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Bernard P, Corcoran G, O'Brien C, Ward P, Kenna L, Laura H, Mooney R, Howard W, Horgan F, Malone A, Masterson S. 224 “OLDER PEOPLE WANT TO BE IN THEIR OWN HOMES”: THEMATIC ANALYSIS- PATIENT AND CARER FEEDBACK AFTER PATHFINDER EMERGENCY CALL RESPONSE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.194] [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: 11/14/2022] Open
Abstract
Abstract
Background
Older adults are frequent attendees at the Emergency Department (ED) and experience high rates of adverse outcomes following ED presentation. There is a growing evidence base for alternative care pathway models at the time of a low acuity emergency medical services (EMS) call. Previous research has found a high level of patient satisfaction with the Pathfinder model, in which an Advanced Paramedic and a Physiotherapist or Occupational Therapist respond to EMS calls [1]. However, the reasons underpinning this from a patient perspective have not previously been reported.
Methods
This is a qualitative study employing thematic analysis of open-ended responses recorded in 429 telephone interviews with service users (patients or their next-of-kin), who had been attended by the Pathfinder service following an EMS call.
Results
Five primary themes were identified: (1) the professionalism of the interdisciplinary clinical team; (2) “the right service, in the right place at the right time”; (3) the role of Pathfinder in “getting the ball rolling” through following up and co-ordinating referrals and services; (4) the lasting impact of the experience on the patient and their next-of-kin; (5) the value of skilled communication with the older person, as well as smooth and “tuned-in” communication across the team.
Conclusion
Older people voiced a clear preference for hospital avoidance, and strongly valued the opportunity to be assessed and treated in their homes at the time of an EMS call rather than automatic conveyance to the ED. They recognised the value of a skilled interdisciplinary team, with a follow-up service, that effectively positions itself between the acute hospital and community services.
Reference
1. Bernard P, Corcoran G, Kenna L, et al. Is Pathfinder a safe alternative to the emergency department for older patients? An observational analysis. Age Ageing 2021; 50(5):1854–1858.
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Affiliation(s)
| | | | | | - P Ward
- Beaumont Hospital , Dublin, Ireland
| | - L Kenna
- National Ambulance Service , Dublin, Ireland
| | - H Laura
- National Ambulance Service , Dublin, Ireland
| | - R Mooney
- National Ambulance Service , Dublin, Ireland
| | - W Howard
- National Ambulance Service , Dublin, Ireland
| | - F Horgan
- Royal College of Surgeons , Dublin, Ireland
| | - A Malone
- Royal College of Surgeons , Dublin, Ireland
| | - S Masterson
- National Ambulance Service , Dublin, Ireland
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Seewald S, Wnent J, Lefering R, Fischer M, Bohn A, Jantzen T, Brenner S, Masterson S, Bein B, Scholz J, Gräsner JT. CaRdiac Arrest Survival Score (CRASS) - A tool to predict good neurological outcome after out-of-hospital cardiac arrest. Resuscitation 2019; 146:66-73. [PMID: 31730900 DOI: 10.1016/j.resuscitation.2019.10.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
AIM The aim of this study was to develop a score to predict the outcome for patients brought to hospital following out-of-hospital cardiac arrest (OHCA). METHODS All patients recorded in the German Resuscitation Registry (GRR) who suffered OHCA 2010-2017, who had ROSC or ongoing CPR at hospital admission were included. The study population was divided into development (2010-2016: 7985) and validation dataset (2017: 1806). Binary logistic regression analysis was used to derive the score. The probability of hospital discharge with good neurological outcome was defined as 1/(1 + e-X), where X is the weighted sum of independent variables. RESULTS The following variables were found to have a significant positive (+) or negative (-) impact: age 61-70 years (-0·5), 71-80 (-0·9), 81-90 (-1·3) and > = 91 (-2·3); initial PEA (-0·9) and asystole (-1·4); presumable trauma (-1·1); mechanical CPR (-0·3); application of adrenalin > 0 - < 2 mg (-1·1), 2 - <4 mg (-1·6), 4 - < 6 mg (-2·1), 6 - < 8 mg (-2·5) and > = 8 mg (-2·8); pre emergency status without previous disease (+0·5) or minor disease (+0·2); location at nursing home (-0·6), working place/school (+0·7), doctor's office (+0·7) and public place (+0·3); application of amiodarone (+0·4); hospital admission with ongoing CPR (-1·9) or normotension (+0·4); witnessed arrest (+0·6); time from collapse until start CPR 2 - < 10 min (-0·3) and > = 10 min (-0·5); duration of CPR <5 min (+0·6). The AUC in the development dataset was 0·88 (95% CI 0·87-0·89) and in the validation dataset 0·88 (95% CI 0·86-0·90). CONCLUSION The CaRdiac Arrest Survival Score (CRASS) represents a tool for calculating the probability of survival with good neurological function for patients brought to hospital following OHCA.
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Affiliation(s)
- S Seewald
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 12, Kiel, 24105, Germany; Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany.
| | - J Wnent
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 12, Kiel, 24105, Germany; Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany; University of Namibia, School of Medicine, Private Bag 13301, Windhoek, Namibia, Germany
| | - R Lefering
- University Witten/Herdecke, Faculty of Health, Institute for Research in Operative Medicine, Ostmerheimer Straße 200, Cologne, 51109, Germany
| | - M Fischer
- Department of Anesthesiology and Intensive Care, Klinik am Eichert, Eichertstraße 3, Göppingen, 73035, Germany
| | - A Bohn
- City of Münster Fire Department, York-Ring 25, Münster, 48159, Germany; Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, building A1, York-Ring 25, Münster, 48149, Germany
| | - T Jantzen
- Interhospital-Transfer-Service Mecklenburg-Vorpommern, German Red Cross Parchim, Ventschowerstraße 1, Cambs, 19067, Germany
| | - S Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden, Fetscherstraße 74, Dresden, 01307, Germany
| | - S Masterson
- National Ambulance Service Lead - Strategy and Evaluation, St. Eunan's Hall, St. Conal's Hospital, Letterkenny, Co. Donegal, Ireland and Discipline of General Practice School of Medicine, National University of Ireland Galway F92 XK84, Ireland
| | - B Bein
- Department of Anesthesiology and Intensive Care Medicine, Asklepios Klinik St. Georg, Lohmühlenstraße 5, Hamburg, 20099, Germany
| | - J Scholz
- University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel, 24105, Germany
| | - J T Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, building 808, Kiel, 24105, Germany
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Maurer H, Masterson S, Tjelmeland I, Gräsner J, Lefering R, Böttiger B, Bossaert L, Herlitz J, Koster R, Rosell-Ortiz F, Perkins G, Wnent J. When is a bystander not a bystander any more? A European survey. Resuscitation 2019; 136:78-84. [DOI: 10.1016/j.resuscitation.2018.12.009] [Citation(s) in RCA: 17] [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] [Received: 10/07/2018] [Revised: 11/09/2018] [Accepted: 12/10/2018] [Indexed: 02/07/2023]
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Masterson S, Wright P, O'Donnell C, Vellinga A, Murphy AW, Hennelly D, Sinnott B, Egan J, O'Reilly M, Keaney J, Bury G, Deasy C. Urban and rural differences in out-of-hospital cardiac arrest in Ireland. Resuscitation 2015; 91:42-7. [PMID: 25818707 DOI: 10.1016/j.resuscitation.2015.03.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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: 01/06/2015] [Revised: 02/20/2015] [Accepted: 03/19/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND More than a third of Ireland's population lives in a rural area, defined as the population residing in all areas outside clusters of 1500 or more inhabitants. This presents a challenge for the provision of effective pre-hospital resuscitation services. In 2012, Ireland became one of three European countries with nationwide Out-of-Hospital Cardiac Arrest (OHCA) register coverage. An OHCA register provides an ability to monitor quality and equity of access to life-saving services in Irish communities. AIM To use the first year of national OHCAR data to assess differences in the occurrence, incidence and outcomes of OHCA where resuscitation is attempted and the incident is attended by statutory Emergency Medical Services between rural and urban settings. METHODS The geographical coordinates of incident locations were identified and co-ordinates were then classified as 'urban' or 'rural' according to the Irish Central Statistics Office (CSO) definition. RESULTS 1798 OHCA incidents were recorded which were attended by statutory Emergency Medical Services (EMS) and where resuscitation was attempted. There was a higher percentage of male patients in rural settings (71% vs. 65%; p = 0.009) but the incidence of male patients did not differ significantly between urban and rural settings (26 vs. 25 males/100,000 population/year p = 0.353). A higher proportion of rural patients received bystander cardiopulmonary resuscitation (B-CPR) 70% vs. 55% (p ≤ 0.001), and had defibrillation attempted before statutory EMS arrival (7% vs. 4% (p = 0.019), respectively). Urban patients were more likely to receive a statutory EMS response in 8 min or less (33% vs. 9%; p ≤ 0.001). Urban patients were also more likely to be discharged alive from hospital (6% vs. 3%; p = 0.006) (incidence 2.5 vs. 1.1/100,000 population/year; p ≤ 0.001). Multivariable analysis of survival showed that the main variable of interest i.e. urban vs. rural setting was also independently associated with discharge from hospital alive (OR 3.23 (95% CI 1.43-7.31)). CONCLUSION There are significant disparities in the incidence of resuscitation attempts in urban and rural areas. There are challenges in the provision of services and subsequent outcomes from OHCA that occur outside of urban areas requiring novel and innovative solutions. An integrated community response system is necessary to improve metrics around OHCA response and outcomes in rural areas.
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Affiliation(s)
- S Masterson
- Department of Public Health Medicine, Health Service Executive, Donegal, Ireland; Discipine of General Practice, National University of Ireland, Galway, Ireland
| | - P Wright
- Department of Public Health Medicine, Health Service Executive, Donegal, Ireland
| | - C O'Donnell
- National Ambulance Service, Health Service Executive, Naas, Ireland
| | - A Vellinga
- Discipine of General Practice, National University of Ireland, Galway, Ireland
| | - A W Murphy
- Discipine of General Practice, National University of Ireland, Galway, Ireland
| | - D Hennelly
- National Ambulance Service, Health Service Executive, Naas, Ireland
| | - B Sinnott
- Irish Heart Foundation, Dublin, Ireland
| | - J Egan
- Pre-Hospital Emergency Care Council, Naas, Ireland
| | | | - J Keaney
- Massachusets General Hospital, Boston, MA, USA
| | - G Bury
- Centre for Emergency Medical Science, University College Dublin, Dublin 4, Ireland
| | - C Deasy
- National Ambulance Service, Health Service Executive, Naas, Ireland; Cork University Hospital, Cork, Ireland; University College Cork, Cork, Ireland.
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Behan C, Doyle R, Masterson S, Shiers D, Clarke M. A double-edged sword: review of the interplay between physical health and mental health. Ir J Med Sci 2014; 184:107-12. [PMID: 25342160 DOI: 10.1007/s11845-014-1205-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/27/2014] [Indexed: 01/22/2023]
Abstract
It is widely acknowledged that there is interplay between physical and mental health, with causality in both directions. A common theme across countries is the uncertainty surrounding who should act as gatekeeper for physical health matters in psychiatry. Much of the metabolic monitoring is carried out by psychiatrists who often feel ill equipped to treat medical problems such as abnormal cholesterol or disturbances of glucose metabolism. However many patients do not attend primary care on a regular basis and may not be likely to follow through on referral to primary care. This review aims to examine the interplay between co-morbid physical and mental health conditions, identify the physical health conditions particularly associated with severe affective and psychotic illness and briefly discuss interventions and recommendations in this area. As people with severe mental illness die 10-20 years younger than their peers, with much of this premature mortality due to cardiovascular disease, this topic is emerging as one of great importance amongst clinicians and policymakers internationally.
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Affiliation(s)
- C Behan
- DETECT Early Intervention Service in Psychosis, Dublin, Ireland,
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Lidder S, Masterson S, Grechenig C, Clement H, Gänsslen A, Grechenig S. The risk of neurovascular injury in minimally invasive plate osteosynthesis (MIPO) when using a distal tibia anterolateral plate: a cadaver study. Acta Chir Orthop Traumatol Cech 2014; 81:313-316. [PMID: 25514338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE OF THE STUDY Percutaneous plating of the distal tibia via a limited incision is an accepted technique of osteosynthesis for extra-articular and simple intra-articular distal tibia fractures. The aim of this study was to analyze structures that are at risk during this approach. MATERIAL AND METHODS Thirteen unpaired adult lower limbs were used for this study. Thirteen, 15-hole LCP anterolateral distal tibial plates were percutaneously inserted according to the recommended technique. Dissection was performed to examine the relation of the superficial and deep peroneal nerves and anterior tibial artery relative to the plate. RESULTS The superficial peroneal nerve was found to cross the vertical limb of the LCP plate at a mean distance of 63 mm (screw hole five) but with a wide range of 21 to 105 mm. The neurovascular bundle (deep peroneal nerve and anterior tibial artery) crossed the plate at a mean of 76 mm (screw hole six) but also with a wide range of 38 to 138 mm. The zone of danger of the neurovascular structures ranges from 21 to 138 mm from the tibial plafond. In one specimen, a significant branch of the deep peroneal nerve was found to be entrapped under the plate. CONCLUSION Caution is advised when using anterolateral minimally invasive technique for plate insertion and screw placement in the distal tibia due to great variability in the neurovascular structures that course distally in the lower leg and cross the ankle.
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Affiliation(s)
- S Lidder
- Guy's and St Thomas' nHS Foundation Trust, Department of Trauma and Orthopaedics, London, UK
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Abstract
Infection is the third commonest cause of total hip arthroplasty failure. Infections of the hip with Candida species are extremely rare with only a few reports in the literature. A case of a 76-year-old female subject is presented illustrating both the difficulty in initial diagnosis and the challenges faced in hip reconstruction.
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Affiliation(s)
- Surjit Lidder
- Department of Trauma and Orthopaedics, Eastbourne DGH, East Sussex, UK.
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Abstract
We report the long-term results of revision total hip replacement using femoral impaction allografting with both uncemented and cemented Freeman femoral components. A standard design of component was used in both groups, with additional proximal hydroxyapatite coating in the uncemented group. A total of 33 hips in 30 patients received an uncemented component and 31 hips in 30 patients a cemented component. The mean follow-up was 9.8 years (2 to 17) in the uncemented group and 6.2 years (1 to 11) in the cemented group. Revision procedures (for all causes) were required in four patients (four hips) in the uncemented group and in five patients (five hips) in the cemented group. Harris hip scores improved significantly in both groups and were maintained independently of the extent of any migration of the femoral component within the graft or graft–cement mantle.
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Affiliation(s)
- S. Masterson
- The Royal London Hospital, Bone
and Joint Research Unit, Whitechapel Road, London E1
1BB, UK
| | - S. Lidder
- The Royal London Hospital, Bone
and Joint Research Unit, Whitechapel Road, London E1
1BB, UK
| | - G. Scott
- The Royal London Hospital, Bone
and Joint Research Unit, Whitechapel Road, London E1
1BB, UK
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Lidder S, Lang K, Lee HJ, Masterson S, Kankate R. Bilateral Hip Fractures Associated with Transient Osteoporosis of Pregnancy. J ROY ARMY MED CORPS 2011; 157:176-8. [DOI: 10.1136/jramc-157-02-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lidder S, Lang KJ, Masterson S, Blagg S. Acute spinal epidural haematoma causing cord compression after chiropractic neck manipulation: an under-recognised serious hazard? J ROY ARMY MED CORPS 2011; 156:255-7. [PMID: 21275361 DOI: 10.1136/jramc-156-04-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spinal manipulative therapy performed by chiropractors is increasingly common in the United Kingdom. Spinal epidural haematoma is a rare complication of such physical therapy but when identified represents a neurological emergency. We describe the case of a 64 year-old man who presented with a dense hemiplegia due to a spinal epidural haematoma following cervical spine manipulation performed for acute neck pain. The clinical features and surgical management of the case are discussed and we stress the importance of recognition of chiropractic manipulation as a potential cause of neurological sequelae and discuss the potential pitfalls of such therapy as it becomes more widespread.
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Affiliation(s)
- S Lidder
- ST3 in Trauma and Orthopaedics, Royal London Hospital, Whitechapel Road, London, UK.
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Masterson S, Wright P, Dowling J, Swann D, Murphy A, Bury G. Survival from OHCA in North West Ireland 1992–2010. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.032] [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: 10/18/2022]
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Masterson S, Wright P, Dowling J, Murphy A, King G, Egan J, Grant P, Sheerin P, Galvin J, Bury G. Building Irish evidence for Irish practice in OHCA management. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.356] [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: 10/18/2022]
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