First published randomised controlled trial of paramedic administered therapy for ultra-acute stroke

EMAS-PTS2_750

Professor Niro Siriwardena from the Community and Health Research Unit joined study lead, Professor Philip Bath, and Dr Sandeep Ankolekar (from the University of Nottingham) together with a team from Nottingham University Hospitals and East Midlands Ambulance Service (EMAS) NHS trusts to complete the first ever randomised trial worldwide of paramedic treatment of ultra-acute stroke, the RIGHT trial published in the journal Stroke.

There is a strong link between (both high and low) blood pressure in patients in the early stages of stroke and future death and disability. Glyceryl trinitrate (GTN) or nitroglycerin, which is more commonly used in the treatment of angina or heart attack, was administered by paramedics from EMAS as a skin patch to lower blood pressure in the RIGHT (Rapid Intervention with GTN in Hypertensive Stroke) trial.

The trial was designed to test the safety of GTN in ultra-acute stroke and the feasibility of paramedics diagnosing, consenting, randomising and treating intervention patients in the emergency prehospital setting. In the study, published this month in the journal Stroke, 41 patients were randomised by 23 (out of 78) trained paramedics to GTN or no GTN.

Intervention patients had a significantly lower systolic blood pressure at two hours and also significantly improved functional status at 90 days with treatment. Patients given GTN were no more likely to die or suffer and adverse event. GTN may act by lowering systolic blood pressure which may be harmful in acute stroke or through some other mechanism such as neuroprotection, immunoregulation or vasodilation of cerebral arteries or small blood vessels. The study will form the basis for future studies of ambulance-based trials of stroke.

New book published on Prehospital Emergency Medicine

ABCPHMcoverA new book, the ABC of Prehospital Emergency Medicine, edited by Tim Nutbeam and Matthew Boylan has been released this month. The book is written for doctors (emergency physicians, general practitioners), nurses and paramedics training in prehospital emergency health care.

It includes a final chapter on ‘Research and development in Prehospital Emergency Medicine‘ written by Profs. Suzanne Mason (Sheffield University) and Niro Siriwardena (University of Lincoln).

The text includes 38 chapters covering a wide scope of causative factors, clinical conditions, and patients seen in this setting and as the editors state in their preface, seeks to provide an “accessible, cutting edge, expert opinion on core PHEM topics”.

Building bridges in primary care: International Federation launch

bridge

The Bosphorus Bridge joining Europe and Asia

Members of the European Forum for Primary Care (EFPC) and delegates from over 30 countries joined together in the EFPC conference whose theme was Balancing The Primary And Secondary Care Provision For More Integration and Better Health Outcomes“. This was a landmark conference, symbolic in being held in the historic city of Istanbul, Turkey where Europe bridges Asia across the Bosphorus.

New members of the EFPC advisory board

New members of the EFPC advisory board: Sophie Rodebjer (Dietician, Sweden) and Marije Bolt (Occupational Therapist, Netherlands)

The conference was an opportunity to build new bridges and restate the values of the EFPC which include community and person-orientated primary care, multiprofessionalism, social justice and inclusivity. As a result of a reorganisation the EFPC established a smaller executive chaired by Jan de Maeseneer (Gent, Belgium) and a new larger interdisciplinary advisory board which includes nursing, allied health (occupational therapy, dietetics, physiotherapy), health economics and general practice from many of the EU member states. In addition, the EFPC Alliance for Community Oriented Primary Care joined with counterparts in Australia, Canada, the United States and globally to form the International Federation of Community Health Centres (IFCHC)to share experiences and knowledge on the potential for CHCs to improve health and access to health care for populations around the world.

 

 

The conference had excellent keynotes on “Future challenges for the EU health workforce” (Katja Neubauer, EC), Developing regional action framework for coordinated/integrated health services delivery in the WHO European region” (Dr Hans Kluge, WHO), “The contribution of nurses in future proof health care” (Marieke Schuumans, University of Applied Sciences

The blue mosque

The blue mosque

Utrecht) and “Integration: examples from Turkey and Europe” (Prof. Mehtap Tatar). There were also keynotes from Dr Pavlos Theodorakis (Greek Ministry of Health) on the financial crisis and primary care in Greece and from Dr Cagri Kalaca (CEO Saglik Bahcesi) on learning pathways.

Making wishes

Lighting wishes over the Bosphorus

The conference was also an opportunity for Prof. Niro Siriwardena (EFPC advisory board) to present joint work from the Universities of Lincoln and Gent on “A meta-synthesis of clinicians’ experiences and perceptions of benzodiazepine prescribing: developing and integrated approach for care of insomnia and sleep problems”.

Tripping down the aisle twice in two weeks

Fiona Togher, graduate research assistant at the CaHRU has had a double celebration this summer. Fiona was led down the aisle at her P1020533recent wedding which she celebrated this summer and here she is pictured in her first dance with her new husband.

P1020539She repeated this at today’s College of Social Science graduation where she was awarded a distinction in the Masters in Clinical Research (Fiona centre, with Karen Windle and Niro Siriwardena pictured at Lincoln Castle after the graduation).

Fiona is currently undertaking her PhD studentship where she is studying patient experiences of ambulance service care.

CaHRU at the 2013 SAPC Annual Scientific Meeting

Researchers from CaHRU attended the national Society for Academic Primary Care (SAPC) Annual Scientific Meeting at the University IMAG0553of Nottingham from Wednesday 3rd – Friday 5th July 2013. The 42nd Conference of the SAPC was jointly organised by the Universities of Nottingham and Leicester, with the over-arching aim of ‘Making a Difference’. There was also an element of poignancy about the conference, dedicated as it was to the memory of Professor Helen Lester, who was hugely influential in the development of the SAPC into the thriving organisation it is today.

On the opening afternoon’s poster session, there was a lot of interest in Jo Middlemass’ work on her qualitative study of Patients’ and Clinicians’ Experiences and Perceptions of the Primary Care Management of Insomnia. The first full day opened with a keynote speech by former Health Secretary, Stephen Dorrell on the meaning of Primary Care. This was then followed by a lively session where four presenters proposed some ‘dangerous ideas’, which the audience were invited to vote on.

In the following Thursday afternoon session, there were two presentations from members of the CaHRU team. First, Coral Sirdifield presented a systematic review and meta-synthesis on ‘Clinicians’ Experiences and Perceptions of Benzodiazepine Prescribing in Western Primary Care Settings’. Later in the session, Fiona Togher presented her research on ‘What Service Users Value in their Experience of Emergency Ambulance Use’. On the final morning session of the conference, Zahid Asghar presented a ‘Self-Controlled Study on Influenza Vaccination and the Risk of Stroke’. The presentations and posters were well-received and all provoked informative discussions.

IMAG0555The Conference wasn’t all about work, work, work; there was also time to relax. Thursday night’s Bollywood-themed conference dinner was excellent. Delegates were provided with a rapid lesson on Indian dancing techniques such as ‘changing a light bulb’ and ‘stroking a Labrador’. The Bollywood dancers were very impressive in their hand-eye co-ordination; some of the delegates less so!

Co-Chair, Professor Kamlesh Khunti, from the University of Leicester presided over the closing session, in which a number of prizes were awarded for outstanding presentations. There was also a taster of what to expect from next year’s Conference in Edinburgh, where CaHRU will once again have a strong presence!

Viet-Hai Phung