Publications

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: 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.

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.

Binocular rivalry occurs when incompatible images presented to each eye lead to alternations between two competing percepts. While several visual and multisensory factors can affect binocular rivalry dynamics, whether perceptual transitions themselves can be subject to cross-modal influences remains unknown. We developed a conditioning paradigm to test whether neutral auditory stimuli, when paired with visual probe-induced perceptual switches, could subsequently influence binocular rivalry dynamics. Participants viewed rivaling orthogonally oriented gratings of different colors. During conditioning, auditory stimuli were systematically paired with visual probes that triggered perceptual switches. Following conditioning, the presentation of conditioned sounds alone produced two effects: shorter dominance durations and, critically, faster perceptual switches. Control conditions confirmed that this conditioning effect could not be attributed to auditory stimulation itself, time on task, or report biases. Our findings provide evidence that binocular rivalry dynamics can be shaped by cross-modal associative learning processes, whereby conditioned sounds serve as predictive cues for perceptual transitions, effectively lowering the threshold for switches between competing stimuli. These results offer new insights into how auditory signals might be incorporated into predictive models that influence visual perception during the resolution of visual ambiguities.

BACKGROUND: Non-compliance with radiotherapy (RT) is a critical barrier to effective cancer care, particularly in low- and middle-income countries like the Philippines. Despite a high national cancer burden, there is a lack of research on the specific factors driving RT non-compliance within the Philippine public health system. This study aimed to identify the independent predictors of non-compliance at a major public cancer center, to inform targeted interventions.

METHODS: This retrospective cohort study analysed the records of 448 patients with breast, cervical, head and neck, endometrial or rectal cancer who underwent curative intent RT at a large public cancer center in the Philippines between January 2022 and April 2024. Non-compliance was defined as missing two or more scheduled RT sessions. A hierarchical multivariable binary logistic regression model was used to identify independent predictors, assessing sociodemographic, clinical and seasonal/systemic factors in sequential blocks.

RESULTS: The overall non-compliance rate was 42.4%. The final multivariable model revealed that non-compliance was primarily driven by a convergence of clinical and systemic factors rather than patient demographics. The strongest predictors reflected clinical severity, specifically cancer type [cervical: odds ratio (OR) = 7.43; head and neck: OR = 3.54] and the need for a treatment replan (OR = 5.60). Systemic factors were also significant predictors, including an internal referral source (OR = 1.83) and treatment timing. Specifically, the risk of non-compliance increased for patients undergoing computed tomography simulation in the third quarter (July-September) and for those starting treatment in the fourth quarter (October-December), which are periods associated with regional climatic and socioeconomic pressures.

CONCLUSION: In this Philippine public cancer center, RT non-compliance is driven by clinical vulnerability and dynamic systemic pressures, not static patient demographics. These findings highlight the need to shift from passive risk assessment to proactive, risk-stratified interventions. Implementing strategies such as patient navigation and support programs, adjusted for predictable seasonal pressures, can mitigate vulnerability, improve treatment adherence and ultimately enhance cancer outcomes in resource-constrained settings.

BACKGROUND: Alcohol consumption is a significant risk factor for liver cancer, particularly hepatocellular carcinoma. In China, the incidence of liver cancer has been rising, necessitating an in-depth analysis of the relationship between alcohol consumption and liver cancer burden.

OBJECTIVE: This study aims to assess the burden of alcohol-associated liver cancer (A-LC) in China from 1990 to 2021, utilising data from the Global Burden of Disease (GBD) Study 2021.

METHODS: This study first gathered data on A-LC in China, focusing on age, sex, incidence, prevalence, mortality, disability-adjusted life years (DALYs) and risk factors, using information from the 2021 GBD study covering the years 1990-2021. Next, the research examined the temporal trends of A-LC burdens in China during the same period, employing linear regression modeling to calculate estimated annual percentage change (EAPC) values. Additionally, the autoregressive integrated moving average and exponential smoothing model were utilised to project future disease burdens from 2022 to 2050. Finally, the study analysed risk factors associated with A-LC.

RESULTS: The number of deaths and DALYs for A-LC grew significantly during the study period 1990-2021 (in 1990, in 2021). However, age-standardised deaths and DALYs declined (deaths: 0.87 in 1990 and 0.85 in 2021, DALYs: 24.26 in 1990 and 22.01 in 2021). EAPC = 0.16 (95% CI 0-0.32) for deaths in patients with A-LC and EAPC = -0.18 (95% CI -0.34 to -0.01) for DALYs. Although age-standardized death rates have declined in the last 3 years, the number of incidence, disease and death cases of A-LC patients in China has increased with the progress of time. In 2021, ASIR and ASPR reached the highest in history and the large base of A-LC patients in China and the overall situation of the people should not be underestimated. While East Asia and the high-income Asia-Pacific region declined over the study period, Central Asia saw an increase in age-standardised DALY rates. Age-standardised DALYs also grew significantly in high-income populations in North America and Australasia.

CONCLUSION: A-LC remains a serious threat to the major health problems of the Chinese people, especially men, and the burden of liver cancer associated with obesity risk factors is also increasing significantly and is expected to continue to grow over the next 25 years.

BACKGROUND: Cancer anorexia-cachexia syndrome (CACS) is a multifactorial metabolic condition prevalent among patients with advanced malignancies and often exacerbated by chemotherapy or radiotherapy (RT). While pharmacologic options such as megestrol and corticosteroids are available, their use is limited by cost or adverse effects. Olanzapine, a second-generation antipsychotic, has recently been recommended by American Society of Clinical Oncology for managing CACS, but real-world data remain scarce.

METHODS: This retrospective cohort study was conducted at a tertiary oncology centre in West Bengal, India, and included patients aged 18-70 years with any solid malignancy and severe anorexia, receiving chemotherapy, RT or palliative care. All patients were treated with low-dose Olanzapine (2.5 mg/day) for 12 weeks. Data were extracted from medical records for the period between 1 January 2024, and 31 January 2025.

RESULTS: Fifty patients met the inclusion criteria. The median age was 44.5 years and 82% had Stage III/IV disease. Of these, 82% (n = 41/50) reported improvement in anorexia symptoms, 82% maintained or gained weight and 16% (n = 8/50) gained at least 1 kg. Among 24 patients with refractory nausea, 50% reported symptomatic relief. No adverse events attributable to Olanzapine were documented.

CONCLUSION: Low-dose olanzapine (2.5 mg/day) is an effective, well-tolerated and cost-efficient option for the management of cancer-related anorexia and nausea in real-world clinical settings. Its use may be particularly beneficial in resource-limited environments and should be considered as a first-line pharmacologic intervention for CACS. Further prospective studies are warranted.