21 research outputs found
The Health Experiences of Asylum Seekers and Refugees in Wales: Technical Report of the HEAR Study
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Pros and cons of using anonymised linked routine data to improve efficiency of randomised controlled trials in healthcare: experience in primary and emergency care
Get PDFParamedicsâ experiences of administering fascia iliaca compartment block to patients in South Wales with suspected hip fracture at the scene of injury: results of focus groups
Get PDFObjectives To explore paramedicsâ experience of delivering fascia iliaca compartment block (FICB) to patients with suspected hip fracture at the scene of injury.Design Focus groups within a randomised controlled trial.Setting Paramedics based at ambulance stations in the catchment area of one Emergency Department in South Wales, recruited and trained in a feasibility study about an alternative to routine prehospital pain management for patients with suspected hip fracture.Participants 11 paramedics.Intervention Paramedic-administered FICB to patients with suspected hip fracture. We randomly allocated eligible patients to FICB, a local anaesthetic injection directly into the hip regionâor usual care, most commonly morphine - using audited scratch cards.Outcomes Paramedicsâ experiences of administering FICB gathered through thematic analysis of interview transcripts by two researchers, one paramedic and one lay member.Results Respondents believed that FICB was a suitable intervention for paramedics to deliver. It aligned with routine practice and was within peopleâs capabilities. They said it took up to 10âminutes longer than usual care to prepare and deliver, in part due to nervousness and unfamiliarity with a new procedure. They praised the training provided but said they were anxious about causing harm by injecting into the wrong location. Confidence increased after one paramedic team successfully treated a patient for local anaesthetic toxicity. Reported challenges related to the emergency context: patients often waited many hours for ambulance arrival; moving patients exacerbated their pain; family and neighbours were present as paramedics administered treatment.Conclusions Paramedics are willing and able to administer FICB to patients with suspected hip fracture before ambulance transport to hospital. Feasibility study findings will inform further research
Building an understanding of Ethnic minority peopleâs Service Use Relating to Emergency care for injuries: the BE SURE study protocol
Get PDFIntroduction: Injuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients with injuries among people from ethnic minorities in the UK. The aim of this study is to investigate what may differ for people from ethnic minorities compared with white British people when presenting with injury to ambulance and Emergency Departments (EDs).Methods and analysis: This mixed methods study covers eight services, four ambulance services (three in England and one in Scotland) and four hospital EDs, located within each ambulance service. The study has five Work Packages (WP): (WP1) scoping review comparing mortality by ethnicity of people presenting with injury to emergency services; (WP2) retrospective analysis of linked NHS routine data from patients who present to ambulances or EDs with injury over 5 years (2016â2021); (WP3) postal questionnaire survey of 2000 patients (1000 patients from ethnic minorities and 1000 white British patients) who present with injury to ambulances or EDs including self-reported outcomes (measured by Quality of Care Monitor and Health Related Quality of Life measured by SF-12); (WP4) qualitative interviews with patients from ethnic minorities (n=40) and focus groupsâfour with asylum seekers and refugees and four with care providers and (WP5) a synthesis of quantitative and qualitative findings.Ethics and dissemination: This study received a favourable opinion by the Wales Research Ethics Committee (305391). The Health Research Authority has approved the study and, on advice from the Confidentiality Advisory Group, has supported the use of confidential patient information without consent for anonymised data. Results will be shared with ambulance and ED services, government bodies and third-sector organisations through direct communications summarising scientific conference proceedings and publications
Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study
Get PDFInvestigating the feasibility of an enhanced contact intervention in self-harm and suicidal behaviour: a protocol for a randomised controlled trial delivering a Social support and Wellbeing Intervention following Self Harm (SWISH)
Get PDFIntroduction: Self harm is a strong predictor for suicide. Risks for repeat behaviour are heightened in the aftermath of an index episode. There is no consensus on the most effective type of intervention to reduce repetition. Treatment options for patients who do not require secondary mental health services include: no support, discharge to General Practitioner, or referral to primary care mental health support services. The aim of this study is to assess whether it is feasible to deliver a brief intervention after an episode and whether this can reduce depressive symptoms and increase sense of wellbeing for patients who self harm.Methods: This is a non-blinded parallel group randomised clinical trial. One hundred and twenty patients presenting with self harm and/or suicidal ideation to mental health services over a twelve month period who are not referred to secondary services will be randomised to either intervention plus treatment as usual (TAU), or control (TAU only). Patients are assessed at baseline, 4 weeks and 12 weeks with standardised measures to collect data on depression, wellbeing, and service use. Primary outcome is depression scores; secondary outcomes are wellbeing scores and use of services. The findings will indicate whether a rapid response brief intervention is feasible and can reduce depression and increase wellbeing among patients who self harm and do not require secondary services. Ethics and dissemination: Ethical approval was granted by the UK National Health Service (NHS) Ethics Committee process (REC 6: 14/WA/0074). The findings of the trial will be disseminated through presentations to the participating Health Board and partners, peer-reviewed journals, national and international conferences. Trial registration: The trial is registered with the International Standard Randomised Controlled Trial Network (ISRCTN 76914248); and UK Clinical Research Network (16229
Case management of people who call 999 frequently â qualitative study of the perspective of people providing and receiving care (STRETCHED)
Get PDFExperiences and views of people who frequently call emergency ambulance services: a qualitative study of UK service users
Get PDFIntroduction: People who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We report results of interviews with people who use emergency ambulance services frequently to understand their experiences of calling and receiving treatment. Methods: We used a twoâstage recruitment process. A UK ambulance service identified six people who were known to them as frequently calling emergency services. Through thirdâsector organisations, we also recruited nine individuals with healthcare experiences reflecting the characteristics of people who call frequently. We gained informed consent to record and transcribe all telephone interviews. We used thematic analysis to explore the results. Results: People said they make frequent calls to emergency ambulance services as a last resort when they perceive their care needs are urgent and other routes to help have failed. Those with the most complex health needs generally felt their immediate requirements were not resolved and underlying mental and physical problems led them to call again. A third of respondents were also attended to by police and were arrested for behaviour associated with their health needs. Those callers receiving case management did not know they were selected for this. Some respondents were concerned that case management could label frequent callers as troublemakers. Conclusion: People who make frequent calls to emergency ambulance services feel their health and care needs are urgent and ongoing. They cannot see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. More research is needed to understand service users' motivations and requirements to inform design and delivery of accessible and effective services. Patient or Public Contribution: People with relevant experience were involved in developing, undertaking and disseminating this research. Two public contributors helped design and deliver the study, including developing and analysing service user interviews and drafting this paper. Eight public members of a Lived Experience Advisory Panel contributed at key stages of study design, interpretation and dissemination. Two more public contributors were members of an independent Study Steering Committee
Ethnic differences in injury mortality rates among adult emergency healthcare service users in High Income Countries (HIC) â A Scoping Review
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