The effect of prehospital critical care on survival following out-of-hospital cardiac arrest: A prospective observational study

AimTo examine the effect of prehospital critical care on survival following OHCA, compared to routine advanced life support (ALS) care.MethodsWe undertook a prospective multi-centre cohort study including two ambulance services and six prehospital critical care services in the United Kingdom (UK), between September 2016 and October 2017. Inclusion criteria were adult patients with non-traumatic OHCA treated by either prehospital critical care teams or ALS paramedics. Patients who received prehospital critical care were matched to those receiving ALS using propensity score matching. Primary outcome was survival to hospital discharge; secondary outcome was survival to hospital admission.ResultsThe primary analysis included 658 patients with OHCA receiving prehospital critical care and 1,847 patients receiving ALS care. Rates of survival to hospital discharge (primary outcome) were 11.9% in both groups; rates of survival to hospital admission (secondary outcome) were 34.4% and 27.7% in the prehospital critical care and ALS group, respectively. The corresponding odds ratios for survival to hospital discharge and survival to hospital admission with prehospital critical care were 1.06 (95% confidence interval 0.75 – 1.49) and 1.39 (95% confidence interval 1.10 – 1.75), respectively. Results were consistent across subgroups and sensitivity analyses.ConclusionsDespite a positive association with the secondary outcome of survival to hospital admission, prehospital critical care was not associated with increased rates of survival to hospital discharge following OHCA

Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison

Background: There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors’ subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy. Aim: We therefore studied the effects on patient's safety and doctors’ work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota. Methods: Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors. Results: Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0–60.0) vs. 52.4 (11.2) (30.0–77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota. Conclusions: Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety

The 3D Grazing Collision of Two Black Holes

We present results for two colliding black holes (BHs), with angular momentum, spin, and unequal mass. For the first time gravitational waveforms are computed for a grazing collision from a full 3D numerical evolution. The collision can be followed through the merger to form a single BH, and through part of the ringdown period of the final BH. The apparent horizon is tracked and studied, and physical parameters, such as the mass of the final BH, are computed. The total energy radiated in gravitational waves is shown to be consistent with the total mass of the spacetime and the final BH mass. The implication of these simulations for gravitational wave astronomy is discussed.Comment: 4 pages, 7 figures, revte

Randomised Evaluation of Modified Valsalva Effectiveness in Re-Entrant Tachycardias (REVERT)

Conference posterThe Valsalva manoeuvre is an internationally recommended physical emergency treatment for supraventricular tachycardia (SVT), an abnormal fast heart rhythm. However in normal practice, the manoeuvre only works in 5–20% of cases and intravenous treatment with adenosine is required. This drug causes a pause in heart activity which patients often find very distressing. A simple posture modification to the Valsalva manoeuvre could improve its effectiveness and we carried out a randomised controlled trial to assess whether it could increase the rate of cardioversion and reduce use of adenosine.REVERT is funded by the National Institute for Health Research (NIHR) through its Research for Patient Benefit (RfPB) Programme: Grant Reference Number PB-PG-0211-24145. The study has been approved by the South West Exeter Research Ethics Committee, is registered with Current Controlled Trials (ISRCTN67937027) and has been adopted by the NIHR Clinical Research Network

The Randomised Evaluation of early topical Lidocaine patches In Elderly patients admitted to hospital with rib Fractures (RELIEF): feasibility trial protocol

Background: Topical lidocaine patches, applied over rib fractures, have been suggested as a non-invasive method of local anaesthetic delivery to improve respiratory function, reduce opioid consumption and consequently reduce pulmonary complications. Older patients may gain most benefit from improved analgesic regimens yet lidocaine patches are untested as an early intervention in the Emergency Department (ED). The aim of this trial is to investigate uncertainties around trial design and conduct, to establish whether a definitive randomised trial of topical lidocaine patches in older patients with rib fractures is feasible. Methods: RELIEF is an open label, multicentre, parallel group, individually randomised, feasibility randomised controlled trial with economic scoping and nested qualitative study. Patients aged ≥ 65 years presenting to the ED with traumatic rib fracture(s) requiring admission will be randomised 1:1 to lidocaine patches (intervention), in addition to standard clinical management, or standard clinical management alone. Lidocaine patches will be applied immediately after diagnosis in ED and continued daily for 72 hours or until discharge. Feasibility outcomes will focus on recruitment, adherence and follow-up data with a total sample size of 100. Clinical outcomes, such as 30-day pulmonary complications, and resource use will be collected to understand feasibility of data collection. Qualitative interviews will explore details of the trial design, trial acceptability and recruitment processes. An evaluation of the feasibility of measuring health economics outcomes data will be completed. Discussion: Interventions to improve outcomes in elderly patients with rib fractures are urgently required. This feasibility trial will test a novel early intervention which has the potential of fulfilling this unmet need. The Randomised Evaluation of early topical Lidocaine patches In Elderly patients admitted to hospital with rib Fractures (RELIEF) feasibility trial will determine whether a definitive trial is feasible. ISRCTN Registration: ISRCTN14813929 (22/04/2021)

A Tale of Three Signatures: practical attack of ECDSA with wNAF

One way of attacking ECDSA with wNAF implementation for the scalar multiplication is to perform a side-channel analysis to collect information, then use a lattice based method to recover the secret key. In this paper, we reinvestigate the construction of the lattice used in one of these methods, the Extended Hidden Number Problem (EHNP). We find the secret key with only 3 signatures, thus reaching the theoretical bound given by Fan, Wang and Cheng, whereas best previous methods required at least 4 signatures in practice. Our attack is more efficient than previous attacks, in particular compared to times reported by Fan et al. at CCS 2016 and for most cases, has better probability of success. To obtain such results, we perform a detailed analysis of the parameters used in the attack and introduce a preprocessing method which reduces by a factor up to 7 the overall time to recover the secret key for some parameters. We perform an error resilience analysis which has never been done before in the setup of EHNP. Our construction is still able to find the secret key with a small amount of erroneous traces, up to 2% of false digits, and 4% with a specific type of error. We also investigate Coppersmith's methods as a potential alternative to EHNP and explain why, to the best of our knowledge, EHNP goes beyond the limitations of Coppersmith's methods

A Tale of Three Signatures: practical attack of ECDSA with wNAF

International audienceAttacking ECDSA with wNAF implementation for the scalar multiplication first requires some side channel analysis to collect information, then lattice based methods to recover the secret key. In this paper, we reinvestigate the construction of the lattice used in one of these methods, the Extended Hidden Number Problem (EHNP). We find the secret key with only 3 signatures, thus reaching a known theoretical bound, whereas best previous methods required at least 4 signatures in practice. Given a specifoc leakage model, our attack is more efficient than previous attacks, and for most cases, has better probability of success. To obtain such results, we perform a detailed analysis of the parameters used in the attack and introduce a preprocessing method which reduces by a factor up to 7 the total time to recover the secret key for some parameters. We perform an error resilience analysis which has never been done before in the setup of EHNP. Our construction find the secret key with a small amount of erroneous traces, up to 2% of false digits, and 4% with a specific type of error