managers to support staff at work, bespoke wellbeing services and an open culture are key to delivering effective support to ambulance staff, especially in the light of the COVID-19 pandemic.
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Sampson FC, Coster J, Bell F, Miller E, Easom N. PP28 Stakeholder perspectives of piloting pre-hospital COVID-19 lateral flow test and direct admissions pathway: exploring why well received ideas have low uptake. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-999.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn January 2021 Yorkshire Ambulance Service and Hull University Teaching Hospitals implemented a pilot COVID-19 lateral flow testing (LFT) and direct admissions pathway to assess the feasibility of using pre-hospital LFTs to bypass the Emergency Department. Due to lower than anticipated uptake of the pilot amongst paramedics, we undertook a service evaluation to assess reasons for low uptake and perceived potential benefits and risks associated with the pilot.MethodsWe undertook semi-structured telephone interviews with 12 paramedics and hospital staff. We aimed to interview paramedics who had taken part in the pilot, those who had received the project information but not taken part and ward staff receiving patients from the pilot. We transcribed interviews verbatim and analysed data using thematic analysis according to the principles of Braun & Clarke (Ref).ResultsParticipants who were involved in the pilot were overwhelmingly positive about the intervention, which they perceived as having limited risks and high potential benefits to the health service, patients and themselves and supported future roll-out. Participation in the pilot appeared to be positively influenced by high personal capacity for undertaking research (being ‘research-keen) and negatively influenced by ‘COVID-19 exhaustion’, electronic information overload and lack of time for training. Barriers to use of the pathway related to ‘poor timing’ of the pilot, restrictive patient eligibility and inclusion criteria. The rapid rollout meant that paramedics had limited knowledge or awareness of the pilot, and pilot participants reported poor understanding of the pilot criteria or the rationale for the criteria.ConclusionsAmbulance clinician involvement in rapid research pilots may be improved by using multiple recruitment methods (electronic and other), providing protected time for training and increased direct support for paramedics with lower personal capacity for research. Improved communication (including face-to-face approaches) may help understanding of eligibility criteria and increase appropriate recruitment.
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Porter A, Bell F, Brady M, Brown S, Carson-Stevens A, Duncan E, England L, Evans B, Foster T, Gallanders J, Gunson I, Harrington B, Harris-Mayes R, Kingston M, Lyons R, Miller E, Newton A, Quinn T, Rosser A, Siriwardena N, Snooks H, Spaight R, Watkins A, Williams V. PP45 ‘Every day was a learning curve’: the experience of implementing COVID-19 triage protocols in UK ambulance services – a qualitative study. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-999.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundTRIM is an evaluation of the models used to triage and manage emergency ambulance service care for patients with suspected Covid-19 during the first wave of the pandemic in 2020. We aimed to understand experiences and concerns of clinical and managerial staff about implementation of triage protocols in call centre and on-scene.MethodsResearch paramedics in four study sites across England interviewed purposively selected stakeholders from ambulance services (call handlers, clinical advisors in call centres, clinicians providing emergency response, managers) and ED clinical staff from one hospital per site. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from the implicit and explicit ideas within participants’ accounts, following the six stages of analysis described by Braun and Clarke, conducted by a group of researchers and PPI partners working together.ResultsWe identified the following themes:Constantly changing guidelines – at some points, updates several times a dayThe ambulance service as part of the wider healthcare system - changes in other parts of the healthcare system left ambulance services as the default optionPeaks and troughs of demand - demand fluctuated greatly over time, with workload varying across the ambulance service, including an increased role for clinical advisorsA stretched system - resources to respond to patient demand were stretched thinner by staff sickness and isolation, longer job times, and increased handover delays at EDEmotional load of responding to the pandemic - particularly for call centre staffDoing the best they can in the face of uncertainty - in the face of a rapidly evolving situation unlike any which ambulance services had faced beforeDiscussionImplementing triage protocols in response to the Covid-19 pandemic was a complex and process which had to be actively managed by a range of front line staff, dealing with external pressures and a heavy emotional load.
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Sampson FC, Bell F, Webster P, Coster J, O’Hara R, Goodacre S, Foster A, Miles J, Millins M, Pountney A, Rosser A, Spaight R, Turner J, Boyd A, Pilbery R, Long J. PP26 Exploring the use of pre-hospital pre-alerts and their impact on patients, ambulance service and emergency department staff: protocol for a mixed methods study. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-999.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAmbulance clinicians use pre-alert calls to inform receiving emergency departments (EDs) of the arrival of a critically unwell patient that will require a specialised response. Little is known about how a decision to pre-alert is made and how this is communicated and acted upon in the receiving ED. Whilst appropriate use of pre-alerts benefits patient care, their overuse carries a risk of harm or opportunity costs. The impact of pre-alerts on ambulance clinicians, ED staff and patients is not currently well understood.MethodsWe are conducting a mixed methods study with five inter-related work packages. We will analyse 12 months of routine data from ambulance pre-alerts in three regions to identify factors in the variation of pre-alert use, including pre-hospital decision-making. We will undertake a national online Qualtrics survey of ambulance clinician perspectives and experience of pre-alerts. We will explore the impacts of a pre-alert on staff, ED facilities and the patient using semi-structured interviews with ambulance clinicians, ED staff, patients and carers and undertake non-participant observation of ED pre-alert response.Expected ResultsWe will describe current pre-alert practice using 12 months’ data for 3 Ambulance Services, including volume and types of pre-alerts. We will identify specific conditions or patient groups for whom pre-alerts are most likely to lead to change in clinical practice, or for whom action is unlikely to provide benefit. We will hold a feedback workshop in which we will share and discuss our findings with key stakeholders.ConclusionsCurrent variation in pre-alert processes, both pre-hospital and in-hospital and the impact on patient care is not understood. The outputs of this study will establish an evidence base to update national guidance for pre-alert practice and identify areas of good pre-alert practice for both ambulance service and Emergency Department staff.
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Ablard S, Cantrell A, Poulton S, Miller E, Booth A, Lee A, Mason S, Bell F. PP22 Delivery of public health interventions by the ambulance sector. J Accid Emerg Med 2022. [DOI: 10.1136/emermed-2022-999.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWith millions of unscheduled patient contacts every year and increasing call outs clustered around the most deprived communities, it is clear the ambulance sector could have a role to play in improving population health. However, the application and value of a public health approach within the ambulance sector has not been comprehensively explored.A rapid review was undertaken to explore the role of the ambulance sector in the delivery of public health interventions and what impact this has on population health and ambulance sector outcomes.MethodsA search strategy was developed to identify published and peer reviewed literature published since 2000 in OECD countries. Targeted grey literature, reference list, and citation searching was also carried out.Search results were downloaded to Microsoft Excel and screened by three reviewers according to pre-determined inclusion/exclusion criteria. Data from included studies was extracted using a data extraction form and narratively synthesized.Results2,399 records were identified, with 49 references included in the final review.Types of public health activity the ambulance sector is involved in were: public health education and advice; emergency medical services providing vaccines; paramedicine; screening tools and referral pathways; and health intelligence using ambulance sector data.ConclusionEvaluations of public health interventions included in the review focused on demand management outcomes (e.g. ambulance call–outs) rather than longer term public health outcomes. Future evaluations need to include data from multiple health sectors (e.g. social services, primary care) to assess the impact of the initiative both by and beyond the ambulance sectorThe ambulance sector should make every clinical contact count, maximising opportunities for public health intervention, prevention, and education. However, this is contingent on the skills and willingness of the workforce to do so, and sufficient time within the role given significant system and operational pressures in the sector
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Marincowitz C, Stone T, Bath P, Campbell R, Turner J, Pilbery R, Thomas B, Sutton L, Bell F, Biggs K, Hopfgartner F, Hussein M, Mazumdar S, Petrie J, Goodacre S. Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: An observational cohort study linking NHS 111 telephone triage, primary and secondary healthcare and mortality records. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectivesSettings in identifying need for emergency care amongst those with suspected COVID-19 infection and identify factors which affect triage accuracy.
ApproachAn observational cohort study of adults who contacted the NHS 111 telephone triage service provided by Yorkshire Ambulance Service between March and June 2020 with symptoms indicating possible COVID-19 infection. Patient-level data encompassing triage call, primary care, hospital care and death registration records relating to 40,261 adults were linked.
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. Multivariable logistic regression was used to identify factors associated with risk of false negative or false positive triage.
ResultsCallers had a 3% (1,200/40,261) risk of serious adverse outcomes. Telephone triage recommended self-care or non-urgent assessment for 60% (24,335/40,261), with a 1.3% (310/24,335) risk of adverse outcomes 30 days from first contact. Telephone triage had 74.2% sensitivity (95% CI: 71.6 to 76.6%) and 61.5% specificity (61% to 62%) for the primary outcome. Analysis suggested respiratory comorbidities may be over-appreciated and diabetes under-appreciated as predictors of deterioration. Repeat contact with triage service appears to be an important under-recognised predictor of deterioration.
ConclusionPatients advised to self-care or receive non-urgent clinical assessment had a small but non-negligible risk of serious clinical deterioration. Repeat contact with telephone services needs recognition as an important predictor of subsequent adverse outcomes.
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Abdel-Fattah AR, Bell F, Boden L, Ferry J, McCormick C, Ross M, Cameron I, Smith T, Baliga S, Myint P. 327 To Fuse or Not to Fuse: The Elderly Patient with Lumbar Stenosis and Low-Grade Spondylolisthesis. Systematic Review and Meta-Analysis of Randomised Controlled Trials. Br J Surg 2022. [DOI: 10.1093/bjs/znac268.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
The optimum surgical intervention for elderly patients with lumbar spinal stenosis(LSS) and low-grade degenerative-spondylolisthesis(LGDS) has been extensively debated. We conducted a systematic review and meta-analysis of randomised-controlled-trials(RCTs) comparing the effectiveness of decompression-alone against gold-standard decompression-with-fusion(D+F) in elderly patients with LSS and LGDS.
Method
A systematic literature search was performed on published databases from inception to October-2021. English-language RCTs of elderly patients (mean age over-65) with LSS and LGDS, who had undergone DA or D+F were included. The quality and weight of evidence was assessed, and a meta-analysis performed.
Results
Seven RCTs (n=581; mean age:65.9 years; 59.9% female) were included. There was no difference in visual-analogue-scale(VAS) scores of back-pain(BP) or leg-pain(LP) at mean follow-up of 28.6 months between both DA and D+F groups (BP: mean-difference (MD)-0.22, 95%CI:-0.76–0.32; LP: MD:-0.26, 95%CI:-0.79–0.27). In addition, subgroup analysis of long-term follow-up (>3 years) showed lower VAS scores for BP and LP in patients who underwent DA (BP MD:-1.70, 95%CI:-2.8-(-0.60); LP MD:-1.00, 95%CI:-1.77-(-0.23)). No difference in disability, measured by Oswestry-Disability-Index(ODI) scores, was found between both groups (MD:0.50, 95%CI: -3.31–4.31). However, patients in DA group had less hospital complications and fewer adverse events (total-surgical-complications OR:0.57, 95%CI:0.36–0.90), despite a higher rate of post-operative DS (OR:8.63, 95%CI:3.35–22.26).
Conclusions
DA is not inferior to D+F in elderly patients with LSS and LGDS. DA has better pain outcomes at three-years follow-up and carries lower risk hospital-complications and fewer adverse-events. Surgeons should weigh these findings with increased risk of DS-progression.
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Affiliation(s)
- AR Abdel-Fattah
- University of Aberdeen , Aberdeen , United Kingdom
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen , Aberdeen , United Kingdom
| | - F Bell
- University of Aberdeen , Aberdeen , United Kingdom
| | - L Boden
- University of Aberdeen , Aberdeen , United Kingdom
| | - J Ferry
- University of Aberdeen , Aberdeen , United Kingdom
| | - C McCormick
- University of Aberdeen , Aberdeen , United Kingdom
| | - M Ross
- University of Aberdeen , Aberdeen , United Kingdom
| | - I Cameron
- University of Aberdeen , Aberdeen , United Kingdom
| | - T Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford , Oxford , United Kingdom
| | - S Baliga
- Department of Trauma & Orthopaedics , Aberdeen Royal Infirmary, Aberdeen , United Kingdom
| | - P Myint
- University of Aberdeen , Aberdeen , United Kingdom
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen , Aberdeen , United Kingdom
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Marincowitz C, Stone T, Hasan M, Campbell R, Bath PA, Turner J, Pilbery R, Thomas BD, Sutton L, Bell F, Biggs K, Hopfgartner F, Mazumdar S, Petrie J, Goodacre S. Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study. BMJ Open 2022; 12:e058628. [PMID: 35577471 PMCID: PMC9114316 DOI: 10.1136/bmjopen-2021-058628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess accuracy of emergency medical service (EMS) telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy. DESIGN Observational cohort study. SETTING Emergency telephone triage provided by Yorkshire Ambulance Service (YAS) National Health Service (NHS) Trust. PARTICIPANTS 12 653 adults who contacted EMS telephone triage services provided by YAS between 2 April 2020 and 29 June 2020 assessed by COVID-19 telephone triage pathways were included. OUTCOME Accuracy of call handler decision to dispatch an ambulance was assessed in terms of death or need for organ support at 30 days from first contact with the telephone triage service. RESULTS Callers contacting EMS dispatch services had an 11.1% (1405/12 653) risk of death or needing organ support. In total, 2000/12 653 (16%) of callers did not receive an emergency response and they had a 70/2000 (3.5%) risk of death or organ support. Ambulances were dispatched to 4230 callers (33.4%) who were not conveyed to hospital and did not deteriorate. Multivariable modelling found variables of older age (1 year increase, OR: 1.05, 95% CI: 1.04 to 1.05) and presence of pre-existing respiratory disease (OR: 1.35, 95% CI: 1.13 to 1.60) to be predictors of false positive triage. CONCLUSION Telephone triage can reduce ambulance responses but, with low specificity. A small but significant proportion of patients who do not receive an initial emergency response deteriorated. Research to improve accuracy of EMS telephone triage is needed and, due to limitations of routinely collected data, this is likely to require prospective data collection.
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Affiliation(s)
- Carl Marincowitz
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Tony Stone
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Madina Hasan
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Richard Campbell
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Peter A Bath
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Janette Turner
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Benjamin David Thomas
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Laura Sutton
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Katie Biggs
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Frank Hopfgartner
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Suvodeep Mazumdar
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Jennifer Petrie
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Marincowitz C, Goodacre S, Stone T, Campbell R, Hasan M, Thomas B, Turner J, Pilberry R, Bell F. 798 Accuracy of telephone triage for predicting adverse outcomes in suspected COVID-19: an observational cohort study. Emerg Med J 2022. [DOI: 10.1136/emermed-2022-rcem.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Aims/Objectives/BackgroundTo reduce the risk of spreading infection and hospitals being overwhelmed, on the 18th February 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 29th June 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, 261 Adverse OutcomeNo Adverse OutcomeAmbulance/urgent assessment 890 15, 035 Sensitivity 74.2% (71.6- 76.6%)Positive Predictive Value5.6% (5.2 - 6%) Self-care/non-urgent assessment 310 24, 025 Specificity 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.
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Marincowitz C, Sutton L, Stone T, Pilbery R, Campbell R, Thomas B, Turner J, Bath PA, Bell F, Biggs K, Hasan M, Hopfgartner F, Mazumdar S, Petrie J, Goodacre S. Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: an observational cohort study. Emerg Med J 2022; 39:317-324. [PMID: 35140074 PMCID: PMC8844966 DOI: 10.1136/emermed-2021-211934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/02/2022] [Indexed: 12/24/2022]
Abstract
Background Tools proposed to triage patient acuity in COVID-19 infection have only been validated in hospital populations. We estimated the accuracy of five risk-stratification tools recommended to predict severe illness and compared accuracy to existing clinical decision making in a prehospital setting. Methods An observational cohort study using linked ambulance service data for patients attended by Emergency Medical Service (EMS) crews in the Yorkshire and Humber region of England between 26 March 2020 and 25 June 2020 was conducted to assess performance of the Pandemic Respiratory Infection Emergency System Triage (PRIEST) tool, National Early Warning Score (NEWS2), WHO algorithm, CRB-65 and Pandemic Medical Early Warning Score (PMEWS) in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support. Results Of the 7549 patients in our cohort, 17.6% (95% CI 16.8% to 18.5%) experienced the primary outcome. The NEWS2 (National Early Warning Score, version 2), PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes with a high sensitivity (>0.95) and specificity ranging from 0.3 (NEWS2) to 0.41 (PRIEST tool). The high sensitivity of NEWS2 and PMEWS was achieved by using lower thresholds than previously recommended. On index assessment, 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84 (95% CI 0.83 to 0.85) and specificity of 0.39 (95% CI 0.39 to 0.40). Conclusion Use of NEWS2, PMEWS, PRIEST tool and WHO algorithm could improve sensitivity of EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool would improve sensitivity of triage without increasing the number of patients conveyed to hospital.
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Affiliation(s)
- Carl Marincowitz
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Laura Sutton
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Tony Stone
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | | | - Richard Campbell
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Benjamin Thomas
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Janette Turner
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Peter A Bath
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.,Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Katie Biggs
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Madina Hasan
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Frank Hopfgartner
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Suvodeep Mazumdar
- Centre for Health Information Management Research (CHIMR) and Health Informatics Research Group, Information School, University of Sheffield, Sheffield, UK
| | - Jennifer Petrie
- Clinical Trials Research Unit (CTRU), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- Centre for Urgent and Emergency Care Research (CURE), Health Services Research School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Gavin P, Bell F. Exploring the role of an advanced physiotherapy practitioner as an independent non-medical prescriber within a secondary care chronic pain service. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bell F, Tocher E. Exploring patients’ perceptions of outcome measures after completing a pain management programme: A qualitative study. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Asghar ZB, Wankhade P, Bell F, Sanderson K, Hird K, Phung VH, Siriwardena AN. Trends, variations and prediction of staff sickness absence rates among NHS ambulance services in England: a time series study. BMJ Open 2021; 11:e053885. [PMID: 34588266 PMCID: PMC8483034 DOI: 10.1136/bmjopen-2021-053885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our aim was to measure ambulance sickness absence rates over time, comparing ambulance services and investigate the predictability of rates for future forecasting. SETTING All English ambulance services, UK. DESIGN We used a time series design analysing published monthly National Health Service staff sickness rates by gender, age, job role and region, comparing the 10 regional ambulance services in England between 2009 and 2018. Autoregressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) models were developed using Stata V.14.2 and trends displayed graphically. PARTICIPANTS Individual participant data were not available. The total number of full-time equivalent (FTE) days lost due to sickness absence (including non-working days) and total number of days available for work for each staff group and level were available. In line with The Data Protection Act, if the organisation had less than 330 FTE days available during the study period it was censored for analysis. RESULTS A total of 1117 months of sickness absence rate data for all English ambulance services were included in the analysis. We found considerable variation in annual sickness absence rates between ambulance services and over the 10-year duration of the study in England. Across all the ambulance services the median days available were 1 336 888 with IQR of 548 796 and 73 346 median days lost due to sickness absence, with IQR of 30 551 days. Among clinical staff sickness absence varied seasonally with peaks in winter and falls over summer. The winter increases in sickness absence were largely predictable using seasonally adjusted (SARIMA) time series models. CONCLUSION Sickness rates for clinical staff were found to vary considerably over time and by ambulance trust. Statistical models had sufficient predictive capability to help forecast sickness absence, enabling services to plan human resources more effectively at times of increased demand.
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Affiliation(s)
- Zahid B Asghar
- Community and Health Research Unit, Lincoln Medical School, School of Health and Social Care, University of Lincoln-Brayford Campus, Lincoln, UK
| | - Paresh Wankhade
- Business School, Edge Hill University, Ormskirk, Liverpool, UK
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Kristy Sanderson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Kelly Hird
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Viet-Hai Phung
- Community and Health Research Unit, Lincoln Medical School, School of Health and Social Care, University of Lincoln-Brayford Campus, Lincoln, UK
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit, Lincoln Medical School, School of Health and Social Care, University of Lincoln-Brayford Campus, Lincoln, UK
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Johnston S, Snooks H, Jones J, Bell F, Benger J, Black S, Dixon S, Edwards A, Evans B, Fuller G, Goodacre S, Hoskins R, John A, Lawrence B, Moore C, Parry E, Hird K, Wait S, Watkins A. PP25 The take home naloxone intervention multicentre emergency setting feasibility (TIME) trial: an early perspective from one UK ambulance service. Arch Emerg Med 2021. [DOI: 10.1136/emermed-2021-999.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDrug poisoning deaths in England and Wales have increased by 52% since 2011 with over half involving opioids. Deaths are preventable if naloxone is administered in time. Take Home Naloxone (THN) kits have been distributed through drug services; however, uptake is low and effectiveness unproven. The TIME trial tests the feasibility of conducting a full randomised controlled trial of providing THN administration and basic life support training to high-risk opioid-users in emergency care settings.MethodsA multi-site feasibility trial commenced in June 2019 with two hospitals and their surrounding ambulance services (Bristol Royal Infirmary (BRI) with South Western Ambulance NHS Foundation Trust (SWASFT) and Hull Royal Infirmary with Yorkshire Ambulance Service) randomly allocated to intervention arms; and sites in Wrexham and Sheffield allocated as ‘usual care’ controls. SWASFT began recruiting in October 2019 with the aim of recruiting and training 50% (n=111) of paramedics working within the BRI’s catchment area, to supply THN to at least 100 eligible patients during a 12-month period.ResultsThe trial was suspended between 17.03.2020-06.08.2020 and extended to 01.03.2021 (COVID-19). Despite this, 121 SWASFT paramedics undertook TIME training. TIME trained paramedics attended 30% (n=57) of the n=190 opioid-related emergency calls requiring naloxone administration during the study period. A total of n=29 potentially eligible patients were identified before and n=28 after the COVID-19 suspension. Two patients were supplied with THN during each period. During the COVID-19 suspension, twenty-two potentially eligible patients were missed. The majority of eligible patients presented with a reduced consciousness level, preventing recruitment (73%; n=42/48). These patients were transported to hospital for further treatment (n=39) or died on scene following advanced life support (n=3).ConclusionsThe lowered consciousness levels of prehospital emergency ambulance patients who present with opioid poisoning, often prevent the delivery of training required to enable the supply of THN.
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Bell F, Pilbery R, Connell R, Fletcher D, Leatherland T, Cottrell L, Webster P. The acceptability and safety of video triage for ambulance service patients and clinicians during the COVID-19 pandemic. Br Paramed J 2021; 6:49-58. [PMID: 34539255 PMCID: PMC8415205 DOI: 10.29045/14784726.2021.9.6.2.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction In response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust introduced video technology to supplement remote triage and 'hear and treat' consultations as a pilot project in the EOC. We conducted a service evaluation with the aim of investigating patient and staff acceptability of video triage, and the safety of the decision-making process. Methods This service evaluation utilised a mixture of routine and bespoke data collection. We sent postal surveys to patients who were recipients of a video triage, and clinicians who were involved in the video triage pilot logged calls they attempted and undertook. Results Between 27 March and 25 August 2020, clinicians documented 1073 triage calls. A successful video triage call was achieved in 641 (59.7%) cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) were also satisfied with the technology and with the care they received. Callers receiving video triage that ended with a disposition of 'hear and treat' had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical hub telephone triage alone (16/212, 7.5% vs. 2508/14349, 17.5% respectively). Conclusion In this single NHS Ambulance Trust evaluation, the use of video triage for low-acuity calls appeared to be safe, with low rates of re-contact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate for or acceptable to patients and technical issues were not uncommon.
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Affiliation(s)
- Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID: https://orcid.org/0000-0003-4503-1903
| | - Richard Pilbery
- Yorkshire Ambulance Service NHS Trust ORCID: https://orcid.org/0000-0002-5797-9788
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Bell F, Hodge A, Pilbery R, Whiterod S. PP31 Patterns of use of ambulance senior support during the COVID-19 pandemic: a service evaluation. Arch Emerg Med 2021. [DOI: 10.1136/emermed-2021-999.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn early March 2020, a senior clinical support cell (SCSC) was established within Yorkshire Ambulance Service NHS Trust (YAS). The SCSC aimed to provide an additional layer of clinical leadership within the Emergency Operations Centre to support call centre and decision support for on-scene ambulance staff working in challenging circumstances. It was staffed by advanced practitioners, doctors and other senior paramedics with range of diverse skills from critical to urgent care. We aimed to understand the patterns of use of a SCSC for emergency 999 calls during the COVID-19 pandemic.MethodsRoutinely collected call data was retrospectively analysed to understand the patterns of use in the first three months of the service. The reason for the call, patient demographic and any regional differences were described. An anonymous survey was distributed to frontline ambulance crews to understand the reasons for contacting the SCSC, or not, and the outcomes of that contact for patient care.Results7296 patient care episodes received either a telephone triage by SCSC for 999 calls or 111 calls transferred for an emergency ambulance response (3160) or had telephone support provided to crews on scene (4136). Telephone triage accounted for 3160 calls where 642 cases (20.3%) resulted in a hear-and-treat outcome, and the findings suggest a low re-contact rate within 24 hours at 2.4%.The primary reasons for crews seeking support/advice from the SCSC were discharge advice or permission (37%); support for pathways in their area (25%); or for cases where patients refused care or conveyance (11%).ConclusionsSCSC was developed in response to the COVID-19 pandemic, and lessons can be learned to prepare for any future significant service challenges as a result of the rapid implementation of the SCSC and the clinical leadership required to support the pace of change and emerging clinical knowledge and practice.
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Bell F, Pilbery R, Connell R, Fletcher D, Leatherland T, Cottrell L, Webster P. PP35 The acceptability and safety of video triage for ambulance service patients and clinicians during the covid-19 pandemic: a service evaluation. Emerg Med J 2021. [DOI: 10.1136/emermed-2021-999.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionIn response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust (YAS) introduced video call technology to supplement remote triage and ‘hear and treat’ consultations as a pilot project in the Emergency Operations Centre (EOC). We aimed to investigate patient and staff acceptability of video triage, and the safety of the decision-making process.MethodsThis service evaluation utilised a mixture of routine 999 call and bespoke data collection from participating clinicians who logged calls they both attempted and undertook. We sent postal surveys to a group of patients who were recipients of a video triage.ResultsBetween 27th March 2020 and 25th August 2020 clinicians documented 1073 video triage calls. A successful video triage call was achieved in 641 (59.7%) of cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) viewed the technology, the ambulance staff and the care planning favourably.Callers receiving video triage that ended with a disposition of ‘hear and treat’, had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical support desk telephone triage alone (16/212, 7.5% vs 2508/14349, 17.5% respectively.)ConclusionIn this single NHS Ambulance Trust evaluation, the use of video triage for low acuity calls appeared to be safe, with low rates of recontact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate or acceptable to patients and technical issues were not uncommon.
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Fish D, Bell F, O’Connell C, Walker A, Evans L, Ramlakhan S. PP40 Pre-hospital and emergency department analgesia for paediatric trauma – a survey of UK trauma centres and ambulance services supports consideration of alternatives such as ketamine. Emerg Med J 2021. [DOI: 10.1136/emermed-2021-999.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundStudies have found that pre-hospital and emergency department (ED) analgesia for children is sub-optimal. In the pre-hospital setting, barriers include limited parenteral routes, education or clinical experience and practice legislation restricting the use of opioids by paramedics. Ketamine is safe and effective with multiple administration routes. It is not bound by the controlled drugs limitations in the pre-hospital setting, and is familiar to pre-hospital and ED practitioners.MethodsQuestionnaires were sent to all UK Ambulance Service Medical Directors and Paediatric Major Trauma Centres to establish current use of parenteral analgesics, and acceptability of alternatives in pre-hospital care such as ketamine. Descriptive analysis was undertaken.ResultsIntranasal opiates were the first line parenteral analgesics in injured children in all EDs. Frequent shortages of IN diamorphine resulted in more variability of second line choices, with 40% opting for another opioid. 96% of EDs would support the use of ketamine by pre-hospital clinicians, although concerns regarding inappropriate (IV) use and use by technician crews were raised. Most ED clinicians were unaware of the limited analgesic choices available to paramedics, with many suggesting alternative opiates as well as ketamine.All ambulance service directors recognised the need for alternative analgesics being made available. Without legislative changes, inhaled/IN agents or oral opiates were the only current options. All services were supportive of research to explore the use of ketamine by paramedics for injured children.ConclusionsThere is support for the addition of IN ketamine into paramedics’ repertoire of analgesics and recognition of potential benefit. However, there is a lack of experience and evidence around its use, thus warranting research to consider the impact on analgesic timeliness, adequacy and effectiveness. An analgesia ‘system of care’ which integrates pre- and in-hospital practice would be facilitated by the use of medicines effective in managing pain and familiar to practitioners in both settings.
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Snooks H, Watkins AJ, Bell F, Brady M, Carson‐Stevens A, Duncan E, Evans BA, England L, Foster T, Gallanders J, Gunson I, Harris‐Mayes R, Kingston M, Lyons R, Miller E, Newton A, Porter A, Quinn T, Rosser A, Siriwardena AN, Spaight R, Williams V. Call volume, triage outcomes, and protocols during the first wave of the COVID-19 pandemic in the United Kingdom: Results of a national survey. J Am Coll Emerg Physicians Open 2021; 2:e12492. [PMID: 34378000 PMCID: PMC8328888 DOI: 10.1002/emp2.12492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES During the first wave of the COVID-19 pandemic in the United Kingdom (UK), to describe volume and pattern of calls to emergency ambulance services, proportion of calls where an ambulance was dispatched, proportion conveyed to hospital, and features of triage used. METHODS Semistructured electronic survey of all UK ambulance services (n = 13) and a request for routine service data on weekly call volumes for 22 weeks (February 1-July 3, 2020). Questionnaires and data request were emailed to chief executives and research leads followed by email and telephone reminders. The routine data were analyzed using descriptive statistics, and questionnaire data using thematic analysis. RESULTS Completed questionnaires were received from 12 services. Call volume varied widely between services, with a UK peak at week 7 at 13.1% above baseline (service range -0.5% to +31.4%). All services ended the study period with a lower call volume than at baseline (service range -3.7% to -25.5%). Suspected COVID-19 calls across the UK totaled 604,146 (13.5% of all calls), with wide variation between services (service range 3.7% to 25.7%), and in service peaks of 11.4% to 44.5%. Ambulances were dispatched to 478,638 (79.2%) of these calls (service range 59.0% to 100.0%), with 262,547 (43.5%) resulting in conveyance to hospital (service range 32.0% to 53.9%). Triage models varied between services and over time. Two primary call triage systems were in use across the UK. There were a large number of products and arrangements used for secondary triage, with services using paramedics, nurses, and doctors to support decision making in the call center and on scene. Frequent changes to triage processes took place. CONCLUSIONS Call volumes were highly variable. Case mix and workload changed significantly as COVID-19 calls displaced other calls. Triage models and prehospital outcomes varied between services. We urgently need to understand safety and effectiveness of triage models to inform care during further waves and pandemics.
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Affiliation(s)
| | | | - Fiona Bell
- Yorkshire Ambulance Service NHS TrustWakefieldUK
| | - Mike Brady
- Welsh Ambulance Services NHS TrustTrust HeadquartersDenbighshireWalesUK
| | | | - Edward Duncan
- Nursing Midwifery and Allied Health Professions Research UnitUniversity of StirlingStirlingUK
| | | | | | - Theresa Foster
- East of England Ambulance Service NHS TrustMelbournCambridgeshireUK
| | - John Gallanders
- Swansea University Medical SchoolSwanseaUK
- Unaffiliated ‐ Patient and Public Contributor
| | - Imogen Gunson
- West Midlands Ambulance Service NHS TrustWest MidlandsUK
| | | | | | | | | | | | | | - Tom Quinn
- Kingston University and St George'sUniversity of LondonLondonUK
| | - Andy Rosser
- West Midlands Ambulance Service NHS TrustWest MidlandsUK
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Bell F, Botham M, Brereton TM, Fenton A, Hodgson J. Grizzled Skippers stuck in the south: Population‐level responses of an early‐successional specialist butterfly to climate across its UK range over 40 years. DIVERS DISTRIB 2021. [DOI: 10.1111/ddi.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fiona Bell
- Department of Evolution, Ecology and Behaviour University of Liverpool Liverpool UK
| | - Marc Botham
- UK Centre for Ecology and Hydrology Crowmarsh Gifford Oxfordshire UK
| | | | - Andy Fenton
- Department of Evolution, Ecology and Behaviour University of Liverpool Liverpool UK
| | - Jenny Hodgson
- Department of Evolution, Ecology and Behaviour University of Liverpool Liverpool UK
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Cubas-Atienzar AI, Bell F, Byrne RL, Buist K, Clark DJ, Cocozza M, Collins AM, Cuevas LE, Duvoix A, Easom N, Edwards T, Ferreira DM, Fletcher T, Groppelli E, Hyder-Wright A, Kadamus E, Kirwan DE, Kontogianni K, Krishna S, Kluczna D, Mark J, Mensah-Kane J, Miller E, Mitsi E, Norton D, O'Connor E, Owen SI, Planche T, Shelley S, Staines HM, Tate D, Thompson CR, Walker G, Williams CT, Wooding D, Fitchett JRA, Adams ER. Accuracy of the Mologic COVID-19 rapid antigen test: a prospective multi-centre analytical and clinical evaluation. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16842.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has highlighted the reliance on antigen detection rapid diagnostic tests (Ag-RDTs). Their evaluation at point of use is a priority. Methods: Here, we report a multi-centre evaluation of the analytical sensitivity, specificity, and clinical accuracy of the Mologic COVID-19 Ag-RDT by comparing to reverse transcriptase polymerase chain reaction (RT-qPCR) results from individuals with and without COVID-19 symptoms. Participants had attended hospitals in Merseyside, hospital and ambulance services in Yorkshire, and drive-through testing facilities in Northumberland, UK. Results: The limit of detection of the Mologic COVID-19 Ag-RDT was 5.0 x 102 pfu/ml in swab matrix with no cross-reactivity and interference for any other pathogens tested. A total of 347 participants were enrolled from 26th of November 2020 to 15th of February 2021 with 39.2% (CI 34.0-44.6) testing RT-qPCR positive for SARS-CoV-2. The overall sensitivity and specificity of the Mologic Ag-RDT compared to the reference SARS-CoV-2 RT-qPCR were 85.0% (95% CI 78.3-90.2) and 97.8% (95.0-99.3), respectively. Sensitivity was stratified by RT-qPCR cycle threshold (Ct) and 98.4% (91.3-100) of samples with a Ct less than 20 and 93.2% (86.5-97.2) of samples with a Ct less than 25 were detected using the Ag-RDT. Clinical accuracy was stratified by sampling strategy, swab type and clinical presentation. Mologic COVID-19 Ag-RDT demonstrated highest sensitivity with nose/throat swabs compared with throat or nose swabs alone; however, the differences were not statistically significant. Conclusions: Overall, the Mologic test had high diagnostic accuracy across multiple different settings, different demographics, and on self-collected swab specimens. These findings suggest the Mologic rapid antigen test may be deployed effectively across a range of use settings.
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Abstract
Background: There is growing evidence to suggest that ambulance service staff may be at increased risk for suicide; however, few studies have explored risk factors within this occupational group. Aim: To investigate factors commonly associated with ambulance staff suicides. Method: Eleven ambulance service trusts across the United Kingdom were asked to return details of staff suicides occurring between January 2014 and December 2015. Coroners were then contacted to request permission to review the records of the deceased. Results: Fifteen suicides were identified (73% male, mean age 42 years). Inquest data were available on 12 deaths. The most common method used was hanging. Possible risk factors identified included recent return to work following a period of sickness absence, poor mental health, relationship and debt problems, history of self-harm and the loss of a driving licence/change in job role. Conclusion: Identifying characteristics of suicide among this high-risk group is important to inform the development of suicide prevention initiatives. Additional research is needed with an adequate control group to further explore the risk factors identified in this study.
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Affiliation(s)
- Becky Mars
- University of Bristol; University Hospitals Bristol NHS Foundation
| | | | | | | | - David Gunnell
- University of Bristol; University Hospitals Bristol NHS Foundation Trust
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Abstract
Introduction: Evidence from the past 20 years has highlighted that acute pain is not managed well in the emergency setting, in particular with children. Inadequate management of pain can result in long-term changes in both physical and mental health. This service evaluation aimed to determine how paediatric pain is assessed and managed by ambulance clinicians in a large region in England. Methods: This retrospective service evaluation analysed electronic patient record (ePR) data routinely collected between September and December 2018. All paediatric patients (< 18 years of age) with pain documented narratively, or a pain score of ≥ 1/10, were included. The primary outcome measure was the proportion of patients with severe pain (defined as a pain score of ≥ 7/10) who achieve effective pain management (reduction in pain score of ≥ 2/10). Results: A total of 2801 paediatric patients who had documented pain were included in the analysis and the median age of patients was three years (interquartile range, 1–12 years). Most had a medical cause of pain (2387/2801, 85.2%), and analgesia was administered by the ambulance crew in 403/2801 (14.4%) patients. Multiple pain scores were recorded for 667 patients. Effective pain management was achieved in 233/271 (86%) patients in moderate pain and 204/210 (97.1%) patients in severe pain. However, of the 437 children in moderate to severe pain who achieved effective pain management, 381 (87%) received no analgesia. Conclusion: Children in severe pain received effective pain management, despite the majority not receiving any analgesia. This should be investigated further since non-pharmacological methods of analgesia are unlikely to explain a reduction of this magnitude. Ambulance staff need to be encouraged to record a pain score promptly after arriving on scene and ensure it is repeated. Pain score should be documented as part of the physiological observations and not in the free text of ePRs to ensure that it is identified during audits.
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Affiliation(s)
- Richard Pilbery
- Yorkshire Ambulance Service NHS Trust: ORCID iD: https://orcid.org/0000-0002-5797-9788
| | - Jamie Miles
- Yorkshire Ambulance Service NHS Trust: ORCID iD: https://orcid.org/0000-0002-1080-768X
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust: ORCID iD: https://orcid.org/0000-0003-4503-1903
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Jones M, Snooks H, Bulger J, Watkins A, Moore C, Edwards A, Evans B, Fuller G, John A, Benger J, Buykx P, Hoskins R, Dixon S, Goodacre S, Black S, Parry E, Lawrence B, Bell F. PP24 Time: take-home naloxone in multicentre emergency settings: protocol for a feasibility study. Arch Emerg Med 2019. [DOI: 10.1136/emermed-2019-999.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundOpioids such as heroin kill more people worldwide than any other drug. Death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid agonist which can be distributed in take home ‘kits’. This intervention is known as Take Home Naloxone (THN).MethodsWe propose to carry out a randomised controlled feasibility trial (RCT) of THN distributed in emergency settings clustered by Emergency Department (ED) catchment area, and local ambulance service; with anonymised linked data outcomes. This will include distribution of THN by paramedics and ED staff to patients at risk of opioid overdose. Existing linked data will be used to develop a discriminant function to retrospectively identify people at high risk of overdose death based on observable predictors of overdose to include in outcome follow up.ResultsWe will gather outcomes up to one year including; deaths (and drug related); emergency admissions; intensive care admissions; ED attendances (and overdose related); 999 attendances (and for overdose); THN kits issued; and NHS resource usage. We will agree progression criteria following consultation with research team members related to sign up of sites; successful identification and provision of THN to eligible participants; successful follow up of eligible participants and opioid decedents; adverse event rate; successful data matching and data linkage; and retrieval of outcomes within three months of projected timeline.ConclusionsTHN programmes are currently run by some drug services in the UK. However, saturation is low. There has been a lack of experimental research in to THN, and so questions remain: Does THN reduce deaths? Are there unforeseen harms associated with THN? Is THN cost effective? This feasibility study will establish whether a fully powered cluster RCT can be used to answer these questions.
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Abstract
BackgroundIn 2015, Ambulance Service Medical Directors raised concerns regarding a perceived increase in suicide deaths among ambulance service staff. The Association of Ambulance Chief Executives (AACE) then commissioned a research study to investigate these concerns and provide recommendations towards a suicide prevention strategy. The aim of this study was to determine whether staff who work in the UK ambulance services (AS) are at higher risk of suicide than staff who work in other professions.MethodsData was requested from the Office for National Statistics (ONS) regarding AS staff suicide. Eighteen AS were invited to return data on Occupational Health (OH). AS in England and Wales (n=11) were also asked to return data on staff suicides. Coroners were contacted to request permission to review the records of the deaths.ResultsThe ONS analysis of occupational suicide risk between 2011 and 2015 indicated that there were 20 suicide deaths amongst paramedics in England during that period. The risk of suicide amongst male paramedics was 75% higher than the national average.Over a 2 year period, 8 AS trusts identified 15 staff suicides (11 male, 4 female). The mean age of those dying by suicide was 42 years. Findings from coroners’ records indicated that the predominant suicide method used was hanging (66.7%).ConclusionsThe following recommendations have been accepted by the AACE: a) Develop a mental health strategy for all staff which includes specific emphasis on suicide prevention b) Review and assess suicide risk at times of increased vulnerability c) Collect and monitor data on AS suicides d) Review occupational health, counselling and support services e) Training for staff in identifying and responding to a colleague in distress f) Return to work discussions should consider and establish the status of an individual’s mental health and wellbeing.
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Affiliation(s)
- Miranda Thew
- Lecturer, Leeds Beckett University, School of Clinical and Applied Sciences, Leeds, UK
| | - Fiona Bell
- MSc Student, Leeds Beckett University, School of Clinical and Applied Sciences, Leeds, UK
- Occupational Therapist, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Eithne Flanagan
- MSc Student, Leeds Beckett University, School of Clinical and Applied Sciences, Leeds, UK
- Occupational Therapist, The Royal London Hospital, London, UK
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Lane M, Zander-Fox D, Hamilton H, Jasper M, Hodgson B, Fraser M, Bell F. Ability to detect aneuploidy from cell free DNA collected from media is dependent on the stage of development of the embryo. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.192] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bell F, Hicken L. 6THINK DELIRIUM! IMPROVING DELIRIUM RECOGNITION AND ASSESSMENT ON HOSPITAL ADMISSION. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zhang Y, Feng ZP, Naselli G, Bell F, Wettenhall J, Auyeung P, Ellis JA, Ponsonby AL, Speed TP, Chong MM, Harrison LC. Corrigendum to ‘MicroRNAs in CD4+ T cell subsets are markers of disease risk and T cell dysfunction in individuals at risk for type 1 diabetes’ [J. Autoimmun. 68C (2016) 52–61]. J Autoimmun 2016; 73:130. [DOI: 10.1016/j.jaut.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iyer S, Bell F, Westphal D, Anwari K, Gulbis J, Smith BJ, Dewson G, Kluck RM. Bak apoptotic pores involve a flexible C-terminal region and juxtaposition of the C-terminal transmembrane domains. Cell Death Differ 2015; 22:1665-75. [PMID: 25744027 DOI: 10.1038/cdd.2015.15] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/07/2015] [Accepted: 01/21/2015] [Indexed: 12/22/2022] Open
Abstract
Bak and Bax mediate apoptotic cell death by oligomerizing and forming a pore in the mitochondrial outer membrane. Both proteins anchor to the outer membrane via a C-terminal transmembrane domain, although its topology within the apoptotic pore is not known. Cysteine-scanning mutagenesis and hydrophilic labeling confirmed that in healthy mitochondria the Bak α9 segment traverses the outer membrane, with 11 central residues shielded from labeling. After pore formation those residues remained shielded, indicating that α9 does not line a pore. Bak (and Bax) activation allowed linkage of α9 to neighboring α9 segments, identifying an α9:α9 interface in Bak (and Bax) oligomers. Although the linkage pattern along α9 indicated a preferred packing surface, there was no evidence of a dimerization motif. Rather, the interface was invoked in part by Bak conformation change and in part by BH3:groove dimerization. The α9:α9 interaction may constitute a secondary interface in Bak oligomers, as it could link BH3:groove dimers to high-order oligomers. Moreover, as high-order oligomers were generated when α9:α9 linkage in the membrane was combined with α6:α6 linkage on the membrane surface, the α6-α9 region in oligomerized Bak is flexible. These findings provide the first view of Bak carboxy terminus (C terminus) membrane topology within the apoptotic pore.
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Affiliation(s)
- S Iyer
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - F Bell
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia
| | - D Westphal
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - K Anwari
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - J Gulbis
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - B J Smith
- Department of Chemistry and Physics, La Trobe Institute for Molecular Sciences, La Trobe University, Melbourne, Victoria 3086, Australia
| | - G Dewson
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - R M Kluck
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, Victoria 3010, Australia
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Bell F. Service-learning in LIS education : the case of the University of Natal's Inadi initiative. South African Journal of Libraries and Information Science 2013. [DOI: 10.7553/73-2-1348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Dyer JM, Bell F, Koehn H, Vernon JA, Cornellison CD, Clerens S, Harland DP. Redox proteomic evaluation of bleaching and alkali damage in human hair. Int J Cosmet Sci 2013; 35:555-61. [DOI: 10.1111/ics.12076] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 06/21/2013] [Indexed: 12/01/2022]
Affiliation(s)
- J. M. Dyer
- Proteins & Biomaterials; AgResearch Lincoln Research Centre; Private Bag 4749 Christchurch 8140 New Zealand
- Biomolecular Interaction Centre; University of Canterbury; Private Bag 4800 Christchurch New Zealand
| | - F. Bell
- Hair Category; Unilever Research and Development; Quarry Road East Bebington Wirral CH63 3JW U.K
| | - H. Koehn
- Proteins & Biomaterials; AgResearch Lincoln Research Centre; Private Bag 4749 Christchurch 8140 New Zealand
| | - J. A. Vernon
- Proteins & Biomaterials; AgResearch Lincoln Research Centre; Private Bag 4749 Christchurch 8140 New Zealand
| | - C. D. Cornellison
- Proteins & Biomaterials; AgResearch Lincoln Research Centre; Private Bag 4749 Christchurch 8140 New Zealand
| | - S. Clerens
- Proteins & Biomaterials; AgResearch Lincoln Research Centre; Private Bag 4749 Christchurch 8140 New Zealand
| | - D. P. Harland
- Proteins & Biomaterials; AgResearch Lincoln Research Centre; Private Bag 4749 Christchurch 8140 New Zealand
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Hinchliffe RF, Bellamy GJ, Bell F, Finn A, Vora AJ, Lennard L. Reference intervals for red cell variables and platelet counts in infants at 2, 5 and 13 months of age: a cohort study. J Clin Pathol 2013; 66:962-6. [PMID: 23853313 DOI: 10.1136/jclinpath-2013-201742] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To derive reference values for red cell variables and platelet counts from a cohort of infants sampled at precise ages during the first 13 months of life. METHODS Blood counts, reticulocyte counts and zinc protoporphyrin concentrations were obtained from healthy term infants of North European ancestry at 2, 5 and 13 months of age. RESULTS Mean cell volume (MCV) and mean cell haemoglobin (MCH) values did not differ significantly between 5 and 13 months and MCH concentration was unaffected by age. Values of all other variables at any one age differed significantly from those at the other two. Haemoglobin, mean cell haemoglobin, zinc protoporphyrin and platelet values (95% ranges) at 2 (n=119), 5 (n=97) and 13 months (n=42) were, respectively, 91-125, 101-129 and 105-133 g/L; 28.6-33.1, 24.5-28.7 and 24.3-28.7 pg; 36-116, 25-91 and 27-57 micromol/mol haem; and 216-658, 241-591 and 209-455×10(9)/L. At 2 and 5 months, respectively, 26.9% and 10.8% of subjects had platelet counts >500×10(9)/L. Reticulocyte counts at 2 months and MCV and MCH values at 5 months were significantly higher in girls. In boys, red cell distribution width values were significantly higher at 5 months, and zinc protoporphyrin values at both 2 and 5 months. CONCLUSIONS These findings indicate the value of obtaining reference data at precise ages during infancy and confirm and extend earlier reports indicating a gender difference in laboratory measures used to assess iron status in early infancy.
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Affiliation(s)
- R F Hinchliffe
- Department of Paediatric Haematology, Sheffield Children's NHS Foundation Trust, , Sheffield, UK
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Wade M, Tucker I, Cunningham P, Skinner R, Bell F, Lyons T, Patten K, Gonzalez L, Wess T. Investigating the origins of nanostructural variations in differential ethnic hair types using X-ray scattering techniques. Int J Cosmet Sci 2013; 35:430-41. [DOI: 10.1111/ics.12061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 04/27/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M. Wade
- School of Optometry & Vision Sciences; Cardiff University; Maindy Road; Cardiff CF24 4LU; U.K
| | - I. Tucker
- Unilever Research & Development Port Sunlight; Quarry Rd East; Bebington Wirral; CH63 3JW; U.K
| | - P. Cunningham
- Unilever Research & Development Port Sunlight; Quarry Rd East; Bebington Wirral; CH63 3JW; U.K
| | - R. Skinner
- Unilever Research & Development Port Sunlight; Quarry Rd East; Bebington Wirral; CH63 3JW; U.K
| | - F. Bell
- Unilever Research & Development Port Sunlight; Quarry Rd East; Bebington Wirral; CH63 3JW; U.K
| | - T. Lyons
- Unilever Research & Development Port Sunlight; Quarry Rd East; Bebington Wirral; CH63 3JW; U.K
| | - K. Patten
- School of Optometry & Vision Sciences; Cardiff University; Maindy Road; Cardiff CF24 4LU; U.K
| | - L. Gonzalez
- School of Optometry & Vision Sciences; Cardiff University; Maindy Road; Cardiff CF24 4LU; U.K
| | - T. Wess
- School of Optometry & Vision Sciences; Cardiff University; Maindy Road; Cardiff CF24 4LU; U.K
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Kirigin FF, Lindstedt K, Sellars M, Ciofani M, Low SL, Jones L, Bell F, Pauli F, Bonneau R, Myers RM, Littman DR, Chong MMW. Dynamic microRNA gene transcription and processing during T cell development. J Immunol 2012; 188:3257-67. [PMID: 22379031 DOI: 10.4049/jimmunol.1103175] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
By disrupting microRNA (miRNA) biogenesis, we previously showed that this pathway is critical for the differentiation and function of T cells. Although various cloning studies have shown that many miRNAs are expressed during T cell development, and in a dynamic manner, it was unclear how comprehensive these earlier analyses were. We therefore decided to profile miRNA expression by next generation sequencing. Furthermore, we profiled miRNA expression starting from the hematopoietic stem cell. This analysis revealed that miRNA expression during T cell development is extremely dynamic, with 645 miRNAs sequenced, and the expression of some varying by as much as 3 orders of magnitude. Furthermore, changes in precursor processing led to altered mature miRNA sequences. We also analyzed the structures of the primary miRNA transcripts expressed in T cells and found that many were extremely long. The longest was pri-mir-29b-1/29a at ∼168 kb. All the long pri-miRNAs also displayed extensive splicing. Our findings indicate that miRNA expression during T cell development is both a highly dynamic and a highly regulated process.
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Affiliation(s)
- Francis F Kirigin
- Kimmel Center for Biology and Medicine, Skirball Institute of Biomolecular Medicine, New York University School of Medicine, New York, NY 10016, USA
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Bell F. Book review of Mackey, T.P. and Jacobson, T.E. 2010. Collaborative information literacy assessments: strategies for evaluating teaching and learning. London: Facet. JIL 2010. [DOI: 10.11645/4.2.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- F. Bell
- a Department of Chemistry , University of California , Berkeley , California 94720 , USA
- b Chemical Sciences Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , USA
| | - D.S. Lambrecht
- a Department of Chemistry , University of California , Berkeley , California 94720 , USA
| | - M. Head-Gordon
- a Department of Chemistry , University of California , Berkeley , California 94720 , USA
- b Chemical Sciences Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , USA
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Carpenter P, Bell F. Experiments in Raman spectroscopy of hair: Exciting light and molecular orientation. Int J Cosmet Sci 2010. [DOI: 10.1111/j.1468-2494.2010.00534_10.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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