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Article ; Online: Towards exploring current challenges and future opportunities relating to the prehospital triage of patients with traumatic brain injury: a mixed-methods study protocol.

Alqurashi, Naif / Alotaibi, Ahmed / Bell, Steve / Lecky, Fiona / Body, Richard

2023 Volume 13, Issue 3, Page(s) e068555

Abstract: Introduction: Traumatic brain injury (TBI) is a major global health burden that results in disability and loss of health. Identifying those patients who require specialist neuroscience care can be challenging due to the low accuracy of existing ... ...

Abstract	Introduction: Traumatic brain injury (TBI) is a major global health burden that results in disability and loss of health. Identifying those patients who require specialist neuroscience care can be challenging due to the low accuracy of existing prehospital trauma triage tools. Despite the widespread use of decision aids to 'rule out' TBI in hospitals, they are not widely used in the prehospital environment. We aim to provide a snapshot of current prehospital practices in the UK, and to explore facilitators and challenges that may be encountered when adopting new tools for decision support. Methods and analysis: A mixed-methods study will be conducted using a convergent design approach. In the first phase, we will conduct a national survey of current practice in which every participating ambulance service in the UK will receive an online questionnaire, and only one response is required. In the second phase, semistructured interviews will be conducted to explore the perceptions of ambulance service personnel regarding the implementation of new triage methods that may enhance triage decisions. The survey questions and the interview topic guide were piloted and externally reviewed. Quantitative data will be summarised using descriptive statistics; qualitative data will be analysed thematically. Ethics and dissemination: This study has been approved by the Health Research Authority (REC reference 22/HRA/2035). Our findings may inform the design of future care pathways and research as well as identify challenges and opportunities for future development of prehospital triage tools for patients with suspected TBI. Our findings will be published in peer-reviewed journals, relevant national and international conferences, and will be included in a PhD thesis.
MeSH term(s)	Humans ; Triage ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/therapy ; Patients ; Ambulances ; Critical Pathways
Language	English
Publishing date	2023-03-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-068555
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Detecting cortical responses to continuous running speech using EEG data from only one channel.

Aljarboa, Ghadah S / Bell, Steve L / Simpson, David M

International journal of audiology

2022 Volume 62, Issue 3, Page(s) 199–208

Abstract: Objective: To explore the detection of cortical responses to continuous speech using a single EEG channel. Particularly, to compare detection rates and times using a cross-correlation approach and parameters extracted from the temporal response function ...

Abstract	Objective: To explore the detection of cortical responses to continuous speech using a single EEG channel. Particularly, to compare detection rates and times using a cross-correlation approach and parameters extracted from the temporal response function (TRF). Design: EEG from 32-channels were recorded whilst presenting 25-min continuous English speech. Detection parameters were cross-correlation between speech and EEG (XCOR), peak value and power of the TRF filter (TRF-peak and TRF-power), and correlation between predicted TRF and true EEG (TRF-COR). A bootstrap analysis was used to determine response statistical significance. Different electrode configurations were compared: Using single channels Cz or Fz, or selecting channels with the highest correlation value. Study sample: Seventeen native English-speaking subjects with mild-to-moderate hearing loss. Results: Significant cortical responses were detected from all subjects at Fz channel with XCOR and TRF-COR. Lower detection time was seen for XCOR (mean = 4.8 min) over TRF parameters (best TRF-COR, mean = 6.4 min), with significant time differences from XCOR to TRF-peak and TRF-power. Analysing multiple EEG channels and testing channels with the highest correlation between envelope and EEG reduced detection sensitivity compared to Fz alone. Conclusions: Cortical responses to continuous speech can be detected from a single channel with recording times that may be suitable for clinical application.
MeSH term(s)	Humans ; Electroencephalography ; Speech ; Speech Perception/physiology ; Hearing Loss
Language	English
Publishing date	2022-02-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2073098-6
ISSN	1708-8186 ; 1499-2027
ISSN (online)	1708-8186
ISSN	1499-2027
DOI	10.1080/14992027.2022.2035832
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Zs.A 549: Show issues

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Article ; Online: The diagnostic accuracy of prehospital triage tools in identifying patients with traumatic brain injury: A systematic review.

Alqurashi, Naif / Alotaibi, Ahmed / Bell, Steve / Lecky, Fiona / Body, Richard

Injury

2022 Volume 53, Issue 6, Page(s) 2060–2068

Abstract: Introduction: Prehospital care providers are usually the first responders for patients with traumatic brain injury (TBI). Early identification of patients with TBI enables them to receive trauma centre care, which improves outcomes. Two recent ... ...

Abstract	Introduction: Prehospital care providers are usually the first responders for patients with traumatic brain injury (TBI). Early identification of patients with TBI enables them to receive trauma centre care, which improves outcomes. Two recent systematic reviews concluded that prehospital triage tools for undifferentiated major trauma have low accuracy. However, neither review focused specifically on patients with suspected TBI. Therefore, we aimed to systematically review the existing evidence on the diagnostic performance of prehospital triage tools for patients with suspected TBI. Methods: A comprehensive search of the current literature was conducted using Medline, EMBASE, CINAHL Plus and the Cochrane library (inception to 1st June 2021). We also searched Google Scholar, OpenGrey, pre-prints (MedRxiv) and dissertation databases. We included all studies published in English language evaluating the accuracy of prehospital triage tools for TBI. We assessed methodological quality and risk of bias using a modified Quality Assessment of Diagnostic Studies (QUADAS-2) tool. Two reviewers independently performed searches, screened titles and abstracts and undertook methodological quality assessments. Due to the heterogeneity in the population of interest and prehospital triage tools used, a narrative synthesis was undertaken. Results: The initial search identified 1787 articles, of which 8 unique eligible studies met the inclusion criteria (5 retrospective, 2 prospective, 1 mixed). Overall, sensitivity of triage tools studied ranged from 19.8% to 87.9% for TBI identification. Specificity ranged from 41.4% to 94.4%. Two decision tools have been validated more than once: HITS-NS (2 studies, sensitivity 28.3-32.6%, specificity 89.1-94.4%) and the Field Triage Decision Scheme (4 studies, sensitivity 19.8-64.5%, specificity 77.4%-93.1%). Existing tools appear to systematically under-triage older patients. Conclusion: Further efforts are needed to improve and optimise prehospital triage tools. Consideration of additional predictors (e.g., biomarkers, clinical decision aids and paramedic judgement) may be required to improve diagnostic accuracy.
MeSH term(s)	Brain Injuries, Traumatic/diagnosis ; Humans ; Prospective Studies ; Retrospective Studies ; Trauma Centers ; Triage
Language	English
Publishing date	2022-02-12
Publishing country	Netherlands
Document type	Journal Article ; Systematic Review
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2022.02.020
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Peer providers: token employees or vanguards of change?

Bell, Steve

Behavioral healthcare

2012 Volume 32, Issue 3, Page(s) 55–56

MeSH term(s)	Community Mental Health Services/economics ; Community Mental Health Services/organization & administration ; Humans ; Organizational Culture ; Organizational Innovation ; Peer Group
Language	English
Publishing date	2012-05
Publishing country	United States
Document type	Journal Article
ISSN	1931-7093
ISSN	1931-7093
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Article ; Online: Developing an alternative care pathway for emergency ambulance responses for adults with epilepsy: A Discrete Choice Experiment to understand which configuration service users prefer. Part of the COLLABORATE project.

Holmes, Emily / Dixon, Pete / Mathieson, Amy / Ridsdale, Leone / Morgan, Myfanwy / McKinlay, Alison / Dickson, Jon / Goodacre, Steve / Jackson, Mike / Foster, Deborah / Hardman, Kristy / Bell, Steve / Marson, Anthony / Hughes, Dyfrig / Noble, Adam J

Seizure

2024 Volume 118, Page(s) 28–37

Abstract: Introduction: To identify service users' preferences for an alternative care pathway for adults with epilepsy presenting to the ambulance service.: Methods: Extensive formative work (qualitative, survey and knowledge exchange) informed the design of ... ...

Abstract	Introduction: To identify service users' preferences for an alternative care pathway for adults with epilepsy presenting to the ambulance service. Methods: Extensive formative work (qualitative, survey and knowledge exchange) informed the design of a stated preference discrete choice experiment (DCE). This hypothetical survey was hosted online and consisted of 12 binary choices of alternative care pathways described in terms of: the paramedic's access to medical records/ 'care plan', what happens next (described in terms of conveyance), time, availability of epilepsy specialists today, general practitioner (GP) notification and future contact with epilepsy specialists. DCE scenarios were described as: (i) typical seizure at home. (ii) typical seizure in public, (iii) atypical seizure. Respondents were recruited by a regional English ambulance service and by national public adverts. Participants were randomised to complete 2 of the 3 DCEs. Results: People with epilepsy (PWE; n = 427) and friends/family (n = 167) who completed the survey were representative of the target population. PWE preferred paramedics to have access to medical records, non-conveyance, to avoid lengthy episodes of care, availability of epilepsy specialists today, GP notification, and contact with epilepsy specialists within 2-3 weeks. Significant others (close family members or friends) preferred PWE experiencing an atypical seizure to be conveyed to an Urgent Treatment Centre and preferred shorter times. Optimal configuration of services from service users' perspective far out ranked current practice (rank 230/288 possible configurations). Discussion: Preferences differ to current practice but have minimal variation by seizure type or stakeholder. Further work on feasibility of these pathways in England, and potentially beyond, is required.
Language	English
Publishing date	2024-04-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1137610-7
ISSN	1532-2688 ; 1059-1311
ISSN (online)	1532-2688
ISSN	1059-1311
DOI	10.1016/j.seizure.2024.04.008
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Zs.A 3573: Show issues

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Article ; Online: Diagnostic Accuracy of Clinical Pathways for Suspected Acute Myocardial Infarction in the Out-of-Hospital Environment.

Alghamdi, Abdulrhman / Hann, Mark / Carlton, Edward / Cooper, Jamie G / Cook, Eloïse / Foulkes, Angela / Siriwardena, Aloysius N / Phillips, John / Thompson, Alexander / Bell, Steve / Kirby, Kim / Rosser, Andy / Body, Richard

Annals of emergency medicine

2023 Volume 82, Issue 4, Page(s) 439–448

Abstract: Study objective: Chest pain is one of the most common reasons for emergency ambulance calls. Patients are routinely transported to the hospital to prevent acute myocardial infarction (AMI). We evaluated the diagnostic accuracy of clinical pathways in ... ...

Abstract	Study objective: Chest pain is one of the most common reasons for emergency ambulance calls. Patients are routinely transported to the hospital to prevent acute myocardial infarction (AMI). We evaluated the diagnostic accuracy of clinical pathways in the out-of-hospital environment. The Troponin-only Manchester Acute Coronary Syndromes decision aid and History, ECG, Age, Risk Factors, Troponin score require cardiac troponin (cTn) measurement, whereas the History and ECG-only Manchester Acute Coronary Syndromes decision aid and History, ECG, Age, Risk Factors score do not. Methods: We conducted a prospective diagnostic accuracy study at 4 ambulance services and 12 emergency departments between February 2019 and March 2020. We included patients who received an emergency ambulance response in whom paramedics suspected AMI. Paramedics recorded the data required to calculate each decision aid and took venous blood samples in the out-of-hospital environment. Samples were tested using a point-of-care cTn assay (Roche cobas h232) within 4 hours. The target condition was a diagnosis of type 1 AMI, adjudicated by 2 investigators. Results: Of 817 included participants, 104 (12.8%) had AMI. Setting the cutoff at the lowest risk group, Troponin-only Manchester Acute Coronary Syndromes had 98.3% sensitivity (95% confidence interval 91.1% to 100%) and 25.5% specificity (21.4% to 29.8%) for type 1 AMI. History, ECG, Age, Risk Factors, Troponin had 86.4% sensitivity (75.0% to 98.4%) and 42.2% specificity (37.5% to 47.0%); History and ECG-only Manchester Acute Coronary Syndromes had 100% sensitivity (96.4% to 100%) and 3.1% specificity (1.9% to 4.7%), whereas History, ECG, Age, Risk Factors had 95.1% sensitivity (88.9% to 98.4%) and 12.1% specificity (9.8% to 14.8%). Conclusion: With point-of-care cTn testing, decision aids can identify patients at a low risk of type 1 AMI in the out-of-hospital environment. When used alongside clinical judgment, and with appropriate training, such tools may usefully enhance out-of-hospital risk stratification.
MeSH term(s)	Humans ; Acute Coronary Syndrome/diagnosis ; Critical Pathways ; Prospective Studies ; Myocardial Infarction/diagnosis ; Troponin ; Hospitals
Chemical Substances	Troponin
Language	English
Publishing date	2023-06-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2023.04.010
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Zs.A 1344: Show issues

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Article ; Online: External validation of the Manchester Acute Coronary Syndromes ECG risk model within a pre-hospital setting.

Alotaibi, Ahmed / Alghamdi, Abdulrhman / Martin, Glen P / Carlton, Edward / Cooper, Jamie G / Cook, Eloïse / Siriwardena, Aloysius Niroshan / Phillips, John / Thompson, Alexander / Bell, Steve / Kirby, Kim Lucy / Rosser, Andy / Pennington, Elspeth / Body, Richard

Emergency medicine journal : EMJ

2023 Volume 40, Issue 6, Page(s) 431–436

Abstract: Objectives: The Manchester Acute Coronary Syndromes ECG (MACS-ECG) prediction model calculates a score based on objective ECG measurements to give the probability of a non-ST elevation myocardial infarction (NSTEMI). The model showed good performance in ...

Abstract	Objectives: The Manchester Acute Coronary Syndromes ECG (MACS-ECG) prediction model calculates a score based on objective ECG measurements to give the probability of a non-ST elevation myocardial infarction (NSTEMI). The model showed good performance in the emergency department (ED), but its accuracy in the pre-hospital setting is unknown. We aimed to externally validate MACS-ECG in the pre-hospital environment. Methods: We undertook a secondary analysis from the Pre-hospital Evaluation of Sensitive Troponin (PRESTO) study, a multi-centre prospective study to validate decision aids in the pre-hospital setting (26 February 2019 to 23 March 2020). Patients with chest pain where the treating paramedic suspected acute coronary syndrome were included. Paramedics collected demographic and historical data and interpreted ECGs contemporaneously (as 'normal' or 'abnormal'). After completing recruitment, we analysed ECGs to calculate the MACS-ECG score, using both a pre-defined threshold and a novel threshold that optimises sensitivity to differentiate AMI from non-AMI. This was compared with subjective ECG interpretation by paramedics. The diagnosis of AMI was adjudicated by two investigators based on serial troponin testing in hospital. Results: Of 691 participants, 87 had type 1 AMI and 687 had complete data for paramedic ECG interpretation. The MACS-ECG model had a C-index of 0.68 (95% CI: 0.61 to 0.75). At the pre-determined cut-off, MACS-ECG had 2.3% (95% CI: 0.3% to 8.1%) sensitivity, 99.5% (95% CI: 98.6% to 99.9%) specificity, 40.0% (95% CI: 10.2% to 79.3%) positive predictive value (PPV) and 87.6% (87.3% to 88.0%) negative predictive value (NPV). At the optimal threshold for sensitivity, MACS-ECG had 50.6% sensitivity (39.6% to 61.5%), 83.1% specificity (79.9% to 86.0%), 30.1% PPV (24.7% to 36.2%) and 92.1% NPV (90.4% to 93.5%). In comparison, paramedics had a sensitivity of 71.3% (95% CI: 60.8% to 80.5%) with 53.8% (95% CI: 53.8% to 61.8%) specificity, 19.7% (17.2% to 22.45%) PPV and 93.3% (90.8% to 95.1%) NPV. Conclusion: Neither MACS-ECG nor paramedic ECG interpretation had a sufficiently high PPV or NPV to 'rule in' or 'rule out' NSTEMI alone.
MeSH term(s)	Humans ; Acute Coronary Syndrome/diagnosis ; Troponin T ; Prospective Studies ; Non-ST Elevated Myocardial Infarction ; Decision Support Techniques ; Troponin ; Emergency Service, Hospital ; Hospitals ; Electrocardiography ; Chest Pain/diagnosis ; Sensitivity and Specificity
Chemical Substances	Troponin T ; Troponin
Language	English
Publishing date	2023-04-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2022-212872
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Zs.A 1941: Show issues

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Book: Lean enterprise systems

Bell, Steve

using IT for continuous improvement

(Wiley series in systems engineering and management)

2006

Author's details	Steve Bell
Series title	Wiley series in systems engineering and management
Keywords	Lean manufacturing ; Management information systems ; Manufacturing processes ; Process control ; Lean Production ; Management-Informationssystem ; Betriebliches Informationssystem ; Informationstechnik ; Performance-Messung
Language	English
Size	XIX, 433 S, Ill., graph. Darst
Publisher	Wiley
Publishing place	Hoboken, NJ
Document type	Book
Note	Includes bibliographical references and index
ISBN	0471677841 ; 9780471677840
Database	Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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Book: Lean enterprise systems

Bell, Steve

using IT for continuous improvement

(Wiley series in systems engineering and management)

2006

Author's details	Steve Bell
Series title	Wiley series in systems engineering and management
Keywords	Lean manufacturing ; Management information systems ; Manufacturing processes ; Process control ; Lean Production ; Management-Informationssystem ; Betriebliches Informationssystem ; Informationstechnik ; Performance-Messung
Language	English
Size	XIX, 433 S, Ill., graph. Darst
Publisher	Wiley
Publishing place	Hoboken, NJ
Document type	Book
Note	Includes bibliographical references and index
ISBN	0471677841 ; 9780471677840
Database	ECONomics Information System

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Book: Lean IT

Bell, Steve / Orzen, Michael A

enabling and sustaining your lean transformation

2011

Title variant	information technology
Author's details	Steven C. Bell; Michael A. Orzen
Keywords	Information resources management ; Information technology/Management
Language	English
Size	XIX, 349 S., Ill., graph. Darst., 24 cm
Publisher	CRC Press
Publishing place	Boca Raton, Fla. u.a.
Document type	Book
Note	Includes bibliographical references and index
ISBN	1439817561 ; 9781439817568
Database	Library catalogue of the German National Library of Science and Technology (TIB), Hannover

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