Author: "Gavin Perkins" - Searchworks@Jio Institute Digital Library Search Results

47 results on '"Gavin Perkins"'

1. The optimal surface for delivery of CPR: An updated systematic review and meta-analysis

Author: Maya Dewan, Eitan Schachna, Kathryn Eastwood, Gavin Perkins, and Janet Bray
Subjects: Cardiac arrest, Systematic review, Chest Compressions, Backboard, Mattress, Specialties of internal medicine, RC581-951
Abstract: Aim: To determine the effect of CPR delivery surface (e.g. firm mattress, floor, backboard) on patient outcomes and CPR delivery. Methods: We searched MEDLINE, Embase, Web of Science and the Cochrane Central Register of Controlled Trials for studies published since 2019 that evaluated the effect of CPR delivery surface in adults and children on patient outcomes and CPR depth (PROSPERO CRD42023467583). We included manikin studies due to a lack of human studies. We identified pre-2019 studies from the 2020 ILCOR evaluation of this topic. Two reviewers independently screened titles/abstracts and full-text papers, extracted data and assessed risk of bias. Evidence certainty for each outcome was evaluated using GRADE methodology. Where appropriate, we pooled data in a meta-analysis, using a random-effects model. Results: Database searches identified 489 citations. We included six studies published since 2019. We analysed these studies together with the eleven studies included in the previous ILCOR review. All included studies were manikin randomised controlled trials. Certainty of evidence was low. Interventions including placing the patient on the floor or the use of backboard had minimal impact on achieving greater compression depth. Meta-analyses of floor versus firm hospital mattress or firm home mattress found a mean difference of 5.36 mm (95% CI −1.59 to 12.32) and 2.11 mm (95% CI −3.23 to 7.45) respectively. Conclusion: The use of a backboard led to a small 2 mm increase in chest compression depth in meta-analysis of multiple mannikin trials. Use of a firm mattress or transitioning to the floor did not affect chest compression depth.
Published: 2024
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2. Public attitudes to emergency care treatment plans: a population survey of Great Britain

Author: Martin Underwood, Frances Griffiths, Anne-Marie Slowther, Gavin Perkins, Sophie Rees, Jenny Harlock, Caroline Huxley, Chris Bain, and Angela Noufaily
Subjects: Medicine
Abstract: Objectives To measure community attitudes to emergency care and treatment plans (ECTPs).Design Population survey.Setting Great Britain.Participants As part of the British Social Attitudes Survey, sent to randomly selected addresses in Great Britain, 1135 adults completed a module on ECTPs. The sample was nationally representative in terms of age and location, 619 (55%) were female and 1005 (89%) were of white origin.Outcome measures People’s attitudes having an ECTP for themselves now, and in the future; how comfortable they might be having a discussion about an ECTP and how they thought such a plan might impact on their future care.Results Predominantly, respondents were in favour of people being able to have an ECTP, with 908/1135 (80%) being at least somewhat in favour. People in good health were less likely than those with activity-limiting chronic disease to want a plan at present (52% vs 64%, OR 1.78 (95% CI 1.30 to 2.45) p
Published: 2024
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3. Alpha 2 agonists for sedation to produce better outcomes from critical illness (A2B Trial): protocol for a multicentre phase 3 pragmatic clinical and cost-effectiveness randomised trial in the UK

Author: John Norrie, Stephen Morris, Daniel Francis McAuley, Bronagh Blackwood, Paul Dark, Matt P Wise, Anthony C Gordon, Kalliopi Kydonaki, Timothy Simon Walsh, David Hope, Christopher Weir, Gavin Perkins, Nazir I Lone, Benedict Creagh-Brown, Julia Boyd, Michael Reade, Richard Anthony Parker, Leanne M Aitken, Valerie J Page, Alasdair MacLullich, Cathrine A McKenzie, Alix Macdonald, Annabel Giddings, Lydia Emerson, and Robert Glen
Subjects: Medicine
Abstract: Introduction Almost all patients receiving mechanical ventilation (MV) in intensive care units (ICUs) require analgesia and sedation. The most widely used sedative drug is propofol, but there is uncertainty whether alpha2-agonists are superior. The alpha 2 agonists for sedation to produce better outcomes from critical illness (A2B) trial aims to determine whether clonidine or dexmedetomidine (or both) are clinically and cost-effective in MV ICU patients compared with usual care.Methods and analysis Adult ICU patients within 48 hours of starting MV, expected to require at least 24 hours further MV, are randomised in an open-label three arm trial to receive propofol (usual care) or clonidine or dexmedetomidine as primary sedative, plus analgesia according to local practice. Exclusions include patients with primary brain injury; postcardiac arrest; other neurological conditions; or bradycardia. Unless clinically contraindicated, sedation is titrated using weight-based dosing guidance to achieve a Richmond-Agitation-Sedation score of −2 or greater as early as considered safe by clinicians. The primary outcome is time to successful extubation. Secondary ICU outcomes include delirium and coma incidence/duration, sedation quality, predefined adverse events, mortality and ICU length of stay. Post-ICU outcomes include mortality, anxiety and depression, post-traumatic stress, cognitive function and health-related quality of life at 6-month follow-up. A process evaluation and health economic evaluation are embedded in the trial.The analytic framework uses a hierarchical approach to maximise efficiency and control type I error. Stage 1 tests whether each alpha2-agonist is superior to propofol. If either/both interventions are superior, stages 2 and 3 testing explores which alpha2-agonist is more effective. To detect a mean difference of 2 days in MV duration, we aim to recruit 1437 patients (479 per group) in 40–50 UK ICUs.Ethics and dissemination The Scotland A REC approved the trial (18/SS/0085). We use a surrogate decision-maker or deferred consent model consistent with UK law. Dissemination will be via publications, presentations and updated guidelines.Trial registration number ClinicalTrials.gov NCT03653832.
Published: 2023
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4. European Registry of Cardiac Arrest – Study-THREE (EuReCa THREE) – An international, prospective, multi-centre, three-month survey of epidemiology, treatment and outcome of patients with out-of-hospital cardiac arrest in Europe – The study protocol

Author: Jan Wnent, Siobhan Masterson, Holger Maurer, Ingvild Tjelmeland, Johan Herlitz, Fernando Rosell Ortiz, Esther Kurbach, Leo Bossaert, Gavin Perkins, and Jan-Thorsten Gräsner
Subjects: Out-of-hospital cardiac arrest, Epidemiology, EuReCa, Survival, Specialties of internal medicine, RC581-951
Abstract: Background: The aim of the European Registry of Cardiac Arrest (EuReCa) network is to provide high quality evidence on epidemiology of out-of-hospital cardiac arrest (OHCA) in Europe by supporting and developing cardiac arrest registries and performing European-wide studies. To date, the EuReCa ONE and EuReCa TWO studies have involved around 28 countries, with population covered increasing from the first to the second study. The aim of the EuReCa THREE study is to build on previous work and to support the promotion of quality data collection on OHCA throughout Europe. Methods/design: EuReCa THREE will be the third prospective cohort study on epidemiology of OHCA and will involve around 30 European countries. The study will be conducted between 1st September and 30th November 2022. Data will be collected on cardiac arrest cases attended, resuscitation attempted, patient and cardiac arrest event characteristics and outcomes (including return of spontaneous circulation, status on hospital arrival and discharge). A particular focus for EuReCa THREE will be to describe key time intervals in OHCA management; time from call to EMS arrival on scene, time from cardiac arrest to start CPR, time from EMS arrival to delivery of patient to hospital.EuReCa THREE was registered with the German Registry of Clinical Trials Registration Number: DRKS00028591 searchable via WHO meta-registry (https://apps.who.int/trialsearch/). Discussion: The EuReCa THREE study will increase our knowledge on longitudinal OHCA epidemiology and provide new knowledge on crucial time intervals in OHCA management in Europe. However, the primary aim of building a network to support quality data on OHCA, remains the central tenant of the EuReCa project.
Published: 2022
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5. Role of immunosuppression in an antibiotic stewardship intervention and its association with clinical outcomes and antibiotic use: protocol for an observational study (RISC-sepsis)

Author: A John Simpson, Paul Dark, Katie Booth, Ranjit Lall, Gavin Perkins, Timothy Walsh, Manu Shankar-Hari, David McDonald, Daniel F McAuley, Andrew Conway Morris, Andrew Filby, Ronan McMullan, Thomas P Hellyer, Jonathan Scott, Loredana Trevi, Hannah McNeil, Tom Ewen, Phil Mawson, Gert Boschman, Vesna Melkebeek, Iain J McCullagh, and Anthony Rostron
Subjects: Medicine
Abstract: Introduction Sepsis is characterised by a dysregulated immune response to infection, with exaggerated pro-inflammatory and anti-inflammatory responses. A predominant immunosuppressive profile affecting both innate and adaptive immune responses is associated with increased hospital-acquired infection and reduced infection-free survival. While hospital-acquired infection leads to additional antibiotic use, the role of the immunosuppressive phenotype in guiding complex decisions, such as those affecting antibiotic stewardship, is uncertain. This study is a mechanistic substudy embedded within a multicentre clinical and cost-effectiveness trial of biomarker-guided antibiotic stewardship. This mechanistic study aims to determine the effect of sepsis-associated immunosuppression on the trial outcome measures.Methods and analysis RISC-sepsis is a prospective, multicentre, exploratory, observational study embedded within the ADAPT-sepsis trial. A subgroup of 180 participants with antibiotics commenced for suspected sepsis, enrolled in the ADAPT-sepsis trial, will be recruited. Blood samples will be collected on alternate days until day 7. At each time point, blood will be collected for flow cytometric analysis into cell preservation tubes. Immunophenotyping will be performed at a central testing hub by flow cytometry. The primary outcome measures are monocyte human leucocyte antigen-DR; neutrophil CD88; programmed cell death-1 on monocytes, neutrophils and T lymphocytes and the percentage of regulatory T cells. Secondary outcome measures will link to trial outcomes from the ADAPT-sepsis trial including antibiotic days; occurrence of hospital-acquired infection and length of ICU-stay and hospital-stay.Ethics and dissemination Ethical approval has been granted (IRAS 209815) and RISC-sepsis is registered with the ISRCTN (86837685). Study results will be disseminated by peer-reviewed publications, presentations at scientific meetings and via patient and public participation groups and social media.
Published: 2022
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6. Study into the reversal of septic shock with landiolol (beta blockade): STRESS-L Study protocol for a randomised trial

Author: Daniel Francis McAuley, Simon Gates, Duncan Young, Nafisa Boota, Anthony C Gordon, Julian Bion, Dipesh Mistry, Ranjit Lall, Janet Lord, Gavin Perkins, Mervyn Singer, Tony Whitehouse, Scott Regan, and Emma Skilton
Subjects: Medicine
Abstract: Introduction In 2013, a single-centre study reported the safe use of esmolol in patients with septic shock and tachycardia who required vasopressor therapy for more than 24 hours. Although not powered to detect a change in mortality, marked improvements were seen in survival (adjusted HR, 0.39; 95% CI, 0.26 to 0.59; p
Published: 2021
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7. Is a definitive trial of prehospital continuous positive airway pressure versus standard oxygen therapy for acute respiratory failure indicated? The ACUTE pilot randomised controlled trial

Author: Steve Goodacre, Tim Harris, Gordon Fuller, Matthew Ward, Cindy Cooper, Mike Bradburn, Alex Scott, Esther Herbert, Gavin Perkins, Andy Rosser, Praveen Thokala, Sam Keating, Imogen Gunson, Josh Miller, and Maggie Marsh
Subjects: Medicine
Abstract: Objectives To determine the feasibility of a large-scale definitive multicentre trial of prehospital continuous positive airway pressure (CPAP) in acute respiratory failure.Design A single-centre, open-label, individual patient randomised, controlled, external pilot trial.Setting A single UK Ambulance Service, between August 2017 and July 2018.Participants Adults with respiratory distress and peripheral oxygen saturations below British Thoracic Society target levels despite controlled oxygen treatment.Interventions Patients were randomised to prehospital CPAP (O-Two system) versus standard oxygen therapy in a 1:1 ratio using simple randomisation.Primary and secondary outcome measures Feasibility outcomes comprised recruitment rate, adherence to allocated treatment, retention and data completeness. The primary clinical outcome was 30-day mortality.Results 77 patients were enrolled (target 120), including 7 cases with a diagnosis where CPAP could be ineffective or harmful. CPAP was fully delivered in 74% (target 75%). There were no major protocol violations. Full data were available for all key outcomes (targets ≥90%). Overall 30-day mortality was 27.3%. Of these deceased patients, 14/21 (68%) either did not have a respiratory condition or had ceiling of treatment decisions implemented excluding hospital non-invasive ventilation and critical care.Conclusions Recruitment rate was below target and feasibility was not demonstrated. Limited compliance with CPAP, and difficulty in identifying patients who could benefit from CPAP, indicate that prehospital CPAP is unlikely to materially reduce mortality. A definitive effectiveness trial of CPAP is therefore not recommended.Trial registration number ISRCTN12048261; Post-results.
Published: 2020
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8. The ACUTE (Ambulance CPAP: Use, Treatment effect and economics) feasibility study: a pilot randomised controlled trial of prehospital CPAP for acute respiratory failure

Author: Gordon W. Fuller, Steve Goodacre, Samuel Keating, Gavin Perkins, Matthew Ward, Andy Rosser, Imogen Gunson, Joshua Miller, Mike Bradburn, Praveen Thokala, Tim Harris, Andrew Carson, Maggie Marsh, and Cindy Cooper
Subjects: Acute respiratory failure, Continuous positive airways pressure, Prehospital, Emergency medical services, Medicine (General), R5-920
Abstract: Abstract Background Acute respiratory failure (ARF) is a common and life-threatening medical emergency. Standard prehospital management involves controlled oxygen therapy and disease-specific ancillary treatments. Continuous positive airway pressure (CPAP) is a potentially beneficial alternative treatment that could be delivered by emergency medical services. However, it is uncertain whether this treatment could work effectively in United Kingdom National Health Service (NHS) ambulance services and if it represents value for money. Methods An individual patient randomised controlled external pilot trial will be conducted comparing prehospital CPAP to standard oxygen therapy for ARF. Adults presenting to ambulance service clinicians will be eligible if they have respiratory distress with peripheral oxygen saturation below British Thoracic Society (BTS) target levels, despite titrated supplemental oxygen. Enrolled patients will be allocated (1:1 simple randomisation) to prehospital CPAP (O_two system) or standard oxygen therapy using identical sealed boxes. Feasibility outcomes will include incidence of recruited eligible patients, number of erroneously recruited patients and proportion of cases adhering to allocation schedule and treatment, followed up at 30 days and with complete data collection. Effectiveness outcomes will comprise survival at 30 days (definitive trial primary end point), endotracheal intubation, admission to critical care, length of hospital stay, visual analogue scale (VAS) dyspnoea score, EQ-5D-5L and health care resource use at 30 days. The cost-effectiveness of CPAP, and of conducting a definitive trial, will be evaluated by updating an existing economic model. The trial aims to recruit 120 patients over 12 months from four regional ambulance hubs within the West Midlands Ambulance Service (WMAS). This sample size will allow estimation of feasibility outcomes with a precision of
Published: 2018
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9. Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study

Author: Chris Moore, Jenna Bulger, Matt Morgan, Timothy Driscoll, Alison Porter, Saiful Islam, Mike Smyth, Gavin Perkins, Bernadette Sewell, Timothy Rainer, Prabath Nanayakkara, Chukwudi Okolie, Susan Allen, Greg Fegan, Jan Davies, Theresa Foster, Nick Francis, Fang Gao Smith, Gemma Ellis, Tracy Shanahan, Robin Howe, and Helen Snooks
Subjects: Paramedic, Sepsis, Antibiotics, Prehospital, Medicine (General), R5-920
Abstract: Abstract Background Sepsis is a common condition which kills between 36,000 and 64,000 people every year in the UK. Early recognition and management of sepsis has been shown to reduce mortality and improve the health and well-being of people with sepsis. Paramedics frequently come into contact with patients with sepsis and are well placed to provide early diagnosis and treatment. We aim to determine the feasibility of undertaking a fully powered randomised controlled trial (RCT) to test the clinical and cost-effectiveness of paramedics obtaining blood cultures from and administering IV antibiotics to patients with sepsis, so we can make a decision about whether to proceed to a fully powered randomised controlled trial, which will answer questions regarding safety and effectiveness for patients and benefit to the National Health Service (NHS). Methods/design This is an individually randomised, two-arm feasibility study for a randomised controlled trial with a 1:1 ratio. Sixty paramedics will receive training to assist them to recognise sepsis using a screening tool, obtain blood cultures, and provide IV antibiotics. If sepsis is suspected, paramedics will randomly allocate patients to intervention or usual care using their next sequential individually issued scratch card. Patients will be followed up at 90 days using linked anonymised data to capture length of hospital admission and mortality. We will also collect self-reported health-related quality of life (using SF-12) at this time. We will interview ten patients by telephone and hold a focus group with paramedics, to find out what they think about the intervention. Discussion At the end of this study, we will make a recommendation about whether a full randomised controlled trial of paramedics obtaining blood cultures and administering IV antibiotics for sepsis is warranted, and if so, we will develop a proposal for research funding in order to take the work forward. Trial registration ISRCTN, ISRCTN36856873
Published: 2018
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10. Effect of high-dose vitamin D3 on 28-day mortality in adult critically ill patients with severe vitamin D deficiency: a study protocol of a multicentre, placebo-controlled double-blind phase III RCT (the VITDALIZE study)

Author: Dhruv Parekh, David Thickett, Gemma Slinn, Peter Brocklehurst, Danny Mcauley, Maria Wittmann, Teresa Melody, Jaimin Patel, Gavin Perkins, Markus Kredel, Peter Kranke, Christian Stoppe, Lars Hummitzsch, Norbert Weiler, Karin Amrein, Sabine Westphal, Jean-Charles Preiser, Andrea Berghold, Regina Riedl, Philipp Eller, Peter Schellongowski, Patrick Meybohm, Corinna Marschalek, Rene Schmutz, Martin Clodi, Michael Resl, Mario Krasser, Matthias Michlmayr, Johann Reisinger, Alexandra Schiller, Nicolas Dominik Verheyen, Dirk von Lewinski, Marlene Sandra Deininger, Andreas Muench, Holger Simonis, Paul Zajic, Ines Lindenau, Alexander Holl, Alexander Pichler, Tadeja Urbanic Purkart, Katharina Ritsch, Simon Schmidt, Romuald Bellmann, Anna Brandtner, Adelheid Ditlbacher, Julia Hasslacher, Michael Joannidis, Andreas Peer, Klemens Zotter, Christoph Martin Biedermann, Andreas Valentin, Franz Wimmer, Susanne Demschar, Markus Koestenberger, Rudolf Likar, Stefan Neuwersch, Michael Pogatschnigg, Brigitte Trummer, Martin Duenser, Jens Meier, Johann Kainz, Romana Sommer, Otmar Schindler, Alexander Lehr, Guenter Mesaric, Yasmin Tinawi, Norbert Watzinger, Randolf Hammerl, Peter Krippl, Stefan Langner, Martin Lux, Matthias Unteregger, Gerwig Fruehauf, Barbara Gruber, Bertram Harzl, Viktor Wutzl, Juergen Berghofer, Nadine Fuch, Gilbert Hainzl, Isolde Pessentheiner, Michael Zink, Petra Hoernler, Ernst Trampitsch, Jakob Muehlbacher, Philipp Riss, Roman Ullrich, Martin Bernardi, Michael Hiesmayr, Katharina Kovac, Cecilia Veraar, Bernhard Zapletal, Elisabeth Lobmeyr, Esther Tiller, Georg Hinterholzer, Daniel Mydza, Sabine Schmaldienst, Maxime van Cutsem, Marianne Blockmans, Alain D’hondt, Vincent Fraipont, Sophie Jacquet, Caroline Abbenhuijs, Katarina Helenarova, Romain Courcelle, Dominique Durand, Amedee Ego, Amina Khaldi, Itesa Nancy Matumikina, Kai Zacharowski, Simone Lindau, Philipp Helmer, Gunnar Elke, Guenther Zick, Tobias Becher, Dirk Schaedler, Matthias Kott, Barbara Vogt, Ingmar Lautenschlaeger, Georg Fuernau, Christian Putensen, Stefan Ehrentraut, Barbara Kapfer, Thomas Felbinger, Ines Kaufmann, Bjoern Andrew Rempiss, Claudia Spiess, Stefan Schaller, Tobias Schlesinger, Magdalena Sitter, Jan Stumpner, Nico Schlegel, Christoph Schimmer, Ekkehard Kunze, Thomas Kerz, Dominik Wesp, Axel Neule, Florian Ringel, Mario Maggiorini, Stephan Jakob, Joerg Schefold, Rebekah Wale, Marlies Ostermann, Matthew Morgan, Mervyn Singer, and Matthew Rowland
Subjects: Medicine
Abstract: Introduction Observational studies have demonstrated an association between vitamin D deficiency and increased risk of morbidity and mortality in critically ill patients. Cohort studies and pilot trials have suggested promising beneficial effects of vitamin D replacement in the critical ill, at least in patients with severe vitamin D deficiency. As vitamin D is a simple, low-cost and safe intervention, it has potential to improve survival in critically ill patients.Methods and analysis In this randomised, placebo-controlled, double-blind, multicentre, international trial, 2400 adult patients with severe vitamin D deficiency (25-hydroxyvitamin D≤12 ng/mL) will be randomised in a 1:1 ratio by www.randomizer.at to receive a loading dose of 540 000 IU cholecalciferol within 72 hours after intensive care unit (ICU) admission, followed by 4000 IU daily for 90 days or placebo. Hypercalcaemia may occur as a side effect, but is monitored by regular checks of the calcium level. The primary outcome is all-cause mortality at 28 days after randomisation. Secondary outcomes are: ICU, hospital, 90-day and 1-year mortality; hospital and ICU length of stay, change in organ dysfunction on day 5 as measured by Sequential Organ Function Assessment (SOFA) score, number of organ failures; hospital and ICU readmission until day 90; discharge destination, self-reported infections requiring antibiotics until day 90 and health-related quality of life. Recruitment status is ongoing.Ethics and dissemination National ethical approval was obtained by the Ethics Committee of the University of Graz for Austria, Erasme University Brussels (Belgium) and University Hospital Frankfurt (Germany), and will further be gained according to individual national processes. On completion, results will be published in a peer-reviewed scientific journal. The study findings will be presented at national and international meetings with abstracts online.Trial registration NCT03188796, EudraCT-No: 2016-002460-13.
Published: 2019
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11. Developing an intervention around referral and admissions to intensive care: a mixed-methods study

Author: Chris Bassford, Frances Griffiths, Mia Svantesson, Mandy Ryan, Nicolas Krucien, Jeremy Dale, Sophie Rees, Karen Rees, Agnieszka Ignatowicz, Helen Parsons, Nadine Flowers, Zoe Fritz, Gavin Perkins, Sarah Quinton, Sarah Symons, Catherine White, Huayi Huang, Jake Turner, Mike Brooke, Aimee McCreedy, Caroline Blake, and Anne Slowther
Subjects: intensive care, critical care, decision-making, patient centred, ethics, ethnography, epistemology, choice experiment, Public aspects of medicine, RA1-1270, Medicine (General), R5-920
Abstract: Background: Intensive care treatment can be life-saving, but it is invasive and distressing for patients receiving it and it is not always successful. Deciding whether or not a patient will benefit from intensive care is a difficult clinical and ethical challenge. Objectives: To explore the decision-making process for referral and admission to the intensive care unit and to develop and test an intervention to improve it. Methods: A mixed-methods study comprising (1) two systematic reviews investigating the factors associated with decisions to admit patients to the intensive care unit and the experiences of clinicians, patients and families; (2) observation of decisions and interviews with intensive care unit doctors, referring doctors, and patients and families in six NHS trusts in the Midlands, UK; (3) a choice experiment survey distributed to UK intensive care unit consultants and critical care outreach nurses, eliciting their preferences for factors used in decision-making for intensive care unit admission; (4) development of a decision-support intervention informed by the previous work streams, including an ethical framework for decision-making and supporting referral and decision-support forms and patient and family information leaflets. Implementation feasibility was tested in three NHS trusts; (5) development and testing of a tool to evaluate the ethical quality of decision-making related to intensive care unit admission, based on the assessment of patient records. The tool was tested for inter-rater and intersite reliability in 120 patient records. Results: Influences on decision-making identified in the systematic review and ethnographic study included age, presence of chronic illness, functional status, presence of a do not attempt cardiopulmonary resuscitation order, referring specialty, referrer seniority and intensive care unit bed availability. Intensive care unit doctors used a gestalt assessment of the patient when making decisions. The choice experiment showed that age was the most important factor in consultants’ and critical care outreach nurses’ preferences for admission. The ethnographic study illuminated the complexity of the decision-making process, and the importance of interprofessional relationships and good communication between teams and with patients and families. Doctors found it difficult to articulate and balance the benefits and burdens of intensive care unit treatment for a patient. There was low uptake of the decision-support intervention, although doctors who used it noted that it improved articulation of reasons for decisions and communication with patients. Limitations: Limitations existed in each of the component studies; for example, we had difficulty recruiting patients and families in our qualitative work. However, the project benefited from a mixed-method approach that mitigated the potential limitations of the component studies. Conclusions: Decision-making surrounding referral and admission to the intensive care unit is complex. This study has provided evidence and resources to help clinicians and organisations aiming to improve the decision-making for and, ultimately, the care of critically ill patients. Future work: Further research is needed into decision-making practices, particularly in how best to engage with patients and families during the decision process. The development and evaluation of training for clinicians involved in these decisions should be a priority for future work. Study registration: The systematic reviews of this study are registered as PROSPERO CRD42016039054, CRD42015019711 and CRD42015019714. Funding: The National Institute for Health Research Health Services and Delivery Research programme. The University of Aberdeen and the Chief Scientist Office of the Scottish Government Health and Social Care Directorates fund the Health Economics Research Unit.
Published: 2019
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12. Patient experience and reflective learning (PEARL): a mixed methods protocol for staff insight development in acute and intensive care medicine in the UK

Author: Jennifer Jones, Felicity Evison, Richard Lilford, Celia Brown, Julian Bion, Carolyn Tarrant, A Joshi, J Mann, Ivo Vlaev, Stephen E Wright, Daniel Wolstenholme, Ian Clement, C Scott, Gavin Perkins, J Thompson, Paul Sullivan, Chris Gibbins, Fang Gao Smith, Catherine Snelson, L Cooper, T Jones, Randeep Mullhi, Julian Archer, H Halliday, Olivia Brookes, Duncan Buckley, Lisa Marie Buckley, Emma Hayton, Greg Packer, Jonathan Shelton, J Willars, C Higenbottam, F Wyton, E Fellows, K Moss, L Flavell, J Flavell, J Raeside, M Hawkesford, H Laugher, S Nevitt, K Naylor, J Sampson, S Ballinger, T Melody, G Buggy, S Majid, P Diviyesh, P Thorpe, A Shaha, R Carvell, K Kneller, C Iles, I O’Neil, G Yeoman, C Randell, H Korovesis, H Doherty, K Protheroe, E Swann, L Dunn, K Mccourt, S Perks, T Chakravorty, C Grindell, and R Bec
Subjects: Medicine
Abstract: Introduction Patient and staff experiences are strongly influenced by attitudes and behaviours, and provide important insights into care quality. Patient and staff feedback could be used more effectively to enhance behaviours and improve care through systematic integration with techniques for reflective learning. We aim to develop a reflective learning framework and toolkit for healthcare staff to improve patient, family and staff experience.Methods & analysis Local project teams including staff and patients from the acute medical units (AMUs) and intensive care units (ICUs) of three National Health Service trusts will implement two experience surveys derived from existing instruments: a continuous patient and relative survey and an annual staff survey. Survey data will be supplemented by ethnographic interviews and observations in the workplace to evaluate barriers to and facilitators of reflective learning. Using facilitated iterative co-design, local project teams will supplement survey data with their experiences of healthcare to identify events, actions, activities and interventions which promote personal insight and empathy through reflective learning. Outputs will be collated by the central project team to develop a reflective learning framework and toolkit which will be fed back to the local groups for review, refinement and piloting. The development process will be mapped to a conceptual theory of reflective learning which combines psychological and pedagogical theories of learning, alongside theories of behaviour change based on capability, opportunity and motivation influencing behaviour. The output will be a locally-adaptable workplace-based toolkit providing guidance on using reflective learning to incorporate patient and staff experience in routine clinical activities.Ethics & dissemination The PEARL project has received ethics approval from the London Brent Research Ethics Committee (REC Ref 16/LO/224). We propose a national cluster randomised step-wedge trial of the toolkit developed for large-scale evaluation of impact on patient outcomes.
Published: 2019
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13. Life Saving Apps: Linking Cardiac Arrest Victims to Emergency Services and Volunteer Responders.

Author: Sarah N. Lim Choi Keung, Mohammed O. Khan, Christopher Smith, Gavin Perkins, Paddie Murphy, and Theodoros N. Arvanitis
Published: 2016
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14. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Author: Tài, Pham, Leo, Heunk, Giacomo, Bellani, Fabiana, Madotto, Irene, Aragao, Gaëtan, Beduneau, Ewan C, Goligher, Giacomo, Grasselli, Jon Henrik, Laake, Jordi, Mancebo, Oscar, Peñuela, Lise, Piquilloud, Antonio, Pesenti, Hannah, Wunsch, Frank, van Haren, Laurent, Brochard, John G, Laffey, Abrough, Fekri, P Acharya, Subhash, Amin, Pravin, Arabi, Yaseen, Aragao, Irene, Bauer, Philippe, Beduneau, Gaëtan, Beitler, Jeremy, Berkius, Johan, Bugedo, Guillermo, Camporota, Luigi, Cerny, Vladimir, Cho, Young-Jae, Clarkson, Kevin, Estenssoro, Elisa, Goligher, Ewan, Grasselli, Giacomo, Gritsan, Alexey, Mohammadreza Hashemian, Seyed, Hermans, Greet, M Heunks, Leo, Jovanovic, Bojan, Kurahashi, Kiyoyasu, Henrik Laake, Jon, Matamis, Dimitrio, Moerer, Onnen, Molnar, Zsolt, Ozyilmaz, Ezgi, Panka, Bernardo, Papali, Alfred, Peñuelas, Óscar, Perbet, Sébastien, Piquilloud, Lise, Qiu, Haibo, Abdel Razek, Assem, Rittayamai, Nuttapol, Roldan, Rollin, Serpa Neto, Ary, Szuldrzynski, Konstanty, Talmor, Daniel, Tomescu, Dana, Van Haren, Frank, Villagomez, Asisclo, Ali Zeggwagh, Amine, Abe, Toshikazu, Aboshady, Abdelrhman, Acampo-de Jong, Melanie, Acharya, Subhash, Adderley, Jane, Adiguzel, Nalan, Kumar Agrawal, Vijay, Aguilar, Gerardo, Aguirre, Gaston, Aguirre-Bermeo, Hernan, Ahlström, Björn, Akbas, Türkay, Akker, Mustafa, Al Sadeh, Ghamdan, Alamri, Sultan, Algaba, Angela, Ali, Muneeb, Aliberti, Anna, Manuel Allegue, Jose, Alvarez, Diana, Amador, Joaquin, H Andersen, Finn, Ansari, Sharique, Apichatbutr, Yutthana, Apostolopoulou, Olympia, Arellano, Daniel, Arica, Mestanza, Arikan, Huseyin, Arinaga, Koichi, Arnal, Jean-Michel, Asano, Kengo, Asín-Corrochano, Marta, Milagrito Avalos Cabrera, Jesu, Avila Fuentes, Silvia, Aydemir, Semih, Aygencel, Gulbin, Azevedo, Luciano, Bacakoglu, Feza, Badie, Julio, Baedorf Kassis, Elia, Bai, Gabriela, Balaraj, Govindan, Ballico, Bruno, Banner-Goodspeed, Valerie, Banwarie, Preveen, Barbieri, Rosella, Baronia, Arvind, Barrett, Jonathan, Barrot, Loïc, Emilio Barrueco-Francioni, Jesu, Barry, Jeffrey, Bawangade, Harshal, Beavis, Sarah, Beck, Eduardo, Beehre, Nina, Belenguer Muncharaz, Alberto, Bellani, Giacomo, Belliato, Mirko, Bellissima, Agrippino, Beltramelli, Rodrigo, Ben Souissi, Asma, Benitez-Cano, Adela, Benlamin, Mohamed, Benslama, Abdellatif, Bento, Lui, Benvenuti, Daniela, Bernabe, Laura, Bersten, Andrew, Berta, Giacomo, Bertini, Pietro, Bertram-Ralph, Elliot, Besbes, Mohamed, Roberto Bettini, Lisandro, Beuret, Pascal, Bewley, Jeremy, Bezzi, Marco, Bhakhtiani, Lakshay, Bhandary, Rakesh, Bhowmick, Kaushik, Bihari, Shailesh, Bissett, Bernie, Blythe, David, Bocher, Simon, Boedjawan, Narain, M Bojanowski, Christine, Boni, Elisa, Boraso, Sabrina, Borelli, Massimo, Borello, Silvina, Borislavova, Margarita, J Bosma, Karen, Bottiroli, Maurizio, Boyd, Owen, Bozbay, Suha, Briva, Arturo, Brochard, Laurent, Bruel, Cédric, Bruni, Andrea, Buehner, Ulrike, Bulpa, Pierre, Burt, Karen, Buscot, Mathieu, Buttera, Stefania, Cabrera, Jorge, Caccese, Roberta, Caironi, Pietro, Canchos Gutierrez, Ivan, Canedo, Nancy, Cani, Alma, Cappellini, Iacopo, Carazo, Jesu, Pablo Cardonnet, Lui, Carpio, David, Carriedo, Demetrio, Carrillo, Ramón, Carvalho, João, Caser, Eliana, Castelli, Antonio, Castillo Quintero, Manuel, Castro, Heloisa, Catorze, Nuno, Cengiz, Melike, Cereijo, Enrique, Ceunen, Helga, Chaintoutis, Christo, Chang, Youjin, Chaparro, Gustavogcha, Chapman, Carmel, Chau, Simon, Eugenia Chavez, Cecilia, Chelazzi, Cosimo, Chelly, Jonathan, Chemouni, Frank, Chen, Kai, Chena, Ariel, Chiarandini, Paolo, Chilton, Phil, Chiumello, Davide, Chou-Lie, Yvette, Chudeau, Nicola, Cinel, Ismail, Cinnella, Gilda, Clark, Michele, Clark, Thoma, Clementi, Stefano, Coaguila, Lui, Jaspe Codecido, Alexi, Collins, Amy, Colombo, Riccardo, Conde, Juan, Consales, Guglielmo, Cook, Tim, Coppadoro, Andrea, Cornejo, Rodrigo, Cortegiani, Andrea, Coxo, Cristina, Neville Cracchiolo, Andrea, Crespo Ramirez, Mónica, Crova, Philippe, Cruz, José, Cubattoli, Lucia, Çukurova, Zafer, Curto, Francesco, Czempik, Piotr, D'Andrea, Rocco, da Silva Ramos, Fernando, Dangers, Laurence, Danguy des Déserts, Marc, Danin, Pierre-Eric, Dantas, Fabianne, Daubin, Cédric, Dawei, Wu, de Haro, Candelaria, de Jesus Montelongo, Felipe, De Mendoza, Diego, de Pablo, Raúl, De Pascale, Gennaro, De Rosa, Silvia, Decavèle, Maxen, Declercq, Pierre-Loui, Deicas, Alberto, Del Carmen Campos Moreno, María, Dellamonica, Jean, Delmas, Benjamin, Demirkiran, Oktay, Demirkiran, Hilmi, Dendane, Tarek, di Mussi, Rossella, Diakaki, Chrysi, Diaz, Anatilde, Diaz, Willy, Dikmen, Yalim, Dimoula, Aikaterini, Doble, Patricia, Doha, Nagwa, Domingos, Guilherme, Dres, Martin, Dries, David, Duggal, Abhijit, Duke, Graeme, Dunts, Pavel, Dybwik, Knut, Dykyy, Maksym, Eckert, Philippe, Efe, Serdar, Elatrous, Souheil, Elay, Gülseren, S Elmaryul, Abubaker, Elsaadany, Mohamed, Elsayed, Hany, Elsayed, Samar, Emery, Malo, Ena, Sébastien, Eng, Kevin, A Englert, Joshua, Erdogan, Elif, Ergin Ozcan, Perihan, Eroglu, Ege, Escobar, Miguel, Esen, Figen, Esen Tekeli, Arzu, Esquivel, Alejandro, Esquivel Gallegos, Helbert, Ezzouine, Hanane, Facchini, Alberto, Faheem, Mohammad, Fanelli, Vito, Fernanda Farina, Maria, Fartoukh, Muriel, Fehrle, Lutz, Feng, Feng, Feng, Yufeng, Fernandez, Irene, Fernandez, Borja, Lorena Fernandez-Rodriguez, Maria, Ferrando, Carlo, João Ferreira da Silva, Maria, Ferreruela, Mireia, Ferrier, Janet, Jesús Flamm Zamorano, Matia, Flood, Laura, Floris, Leda, Fluckiger, Martin, Forteza, Catalina, Fortunato, Antonella, Frans, Eric, Frattari, Antonella, Fredes, Sebastian, Frenzel, Tim, Fumagalli, Roberto, Andres Furche, Mariano, Fusari, Maurizio, Fysh, Edward, Luis Galeas-Lopez, Juan, Galerneau, Louis-Marie, Garcia, Analía, Fernanda Garcia, María, Garcia, Elisabet, Garcia Olivares, Pablo, Garlicki, Jaroslaw, Garnero, Aude, Garofalo, Eugenio, Gautam, Prabha, Gazenkampf, Andrey, Gelinotte, Stéphanie, Gelormini, Domenico, Ghrenassia, Etienne, Giacomucci, Angelo, Giannoni, Robert, Gigante, Andrea, Glober, Nancy, Gnesin, Paolo, Gollo, Yari, Gomaa, Dina, Gomero Paredes, Rosita, Gomes, Rui, Alejandro Gomez, Raúl, Gomez, Oscar, Gomez, Aroa, Gondim, Louise, Gonzalez, Manuel, Gonzalez, Isabel, Gonzalez-Castro, Alejandro, Gordillo Romero, Orlando, Gordo, Federico, Gouin, Philippe, Graf Santos, Jerónimo, Grainne, Rooney, Grando, Matilde, Granov Grabovica, Sanja, Grasso, Salvatore, Grasso, Rinaldo, Grimmer, Lisa, Grissom, Colin, Gu, Qing, Guan, Xiang-Dong, Guarracino, Fabio, Guasch, Neu, Guatteri, Luca, Gueret, Renaud, Guérin, Claude, Guerot, Emmanuel, Guitard, Pierre-Gilda, Gül, Fethi, Gumus, Ayca, Gurjar, Mohan, Gutierrez, Patricia, Hachimi, Abdelhamid, Hadzibegovic, Adi, Hagan, Samantha, Hammel, Clare, Han Song, Joo, Hanlon, Gabrielle, Heines, Serge, Henriksson, Johanna, Herbrecht, Jean-Etienne, Omar Heredia Orbegoso, Gabriel, Hermon, Andrew, Hernandez, Rosana, Hernandez, Carmen, Herrera, Lui, Herrera-Gutierrez, Manuel, Heunks, Leo, Hidalgo, Juan, Hill, Dianne, Holmquist, Dagmar, Homez, Marcela, Hongtao, Xia, Hormis, Anil, Horner, Daniel, Carmen Hornos, M, Hou, Meihong, House, Stacy, Housni, Brahim, Hugill, Keith, Humphreys, Sally, Humbert, Loui, Hunter, Stephanie, Hwa Young, Lee, Iezzi, Nicola, Ilutovich, Santiago, Inal, Volkan, Innes, Richard, Ioannides, Panagioti, Antonio Iotti, Giorgio, Ippolito, Mariachiara, Irie, Hiromasa, Iriyama, Hiroki, Itagaki, Taiga, Izura, Javier, Izza, Santiago, Jabeen, Rakhshanda, Jamaati, Hamidreza, Jamadarkhana, Sunil, Jamoussi, Amira, Jankowski, Milosz, Alberto Jaramillo, Lui, Jeon, Kyeongman, Jeong Lee, Seok, Jeswani, Deepak, Jha, Simant, Jiang, Liangyan, Jing, Chen, Jochmans, Sébastien, Anders Johnstad, Bror, Jongmin, Lee, Joret, Aurélie, Junhasavasdikul, Detajin, Teresa Jurado, Maria, Kam, Elisa, Kamohara, Hidenobu, Kane, Caroline, Kara, Iskender, Karakurt, Sait, Karnjanarachata, Cherdkiat, Kataoka, Jun, Katayama, Shinshu, Kaushik, Shuchi, Kelebek Girgin, Nermin, Kerr, Kathryn, Kerslake, Ian, Khairnar, Prakash, Khalid, Abidi, Khan, Akram, K Khanna, Ashish, Khorasanee, Reza, Kienhorst, Dieneke, Kirakli, Cenk, Knafelj, Rihard, Kol Kol, Mark, Kongpolprom, Napplika, Kopitko, Csaba, Korkmaz Ekren, Pervin, Kubisz-Pudelko, Agnieszka, Kulcsar, Zoltan, Kumasawa, Junji, Kuriyama, Akira, Kutchak, Fernanda, Labarca, Eduardo, Labat, Françoise, Laborda, César, Alberto Laca Barrera, Manuel, Lagache, Laurie, Landaverde Lopez, Antonio, Lanspa, Michael, Lascari, Valeria, Le Meur, Matthieu, Hwan Lee, Su, Ju Lee, Young, Lee, Jinwoo, Lee, Won-Yeon, Lee, Jarone, Legernaes, Terje, Leiner, Tamaa, Lemiale, Virginie, Leonor, Tiago, M Lepper, Philipp, Li, Dahuan, Li, Hongbin, Li, Oleg, Raquel Lima, Ana, Lind, Dan, Litton, Edward, Liu, Ning, Liu, Ling, Liu, Jialin, Llitjos, Jean-Françoi, Llorente, Beatriz, Lopez, Rodolfo, Elizabeth Lopez, Claudia, Lopez Nava, Claudia, Lovazzano, Pablo, Lu, Min, Lucchese, Francesca, Lugano, Manuela, Lugo Goytia, Gustavo, Luo, Hua, Lynch, Ceri, Macheda, Sebastiano, Hugo Madrigal Robles, Victor, Maurizio Maggiore, Salvatore, Magret Iglesias, Mònica, Malaga, Peter, Mallapura Maheswarappa, Harish, Malpartida, Guillermo, Malyarchikov, Andrey, Mansson, Helena, Manzano, Anaid, Marey, Ismael, Marin, Nathalie, Del Carmen Marin, Maria, Markman, Eliana, Martin, Felix, Martin, Alex, Martin Dal Gesso, Cristina, Martinez, Felipe, Martínez-Fidalgo, Conchita, Martin-Loeches, Ignacio, Mas, Arantxa, Masaaki, Sakuraya, Maseda, Emilio, Massa, Eleni, Mattsson, Anna, Maugeri, Jessica, Mccredie, Victoria, Mccullough, Jame, Mcguinness, Shay, Mckown, Andrew, Medve, László, Mei, Chengqing, Mellado Artigas, Ricard, Mendes, Vitor, Khalaf Ebraheim Mervat, Mohamed, Michaux, Isabelle, Mikhaeil, Michael, Milagros, Olga, Milet, Igor, Teresa Millan, Maria, Minwei, Zhang, Mirabella, Lucia, Mishra, Sanghamitra, Mistraletti, Giovanni, Mochizuki, Katsunori, Moghal, Arif, Mojoli, Francesco, Molin, Alexandre, Montiel, Raquel, Montini, Luca, Monza, Gianmario, Mora Aznar, Maria, Morakul, Sunthiti, Morales, Maria, Moreno Torres, Daniel, Rolando Morocho Tutillo, Diego, Motherway, Catherine, Mouhssine, Doumiri, Mouloudi, Eleni, Muñoz, Tapia, Munoz de Cabo, Carlo, Mustafa, Mohamed, Muthuchellappan, Radhakrishnan, Muthukrishnan, Muraleekrishnan, Muttini, Stefano, Nagata, Isao, Nahar, Dick, Nakanishi, Misuzu, Nakayama, Izumi, Antonio Namendys-Silva, Silvio, Nanchal, Rahul, Nandakumar, Sivakumar, Nasi, Alessandra, Nasir, Kamal, Navalesi, Paolo, Naz Aslam, Tayyba, Nga Phan, Thuy, Nichol, Alistair, Niiyama, Shuhei, Nikolakopoulou, Sofia, Nikolic, Elena, Nitta, Kenichi, Noc, Marko, Nonas, Stephanie, Nseir, Saad, Nur Soyturk, Ayse, Obata, Yukako, Oeckler, Richard, Oguchi, Moe, Ohshimo, Shinichiro, Oikonomou, Marina, Ojados, Agueda, Teresa Oliveira, Maria, Oliveira Filho, Wilson, Oliveri, Carlo, Olmos, Aitor, Omura, Kazuya, Cristina Orlandi, Maria, Orsenigo, Francesca, Ortiz-Ruiz De Gordoa, Laura, Ota, Kei, Ovalle Olmos, Rainier, Öveges, Nándo, Oziemski, Peter, Ozkan Kuscu, Ozlem, Özyilmaz, Ezgi, Pachas Alvarado, Fernando, Pagella, Gonzalo, Palaniswamy, Vijayanand, Luis Palazon Sanchez, Eugenio, Palmese, Salvatore, Pan, Guojun, Pan, Wensen, Papanikolaou, Metaxia, Papavasilopoulou, Theonymfi, Parekh, Ameet, Parke, Rachael, J Parrilla, Francisco, Parrilla, Dácil, Pasha, Taha, Pasin, Laura, Patão, Lui, Patel, Mayur, Patel, Grisma, Kumar Pati, Basanta, Patil, Jayaprakash, Pattnaik, Saroj, Paul, Daniel, Pavesi, Maurizio, Alejandra Pavlotsky, Vanesa, Paz, Graciela, Paz, Enrique, Pecci, Elisabetta, Pellegrini, Carlo, Gabriela Peña Padilla, Andrea, Perchiazzi, Gaetano, Pereira, Tiago, Pereira, Vera, Perez, Manuel, Perez Calvo, Cesar, Perez Cheng, Meisy, Perez Maita, Ronald, Pérez-Araos, Rodrigo, Perez-Teran, Purificación, Perez-Torres, David, Perkins, Gavin, Persona, Paolo, Petnak, Tananchai, Petrova, Marina, Pham, Tai, Philippart, Françoi, Picetti, Edoardo, Pierucci, Elisabetta, Piervincenzi, Edoardo, Pinciroli, Riccardo, Pintado, Maria-Consuelo, Piraino, Thoma, Piras, Stephanie, Piras, Claudio, Pirompanich, Pattarin, Pisani, Luigi, Platas, Enrique, Plotnikow, Gustavo, Porras, Willy, Porta, Virginia, Portilla, Mariana, Portugal, José, Povoa, Pedro, Prat, Gwenael, Pratto, Romina, Preda, Gabriel, Prieto, Isidro, Prol-Silva, Estefania, Pugh, Richard, Qi, Yupeng, Qian, Chuanyun, Qin, Tiehe, Qu, Hongping, Quintana, Teobaldo, Quispe Sierra, Rosari, Quispe Soto, Rocio, Rabbani, Raihan, Rabee, Mohamed, Rabie, Ahmed, Augusta Rahe Pereira, Maria, Rai, Ashish, Raj Ashok, Sundar, Rajab, Mostafa, Ramdhani, Navin, Ramey, Elizabeth, Ranieri, Marco, Rathod, Darshana, Ray, Banambar, Mahmud Redwanul Huq, Shihan, Regli, Adrian, Reina, Rosa, Resano Sarmiento, Natalia, Reynaud, Faustine, Rialp, Gemma, Ricart, Pilar, Rice, Todd, Richardson, Angu, Rieder, Marcelo, Rinket, Martin, Rios, Fernando, Risso Vazquez, Alejandro, Riva, Ivano, Rivette, Monaly, Roca, Oriol, Roche-Campo, Ferran, Rodriguez, Covadonga, Rodriguez, Gabriel, Rodriguez Gonzalez, Daniel, Yanina Rodriguez Tucto, Xandra, Rogers, Angela, Elena Romano, María, Rørtveit, Linda, Rose, Alastair, Roux, Damien, Rouze, Anahita, Nahuel Rubatto Birri, Paolo, Ruilan, Wang, Ruiz Robledo, Aldana, Luis Ruiz-Aguilar, Antonio, Sadahiro, Tomohito, Saez, Ignacio, Sagardia, Judith, Saha, Rajnish, Saha, Rohit, Saiphoklang, Narongkorn, Saito, Shigeki, Salem, Maie, Sales, Gabriele, Salgado, Patricia, Samavedam, Sriniva, Sami Mebazaa, Mhamed, Samuelsson, Line, San Juan Roman, Nandyelly, Sanchez, Patricia, Sanchez-Ballesteros, Jesu, Sandoval, Yazcitk, Sani, Emanuele, Santos, Martin, Santos, Carla, Sanui, Masamitsu, Saravanabavan, Lakshmikanthcharan, Sari, Sema, Sarkany, Agne, Sauneuf, Bertrand, Savioli, Monica, Sazak, Hilal, Scano, Riccardo, Schneider, Franci, Schortgen, Frédérique, J Schultz, Marcu, Leonie Schwarz, Gabriele, Seçkin Yücesoy, Faruk, Seely, Andrew, Seiler, Frederik, Seker Tekdos, Yasemin, Seok Chan, Kim, Serano, Luca, Serednicki, Wojciech, Setten, Mariano, Shah, Asim, Shah, Bhagyesh, Shang, You, Shanmugasundaram, Pradeep, Shapovalov, Konstantin, Shebl, Eman, Shiga, Takuya, Shime, Nobuaki, Shin, Phil, Short, Jack, Shuhua, Chen, Siddiqui, Sughrat, Ignacio Silesky Jimenez, Juan, Silva, Daniel, Silva Sales, Betania, Simons, Koen, Ågot Sjøbø, Brit, Slessor, David, Smiechowicz, Jakub, Smischney, Nathan, Smith, Paul, Smith, Tim, Smith, Mark, Snape, Sarah, Snyman, Lindi, Soetens, Filiep, Sook Hong, Kyung, Ángel Sosa Medellin, Miguel, Soto, Giovanna, Souloy, Xavier, Sousa, Elsa, Sovatzis, Stefania, Sozutek, Didem, Spadaro, Savino, Spagnoli, Marco, Spångfors, Martin, Spittle, Nick, Spivey, Mike, Stapleton, Andrew, Stefanovic, Branislava, Stephenson, Lorraine, Stevenson, Elizabeth, Strand, Kristian, Teresa Strano, Maria, Straus, Slavenka, Sun, Chenliang, Sun, Rongqing, Sundaram, Venkat, Sunpark, Tai, Surlemont, Elisabeth, Sutherasan, Yuda, Szabo, Zsuzsanna, Tainter, Christopher, Takaba, Akihiro, Tallott, Mandy, Tamasato, Tamasato, Tang, Zhanhong, Tangsujaritvijit, Viratch, Taniguchi, Leandro, Taniguchi, Daisuke, Tarantino, Fabio, Teerapuncharoen, Krittika, Temprano, Susana, Terragni, Pierpaolo, Terzi, Nicola, Thakur, Anand, Theerawit, Pongdhep, W Thille, Arnaud, Thomas, Matt, Thungtitigul, Poungrat, Thyrault, Martial, Tilouch, Nejla, Timenetsky, Karina, Tirapu, Juna, Todeschini, Manuel, Tomas, Roser, Tomaszewski, Christian, Tonetti, Tommaso, Tonnelier, Alexandre, Trinder, John, Trongtrakul, Konlawij, Truwit, Jonathon, Tsuei, Betty, Tulaimat, Aiman, Turan, Sema, Turkoglu, Melda, Tyagi, Sanjeev, Ubeda, Alejandro, Vagginelli, Federica, Florencia Valenti, María, Vallverdu, Imma, Van Axel, Alisha, van den Hul, Ingrid, van der Hoeven, Han, Van Der Meer, Nardo, Vanhoof, Marc, Vargas-Ordoñez, Mónica, Vaschetto, Rosanna, Vascotto, Ettore, Vatsik, Maria, Vaz, Ana, Vazquez-Sanchez, Antonia, Ventura, Sara, Wytze Vermeijden, Jan, Vidal, Anxela, Vieira, Jocyelle, Vilela Costa Pinto, Bruno, Villagra, Ana, Villegas Succar, Cristina, Georg Vinorum, Ole, Vitale, Giovanni, Vj, Ramesh, Vochin, Ana, Voiriot, Guillaume, Alberto Volta, Carlo, von Seth, Magnu, Wajdi, Maazouzi, Walsh, Don, Wang, Shouhong, Wardi, Gabriel, Christian Ween-Velken, Nil, Wei, Bi-Lin, Weller, Dolf, Welsh, Deborah, Welters, Ingeborg, Wert, Michael, Whiteley, Simon, Wilby, Elizabeth, Williams, Erin, Williams, Karen, Wilson, Antoinette, Wojtas, Jadwiga, Won Huh, Jin, Wrathall, David, Wright, Christopher, Wu, Jian-Feng, Xi, Guo, Xing, Zheng-Jiang, Xu, Hongyang, Yamamoto, Kotaro, Yan, Jie, Yáñez, Julio, Yang, Xiaobo, Yates, Elliot, Yazicioglu Mocin, Ozlem, Ye, Zhenglong, Yildirim, Fatma, Yoshida, Norifumi, Higo Leon Yoshido, Hector, Young Lee, Bo, Yu, Rongguo, Yu, Gong, Yu, Tao, Yuan, Boyun, Yuangtrakul, Nadwipa, Yumoto, Tetsuya, Yun, Xie, Zakalik, Graciela, Zaki, Ahmad, Zalba-Etayo, Begoña, Zambon, Massimo, Zang, Bin, Zani, Gianluca, Zarka, Jonathan, Maria Zerbi, Simone, Zerman, Avsar, Zetterquist, Harald, Zhang, Jiuzhi, Zhang, Hongwen, Zhang, Wei, Zhang, Guoxiu, Zhang, Weixin, Zhao, Hongsheng, Zheng, Jia, Zhu, Bin, Zumaran, Ronald, Pham, Tài, Madotto, Fabiana, Goligher, Ewan C, Laake, Jon Henrik, Mancebo, Jordi, Peñuelas, Oscar, Pesenti, Antonio, Wunsch, Hannah, van Haren, Frank, Laffey, John G, Fekri Abrough, Subhash P Acharya, Pravin Amin, Yaseen Arabi, Irene Aragao, Philippe Bauer, Gaëtan Beduneau, Jeremy Beitler, Johan Berkius, Guillermo Bugedo, Luigi Camporota, Vladimir Cerny, Young-Jae Cho, Kevin Clarkson, Elisa Estenssoro, Ewan Goligher, Giacomo Grasselli, Alexey Gritsan, Seyed Mohammadreza Hashemian, Greet Hermans, Leo M Heunks, Bojan Jovanovic, Kiyoyasu Kurahashi, Jon Henrik Laake, Dimitrios Matamis, Onnen Moerer, Zsolt Molnar, Ezgi Ozyilmaz, Bernardo Panka, Alfred Papali, Óscar Peñuelas, Sébastien Perbet, Lise Piquilloud, Haibo Qiu, Assem Abdel Razek, Nuttapol Rittayamai, Rollin Roldan, Ary Serpa Neto, Konstanty Szuldrzynski, Daniel Talmor, Dana Tomescu, Frank Van Haren, Asisclo Villagomez, Amine Ali Zeggwagh, Toshikazu Abe, Abdelrhman Aboshady, Melanie Acampo-de Jong, Subhash Acharya, Jane Adderley, Nalan Adiguzel, Vijay Kumar Agrawal, Gerardo Aguilar, Gaston Aguirre, Hernan Aguirre-Bermeo, Björn Ahlström, Türkay Akbas, Mustafa Akker, Ghamdan Al Sadeh, Sultan Alamri, Angela Algaba, Muneeb Ali, Anna Aliberti, Jose Manuel Allegue, Diana Alvarez, Joaquin Amador, Finn H Andersen, Sharique Ansari, Yutthana Apichatbutr, Olympia Apostolopoulou, Daniel Arellano, Mestanza Arica, Huseyin Arikan, Koichi Arinaga, Jean-Michel Arnal, Kengo Asano, Marta Asín-Corrochano, Jesus Milagrito Avalos Cabrera, Silvia Avila Fuentes, Semih Aydemir, Gulbin Aygencel, Luciano Azevedo, Feza Bacakoglu, Julio Badie, Elias Baedorf Kassis, Gabriela Bai, Govindan Balaraj, Bruno Ballico, Valerie Banner-Goodspeed, Preveen Banwarie, Rosella Barbieri, Arvind Baronia, Jonathan Barrett, Loïc Barrot, Jesus Emilio Barrueco-Francioni, Jeffrey Barry, Harshal Bawangade, Sarah Beavis, Eduardo Beck, Nina Beehre, Alberto Belenguer Muncharaz, Giacomo Bellani, Mirko Belliato, Agrippino Bellissima, Rodrigo Beltramelli, Asma Ben Souissi, Adela Benitez-Cano, Mohamed Benlamin, Abdellatif Benslama, Luis Bento, Daniela Benvenuti, Laura Bernabe, Andrew Bersten, Giacomo Berta, Pietro Bertini, Elliot Bertram-Ralph, Mohamed Besbes, Lisandro Roberto Bettini, Pascal Beuret, Jeremy Bewley, Marco Bezzi, Lakshay Bhakhtiani, Rakesh Bhandary, Kaushik Bhowmick, Shailesh Bihari, Bernie Bissett, David Blythe, Simon Bocher, Narain Boedjawan, Christine M Bojanowski, Elisa Boni, Sabrina Boraso, Massimo Borelli, Silvina Borello, Margarita Borislavova, Karen J Bosma, Maurizio Bottiroli, Owen Boyd, Suha Bozbay, Arturo Briva, Laurent Brochard, Cédric Bruel, Andrea Bruni, Ulrike Buehner, Pierre Bulpa, Karen Burt, Mathieu Buscot, Stefania Buttera, Jorge Cabrera, Roberta Caccese, Pietro Caironi, Ivan Canchos Gutierrez, Nancy Canedo, Alma Cani, Iacopo Cappellini, Jesus Carazo, Luis Pablo Cardonnet, David Carpio, Demetrio Carriedo, Ramón Carrillo, João Carvalho, Eliana Caser, Antonio Castelli, Manuel Castillo Quintero, Heloisa Castro, Nuno Catorze, Melike Cengiz, Enrique Cereijo, Helga Ceunen, Christos Chaintoutis, Youjin Chang, Gustavogcha Chaparro, Carmel Chapman, Simon Chau, Cecilia Eugenia Chavez, Cosimo Chelazzi, Jonathan Chelly, Frank Chemouni, Kai Chen, Ariel Chena, Paolo Chiarandini, Phil Chilton, Davide Chiumello, Yvette Chou-Lie, Nicolas Chudeau, Ismail Cinel, Gilda Cinnella, Michele Clark, Thomas Clark, Stefano Clementi, Luis Coaguila, Alexis Jaspe Codecido, Amy Collins, Riccardo Colombo, Juan Conde, Guglielmo Consales, Tim Cook, Andrea Coppadoro, Rodrigo Cornejo, Andrea Cortegiani, Cristina Coxo, Andrea Neville Cracchiolo, Mónica Crespo Ramirez, Philippe Crova, José Cruz, Lucia Cubattoli, Zafer Çukurova, Francesco Curto, Piotr Czempik, Rocco D'Andrea, Fernando da Silva Ramos, Laurence Dangers, Marc Danguy des Déserts, Pierre-Eric Danin, Fabianne Dantas, Cédric Daubin, 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Mariachiara Ippolito, Hiromasa Irie, Hiroki Iriyama, Taiga Itagaki, Javier Izura, Santiago Izza, Rakhshanda Jabeen, Hamidreza Jamaati, Sunil Jamadarkhana, Amira Jamoussi, Milosz Jankowski, Luis Alberto Jaramillo, Kyeongman Jeon, Seok Jeong Lee, Deepak Jeswani, Simant Jha, Liangyan Jiang, Chen Jing, Sébastien Jochmans, Bror Anders Johnstad, Lee Jongmin, Aurélie Joret, Detajin Junhasavasdikul, Maria Teresa Jurado, Elisa Kam, Hidenobu Kamohara, Caroline Kane, Iskender Kara, Sait Karakurt, Cherdkiat Karnjanarachata, Jun Kataoka, Shinshu Katayama, Shuchi Kaushik, Nermin Kelebek Girgin, Kathryn Kerr, Ian Kerslake, Prakash Khairnar, Abidi Khalid, Akram Khan, Ashish K Khanna, Reza Khorasanee, Dieneke Kienhorst, Cenk Kirakli, Rihard Knafelj, Mark Kol Kol, Napplika Kongpolprom, Csaba Kopitko, Pervin Korkmaz Ekren, Agnieszka Kubisz-Pudelko, Zoltan Kulcsar, Junji Kumasawa, Akira Kuriyama, Fernanda Kutchak, Eduardo Labarca, Françoise Labat, César Laborda, Manuel Alberto Laca Barrera, Laurie 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Maseda, Eleni Massa, Anna Mattsson, Jessica Maugeri, Victoria McCredie, James McCullough, Shay McGuinness, Andrew McKown, László Medve, Chengqing Mei, Ricard Mellado Artigas, Vitor Mendes, Mohamed Khalaf Ebraheim Mervat, Isabelle Michaux, Michael Mikhaeil, Olga Milagros, Igor Milet, Maria Teresa Millan, Zhang Minwei, Lucia Mirabella, Sanghamitra Mishra, Giovanni Mistraletti, Katsunori Mochizuki, Arif Moghal, Francesco Mojoli, Alexandre Molin, Raquel Montiel, Luca Montini (ORCID:0000-0003-4602-5134), Gianmario Monza, Maria Mora Aznar, Sunthiti Morakul, Maria Morales, Daniel Moreno Torres, Diego Rolando Morocho Tutillo, Catherine Motherway, Doumiri Mouhssine, Eleni Mouloudi, Tapia Muñoz, Carlos Munoz de Cabo, Mohamed Mustafa, Radhakrishnan Muthuchellappan, Muraleekrishnan Muthukrishnan, Stefano Muttini, Isao Nagata, Dick Nahar, Misuzu Nakanishi, Izumi Nakayama, Silvio Antonio Namendys-Silva, Rahul Nanchal, Sivakumar Nandakumar, Alessandra Nasi, Kamal Nasir, Paolo Navalesi, Tayyba Naz 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Joret, Aurélie, Junhasavasdikul, Detajin, Teresa Jurado, Maria, Kam, Elisa, Kamohara, Hidenobu, Kane, Caroline, Kara, Iskender, Karakurt, Sait, Karnjanarachata, Cherdkiat, Kataoka, Jun, Katayama, Shinshu, Kaushik, Shuchi, Kelebek Girgin, Nermin, Kerr, Kathryn, Kerslake, Ian, Khairnar, Prakash, Khalid, Abidi, Khan, Akram, K Khanna, Ashish, Khorasanee, Reza, Kienhorst, Dieneke, Kirakli, Cenk, Knafelj, Rihard, Kol Kol, Mark, Kongpolprom, Napplika, Kopitko, Csaba, Korkmaz Ekren, Pervin, Kubisz-Pudelko, Agnieszka, Kulcsar, Zoltan, Kumasawa, Junji, Kuriyama, Akira, Kutchak, Fernanda, Labarca, Eduardo, Labat, Françoise, Laborda, César, Alberto Laca Barrera, Manuel, Lagache, Laurie, Landaverde Lopez, Antonio, Lanspa, Michael, Lascari, Valeria, Le Meur, Matthieu, Hwan Lee, Su, Ju Lee, Young, Lee, Jinwoo, Lee, Won-Yeon, Lee, Jarone, Legernaes, Terje, Leiner, Tamaa, Lemiale, Virginie, Leonor, Tiago, M Lepper, Philipp, Li, Dahuan, Li, Hongbin, Li, Oleg, Raquel Lima, Ana, Lind, Dan, Litton, Edward, Liu, Ning, Liu, Ling, Liu, Jialin, Llitjos, Jean-Françoi, Llorente, Beatriz, Lopez, Rodolfo, Elizabeth Lopez, Claudia, Lopez Nava, Claudia, Lovazzano, Pablo, Lu, Min, Lucchese, Francesca, Lugano, Manuela, Lugo Goytia, Gustavo, Luo, Hua, Lynch, Ceri, Macheda, Sebastiano, Hugo Madrigal Robles, Victor, Maurizio Maggiore, Salvatore, Magret Iglesias, Mònica, Malaga, Peter, Mallapura Maheswarappa, Harish, Malpartida, Guillermo, Malyarchikov, Andrey, Mansson, Helena, Manzano, Anaid, Marey, Ismael, Marin, Nathalie, Del Carmen Marin, Maria, Markman, Eliana, Martin, Felix, Martin, Alex, Martin Dal Gesso, Cristina, Martinez, Felipe, Martínez-Fidalgo, Conchita, Martin-Loeches, Ignacio, Mas, Arantxa, Masaaki, Sakuraya, Maseda, Emilio, Massa, Eleni, Mattsson, Anna, Maugeri, Jessica, Mccredie, Victoria, Mccullough, Jame, Mcguinness, Shay, Mckown, Andrew, Medve, László, Mei, Chengqing, Mellado Artigas, Ricard, Mendes, Vitor, Khalaf Ebraheim Mervat, Mohamed, Michaux, Isabelle, Mikhaeil, 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Manzano, Ismael Marey, Nathalie Marin, Maria Del Carmen Marin, Eliana Markman, Felix Martin, Alex Martin, Cristina Martin Dal Gesso, Felipe Martinez, Conchita Martínez-Fidalgo, Ignacio Martin-Loeches, Arantxa Mas, Sakuraya Masaaki, Emilio Maseda, Eleni Massa, Anna Mattsson, Jessica Maugeri, Victoria McCredie, James McCullough, Shay McGuinness, Andrew McKown, László Medve, Chengqing Mei, Ricard Mellado Artigas, Vitor Mendes, Mohamed Khalaf Ebraheim Mervat, Isabelle Michaux, Michael Mikhaeil, Olga Milagros, Igor Milet, Maria Teresa Millan, Zhang Minwei, Lucia Mirabella, Sanghamitra Mishra, Giovanni Mistraletti, Katsunori Mochizuki, Arif Moghal, Francesco Mojoli, Alexandre Molin, Raquel Montiel, Luca Montini (ORCID:0000-0003-4602-5134), Gianmario Monza, Maria Mora Aznar, Sunthiti Morakul, Maria Morales, Daniel Moreno Torres, Diego Rolando Morocho Tutillo, Catherine Motherway, Doumiri Mouhssine, Eleni Mouloudi, Tapia Muñoz, Carlos Munoz de Cabo, Mohamed Mustafa, Radhakrishnan Muthuchellappan, Muraleekrishnan Muthukrishnan, Stefano Muttini, Isao Nagata, Dick Nahar, Misuzu Nakanishi, Izumi Nakayama, Silvio Antonio Namendys-Silva, Rahul Nanchal, Sivakumar Nandakumar, Alessandra Nasi, Kamal Nasir, Paolo Navalesi, Tayyba Naz Aslam, Thuy Nga Phan, Alistair Nichol, Shuhei Niiyama, Sofia Nikolakopoulou, Elena Nikolic, Kenichi Nitta, Marko Noc, Stephanie Nonas, Saad Nseir, Ayse Nur Soyturk, Yukako Obata, Richard Oeckler, Moe Oguchi, Shinichiro Ohshimo, Marina Oikonomou, Agueda Ojados, Maria Teresa Oliveira, Wilson Oliveira Filho, Carlo Oliveri, Aitor Olmos, Kazuya Omura, Maria Cristina Orlandi, Francesca Orsenigo, Laura Ortiz-Ruiz De Gordoa, Kei Ota, Rainier Ovalle Olmos, Nándo Öveges, Peter Oziemski, Ozlem Ozkan Kuscu, Ezgi Özyilmaz, Fernando Pachas Alvarado, Gonzalo Pagella, Vijayanand Palaniswamy, Eugenio Luis Palazon Sanchez, Salvatore Palmese, Guojun Pan, Wensen Pan, Metaxia Papanikolaou, Theonymfi Papavasilopoulou, Ameet Parekh, Rachael Parke, Francisco J Parrilla, Dácil Parrilla, Taha Pasha, Laura Pasin, Luis Patão, Mayur Patel, Grisma Patel, Basanta Kumar Pati, Jayaprakash Patil, Saroj Pattnaik, Daniel Paul, Maurizio Pavesi, Vanesa Alejandra Pavlotsky, Graciela Paz, Enrique Paz, Elisabetta Pecci, Carlos Pellegrini, Andrea Gabriela Peña Padilla, Gaetano Perchiazzi, Tiago Pereira, Vera Pereira, Manuel Perez, Cesar Perez Calvo, Meisy Perez Cheng, Ronald Perez Maita, Rodrigo Pérez-Araos, Purificación Perez-Teran, David Perez-Torres, Gavin Perkins, Paolo Persona, Tananchai Petnak, Marina Petrova, Tai Pham, François Philippart, Edoardo Picetti, Elisabetta Pierucci, Edoardo Piervincenzi, Riccardo Pinciroli, Maria-Consuelo Pintado, Thomas Piraino, Stephanie Piras, Claudio Piras, Pattarin Pirompanich, Luigi Pisani, Enrique Platas, Gustavo Plotnikow, Willy Porras, Virginia Porta, Mariana Portilla, José Portugal, Pedro Povoa, Gwenael Prat, Romina Pratto, Gabriel Preda, Isidro Prieto, Estefania Prol-Silva, Richard Pugh, Yupeng Qi, Chuanyun Qian, Tiehe Qin, Hongping Qu, Teobaldo Quintana, Rosari Quispe Sierra, Rocio Quispe Soto, Raihan Rabbani, Mohamed Rabee, Ahmed Rabie, Maria Augusta Rahe Pereira, Ashish Rai, Sundar Raj Ashok, Mostafa Rajab, Navin Ramdhani, Elizabeth Ramey, Marco Ranieri, Darshana Rathod, Banambar Ray, Shihan Mahmud Redwanul Huq, Adrian Regli, Rosa Reina, Natalia Resano Sarmiento, Faustine Reynaud, Gemma Rialp, Pilar Ricart, Todd Rice, Angus Richardson, Marcelo Rieder, Martin Rinket, Fernando Rios, Alejandro Risso Vazquez, Ivano Riva, Monaly Rivette, Oriol Roca, Ferran Roche-Campo, Covadonga Rodriguez, Gabriel Rodriguez, Daniel Rodriguez Gonzalez, Xandra Yanina Rodriguez Tucto, Angela Rogers, María Elena Romano, Linda Rørtveit, Alastair Rose, Damien Roux, Anahita Rouze, Paolo Nahuel Rubatto Birri, Wang Ruilan, Aldana Ruiz Robledo, Antonio Luis Ruiz-Aguilar, Tomohito Sadahiro, Ignacio Saez, Judith Sagardia, Rajnish Saha, Rohit Saha, Narongkorn Saiphoklang, Shigeki Saito, Maie Salem, Gabriele Sales, Patricia Salgado, Srinivas Samavedam, Mhamed Sami Mebazaa, Line Samuelsson, Nandyelly San Juan Roman, Patricia Sanchez, Jesus Sanchez-Ballesteros, Yazcitk Sandoval, Emanuele Sani, Martin Santos, Carla Santos, Masamitsu Sanui, Lakshmikanthcharan Saravanabavan, Sema Sari, Agnes Sarkany, Bertrand Sauneuf, Monica Savioli, Hilal Sazak, Riccardo Scano, Francis Schneider, Frédérique Schortgen, Marcus J Schultz, Gabriele Leonie Schwarz, Faruk Seçkin Yücesoy, Andrew Seely, Frederik Seiler, Yasemin Seker Tekdos, Kim Seok Chan, Luca Serano, Wojciech Serednicki, Mariano Setten, Asim Shah, Bhagyesh Shah, You Shang, Pradeep Shanmugasundaram, Konstantin Shapovalov, Eman Shebl, Takuya Shiga, Nobuaki Shime, Phil Shin, Jack Short, Chen Shuhua, Sughrat Siddiqui, Juan Ignacio Silesky Jimenez, Daniel Silva, Betania Silva Sales, Koen Simons, Brit Ågot Sjøbø, David Slessor, Jakub Smiechowicz, Nathan Smischney, Paul Smith, Tim Smith, Mark Smith, Sarah Snape, Lindi Snyman, Filiep Soetens, Kyung Sook Hong, Miguel Ángel Sosa Medellin, Giovanna Soto, Xavier Souloy, Elsa Sousa, Stefania Sovatzis, Didem Sozutek, Savino Spadaro, Marco Spagnoli, Martin Spångfors, Nick Spittle, Mike Spivey, Andrew Stapleton, Branislava Stefanovic, Lorraine Stephenson, Elizabeth Stevenson, Kristian Strand, Maria Teresa Strano, Slavenka Straus, Chenliang Sun, Rongqing Sun, Venkat Sundaram, Tai SunPark, Elisabeth Surlemont, Yuda Sutherasan, Zsuzsanna Szabo, Christopher Tainter, Akihiro Takaba, Mandy Tallott, Tamasato Tamasato, Zhanhong Tang, Viratch Tangsujaritvijit, Leandro Taniguchi, Daisuke Taniguchi, Fabio Tarantino, Krittika Teerapuncharoen, Susana Temprano, Pierpaolo Terragni, Nicolas Terzi, Anand Thakur, Pongdhep Theerawit, Arnaud W Thille, Matt Thomas, Poungrat Thungtitigul, Martial Thyrault, Nejla Tilouch, Karina Timenetsky, Juna Tirapu, Manuel Todeschini, Roser Tomas, Christian Tomaszewski, Tommaso Tonetti, Alexandre Tonnelier, John Trinder, Konlawij Trongtrakul, Jonathon Truwit, Betty Tsuei, Aiman Tulaimat, Sema Turan, Melda Turkoglu, Sanjeev Tyagi, Alejandro Ubeda, Federica Vagginelli, María Florencia Valenti, Imma Vallverdu, Alisha Van Axel, Ingrid van den Hul, Hans van der Hoeven, Nardo Van Der Meer, Marc Vanhoof, Mónica Vargas-Ordoñez, Rosanna Vaschetto, Ettore Vascotto, Maria Vatsik, Ana Vaz, Antonia Vazquez-Sanchez, Sara Ventura, Jan Wytze Vermeijden, Anxela Vidal, Jocyelle Vieira, Bruno Vilela Costa Pinto, Ana Villagra, Cristina Villegas Succar, Ole Georg Vinorum, Giovanni Vitale, Ramesh Vj, Ana Vochin, Guillaume Voiriot, Carlo Alberto Volta, Magnus von Seth, Maazouzi Wajdi, Don Walsh, Shouhong Wang, Gabriel Wardi, Nils Christian Ween-Velken, Bi-Lin Wei, Dolf Weller, Deborah Welsh, Ingeborg Welters, Michael Wert, Simon Whiteley, Elizabeth Wilby, Erin Williams, Karen Williams, Antoinette Wilson, Jadwiga Wojtas, Jin Won Huh, David Wrathall, Christopher Wright, Jian-Feng Wu, Guo Xi, Zheng-Jiang Xing, Hongyang Xu, Kotaro Yamamoto, Jie Yan, Julio Yáñez, Xiaobo Yang, Elliot Yates, Ozlem Yazicioglu Mocin, Zhenglong Ye, Fatma Yildirim, Norifumi Yoshida, Hector Higo Leon Yoshido, Bo Young Lee, Rongguo Yu, Gong Yu, Tao Yu, Boyun Yuan, Nadwipa Yuangtrakul, Tetsuya Yumoto, Xie Yun, Graciela Zakalik, Ahmad Zaki, Begoña Zalba-Etayo, Massimo Zambon, Bin Zang, Gianluca Zani, Jonathan Zarka, Simone Maria Zerbi, Avsar Zerman, Harald Zetterquist, Jiuzhi Zhang, Hongwen Zhang, Wei Zhang, Guoxiu Zhang, Weixin Zhang, Hongsheng Zhao, Jia Zheng, Bin Zhu, and Ronald Zumaran
Abstract: Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 d
Published: 2023

15. Role of immunosuppression in an antibiotic stewardship intervention and its association with clinical outcomes and antibiotic use: protocol for an observational study (RISC-sepsis)

Author: Jonathan Scott, Loredana Trevi, Hannah McNeil, Tom Ewen, Phil Mawson, David McDonald, Andrew Filby, Ranjit Lall, Katie Booth, Gert Boschman, Vesna Melkebeek, Gavin Perkins, Ronan McMullan, Daniel F McAuley, Iain J McCullagh, Timothy Walsh, Anthony Rostron, Manu Shankar-Hari, Paul Dark, A John Simpson, Andrew Conway Morris, Thomas P Hellyer, McAuley, Daniel F [0000-0002-3283-1947], Shankar-Hari, Manu [0000-0002-5338-2538], Hellyer, Thomas P [0000-0001-5346-7411], and Apollo - University of Cambridge Repository
Subjects: Immunosuppression Therapy, Cross Infection, MICROBIOLOGY, INTENSIVE & CRITICAL CARE, General Medicine, INFECTIOUS DISEASES, Sepsis/drug therapy, Cross Infection/drug therapy, Anti-Bacterial Agents, Anti-Bacterial Agents/therapeutic use, Antimicrobial Stewardship, Observational Studies as Topic, Antimicrobial Stewardship/methods, Sepsis, Intensive care, Humans, Prospective Studies
Abstract: Peer reviewed: True, INTRODUCTION: Sepsis is characterised by a dysregulated immune response to infection, with exaggerated pro-inflammatory and anti-inflammatory responses. A predominant immunosuppressive profile affecting both innate and adaptive immune responses is associated with increased hospital-acquired infection and reduced infection-free survival. While hospital-acquired infection leads to additional antibiotic use, the role of the immunosuppressive phenotype in guiding complex decisions, such as those affecting antibiotic stewardship, is uncertain. This study is a mechanistic substudy embedded within a multicentre clinical and cost-effectiveness trial of biomarker-guided antibiotic stewardship. This mechanistic study aims to determine the effect of sepsis-associated immunosuppression on the trial outcome measures. METHODS AND ANALYSIS: RISC-sepsis is a prospective, multicentre, exploratory, observational study embedded within the ADAPT-sepsis trial. A subgroup of 180 participants with antibiotics commenced for suspected sepsis, enrolled in the ADAPT-sepsis trial, will be recruited. Blood samples will be collected on alternate days until day 7. At each time point, blood will be collected for flow cytometric analysis into cell preservation tubes. Immunophenotyping will be performed at a central testing hub by flow cytometry. The primary outcome measures are monocyte human leucocyte antigen-DR; neutrophil CD88; programmed cell death-1 on monocytes, neutrophils and T lymphocytes and the percentage of regulatory T cells. Secondary outcome measures will link to trial outcomes from the ADAPT-sepsis trial including antibiotic days; occurrence of hospital-acquired infection and length of ICU-stay and hospital-stay. ETHICS AND DISSEMINATION: Ethical approval has been granted (IRAS 209815) and RISC-sepsis is registered with the ISRCTN (86837685). Study results will be disseminated by peer-reviewed publications, presentations at scientific meetings and via patient and public participation groups and social media.
Published: 2022
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16. Caring in the silences : why physicians and surgeons do not discuss emergency care and treatment planning with their patients — an analysis of hospital-based ethnographic case studies in England

Author: Frances Griffiths, Anne-Marie Slowther, Karin Eli, Gavin Perkins, and Claire Hawkes
Subjects: Surgeons, Emergency Medical Services, Communication, Humans, General Medicine, RA, Hospitals, Qualitative Research, State Medicine
Abstract: BackgroundDespite increasing emphasis on integrating emergency care and treatment planning (ECTP) into routine medical practice, clinicians continue to delay or avoid ECTP conversations with patients. However, little is known about the clinical logics underlying barriers to ECTP conversations.ObjectiveThis study aims to develop an ethnographic account of how and why clinicians defer and avoid ECTP conversations, and how they rationalise these decisions as they happen.DesignA multisited ethnographic study.SettingMedical, orthopaedic and surgical wards in hospitals within four acute National Health Service trusts in England.ParticipantsThirty-four doctors were formally observed and 32 formally interviewed. Following an ethnographic case study approach, six cases were selected for in-depth analysis.AnalysisFieldnote data were triangulated with interview data, to develop a ‘thick description’ of each case. Using a conceptual framework of care, the analysis highlighted the clinical logics underlying these cases.ResultsThe deferral or avoidance of ECTP conversations was driven by concerns over caring well, with clinicians attempting to optimise both medical and bedside practice. Conducting an ECTP conversation carefully meant attending to patients’ and relatives’ emotions and committing sufficient time for an in-depth discussion. However, conversation plans were often disrupted by issues related to timing and time constraints, leading doctors to defer these conversations, sometimes indefinitely. Additionally, whereas surgeons and geriatricians deferred conversations because they did not have the time to offer detailed discussions, emergency and acute medicine clinicians deferred conversations because the high-turnover ward environment, combined with patients’ acute conditions, meant triaging conversations to those most in need.ConclusionOvercoming barriers to ECTP conversations is not simply a matter of enhancing training or hospital policies, but of promoting good conversational practices that take into account the affordances of hospital time and space, as well as clinicians’ understandings of caring well.
Published: 2022

17. The epidemiology of out-of-hospital cardiac arrest in Australia and New Zealand: A binational report from the Australasian Resuscitation Outcomes Consortium (Aus-ROC)

Author: Janet Bray, Stuart Howell, Stephen Ball, Tan Doan, Emma Bosley, Karen Smith, Bridget Dicker, Steven Faddy, Melanie Thorrowgood, Andy Swain, Andrew Thomas, Alexander Wilson, Carol Shipp, Tony Walker, Paul Bailey, Judith Finn, Tony Smith, Stephen Bernard, Hugh Grantham, Damien Norsworthy, Howard Wren, Keith Driscoll, Mike McDermott, Abhishek Ranjan, Richard Larsen, Samuel Perillo, Con Georgakas, Jeff Waters, Peter Cameron, Graham Nichol, and Gavin Perkins
Subjects: Adult, Male, Emergency Medical Services, Emergency Medicine, Australia, Humans, Registries, Emergency Nursing, Cardiology and Cardiovascular Medicine, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest, New Zealand
Abstract: The Australasian Resuscitation Outcomes Consortium (Aus-ROC) out-of-hospital cardiac arrest (OHCA) Epistry (Epidemiological Registry) now covers 100% of Australia and New Zealand (NZ). This study reports and compares the Utstein demographics, arrest characteristics and outcomes of OHCA patients across our region.We included all OHCA cases throughout 2019 as submitted to the Epistry by the eight Australian and two NZ emergency medical services (EMS). We calculated crude and age-standardised incidence rates and performed a national and EMS regional comparison.We obtained data for 31,778 OHCA cases for 2019: 26,637 in Australia and 5,141 in NZ. Crude incidence was 107.9 per 100,000 person-years in Australia and 103.2/100,000 in NZ. Overall, the majority of OHCAs occurred in adults (96%), males (66%), private residences (76%), were unwitnessed (63%), of presumed medical aetiology (83%), and had an initial monitored rhythm of asystole (64%). In non-EMS-witnessed cases, 38% received bystander CPR and 2% received public defibrillation. Wide variation was seen between EMS regions for all OHCA demographics, arrest characteristics and outcomes. In patients who received an EMS-attempted resuscitation (13,664/31,778): 28% (range across EMS = 13.1% to 36.7%) had return of spontaneous circulation (ROSC) at hospital arrival and 13% (range across EMS = 9.9% to 20.7%) survived to hospital discharge/30-days. Survival in the Utstein comparator group (bystander-witnessed in shockable rhythm) varied across the EMS regions between 27.4% to 42.0%.OHCA across Australia and NZ has varied incidence, characteristics and survival. Understanding the variation in survival and modifiable predictors is key to informing strategies to improve outcomes.
Published: 2021

18. P089 Media coverage of the PARAMEDIC-2 trial: an analysis of print media reports

Author: Tom Knowles, Leanne Last, Gavin Perkins, and Keith Couper
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2022
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19. Y03 The nationwide impact of COVID-19 on Advanced Life Support courses. A retrospective evaluation by Resuscitation Council UK

Author: Christopher Thorne, Sue Hampshire, Isabelle Hamilton-Bower, Adam Benson-Clarke, Sultana Begum-Ali, Keith Couper, Joyce Yeung, Andrew Lockey, Gavin Perkins, and Jasmeet Soar
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2022
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20. OR13 How well do the EQ-5D-5L and SF-12v2 measure change in Health-related Quality of Life (HRQoL) following Out-of-Hospital Cardiac Arrest (OHCA)? : a comparative analysis of measurement responsiveness

Author: Hannah Beswick, Felix Achana, Chen Ji, Ranjit Lall, Gavin Perkins, and Kirstie Haywood
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2022
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21. Editorial introductions

Author: Gavin Perkins
Subjects: Critical Care and Intensive Care Medicine
Published: 2022
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22. OR14 How well do the EQ-5D-5L and SF-12v2 measure Health-related Quality of Life (HRQoL) in Out-of-Hospital Cardiac Arrest (OHCA) survivors?: a comparative analysis of measurement validity

Author: Hannah Beswick, Felix Achana, Chen Ji, Ranjit Lall, Gavin Perkins, and Kirstie Haywood
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2022
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23. Shockingly simple? Should you use manual or automated defibrillation in out of hospital cardiac arrest?

Author: Caroline Leech and Gavin Perkins
Subjects: Emergency Medical Services, Electric Countershock, Emergency Medicine, Humans, General Medicine, Critical Care and Intensive Care Medicine, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest
Published: 2022
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24. PP31 Airway management at adult out-of-hospital cardiac arrest: a survey of current UK ambulance service policy

Author: Mohammed Aljanoubi, Terry Brown, Keith Couper, Rachel Fothergill, and Gavin Perkins
Subjects: Emergency Medicine, General Medicine, Critical Care and Intensive Care Medicine
Abstract: BackgroundOver 80% of the 30,000 out-of-hospital cardiac arrest (OHCA) patients treated in the UK each year receive advanced airway management (tracheal tube or supraglottic airway). Recent data from large randomised control trials have highlighted uncertainty regarding the clinical benefits of tracheal intubation and may have driven changes in ambulance service policy. We conducted a survey study to investigate the current UK ambulance service policy on the use of tracheal intubation during adult cardiac arrest.MethodsWe surveyed all UK ambulance services using an online survey platform to determine which staff groups are permitted to perform tracheal intubation and associated information linked to advanced airway management in adult cardiac arrest. A single representative of each ambulance service was requested to respond to the survey. The University of Warwick Biomedical & Scientific Research Ethics Committee provided ethical approval for the study.ResultsWe received survey responses from all 14 UK NHS ambulance services (response rate 100%).Five ambulance services (35.71%) do not permit non-specialist paramedics to perform tracheal intubation at adult out-of-hospital cardiac arrest. Of these services, the first service to withdraw tracheal intubation did so in 2010, whilst the remaining four did so from 2019 onwards. One further ambulance service stated they are currently in the process of withdrawing tracheal intubation.Of the five services that have withdrawn tracheal intubation, cited reasons for the policy change were challenges in providing ongoing training (n=5, 100%), results of clinical trials (n=4, 80%), clinical incidents of tracheal tube misplacement (n=4, 80%), and low tracheal intubation success rate (n=3, 60%).All 14 ambulance services (100%) reported that waveform capnography was available to ambulance crews.ConclusionThis study identified UK ambulance service policy variations concerning non-specialist paramedic use of tracheal intubation in adult cardiac arrest. The clinical impact of this variation requires further research.
Published: 2022
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25. OR21 Cardiopulmonary resuscitation quality at in-hospital cardiac arrest: a cohort study

Author: Keith Couper, George Bouliotis, and Gavin Perkins
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2022
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26. P120 The influence of locked automated external defibrillators (AEDs) cabinets on the rates of vandalism and theft

Author: Kate Cheema, Daniel O'Connell, Naomi Herz, Abbey Adebayo, Jason Thorpe, Adam Benson-Clarke, and Gavin Perkins
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2022
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27. Impact of bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England

Author: Hussin Albargi, Susan Mallett, Scott Booth, Claire Hawkes, Gavin Perkins, and Barnaby Scholefield
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2020
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28. Survival in out-of-hospital cardiac arrests presenting with an initial non-shockable rhythm in England

Author: Terry Brown, Michael Smyth, Gavin Perkins, Claire Hawkes, Scott Booth, and Adam de Paeztron
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2020
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29. Are public access defibrillators disproportionately placed in affluent areas in England?

Author: Terry Brown and Gavin Perkins
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2020
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30. Research in intensive care

Author: Gavin Perkins and Catriona Frankling
Subjects: business.industry, Intensive care, medicine, Medical emergency, medicine.disease, business
Published: 2018
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31. LSC Abstract – Vitamin D stimulates macrophage efferocytosis and encourages a proresolution phenotype

Author: Dhruv Parekh, Gavin Perkins, and David Thickett
Published: 2016
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32. Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) trial: the protocol for a large pilot study

Author: Tarek Samy, Abdelaziz, Antje, Lindenmeyer, Jyoti, Baharani, Hema, Mistry, Alice, Sitch, R Mark, Temple, Gavin, Perkins, and Mark, Thomas
Subjects: Adult, Male, Outreach, Adolescent, Rapid response teams, Pilot Projects, Acute kidney injury, community acquired, urologic and male genital diseases, Young Adult, Protocol, Humans, Prospective Studies, Acute kidney injury, hospital acquired, Aged, Renal Medicine, Primary Health Care, Acute Kidney Injury, Middle Aged, Prognosis, Electronic alerts, female genital diseases and pregnancy complications, Hospitalization, Early Diagnosis, England, Costs and Cost Analysis, Disease Progression, Female, Healthcare outcomes
Abstract: Introduction Acute kidney injury (AKI) contributes to morbidity and mortality, and its care is often suboptimal and/or delayed. The Acute Kidney Outreach to Reduce Deterioration and Death (AKORDD) study is a large pilot testing provision of early specialist advice, to improve outcomes for patients with AKI. Methods and analysis This before and after study will test an Outreach service for adult patients with AKI, identified using the national algorithm. During the 2-month before phase, AKI outcomes (30-day mortality, need for dialysis or AKI stage deterioration) will be observed in the intervention and control hospitals and their respective community areas; no interventions will be delivered. Patients will receive good standard care. During the 5-month after phase, the intervention will be delivered to patients with AKI in the intervention hospital and its area. Patients with AKI in the control hospital and its area will continue to have good standard care only. Patients already on dialysis and at end of life will be excluded. The interventions will be initially delivered via a phone call, with or without a visit to the primary clinician, aiming at rapidly establishing the aetiology, correcting reversible causes and conducting further appropriate investigation. Surviving stage 3 patients will be followed-up in an AKI clinic. We will conduct qualitative research using focus group-based discussions with primary and secondary care clinicians during the early and late phases of the trial. This will help break down potential barriers and improve care delivery. Ethics and dissemination Patients will be contacted about the study allowing them to ‘opt out’. The work of an Outreach team, guided by AKI alerts and delivering timely advice to clinicians, may improve outcomes. If the results suggest that benefits are delivered by an AKI Outreach team, this study will lead to a full cluster randomised trial. Trial registration number NCT02398682: Pre-results.
Published: 2016

33. Life Saving Apps: Linking Cardiac Arrest Victims to Emergency Services and Volunteer Responders

Author: Sarah N, Lim Choi Keung, Mohammed O, Khan, Christopher, Smith, Gavin, Perkins, Paddie, Murphy, and Theodoros N, Arvanitis
Subjects: Volunteers, Emergency Medical Services, Humans, Mobile Applications, Out-of-Hospital Cardiac Arrest, Defibrillators
Abstract: In cases of emergency, such as out-of-hospital cardiac arrests, the first few minutes are crucial for victims to receive care and have a positive outcome. However, emergency services often arrive on scene after those first few minutes, making any bridging solutions key. Finding a defibrillator or accessing a trained volunteer responder are some of the technological solutions that are being developed to support the chain of survival. This paper looks at technologies, in particular those linked to mobile apps that have been used to locate defibrillators and responder apps that enable responders to attend to nearby emergencies. We review a selection of apps and also assess the challenges and considerations for such apps.
Published: 2016

34. Survey of Trainee Membership of the Intensive Care Society

Author: Andrew J Cadamy, Kate Osborne, Sam Waddy, Gavin Perkins, Rachael Challiner, Juliane Kause, John Moore, and Malcolm Sim
Subjects: Nursing, Work (electrical), business.industry, Intensive care, embryonic structures, education, Advanced stage, Specialty, Text messaging, Medicine, Critical Care and Intensive Care Medicine, Critical Care Nursing, business
Abstract: In October/November 2007 we conducted a survey of the trainee membership of the Intensive Care Society in order to ascertain their views, primarily on the potential introduction of a compulsory examination in intensive care medicine (ICM). Their views on other training issues were also sought. There were 313 responses from a trainee membership of 446. A majority were supportive of a compulsory examination, but this view was heavily qualified by a large number of free text responses. The current UK diploma in ICM was not felt to be suitable as a compulsory examination. The timing of any examination would have to be flexible to avoid conflict with parent specialty training and associated examinations. Many of those training in ICM are at an advanced stage in their careers and the burden on their work and home lives presented by a further examination would be considerable. The survey also highlighted other matters important to training and employment in ICM in the UK, including the difficulties in finding employment in ICM faced by those training from parent specialties other than anaesthesia.
Published: 2008
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35. The UK Out of Hospital Cardiac Arrest Outcome (OHCAO) project

Author: Jerry Nolan, Rachael Fothergill, Timothy Coats, Samantha McDonnell, and Gavin Perkins
Subjects: medicine.medical_specialty, Emergency Medical Services, Quality management, Epidemiology, medicine.medical_treatment, Ambulances, Return of spontaneous circulation, STATISTICS & RESEARCH METHODS, ACCIDENT & EMERGENCY MEDICINE, Outcome Assessment, Health Care, Emergency medical services, Protocol, Medicine, Humans, Confidentiality, Cardiopulmonary resuscitation, Prospective Studies, Registries, Prospective cohort study, business.industry, Incidence, General Medicine, medicine.disease, Quality Improvement, Cardiopulmonary Resuscitation, Survival Rate, Observational study, Medical emergency, business, Out-of-Hospital Cardiac Arrest, RC
Abstract: Introduction: \ud Reducing premature death is a key priority for the UK National Health Service (NHS). NHS Ambulance services treat approximately 30 000 casesof suspected cardiac arrest each year but survival rates vary. The British Heart Foundation and Resuscitation Council (UK) have funded a structured research programme—the Out of Hospital Cardiac Arrest Outcomes (OHCAO) programme. The aim of the project is to establish the epidemiology and outcome of OHCA, explore sources of variation in outcome and establish the feasibility of setting up a national OHCA registry.\ud \ud Methods and analysis: \ud This is a prospective observational study set in UK NHS Ambulance Services. The target population will be adults and children sustaining an OHCA who are attended by an NHS ambulance emergency response and where resuscitation is attempted. The data collected will be characterised broadly as system characteristics, emergency medical services (EMS) dispatch characteristics, patient characteristics and EMS process variables. The main outcome variables of interest will be return of spontaneous circulation and medium—long-term survival (30 days to 10-year survival).\ud \ud Ethics and dissemination: \ud Ethics committee permissions were gained and the study also has received approval from the Confidentiality Advisory Group Ethics and Confidentiality committee which provides authorisation to lawfully hold identifiable data on patients without their consent. To identify the key characteristics contributing to better outcomes in some ambulance services, reliable and reproducible systems need to be established for collecting data on OHCA in the UK. Reports generated from the registry will focus on data completeness, timeliness and quality. Subsequent reports will summarise demographic, patient, process and outcome variables with aim of improving patient care through focus quality improvement initiatives.
Published: 2015

36. Proposed revisions to the EU clinical trials directive--comments from the European Resuscitation Council

Author: Diana Cimpoesu, ANTONIO CABALLERO-OLIVER, Jerry Nolan, Freddy Lippert, Ian Maconochie, KUBILAY DEMIRAG, Patrick Van de Voorde, Stefan Beckers, Pascal Cassan, Peter Paal, Gavin Perkins, Anatolij Truhlář, Koenraad Monsieurs, and Cardiology
Subjects: Evidence-Based Medicine, Informed Consent, business.industry, Legislation, Subject (documents), Emergency Nursing, medicine.disease, Directive, Emergency situations, Clinical trial, Informed consent, Law, Emergency Medicine, Medicine, media_common.cataloged_instance, Humans, In patient, Medical emergency, European union, Cardiology and Cardiovascular Medicine, business, media_common
Abstract: An editorial written by Fritz Stertz et al. in 2002 and pubished in this journal was one of the first to highlight concerns bout the introduction of a new European Union (EU) clinical trils directive (Clinical Trials Directive 2001/20/EC) particularly for esearch in emergency settings.1 The directive sought “to simplify nd harmonize the administrative provisions governing clinical rials in the European Community, by establishing a clear, transarent procedure for conducting studies involving investigational edicinal products”. It is widely acknowledged that the Directive rought inunnecessary administrative and regulatoryburdens. The nflexibility of the Directive led to individual countries creating ocal legislation in an attempt to facilitate emergency research, hich increasedvariationbetweencountries, andaddeddelays and ncreased costs for researchers.2 A group of clinicians, ethicists and awyers (the ‘Vienna Initiative to save European Research’ (VISEAR) nvestigators) produced a consensus document to promote a unied approach to local legislation,3 although the recommendations ere never fully implemented. The EU announced its intent to revise the Clinical Trials Direcive 2001/20/EC in July 2012.4 The consultation paper draws pecific attention to research in patients without capacity statng: “Regarding clinical trials in emergency situations, Directive 001/20/EC does so far not address the specific situation where, ecause of the urgency of the situation, it is impossible to obtain ree and informed consent from the subject or the legal repreentative (‘clinical trials in emergency situations’). To address this, pecific provisions on clinical trials in emergency situations have een added in linewith existing international guidance documents n this issue.”
Published: 2013

37. Carl McQueen

Author: Samantha McDonnell and Gavin Perkins
Subjects: England, Emergency Medicine, General Medicine, History, 21st Century
Published: 2016
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38. Reply: Importance of the Kidney, Vessels, and Heart with Administration of β2 Adrenergic Receptor Agonists in Patients Susceptible to Acute Respiratory Distress Syndrome

Author: David Thickett, Fang G Smith, Daniel McAuley, and Gavin Perkins
Subjects: Pulmonary and Respiratory Medicine, Critical Care and Intensive Care Medicine
Published: 2014
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39. Post-resuscitation care

Author: Gavin Perkins
Subjects: medicine.medical_specialty, business.industry, Intensive care, Health care, Medicine, Chain of survival, Post resuscitation, Organ donation, Medical emergency, Pain management, business, Intensive care medicine, medicine.disease
Published: 2010
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40. The impact of airway management on quality of cardiopulmonary resuscitation: An observational study in patients during cardiac arrest

Author: Joyce Yeung, Robin Davies, Richard Field, Mehboob Chilwan, Fang Gao, and Gavin Perkins
Subjects: Emergency Medicine, Emergency Nursing, Cardiology and Cardiovascular Medicine
Published: 2012
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41. Editorial introductions

Author: Gavin Perkins
Subjects: Critical Care and Intensive Care Medicine
Published: 2010
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42. There is a Role for Nonbronchoscopic Lavage for Investigating Alveolar Inflammation in Acute Respiratory Distress Syndrome

Author: David Thickett, Fang G Smith, and Gavin Perkins
Subjects: Prone position, business.industry, Acoustics, Medicine, High frequency oscillation, Critical Care and Intensive Care Medicine, business
Published: 2006
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43. Cardiopulmonary resuscitation

Author: Jerry Nolan, Jasmeet Soar, and Gavin Perkins
Subjects: Practice Guidelines as Topic, Humans, General Medicine, Algorithms, Cardiopulmonary Resuscitation, Heart Arrest
Published: 2012
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44. AP086 In-hospital evaluation of basic life support training programs: A randomized controlled trial

Author: Naheed Akhtar, Robin Davies, Michelle Davies, Natalie Husselbee, Richard Field, Matthew Cooke, and Gavin Perkins
Subjects: medicine.medical_specialty, Randomized controlled trial, law, business.industry, Emergency Medicine, Physical therapy, medicine, Basic life support, Emergency Nursing, Cardiology and Cardiovascular Medicine, business, law.invention
Published: 2011
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45. ICS Research Prioritisation Exercise 2008

Author: Gavin Perkins and Danny McAuley
Subjects: Critical Care and Intensive Care Medicine, Critical Care Nursing
Published: 2009
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46. Do changes in pulse oximeter oxygen saturation predict equivalent changes in arterial oxygen saturation?

Author: Gavin Perkins, Mcauley, D. F., Giles, S., Routledge, H., and Gao, F.
Subjects: Aged, 80 and over, Male, anaemia, Research, Critical Illness, arterial oxygen saturation, Anemia, Arteries, Middle Aged, United Kingdom, respiratory tract diseases, pulse oximetry, critical care, Oxygen, Intensive Care Units, Oxygen Consumption, Humans, Female, sense organs, acidosis, Oximetry, skin and connective tissue diseases, Aged
Abstract: Introduction This study investigates the relation between changes in pulse oximeter oxygen saturation (SpO2) and changes in arterial oxygen saturation (SaO2) in the critically ill, and the effects of acidosis and anaemia on precision of using pulse oximetry to predict SaO2. Patients and methods Forty-one consecutive patients were recruited from a nine-bed general intensive care unit into a 2-month study. Patients with significant jaundice (bilirubin >40 μmol/l) or inadequate pulse oximetry tracing were excluded. Results A total of 1085 paired readings demonstrated only moderate correlation (r= 0.606; P < 0.01) between changes in SpO2 and those in SaO2, and the pulse oximeter tended to overestimate actual changes in SaO2. Anaemia increased the degree of positive bias whereas acidosis reduced it. However, the magnitude of these changes was small. Conclusion Changes in SpO2 do not reliably predict equivalent changes in SaO2 in the critically ill. Neither anaemia nor acidosis alters the relation between SpO2 and SaO2 to any clinically important extent.

47. Cardiopulmonary resuscitation training

Author: Gavin Perkins, Hulme, J., Shore, H., and Bion, J.

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