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Link rowid ▼ title DOI URL created subject references-count is-referenced-by-count ISSN container-title abstract author_number orcids names award_numbers funder_names funder_dois
31 ["Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset"] 10.1136/bmjopen-2018-026396 http://dx.doi.org/10.1136/bmjopen-2018-026396 2019-05-02T08:39:22Z ["General Medicine"] 50 3 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Open cohort study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>A representative sample of 550 Australian general practices contributing data to the MedicineInsight programme.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>ILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>ILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p&lt;0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p&lt;0.05), antibiotic (30.7% vs 23.4%, p&lt;0.05) and antiviral (34.2% vs 13.5%, p&lt;0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation r… 3 ["http://orcid.org/0000-0001-6998-6419", "http://orcid.org/0000-0002-7153-2878", "http://orcid.org/0000-0002-9018-0361"] ["Carla De Oliveira Bernardo", "David Gonzalez-Chica", "Nigel Stocks"] [""] [""] [""]
42 ["Hyper-reflexia in Guillain-Barr\u00e9 syndrome: systematic review"] 10.1136/jnnp-2019-321890 http://dx.doi.org/10.1136/jnnp-2019-321890 2020-01-14T22:33:50Z ["Surgery", "Psychiatry and Mental health", "Clinical Neurology"] 43 1 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:p>Areflexia or hyporeflexia is a mandatory clinical criterion for the diagnosis of Guillain-Barré syndrome (GBS). A systematic review of the literature from 1 January 1993 to 30 August 2019 revealed 44 sufficiently detailed patients with GBS and hyper-reflexia, along with one we describe. 73.3% of patients were from Japan, 6.7% from the USA, 6.7% from India, 4.4% from Italy, 4.4% from Turkey, 2.2% from Switzerland and 2.2% from Slovenia, suggesting a considerable geographical variation. Hyper-reflexia was more frequently associated with antecedent diarrhoea (56%) than upper respiratory tract infection (22.2%) and the electrodiagnosis of acute motor axonal neuropathy (56%) than acute inflammatory demyelinating polyneuropathy (4.4%). Antiganglioside antibodies were positive in 89.7% of patients. Hyper-reflexia was generalised in 90.7% of patients and associated with reflex spread in half; it was present from the early progressive phase in 86.7% and disappeared in a few weeks or persisted until 18 months. Ankle clonus or Babinski signs were rarely reported (6.7%); spasticity never developed. 53.3% of patients could walk unaided at nadir, none needed mechanical ventilation or died. 92.9% of patients with limb weakness were able to walk unaided within 6 months. Electrophysiological studies showed high soleus maximal H-reflex amplitude to maximal compound muscle action potential amplitude ratio, suggestive of spinal motoneuron hyperexcitability, and increased central conduction time, suggestive of corticospinal tract involvement, although a structural damage was never demonstrated by MRI. Hyper-reflexia is not inconsistent with the GBS diagnosis and should not delay treatment. All GBS variants and subtypes can present with hyper-reflexia, and this eventuality should be mentioned in future diagnostic criteria for GBS.</jats:p> 3 ["http://orcid.org/0000-0002-8131-8912", "http://orcid.org/0000-0002-4716-8578"] ["Antonino Uncini", "Francesca Notturno", "Satoshi Kuwabara"] [""] [""] [""]
63 ["TM2-2\u2005Analysis of adverse events in the management of chronic headache by occipital nerve stimulation"] 10.1136/jnnp-2019-abn.41 http://dx.doi.org/10.1136/jnnp-2019-abn.41 2019-02-14T22:48:47Z ["Surgery", "Psychiatry and Mental health", "Clinical Neurology"] 0 0 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:sec><jats:title>Objectives</jats:title><jats:p>To analyse long-term adverse events of occipital nerve stimulation (ONS).</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective open-label observational study.</jats:p></jats:sec><jats:sec><jats:title>Subjects</jats:title><jats:p>134 patients with refractory headaches implanted between 2007–2014 in a single specialised centre.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Information was collected on ONS device, implantable pulse generator (IPG) site and adverse event rates. The impact of implanter experience and the association between IPG site and adverse event rates was also explored.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean follow up was 46 months (6–108 months). A total of 139 adverse events were recorded in 75 patients (56%). A total of 59 additional surgeries were needed in 39 patients. A significant difference was seen in the rates of adverse events recorded between 2007–2010 and 2011–2014 (60.7% vs 42.6%, p=0.002). A significant reduction in ONS revision was seen over time (25.7% vs 5.9%, p=0.002). Analysis of adverse events with IPG site showed those with abdominal implants recorded higher adverse event rate that those with an IPG in the chest (65.8% vs 40.3%, p=0.004).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In specialist centres, adverse event rates of ONS can be much lower than reported in the literature. Our results suggest implanter experience and IPG site both have an effect on adverse event rate.</jats:p></jats:sec> 3 [] ["S Miller", "L Watkins", "M Matharu"] [""] [""] [""]
64 ["Mapping the use of soft systems methodology for change management in healthcare: a scoping review protocol"] 10.1136/bmjopen-2018-026028 http://dx.doi.org/10.1136/bmjopen-2018-026028 2019-04-02T07:34:20Z ["General Medicine"] 0 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Introduction</jats:title><jats:p>It is notoriously challenging to implement evidence-based care and to update and improve healthcare practices. One reason for the difficulty is the complexity of healthcare and the powerful influence of context on implementation and improvement efforts. Thus, there is a need for multifaceted, flexible change methods that takes these complexities into consideration. One approach that has the potential in this regard is soft systems methodology (SSM). However, little is known about how SSM has been applied in healthcare settings, making it difficult to assess the usefulness of SSM for implementation science or improvement research. The aim of the proposed scoping review is to examine and map the use and outcomes of SSM in healthcare.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>The review will adapt the framework outlined by Arksey and O’Malley (2005). Citations will be uncovered through a comprehensive database search of the peer-reviewed literature. Two reviewers will conduct a two-stage review and selection process where the titles/abstracts are examined followed by a screening of full texts of the selected citations. Reference lists of included citations will be snowballed to identify potential additional citations. Inclusion criteria are English language, peer-reviewed empirical papers focusing on the application of SSM in a healthcare setting. Both general information about the citations and information related to the objective of the review will be extracted from the included citations and entered into a data charting form. The extracted information will be reported in diagrams and tables and summarised to present a narrative account of the literature. The proposed review will provide information on the potential for using SSM to affect change in healthcare.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>No primary data will be collected, and thus ethical permission is unnecessar… 3 ["http://orcid.org/0000-0001-6203-0676", "http://orcid.org/0000-0003-0296-4957"] ["Hanna Augustsson", "Kate Churruca", "Jeffrey Braithwaite"] [] ["National Health and Medical Research Council"] ["10.13039/501100000925"]
89 ["Contralateral effect of systemic absorption of low dose bevacizumab (Avastin) after unilateral intravitreal injection in severe retinopathy of prematurity (ROP)"] 10.1136/bcr-2019-232359 http://dx.doi.org/10.1136/bcr-2019-232359 2020-03-13T09:15:12Z [] 18 0 ["1757-790X"] BMJ Case Reports <jats:p>An extremely premature baby boy born at 23 weeks’ gestational age was treated with unilateral low dose of 0.16 mg/0.025 mL intravitreal bevacizumab in the left eye for aggressive retinopathy of prematurity (ROP). He developed photographically documented changes in his contralateral right eye on imaging 5 days later. Second eye treatment was at 12 days. He has development assessment and ophthalmic review beyond age 2, which is normal. Systemic absorption of the drug caused an end organ effect to slow down and reverse ROP in his untreated right eye. Both eyes vascularised fully. His normal Bayley III developmental score at age 2 is uncommon for a 23-week gestation baby. Even at a low dose, bevacizumab has the potential for end organ effect on the second eye, and therefore other organs. In this case, there are no medium-term measurable neurodevelopmental side-effects. We suggest longer term follow-up is required before excluding unwanted side-effects.</jats:p> 3 [] ["Ayad Shafiq", "Roxane Hillier", "Richard Hearn"] [""] [""] [""]
99 ["Randomised evaluation of government health programmes does present a challenge to standard research ethics frameworks"] 10.1136/medethics-2019-106003 http://dx.doi.org/10.1136/medethics-2019-106003 2019-12-18T22:15:26Z ["Health Policy", "Arts and Humanities (miscellaneous)", "Issues, ethics and legal aspects", "Health(social science)"] 5 0 ["0306-6800", "1473-4257"] Journal of Medical Ethics <jats:title>Abstract</jats:title><jats:p>In a recent issue of Journal of Medical Ethics (JME), we discussed the ethical review of evaluations of interventions that would occur whether or not the evaluation was taking place. We concluded that standard research ethics frameworks including the Ottawa Statement, which requires justification for all aspects of an intervention and its roll-out, were a poor guide in this area. We proposed that a consideration of researcher responsibility, based on the consequences of the research taking place, would be a more appropriate way delineate the scope of research ethics review. Weijer and Taljaard present a counterargument to our proposal, which we address in this reply. They claim that a focus on researcher responsibility will weaken the protection of research participants and link it to ‘unethical research’ and a ‘government experimenting on its own people’. However, the moral responsibility of researchers is defined in terms of the consequences of the research on human welfare and harm, not in opposition to it. Weijer and Taljaard argue that researchers must justify what they are studying whether or not they have any control over it and that governments must justify their programmes, including by demonstrating equipoise, to a research ethics committee if they implement them in a randomised way. We strongly disagree that this is a defensible way to define the scope of research ethics review and argue that this provides no further protections to research participants beyond what we propose, but places a potential barrier to learning from government programmes.</jats:p> 3 [] ["Samuel I Watson", "Mary Dixon-Woods", "Richard J Lilford"] ["WT09789"] ["Wellcome Trust", "National Institute for Health Research"] ["10.13039/100004440", "10.13039/501100000272"]

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