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59 59 ["Diagnosis and management of acute ischaemic stroke"] 10.1136/practneurol-2020-002557 http://dx.doi.org/10.1136/practneurol-2020-002557 2020-06-07T21:19:36Z ["Clinical Neurology", "General Medicine"] 130 0 ["1474-7758", "1474-7766"] Practical Neurology <jats:p>Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients should be admitted directly to an acute stroke unit for close monitoring for early neurological deterioration and prevention of secondary complications. Prompt investigation of the mechanism of stroke allows patients to start appropriate secondary preventative treatment. Future objectives include improving accessibility to endovascular thrombectomy, using advanced imaging to extend therapeutic windows and developing neuroprotective agents to prevent secondary neuronal damage.</jats:p> 4 ["http://orcid.org/0000-0002-4226-7681", "http://orcid.org/0000-0001-9535-022X"] ["Robert Hurford", "Alakendu Sekhar", "Tom A T Hughes", "Keith W Muir"] [""] [""] [""]
70 70 ["TGF-\u03b22 silencing to target biliary-derived liver diseases"] 10.1136/gutjnl-2019-319091 http://dx.doi.org/10.1136/gutjnl-2019-319091 2020-01-28T21:17:00Z ["Gastroenterology"] 0 0 ["0017-5749", "1468-3288"] Gut <jats:sec><jats:title>Objective</jats:title><jats:p>TGF-β2 (TGF-β, transforming growth factor beta), the less-investigated sibling of TGF-β1, is deregulated in rodent and human liver diseases. Former data from bile duct ligated and MDR2 knockout (KO) mouse models for human cholestatic liver disease suggested an involvement of TGF-β2 in biliary-derived liver diseases.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>As we also found upregulated <jats:italic>TGFB2</jats:italic> in liver tissue of patients with primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC), we now fathomed the positive prospects of targeting TGF-β2 in early stage biliary liver disease using the MDR2-KO mice. Specifically, the influence of <jats:italic>TgfB2</jats:italic> silencing on the fibrotic and inflammatory niche was analysed on molecular, cellular and tissue levels.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p><jats:italic>TgfB2</jats:italic>-induced expression of fibrotic genes in cholangiocytes and hepatic stellate cellswas detected. <jats:italic>TgfB2</jats:italic> expression in MDR2-KO mice was blunted using <jats:italic>TgfB2</jats:italic>-directed antisense oligonucleotides (AON). Upon AON treatment, reduced collagen deposition, hydroxyproline content and αSMA expression as well as induced <jats:italic>PparG</jats:italic> expression reflected a significant reduction of fibrogenesis without adverse effects on healthy livers. Expression analyses of fibrotic and inflammatory genes revealed AON-specific regulatory effects on <jats:italic>Ccl3</jats:italic>, <jats:italic>Ccl4</jats:italic>, <jats:italic>Ccl5</jats:italic>, <jats:italic>Mki67</jats:italic> and <jats:italic>Notch3</jats:italic> expression. Further, AON treatment of MDR2-KO mice increased tissue infiltration by F4/80-positive cells including eosinophils, whereas the number of CD45-positive inflammatory cells decreased. In line, <jats:italic>TGFB2</jats:italic> and CD45 expression correlated positively in PS… 29 ["http://orcid.org/0000-0002-4840-6240", "http://orcid.org/0000-0001-7953-8927", "http://orcid.org/0000-0003-3135-1359", "http://orcid.org/0000-0002-6022-073X", "http://orcid.org/0000-0003-0336-0581", "http://orcid.org/0000-0003-0211-352X"] ["Anne Dropmann", "Steven Dooley", "Bedair Dewidar", "Seddik Hammad", "Tatjana Dediulia", "Julia Werle", "Vanessa Hartwig", "Shahrouz Ghafoory", "Stefan Woelfl", "Hanna Korhonen", "Michel Janicot", "Katja Wosikowski", "Timo Itzel", "Andreas Teufel", "Detlef Schuppan", "Ana Stojanovic", "Adelheid Cerwenka", "Stefanie Nittka", "Albrecht Piiper", "Timo Gaiser", "Naiara Beraza", "Malgorzata Milkiewicz", "Piotr Milkiewicz", "John G Brain", "David E J Jones", "Thomas S Weiss", "Ulrich M Zanger", "Matthias Ebert", "Nadja M Meindl-Beinker"] ["non"] ["Robert Bosch Stiftung", "Bundesministerium f\u00fcr Bildung und Forschung", "Deutsche Forschungsgemeinschaft", "ESF Baden W\u00fcrttemberg (www.esf-bw.de) and the Ministerium f\u00fcr Wissenschaft, Forschung und Kunst, Baden W\u00fcrttemberg", "EU", "Isarna Therapeutics GmbH", "SPP 1937"] ["10.13039/501100001646", "10.13039/501100002347", "10.13039/501100001659", [""], [""], [""], [""]]
77 77 ["Metabolic and cardiovascular effects of chronic mild hyperuricemia in rodents"] 10.1136/jim-2018-000729 http://dx.doi.org/10.1136/jim-2018-000729 2018-07-24T17:51:06Z ["General Biochemistry, Genetics and Molecular Biology", "General Medicine"] 33 0 ["1081-5589", "1708-8267"] Journal of Investigative Medicine <jats:p>Mildly elevated serum uric acid levels are common in people with metabolic syndrome and type 2 diabetes mellitus (T2DM), but whether elevated uric acid has a causal role in the pathogenesis of diabetes remains uncertain. We tested whether chronic mild hyperuricemia in rodents under controlled laboratory conditions can cause glucose intolerance in otherwise healthy animals, or whether it can worsen glucometabolic control in animals that are genetically predisposed to T2DM. We used an established model of experimental hyperuricemia in rodents with potassium oxonate dietary supplementation, which led to sustained, approximately two-fold elevation of uric acid compared with control animals. We also reversed the hyperuricemic effect of oxonate in some animals by treatment with a xanthine oxidase inhibitor. Manipulation of serum uric acid levels in Sprague-Dawley rats for up to 18 weeks did not affect fasting glucose and glucose tolerance. Blood pressure was also not affected by hyperuricemia in rats fed a Western-type diet. We next sought to determine whether uric acid may aggravate or accelerate the onset of glucometabolic abnormalities in rats already predisposed to T2DM. Chronic oxonate treatment in Zucker diabetic fatty (ZDF) and lean control rats for up to 6 weeks did not affect fasting glucose, insulin, and glucose tolerance in ZDF rats. Taken together, these findings indicate that elevated uric acid does not directly contribute to the pathogenesis of glucose intolerance and T2DM in rodents.</jats:p> 7 [] ["Sun K Park", "Tara R Rosenthal", "Jessica S Williams", "John M Shelton", "Masaya Takahashi", "Shanrong Zhang", "Ion Alexandru Bobulescu"] [] ["National Institutes of Health", "Takeda Pharmaceuticals U.S.A."] ["10.13039/100000002", "10.13039/100007723"]
64 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"]
65 65 ["Biomarker-guided implementation of the KDIGO guidelines to reduce the occurrence of acute kidney injury in patients after cardiac surgery (PrevAKI-multicentre): protocol for a multicentre, observational study followed by randomised controlled feasibility trial"] 10.1136/bmjopen-2019-034201 http://dx.doi.org/10.1136/bmjopen-2019-034201 2020-04-07T09:55:55Z ["General Medicine"] 18 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Introduction</jats:title><jats:p>Acute kidney injury (AKI) is a frequent complication after cardiac surgery with adverse short-term and long-term outcomes. Although prevention of AKI (PrevAKI) is strongly recommended, the optimal strategy is uncertain. The Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommended a bundle of supportive measures in high-risk patients. In a single-centre trial, we recently demonstrated that the strict implementation of the KDIGO bundle significantly reduced the occurrence of AKI after cardiac surgery. In this feasibility study, we aim to evaluate whether the study protocol can be implemented in a multicentre setting in preparation for a large multicentre trial.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>We plan to conduct a prospective, observational survey followed by a randomised controlled, multicentre, multinational clinical trial including 280 patients undergoing cardiac surgery with cardiopulmonary bypass. The purpose of the observational survey is to explore the adherence to the KDIGO recommendations in routine clinical practice. The second phase is a randomised controlled trial. The objective is to investigate whether the trial protocol is implementable in a large multicentre, multinational setting. The primary endpoint of the interventional part is the compliance rate with the protocol. Secondary endpoints include the occurrence of any AKI and moderate/severe AKI as defined by the KDIGO criteria within 72 hours after surgery, renal recovery at day 90, use of renal replacement therapy (RRT) and mortality at days 30, 60 and 90, the combined endpoint major adverse kidney events consisting of persistent renal dysfunction, RRT and mortality at day 90 and safety outcomes.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>The PrevAKI multicentre study has been approved by the leading Research Ethics Committee of the University of Münster and the respective Research Ethic… 29 ["http://orcid.org/0000-0002-2124-1714"] ["Mira K\u00fcllmar", "Christina Massoth", "Marlies Ostermann", "Sara Campos", "Neus Grau Novellas", "Gary Thomson", "Michael Haffner", "Christian Arndt", "Hinnerk Wulf", "Marc Irqsusi", "Fabrizio Monaco", "Ambra Di Prima", "Mercedes Garcia Alvarez", "Stefano Italiano", "Virginia Cegarra SanMartin", "Gudrun Kunst", "Shrijit Nair", "Camilla L'Acqua", "Eric A J Hoste", "Wim Vandenberghe", "Patrick Honore", "John Kellum", "Lui Forni", "Philippe Grieshaber", "Raphael Weiss", "Joachim Gerss", "Carola Wempe", "Melanie Meersch", "Alexander Zarbock"] [] ["European Society of Intensive Care Medicine"] ["10.13039/501100013347"]
66 66 ["Uptake of routine viral load testing among people living with HIV and its implementation challenges in Yangon region of Myanmar: a mixed-methods study"] 10.1136/bmjopen-2019-032678 http://dx.doi.org/10.1136/bmjopen-2019-032678 2019-12-03T15:46:41Z ["General Medicine"] 29 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>In 2017, Myanmar implemented routine viral load (VL) monitoring for assessing the response to antiretroviral therapy (ART) among people living with HIV (PLHIV). The performance of routine VL testing and implementation challenges has not yet assessed. We aimed to determine the uptake of VL testing and factors associated with it among PLHIV initiated on ART during 2017 in ART clinics of Yangon region and to explore the implementation challenges as perceived by the healthcare providers.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>An explanatory mixed-methods study was conducted. The quantitative component was a cohort study, and the qualitative part was a descriptive study with in-depth interviews.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Six ART clinics operated by AIDS/sexually transmitted infection teams under the National AIDS Programme.</jats:p></jats:sec><jats:sec><jats:title>Primary outcome measures</jats:title><jats:p>(1) The proportion who underwent VL testing by 30 March 2019 and the proportion with virological suppression (plasma VL &lt;1000 copies/mL); (2) association between patient characteristics and ‘not tested’ was assessed using log binomial regression and (3) qualitative codes on implementation challenges.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 567 PLHIV started on ART, 498 (87.8%) retained in care for more than 6 months and were eligible for VL testing. 288 (57.8%, 95% CI: 53.3% to 62.2%) PLHIV underwent VL testing, of which 263 (91.3%, 95% CI: 87.1% to 94.4%) had virological suppression. PLHIV with WHO clinical stage 4 had significantly higher rates of ‘not being tested’ for VL. Collection of sample for VL testing only twice a month, difficulties in sample collection and transportation, limited trained workforce, wage loss and out-of-pocket expenditure for patients due to added visits were major implementation challenges.</jats:p></jats:sec><jats:sec><jats… 8 [] ["Khine Khine Thinn", "Pruthu Thekkur", "Nang Thu Thu Kyaw", "Nyein Su Aye", "Tin Maung Zaw", "Pyae Soan", "San Hone", "Htun Nyunt Oo"] [""] [""] [""]
78 78 ["Construction of the secondary care administrative records frailty (SCARF) index and validation on older women with operable invasive breast cancer in England and Wales: a cohort study"] 10.1136/bmjopen-2019-035395 http://dx.doi.org/10.1136/bmjopen-2019-035395 2020-05-06T10:36:50Z ["General Medicine"] 48 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>Studies that use national datasets to evaluate the management of older women with breast cancer are often constrained by a lack of information on patient fitness. This study constructed a frailty index for use with secondary care administrative records and evaluated its ability to improve models of treatment patterns and overall survival in women with breast cancer.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Retrospective cohort study.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Women aged ≥50 years with oestrogen receptor (ER) positive early invasive breast cancer diagnosed between 2014 and 2017 in England.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The secondary care administrative records frailty (SCARF) index was based on the cumulative deficit model of frailty, using International Statistical Classification of Diseases, Injuries and Causes of Death, 10th revision codes to define a set of deficits. The index was applied to administrative records that were linked to national cancer registry datasets. The ability of the SCARF index to improve the performance of regression models to explain observed variation in the rate of surgery and overall survival was evaluated using Harrell’s c-statistic and decision curve analysis. External validation was performed on a dataset of similar women diagnosed in Wales.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The SCARF index captured 32 deficits that cover functional impairment, geriatric syndromes, problems with nutrition, cognition and mood, and medical comorbidities. In the English dataset (n=67 925), the prevalence of frailty in women aged 50–69, 70–79 and ≥80 years was 15%, 28% and 47%, respectively. Adding a frailty measure to regression models containing age, tumour characteristics and comorbidity improved their ability to: (1) discriminate between whether a woman was likely to have surgery and (2) predict over… 11 ["http://orcid.org/0000-0002-4761-8655"] ["Yasmin Jauhari", "Melissa Ruth Gannon", "David Dodwell", "Kieran Horgan", "Karen Clements", "Jibby Medina", "Carmen Tsang", "Thompson Robinson", "Sarah Shuk-Kay Tang", "Ruth Pettengell", "David A Cromwell"] [] ["Healthcare Quality Improvement Partnership"] [[""]]
82 82 ["Determinants of imbalanced sex ratio at birth in Nepal: evidence from secondary analysis of a large hospital-based study and nationally-representative survey data"] 10.1136/bmjopen-2018-023021 http://dx.doi.org/10.1136/bmjopen-2018-023021 2019-01-31T10:06:09Z ["General Medicine"] 31 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To quantify sex ratios at births (SRBs) in hospital deliveries in Nepal, and understand the socio-demographic correlates of skewed SRB. Skewed SRBs in hospitals could be explained by sex selective abortion, and/or by decision to have a son delivered in a hospital—increased in -utero investments for male fetus. We use data on ultrasound use to quantify links between prenatal knowledge of sex, parity and skewed SRBs.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Secondary analysis of: (1) de-identified data from a randomised controlled trial, and (2) 2011 Nepal Demographic and Health Survey (NDHS).</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Nepal.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>(1) 75 428 women who gave birth in study hospitals, (2) NDHS: 12 674 women aged 15–49 years.</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>SRB, and conditional SRB of a second child given first born male or female were calculated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Using data from 75 428 women who gave birth in six tertiary hospitals in Nepal between September 2015 and March 2017, we report skewed SRBs in these hospitals, with some hospitals registering deliveries of 121 male births per 100 female births. We find that a nationally representative survey (2011 NDHS) reveals no difference in the number of hospital delivery of male and female babies. Additionally, we find that: (1) estimated SRB of second-order births conditional on the first being a girl is significantly higher than the biological SRB in our study and (2) multiparous women are more likely to have prenatal knowledge of the sex of their fetus and to have male births than primiparous women with the differences increasing with increasing levels of education.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our analysis supports sex-selective abortion a… 6 [] ["Elina Pradhan", "Erin Pearson", "Mahesh Puri", "Manju Maharjan", "Dev Chandra Maharjan", "Iqbal Shah"] [] ["Susan Thompson Buffett Foundation", "Harvard T.H. Chan School of Public Health"] ["10.13039/100007447", "10.13039/100008548"]
84 84 ["How far are we from a medication use process aiming at well-informed adherent patients with long-term medications in Finland? Qualitative study"] 10.1136/bmjopen-2019-036526 http://dx.doi.org/10.1136/bmjopen-2019-036526 2020-06-22T07:06:08Z ["General Medicine"] 72 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objective</jats:title><jats:p>Finland is one of the few countries that has established a national Medicines Information (MI) Strategy. The ultimate goal of the strategy is a well-implemented medication use process resulting in well-informed adherent patients. This study aimed at evaluating the implementation of the strategy 3 years after its launch.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>The evaluation applied a pragmatic approach and was conducted by interviewing stakeholders involved in the National MI Network enhancing the MI Strategy’s implementation. The network comprises national key stakeholders producing and using MI. Data were deductively analysed according to the medication use process of the MI Strategy using the framework method, complemented with inductively derived categories.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>National implementation of the MI Strategy throughout the healthcare system after the first operational period (2012–2014) in 2015.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>The members of the National MI Network (n=79/111, participation rate 71%, representing 42/53 stakeholder organisations).</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>A new conceptual framework was developed based on stakeholders’ views on well-implemented actions and actions needing development in the medication use process at (1) infrastructure (<jats:italic>macro</jats:italic>), (2) healthcare professionals (<jats:italic>meso</jats:italic>) and (3) patient (<jats:italic>micro</jats:italic>) levels.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Medication counselling by community pharmacists was the primary implemented action, followed by physicians’ actions while starting a new medication, and advice given by nurses. The major development needs concerned (1) poor access to patient information and its transfer in healthcare, particularly the lack of r… 4 ["http://orcid.org/0000-0001-7846-3492"] ["Niina Mononen", "Marika Pohjanoksa-M\u00e4ntyl\u00e4", "Marja SA Airaksinen", "Katri H\u00e4meen-Anttila"] [] ["Elli Turunen Fund of the Finnish Cultural Foundation"] [[""]]
86 86 ["Determining responsiveness and meaningful changes for the Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways"] 10.1136/bmjopen-2018-025357 http://dx.doi.org/10.1136/bmjopen-2018-025357 2019-10-04T11:25:15Z ["General Medicine"] 26 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>We have previously developed and validated the Arthritis Research UK Musculoskeletal Health Questionnaire (MSK-HQ) for use across musculoskeletal care pathways, showing encouraging psychometric test results. The objective of this study was to determine the responsiveness of MSK-HQ following MSK treatments and to determine the minimally important change (MIC).</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>We collected data in four cohorts from community physiotherapy and secondary-care orthopaedic hip, knee and shoulder clinics.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>592 individuals were recruited; 210 patients treated with physiotherapy for a range of MSK conditions in primary care; 150 patients undergoing hip replacement, 150 patients undergoing knee replacement and 82 undergoing shoulder surgery in secondary care.</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>Preoperative data were collected including the MSK-HQ, European Quality of Life-5D (EQ-5D) and the OHS, OKS or OSS in each joint-specific group. The same scores, together with anchor questions, were collected postintervention at 3 months for the physiotherapy group and 6 months for all others. Following COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines, responsiveness was assessed using correlation between scores and the MIC was calculated for the entire cohort using receiver operating characteristic curve analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The MSK-HQ demonstrated strong correlation (R=0.73) with EQ-5D across the entire cohort and with each of the joint-specific Oxford scores (hip R=0.87, knee R=0.92 and shoulder R=0.77). Moderate correlation was seen between MSK-HQ and EQ-5D across each individual group (R value range 0.60–0.68), apart from the hip group where correlation was strong (R=0.77). The effect size with MSK-… 15 ["http://orcid.org/0000-0002-4258-5866"] ["Andrew James Price", "Reuben Ogollah", "Sujin Kang", "Elaine Hay", "Karen L Barker", "Elena Benedetto", "Stephanie Smith", "James Smith", "James B Galloway", "Benjamin Ellis", "Jonathan Rees", "Sion Glyn-Jones", "David Beard", "Ray Fitzpatrick", "Jonathan C Hill"] ["20518"] ["Arthritis Research UK"] ["10.13039/501100000341"]
88 88 ["Systematic review and meta-analysis of prognostic factors of acute exacerbation of idiopathic pulmonary fibrosis"] 10.1136/bmjopen-2019-035420 http://dx.doi.org/10.1136/bmjopen-2019-035420 2020-06-16T06:15:18Z ["General Medicine"] 89 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objective</jats:title><jats:p>To clarify prognostic factors of acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF).</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A systematic review and meta-analysis.</jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p>Medline, Embase and Science Citation Index Expanded were searched from 2002 through 1 March 2019.</jats:p></jats:sec><jats:sec><jats:title>Eligibility criteria for selecting studies</jats:title><jats:p>The review included primary studies addressing the association between the outcomes such as all-cause mortality of AE of IPF and its potential prognostic factors, which were designated as any clinical information related to the outcomes.</jats:p></jats:sec><jats:sec><jats:title>Data extraction and synthesis</jats:title><jats:p>Two reviewers extracted relevant data independently and assessed risk of bias. Univariate results were pooled using a random-effect model if at least three studies were available. Prognostic factors were determined based on significant and consistent results on both univariate and multivariate analyses in the majority of studies.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Out of a total of 6763 articles retrieved, 37 were eligible and 31 potential prognostic factors for all-cause mortality were selected. Each study was subject to certain methodological shortcomings. The following five factors were statistically significant by a meta-analysis of univariate results, which was confirmed by multivariate analysis, that is, Acute Physiology and Chronic Health Evaluation (APACHE) II score (HR 1.10, 1.01 to 1.19), partial pressure of arterial oxygen to fraction of inspired oxygen (PaO<jats:sub>2</jats:sub>/FiO<jats:sub>2</jats:sub>) ratio (ORs 0.99 in two studies and HRs 0.31 and 0.99 in two studies, respectively), lactate dehydrogenase (LDH) (HRs 1.002, 1.003, 1.01 and 1.02), white blood cell (WBC) count (OR 1.38, 1.04 to 1.83) and oxygen therapy bef… 2 ["http://orcid.org/0000-0001-5623-1279"] ["Hiroyuki Kamiya", "Ogee Mer Panlaqui"] [""] [""] [""]
91 91 ["Dance PREEMIE, a Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age: an Australian feasibility trial protocol"] 10.1136/bmjopen-2019-034256 http://dx.doi.org/10.1136/bmjopen-2019-034256 2020-01-27T10:04:30Z ["General Medicine"] 41 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Introduction</jats:title><jats:p>Children born extremely preterm (EP: &lt;28 weeks gestation) and/or extremely low birth weight (ELBW: &lt;1000 g) are at increased risk of motor impairment compared with children born at term. Children with motor impairment have lower rates of physical activity (PA) participation compared with their typically developing peers. PA participation is an important outcome for children with motor impairment, however, there is limited evidence available to support interventions that improve PA participation in this population. The aim of this study is to assess the feasibility, including the recruitment and retention, acceptability and fidelity, of a preschool dance participation intervention for children born EP/EBLW with motor impairment called Dance PaRticipation intervention for Extremely prEterm children with Motor Impairment at prEschool age.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This feasibility case series trial will recruit EP/ELBW children with motor impairment (n=10) from the Victorian Infant Collaborative Study 2016/2017 cohort, a prospective longitudinal cohort study. Up to 10 community-based dance teachers will be recruited and provided with physiotherapy-led training and support to facilitate the participation of EP/ELBW children in community dance classes. A mixed-methods approach (quantitative and qualitative) will be used to analyse the primary aim, to determine the feasibility of the intervention from the perspectives of families and dance teachers.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>This study is approved by the Human Research Ethics Committees of The Royal Children’s Hospital and The Royal Women’s Hospital, Melbourne. Study outcomes will be disseminated through conference presentations, peer-reviewed publications and social media.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>ACTRN12619001266156</jats:p></jats:s… 6 ["http://orcid.org/0000-0001-5447-594X", "http://orcid.org/0000-0003-3775-9267", "http://orcid.org/0000-0003-1344-1465", "http://orcid.org/0000-0001-5474-6404", "http://orcid.org/0000-0001-5901-0455", "http://orcid.org/0000-0002-6535-661X"] ["Kate L Cameron", "Jennifer L McGinley", "Kim Allison", "Natalie A Fini", "Jeanie L Y Cheong", "Alicia J Spittle"] ["S18-021"] ["Physiotherapy Research Foundation", "National Health and Medical Research Council"] ["10.13039/501100008305", "10.13039/501100000925"]
95 95 ["Another look at what teachers and students think about interprofessional learning as a shared experience in Iran: a qualitative research"] 10.1136/bmjopen-2017-020015 http://dx.doi.org/10.1136/bmjopen-2017-020015 2018-10-31T06:05:15Z ["General Medicine"] 39 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To explore experiences of interprofessional learning (IPL), and how faculty and students might want to participate in IPL opportunities as a form of shared learning.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Qualitative study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Ministry of Health and Medical Education which is accountable for rendering service to the public, providing healthcare needs and improving the quality of medical education was established in Iran in 1985, to integrate medical education with healthcare services.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>A sample of six faculty members and seven students, purposively sampled for demographic characteristics and their experience regarding shared learning.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A descriptive qualitative study using thematic analysis of content was conducted. Data were obtained using semistructured interviews and then analysed thematically. Data collection and analysis were concurrent.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Three categories were identified: the role of prologues in IPL, the role of structured IPL, and the role of context and structure in such a system for learning, representing seven subcategories.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The findings indicate that experiences of learning with different professionals are complex, and these experiences shape their present and future workplace relations. Matching the existing educational context and structure with IPL and providing planned interaction and reflection among professionals are necessary to support IPL.</jats:p></jats:sec> 2 [] ["Soleiman Ahmady", "Mahboobeh Khabaz Mafinejad"] [""] [""] [""]
96 96 ["What predicts regression from pre-diabetes to normal glucose regulation following a primary care nurse-delivered dietary intervention? A study protocol for a prospective cohort study"] 10.1136/bmjopen-2019-033358 http://dx.doi.org/10.1136/bmjopen-2019-033358 2019-12-10T05:19:18Z ["General Medicine"] 0 0 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Introduction</jats:title><jats:p>Pre-diabetes is a high-risk state for the development of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Regression to normoglycaemia, even if transient, significantly reduces the risk of developing T2DM. The primary aim of this mixed-methods study is to determine if there are clinically relevant differences among those with pre-diabetes and excess weight who regress to normoglycaemia, those who have persistent pre-diabetes and those who progress to T2DM following participation in a 6-month primary care nurse-delivered pre-diabetes dietary intervention. Incidence of T2DM at 2 years will be examined.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>Four hundred participants with pre-diabetes (New Zealand definition glycated haemoglobin 41–49 mmol/mol) and a body mass index <jats:underline>&gt;</jats:underline>25 kg/m<jats:sup>2</jats:sup> will be recruited through eight primary care practices in Hawke’s Bay, New Zealand. Trained primary care nurses will deliver a 6-month structured dietary intervention, followed by quarterly reviews for 18 months post-intervention. Clinical data, data on lifestyle factors and health-related quality of life (HR-QoL) and blood samples will be collected at baseline, 6 months, 12 months and 24 months. Sixty participants purposefully selected will complete a semi-structured interview following the 6-month intervention. Poisson regression with robust standard errors and clustered by practice will be used to identify predictors of regression or progression at 6 months, and risk factors for developing T2DM at 2 years. Qualitative data will be analysed thematically. Changes in HR-QoL will be described and potential cost savings will be estimated from a funder’s perspective at 2 years.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>This study was approved by the Northern A Health and Disability Ethics Committee, New Zealand (Ethics Reference: 17/NTA/24).… 10 ["http://orcid.org/0000-0003-0996-2874"] ["Kirsten Coppell", "Trish Freer", "Sally Abel", "Lisa Whitehead", "David Tipene-Leach", "Andrew R Gray", "Tony Merriman", "Trudy Sullivan", "Jeremy Krebs", "Leigh Perreault"] ["16/344"] ["Health Research Council of New Zealand"] ["10.13039/501100001505"]
53 53 ["Diagnostic value of blood variables following attenuation of congenital extrahepatic portosystemic shunt in dogs"] 10.1136/vr.105296 http://dx.doi.org/10.1136/vr.105296 2019-10-29T21:28:27Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:sec><jats:title>Background</jats:title><jats:p>The aims of this study were to determine if extrahepatic portosystemic shunt (EHPSS) postoperative closure could be predicted based on preoperative blood analyses and to determine the accuracy of blood variables to evaluate persistence of portosystemic shunting postoperatively (multiple acquired portosystemic shunts (MAPSS) or persistent EHPSS).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Retrospectively, 62 dogs treated surgically for congenital EHPSS that underwent postoperative trans-splenic portal scintigraphy or CT angiography three to six months postoperatively were included.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>None of the studied preoperative blood variables could unambiguously predict surgical outcome. Elevated postoperative fasting venous ammonia (FA) concentration always indicated surgical failure (persistent shunting or MAPSS), but normal FA did not provide any information on the postoperative shunting status. Paired serum bile acids (SBA) were not reliable enough to confirm or exclude postoperative shunting. In the presence of low normal postoperative FA levels, elevated preprandial SBA was more likely in dogs with persistent shunting (sensitivity of 0.79, specificity of 0.83), whereas postprandial SBA below reference limit was more often observed in case of surgical success (sensitivity of 0.93, specificity of 0.67).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Blood variables, and more specifically the combination of FA and SBA, are not a valuable alternative to advanced medical imaging to reliably assess the surgical outcome after EHPSS surgery.</jats:p></jats:sec> 9 ["http://orcid.org/0000-0002-2426-9296"] ["Nicolas Vallarino", "Steven Pil", "Nausikaa Devriendt", "Matan Or", "Eva Vandermeulen", "Gon\u00e7alo Serrano", "Dominique Paepe", "Tim Bosmans", "Hilde de Rooster"] [""] [""] [""]
75 75 ["Coming together to learn, discuss and support"] 10.1136/vr.m2361 http://dx.doi.org/10.1136/vr.m2361 2020-06-11T21:07:16Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p><jats:bold>Rachel Garty</jats:bold>, national president of the Farm Animal Veterinary Society and final-year vet student, introduces ‘Carpool Cases’ and highlights the importance of supporting the next generation of vets.</jats:p> 0 [""] [""] [""] [""] [""]
87 87 ["From teacher to trailblazer"] 10.1136/vr.k5185 http://dx.doi.org/10.1136/vr.k5185 2018-12-06T21:54:32Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p><jats:bold>Nalinika Obeyesekere</jats:bold> was recently awarded the World Small Animal Veterinary Association’s inaugural award for companion animal welfare in recognition of her contribution to raising standards of veterinary care in Sri Lanka.</jats:p> 0 [""] [""] [""] [""] [""]
92 92 ["Building confidence in independent practice"] 10.1136/vr.l619 http://dx.doi.org/10.1136/vr.l619 2019-02-08T10:40:35Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p>Never short of an opinion, <jats:bold>Andrew Curwen</jats:bold> is bullish about the future of independent vet businesses. The chief executive serving XLVets tells Adele Waters why it’s time to start shouting about the benefits of collaboration.</jats:p> 0 [""] [""] [""] [""] [""]
100 100 ["Support and share our manifesto for animals, vets and public health"] 10.1136/vr.l6849 http://dx.doi.org/10.1136/vr.l6849 2019-12-05T21:35:15Z ["General Veterinary", "General Medicine"] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p>With this month’s General Election fast approaching, BVA Public Affairs Manager <jats:bold>Helena Cotton</jats:bold> highlights the 10 pledges BVA has been encouraging all political parties to include in their manifestos.</jats:p> 0 [""] [""] [""] [""] [""]
56 56 ["High-grade astrocytoma with ventricular invasion in a dog"] 10.1136/vetreccr-2019-000958 http://dx.doi.org/10.1136/vetreccr-2019-000958 2019-12-03T10:42:48Z ["General Veterinary"] 22 0 ["2052-6121"] Veterinary Record Case Reports <jats:p>A 13-year-old female German Shepherd dog was euthanised and submitted to necropsy after a 7-month history of prolonged recumbency and vocalisation. Gross anatomical changes consisted of a well-demarcated, 3.5×1.5 cm, soft red mass that effaced the right lateral ventricle and compressed the adjacent neuroparenchyma. Histologically, elongate neoplastic cells with astrocytic morphology were arranged in short bundles and streams supported by a neuropil-like stroma. Neoplastic cells were immunopositive for glial fibrillar acidic protein (GFAP) and oligodendrocyte transcription factor 2 (Olig2), and immunonegative for e-cadherin and pancytokeratin. Histological and immunohistochemical features were consistent with a high-grade astrocytoma with ventricular invasion, a rare feature of astrocytic tumours in dogs.</jats:p> 5 ["http://orcid.org/0000-0002-7128-8756"] ["Rayane Chitolina Pupin", "Daniel R Rissi", "Danilo Carloto Gomes", "Amanda Gimelli", "Mariana Isa Poci Palumbo"] [""] [""] [""]
99 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"]
67 67 ["Risk and protective factors associated with BV chronicity among women in Rakai, Uganda"] 10.1136/sextrans-2019-054145 http://dx.doi.org/10.1136/sextrans-2019-054145 2019-10-10T21:16:02Z ["Infectious Diseases", "Dermatology"] 0 0 ["1368-4973", "1472-3263"] Sexually Transmitted Infections <jats:sec><jats:title>Objectives</jats:title><jats:p>To assess risk and protective factors associated with bacterial vaginosis (BV) chronicity ascertained by Nugent score criteria.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A longitudinal cohort study included 255 sexually experienced, postmenarcheal women who provided weekly self-collected vaginal swabs for up to 2 years. Vaginal swabs were scored using Nugent criteria and classified as normal (≤3), intermediate (4–6) and Nugent-BV (≥7). Detailed behavioural/health information were assessed every 6 months. A per-woman longitudinal summary measure of BV chronicity was defined as the percentage of each woman’s weekly vaginal assessments scored as Nugent-BV over a 6-month interval. Risk and protective factors associated with BV chronicity were assessed using multiple linear regression with generalised estimating equations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Average BV chronicity was 39% across all follow-up periods. After adjustment, factors associated with BV chronicity included baseline Nugent-BV (β=35.3, 95% CI 28.6 to 42.0) compared with normal baseline Nugent scores and use of unprotected water for bathing (ie, rainwater, pond, lake/stream) (β=12.0, 95% CI 3.4 to 20.5) compared with protected water sources (ie, well, tap, borehole). Women had fewer BV occurrences if they were currently pregnant (β=−6.6, 95% CI −12.1 to 1.1), reported consistent condom use (β=−7.7, 95% CI −14.2 to 1.3) or their partner was circumcised (β=−5.8, 95% CI −11.3 to 0.3).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Factors associated with higher and lower values of BV chronicity were multifactorial. Notably, higher values of BV chronicity were associated with potentially contaminated bathing water. Future studies should examine the role of waterborne microbial agents in the pathogenesis of BV.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0001-9267-4384", "http://orcid.org/0000-0001-8762-6214"] ["Marie E Thoma", "Rebecca M Brotman", "Ronald H Gray", "Nelson K Sewankambo", "Maria J Wawer"] ["R01AI47608"] ["Eunice Kennedy Shriver National Institute of Child Health and Human Development", "Centers for Disease Control and Prevention", "National Institute of Allergy and Infectious Diseases"] ["10.13039/100009633", "10.13039/100000030", "10.13039/100000060"]
60 60 ["Successful use of anti-retroviral therapy in combination with cytotoxic chemotherapy for persistent molar pregnancy: A case report"] 10.1136/ijgc-00009577-200303000-00026 http://dx.doi.org/10.1136/ijgc-00009577-200303000-00026 2019-03-06T09:50:37Z ["Obstetrics and Gynaecology", "Oncology"] 0 0 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>Due to the HIV pandemic, the chances of finding gynecological malignancies in HIV-infected women are increased. This poses management and ethical dilemmas as the treatment for such malignancies are likely to further decrease their immunity. Gestational trophoblastic disease occurs predominantly among young women and has excellent response to chemotherapy. However, such therapy is not possible if their immunity (CD<jats:sub>4</jats:sub> counts) is markedly depressed. The patient described presented with persistent molar pregnancy and had low CD<jats:sub>4</jats:sub> count. She was given antiretroviral therapy and once the CD<jats:sub>4</jats:sub> count had risen to acceptable levels cytotoxic chemotherapy was administered. She received a total of 13 cycles of chemotherapy with no significant untoward effects. After a 6-month follow-up period the patient was well with a negative serum βHCG level and CD<jats:sub>4</jats:sub> count above 200. We conclude that HIV-infected women with gestational trophoblastic disease may be safely treated with cytotoxic chemotherapy provided anti-retroviral therapy is concurrently administered to boost immunity.</jats:p> 2 [] ["M. Moodley", "J. Moodley"] [""] [""] [""]
62 62 ["The Selection of Time Interval Between Surgery and Adjuvant Therapy in Early Stage Cervical Cancer"] 10.1097/igc.0000000000001307 http://dx.doi.org/10.1097/igc.0000000000001307 2018-08-02T22:02:59Z ["Obstetrics and Gynaecology", "Oncology"] 21 0 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Objectives</jats:title><jats:p>The optimal interval between surgery and adjuvant treatment has not yet been found in cervical cancer. And whether patients with different FIGO stage should choose different interval is unknown. The purpose of this study was to evaluate whether interval has a different effect on oncologic outcome for patients with different tumor stages.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed a retrospective study of 226 cervical cancer patients who were treated by surgery and adjuvant therapy from May 2005 to August 2015. All patients were divided into 2 groups according to the interval of 5 weeks. Overall survival (OS) and disease-free survival (DFS) were compared between patients with interval shorter and longer than 5 weeks in the whole group and subgroups. Recurrence patterns were also analyzed. Multivariate analysis was performed to explore clinical factors significantly associated with DFS, local recurrence-free survival and distant metastasis-free survival for patients with stage IB2–IIA.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>For patients with stage IA2–IB1, the 5-year OS and DFS were similar between groups of short and long interval with also the comparable results of local and distant failure. For patients with IB2–IIA, both the OS and DFS in the short-interval group were higher than that in the long-interval group. Besides, the rates of local recurrence were found higher in the group of long interval compared with short interval. Multivariable analysis indicated that time interval was an independent predictor of DFS and local recurrence-free survival for patients with stage IB2–IIA.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In cervical cancer patients, time interval between surgery and adjuvant therapy may have different effects on the prognosis in different FIGO stages.</jats:p></jats:sec> 6 [] ["Kai-Yun You", "Xin-Hui Zhou", "Yan-Hui Jiang", "Zhuo-Fei Bi", "Yi-Min Liu", "Xing-Sheng Qiu"] [""] [""] [""]
71 71 ["Phase III randomized pilot study comparing interferon \u03b1- 2b in combination with radiation therapy versus radiation therapy alone in patients with stage III-B carcinoma of the cervix"] 10.1136/ijgc-00009577-200303000-00011 http://dx.doi.org/10.1136/ijgc-00009577-200303000-00011 2019-03-06T14:50:37Z ["Obstetrics and Gynaecology", "Oncology"] 0 0 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>This randomized pilot study was designed to determine whether the addition of interferon α-2b to standard radiation therapy offered an advantage in loco-regional control and survival over radiation therapy alone in a homogeneous group of patients with stage IIIB carcinoma of the cervix. Thirty-six patients were treated with a combination of interferon α-2b plus radiation therapy, and 38 patients were treated with radiation therapy alone. Patients with evidence of ureteral obstruction were excluded from the study. Evaluation of loco-regional response was determined by pelvic examination, cervical cytology, biopsies and CT scans when indicated. Survival time was measured from initiation of treatment to date of death or last follow-up. Patient characteristics were comparable between both study arms. The objective complete response rate was 67% in the combined therapy group and 55% in the radiation alone group (<jats:italic>P</jats:italic> = 0.454). With a median follow-up of 17 months for all patients and 31 months for live patients, 50% of the combined group survived vs. 39.5% of the radiation alone group (<jats:italic>P</jats:italic> = 0.424). We conclude that the addition of interferon α-2b to standard radiation therapy did not significantly improve loco-regional response or survival, although such a trend was noted. We encourage the design of a larger randomized study with sufficient power to detect meaningful differences to prove whether the tendency observed in the present investigation holds any promise to improve the outcome of these patients.</jats:p> 14 [] ["R. Yazigi", "G. Aliste", "R. Torres", "A. M. Ciudad", "M. Cuevas", "J. Garrido", "S. Prado", "A. Sol\u00e1", "R. Castillo", "B. Cerda", "M. A. Cumsille", "M. Gonz\u00e1lez", "C. Navarro", "J. M. Reyes"] [""] [""] [""]
69 69 ["Cell therapy for the preterm infant: promise and practicalities"] 10.1136/archdischild-2019-317896 http://dx.doi.org/10.1136/archdischild-2019-317896 2020-04-06T21:15:32Z ["Obstetrics and Gynaecology", "Pediatrics, Perinatology, and Child Health", "General Medicine"] 0 0 ["1359-2998", "1468-2052"] Archives of Disease in Childhood - Fetal and Neonatal Edition <jats:p>Recent decades have seen the rapid progress of neonatal intensive care, and the survival rates of the most preterm infants are improving. This improvement is associated with changing patterns of morbidity and new phenotypes of bronchopulmonary dysplasia and preterm brain injury are recognised. Inflammation and immaturity are known contributors to their pathogenesis. However, a new phenomenon, the exhaustion of progenitor cells is emerging as an important factor. Current therapeutic approaches do not adequately address these new mechanisms of injury. Cell therapy, that is the use of stem and stem-like cells, with its potential to both repair and prevent injury, offers a new approach to these challenging conditions. This review will examine the rationale for cell therapy in the extremely preterm infant, the preclinical and early clinical evidence to support its use in bronchopulmonary dysplasia and preterm brain injury. Finally, it will address the challenges in translating cell therapy from the laboratory to early clinical trials.</jats:p> 5 ["http://orcid.org/0000-0001-6742-7314"] ["Elizabeth K Baker", "Susan E Jacobs", "Rebecca Lim", "Euan M Wallace", "Peter G Davis"] ["Research Training Program Scholarship"] ["University of Melbourne", "National Health and Medical Research Council"] ["10.13039/501100001782", "10.13039/501100000925"]
72 72 ["Diffuse excessive high signal intensity on term equivalent MRI does not predict disability: a systematic review and meta-analysis"] 10.1136/archdischild-2019-318207 http://dx.doi.org/10.1136/archdischild-2019-318207 2020-05-25T21:17:07Z ["Obstetrics and Gynaecology", "Pediatrics, Perinatology, and Child Health", "General Medicine"] 39 0 ["1359-2998", "1468-2052"] Archives of Disease in Childhood - Fetal and Neonatal Edition <jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate whether diffuse excessive high signal intensity (DEHSI) on term equivalent age MRI (TEA-MRI) predicts disability in preterm infants.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This is a systematic review and meta-analysis. Medline, EMBASE, Cochrane Library, EMCARE, Google Scholar and MedNar databases were searched in July 2019. Studies comparing developmental outcomes of isolated DEHSI on TEA-MRI versus normal TEA-MRI were included. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was undertaken where data were available in a format suitable for pooling.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Neurodevelopmental outcomes ≥1 year of corrected age based on validated tools.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 15 studies (n=1832) were included, of which data from 9 studies were available for meta-analysis. The pooled estimate (n=7) for sensitivity of DEHSI in predicting cognitive/mental disability was 0.58 (95% CI 0.34 to 0.79) and for specificity was 0.46 (95% CI 0.20 to 0.74). The summary area under the receiver operating characteristics (ROC) curve was low at 0.54 (CI 0.50 to 0.58). A pooled diagnostic OR (DOR) of 1 indicated that DEHSI does not discriminate preterm infants with and without mental disability. The pooled estimate (n=8) for sensitivity of DEHSI in predicting cerebral palsy (CP) was 0.57 (95% CI 0.37 to 0.75) and for specificity was 0.41 (95% CI 0.24 to 0.62). The summary area under the ROC curve was low at 0.51 (CI 0.46 to 0.55). A pooled DOR of 1 indicated that DEHSI does not discriminate between preterm infants with and without CP.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>DEHSI on TEA-MRI did not predict future development of cognitive/mental disabilities or CP.</jats:p></jats:sec><jats:sec><jats:title>PROSPERO registration number</jats:title><jats:p>CRD4… 4 [] ["Chandra Prakash Rath", "Saumil Desai", "Shripada C Rao", "Sanjay Patole"] [""] [""] [""]
52 52 ["DEVELOPMENT AND ESTABLISHMENT OF A QUALITY-FRAMEWORK FOR THE LENA PROJECT"] 10.1136/archdischild-2015-310148.72 http://dx.doi.org/10.1136/archdischild-2015-310148.72 2015-12-15T08:07:33Z ["Pediatrics, Perinatology, and Child Health"] 0 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>The LENA (Labeling of Enalapril from Neonates up to Adolescents) project has been initiated to improve the healthcare of children with heart failure by an enalapril orodispersible mini-tablet. The LENA consortium combines academic clinical research centers, SMEs (small and medium-sized enterprises) and a patient/parent advocacy organization. The objective of the project requires to comply with respective GxP regulations like Good Manufacturing Practice (GMP), Good Clinical (Laboratory) Practice (GCP/“GCLP”1) and Good Vigilance Practice (GVP). The project team is comprised of sub-teams experienced in paediatric clinical practice, medicines development, clinical research and project management, but not all team members work in an appropriate quality framework. Aim: To establish a well-documented, efficient quality system applying a new approach for ensuring quality in all trial aspects by combining existing organization-related quality system elements of the project partners with newly developed SOPs and overarching, integrating trial-specific elements to ensure a reliable quality environment for the LENA Phase I clinical trial.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Based on the network-structure of the project organization, a strategy based on a team approach with joint responsibilities for the quality conduct of the project was pursuit, forming a QM Team consisting of the project leader, the leaders for pharmaceutical and clinical development and an external quality expert. The team compiled a quality manual and an organizational chart displaying the sub-teams and their responsibilities. Another responsibility of the team is the integration of existing SOPs and Work Instructions as well as the creation of procedures at the project level and furthermore the verification of appropriate qualification of all staff involved in the project through CVs, job descriptions and training records.</jats:p></jats:sec><jats:sec><jats:title>Resul… 7 [] ["Agnes M. Ciplea", "Karl Kleine", "Bj\u00f6rn B. Burckhardt", "Stephanie L\u00e4er", "J\u00f6rg Breitkreutz", "Lucie \u0160patenkov\u00e1", "Ingrid Klingmann"] [""] [""] [""]
55 55 ["MEDICATION USE IN NEONATAL INTENSIVE CARE UNITS ACROSS EUROPE"] 10.1136/archdischild-2015-310148.11 http://dx.doi.org/10.1136/archdischild-2015-310148.11 2015-12-15T08:07:33Z ["Pediatrics, Perinatology, and Child Health"] 0 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Objectives</jats:title><jats:p>This is the first Europe-wide study aiming to describe the medication use in Neonatal Intensive Care Units and to analyse the factors that might influence the prescription pattern.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A pan-European one day point-prevalence study was conducted in 2012 where all of the prescriptions for hospitalised neonates were recorded. A trade name, manufacturer, active pharmaceutical ingredients (API), strength, galenic form and route of administration were registered.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Altogether 2173 prescriptions were administered to 726 neonates from 21 countries, of whom 66% (477/726) were preterm, 12% (84/726) extremely preterm. There was inverse correlation between gestational age (GA) and median number of prescriptions per neonate (group median 2/IQR 1–4, extremely preterm 4/3–6, very preterm 3/2–5, late preterm 2/1–3, full-term 2/1–3). Median number of prescriptions per neonate was highest in the eastern region, among extremely preterm neonates (median=6.5/IQR 6–8.5). Highest prescription rate was for alimentary medicines (93/per 100 admissions), systemic antiinfectives (79/100) and medicines for blood (71/100). Antiinfectives were most frequently prescribed in the southern region (103/100). Multivitamins were most frequently used medications in most regions (western 74, southern 31, northern 31/100), except in eastern region (5/100). Most commonly prescribed API-s were multivitamins (32/100), caffeine (19/100), gentamicin (18/100), amino acids (18/100) and colecalciferol (15/100). Most frequently prescribed medications among extremely preterm neonates were caffeine (60/100), among very preterms multivitamins and caffeine (45 and 43/100), among late preterms multivitamins (44/100) and among full-terms phytomenadione (26/100) and gentamicin (24/100).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our study revealed the most c… 4 [] ["Inge Mesek", "Georgi Nellis", "Jana Lass", "Irja Lutsar"] [""] [""] [""]
68 68 ["Drug utilisation among Dutch adolescents: a pharmacy prescription records study"] 10.1136/archdischild-2017-314692 http://dx.doi.org/10.1136/archdischild-2017-314692 2018-06-01T16:16:30Z ["Pediatrics, Perinatology, and Child Health"] 12 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>Studies on adolescent drug use are scarce as most studies do not distinguish between children and adolescents. Therefore, we assessed overall drug use in adolescents.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective cohort study was conducted using pharmacy dispensing records from 62 community pharmacies in the Netherlands. Dispensing records of the previous 5 years were extracted for adolescents (12–18 years).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The study population consisted of 47 421 adolescents who collected at least one medication prescription during adolescence (mean age 15.5±1.8 years; 48.9% males). Half of them collected dermatologicals (46.2% males; 52.3% females), followed by drugs for the respiratory system (43.4% males; 40.3% females) and anti-infectives for systemic use (31.3% males; 39.1% females). The percentage of males using dermatologicals slightly increased, while the percentage of female users decreased with age. The most prescribed active ingredient was methylphenidate.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These insights into adolescent drug use help us to better understand adolescent healthcare use.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>Dutch trial register NTR5061.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0001-9059-1278"] ["Richelle C Kosse", "Ellen S Koster", "Tjalling W de Vries", "Marcel L Bouvy"] [""] [""] [""]
74 74 ["SELF-ADMINISTRATION OF IN-PATIENT MEDICATIONS: A PILOT STUDY IN CHILDREN WITH CYSTIC FIBROSIS"] 10.1136/archdischild-2016-311535.70 http://dx.doi.org/10.1136/archdischild-2016-311535.70 2016-08-18T07:07:30Z ["Pediatrics, Perinatology, and Child Health"] 1 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Introduction</jats:title><jats:p>Children with Cystic Fibrosis (CF) have complex medication regimens, where responsibility for administration usually lies with the parent/carer until the child is older and able to take over this role.1 On admission to hospital this role is usually undertaken by nurses, leaving patients/parents/carers feeling disempowered, and unprepared for discharge.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>All CF admissions to be offered the Self-Administration Of Medicines Scheme (SAM).</jats:p><jats:p>▸ Empower patients/parents/carers with responsibility of administering their own medications</jats:p><jats:p>▸ Reduce nursing time</jats:p><jats:p>▸ Educate patients/parents/carers about their medications</jats:p><jats:p>▸ Cost-saving by utilising Patients Own Medicines (PODs).</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>A policy and training programme was developed and approved by the Trust's Medicines Management Board. This provided a framework for staff to use so that they may:</jats:p><jats:p>▸ Obtain consent</jats:p><jats:p>▸ Evaluate and re-use PODs</jats:p><jats:p>▸ Safely store and obtain supplies</jats:p><jats:p>▸ Continuously negotiate accountability for administration with patient/parent/carer.</jats:p><jats:p>The study was conducted over a 10 month period, where all families with CF admitted, were assessed for participation in SAM. The nursing teams acted as the primary assessors for SAM and any concerns were referred to the paediatric CF multidisciplinary team. To evaluate the pilot, families were given questionnaires to establish their views about the scheme. Nurses were asked to feedback if SAM decreased time for medication administration. To evaluate the associated cost-saving, data on PODs suitable for re-use was collected.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>159 children with CF were admitted to the ward, 95 (60%) were assessed to participate in the scheme and 64 (40%) of the… 7 [] ["Khola Khan", "Aoife Harrington", "Rupinder Pannu", "Sian Bentley", "Sukeshi Makhecha", "Nimla Pentayya", "Clare Pheasant"] [""] [""] [""]
98 98 ["Children with chronic health disorders travelling to the tropics: a prospective observational study"] 10.1136/archdischild-2015-309436 http://dx.doi.org/10.1136/archdischild-2015-309436 2016-06-11T04:55:23Z ["Pediatrics, Perinatology, and Child Health"] 19 0 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Background</jats:title><jats:p>The number of trips to the tropics taken by children with chronic health disorders (CHDs) is increasing.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>All of the children with CHDs who attended two international vaccination centres in France before travelling to the tropics were included in a prospective, exposed/unexposed study. Each child was age-matched with two control children and followed for 1 month after returning from the tropics.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Fifty-six children with CHDs and 107 control children were included. The children's median age was 6 years old (IQR 2–11). Of the study participants, 127/163 (78%) travelled to West Africa, mainly to visit relatives. The median duration of the stay was 42 days (IQR 31–55). The age of the children, the destination and the duration of the trip were similar between the two groups. Sickle cell disease (23/56) and asthma (16/56) were the most common CHDs. Overall, the children with CHDs experienced more clinical events than the control patients did (p&lt;0.05); however, there was no difference when chronic disease exacerbations were excluded (p=0.64) or when only the period abroad was considered (p=0.24). One child with a recent genetic diagnosis of atypical haemolytic uraemic syndrome died from a first disease exacerbation.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Health problems among children with CHDs travelling abroad are mainly related to chronic disease exacerbations, which mostly occur after the children return. Patients with diseases that require highly specialised care for an exacerbation should avoid travelling to resource-limited tropical countries.</jats:p></jats:sec> 12 [] ["Camille Ducrocq", "Julie Sommet", "Dora Levy", "Thanh-Van Trieu", "Fabrice Quercia", "Laurence Morin", "Xavier Belletre", "B\u00e9reng\u00e8re Koehl", "Frederic Sorge", "Corinne Alberti", "Loic de Pontual", "Albert Faye"] [""] [""] [""]
48 48 ["Cancer and the emotions in 18th-century literature"] 10.1136/medhum-2018-011639 http://dx.doi.org/10.1136/medhum-2018-011639 2019-11-06T22:15:31Z ["Philosophy", "Pathology and Forensic Medicine"] 0 0 ["1468-215X", "1473-4265"] Medical Humanities <jats:p>This essay argues that the emotional rhetoric of today’s breast cancer discourse—with its emphasis on stoicism and ‘positive thinking’ in the cancer patient, and its use of sympathetic feeling to encourage charitable giving—has its roots in the long 18th century. While cancer had long been connected with the emotions, 18th-century literature saw it associated with both ‘positive’ and ‘negative’ feelings, and metaphors describing jealousy, love and other sentiments as ‘like a cancer’ were used to highlight the danger of allowing feelings—even benevolent or pleasurable feelings—to flourish unchecked. As the century wore on, breast cancer in particular became an important literary device for exploring the dangers of feeling in women, with writers of both moralising treatises and sentimental novels connecting the growth or development of cancer with the indulgence of feeling, and portraying emotional self-control as the only possible form of resistance against the disease. If, as Barbara Ehrenreich suggests, today’s discourse of ‘positive thinking’ has been mobilised to make patients with breast cancer more accepting of their diagnosis and more cooperative with punitive treatment regimens, then 18th-century fictional exhortations to stay cheerful served similarly conservative political and economic purposes, encouraging continued female submission to male prerogatives inside and outside the household.</jats:p> 1 ["http://orcid.org/0000-0002-7826-495X"] ["Noelle Gallagher"] [] ["University of Manchester"] ["10.13039/501100000770"]
94 94 ["Shame-to-cynicism conversion in The Citadel and The House of God"] 10.1136/medhum-2020-011882 http://dx.doi.org/10.1136/medhum-2020-011882 2020-06-16T22:00:13Z ["Philosophy", "Pathology and Forensic Medicine"] 34 0 ["1468-215X", "1473-4265"] Medical Humanities <jats:p>This article considers the dynamics of shame and cynicism in A J Cronin’s <jats:italic>The Citadel</jats:italic> (1937) and Samuel Shem’s <jats:italic>The House of God</jats:italic> (1978). The protagonists of both novels are forced into shameful situations. Their response to these situations is increased cynicism. This results in a feedback loop: cynicism begets shame, which, in turn, causes more cynicism. Drawing on Bonnie Mann’s work on shame-to-power conversion, the article suggests that the novels stage a shame-to-cynicism conversion, which anticipates possible links between cynicism and shame in medical education. The overwhelming success of both novels in shaping the popular imaginary of healthcare professionals means that this dynamic, far from being isolated to the novels, might speak to shared concerns in the education scholarship.</jats:p> 1 ["http://orcid.org/0000-0003-0817-6898"] ["Arthur Rose"] [""] [""] [""]
79 79 ["Processes and contexts influencing health inequalities among women who are mothers"] 10.1136/jech-2019-212229 http://dx.doi.org/10.1136/jech-2019-212229 2019-06-10T21:19:16Z ["Public Health, Environmental and Occupational Health", "Epidemiology"] 20 0 ["0143-005X", "1470-2738"] Journal of Epidemiology and Community Health <jats:p>This paper presents a conceptual framework that aims to conceptualise the different processes and contexts influencing health inequalities among women who are mothers. On the one hand, four processes are shown: (1) social stratification; (2) route into motherhood; (3) exposure and vulnerability to risk factors; and (4) generation of health inequalities. On the other hand, the role of the socioeconomic and political context, the labour market context, and the social, community and family context, as well as their inter-relationships, are presented. In addition, different family policy models, social values and cultural imperatives are considered.</jats:p> 5 ["http://orcid.org/0000-0001-6653-3393", "http://orcid.org/0000-0002-1170-2505"] ["Sara Trujillo-Alem\u00e1n", "Gloria Perez", "Jillian Reynolds", "Silvia Rueda", "Carme Borrell"] ["278173-2"] ["SOPHIE Project - Evaluating the Impact of Structural Policies on Health Inequalities and their Social Determinants and Fostering Change"] [[""]]
61 61 ["At the speed of Juul: measuring the Twitter conversation related to ENDS and Juul across space and time (2017\u20132018)"] 10.1136/tobaccocontrol-2019-055427 http://dx.doi.org/10.1136/tobaccocontrol-2019-055427 2020-03-20T21:16:55Z ["Public Health, Environmental and Occupational Health", "Health(social science)"] 0 0 ["0964-4563", "1468-3318"] Tobacco Control <jats:sec><jats:title>Background</jats:title><jats:p>Electronic nicotine delivery systems (ENDS) are the most-used tobacco product by adolescents, and Juul has rapidly become the most popular ENDS brand. Evidence indicates that Juul has been marketed heavily on social media. In light of recent lawsuits against the FDA spurred by claims that the agency responded inadequately to this marketing push, measuring the social media conversation about ENDS like Juul has important public health implications.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We employed search filters to collect Juul-related and other ENDS-related data from Twitter in 2017–2018 using Gnip Historic PowerTrack. Trained coders labelled random samples for Juul and ENDS relevance, and the labelled samples were used to train a supervised learning classifier to filter out irrelevant tweets. Tweets were geolocated into US counties and their <jats:italic>fitness for use</jats:italic> was assessed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The amount of Juul-related tweets increased 67 times over the study period (from 18 849 in the first quarter of 2017 to 1 287 028 in the last quarter of 2018), spreading widely across US counties. By the last quarter 2018, 34% of US counties had more than 6 Juul-related posts per 10 000 people, up from 0% in the first quarter 2017. However, during the same period, the total of non-Juul ENDS-related tweets decreased by 25%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Juul-related content grew exponentially on Twitter and spread across the entire country during the time when the brand was gaining market share. This social media buzz continued to increase even after FDA’s multiple interventions to curb promotions targeting minors.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0002-1685-1753", "http://orcid.org/0000-0002-3425-9155"] ["Yoonsang Kim", "Sherry L Emery", "Lisa Vera", "Bryn David", "Jidong Huang"] ["R01CA194681-04S1"] ["National Cancer Institute"] ["10.13039/100000054"]
57 57 ["Integrating complex systems science into road safety research and practice, part 1: review of formative concepts"] 10.1136/injuryprev-2019-043315 http://dx.doi.org/10.1136/injuryprev-2019-043315 2019-09-24T21:15:30Z ["Public Health, Environmental and Occupational Health"] 60 0 ["1353-8047", "1475-5785"] Injury Prevention <jats:p>Many of our most persistent public health problems are complex problems. They arise from a web of factors that interact and change over time and may exhibit resistance to intervention efforts. The domain of systems science provides several tools to help injury prevention researchers and practitioners examine deep, complex and persistent problems and identify opportunities to intervene. Using the increase in pedestrian death rates as an example, we provide (1) an accessible overview of how complex systems science approaches can augment established injury prevention frameworks and (2) a straightforward example of how specific systems science tools can deepen understanding, with a goal of ultimately informing action.</jats:p> 7 ["http://orcid.org/0000-0002-6648-0794"] ["Rebecca B Naumann", "Jill Kuhlberg", "Laura Sandt", "Stephen Heiny", "Yorghos Apostolopoulos", "Stephen W Marshall", "Kristen Hassmiller Lich"] ["R49/CE0042479"] ["National Center for Injury Prevention and Control", "Federal Highway Administration"] ["10.13039/100005217", "10.13039/100006285"]
76 76 ["O5A.1\u2005Definition of case management for return-to-work in the approach of workers with musculoskeletal disorders: an update using a scoping review"] 10.1136/oem-2019-epi.110 http://dx.doi.org/10.1136/oem-2019-epi.110 2020-05-08T06:57:14Z ["Public Health, Environmental and Occupational Health"] 0 0 ["1351-0711", "1470-7926"] Occupational and Environmental Medicine <jats:sec><jats:title>Purpose</jats:title><jats:p>We aim to identify the elements and functions that define the case management in the individual approach of workers with musculoskeletal disorders for return to work and to propose an updated definition.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Relevant articles were identified through a computerized search up to 1 December 2017 in the bibliographic databases PubMed, Web of Science, Scopus, Cochrane Library, IBECS, EMBASE, and LILACS. Language filter (English and Spanish) was included in the search. The inclusion criteria were working age population with musculoskeletal disorders, studies that described or evaluated case management interventions, and return to work interventions. Military personnel, and rheumatic and surgical pathologies were excluded. Independent pairs reviewed all cites and articles and extracted data, and narrative synthesis was carried out.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Our searches identified 1950 possible relevant articles, of which 27 were included for data extraction. Of these, 15 papers included definitions of case management, and 14 common elements were identified. Twenty two explained the role of case manager and in 18 a description of tasks was found. In 25 articles referral services were mentioned. The most common defining elements were ‘return to work intervention’, ‘multidisciplinary assessment’ and ‘interdisciplinary intervention’ (53.8%). The 40% of the articles emphasized the ’coordination’, ‘to influence multiple factors’ (33.3%) and ‘individual approach’ (26.7%). The tasks included ’to establish goals and plan the rehabilitation for return to work’ (50%), and ’supervise or coordinate return to work process and to offer/refer the employee to services/adaptations or therapeutic workplaces’ (36.4%) The most common offered services were mental health (64.0%), and rehabilitation (48.0%).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Despite… 5 [] ["Merc\u00e8 Soler Font", "Jos\u00e9 Maria Ramada Rodilla", "Jos\u00e9 Maria Gonzalez", "Francisco Palencia Sanchez", "Consol Serra Pujadas"] [""] [""] [""]
49 49 Nature, content and shifts over time of the most impactful unruptured intracranial aneurysms articles: a bibliometric analysis 10.1136/neurintsurg-2020-016238 http://dx.doi.org/10.1136/neurintsurg-2020-016238 2020-06-30T21:27:03Z ["Surgery", "Clinical Neurology", "General Medicine"] 29 0 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Background</jats:title><jats:p>The management of unruptured intracranial aneurysms (UIAs) has evolved significantly over the last few decades. Our objective was to evaluate the 100 most cited UIA articles by bibliometric analysis to identify nature, content and shifts over time.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Elsevier’s Scopus database was interrogated for the 100 most cited articles that focused on UIA. Older versus newer articles were compared, with categorical data analyzed using Pearson’s Chi-square, and continuous data analyzed using Wilcoxon’s rank-sum test.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The 100 most cited articles were published between 1975 and 2015, with the majority of these reporting patient clinical outcomes (n=69). There were 47/69 (68%) articles that described surgical intervention, with 38/47 (81%) and 18/47 (38%) including endovascular and open approaches, respectively . Publications peaked in 2004 (n=8), and the most common country of correspondence was the United States (n=59). Compared to older articles, newer articles had statistically higher citation rates (P&lt;0.01), higher number of authors (P&lt;0.01) with more multiple institution collaborations (P=0.01), greater disclosures of funding (P&lt;0.01), more focus on endovascular treatments (P=0.04), in more journals with a clinical, non-surgical focus (P&lt;0.01) published under open access policies (P&lt;0.01).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In the 100 most cited articles about UIAs to date, there is a distinct shift towards more co-authored efforts utilizing multi-institutional efforts focused on endovascular approaches supported by funding. The emergence of endovascular techniques has refreshed the need for more contemporary rupture risk prediction models and natural history data to validate current attitudes towards clinical management after these minimally invasive procedures for UIAs.</jats:p></ja… 4 ["http://orcid.org/0000-0002-9470-5890", "http://orcid.org/0000-0002-3679-3212"] ["Victor M Lu", "Stephanie H Chen", "Christopher C Young", "Robert M Starke"] ["R01NS111119-01A1"] ["Foundation for the National Institutes of Health"] ["10.13039/100000009"]
63 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"] [""] [""] [""]
50 50 ["Mediastinal cystic teratoma masquerading as a hydatid cyst"] 10.1136/bcr-2020-234755 http://dx.doi.org/10.1136/bcr-2020-234755 2020-06-30T06:17:26Z [] 8 0 ["1757-790X"] BMJ Case Reports <jats:p>A case is presented in which a preoperatively diagnosed hydatid cyst was found to be a mature cystic teratoma on pathological examination. Diagnostic dilemmas surrounding each disease are discussed.</jats:p> 4 [] ["David Williams", "Fang Zhou", "Max Grovenburg", "Mikhail Vaynblat"] [""] [""] [""]
51 51 ["A challenging presentation of invasive nasopharyngeal sarcomatoid carcinoma"] 10.1136/bcr-2018-226168 http://dx.doi.org/10.1136/bcr-2018-226168 2019-07-09T10:09:12Z [] 13 0 ["1757-790X"] BMJ Case Reports <jats:p>Sarcomatoid carcinoma is a rare clinical entity, especially when presenting in the nasopharynx. We describe the first documented case of nasopharyngeal sarcomatoid carcinoma with intracranial extension in a 59-year-old Caucasian man presenting with severe bifrontal headache and diplopia, secondary to left abducens nerve palsy. We highlight some of the major diagnostic challenges and describe its unusual histological appearance. We outline the importance of a multidisciplinary approach to his management, which includes input from the medicine, neurosurgery, Ear, Nose and Throat (ENT), pathology, radiology, oncology and respiratory teams. In the context of limited evidence, we then describe the rationale to proceed with induction chemotherapy followed by concurrent chemoradiotherapy. Although there was a partial response to treatment, it was not sufficient enough to allow subsequent surgical clearance. The plan going forward is to palliate with chemotherapy as and when the disease progresses.</jats:p> 5 ["http://orcid.org/0000-0002-9143-8942"] ["Alexander Yao", "Haroon Saeed", "Gavin Udall", "Vivek Kaushik", "Lip Wai Lee"] [""] [""] [""]
54 54 ["PO 8417\u2005RISING TRENDS IN TB MORTALITY AMID DECLINE IN CASES NOTIFIED IN A RURAL COUNTY IN KENYA: COHORT STUDY"] 10.1136/bmjgh-2019-edc.89 http://dx.doi.org/10.1136/bmjgh-2019-edc.89 2019-04-24T15:32:16Z [] 0 0 ["2059-7908"] BMJ Global Health <jats:sec><jats:title>Background</jats:title><jats:p>Despite introduction of rapid and accurate diagnostic tools and aggressive treatment for tuberculosis (TB), it is still a global health problem. In 2016, globally, 1.7 million people died of TB, 95% from resource-poor countries. This study aimed to estimate changing trends in all-cause mortality rate and identify features associated with mortality among suspected TB patients on treatment.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A cohort study of patients registered in a TB surveillance system from 2012 to 2016 and followed up for six months during TB treatment. The outcome was all-cause mortality within six months of TB treatment. The exposures examined were demographic and clinical features at the time of starting TB treatment.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 10,717 participants, median (IQR) age 33 (24–45) years, of which 3163 (30%) were HIV-infected were included in the analyses. During follow-up of 5175.5 person-years (PY), 585/10,717 (5.5%) participants died; mortality rate was 12.2 (95% CI 11.3,13.3) deaths per 100PY. The yearly mortality rate increased from 7.79 (95% CI 6.35, 9.54) in 2012 to 17.73 (95% CI 14.93, 21.06) in 2016 per 100PY (P<jats:sub>trend</jats:sub> &lt;0.001) but the number of suspected-TB notifications declined from 2610 (24%) in 2012 to 1689 (16%) in 2016 (P<jats:sub>trend</jats:sub>=0.02). 77% of all deaths occurred by month three. Mortality among HIV-infected participants was higher (325/3163; 10.3%) than among HIV-non-infected participants (251/7413; 3.4%; p&lt;0.001). Old age, being a female, type of TB diagnosis used, body mass index (BMI) &lt;18.5, HIV status and year of diagnosis were associated with mortality in the multivariate regression model.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This large population level TB study identifies an alarming trend of patients dying within months of starting treatment. These early dea… 5 [] ["Moses Ngari", "Osman Abdullahi", "Deche Sanga", "Geoffrey Katana", "Annie Willetts"] [""] [""] [""]
58 58 ["Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands"] 10.1136/bmjdrc-2019-000767 http://dx.doi.org/10.1136/bmjdrc-2019-000767 2020-01-08T10:45:11Z [] 0 0 ["2052-4897"] BMJ Open Diabetes Research & Care <jats:sec><jats:title>Rationale and objectives</jats:title><jats:p>Different classes of glucose-lowering medications are used for patients with type 2 diabetes mellitus (T2DM) management. It is unclear how often these medications are prescribed in clinical practice. In this study, we aimed to describe treatment patterns of glucose-lowering medications in patients with T2DM in the Netherlands.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We studied a cohort of 73 819 patients with T2DM, aged ≥45 years with a first prescription for oral glucose-lowering medication between 2011 and 2017. We used the NControl database with dispensing data from 800 pharmacies in the Netherlands. Prevalence of each glucose-lowering medication class during 6 years after the index date was calculated. Using SQL Server, we identified stepwise patterns of medication prescription in this population.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>During the study period, prevalence of biguanides (BIGU) decreased from 95.6% to 80.8% and use of sulfonylureas (SU) increased from 27.3% to 42.3%. 55.2% of all patients only received BIGUs, 19.1% of all patients started on BIGUs but switched to BIGU +SU. 13.5% of patients with T2DM initiated insulins, on average 532 days (almost 18 months) after the index date.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our findings showed that in the Netherlands, medication treatment in patients with T2DM is mainly consistent with the clinical guidelines in the Netherlands during the study period.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0003-2775-7276", "http://orcid.org/0000-0002-2957-5436"] ["Jan Maurik van den Heuvel", "Niloufar Farzan", "Mandy van Hoek", "Anke-Hilse Maitland-van der Zee", "Fariba Ahmadizar"] [""] [""] [""]
73 73 ["Synchronous recurrence of concurrent colon adenocarcinoma and dedifferentiated liposarcoma"] 10.1136/bcr-2018-228868 http://dx.doi.org/10.1136/bcr-2018-228868 2019-05-14T11:54:19Z [] 19 0 ["1757-790X"] BMJ Case Reports <jats:p>A 62-year-old man presented with concurrent sigmoid colon adenocarcinoma and small bowel mesenteric dedifferentiated liposarcoma. Following surgical resection of the colon cancer, complete excision of the mesenteric sarcoma and adjuvant folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy, the patient demonstrated no radiological evidence of disease for more than 2 years. The patient then developed synchronous recurrence of both cancers: the colon cancer metastasised to the liver and a pelvic lymph node, and the liposarcoma recurred in the original location. The patient underwent additional chemotherapy with complete response of the metastatic colon cancer and stable disease for the liposarcoma. The recurrent mesenteric tumour was subsequently resected. Although concurrent cancers have been reported, this unique case of synchronous recurrence raises interesting hypotheses regarding host–tumour interaction and immune surveillance.</jats:p> 7 ["http://orcid.org/0000-0001-8440-1271"] ["Eric E Jung", "F Scott Heinemann", "Colt A Egelston", "Jennifer Wang", "Raphael E Pollock", "Peter P Lee", "William W Tseng"] [""] [""] [""]
80 80 ["Odontogenic myxomas: what is the ideal treatment?"] 10.1136/bcr-2018-228540 http://dx.doi.org/10.1136/bcr-2018-228540 2019-05-22T11:16:59Z [] 13 0 ["1757-790X"] BMJ Case Reports <jats:p>There is no consensus regarding the ideal treatment for odontogenic myxomas, an odontogenic mesenchymal neoplasm. Various authors have suggested en bloc resection due to a concern regarding inadequate clearance while others have suggested more conservative treatment. We present a case managed by buccal cortical resection and an iliac crest bone graft. The patient had no recurrence for over 7 years.</jats:p> 2 [] ["Milad Tavakoli", "Raymond Williamson"] [""] [""] [""]
81 81 ["British Veterinary Association Annual General Meeting Belfast, September 21, 2017"] 10.1136/vr.j3847 http://dx.doi.org/10.1136/vr.j3847 2017-08-18T17:40:35Z [] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p>The 2017 Annual General Meeting of the British Veterinary Association will be held at W5 at Odyssey, 2 Queen’s Quay, Belfast, Antrim, on Thursday, September 21, 2017, at 15.50.</jats:p> 1 [] ["D. Thorpe"] [""] [""] [""]
83 83 ["Reliability of administrative data to identify sexually transmitted infections for population health: a systematic review"] 10.1136/bmjhci-2019-100074 http://dx.doi.org/10.1136/bmjhci-2019-100074 2020-04-22T00:34:06Z [] 29 0 ["2632-1009"] BMJ Health & Care Informatics <jats:sec><jats:title>Introduction</jats:title><jats:p>International Classification of Diseases (ICD) codes in administrative health data are used to identify cases of disease, including sexually transmitted infections (STIs), for population health research. The purpose of this review is to examine the extant literature on the reliability of ICD codes to correctly identify STIs.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a systematic review of empirical articles in which ICD codes were validated with respect to their ability to identify cases of chlamydia, gonorrhoea, syphilis or pelvic inflammatory disease (PID). Articles that included sensitivity, specificity and positive predictive value of ICD codes were the target. In addition to keyword searches in PubMed and Scopus databases, we further examined bibliographies of articles selected for full review to maximise yield.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>From a total of 1779 articles identified, only two studies measured the reliability of ICD codes to identify cases of STIs. Both articles targeted PID, a serious complication of chlamydia and gonorrhoea. Neither article directly assessed the validity of ICD codes to identify cases of chlamydia, gonorrhoea or syphilis independent of PID. Using ICD codes alone, the positive predictive value for PID was mixed (range: 18%–79%).</jats:p></jats:sec><jats:sec><jats:title>Discussion and conclusion</jats:title><jats:p>While existing studies have used ICD codes to identify STI cases, their reliability is unclear. Further, available evidence from studies of PID suggests potentially large variation in the accuracy of ICD codes indicating the need for primary studies to evaluate ICD codes for use in STI-related public health research.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0002-1121-0607"] ["Brian E Dixon", "Saurabh Rahurkar", "Yenling Ho", "Janet N Arno"] ["T15LM012502"] ["U.S. National Library of Medicine", "National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention"] ["10.13039/100000092", "10.13039/100005258"]
85 85 ["ID: 129: PARTICULATE MATTER DISRUPTS ENDOTHELIAL CELL PERMEABILITY VIA GAP JUNCTION PROTEIN"] 10.1136/jim-2016-000120.124 http://dx.doi.org/10.1136/jim-2016-000120.124 2016-05-10T23:43:02Z [] 0 0 ["1081-5589", "1708-8267"] Journal of Investigative Medicine <jats:sec><jats:title>Introduction</jats:title><jats:p>Particulate matter (PM) is significantly associated with cardiopulmonary morbidity and mortality. We previously demonstrated that PM induces endothelial barrier disruption via reactive oxygen species (ROS)-dependent mechanisms. This study is focused on characterization of PM-regulated endothelial dysfunction via connexin43 (Cx43), a Gap junction protein. Gap junction is designated as intercellular channel which allows cells to communicate with each other, share nutrients, and transfer chemical or electrical signals, in turn, enables cells in a tissue to function in a coordinated manner.</jats:p></jats:sec><jats:sec><jats:title>Methods and Results</jats:title><jats:p>Cx43 protein levels were evaluated by western blotting, and band density quantified using MyImageAnalysis. Real-time PCR was conducted to determine Cx43 mRNA levels. Human pulmonary artery endothelial cell (EC) barrier function was measured using the electrical cell-substrate impedance sensing (ECIS) system (Applied Biophysics) that provides a readout of transendothelial electrical resistance (TER). PM sample (0.1–0.3 µm of aerodynamic diameter) was collected (April of 2005) from the Ft. McHenry Tunnel, Baltimore, MD using a high-volume cyclone collector. PM (100 µg/ml) induced time-dependent increases in EC Cx43 mRNA levels (∼5 fold increase at 4 hr) and protein expression which was attenuated by N-acetyl-cysteine (NAC, 5 mM, 1 hr pretreatment), an ROS scavenger. Unlike Cx43, Cx37, another connexin expressed in ECs, remained unaltered by PM challenge. In addition, EC pretreatment with a Cx43 inhibitor, connexin-mimetic peptide Gap27 (500 µM, 2 hr pretreatment), significantly attenuated PM-reduced TER reduction by 45%, suggesting a central role of Cx43 in PM-induced lung EC barrier integrity disruption and signal transduction.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results suggest Cx43 as a key and novel participant in PM-mediated signal transduction that resu… 4 [] ["X Wu", "X Xu", "JG Garcia", "T Wang"] [""] [""] [""]
89 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"] [""] [""] [""]
90 90 ["Junctional bradycardia caused by ciguatera intoxication"] 10.1136/bcr-2019-229354 http://dx.doi.org/10.1136/bcr-2019-229354 2019-05-31T12:15:32Z [] 9 0 ["1757-790X"] BMJ Case Reports <jats:p>Ciguatera is a common but underreported tropical disease caused by the consumption of coral reef fish contaminated by ciguatoxins. Gastrointestinal and neurological symptoms predominate, but may be accompanied by cardiovascular features such as hypotension and sinus bradycardia. Here, we report an unusual case of junctional bradycardia caused by ciguatera in the Caribbean; to our knowledge, the first such report from the region. An increase in global sea temperatures is predicted to lead to the spread of ciguatera beyond traditional endemic areas, and the globalisation of trade in coral reef fish has resulted in sporadic cases occurring in developed countries far away from endemic areas. This case serves as a reminder to consider environmental intoxications such as ciguatera within the differential diagnosis of bradycardias.</jats:p> 4 ["http://orcid.org/0000-0001-6099-0948"] ["Rajendra Raman", "Sarah Coppes", "Tessa Hellingman", "Casper Lacl\u00e9"] [""] [""] [""]
93 93 ["Analysis of the risk of ovarian torsion in 49 consecutive pediatric patients treated at a single institution"] 10.1136/wjps-2018-000009 http://dx.doi.org/10.1136/wjps-2018-000009 2019-06-05T21:11:19Z [] 15 0 ["2516-5410"] World Journal of Pediatric Surgery <jats:sec><jats:title>Purpose</jats:title><jats:p>An early diagnosis of ovarian torsion is sometimes difficult due to variable clinical symptoms and non-specific imaging findings. We retrospectively reviewed patients with pediatric ovarian masses manifesting torsion.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fifty-eight ovarian masses (55 episodes) in 49 non-neonatal patients treated from April 1984 to March 2017 were retrospectively analyzed. The Mann-Whitney U test and Fisher’s exact test were used for the statistical analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The median age of these 55 episodes was 10.5 years old (range 1.0–23.0). Thirty-three patients presented with abdominal pain. Forty-five tumors and 13 cystic masses were resected and diagnosed pathologically (50 benign and 8 malignant). Torsion was identified in 15 cases (25.9%) at operation. The torsion masses were all benign, and 8 ovaries (53.3%) were successfully preserved. Comparing the torsion cases with the non-torsion cases, only the white cell count was significantly higher in the torsion cases (p=0.0133) and in the patients presented with abdominal pain (p=0.0068). The duration of abdominal pain was significantly shorter in ovary preserved cases than in oophorectomy cases.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The white blood cell may be a helpful indicator of the presence of torsion as well as the need for surgery.</jats:p></jats:sec> 13 [] ["Koshiro Sugita", "Takafumi Kawano", "Mukai Motoi", "Toshihiro Muraji", "Shun Onishi", "Tomoe Moriguchi", "Koji Yamada", "Waka Yamada", "Ryuta Masuya", "Seiro Machigashira", "Kazuhiko Nakame", "Tatsuru Kaji", "Satoshi Ieiri"] [""] [""] [""]
97 97 ["Sex, gender or occupational psychology: what matters most to preventing heat-related illnesses and improving outcomes for women in ground close combat?"] 10.1136/bmjmilitary-2020-001480 http://dx.doi.org/10.1136/bmjmilitary-2020-001480 2020-04-28T07:44:52Z [] 0 0 ["2633-3767", "2633-3775"] BMJ Military Health <jats:p>Since the advent of women in ground close combat (WGCC) roles, the impact on women of the attendant risk of heat stress and heat illness has been considered. Much emphasis has been placed on sex differences in thermal physiology. This article considers the application of evidence of sex-associated thermoregulatory variation to the occupational and environmental setting of WGCC, and weighs the relative importance of physiological differences arising from biological sex, and behaviour associated with gender normatives. Quantifying the risk of heat illness to WGCC should draw on data from their real-world occupational context.</jats:p> 4 ["http://orcid.org/0000-0002-6248-6400"] ["Robert M Gifford", "N Taylor", "M Stacey", "D R Woods"] [""] [""] [""]

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