Publications

INTRODUCTION: Ambulance clinicians manage a wide range of complex and often challenging clinical presentations. Despite spending significant time with patients during the pre-hospital phase, they rarely receive meaningful feedback on the diagnosis, progress or outcome of their patients from the hospital. This lack of structured feedback represents a missed opportunity for learning and emotional closure. To address this gap, Wexham Park Hospital (WPH) introduced a formal patient outcome feedback service for ambulance clinicians. This mixed-methods service evaluation aimed to explore the effectiveness and impact of the feedback service.

METHODS: An electronic questionnaire was distributed to all previous and present users of the feedback service. The questionnaire included 12 quantitative and qualitative items designed to explore users' experience. Quantitative data were analysed descriptively, while qualitative responses underwent thematic analysis by all authors to identify key themes of the service's impact.

RESULTS: A total of 101 questionnaires were completed and included in the analysis. Satisfaction with the service was very high: 98% of respondents reported being satisfied; 91% indicated that the feedback received was likely to influence their clinical practice; and 68% reported an impact on their mental well-being resulting from the feedback, assumed to be positive.Four domains of improved clinical care were identified by thematic analysis: diagnostic insight and knowledge development; clinical decision-making; confidence and professional growth; continued learning and reflection. The feedback was perceived to have a positive emotional and mental effect, providing clinicians with closure, peace of mind, reassurance and a reduction in uncertainty.

CONCLUSION: The service was viewed by users to enhance clinical practice, support well-being and improve patient care. It fostered confidence in diagnostic and decision-making skills, reduced anxiety and uncertainty and encouraged self-reflection and professional growth. We recommend that feedback services be implemented at facilities where pre-hospital teams interface with hospital care providers.

INTRODUCTION: At the end of life, anticipatory or just-in-case (JIC) medications may help manage patients' symptoms. Sometimes, emergency ambulances attend patients for whom JIC medications have not been prescribed. In Wales, UK, a Welsh Ambulance Services University NHS Trust (WAST) JIC intervention was launched in May 2020 in response to COVID-19, to enable ambulance paramedics to administer JIC medications to patients for whom they had not previously been prescribed. The ambulance JIC intervention is an ongoing feature of WAST pre-hospital care but has received limited evaluation. This study will explore the rationale, usage, costs and views of stakeholders of the WAST JIC medications intervention.

METHODS: We will employ a multi-method observational study design that incorporates both quantitative and qualitative aspects, informed by implementation science. We will prepare a detailed description of the WAST JIC medications intervention, its rationale and its use. We will interview paramedics and doctors who have provided the intervention, as well as paid and informal carers who were present during the care episode. We will also hold a focus group with paramedics who have not administered the intervention and undertake a cost analysis to estimate costs and savings associated with the intervention. We will use descriptive statistics to analyse quantitative data and a framework approach for qualitative data.

CONCLUSION: This study, which focuses on the voices of patient advocates and practitioners, has the potential to shape future provision of this and similar services in WAST and other care providers.

Three decades after the landmark Diabetes Control and Complications Trial (DCCT), type 1 diabetes (T1D) care in India continues to face systemic, socioeconomic, and technological challenges. Despite a relatively lower incidence compared to high-income countries, India bears a disproportionate burden of T1D-related morbidity and premature mortality due to late diagnoses, fragmented care, limited access to insulin, and underutilization of glucose-monitoring technologies. This editorial explores the current landscape of T1D management in India through the lens of the T1D Index, highlighting critical disparities in care quality, life expectancy, and health-adjusted life years lost. We reflect on the need for a national T1D registry, improved access to advanced therapies such as continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems, and the establishment of multidisciplinary pediatric diabetes centers. The manuscript emphasizes systemic reforms, including public-private partnerships, indigenous manufacturing of diabetes technologies, and expanded education and psychosocial support frameworks. By integrating global best practices with localized solutions, India can bridge the care gap and redefine T1D outcomes for future generations.

Cardiac rehabilitation (CR) is a critical component of secondary prevention in cardiovascular disease (CVD) management. In India, where CVD prevalence is rising rapidly, CR remains severely underutilized due to multiple systemic barriers. These include limited infrastructure, insufficient funding, low awareness, and inequitable access across urban and rural regions. This review assesses the current CR landscape in India, contrasts it with global benchmarks, and highlights key implementation gaps. It further explores scalable solutions such as telerehabilitation, community-based programs, and integrated multidisciplinary models. The paper emphasizes the need for robust policy frameworks, sustainable funding, infrastructure strengthening, and comprehensive workforce development. Achieving universal access to CR in India demands a multisectoral, collaborative approach involving government agencies, healthcare providers, academic institutions, nongovernmental organizations (NGOs), and private stakeholders. Enhancing CR services is not only a clinical necessity but also a national public health priority.

Accurate prediction of patient outcomes in intensive care units (ICUs) is crucial for enhancing clinical decision-making, patient care, and resource allocation. Traditional scoring systems like Acute Physiology and Chronic Health Evaluation (APACHE), Simplified Acute Physiology Score (SAPS), and Sequential Organ Failure Assessment (SOFA), while valuable, fall short of fully capturing the complexities of critically ill patients. Advances in machine learning (ML) enable the analysis of high-dimensional data, including electronic health records (EHRs), physiological parameters, and genomic information, providing a more comprehensive approach to outcome prediction. This review aims to assess the impact of ML techniques, including deep learning (DL), ensemble machine learning (EML), and reinforcement learning (RL), in improving ICU outcome predictions, particularly in identifying high-risk patients and enabling proactive interventions. Machine learning models have shown superiority over traditional systems, enabling more accurate identification of critical patients. However, implementing ML in ICU settings comes with challenges, including data quality, model interpretability, ethical concerns, and workflow integration. Collaborative efforts between clinicians, data scientists, and multidisciplinary teams, supported by shared databases like Medical Information Mart for Intensive Care (MIMIC), are essential for developing generalizable ML models that work across diverse healthcare environments. Future research should focus on improving real-time prediction using wearable technology and personalized risk assessments to further individualize ICU care. Ethical considerations, particularly data privacy and model transparency, must be addressed as ML becomes more integrated into critical care.

Lyme disease (LD) is a multisystem inflammatory zoonosis affecting the skin, heart, nervous system, and joints, transmitted by ticks and caused by infection with species of the Borrelia burgdorferi sensu lato (B. burgdorferi s.l.) complex. It is the most common emerging vector-borne disease in the United States. The Centers for Disease Control and Prevention (CDC) estimated the annual occurrence of 3,29,000 cases of LD in the United States during 2005-2010, and it increased to 4,76,000 during 2010-2018. The incidence of various clinical manifestations of LD differs among countries or regions based on the prevalent genospecies of the B. burgdorferi s.l. complex responsible for infection. Ticks of Ixodes spp. are the main vectors involved in the transmission of LD, which occurs mainly during the spring season. However, in North America and Europe, there is a rise in temperature due to global warming, leading to the extension of tick habitats toward northern areas. These ticks now stay active for an extended period of the year, increasing the chances of transmission to humans, and it is postulated to be one of the reasons responsible for the rising cases of LD. Early diagnosis and treatment with appropriate antibiotics can resolve the early manifestations of LD and prevent subsequent complications, which are known to occur if not treated appropriately. The disease is most common in rural areas and is difficult to differentiate clinically from other tropical infections such as rickettsial infections. The literature on LD in India is limited; however, LD has been reported from at least 12 states of India. A recently concluded study by the Indian Council of Medical Research (ICMR) has documented the seroprevalence of this disease in eight sites situated in areas of North (Himachal Pradesh and Haryana) and Northeast India (Meghalaya, Assam, Mizoram, and Tripura). LD remains grossly underdiagnosed in India. The lack of awareness among clinicians regarding the prevalence of LD and the limited availability of diagnostic investigations may have contributed toward it. LD should no longer be confined to textbooks, but it should find a place in the list of differential diagnoses in clinical practice. This review is an endeavor to sensitize physicians regarding LD and its impending rise worldwide due to global warming.