Emergency department (ED or A&E)

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Research outputs from the Emergency Department at the RD&E.

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Now showing 1 - 5 of 56
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    Ultrasound Directed Reduction of Colles' type distal radial fractures in ED (UDiReCT): a feasibility randomised controlled trial
    (BMJ, 2023-11-28) Malik, H.; Wood, D.; Stone, O.; Gough, A.; Taylor, G.; Knapp, K. M.; Heggs, D.; Appelboam, A.
    BACKGROUND: There is a high rate of surgical fixation of displaced Colles' type distal radial wrist fractures despite fracture manipulation in the ED. Point-of-care ultrasound has been used to guide ED manipulations but its effect on the quality of fracture reduction or subsequent need for surgical fixation is unknown. This study aims to assess the feasibility of conducting a definitive randomised controlled trial to assess the use of ultrasound to guide these fracture manipulations. METHODS: We conducted a pragmatic randomised controlled feasibility trial in two EDs in England over a 6-month period (7 October 2019 to 6 April 2020). Adult patients with wrist fractures undergoing manipulation in the ED were randomised 1:1 to ultrasound-guided distal radial fracture manipulation or manipulation with sham ultrasound. The primary outcome for this study was trial recruitment rate. Other measures were recorded to assess potential future definitive trial outcomes and feasibility. RESULTS: Of 120 patients meeting inclusion criteria, 48 (40%) were recruited and randomised in the two centres, giving overall recruitment rates of 0.3 and 1.8 participants per week at each site, respectively, and 1 participant per week overall. The most common reason that patients were not included was research staff availability. After 6 weeks, six patients in each group (26% intervention, 24% control) had undergone surgical fixation, with 98% data completeness for this potential definitive trial primary outcome. Randomisation, blinding and data collection processes were effective but there were data limitations in the X-ray assessment of fracture positions. CONCLUSION: A definitive study of a similar design would be feasible within UK ED practice but organisational factors and research staff availability should be considered when estimating the predicted recruitment rate and required sites. 6-week surgical fixation rate was the most reliable outcome measure. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03868696).
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    How do patients and other members of the public engage with the orphan drug development? A narrative qualitative synthesis
    (BioMed Central, 2023-04-01) Frost, J.; Hall, A.; Taylor, E.; Lines, S.; Mandizha, J.; Pope, C.
    BACKGROUND: The diversity of patient experiences of orphan drug development has until recently been overlooked, with the existing literature reporting the experience of some patients and not others. The current evidence base (the best available current research) is dominated by quantitative surveys and patient reported outcome measures defined by researchers. Where research that uses qualitative methods of data collection and analysis has been conducted, patient experiences have been studied using content analysis and automatic textual analysis, rather than in-depth qualitative analytical methods. Systematic reviews of patient engagement in orphan drug development have also excluded qualitative studies. The aim of this paper is to review qualitative literature about how patients and other members of the public engage with orphan drug development. METHODS: We conducted a systematic search of qualitative papers describing a range of patient engagement practices and experiences were identified and screened. Included papers were appraised using a validated tool (CASP), supplemented by reporting guidance (COREQ), by two independent researchers. RESULTS: 262 papers were identified. Thirteen papers reported a range of methods of qualitative data collection. Many conflated patient and public involvement and engagement (PPIE) with qualitative research. Patients were typically recruited via their physician or patient organisations. We identified an absence of overarching philosophical or methodological frameworks, limited details of informed consent processes, and an absence of recognisable methods of data analysis. Our narrative synthesis suggests that patients and caregivers need to be involved in all aspects of trial design, including the selection of clinical endpoints that capture a wider range of outcomes, the identification of means to widen access to trial participation, the development of patient facing materials to optimise their decision making, and patients included in the dissemination of trial results. CONCLUSIONS: This narrative qualitative synthesis identified the explicit need for methodological rigour in research with patients with rare diseases (e.g. appropriate and innovative use of qualitative methods or PPIE, rather than their conflation); strenuous efforts to capture the perspectives of under-served, under-researched or seldom listened to communities with experience of rare diseases (e.g. creative recruitment and wider adoption of post-colonial practices); and a re-alignment of the research agenda (e.g. the use of co-design to enable patients to set the agenda, rather than respond to what they are being offered).
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    Evaluation of the prehospital use of a Valsalva assist device in the emergency treatment of supraventricular tachycardia (EVADE SVT): study protocol for a stepped wedge cluster randomised controlled trial
    (BMJ, 2023-06-01) Appelboam, A.; Osborne, R.; Ukoumunne, O.; Black, S.; Boot, S.; Richards, N.; Scotney, N.; Rhodes, S.; Cranston, T.; Hawker, R.; Gillett, A.; Jones, B.; Hawton, A.; Dayer, M.; Creanor, S.
    INTRODUCTION: Patients with episodes of supraventricular tachycardia (SVT), a common heart arrhythmia, are often attended by ambulance services. International guidelines advocate treatment with the Valsalva manoeuvre (VM), but this simple physical treatment has a low success rate, with most patients requiring conveyance to hospital. The Valsalva Assist Device (VAD) is a simple device that might help practitioners and patients perform a more effective VM and reduce the need for patients to be taken to hospital. METHODS AND ANALYSIS: This stepped wedge cluster randomised controlled trial, conducted within a UK ambulance service, compares the current standard VM with a VAD-delivered VM in stable adult patients presenting to the ambulance service with SVT. The primary outcome is conveyance to hospital; secondary outcomes measures include cardioversion rates, duration of ambulance care and number of subsequent episodes of SVT requiring ambulance service care. We plan to recruit approximately 800 patients, to have 90% power to detect an absolute reduction in conveyance rate of 10% (from 90% to 80%) between the standard VM (control) and VAD-delivered VM (intervention). Such a reduction in conveyance would benefit patients, the ambulance service and receiving emergency departments. It is estimated potential savings would pay for devices for the entire ambulance trust within 7 months. ETHICS AND DISSEMINATION: The study has been approved by the Oxford Research Ethics Committee (reference 22/SC/0032). Dissemination will be through peer-reviewed journal publication, presentation at national and international conferences and by the Arrhythmia Alliance, a patient support charity. TRIAL REGISTRATION NUMBER: ISRCTN16145266.
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    EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) LONG VERSION
    (Thieme Gruppe, 2022-10-13) Jarman, R. D.; McDermott, C.; Colclough, A.; Bøtker, M.; Knudsen, L.; Harris, T.; Albaroudi, B.; Albaroudi, O.; Haddad, M.; Darke, R.; Berry, E.; Breslin, T.; Fitzpatrick, G.; Flanagan, L.; Olusanya, O.; Craver, D.; Omar, A.; Simpson, T.; Cherian, N.; Dore, M.; Prosen, G.; Kay, S.; Villén-Villegas, T.; Gargani, L.; Carley, S.; Woo, M.; Dupriez, F.; Hussain, A.; Via, G.; Connolly, J. A.; Peck, M.; Melniker, L.; Walden, A.; Attard Biancardi, M. A.; Żmijewska-Kaczor, O.; Lalande, E.; Geukens, P.; McLaughlin, R.; Olszynski, P.; Hoffmann, B.; Chin, E.; Muhr, C.; Kim, D. J.; Mercieca, A.; Shukla, D.; Hayward, S.; Smith, M.; Gaspari, R.; Smallwood, N.; Pes, P.; Tavazzi, G.; Corradi, F.; Lambert, M.; Morris, C.; Trauer, M.; Baker, K.; Bystrzycki, A.; Goudie, A.; Liu, R.; Rudd, L.; Dietrich, C. F.; Jenssen, C.; Sidhu, P. S.
    AIMS:  To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS). METHODS:  We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of strongly agree" and "agree" on the Likert scale responses. FINDINGS AND RECOMMENDATIONS:  One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). CONCLUSION:  These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings."
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    EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) SHORT VERSION
    (Thieme Gruppe, 2022-10-13) Jarman, R. D.; Colclough, A.; McDermott, C.; Bøtker, M.; Knudsen, L.; Harris, T.; Albaroudi, B.; Albaroudi, O.; Haddad, M.; Darke, R.; Berry, E.; Breslin, T.; Fitzpatrick, G.; Flanagan, L.; Olusanya, O.; Craver, D.; Omar, A.; Simpson, T.; Cherian, N.; Dore, M.; Prosen, G.; Kay, S.; Villén-Villegas, T.; Gargani, L.; Carley, S.; Woo, M.; Dupriez, F.; Hussain, A.; Via, G.; Connolly, J. A.; Peck, M.; Melniker, L.; Walden, A.; Attard Biancardi, M. A.; Żmijewska-Kaczor, O.; Lalande, E.; Geukens, P.; McLaughlin, R.; Olszynski, P.; Hoffmann, B.; Chin, E.; Muhr, C.; Kim, D. J.; Mercieca, A.; Shukla, D.; Hayward, S.; Smith, M.; Gaspari, R.; Smallwood, N.; Pes, P.; Tavazzi, G.; Corradi, F.; Lambert, M.; Morris, C.; Trauer, M.; Baker, K.; Bystrzycki, A.; Goudie, A.; Liu, R.; Rudd, L.; Dietrich, C. F.; Jenssen, C.; Sidhu, P. S.
    OBJECTIVE:  To evaluate the evidence and produce a summary and recommendations for the most common heart and lung point-of-care ultrasound (PoCUS). METHODS:  We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendations were produced, including assigning levels of evidence (LoE) and grading of recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement of the summary and recommendation for each question (using a 5-point Likert scale), which was approved in the case of a level of agreement of greater than 75 %. A level of agreement was defined as a summary of strongly agree" and "agree" on the Likert scale responses. FINDINGS AND RECOMMENDATIONS:  One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1), the remaining 9 questions achieved broad agreement with an assigned LoE of 4 and a weak GRADE recommendation (question 2), three achieved an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8) and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). CONCLUSION:  These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings."