Herts and Essex Hospital

ABSTRACT The increasing spread of highly pathogenic avian influenza (HPAI) A/H5 viruses poses a pandemic threat. Circulating clade 2.3.4.4b viruses have demonstrated rapid transcontinental dissemination, extensive reassortment, epizootic spread and potential sustained mammal-to-mammal transmission, signifying a heightened risk of becoming a human pathogen of high consequence. A broadly protective, future-proof vaccine against multiple clades of H5 influenza is urgently needed for pandemic preparedness. Here, we combine two novel vaccine technologies to generate a Digitally Immune Optimised and Selected H5 antigen (DIOSvax-H5inter) displayed multivalently on the mi3 nanocage using the SpyTag003/SpyCatcher003 conjugation system. Mice immunized with DIOSvax-H5inter Homotypic Nanocages at low doses demonstrate potent, cross-clade neutralizing antibody and T cell responses against diverse H5 strains. DIOSvax-H5inter Homotypic Nanocages provide a scalable vaccine candidate with the potential for pan-H5 protection against drifted or newly emergent H5 strains. This World Health Organization preferred characteristic is essential for prospective strategic stockpiling in the pre-pandemic phase.

The survival of dogs with pheochromocytoma (PCC) treated with adrenoreceptor antagonists has not been described or compared to surgically managed cases. The objective of this study is to evaluate the survival of medically and surgically managed dogs with PCC and investigate factors associated with survival. Two hundred fifty-five dogs with PCC, treated with alpha-adrenoreceptor antagonists (AA) without adrenalectomy (Group 1, n = 75), adrenalectomy +/- AA (Group 2, n = 128), or neither treatment (Group 3, n = 52). Retrospective, multicenter review of medical records. Median overall survival time (OST) for Groups 1 and 2 combined was calculated using Kaplan-Meier estimates, and then compared between Group 1 and Group 2 using Log-Rank testing. Cox proportional hazard analysis identified factors associated with survival in Groups 1 and 2 individually and combined. Median OST for all cases was 854 (95% CI: 572-1136) days. Median OST was lower in Group 1 (247 days, 95% CI: 76-418 days) than in Group 2 (927 days, 95% CI: 587-1267 days; p < 0.001). In Group 2, 88/92 dogs (97.8%) that received presurgical AA treatment survived to discharge compared to 23/27 (85.2%) that did not receive AA pretreatment (p = 0.03). Lack of clinical signs at presentation was associated with increased survival in both groups combined (HR 0.5; 95% CI 0.3-0.9; p = 0.02) and in Group 2 alone (HR 0.3; 95% CI 0.1-0.7; p = 0.01). Dogs with PCC treated with adrenalectomy have longer survival compared to those managed with AA without adrenalectomy.

Abstract The polarisation of attitudes towards dyslexia appears to be contingent upon the awareness of the implications of adopting a medical model to interpreting dyslexia (as a medical ‘condition’) or applying an educational overlay, based upon difficulties in certain areas, to interpreting and making provision for those with dyslexia. Specifically, it underscores the difficulties dyslexics have in reading and the comprehension of what has been read. Furthermore, it accentuates the approaches taken in the 1980s and the turn of the century to dyslexia was, for these interviewees, unfitting. However, it raises other questions about whether the current practice is suited to the needs of those with dyslexia, or whether a universal offer is made, regardless of specific need. In the wake of this research, three emergent themes occur, dyslexia and stigmatisation, the impact of stigmatisation and poorly suited provision upon self‐esteem and the stress this generates. As key practitioner points, this disquisition underlines the need to tailor provision for inclusive education based upon the needs of the individual with dyslexia. It further illumines the stress of unsuitable provision, manifesting the imperative nature of adequate training and resourcing for dyslexia.

BackgroundHelicopter Emergency Medical Services (HEMS) are a limited and expensive resource, and should be intelligently tasked. HEMS dispatch was identified as a key research priority in 2011, with a call to identify a ‘general set of criteria with the highest discriminating potential’. However, there have been no published data analyses in the past decade that specifically address this priority, and this priority has been reaffirmed in 2023. The objective of this study was to define the dispatch criteria available at the time of the initial emergency call with the greatest HEMS utility using a large, regional, multi-organizational dataset in the UK.MethodsThis retrospective observational study utilized dispatch data from a regional emergency medical service (EMS) and three HEMS organisations in the East of England, 2016–2019. In a logistic regression model, Advanced Medical Priority Dispatch System (AMPDS) codes with ≥ 50 HEMS dispatches in the study period were compared with the remainder to identify codes with high-levels of HEMS patient contact and HEMS-level intervention/drug/diagnostic (HLIDD). The primary outcome was to identify AMPDS codes with a > 10% HEMS dispatch rate of all EMS taskings that would result in 10–20 high-utility HEMS dispatches per 24-h period in the East of England. Data were analysed in R, and are reported as number (percentage); significance was p < 0.05.ResultsThere were n = 25,491 HEMS dispatches (6400 per year), of which n = 23,030 (90.3%) had an associated AMPDS code. n = 13,778 (59.8%) of HEMS dispatches resulted in patient contact, and n = 8437 (36.6%) had an HLIDD. 43 AMPDS codes had significantly greater rates of patient contact and/or HLIDD compared to the reference group. In an exploratory analysis, a cut-off of ≥ 70% patient contact rate and/or ≥ 70% HLIDD (with a > 10% HEMS dispatch of all EMS taskings) resulted in 17 taskings per 24-h period. This definition derived nine AMPDS codes with high HEMS utility.ConclusionWe have identified nine ‘golden’ AMPDS codes, available at the time of initial emergency call, that are associated with high-levels of whole-system and HEMS utility in the East of England. We propose that UK EMS should consider immediate HEMS dispatch to these codes.

Aims, Objectives and BackgroundPrehospital emergency anaesthesia (PHEA) is a safe and necessary procedure for the most seriously injured trauma patients. The avoidance of secondary insults such as hypoxia and hypotension are key to reduce mortality. Despite this, a proportion of patients experience post-intubation hypotension (PIH), for which the determinants remain unclear. This multi-centre study aims to compare the differential determinants of PIH in trauma patients undergoing PHEA.Method and DesignIn this retrospective observational study, across three regional Helicopter Emergency Medical Services (HEMS), data were obtained from the electronic medical records for a consecutive sample of adult trauma patients who underwent PHEA, 2015–2020 inclusive.Hypotension was defined as new systolic blood pressure (SBP) <90mmHg or >10% drop if SBP<90mmHg pre-PHEA, within 10 minutes of PHEA. A purposeful selection logistic regression model was used. Each variable was first tested in turn to explore the unadjusted association with the outcome. Significant variables were then included in the multivariable analysis. Variables were successively eliminated until only statistically significant variables remained. The ARU Research Ethics Panel granted ethical approval (AH-SREP-20–047).Results and ConclusionDuring the study period, 6184 patients were identified. After predefined exclusions, 998 patients were included in the final analysis. 218 (21.8%) patients recorded one or more episodes of PIH, with a peak prevalence at 8 minutes. The variables significantly associated with PIH were: age >55 years, pre-PHEA tachycardia (>100/minute), fluid administration prior to HEMS arrival, and fentanyl omission at induction, table 1.The pseudo-R2 for the final model suggests there is significant variation in the outcome not explained by the captured variables alone. Clinician gestalt appears to successfully identify patients most at-risk of PIH, demonstrated by the omission of fentanyl for this group. 1491 Table 1Multivariate analysis of variables associated with post-induction hypotension within 10 minutes of prehospital emergency anaesthesiaIn addition to drug-dose modification, pre-PHEA volume administration, cautious haemodynamic observation, and early vasopressor intervention may be warranted to reduce avoidable harm in trauma patients undergoing PHEA.

This integrative review aims to evaluate the experiences of health and social care practitioners with regard to how they exercise professional curiosity in child protection practice. Professional curiosity gained significant currency following the Munro Review of Child Protection (2010) in England, as a means of seeking clarity on what is happening within a family. However, a recurrent finding from child safeguarding practice reviews is that practitioners continue to struggle to exercise curiosity. This is evident within both the United Kingdom and international literature, although descriptors for the concept may differ. This study attempted to identify facilitators and barriers to applying professional curiosity to provide a greater understanding of this theoretical concept. Title and abstract review of 1428 articles identified from databases and 11 from other sources resulted in 52 papers for full-text review. The quality of each article was appraised using the Critical Appraisal Skills Programme tool for qualitative studies, the Mixed Methods Appraisal Tool (MMAT) for quantitative/mixed method studies and the Joanna Briggs framework for theoretical/opinion papers. Key findings were recorded in the Summary Table of Literature Reviewed. Data extracts were thematically analysed. Twenty-four papers predominantly from the UK, but also from Australia, Italy, Sweden and USA formed the data set. Overarching themes that emerged from the thematic analysis included: noticing dissonance, emitting curiosity, constructing meaning, facilitators, individual professional challenges, organisational and macro-level influences and conceptual development. This review demonstrated that professional curiosity is multifaceted and involves a whole system approach, from empowered, knowledgeable and competent frontline practitioners to creative, innovative and empathic organisations, that value staff contributions and place the child's best interests at the forefront of service development. Recommendations are made for practice and further research.

ObjectiveHelicopter emergency medical services (HEMS) observers may be at risk of negative psychological effects associated with exposure to traumatic events during shifts. This article describes a quality improvement project for HEMS observers at Essex & Herts Air Ambulance. MethodsA psychological resilience briefing intervention (PRBi) was developed and delivered during induction training with 60 HEMS observers. The PRBi aimed to raise awareness of traumatic events that observers may experience and provided basic education on 5 domains, including likely forms of trauma exposure, possible psychological reactions, advice on coping strategies and supporting colleagues, and resources that they could use if required. The intervention was intended to bolster resilience and reduce posttraumatic stress disorder symptoms, and to encourage adaptive coping styles in observers. ResultsObservers learned from and valued the PRBi; statistically significant increases were observed in awareness of the 5 domains from pre- to post-delivery, and free-text responses cited a variety of benefits to the observers. There was no indication that the PRBi caused harm. ConclusionThe PRBi has now been included in the routine induction of observers at Essex & Herts Air Ambulance and has the potential to be repurposed for use in other settings, including medical schools.