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Background/aimsThe demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model.MethodsThis qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken.ResultsThe three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community.ConclusionsCare homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

Background/AimsThe demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model.MethodsThis qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken.ResultsThe three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community.ConclusionsCare homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

Anecdotal experience demonstrates the existence of patients with superiorly located carotid stenosis, neoplasms, or aneurysms where the mandible obstructs effective surgical access using standard techniques. As carotid pathology extends anatomically beyond the limits of standard operative technique, additional exposure becomes paramount to safely and effectively address the lesion. Double mandibular osteotomy (DMO) is one of several techniques to obtain additional exposure to high-carotid pathology; however, there is no large series to address the outcomes of patients undergoing this procedure.

Background:This study seeks to understand part of the emerging clinical leadership framework implemented in the UK's NHS ambulance services in recent years. The aim is to explore the relatively new role of consultant paramedics and understand their leadership activities in relationship to nationally determined requirements, and the challenges they face performing this crucial leadership role.Methods:Semi-structured interviews were conducted with all consultant paramedics in the UK in 2013. Thematic analysis and coding were used to analyse the data and identify emergent themes. Additionally, basic demographic data was collected for comparison against national requirements.Findings:The findings illustrated three key themes: credible clinical leadership, an emerging empowered profession, and role expectations. There is a clear indication that consultant paramedics are a key part of clinical leadership for the paramedic profession. However, they are challenged to remain clinically competent by undertaking regular clinical practice and providing visible leadership on the ground, while strategically taking the profession forward. Operational resistance and power issues were highlighted as some of the problems faced by these clinical leaders.Implications:The findings may prove useful for employers in reviewing their clinical leadership structures, and in workforce planning for future consultant paramedics. The paramedic profession and its professional body may equally find this study useful for informing future strategic planning.

BackgroundOne-fifth of conveyances to the emergency department (ED) are due to acute-on-chronic breathlessness. Paramedic breathlessness management may ease distress quicker and/or reduce ED conveyances. We evaluated the feasibility of a full trial of a paramedic delivered intervention to reduce avoidable conveyances (recruitment, randomisation, consent, training and intervention acceptability, adherence, data quality, best primary outcome, sample size estimation). The intervention comprised evidence-based non-drug techniques and a self-management booklet.MethodsThis mixed-methods feasibility cluster randomised controlled trial (ISRCTN80330546) with embedded qualitative study about trial processes, training and intervention delivery, randomised paramedics to usual care or to intervention+usual care. Retrospective patient consent to use call-out data and prospective patient/carer consent for follow-up was sought. Potential primary outcomes were breathlessness intensity (numerical rating scale) and ED conveyance. Follow-up included an interview for patients/carers and questionnaires at 14 days, 1 and 6 months and paramedic focus groups and survey.ResultsRecruitment was during the COVID-19 pandemic, leading to high demands on paramedics and fewer call-outs by eligible patients. We enrolled 29 paramedics; 9 withdrew. Randomisation/trial procedures were acceptable. Paramedics recruited 13 patients; 8 were followed up. Data quality was good. The intervention did not extend call-out time, was delivered with fidelity and no contamination and was acceptable to patients, carers, and paramedics. There were no repeat call-outs < 48 hours. Recruitment stop-go criteria were not met. We had insufficient data for sample size estimation.ConclusionsA full trial in the samecircumstances is not feasible. However, valuable information was gained on recruitment, attrition, consent, training and intervention acceptability and adherence, and patient-reported data collection.

The purpose of this study is to describe the Australian experience with TSPV in the aortic position in 543 patients followed for up to 8 years. Prospectively collected data were reviewed. The average age was 73.5 years, with 74.4% older than 70 years. Eighty-five percent of valves were calcified and 79.5% stenotic. Most valves implanted (79.3%) were sizes 25, 27, or 29 mm. Concomitant coronary bypass was performed in 45.3% of patients. Total cumulative follow-up for the 543 patients was 2131 patient years. At 6 years, 82.1% and at 8 years, 76.3% were in New York Heart Association class I, 55% had no aortic insufficiency. The average mean systolic gradient for all valves at 6 years was 7.4 mmHg. The effective orifice area varied from 1.7 cm(2) (23-mm valve) to 1.96 cm(2) (29-mm valve). Actuarial survival at 8 years was 79.3%. Freedom from valve-related deaths was 93.2%. There was one instance of primary tissue valve failure during follow-up, with 93.3% freedom from explant. The early hemodynamic benefits of the TSPV are well maintained during more than 8 years of follow-up, without evident significant valvular dysfunction. Longer follow-up time is required to validate durability.

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.

Focuses on the restoration of ANZ Chambers in High St, in New Zealand, which have been registered as Category II historic places as of Spring 2003. Appraisal of the architecture of buildings; Restoration and conservation of buildings in High St.

The prevalence of sexual dysfunction in schizophrenia patients was investigated as part of this large (n=7655), prospective, international (27 countries) study. Based on patient reports, sexual dysfunction affected approx. 50% of patients and the prevalence of complaints varied significantly between regions (p<0.0001). The prevalence of sexual dysfunction, as perceived by psychiatrists, also varied significantly across regions (p<0.0001). Psychiatrists significantly underestimated the presence of impotence/sexual dysfunction (p<0.0001) and loss of libido (p<0.0001), compared to reports from patients. The frequency of sexual dysfunction was significantly higher in patients who had been using prolactin-elevating antipsychotics prior to study entry, compared to those who had been treated with prolactin-sparing antipsychotics (patient reports, p=0.002; psychiatrist perception, p=0.0004). This study has shown that the prevalence of sexual dysfunction is high in both male and female patients with schizophrenia and frequently underestimated by psychiatrists. Regional variation is evident in both psychiatrist perceptions and patient reports of sexual dysfunction. Given the importance of sexual function to quality of life and treatment compliance, proactive assessment of sexual function is required to optimize schizophrenia management.