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1. Consensus on innovations and future directions of community first responder schemes in United Kingdom: a national nominal group technique study

Author

Patel, Gupteswar, Botan, Vanessa, Phung, Viet-Hai, Trueman, Ian, Hosseini, Mehrshad Parvin, Smith, Murray D., Ørner, Roderick, Pattinson, Julie, Asghar, Zahid, Rowan, Elise, Spaight, Robert, Mortimer, Craig, Brewster, Amanda, Mountain, Pauline, Miller, Joshua, Brown, Martina, and Siriwardena, Aloysius Niroshan

Published
2024
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3. Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3)

Author

Couper, Keith, Ji, Chen, Lall, Ranjit, Deakin, Charles D, Fothergill, Rachael, Long, John, Mason, James, Michelet, Felix, Nolan, Jerry P, Nwankwo, Henry, Quinn, Tom, Slowther, Anne-Marie, Smyth, Michael A, Walker, Alison, Chowdhury, Loraine, Norman, Chloe, Sprauve, Laurille, Starr, Kath, Wood, Sara, Bell, Steve, Bradley, Gemma, Brown, Martina, Brown, Shona, Charlton, Karl, Coppola, Alison, Evans, Charlotte, Evans, Christine, Foster, Theresa, Jackson, Michelle, Kearney, Justin, Lang, Nigel, Mellett-Smith, Adam, Osborne, Ria, Pocock, Helen, Rees, Nigel, Spaight, Robert, Tibbetts, Belinda, Whitley, Gregory A., Wiles, Jason, Williams, Julia, Wright, Adam, and Perkins, Gavin D

Published
2024
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5. Remote COVID-19 Assessment in Primary Care (RECAP) risk prediction tool: derivation and real-world validation studies

Author

Espinosa-Gonzalez, Ana, Prociuk, Denys, Fiorentino, Francesca, Ramtale, Christian, Mi, Ella, Mi, Emma, Glampson, Ben, Neves, Ana Luisa, Okusi, Cecilia, Husain, Laiba, Macartney, Jack, Brown, Martina, Browne, Ben, Warren, Caroline, Chowla, Rachna, Heaversedge, Jonty, Greenhalgh, Trisha, de Lusignan, Simon, Mayer, Erik, and Delaney, Brendan C

Published
2022
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7. Introduction of a section for recording dementia improves data capture on the ambulance electronic patient record: evidence from a regional quality improvement project.

Author

King, Phil, Jadzinski, Patryk, Pocock, Helen, Lofthouse-Jones, Chloe, Brown, Martina, and Fogg, Carole

Subjects
AUDITING, COMPUTERS, COMPUTER software, MENTAL health, DATA analysis, RESEARCH funding, STATISTICAL sampling, DESCRIPTIVE statistics, ACQUISITION of data, ELECTRONIC health records, AMBULANCES, GERIATRIC assessment, DEMENTIA, DATA warehousing
Abstract

Introduction: Dementia is a common co-morbidity in older people who require urgent or emergency ambulance attendance and influences clinical decisions and care pathways. Following an initial audit of dementia data and consultation with staff, a specific section (tab) to record dementia was introduced on an ambulance service electronic patient record (ePR). This includes a dementia diagnosis button and a free-text section. We aimed to assess whether and how this improved recording. Methods: To re-audit the proportion of ambulance ePRs where dementia is recorded for patients aged ≥65 years, and to describe the frequency of recording in patients aged <65; to analyse discrepancies in the place of recording dementia on the ePR by comparing data from the new dementia tab and other sections of the ePR. Results: We included 112,193 ePRs of patients aged ≥65 with ambulance attendance from a six-month period. The proportion with dementia recorded in patients aged ≥65 was 16.5%, increasing to 19.9% in patients aged ≥75, as compared to 13.5% (≥65) and 16.5% (≥75) in our previous audit. In this audit, of the 16.5% (n = 18,515) of records with dementia recorded, 69.9% (n = 12,939) used the dementia button and 25.4% (n = 4704) recorded text in the dementia tab. Dementia was recorded in ePR free-text fields (but not the dementia tab) in 29.7% of records. Eighteen other free-text fields were used in addition to, or instead of, the dementia tab, including the patient's social history, previous medical history and mental health. Dementia was present on the ePR of 0.4% (n = 461) of patients aged <65. Conclusions: An ePR dementia tab enabled ambulance clinicians to standardise the location of recording dementia and may have facilitated increased recording. We would recommend other ambulance trusts capture this information in a specific section to improve information sharing and to inform care planning for this patient group. [ABSTRACT FROM AUTHOR]

Published
2024
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8. The COVID-19 ambulance response assessment (CARA) study: a national survey of ambulance service healthcare professionals’ preparedness and response to the COVID-19 pandemic

Author

Barrett, Jack William, primary, Eastley, Kate Bennett, additional, Herbland, Anthony, additional, Owen, Peter, additional, Naeem, Salman, additional, Mortimer, Craig, additional, King, James, additional, Foster, Theresa, additional, Rees, Nigel, additional, Rosser, Andy, additional, Black, Sarah, additional, Bell, Fiona, additional, Fothergill, Rachael, additional, Mellett-Smith, Adam, additional, Jackson, Michelle, additional, McClelland, Graham, additional, Gowens, Paul, additional, Spaight, Robert, additional, Igbodo, Sandra, additional, Brown, Martina, additional, and Williams, Julia, additional

Published
2024
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10. PP44 Consensus on innovations and future change agenda in community first responder schemes in England: a national Nominal Group Technique study

Author

Patel, Gupteswar, primary, Botan, Vanessa, additional, Phung, Viet-Hai, additional, Trueman, Ian, additional, Pattinson, Julie, additional, Parvin Hosseini, Seyed Mehrshad, additional, Ørner, Roderick, additional, Asghar, Zahid, additional, Smith, Murray D, additional, Rowan, Elise, additional, Spaight, Robert, additional, Evans, Jason, additional, Brewster, Amanda, additional, Mountain, Pauline, additional, Mortimer, Craig, additional, Miller, Joshua, additional, Brown, Martina, additional, and Siriwardena, Aloysius Niroshan, additional

Published
2023
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11. What Factors Determine Treatment Outcome in Aneurysmal Subarachnoid Hemorrhage in the Modern Era? A Post Hoc STASH Analysis

Author

Kirkpatrick, Peter J., Turner, Carole L., Murray, Gordon D., Hutchinson, Peter J., Teasdale, Graham, Mendelow, A. David, Muir, Keith, Smith, Martin, McCabe, Peter, Pearson, Jeremy, Ford, Gary, Vail, Andrew, King, Andrew, Tyrrell, Pippa, Richards, Hugh, Bond, Simon, Smith, Christopher, Warburton, Elizabeth, Tseng, Ming, Bulters, Diederik, Brown, Martina, Critchley, Giles, Spurling, Gavin, Gaylard, Jane, Javadpour, Mohsen, Eldridge, Paul, Murray, Lorna, Nelson, Richard, Taylor, Ros, Hierons, Sarah, Tobin, Bianca, Storey, Kelley, Walsh, Daniel, Mistry, Bejal, Aeron-Thomas, John, Puppo, Corina, Papadopoulos, Mario, Montague, Laura, Gan, Peter, Flint, Graham, Hurley, Jennie, Ronne, Elizabeth, Stjernling, Inger, Wang, Ernest, Leen Cheng, Ei, Lai, Jing Li, Ross, Stuart, Bellfield, Ruth, Mandizvidza, Linetty, Whitfield, Peter, Persad, Nicola, Suttner, Nigel, Teo, Mario, McGuigan, Kate, Cloughley, Linda, Patel, Hiren, Ingham, Andrea, Shaw, Kellymarie, Vindlacheruvu, Raghu, Millo, Julian, Warner, Orlando, Teal, Rachel, Bernard, Francis, Sirois, Carol, Joshi, Shaban, Nyabadza, Sheila, Grieve, Joan, Kitchen, Neil, Bassan, Vanessa, Rayson, Philip, Zeitlin, Alexander, Findlay, Max, Sonnema, Leeca, Poworoznik, Brenda, Quintero, Juan, Eljamel, Sam, Rasulo, Frank, Ng, Ivan, Mathew, Bruce, Grieg, Jill, Hanel, Ricardo, Richie, Alexa, Fleetwood, Ian, Reardon-White, Elizabeth, Hampton, Ginger, Lewis, Stephen, Miralia, Lynn, Brydon, Howard, Maguire, Holly, Patel, Umang, Sanderson, Helen, Birchall, Kathryn, Bayliss, Pauline, O'Neill, Kevin, Sachs, Tina, Kett-White, Rupert, Quinn, Leanne, Guilfoyle, Mathew R., and Turner, Carole

Published
2017
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12. Remote Covid Assessment in Primary Care (RECAP) risk prediction tool: derivation and real-world validation studies

Author

Espinosa-Gonzalez, Ana, primary, Prociuk, Denys, additional, Fiorentino, Francesca, additional, Ramtale, Christian, additional, Mi, Ella, additional, Mi, Emma, additional, Glampson, Ben, additional, Neves, Ana Luisa, additional, Okusi, Cecilia, additional, Hussain, Laiba, additional, Macartney, Jack, additional, Brown, Martina, additional, Browne, Ben, additional, Warren, Caroline, additional, Chowla, Rachna, additional, Heaversedge, Jonty, additional, Greenhalgh, Trisha, additional, de Lusignan, Simon, additional, Mayer, Erik, additional, and Delaney, Brendan, additional

Published
2021
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13. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Author

McManus, Richard J., Little, Paul, Stuart, Beth, Morton, Katherine, Raftery, James, Kelly, Jo, Bradbury, Katherine, Zhang, Jin, Zhu, Shihua, Murray, Elizabeth, May, Carl R., Mair, Frances S., Michie, Susan, Smith, Peter, Band, Rebecca, Ogburn, Emma, Allen, Julie, Rice, Cathy, Nuttall, Jacqui, Williams, Bryan, Yardley, Lucy, HOME BP investigators, Jones, Adam, Hussain, Ajmal, McHardy, Alistair, Harrison, Anna, LaLonde, Anna, Malik, Asim, Hernandez-Diaz, Basilio, Cranfield, Ben, Nicholson, Brian, Anandan, Carl, Neden, Catherine, Bobrow, Cathy, Evans, Chloe, Keast, Christopher, Henderson, Clare, Sutherland, Corrine, Kyte, Craig, Henderson, Dan, Noble, Debbie, Capo-Bianco, Ed, Williams, Edward, Shaw, Elizabeth, Mohri, Fatima, Asal, Gaurav, Dougall, Greig, Bhupal, Hardeep, Luckhurst, Heidi, Dosanjh, Hergeven, Nowell, Hilary, Brown, Jan, Flett, Jennifer, Barber, Julian, Rutter, Heather, Thompson, Julian, Ramanan, Kanjhana, Madronal, Karen, Malone, Karen, Etherington, Katie, Tsoi, Kenney, Knox, Kyle, Amin, Laila, Hirst, Lisa, Allen, Lucy, Skellern, Luke, Flynn, Lynne, McEwan, Lorne, Pugsley, Mark, Frassen, Marloes, Gaw, Matthew, Prendergast, Matthew, Wallard, Matthew, Faisal, Muhammad, Wooding, Nick, Lees, Nienke, Wainman, Paul, Nanda, Nithya, Moore, Patrick, Conley, Paul, Johnson, Paul, Wilson, Penny, Jacobs, Phillip, Whitbred, Pippa, Zamir, Rebecca, Reed, Richard, Tribley, Richard, Woof, Richard, Danson, Ruth, Lawes, Ruth, Gallagher, Sarah, Wadsworth, Sarah, Macanovic, Serge, Cartwright, Simon, Pettitt, Simon, Tucker, Simon, Doggett, Stephen, Sevenoaks, Tamsin, Watson, Tara, Talbot, Tess, Imrie, Ruth, Herbert, Thomas, Crockett, Tony, Wright, Tony, Sharma, Vanshika, Telford, Vicki, Almashta, Zaid, Cheng, Zelda, Ali, Zishan, Grube, Alice, Claxton, Andy, Asante, Barbara, Weare, Becki, McKee, Eleanor, Werrett, Bertha, Barwell, Carmel, Mulvihill, Carole, Sherwood, Caroline, MacDonald, Clare, Tabor, Dadirayi, Denning, Dawn, Roberts, Debbie, Adshead, Diane, Clarke, Gemma, Huntley, Heather, Pinder, Heather, Qasim, Irene, Merrison, Jane, King, Jill, Allison, Julie, Johal, Kam, Terry, Karen, Wood, Karine, Balmford, Kathryn, Barnes, Katie, Post, Katie, Bowden, Kelly-Marie, Edmunds, Kirsty, Whittle, Klaire, Peniket, Lara, Carnegie, Leann, Neale, Linda, Davey, Lisa, Bartlett, Liz, Smith, Louise, Clack, Lucy, Brown, Martina, McKenna, Naomi, Kay, Pam, Jacobs, Polly, Cutts, Rebecca, Pearse, Robert, Atkinson, Ruth, Barter, Sally, Mackie, Sally, Norris, Sam, Cook, Sandra, Elderfield, Sarah, Nzante, Sarah, Cronin, Sharon, Maslen, Sophie, Marchant, Stephanie, Wright, Stephanie, Keene, Sue, Smith, Sue, Cimelli, Suzie, Stone, Tracy, Joyce, Tricia, Le Marechal, Trudie, Kettle, Vicky, Osborne, Victoria, Cubiss, Wendy, Marsden, Wendy, Kowalczyk-Williams, Wioletta, and Bailey, Zoe

Abstract

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648.

Published
2021

14. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Author

McManus, Richard J, Little, Paul, Stuart, Beth, Morton, Katherine, Raftery, James, Kelly, Jo, Bradbury, Katherine, Zhang, Jin, Zhu, Shihua, Murray, Elizabeth, May, Carl R, Mair, Frances S, Michie, Susan, Smith, Peter, Band, Rebecca, Ogburn, Emma, Allen, Julie, Rice, Cathy, Nuttall, Jacqui, Williams, Bryan, Yardley, Lucy, Jones, Adam, Hussain, Ajmal, McHardy, Alistair, Harrison, Anna, LaLonde, Anna, Malik, Asim, Hernandez-Diaz, Basilio, Cranfield, Ben, Nicholson, Brian, Anandan, Carl, Neden, Catherine, Bobrow, Cathy, Evans, Chloe, Keast, Christopher, Henderson, Clare, Sutherland, Corrine, Kyte, Craig, Henderson, Dan, Noble, Debbie, Capo-Bianco, Ed, Williams, Edward, Shaw, Elizabeth, Mohri, Fatima, Asal, Gaurav, Dougall, Greig, Bhupal, Hardeep, Luckhurst, Heidi, Dosanjh, Hergeven, Nowell, Hilary, Brown, Jan, Flett, Jennifer, Barber, Julian, Rutter, Heather, Thompson, Julian, Ramanan, Kanjhana, Madronal, Karen, Malone, Karen, Etherington, Katie, Tsoi, Kenney, Knox, Kyle, Amin, Laila, Hirst, Lisa, Allen, Lucy, Skellern, Luke, Flynn, Lynne, McEwan, Lorne, Pugsley, Mark, Frassen, Marloes, Gaw, Matthew, Prendergast, Matthew, Wallard, Matthew, Faisal, Muhammad, Wooding, Nick, Lees, Nienke, Wainman, Paul, Nanda, Nithya, Moore, Patrick, Conley, Paul, Johnson, Paul, Wilson, Penny, Jacobs, Phillip, Whitbred, Pippa, Zamir, Rebecca, Reed, Richard, Tribley, Richard, Woof, Richard, Danson, Ruth, Lawes, Ruth, Gallagher, Sarah, Wadsworth, Sarah, Macanovic, Serge, Cartwright, Simon, Pettitt, Simon, Tucker, Simon, Doggett, Stephen, Sevenoaks, Tamsin, Watson, Tara, Talbot, Tess, Imrie, Ruth, Herbert, Thomas, Crockett, Tony, Wright, Tony, Sharma, Vanshika, Telford, Vicki, Almashta, Zaid, Cheng, Zelda, Ali, Zishan, Grube, Alice, Claxton, Andy, Asante, Barbara, Weare, Becki, McKee, Eleanor, Werrett, Bertha, Barwell, Carmel, Mulvihill, Carole, Sherwood, Caroline, MacDonald, Clare, Tabor, Dadirayi, Denning, Dawn, Roberts, Debbie, Adshead, Diane, Clarke, Gemma, Huntley, Heather, Pinder, Heather, Qasim, Irene, Merrison, Jane, King, Jill, Allison, Julie, Johal, Kam, Terry, Karen, Wood, Karine, Balmford, Kathryn, Barnes, Katie, Post, Katie, Bowden, Kelly-Marie, Edmunds, Kirsty, Whittle, Klaire, Peniket, Lara, Carnegie, Leann, Neale, Linda, Davey, Lisa, Bartlett, Liz, Smith, Louise, Clack, Lucy, Brown, Martina, McKenna, Naomi, Kay, Pam, Jacobs, Polly, Cutts, Rebecca, Pearse, Robert, Atkinson, Ruth, Barter, Sally, Mackie, Sally, Norris, Sam, Cook, Sandra, Elderfield, Sarah, Nzante, Sarah, Cronin, Sharon, Maslen, Sophie, Marchant, Stephanie, Wright, Stephanie, Keene, Sue, Smith, Sue, Cimelli, Suzie, Stone, Tracy, Joyce, Tricia, Le Marechal, Trudie, Kettle, Vicky, Osborne, Victoria, Cubiss, Wendy, Marsden, Wendy, Kowalczyk-Williams, Wioletta, and Bailey, Zoe

Subjects
Male, medicine.medical_specialty, General Practice, Psychological intervention, Blood Pressure, law.invention, Randomized controlled trial, law, Diabetes mellitus, Clinical endpoint, Humans, Medicine, Antihypertensive Agents, Aged, business.industry, Research, Self-Management, General Medicine, Blood Pressure Monitoring, Ambulatory, Middle Aged, medicine.disease, Telemedicine, United Kingdom, Confidence interval, Mean blood pressure, Blood pressure, Hypertension, Physical therapy, Female, Physical and Mental Health, business, Incremental cost-effectiveness ratio
Abstract

Objective The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting 76 general practices in the United Kingdom. Participants 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration ISRCTN13790648 .

Published
2020
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16. What Factors Determine Treatment Outcome in Aneurysmal Subarachnoid Hemorrhage in the Modern Era? A Post Hoc STASH Analysis

Author

Teo, Mario, primary, Guilfoyle, Mathew R., additional, Turner, Carole, additional, Kirkpatrick, Peter J., additional, Turner, Carole L., additional, Murray, Gordon D., additional, Hutchinson, Peter J., additional, Teasdale, Graham, additional, Mendelow, A. David, additional, Muir, Keith, additional, Smith, Martin, additional, McCabe, Peter, additional, Pearson, Jeremy, additional, Ford, Gary, additional, Vail, Andrew, additional, King, Andrew, additional, Tyrrell, Pippa, additional, Richards, Hugh, additional, Bond, Simon, additional, Smith, Christopher, additional, Warburton, Elizabeth, additional, Tseng, Ming, additional, Bulters, Diederik, additional, Brown, Martina, additional, Critchley, Giles, additional, Spurling, Gavin, additional, Gaylard, Jane, additional, Javadpour, Mohsen, additional, Eldridge, Paul, additional, Murray, Lorna, additional, Nelson, Richard, additional, Taylor, Ros, additional, Hierons, Sarah, additional, Tobin, Bianca, additional, Storey, Kelley, additional, Walsh, Daniel, additional, Mistry, Bejal, additional, Aeron-Thomas, John, additional, Puppo, Corina, additional, Papadopoulos, Mario, additional, Montague, Laura, additional, Gan, Peter, additional, Flint, Graham, additional, Hurley, Jennie, additional, Ronne, Elizabeth, additional, Stjernling, Inger, additional, Wang, Ernest, additional, Leen Cheng, Ei, additional, Lai, Jing Li, additional, Ross, Stuart, additional, Bellfield, Ruth, additional, Mandizvidza, Linetty, additional, Whitfield, Peter, additional, Persad, Nicola, additional, Suttner, Nigel, additional, Teo, Mario, additional, McGuigan, Kate, additional, Cloughley, Linda, additional, Patel, Hiren, additional, Ingham, Andrea, additional, Shaw, Kellymarie, additional, Vindlacheruvu, Raghu, additional, Millo, Julian, additional, Warner, Orlando, additional, Teal, Rachel, additional, Bernard, Francis, additional, Sirois, Carol, additional, Joshi, Shaban, additional, Nyabadza, Sheila, additional, Grieve, Joan, additional, Kitchen, Neil, additional, Bassan, Vanessa, additional, Rayson, Philip, additional, Zeitlin, Alexander, additional, Findlay, Max, additional, Sonnema, Leeca, additional, Poworoznik, Brenda, additional, Quintero, Juan, additional, Eljamel, Sam, additional, Rasulo, Frank, additional, Ng, Ivan, additional, Mathew, Bruce, additional, Grieg, Jill, additional, Hanel, Ricardo, additional, Richie, Alexa, additional, Fleetwood, Ian, additional, Reardon-White, Elizabeth, additional, Hampton, Ginger, additional, Lewis, Stephen, additional, Miralia, Lynn, additional, Brydon, Howard, additional, Maguire, Holly, additional, Patel, Umang, additional, Sanderson, Helen, additional, Birchall, Kathryn, additional, Bayliss, Pauline, additional, O'Neill, Kevin, additional, Sachs, Tina, additional, Kett-White, Rupert, additional, and Quinn, Leanne, additional

Published
2017
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17. PP44 Consensus on innovations and future change agenda in community first responder schemes in England: a national Nominal Group Technique study

Author

Patel, Gupteswar, Botan, Vanessa, Phung, Viet-Hai, Trueman, Ian, Pattinson, Julie, Parvin Hosseini, Seyed Mehrshad, Ørner, Roderick, Asghar, Zahid, Smith, Murray D, Rowan, Elise, Spaight, Robert, Evans, Jason, Brewster, Amanda, Mountain, Pauline, Mortimer, Craig, Miller, Joshua, Brown, Martina, and Siriwardena, Aloysius Niroshan

Abstract

BackgroundCommunity First Responder (CFR) schemes provide important and growing contributions to the Emergency Medical Services response, particularly in rural areas. Ambulance services have sought to improve the function of CFRs through various innovations, but these remain under-studied. This consensus study aimed to identify and prioritise innovations in CFR schemes.MethodsA modified-nominal group technique was adopted recruiting participants from regional and national stakeholders and a patient and public involvement panel. The consensus workshop consisted of four hybrid (face-to-face and online) sessions on one day: introduction and research findings; round-robin introduction of additional innovations; discussion and ranking; and concluding statement. Participants identified innovations and scored them on a 5-point Likert scale. Discussions were recorded, transcribed, and thematically analysed. The findings of the survey were analysed using descriptive statistics.ResultsThe meeting included 17 participants from across England including patient contributors, ambulance leads, commissioners and research staff. Innovations were classified into two broad categories: process innovations and technological innovations. Process innovations included six categories: roles, governance, training, policies and protocols, recruitment, and awareness. There were three categories of technological innovations: information and communication technology, transport technology, and health technology. Ranking of innovations was done independently with an online survey using a 1-5 scale showed that counselling and support for CFRs (median: 5 IQR: 5,5), peer support [5 (4,5)], and enhanced communication with the control room [5 (4,5)] were essential priorities. In contrast, innovations such as the provision of dual CFR crew [1.5 (1,3)], CFR responsibilities in patient transport to hospital [1 (1,2)], and CFR access to emergency blue light [1 (1,1.5)] were not deemed priorities.ConclusionsThis study established consensus on innovations in the CFR schemes and their ranking for improving the functions of CFR schemes. The consensus exercise also informed policy- and decision- makers on the potential future change agenda.

Published
2023
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18. A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest.

Author

Couper K, Ji C, Deakin CD, Fothergill RT, Nolan JP, Long JB, Mason JM, Michelet F, Norman C, Nwankwo H, Quinn T, Slowther AM, Smyth MA, Starr KR, Walker A, Wood S, Bell S, Bradley G, Brown M, Brown S, Burrow E, Charlton K, Claxton Dip A, Dra'gon V, Evans C, Falloon J, Foster T, Kearney J, Lang N, Limmer M, Mellett-Smith A, Miller J, Mills C, Osborne R, Rees N, Spaight RES, Squires GL, Tibbetts B, Waddington M, Whitley GA, Wiles JV, Williams J, Wiltshire S, Wright A, Lall R, and Perkins GD

Abstract

Background: In patients with out-of-hospital cardiac arrest, the effectiveness of drugs such as epinephrine is highly time-dependent. An intraosseous route of drug administration may enable more rapid drug administration than an intravenous route; however, its effect on clinical outcomes is uncertain., Methods: We conducted a multicenter, open-label, randomized trial across 11 emergency medical systems in the United Kingdom that involved adults in cardiac arrest for whom vascular access for drug administration was needed. Patients were randomly assigned to receive treatment from paramedics by means of an intraosseous-first or intravenous-first vascular access strategy. The primary outcome was survival at 30 days. Key secondary outcomes included any return of spontaneous circulation and favorable neurologic function at hospital discharge (defined by a score of 3 or less on the modified Rankin scale, on which scores range from 0 to 6, with higher scores indicating greater disability). No adjustment for multiplicity was made., Results: A total of 6082 patients were assigned to a trial group: 3040 to the intraosseous group and 3042 to the intravenous group. At 30 days, 137 of 3030 patients (4.5%) in the intraosseous group and 155 of 3034 (5.1%) in the intravenous group were alive (adjusted odds ratio, 0.94; 95% confidence interval [CI], 0.68 to 1.32; P = 0.74). At the time of hospital discharge, a favorable neurologic outcome was observed in 80 of 2994 patients (2.7%) in the intraosseous group and in 85 of 2986 (2.8%) in the intravenous group (adjusted odds ratio, 0.91; 95% CI, 0.57 to 1.47); a return of spontaneous circulation at any time occurred in 1092 of 3031 patients (36.0%) and in 1186 of 3035 patients (39.1%), respectively (adjusted odds ratio, 0.86; 95% CI, 0.76 to 0.97). During the trial, one adverse event, which occurred in the intraosseous group, was reported., Conclusions: Among adults with out-of-hospital cardiac arrest requiring drug therapy, the use of an intraosseous-first vascular access strategy did not result in higher 30-day survival than an intravenous-first strategy. (Funded by the National Institute for Health and Care Research; PARAMEDIC-3 ISRCTN Registry number, ISRCTN14223494.)., (Copyright © 2024 Massachusetts Medical Society.)

Published
2024
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19. Route of drug administration in out-of-hospital cardiac arrest: A protocol for a randomised controlled trial (PARAMEDIC-3).

Author

Couper K, Ji C, Lall R, Deakin CD, Fothergill R, Long J, Mason J, Michelet F, Nolan JP, Nwankwo H, Quinn T, Slowther AM, Smyth MA, Walker A, Chowdhury L, Norman C, Sprauve L, Starr K, Wood S, Bell S, Bradley G, Brown M, Brown S, Charlton K, Coppola A, Evans C, Evans C, Foster T, Jackson M, Kearney J, Lang N, Mellett-Smith A, Osborne R, Pocock H, Rees N, Spaight R, Tibbetts B, Whitley GA, Wiles J, Williams J, Wright A, and Perkins GD

Abstract

Aims: The PARAMEDIC-3 trial evaluates the clinical and cost-effectiveness of an intraosseous first strategy, compared with an intravenous first strategy, for drug administration in adults who have sustained an out-of-hospital cardiac arrest., Methods: PARAMEDIC-3 is a pragmatic, allocation concealed, open-label, multi-centre, superiority randomised controlled trial. It will recruit 15,000 patients across English and Welsh ambulance services. Adults who have sustained an out-of-hospital cardiac arrest are individually randomised to an intraosseous access first strategy or intravenous access first strategy in a 1:1 ratio through an opaque, sealed envelope system. The randomised allocation determines the route used for the first two attempts at vascular access. Participants are initially enrolled under a deferred consent model.The primary clinical-effectiveness outcome is survival at 30-days. Secondary outcomes include return of spontaneous circulation, neurological functional outcome, and health-related quality of life. Participants are followed-up to six-months following cardiac arrest. The primary health economic outcome is incremental cost per quality-adjusted life year gained., Conclusion: The PARAMEDIC-3 trial will provide key information on the clinical and cost-effectiveness of drug route in out-of-hospital cardiac arrest.Trial registration: ISRCTN14223494, registered 16/08/2021, prospectively registered., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: GDP is co-chair of the International Liaison Committee on Resuscitation (ILCOR). CD and JPN are emeritus members of the ILCOR Advanced Life Support task force. KC and HP are current members of the ILCOR Advanced Life Support task force. GDP is editor-in-chief and JPN is founding editor of Resuscitation Plus. KC is associate editor of Resuscitation Plus and guest editor for the research methodology special edition., (© 2023 The Authors.)

Published
2023
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