Emergency medicine journal : EMJ
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Communicating treatment risks and benefits to patients and their carers is central to clinical practice in modern healthcare. We investigated the challenges of risk communication by clinicians offering thrombolytic therapy for hyperacute stroke where treatment must be administered rapidly to maximise benefit. ⋯ Risk communication about thrombolysis involves complex uncertainties. We elucidate the challenges of effective risk communication in a hyperacute setting and identify the issues regarding variation in risk communication and the use of less effective formats for the communication of numerical risks and benefits. The paper identifies good practice, such as the phased transfer of information over the care pathway, and ways in which clinicians might be supported to overcome challenges. This includes standardised risk and benefit information alongside appropriate personalisation of risk communication. Effective risk communication in emergency settings requires presentation of high-quality data which is amenable to tailoring to individual patients' circumstances. It necessitates clinical skills development supported by personalised risk communication tools.
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Research collaborations with patient and professional groups can ensure health research funders are aware of what matters to patients, carers and clinicians. Increasing service user involvement in research improves research quality, accountability and provision of patient-centred services. There is little evidence about involving service users in trials or pre-hospital emergency care research. Most research involving service users concerns a condition or treatment rather than service delivery or point of entry to the healthcare system. The SAFER 2 trial evaluates a complex intervention enabling paramedics to assess older people who fall and call 999 and, where appropriate, refer them to a community care pathway. ⋯ The principles and processes of the SOP provided a model that could be replicated across each trial site. We found it necessary to tailor and adapt.
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Timely diagnosis and appropriate management of patients with ST-segment elevation myocardial infarction (STEMI) depends on accurate interpretation of the 12-lead ECG by paramedics. Computer interpretation messages on ECGs are often provided, but the effect they exert on paramedics' decision making is not known. The objective of this pilot study was to assess the feasibility of a trial using an online assessment tool, to determine the effect of computer interpretation messages on paramedics' diagnosis of STEMI. ⋯ A randomised crossover trial to determine the effect of computer interpretation messages is feasible. Pilot data have provided an indication about expected rates of discordance and suggest that incorrect computer messages have a stronger influence across participants and ECGs.
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Older people who fall have been a priority area for the NHS since the publication of the National Service Framework for Older People. Evidence suggests falls prevention can reduce further falls. With rising numbers using Emergency Departments, there is a policy shift for ambulances to convey fewer patients and efforts to refer falls patients to other services ⋯ Despite national priority about preventing falls and calls for reduced emergency department use, there are few studies and weak evidence about the most effective ways to support paramedics to use alternative treatments to target best treatment for older people who fall.
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In Scotland approximately 70% of patients with diabetes treated for a hypoglycaemic event by ambulance clinicians remain at home after treatment. However, many of these individuals experience repeat or subsequent hypoglycaemic events. Current clinical guidance recommends that individuals are advised to follow-up care with their GP, however evidence suggests only a minority make these appointments. The reasons for this are unknown. ⋯ Interventions aimed at improving self-referral for follow-up care are required to address these perceptions.