Publications

This systematic review examined the role of bedside teaching (BST) in undergraduate medical education, focusing on its impact on clinical competence and professional growth. The review included 15 studies that investigated the effects of BST on physical examination skills, diagnostic abilities, communication skills, and confidence among medical students. The results showed that BST significantly improved physical examination skills, diagnostic abilities, and communication skills, and increased confidence among students. BST was also found to enhance empathy and professionalism among students. However, the review highlighted several challenges in implementing BST, including time constraints, lack of trained faculty, and declining opportunities for BST. To address these challenges, the review recommended integrating BST into the medical curriculum, providing faculty development programs, and utilizing technology-enhanced learning tools. The findings of this systematic review underscore the importance of BST in undergraduate medical education, emphasizing its potential to enhance clinical competence and professional growth among future healthcare professionals.

PURPOSE: To extend wavelet analysis of pattern electroretinography (PERG) from macular cone to retinal ganglion cell (RGC) dysfunction in optic nerve disease (OND) by validating Symlet-2 (sym2) discrete wavelet transform (DWT) features.

METHODS: From the open access PERG-Institute of Applied Ophthalmobiology (IOBA) dataset, 58 recordings from OND subjects and 262 recordings from healthy volunteers (HVs) were analyzed. Five pre-selected sym2 coefficients (D5-2, D6-2, D6-3, A6-3, A6-4) were quantified. Their correlations with canonical amplitudes (|P50-N35|, |N95-P50|) and group separation (rank-biserial effect size, |rrb|) were analyzed. We also assessed a previously defined DWT energy index based on the Daubechies 8 mother wavelet (7N), capturing RGC activity.

RESULTS: The macular cone-specific sym2-D6-2 correlated tightly with |P50-N35| in HVs (rcorr = 0.95) and OND subjects (rcorr = 0.97). In contrast, sym2-A6-4 (112-150 ms, 0-13 Hz) was best suited to capture differences between the HV and OND groups (|rrb| = 0.549), compared to |N95-P50| (|rrb| = 0.358). Bootstrap benchmarking confirmed that sym2-A6-4 outperformed |P50-N35| and |N95-P50| (Δ|rrb| = 0.362 and 0.187; Pboot = 0.005 and 0.036, respectively). The 7N feature failed to yield effective results on all measures (|rrb| = 0.084).

CONCLUSIONS: Sym2 DWT features provide compartment-specific, multidimensional biomarkers that outperform traditional canonical peaks for both macular cone (sym2-D6-2) and RGC (sym2-A6-4) assessment. Future work should validate these biomarkers in a large, diverse, genetically and phenotypically characterized external cohort to confirm generalizability and clinical utility.

TRANSLATIONAL RELEVANCE: Sym2 wavelet indices provide robust and sensitive PERG biomarkers that could serve as quantitative endpoints in clinical trials.

INTRODUCTION: Work-related burnout is a serious and frequently documented issue affecting the mental health and well-being of a large proportion of people, including ambulance service personnel. Owing to the nature of their emergency services role, ambulance service professionals are frequently exposed to highly demanding and stressful situations, resulting in stress and subsequent burnout. In addition, the causal link between burnout, depression, anxiety and subsequent suicidal ideation highlights the importance of researching burnout in ambulance personnel. As a result, the aim of this study was to discuss the incidence of burnout in Yorkshire Ambulance Service NHS Trust emergency medical services staff.

METHODS: This single ambulance service study was a mixed-methods survey study with data collection utilising the 19-question Copenhagen Burnout Inventory, which measures burnout across three domains: personal burnout, work-related burnout and patient-related burnout. The questionnaire was amended to incorporate a free-text space to provide opinions on causation of burnout, alongside suggestions of how current practice can be improved.

RESULTS: Seventy-eight staff members completed the questionnaire. Thirty-eight (48.7%) staff members were found to be experiencing personal burnout, 42 (53.8%) staff members experienced work-related burnout and patient-related burnout was found in 29 (37.1%) respondents. Within the questionnaire, four themes were identified through thematic analysis: external factors; patterns of work; management support; and sickness absence.

CONCLUSION: Findings suggested that burnout was prevalent within this Trust. This requires further investigation into causation, alongside consideration of preventative measures and interventions that would improve well-being within the emergency medical services, as literature suggests that burnout is associated with declining mental health and increased staff sickness absence rates.

INTRODUCTION: Traumatic haemorrhage is a major cause of preventable death, and blood transfusion is a crucial component of damage control resuscitation. Several diagnostic strategies exist to anticipate hypovolaemic shock and subsequent blood transfusion requirements, but their pre-hospital utility is inconsistent. Capnography or end-tidal carbon dioxide (EtCO2) measurement has received growing recognition for prognostic capability in metabolic, respiratory and cardiac disease. This systematic review examines EtCO2 efficacy in predicting hypovolaemic shock and subsequent blood transfusion in pre-hospital adult trauma patients.The aims and objectives of this study were, first, to determine if early EtCO2 measurement in pre-hospital adult trauma patients can reliably predict hypovolaemic shock and/or blood transfusion when compared to existing strategies and scoring tools and, second, to identify if an EtCO2 predictive threshold can facilitate this.

METHODS: A systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted. Seven electronic databases were searched using relevant indexed terms and keywords. Inclusion criteria were adult (>13 years) trauma patients with suspected or confirmed haemorrhage and with early (pre-diagnostic) EtCO2 data from mainstream or side-stream devices, as related in peer-reviewed publications. All articles (n = 1932) were double-blind screened at abstract and title, then at full-text stage by two reviewers. Issues were discussed by the authors. Critical Appraisal Skills Programme (CASP) tools were used. Findings were narratively synthesised.

RESULTS: Thirteen articles were included. Significant heterogeneity, quality limitations and inconsistent reporting hindered direct comparison of results. Nevertheless, 10 comparator strategies/tools were identified and most studies demonstrated EtCO2's efficacy in predicting hypovolaemic shock / blood transfusion, with thresholds below 35 mmHg consistently suggested as predictive.

CONCLUSION: A universal definition for major blood transfusion is still lacking. Further research is needed to identify accurate markers of haemorrhage, including EtCO2 as a potential predictor. A high index of suspicion for haemorrhage and need for blood transfusion is recommended for adult trauma patients with EtCO2 levels below 35 mmHg (4.7 kPa).

INTRODUCTION: People in prison experience substantial health inequalities, including higher prevalence of physical and mental health conditions, substance misuse and mortality. Despite this, ambulance service activity involving the prison population is poorly understood. The aim of this service evaluation was to understand the nature and volume of emergency ambulance calls from prisons in the Yorkshire and Humber region.

METHODS: This service evaluation used retrospective data from Yorkshire Ambulance Service (YAS) dispatch records for emergency calls for adults (≥18 years) from 13 regional prisons between 1 April 2021 and 31 March 2022. Call details included the call reason, the patient disposition (defined as the plan after assessment and/or treatment, categorised as transported or not transported) and call timings. Publicly available Ministry of Justice statistics on prison populations were also consulted for context. Descriptive analyses were performed using counts, proportions, means, medians and confidence intervals. Conveyance rates (the percentage of calls attended by a YAS vehicle that resulted in patient transport) were calculated and compared to conveyance rates from incidents attended by YAS as a whole.

RESULTS: YAS received 1263 calls from prisons, with at least one ambulance dispatched to 1025. These calls accounted for 0.14% of total incidents attended by YAS. Of these, 730 incidents resulted in conveyance, representing a 71.2% conveyance rate, which was approximately one-third higher than the regional average. However, the clinical acuity of patients did not consistently justify this. Considerable variation in call frequency was observed between prisons.

CONCLUSION: Calls to the ambulance service from prisons represent a small proportion of overall YAS workload. Initial call triage placed a greater proportion of calls from prisons in the highest priority category, and both attendance and conveyance rates were higher from prisons compared to the general population.

INTRODUCTION: Pre-hospital pain is prevalent and frequently undertreated. Limited UK-based research has examined the influence of demographic and deprivation factors on paramedic-led pain management. Early effective management of acute pain has been shown to improve patient satisfaction and outcomes, and evaluating the effectiveness of such an important intervention is critical given the limited formulary that paramedics have access to, combined with the diverse communities that paramedics serve. Hence, this service evaluation aimed to evaluate the overall effectiveness of paramedic-led pain management, considering the effectiveness in relation to demographic and deprivation factors in adult patients in the pre-hospital setting.

METHODS: A retrospective observational service evaluation was conducted using anonymised adult (18+) clinical record data. This was collected from the North East Ambulance Service NHS Foundation Trust for the period of 1 July 2023 to 30 June 2024. The primary outcome was the achievement of the minimum clinically important difference (MCID: ≥2-point or 30% reduction) and adequate pain management (APM: ≥50% reduction) on the 11-point numeric pain scale (NRS-11). Outcomes were compared across sex, age and Index of Multiple Deprivation decile.

RESULTS: Of 54,998 eligible cases, the MCID was achieved in 41.98% and APM in 24.76% of patients. As social deprivation increases, patients become significantly less likely to achieve the MCID or APM (MCID: ρ = 0.81, 95% CI: 0.39, 0.96, p = 0.007; APM: ρ = 0.88, 95% CI: 0.56, 0.97, p = 0.002). Male patients were marginally more likely to achieve APM than female (1.13%, 95% CI: 0.40, 1.86%, p = 0.002). Increasing age correlated strongly with both MCID (ρ = 0.90, 95% CI: 0.74, 0.96, p <0.001) and APM (ρ = 0.90, 95% CI: 0.75, 0.96, p <0.001) achievement.

CONCLUSION: Paramedic-led pain management is associated with a pain reduction in most cases; however, the magnitude of this reduction varies. Increased age, lower social deprivation and the male sex were associated with greater reported analgesic effectiveness. The reasoning for this is unclear. Further research to determine causality and inform practice in pre-hospital pain management are required before definitive conclusions can be drawn.

INTRODUCTION: Ventilation with a bag-valve-mask is a standard part of cardiopulmonary resuscitation (CPR) performed by ambulance clinicians. Ventilation quality has received little attention until recently, when ventilation feedback devices (VFDs) became available. Evidence suggests that clinicians struggle to ventilate according to guidelines without feedback and that a VFD improves ventilation quality. This study explored the impact of regular VFD use compared with a single episode of VFD use and no VFD use on ventilation quality during simulated CPR across a six-month period.

METHODS: The study comprised a single-site, exploratory, randomised controlled trial conducted in North East Ambulance Service NHS Foundation Trust. Participants completed six-minute CPR scenarios, with ventilation quality recorded, repeated three times over six months. Participants were randomised 1:1:1 to ventilation feedback at each session, feedback at the first session only or no feedback (control). The primary outcome was ventilation quality (rate and volume) at the final study session.

RESULTS: The study ran from February to July 2025 and included 51 participants, mostly male (82%), with a median age of 39 years (IQR 33-45), who were primarily paramedics (92%). Participants completed 150 study sessions, generating 15.5 hours of ventilation data. There was a clear difference in ventilation quality (rate and volume) with VFD versus no VFD. The ventilation quality of the group that had feedback at only the first session declined sharply when feedback was removed, and by the third (final) study session this group was statistically no different from the control group. VFD use reduced instances of hyper- and hypoventilation.

CONCLUSION: This simulation-based, exploratory, randomised controlled trial demonstrated that VFD use improved the ability of ambulance clinicians to ventilate according to guidelines but when the VFD was removed, they rapidly reverted to a low level of compliance. Future work needs to study VFD use in clinical practice and to explore any impact on patient outcomes.

INTRODUCTION: The growth of the paramedic profession over recent years is reflected in the growing body of publications by paramedics or related to paramedics, ambulance services and pre-hospital care. Publications are not the only method by which new knowledge can be disseminated, and conferences represent another method of dissemination. Conference presentations may or may not be published, so studying these presents a different perspective on topics of interest and research happening within the profession. This study set out to report on material presented at large conferences relevant to UK paramedics between 2010 and 2023.

METHODS: The project comprised a bibliometric study describing presentations from UK conferences relevant to paramedics between 2010 and 2023. Conferences relevant to paramedic practice were selected by the study team based on pre-determined criteria. Standardised forms were used to extract data on presentations and presenters. Data are presented descriptively.

RESULTS: Six large conferences (999 EMS Research Forum, Ambulance Leadership Forum, Faculty of Pre-Hospital Care Conference, College of Paramedics National Conference, Research Conference and Student Conference) were selected, and data from 43 individual conferences were collected, representing 70% of the potential conferences during this time frame. The data include 690 presentations given by 551 individual presenters. Paramedics were the most common professional group presenting. The London Ambulance Service, North East Ambulance Service and University of Sheffield were the most common institutions represented. The most common topics under discussion were policy and practice, research and trauma. The most common methodologies were qualitative.

CONCLUSION: This study provides an overview of research presented at paramedic, ambulance service and pre-hospital conferences. A wide range of research was presented at the selected conferences by many individuals. A wide range of topics feature in the data, but high-impact, low-frequency clinical conditions, such as cardiac arrest and major trauma, feature highly.