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Article ; Online: Risk factors for reflex syncope in the British Army.

Parsons, Iain T / Ellwood, J / Stacey, M J / Gall, N / Chowienczyk, P / Woods, D R

2023 Volume 169, Issue 6, Page(s) 548–553

Abstract: Introduction: Reflex syncope in the UK Armed Forces is reportedly higher than comparable militaries and civilian populations and is significantly more common in soldiers who take part in State Ceremonial and Public Duties (SCPD) compared with other ... ...

Abstract	Introduction: Reflex syncope in the UK Armed Forces is reportedly higher than comparable militaries and civilian populations and is significantly more common in soldiers who take part in State Ceremonial and Public Duties (SCPD) compared with other British Army service personnel (SP). This study aimed to investigate individual susceptibility factors for syncope in soldiers who regularly take part in SCPD. Methods: A retrospective cohort study was performed in 200 soldiers who perform SCPD. A questionnaire was undertaken reviewing soldiers' medical history and circumstances of any fainting episodes. A consented review of participants' electronic primary healthcare medical record was also performed. Participants were divided into two groups (syncope, n=80; control, n=120) based on whether they had previously fainted. Results: In the syncope group orthostasis (61%) and heat (35%) were the most common precipitating factors. The most common interventions used by soldiers were to maintain hydration (59%) and purposeful movements (predominantly Conclusion: This is the first study, in the British Army, to describe, categorise and establish potential risk factors for reflex syncope. Orthostatic-mediated reflex syncope is the most common cause in soldiers who regularly perform SCPD and this is further exacerbated by heat exposure. Soldiers do not use evidence-based methods to avoid reflex syncope. These data could be used to target interventions for SP who have previously fainted or to prevent fainting during SCPD.
MeSH term(s)	Humans ; Male ; Retrospective Studies ; Risk Factors ; Syncope ; Military Personnel ; Reflex
Language	English
Publishing date	2023-11-22
Publishing country	England
Document type	Journal Article
ZDB-ID	3011686-7
ISSN	2633-3775 ; 2633-3767
ISSN (online)	2633-3775
ISSN	2633-3767
DOI	10.1136/bmjmilitary-2021-002040
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Article ; Online: Evaluation of stroke volume estimation during orthostatic stress: the utility of Modelflow.

Lucci, Vera-Ellen M / Parsons, Iain T / Hockin, Brooke C D / Claydon, Victoria E

Blood pressure monitoring

2023 Volume 28, Issue 6, Page(s) 330–337

Abstract: Advanced blood pressure monitoring devices contain algorithms that permit estimation of stroke volume (SV). Modelflow (Finapres Medical Systems) is one common method to non-invasively estimate beat-to-beat SV. However, Modelflow accuracy during profound ... ...

Abstract	Advanced blood pressure monitoring devices contain algorithms that permit estimation of stroke volume (SV). Modelflow (Finapres Medical Systems) is one common method to non-invasively estimate beat-to-beat SV. However, Modelflow accuracy during profound reductions in SV is unclear. We aimed to compare SV estimation by Modelflow and echocardiography, at rest and during orthostatic challenge. We tested 13 individuals (age 24 ± 2 years; 7 female) using combined head-up tilt and graded lower body negative pressure, continued until presyncope. SV was derived by both Modelflow and echocardiography on multiple occasions while supine, during orthostatic stress, and at presyncope. SV index (SVI) was determined by normalising SV for body surface area. Bias and limits of agreement were determined using Bland-Altman analyses. Two one-sided tests (TOST) examined equivalency. Across all timepoints, Modelflow estimates of SV (73.2 ± 1.6 ml) were strongly correlated with echocardiography estimates (66.1 ± 1.3 ml) (r = 0.56, P < 0.001) with a bias of +7.1 ± 21.1 ml. Bias across all timepoints was further improved when SV was indexed (+3.6 ± 12.0 ml.m -2 ). Likewise, when assessing responses relative to baseline, Modelflow estimates of SV (-23.4 ± 1.4%) were strongly correlated with echocardiography estimates (-19.2 ± 1.3%) (r = 0.76, P < 0.001), with minimal bias (-4.2 ± 13.1%). TOST testing revealed equivalency to within 15% of the clinical standard for SV and SVI, both expressed as absolute values and relative to baseline. Modelflow can be used to track changes in SV during profound orthostatic stress, with accuracy enhanced with correction relative to baseline values or body size. These data support the use of Modelflow estimates of SV for autonomic function testing.
MeSH term(s)	Humans ; Female ; Young Adult ; Adult ; Stroke Volume/physiology ; Blood Pressure/physiology ; Echocardiography ; Syncope ; Standing Position
Language	English
Publishing date	2023-08-24
Publishing country	England
Document type	Journal Article
ZDB-ID	1324472-3
ISSN	1473-5725 ; 1359-5237
ISSN (online)	1473-5725
ISSN	1359-5237
DOI	10.1097/MBP.0000000000000671
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Article: The health of the Role 1 doctor.

Parsons, Iain T

Journal of the Royal Army Medical Corps

2015 Volume 161, Issue 4, Page(s) 300–303

Abstract: Many pitfalls are evident in the event that a doctor becomes a patient requiring investigation or treatment. The military environment theoretically creates an added dimension to difficulties such as self-treatment, insight and objectivity, vulnerability, ...

Abstract	Many pitfalls are evident in the event that a doctor becomes a patient requiring investigation or treatment. The military environment theoretically creates an added dimension to difficulties such as self-treatment, insight and objectivity, vulnerability, mental health and medication abuse, confidentiality and the kerb-side consultation. These are explored with the military and civilian perspectives contrasted. Further qualitative research is required to formally assess what barriers military doctors face in accessing military healthcare. This, along with national guidelines should be incorporated into formal policy.
MeSH term(s)	Confidentiality ; Humans ; Military Medicine ; Physician's Role ; Referral and Consultation ; Self Care ; United Kingdom
Language	English
Publishing date	2015-12
Publishing country	England
Document type	Journal Article
ZDB-ID	840678-9
ISSN	2052-0468 ; 0035-8665
ISSN (online)	2052-0468
ISSN	0035-8665
DOI	10.1136/jramc-2013-000200
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Article: Deployed communication between the Role 3 and Role 1.

Parsons, Iain T

Journal of the Royal Army Medical Corps

2015 Volume 161, Issue 2, Page(s) 144–146

Abstract: Introduction: The discharge summary is the most common method for documenting a patient's diagnostic findings, hospital management and arrangements for post-discharge follow up. After being discharged from hospital, patients are routinely reviewed ... ...

Abstract	Introduction: The discharge summary is the most common method for documenting a patient's diagnostic findings, hospital management and arrangements for post-discharge follow up. After being discharged from hospital, patients are routinely reviewed without a discharge summary being available. A recent review revealed that a significant proportion of patients discharged from the Role 3 had no evidence of their admission on their permanent medical record. The aim of this audit was to assess the transition of discharge summaries from Role 3 to Role 1 during Op HERRICK 18. The intention was to review where errors in the transfer of discharge information between Role 3 and Role 1 might be occurring with a view to implementing improvements. Methods: Two audits assessed the delivery of discharge information. A re-audit was performed 1 month after a system was implemented. Results: The transfer of discharge information was poor with only 1/40 (2.5%) summaries arriving from R3 to R1. Following implementation of a system the transfer of discharge information improved to 24/30 (80%). Conclusions: The adoption of a system to transit discharge information from R3 to R1 resulted in a drastic improvement. Ideally, a future electronic patient record system used by all facets of Defence Medical Services would limit the potential for future adverse events due to communication failure. Regular audits assessing the transfer of discharge information should form part of standard audit cycles in future contingency operations.
MeSH term(s)	Communication ; Continuity of Patient Care ; Electronic Health Records ; Hospitals, Military ; Humans ; Medical Audit ; Military Medicine/methods ; Patient Discharge ; United Kingdom
Language	English
Publishing date	2015-06
Publishing country	England
Document type	Journal Article
ZDB-ID	840678-9
ISSN	2052-0468 ; 0035-8665
ISSN (online)	2052-0468
ISSN	0035-8665
DOI	10.1136/jramc-2014-000357
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Article ; Online: Pain associated with intravascular instrumentation reduces orthostatic tolerance and predisposes to vasovagal reactions in healthy young adults without needle phobia: a randomised controlled study.

Hockin, Brooke C D / Lucci, Vera-Ellen M / Wu, Ryan E Y / Nicholas, Michelle / Parsons, Iain T / Claydon, Victoria E

Clinical autonomic research : official journal of the Clinical Autonomic Research Society

2023 Volume 33, Issue 6, Page(s) 673–689

Abstract: Purpose: Vasovagal syncope (VVS), or fainting, is frequently triggered by pain, fear, or emotional distress, especially with blood-injection-injury stimuli. We aimed to examine the impact of intravenous (IV) instrumentation on orthostatic tolerance (OT; ...

Abstract	Purpose: Vasovagal syncope (VVS), or fainting, is frequently triggered by pain, fear, or emotional distress, especially with blood-injection-injury stimuli. We aimed to examine the impact of intravenous (IV) instrumentation on orthostatic tolerance (OT; fainting susceptibility) in healthy young adults. We hypothesized that pain associated with IV procedures would reduce OT. Methods: In this randomised, double-blind, placebo-controlled, cross-over study, participants (N = 23; 14 women; age 24.2 ± 4.4 years) underwent head-up tilt with combined lower body negative pressure to presyncope on three separate days: (1) IV cannulation with local anaesthetic cream (EMLA) (IV + EMLA); (2) IV cannulation with placebo cream (IV + Placebo); (3) sham IV cannulation with local anaesthetic cream (Sham + EMLA). Participants rated pain associated with IV procedures on a 1-5 scale. Cardiovascular (finger plethysmography and electrocardiogram; Finometer Pro), and forearm vascular resistance (FVR; brachial Doppler) responses were recorded continuously and non-invasively. Results: Compared to Sham + EMLA (27.8 ± 2.4 min), OT was reduced in IV + Placebo (23.0 ± 2.8 min; p = 0.026), but not in IV + EMLA (26.2 ± 2.2 min; p = 0.185). Pain was increased in IV + Placebo (2.8 ± 0.2) compared to IV + EMLA (2.0 ± 2.2; p = 0.002) and Sham + EMLA (1.1 ± 0.1; p < 0.001). Orthostatic heart rate responses were lower in IV + Placebo (84.4 ± 3.1 bpm) than IV + EMLA (87.3 ± 3.1 bpm; p = 0.007) and Sham + EMLA (87.7 ± 3.1 bpm; p = 0.001). Maximal FVR responses were reduced in IV + Placebo (+ 140.7 ± 19.0%) compared to IV + EMLA (+ 221.2 ± 25.9%; p < 0.001) and Sham + EMLA (+ 190.6 ± 17.0%; p = 0.017). Conclusions: Pain plays a key role in predisposing to VVS following venipuncture, and our data suggest this effect is mediated through reduced capacity to achieve maximal sympathetic activation during orthostatic stress. Topical anaesthetics, such as EMLA, may reduce the frequency and severity of VVS during procedures requiring needles and intravascular instrumentation.
MeSH term(s)	Female ; Young Adult ; Humans ; Adult ; Anesthetics, Local/therapeutic use ; Lidocaine, Prilocaine Drug Combination ; Prilocaine/therapeutic use ; Lidocaine/therapeutic use ; Syncope, Vasovagal/etiology ; Syncope, Vasovagal/prevention & control ; Cross-Over Studies ; Pain/etiology ; Pain/drug therapy ; Double-Blind Method ; Phobic Disorders/drug therapy
Chemical Substances	Anesthetics, Local ; Lidocaine, Prilocaine Drug Combination ; Prilocaine (046O35D44R) ; Lidocaine (98PI200987)
Language	English
Publishing date	2023-08-17
Publishing country	Germany
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1080007-4
ISSN	1619-1560 ; 0959-9851
ISSN (online)	1619-1560
ISSN	0959-9851
DOI	10.1007/s10286-023-00972-8
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Article: Heat Adaptation in Military Personnel: Mitigating Risk, Maximizing Performance.

Parsons, Iain T / Stacey, Michael J / Woods, David R

Frontiers in physiology

2019 Volume 10, Page(s) 1485

Abstract: The study of heat adaptation in military personnel offers generalizable insights into a variety of sporting, recreational and occupational populations. Conversely, certain characteristics of military employment have few parallels in civilian life, such ... ...

Abstract	The study of heat adaptation in military personnel offers generalizable insights into a variety of sporting, recreational and occupational populations. Conversely, certain characteristics of military employment have few parallels in civilian life, such as the imperative to achieve mission objectives during deployed operations, the opportunity to undergo training and selection for elite units or the requirement to fulfill essential duties under prolonged thermal stress. In such settings, achieving peak individual performance can be critical to organizational success. Short-notice deployment to a hot operational or training environment, exposure to high intensity exercise and undertaking ceremonial duties during extreme weather may challenge the ability to protect personnel from excessive thermal strain, especially where heat adaptation is incomplete. Graded and progressive acclimatization can reduce morbidity substantially and impact on mortality rates, yet individual variation in adaptation has the potential to undermine empirical approaches. Incapacity under heat stress can present the military with medical, occupational and logistic challenges requiring dynamic risk stratification during initial and subsequent heat stress. Using data from large studies of military personnel observing traditional and more contemporary acclimatization practices, this review article (1) characterizes the physical challenges that military training and deployed operations present (2) considers how heat adaptation has been used to augment military performance under thermal stress and (3) identifies potential solutions to optimize the risk-performance paradigm, including those with broader relevance to other populations exposed to heat stress.
Language	English
Publishing date	2019-12-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2564217-0
ISSN	1664-042X
ISSN	1664-042X
DOI	10.3389/fphys.2019.01485
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Article ; Online: FFR-CT strengthens multi-disciplinary reporting of CT coronary angiography.

Parsons, Iain T / Hickman, Michael / Ingram, Mark / Leatham, Edward W

The British journal of cardiology

2020 Volume 27, Issue 4, Page(s) 34

Abstract: The utility of computed tomography (CT) coronary angiography (CTCA) is underpinned by its excellent sensitivity and negative-predictive value for coronary artery disease (CAD), although it lacks specificity. Invasive coronary angiography (ICA) and ... ...

Abstract	The utility of computed tomography (CT) coronary angiography (CTCA) is underpinned by its excellent sensitivity and negative-predictive value for coronary artery disease (CAD), although it lacks specificity. Invasive coronary angiography (ICA) and invasive fractional flow reserve (FFR), are gold-standard investigations for coronary artery disease, however, they are resource intensive and associated with a small risk of serious complications. FFR-CT has been shown to have comparable performance to FFR measurements and has the potential to reduce unnecessary ICAs. The aim of this study is to briefly review FFR-CT, as an investigational modality for stable angina, and to share 'real-world' UK data, in consecutive patients, following the initial adoption of FFR-CT in our district general hospital in 2016. A retrospective analysis was performed of a previously published consecutive series of 157 patients referred for CTCA by our group in a single, non-interventional, district general hospital. Our multi-disciplinary team (MDT) recorded the likely definitive outcome following CTCA, namely intervention or optimised medical management. FFR-CT analysis was performed on 24 consecutive patients where the MDT recommendation was for ICA. The CTCA + MDT findings, FFR-CT and ICA ± FFR were correlated along with the definitive outcome. In comparing CTCA + MDT, FFR-CT and definitive outcome, in terms of whether a percutaneous coronary intervention was performed, FFR-CT was significantly correlated with definitive outcome (r=0.471, p=0.036) as opposed to CTCA + MDT (r=0.378, p=0.07). In five cases (21%, 5/24), FFR-CT could have altered the management plan by reclassification of coronary stenosis. FFR-CT of 60 coronary artery vessels (83%, 60/72) (mean FFR-CT ratio 0.82 ± 0.10) compared well with FFR performed on 18 coronary vessels (mean 0.80 ± 0.11) (r=0.758, p=0.0013). In conclusion, FFR-CT potentially adds value to MDT outcome of CTCA, increasing the specificity and predictive accuracy of CTCA. FFR-CT may be best utilised to investigate CTCAs where there is potentially prognostically significant moderate disease or severe disease to maximise cost-effectiveness. These data could be used by other NHS trusts to best incorporate FFR-CT into their diagnostic pathways for the investigation of stable chest pain.
Language	English
Publishing date	2020-10-16
Publishing country	England
Document type	Journal Article
ZDB-ID	1354589-9
ISSN	1753-4313 ; 0969-6113
ISSN (online)	1753-4313
ISSN	0969-6113
DOI	10.5837/bjc.2020.034
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Zs.A 4578: Show issues

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Article ; Online: Changes in gastrointestinal cell integrity after marathon running and exercise-associated collapse.

Walter, Edward / Gibson, Oliver R / Stacey, Michael / Hill, Neil / Parsons, Iain T / Woods, David

European journal of applied physiology

2021 Volume 121, Issue 4, Page(s) 1179–1187

Abstract: Purpose: Endurance exercise and hyperthermia are associated with compromised intestinal permeability and endotoxaemia. The presence of intestinal fatty acid-binding protein (I-FABP) in the systemic circulation suggests intestinal wall damage, but this ... ...

Abstract	Purpose: Endurance exercise and hyperthermia are associated with compromised intestinal permeability and endotoxaemia. The presence of intestinal fatty acid-binding protein (I-FABP) in the systemic circulation suggests intestinal wall damage, but this marker has not previously been used to investigate intestinal integrity after marathon running. Methods: Twenty-four runners were recruited as controls prior to completing a standard marathon and had sequential I-FABP measurements before and on completion of the marathon, then at four and 24 h later. Eight runners incapacitated with exercise-associated collapse (EAC) with hyperthermia had I-FABP measured at the time of collapse and 1 hour later. Results: I-FABP was increased immediately on completing the marathon (T0; 2593 ± 1373 ng·l Conclusion: I-FABP is a recently described biomarker whose presence in the circulation is associated with intestinal wall damage. I-FABP levels increase after marathon running and increase further if the endurance exercise is associated with EAC and hyperthermia. After EAC, I-FABP remains high in the circulation for an extended period, suggesting ongoing intestinal wall stress.
MeSH term(s)	Adult ; Biomarkers/blood ; Fatty Acid-Binding Proteins/blood ; Female ; Heat Exhaustion/blood ; Heat Exhaustion/etiology ; Heat Exhaustion/physiopathology ; Humans ; Hyperthermia/blood ; Hyperthermia/etiology ; Hyperthermia/physiopathology ; Intestinal Mucosa/metabolism ; Intestinal Mucosa/physiopathology ; Male ; Marathon Running/physiology ; Middle Aged
Chemical Substances	Biomarkers ; FABP2 protein, human ; Fatty Acid-Binding Proteins
Language	English
Publishing date	2021-01-29
Publishing country	Germany
Document type	Journal Article
ZDB-ID	124793-1
ISSN	1439-6327 ; 1432-1025 ; 0301-5548 ; 1439-6319
ISSN (online)	1439-6327 ; 1432-1025
ISSN	0301-5548 ; 1439-6319
DOI	10.1007/s00421-021-04603-w
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Article: Military application of mechanical CPR devices: a pressing requirement?

Parsons, Iain T / Cox, A T / Rees, P S C

Journal of the Royal Army Medical Corps

2018 Volume 164, Issue 6, Page(s) 438–441

Abstract: Maintaining high-quality chest compressions during cardiopulmonary resuscitation following cardiac arrest presents a challenge. The currently available mechanical CPR (mCPR) devices are described in this review, coupled with an analysis of the evidence ... ...

Abstract	Maintaining high-quality chest compressions during cardiopulmonary resuscitation following cardiac arrest presents a challenge. The currently available mechanical CPR (mCPR) devices are described in this review, coupled with an analysis of the evidence pertaining to their efficacy. Overall, mCPR appears to be at least equivalent to high-quality manual CPR in large trials. There is potential utility for mCPR devices in the military context to ensure uninterrupted quality CPR following a medical cardiac arrest. Particular utility may be in a prohibitive operational environment, where manpower is limited or where timelines to definitive care are stretched resulting in a requirement for prolonged resuscitation. mCPR can also act as a bridge to advanced endovascular resuscitation techniques should they become more mainstream therapy.
MeSH term(s)	Cardiopulmonary Resuscitation/instrumentation ; Equipment Design ; Humans ; Military Medicine
Language	English
Publishing date	2018-04-06
Publishing country	England
Document type	Editorial ; Review
ZDB-ID	840678-9
ISSN	2052-0468 ; 0035-8665
ISSN (online)	2052-0468
ISSN	0035-8665
DOI	10.1136/jramc-2018-000908
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Article: Exaggerated postural sway improves orthostatic cardiovascular and cerebrovascular control.

Williams, Erin L / Hockin, Brooke C D / Heeney, Natalie D / Elabd, Karam / Chong, Helen / Blaber, Andrew P / Robinovitch, Stephen N / Parsons, Iain T / Claydon, Victoria E

Frontiers in cardiovascular medicine

2023 Volume 10, Page(s) 1040036

Abstract: Introduction: Healthy individuals with poor cardiovascular control, but who do not experience syncope (fainting), adopt an innate strategy of increased leg movement in the form of postural sway that is thought to counter orthostatic (gravitational) ... ...

Abstract	Introduction: Healthy individuals with poor cardiovascular control, but who do not experience syncope (fainting), adopt an innate strategy of increased leg movement in the form of postural sway that is thought to counter orthostatic (gravitational) stress on the cardiovascular system. However, the direct effect of sway on cardiovascular hemodynamics and cerebral perfusion is unknown. If sway produces meaningful cardiovascular responses, it could be exploited clinically to prevent an imminent faint. Methods: Twenty healthy adults were instrumented with cardiovascular (finger plethysmography, echocardiography, electrocardiogram) and cerebrovascular (transcranial Doppler) monitoring. Following supine rest, participants performed a baseline stand (BL) on a force platform, followed by three trials of exaggerated sway (anterior-posterior, AP; mediolateral, ML; square, SQ) in a randomized order. Results: All exaggerated postural sway conditions improved systolic arterial pressure (SAP, Discussion: Exaggerated sway improves cardiovascular and cerebrovascular control and may supplement cardiovascular reflex responses to orthostatic stress. This movement provides a simple means to boost orthostatic cardiovascular control for individuals with syncope, or those with occupations that require prolonged motionless standing.
Language	English
Publishing date	2023-02-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.1040036
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