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19 ["Clinical significance of the circle of Willis in intracranial atherosclerotic stenosis"] 10.1136/neurintsurg-2014-011439 http://dx.doi.org/10.1136/neurintsurg-2014-011439 2014-12-10T04:09:30Z [] 19 6 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Introduction</jats:title><jats:p>The effectiveness of a scoring system based on the circle of Willis for evaluations of collateral circulation was studied in patients with intracranial atherosclerotic stenosis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Eighty-three patients who underwent medical or endovascular treatment for symptomatic and severe intracranial atherosclerotic stenosis were enrolled in the study. Clinical profiles, status of the circle of Willis (poor and good integrity group), and clinical outcomes were analyzed. Primary endpoints were: (1) symptomatic ischemic or hemorrhagic stroke within 30 days; and (2) recurrent transient ischemic attack or ischemic stroke beyond 30 days.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The estimated rates of the primary endpoint at 1 and 2 years after treatment were 8.5% and 11.4% in the medical group and 7.0% and 9.7% in the endovascular group, respectively. A primary endpoint event after medical treatment was only identified in patients with poor integrity of the circle of Willis (p=0.059). In patients with poor integrity of the circle of Willis, previous antiplatelet medication before initial presentation (p=0.026) and hypertension (p=0.006) were more prevalent. During the follow-up period, complete arterial occlusion was identified in 9 patients. The circle of Willis score of the patients with complete arterial occlusion was 1.33±1.52 in the fatal stroke group (n=3) and 3.20±1.64 in the asymptomatic group (n=6, p=0.099).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>If patients have poor integrity of the circle of Willis, the risk of recurrent stroke may be increased. Such patients appear to be good candidates for endovascular treatment.</jats:p></jats:sec> 6 [] ["Kang Min Kim", "Hyun-Seung Kang", "Woong Jae Lee", "Young Dae Cho", "Jeong Eun Kim", "Moon Hee Han"] [""] [""] [""]
20 ["Google search histories of patients presenting to an emergency department: an observational study"] 10.1136/bmjopen-2018-024791 http://dx.doi.org/10.1136/bmjopen-2018-024791 2019-02-20T19:00:11Z ["General Medicine"] 0 6 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objective</jats:title><jats:p>To test patients’ willingness to share and link their prior Google search histories with data from their electronic medical record (EMR), and to explore associations between search histories and clinical conditions.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Cross-sectional study of emergency department (ED) patients from 2016 to 2017.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Academic medical centre ED.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>A total of 703 patients were approached; 334 of a volunteer sample of 411 (81%) reported having a Google account; 165 of those (49%) consented to share their Google search histories and EMR data; 119 (72%) were able to do so. 16 (13%) of those 119 patients had no data and were not included in the final count. Patients under the age of 18 or with a triage level of 1 were considered ineligible and were not approached.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Health relatedness of searches in the remote past and within 7 days of the ED visit, and associations between patients’ clinical and demographic characteristics and their internet search volume and search content.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The 103 participants yielded 591 421 unique search queries; 37 469 (6%) were health related. In the 7 days prior to an ED visit, the percentage of health-related searches was 15%. During that time, 56% of patients searched for symptoms, 53% for information about a hospital and 23% about the treatment or management of a disease. 53% of participants who used Google in the week leading up to their ED visit searched for content directly related to their chief complaint.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Patients were willing to allow researchers simultaneous access to their Google search histories and their EMR data. The change in vo… 6 [] ["Jeremy M Asch", "David A Asch", "Elissa V Klinger", "Justine Marks", "Norah Sadek", "Raina M Merchant"] [] ["Robert Wood Johnson Foundation"] ["10.13039/100000867"]
24 ["Protocol for the Lactoferrin Infant Feeding Trial (LIFT): a randomised trial of adding lactoferrin to the feeds of very-low birthweight babies prior to hospital discharge"] 10.1136/bmjopen-2018-023044 http://dx.doi.org/10.1136/bmjopen-2018-023044 2018-10-03T04:55:26Z ["General Medicine"] 50 5 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Introduction</jats:title><jats:p>Very-low birthweight (VLBW, &lt;1500 g) infants comprise about 1%–1.4% of all births in high-income countries. Every year, about 3000 VLBW babies in Australia and New Zealand receive intensive care. Many die or else survive with severe brain injury, retinopathy, late-onset sepsis or necrotising enterocolitis (NEC), each of which carries substantial risk of disability.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This trial tests whether adding bovine lactoferrin (bLF) to feeds in VLBW infants improves (1) survival to hospital discharge free from brain injury, late-onset sepsis, NEC and treated retinopathy of prematurity (primary composite end point); (2) each component of the primary composite end point and (3) time to reach full enteral feeds, number of blood transfusions, chronic lung disease and length of hospital stay. It includes a cost-effectiveness analysis of bLF in improving survival free from major morbidity, and evaluates the effect of bLF on survival and developmental outcomes at 24 to 36 months corrected gestational age.</jats:p><jats:p>This is a multicentre, two-arm, randomised trial comparing the treatment group receiving bLF added to breast milk or formula milk daily (up to 250 mg/kg/day bLF) versus the control group receiving no bLF supplementation. The intervention is administered until 34 completed weeks corrected gestation or for 2 weeks, whichever is longer, or until discharge home, if earlier. The target sample size of 1500 participants yields 85% power, at the two-sided 5% level significance, to detect a difference in proportions meeting the primary outcome assuming the true probability is 74% in controls and 80.5% in the bLF group.</jats:p></jats:sec><jats:sec><jats:title>Ethics and dissemination</jats:title><jats:p>This protocol was approved by Northern Sydney Local Human Research Ethics Committee in January 2017 (Version 2.0, Reference 1003-118M) and other relevant ethics committees. The findings … 6 [] ["Andrew Martin", "Alpana Ghadge", "Paolo Manzoni", "Kei Lui", "Rebecca Brown", "William Tarnow-Mordi"] [] ["National Health and Medical Research Council"] ["10.13039/501100000925"]
35 ["Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis"] 10.1136/gutjnl-2020-321191 http://dx.doi.org/10.1136/gutjnl-2020-321191 2020-04-10T21:25:23Z ["Gastroenterology"] 0 2 ["0017-5749", "1468-3288"] Gut <jats:sec><jats:title>Objectives</jats:title><jats:p>National guidelines for the management of irritable bowel syndrome (IBS) recommend that psychological therapies should be considered, but their relative efficacy is unknown, because there have been few head-to-head trials. We performed a systematic review and network meta-analysis to try to resolve this uncertainty.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>We searched the medical literature through January 2020 for randomised controlled trials (RCTs) assessing efficacy of psychological therapies for adults with IBS, compared with each other, or a control intervention. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic, with a 95% CI to summarise efficacy of each comparison tested, and ranked by therapy according to P score.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We identified 41 eligible RCTs, containing 4072 participants. After completion of therapy, the psychological interventions with the largest numbers of trials, and patients recruited, demonstrating efficacy included self-administered or minimal contact cognitive behavioural therapy (CBT) (RR 0.61; 95% CI 0.45 to 0.83, P score 0.66), face-to-face CBT (RR 0.62; 95% CI 0.48 to 0.80, P score 0.65) and gut-directed hypnotherapy (RR 0.67; 95% CI 0.49 to 0.91, P score 0.57). After completion of therapy, among trials recruiting only patients with refractory symptoms, group CBT and gut-directed hypnotherapy were more efficacious than either education and/or support or routine care, and CBT via the telephone, contingency management, CBT via the internet and dynamic psychotherapy were all superior to routine care. Risk of bias of trials was high, with evidence of funnel plot asymmetry; the efficacy of psychological therapies is therefore likely to have been overestimated.</jats:p></jats:sec><jats:sec><… 6 ["http://orcid.org/0000-0003-4151-7180", "http://orcid.org/0000-0001-6371-4359"] ["Christopher J Black", "Elyse R Thakur", "Lesley A Houghton", "Eamonn M M Quigley", "Paul Moayyedi", "Alexander C Ford"] [""] [""] [""]
40 ["Infant sleep and child mental health: a longitudinal investigation"] 10.1136/archdischild-2019-318014 http://dx.doi.org/10.1136/archdischild-2019-318014 2020-03-10T03:55:23Z ["Pediatrics, Perinatology, and Child Health"] 25 1 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Objective</jats:title><jats:p>To determine whether infants with severe persistent sleep problems are at increased risk of (1) meeting diagnostic criteria for a psychiatric disorder (age 10 years), and (2) having elevated symptoms of mental health difficulties (ages 4 and 10 years), in comparison with infants with settled sleep.</jats:p></jats:sec><jats:sec><jats:title>Design and setting</jats:title><jats:p>Prospective longitudinal community cohort study—the Maternal Health Study. Mothers completed questionnaires/interviews at 15 weeks' gestation; 3, 6, 9 and 12 months post partum; and when their child turned 4 and 10 years old. Measures included parental report of infant night waking and sleep problems and child mental health (Strengths and Difficulties Questionnaire; Spence Children’s Anxiety Scale; Development and Well-being Assessment).</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>1460 mother-infant dyads.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>283 (19.4%) infants had persistent severe sleep problems, 817 (56.0%) had moderate/fluctuating sleep problems and 360 (24.7%) infants were settled. Infants with persistent severe sleep problems were more likely to report emotional symptoms at age 4 (adjusted odds ratio (AOR)=2.70, 95% CI 1.21 to 6.05, p=0.02), and meet diagnostic criteria for an emotional disorder at age 10 (AOR=2.37, 95% CI 1.05 to 5.36, p=0.04). Infants with persistent severe sleep problems also had elevated symptoms of separation anxiety (AOR=2.44, 95% CI 1.35 to 4.41, p&lt;0.01), fear of physical injury (AOR=2.14, 95% CI 1.09 to 4.18, p=0.03) and overall elevated anxiety (AOR=2.20, 95% CI 1.13 to 4.29, p=0.02) at age 10.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Infants with persistent severe sleep problems during the first postnatal year have an increased risk of anxiety problems and emotional disorders at age 10.</jats:p></jats:sec> 6 ["http://orcid.org/0000-0001-6477-3940"] ["Fallon Cook", "Laura J Conway", "Rebecca Giallo", "Deirdre Gartland", "Emma Sciberras", "Stephanie Brown"] ["199222", "433006", "491205"] ["National Health and Medical Research Council", "Victorian Government Operational Infrastructure Support Program"] ["10.13039/501100000925", [""]]
43 ["Thyroid scintigraphy differentiates subtypes of congenital hypothyroidism"] 10.1136/archdischild-2019-317665 http://dx.doi.org/10.1136/archdischild-2019-317665 2019-11-14T22:15:30Z ["Pediatrics, Perinatology, and Child Health"] 0 1 ["0003-9888", "1468-2044"] Archives of Disease in Childhood <jats:sec><jats:title>Introduction</jats:title><jats:p>UK screening for congenital hypothyroidism (CH) is based on dried blood spot Thyroid Stimulating Hormone (TSH). Scintigraphy may identify CH subtypes classified as dysplasia, gland in situ (GIS) and ectopia, but is not performed in all centres. We retrospectively investigated the role of scintigraphy to identify CH subtypes in a single tertiary centre cohort.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Babies who screened positive for CH between 2007 and 2017 were studied (n=418 of 534 783). Scintigraphy outcomes were correlated with TSH and levothyroxine dose. GIS patients were analysed for 3-year outcomes.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>303 patients started levothyroxine. Scintigraphy demonstrated three subtypes: GIS (n=139, 46%) ectopia (n=84, 28%) and dysplasia (n=80, 26%). Three-year follow up demonstrated permanence in 54% of 37 GIS cases.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>Thyroid scintigraphy differentiates subtypes of CH and suggests a higher than expected proportion of patients with GIS and ectopia. CH is permanent in half of those with GIS.</jats:p></jats:sec> 6 [] ["Chris Worth", "Beverly Hird", "Lesley Tetlow", "Neville Wright", "Leena Patel", "Indraneel Banerjee"] [""] [""] [""]
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"] [""] [""] [""]
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"]
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"]

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