Aim: Despite a vast array of research in heart failure (HF), no bibliometric analysis has been conducted for HF. Therefore, we sought to identify in-depth characteristics of 100 most cited publications in HF. Materials & methods: Two independent reviewers searched the Scopus Library Database using a variety of keywords to extract the top 100 articles. Results: Majority (36%) of top 100 cited articles were published between 2001 and 2005. The total number of citations ranged from 6294 to 1003. Females had less than a quarter representation in both first and senior author position. More than three-fourths (86%) of the articles were funded. Conclusion: Our analysis highlights focal areas of research activity in order to guide HF specialists toward impactful research areas.
Acquired hemophilia A (AHA) is a bleeding diathesis caused by auto-antibody generation against factor VIII, an essential component of the coagulation cascade. Although having many etiologies, pregnancy is also one of the conditions associated with AHA. It mostly presents as a raised activated partial thromboplastin time (aPTT), and during the peripartum and postpartum period, concern for AHA should be raised as delays in diagnosis can be detrimental. Herein, we present a case of a 31-year-old female with sickle cell trait who developed venous bleeding and, later, neuraxial, musculoskeletal, and subcutaneous bleeding. She underwent an extensive course of treatment before getting into remission.
BackgroundIn response to rising demand for health care and limited availability of GPs, paramedics are increasingly working in general practices, most commonly to carry out home visits. UK policy supports this change which involves role substitution across professional groups and sectors of care. In Wales, schemes have recently been introduced with various configuration, employment and governance arrangements, but we do not know the risks and benefits of Paramedics working in Primary Care (PPC), or which model works best. As well as effects at individual patient level (safety, acceptability, and quality of care), this interface-crossing innovation may have an impact on service and workforce issues including efficiency, costs, professional role development, emergency ambulance availability and 999 response. There is an urgent need to better understand the PPC innovation. We aim to describe the evidence base, theoretical underpinning and current initiatives; and determine the feasibility of undertaking a definitive evaluation of PPC in order to produce generalisable evidence to inform policy and practice.MethodA survey of Welsh Health boards has been undertaken to identify sites and stakeholders to take part in qualitative interviews. We will conduct a feasibility study using a controlled before and after natural experiment design with three GP practice sites: one with a directly-employed paramedic; one with a Welsh Ambulance Service-employed paramedic; and a control site. We will collect the following outcomes:Number of home visits requestedHome visit outcomes – the proportion resolved; further home visit required; emergency admission; 999 call placedPrescribing patternsSubsequent health care contactsPatient satisfactionSerious Adverse EventsCost profileConclusionWe will submit an application for a fully powered application to NIHR HS&DR if indicated by our progression criteria.ResultsWelsh Health board survey and qualitative findings will be available at the time of the conference.
BackgroundIn response to rising healthcare demand and shortages of general practitioners (GPs), policy across the UK supports paramedics joining the clinical team in primary care. Numbers of paramedics in primary care (PPC) are increasing in England and Wales through a range of local initiatives. As the first stage in the ARRIVE feasibility study evaluating PPC, we conducted preliminary qualitative research to:Understand the key components of the PPC intervention and its potential impactsIdentify sites with PPC and describe the range of existing interventionsDevelop a logic model to describe PPC.MethodsWe interviewed a total of 19 stakeholders from across Wales, including Health Board managers, GPs, practice managers and paramedics. Interviews were recorded and transcribed in full, then analysed thematically. We held a stakeholder event, bringing together 21 people involved in commissioning, planning and delivering PPC to discuss the key components of a logic model, including outcome measures for evaluation.ResultsWe developed a logic model describing how paramedics provide direct clinical contact with patients in a primary care setting. Potential positive impacts include better patient experience, reductions in emergency admissions through better proactive care, increased sustainability of primary care, and increased levels of clinical skills and satisfaction for paramedics. Components of the intervention which varied across sites included type of patient contact (home visit or surgery); approaches to patient selection and triage; employment model; training and induction; and clinical supervision and support from GPs.ImplicationsPPC is a rapidly developing area of provision in primary care, but there is great variation in the nature of models which have been implemented, and there is still uncertainty about the risks and benefits of PPC, and about how best to deliver it. Our logic model underpins the ARRIVE feasibility study, which will help to build the evidence base urgently needed on the PPC innovation.
BackgroundIn response to rising demand for health care and limited availability of GPs, paramedics are increasingly working in general practices, most commonly to carry out home visits. UK policy supports this change which involves role substitution across professional groups and sectors of care. In Wales, schemes have been introduced over the past few years, with various configuration, employment, and governance arrangements, but we do not know the risks and benefits of Paramedics working in Primary Care (PPC), or which model works best. There is an urgent need to better understand the PPC innovation.AimTo describe the evidence base, theoretical underpinning and current initiatives; and determine the feasibility of undertaking a definitive evaluation of PPC in order to produce generalisable evidence to inform policy and practice.MethodA survey of Welsh Health Boards has been undertaken to identify sites and stakeholders to take part in qualitative interviews. A feasibility study will be conducted with three GP practice sites: one with a directly-employed paramedic; one with a Welsh Ambulance Service-employed paramedic; and a control site. Data will be collected for the following outcomes: 1) number of home visits requested; 2) home visit outcomes (the proportion resolved, further home visit required, emergency admission, 999 call placed); 3) prescribing patterns; 4) subsequent healthcare contacts; 5) patient satisfaction; 6) serious adverse events; and 7) cost profile.ResultsWelsh Health Board survey and qualitative findings will be available at the time of the conference.ConclusionWe will submit an application for a fully powered application to NIHR HS&DR if indicated by our progression criteria.
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