Patients have been asked to use services wisely
Thousands of ambulance service workers across the region are expected to walkout in the first day of the most significant ambulance strike action for more than three decades. In Nottinghamshire, staff are striking for 24 hours with campaigners on various picket lines from 6am on Wednesday .
Officials at East Midlands Ambulance Service [EMAS] say up to half of the 4,000-strong workforce are part of the GMB trade union who could strike. Agreements have been made to maintain response times to life-threatening calls but less urgent calls, such as for falls, could see long waits. Ben Holdaway, director of operations at EMAS, said patients should continue to call for an ambulance as normal if they experience a life-threatening emergency. "Our operational teams have developed contingency plans to aim to maximise the number of ambulance staff and volunteers we have available to respond to patients, as well as clinical staff able to carry out remote clinical assessments," he said.
GMB picket lines include at the EMAS headquarters at the Nottingham Business Park, between Strelley and Nuthall, the Stapleford Ambulance Station in Ewe Lamb Lane and the Beechdale Ambulance Station off the A6514 Western Boulevard. Paramedics and call handlers will be among tens of thousands of staff to strike over pay across England and Wales. GMB members from nine ambulance services are taking part in the industrial action.
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Frontiers | Loss of perceived social role, an index of social frailty, is an independent predictor of future adverse events in hospitalized patients with heart failureAims Although the impact of physical frailty on prognosis and the effect of cardiac rehabilitation in HF patients has been well established, data for the prognostic impact of social frailty (SF) in HF patients are limited. In addition, the relative importance of each SF domain in clinical outcomes remains unclear. We aimed to get a new insight into the associations of SF with clinical outcomes in elderly hospitalized HF patients. Methods A single-center, retrospective cohort study was conducted using data from 310 in-hospital HF patients aged ≥ 65 years (mean age of 78 ± 8 years; 49% women). Makizako’s five questions, a self-reported questionnaire, were used to define SF. The primary outcome was composite events defined by all-cause death and cardiovascular events. Results Of the 310 elderly HF patients, 189 patients (61%) had SF. Seventy-five patients (24%) had composite events during a mean follow-up period of 1.93 ± 0.91 years. Kaplan-Meier curves showed that patients with SF had a significantly higher composite event rate than patients without SF. In multivariate Cox regression analyses, SF was independently associated with a higher composite event rate after adjusting for prognostic markers [adjusted hazard ratio (HR), 2.01; 95% confidence interval (CI), 1.07 to 3.78; p=0.04]. Of the 5 questions for defining SF, an answer of yes to the question about not feeling helpful toward friends or family, which indicates loss of perceived social role, was an independent predictor of composite events (adjusted HR, 2.28; 95% CI, 1.36 to 3.82; p | 0.01). Inclusion of loss of perceived social role into the baseline prognostic model improved both the continuous net reclassification improvement (0.562; 95% CI, 0.298 to 0.827; p | 0.01) and integrated discrimination improvement (0.031; 95% CI, 0.006 to 0.056; p=0.02). Conclusion Loss of perceived social role is associated with increased adverse event risk and provides additive prognostic information in elderly HF patients.
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