A new integrated care pathway for Ambulance attended severe hypoglycaemia in the East of England: the Eastern Academic Health Science Network (EAHSN) model, Diabetes Research and Clinical Practice (2017), doi: http://dx.doi.org/10.1016/ j.diabres. 2017.08.017 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Methods SH patients attended by Ambulance crew receive written information on SH avoidance, and are contacted for further education through a new regional SH prevention team. All patients are contacted unless they actively decline.Results Median age (IQR) was 67 (50 -80) years, 23.6% of calls were for patients over 80 years old, and patients more than 90 years old were more common than 20 -25 year olds in this population. Most calls were for patients (84.9%) who were insulin treated, even those over 80 years (75%). One -third of patients attended after a call were unconscious on attendance. 5.6% of patients in this call population had 3 or more ambulance call outs, and they generated 17.6% of all calls. In total, 728 episodes (36.4%) were repeat calls. Insulin related events were clinically more severe than oral hypoglycaemic related events. Patients conveyed to hospitals (13.8%) were significantly older, with poorer recovery in biochemical hypoglycaemia after ambulance crew attendance. Only 19 (1 %) opted out of further contact. Patients were contacted by the SH prevention team after a median 3 (0 -6) days. The most common patient self -reported cause for their SH episode was related to percieved errors in insulin management (31.4%). ConclusionsThis new clinical service is simple, acceptable to patients, and a translatable model for prevention of recurrent SH in this largely elderly insulin treated SH population.

Nine million adults have symptomatic knee osteoarthritis (OA) in the U.S. and almost half of those people have a walking aid such as a cane. Proper cane loading (e.g. 15% body weight [BW]) can reduce knee loading and may slow OA progression. The purpose of this study was to investigate the efficacy of a novel smart cane with vibrotactile biofeedback that aims to facilitate increased cane loading. Ten subjects with knee OA performed a 50 m hallway walk test under four conditions: 1) naïve, 2) conventional cane with verbal instruction, 3) smart cane, and 4) conventional cane post smart cane. The cane load (% BW; mean ± 1 standard deviation) for the four conditions was 9.0 ± 1.9 (naïve), 12.7 ± 2.6 (conventional cane), 17.6 ± 2.4 (smart cane), and 15.6 ±3.1 (conventional cane post smart cane). These results indicate that the smart cane's vibrotactile biofeedback helped the users achieve the target cane loading of 15% BW or more as compared to naïve or verbal instruction alone. After using the smart cane, conventional cane loading was higher than the naïve and verbal instruction conditions demonstrating a potential smart cane training effect. Long term increased cane loading may reduce knee pain and improve joint function.

Background: Acute stroke patients are usually transported to the nearest hospital regardless of their required level of care. This can lead to increased pressure on emergency departments and treatment delay. Objective: The aim of the study was to explore the benefit of a mobile stroke unit (MSU) in the UK National Health Service (NHS) for reduction of hospital admissions. Methods: Prospective cohort audit observation with dispatch of the MSU in the East of England Ambulance Service area in Southend-on-Sea was conducted. Emergency patients categorized as code stroke and headache were included from June 5, 2018, to December 18, 2018. Rate of avoided admission to the accident and emergency (A&E) department, rate of admission directly to target ward, and stroke management metrics were assessed. Results: In 116 MSU-treated patients, the following diagnoses were made: acute stroke, n = 33 (28.4%); transient ischaemic attacks, n = 13 (11.2%); stroke mimics, n = 32 (27.6%); and other conditions, n = 38 (32.8%). Pre-hospital thrombolysis was administered to 8 of 28 (28.6%) ischaemic stroke patients. Pre-hospital diagnosis avoided hospital admission for 29 (25.0%) patients. As hospital treatment was indicated, 35 (30.2%) patients were directly triaged to the stroke unit, 1 patient (0.9%) even directly to the catheter laboratory. Thus, only 50 (43.1%) patients required transfer to the A&E department. Moreover, the MSU enabled thrombolysis with a median dispatch-to-needle time of 42 min (interquartile range, 40–60). Conclusion: This first deployment of an MSU in the UK NHS demonstrated improved triage decision-making for or against hospital admission and admission to the appropriate target ward, thereby reducing pressure on strained A&E departments.

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