Emergency medicine journal : EMJ
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The SAFER 2 study, in three UK ambulance services, evaluated a complex intervention to support paramedics safely to leave older patients at home with referral to a falls service, following a call to 999 for a fall. The intervention comprised a training programme, referral pathway, clinical support, clinical decision flowchart and referral feedback. Normalisation Process Theory (NPT) examines the factors required for successful implementation of an intervention such as SAFER 2 into routine practice, through four components: coherence, cognitive participation, collective action and reflexive monitoring. We used NPT to frame an analysis of paramedics' views of implementation of SAFER 2. ⋯ Usage of NPT to support analysis of paramedic views on implementation of the SAFER 2 intervention highlighted issues with coherence and collective action that may have affected the trial. The novel intervention was seen as beneficial by paramedics during both pre- and post-trial interviews, although barriers to utilisation were identified.
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Acute heart failure (AHF) symptoms are similar to some respiratory conditions making it challenging for paramedics to diagnose AHF accurately, especially as they infrequently encounter it. Little is known about the clinical reasoning strategies (CRS) used by student or qualified paramedics to diagnose and manage patients with AHF, inaccurate diagnosis associated with inappropriate diuretic management can cause patient complications. ⋯ Although a small study, consideration should be given to participants immature CRS; they may require post-registration support to develop consistently accurate and appropriate clinical decisions which avoid patient exposure to risk. Further research should identify whether other paramedic students, from the various registration routes, reflect these results.
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Comparative Study
Paediatric ED reattendance rates: comparing nurse practitioners and other clinicians.
The aim of this project is to establish the unplanned reattendance rate for paediatric emergency nurse practitioners (PENPs) working in a designated paediatric emergency department (PED) while identifying the case mix of patients seen by PENPs compared with their medical counterparts. ⋯ PENPs work autonomously when seeing children presenting with minor trauma and make a positive contribution in achieving the reattendance Clinical Quality Indicator.
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Observational Study
Cerebral oximetry levels during CPR are associated with return of spontaneous circulation following cardiac arrest: an observational study.
Cerebral oximetry using near-infrared spectroscopy measures regional cerebral oxygen saturation (rSO2) non-invasively and may provide information regarding the quality of cerebral oxygen perfusion. We determined whether the level of rSO2 obtained during cardiopulmonary resuscitation is associated with return of spontaneous circulation (ROSC) and survival in Emergency Department (ED) patients presenting with cardiac arrest. ⋯ In ED patients with cardiac arrest higher cerebral oxygen saturations are associated with higher rates of ROSC.
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A minority of patients make frequent and excessive calls to the ambulance service, placing a significant burden on limited resources at a time when demand on urgent and emergency care systems is steadily increasing. Little is known about the reasons underlying frequent caller behaviour or the best way to manage this group of patients. ⋯ Effective management of this complex patient group requires an individualised case management approach in order to identify and tackle the underlying causes of behaviour.