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5 ["How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial"] 10.1136/bmjopen-2015-010581 http://dx.doi.org/10.1136/bmjopen-2015-010581 2016-09-13T01:49:12Z ["General Medicine"] 0 19 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>We studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Participants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU). Participants (N=197) had in-person interviews every 3 months for 2 years.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The HF+ACT group spent more time stably housed compared to the TAU group with the mean difference between the groups of 45.8% (95% CI 37.1% to 54.4%, p&lt;0.0001). Accounting for baseline differences, HF+ACT group showed significant improvements over TAU group for community functioning, selected quality-of-life subscales and arrests at some time points during follow-up. No differences between HF+ACT and TAU groups over the follow-up were observed for health service usage, community integration and substance use.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>HF for individuals with high levels of need increased housing stability and selected health and justice outcomes over 2 years in a city with many social and health services.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>ISRCTN42520374.</jats:p></jats:sec> 10 [] ["Patricia O'Campo", "Vicky Stergiopoulos", "Pam Nir", "Matthew Levy", "Vachan Misir", "Antony Chum", "Bouchra Arbach", "Rosane Nisenbaum", "Matthew J To", "Stephen W Hwang"] [""] [""] [""]
13 ["Assessing clinical reasoning using a script concordance test with electrocardiogram in an emergency medicine clerkship rotation"] 10.1136/emermed-2012-201737 http://dx.doi.org/10.1136/emermed-2012-201737 2013-03-29T00:49:44Z ["Critical Care and Intensive Care Medicine", "Emergency Medicine", "General Medicine"] 19 10 ["1472-0205", "1472-0213"] Emergency Medicine Journal <jats:sec><jats:title>Objectives</jats:title><jats:p>Script concordance tests (SCTs) can be used to assess clinical reasoning, especially in situations of uncertainty, by comparing the responses of examinees with those of emergency physicians. The examinee's answers are scored based on the level of agreement with responses provided by a panel of experts. Emergency physicians are frequently uncertain in the interpretation of ECGs. Thus, the aim of this study was to validate an SCT combined with an ECG.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>An SCT-ECG was developed. The test was administered to medical students, residents and emergency physicians. Scoring was based on data from a panel of 12 emergency physicians. The statistical analyses assessed the internal reliability of the SCT (Cronbach's α) and its ability to discriminate between the different groups (ANOVA followed by Tukey's post hoc test).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The SCT-ECG was administered to 21 medical students, 19 residents and 12 emergency physicians. The internal reliability was satisfactory (Cronbach's α=0.80). Statistically significant differences were found between the groups (F<jats:sub>0.271</jats:sub>=21.07; p&lt;0.0001). Moreover, significant differences (post hoc test) were detected between students and residents (p&lt;0.001), students and experts (p&lt;0.001), and residents and experts (p=0.017).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This SCT-ECG is a valid tool to assess clinical reasoning in a context of uncertainty due to its high internal reliability and its ability to discriminate between different levels of expertise.</jats:p></jats:sec> 5 [] ["Caroline Boulouffe", "Bruno Doucet", "Xavier Muschart", "Bernard Charlin", "Dominique Vanpee"] [""] [""] [""]
15 ["Comparative effectiveness of treatment options for plantar heel pain: a systematic review with network meta-analysis"] 10.1136/bjsports-2017-098998 http://dx.doi.org/10.1136/bjsports-2017-098998 2019-01-21T15:05:26Z ["Physical Therapy, Sports Therapy and Rehabilitation", "Orthopedics and Sports Medicine", "General Medicine"] 62 9 ["0306-3674", "1473-0480"] British Journal of Sports Medicine <jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the comparative effectiveness of current treatment options for plantar heel pain (PHP).</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Systematic review and network meta-analysis (NMA).</jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p>Medline, EMBASE, CINAHL, AMED, PEDro, Cochrane Database, Web of Science and WHO Clinical Trials Platform were searched from their inception until January 2018.</jats:p></jats:sec><jats:sec><jats:title>Study selection</jats:title><jats:p>Randomised controlled trials (RCTs) of adults with PHP investigating common treatments (ie, corticosteroid injection, non-steroidal anti-inflammatory drugs, therapeutic exercise, orthoses and/or extracorporeal shockwave therapy (ESWT)) compared with each other or a no treatment, placebo/sham control.</jats:p></jats:sec><jats:sec><jats:title>Data extraction and analysis</jats:title><jats:p>Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects NMA in the short term, medium term and long term. Relative ranking of treatments was assessed by surface under the cumulative ranking probabilities (0–100 scale).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Thirty-one RCTs (total n=2450 patients) were included. There was no evidence of inconsistency detected between direct and indirect treatment comparisons in the networks, but sparse data led to frequently wide CIs. Available evidence does not suggest that any of the commonly used treatments for the management of PHP are better than any other, although corticosteroid injections, alone or in combination with exercise, and ESWT were ranked most likely to be effective for the management of short-term, medium-term and long-term pain or function; placebo/sham/control appeared least likely to be effective; and exercise appeared to only be beneficial for … 8 ["http://orcid.org/0000-0002-5064-6446", "http://orcid.org/0000-0002-7703-727X", "http://orcid.org/0000-0002-7248-6703"] ["Opeyemi O Babatunde", "Amardeep Legha", "Chris Littlewood", "Linda S Chesterton", "Martin J Thomas", "Hylton B Menz", "Danielle van der Windt", "Edward Roddy"] [] ["National Health and Medical Research Council", "National Institute for Health Research"] ["10.13039/501100000925", "10.13039/501100000272"]
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"]
23 ["What fluids are given during air ambulance treatment of patients with trauma in the UK, and what might this mean for the future? Results from the RESCUER observational cohort study"] 10.1136/bmjopen-2017-019627 http://dx.doi.org/10.1136/bmjopen-2017-019627 2018-01-23T09:51:02Z ["General Medicine"] 0 5 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>We investigated how often intravenous fluids have been delivered during physician-led prehospital treatment of patients with hypotensive trauma in the UK and which fluids were given. These data were used to estimate the potential national requirement for prehospital blood products (PHBP) if evidence from ongoing trials were to report clinical superiority.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Regional Exploration of Standard Care during Evacuation Resuscitation (RESCUER) retrospective observational study was a collaboration between 11 UK air ambulance services. Each was invited to provide up to 5 years of data and total number of taskings during the same period.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Patients with hypotensive trauma (systolic blood pressure &lt;90 mm Hg or absent radial pulse) attended by a doctor.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>The primary outcome was the number of patients with hypotensive trauma given prehospital fluids. Secondary outcomes were types and volumes of fluids. These data were combined with published data to estimate potential national eligibility for PHBP.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 29 037 taskings, 729 (2.5%) were for patients with hypotensive trauma attended by a physician. Half were aged 21–50 years; 73.4% were male. A total of 537 out of 729 (73.7%) were given fluids. Five hundred and ten patients were given a single type of fluid; 27 received &gt;1 type. The most common fluid was 0.9% saline, given to 486/537 (90.5%) of patients who received fluids, at a median volume of 750 (IQR 300–1500) mL. Three per cent of patients received PHBP. Estimated projections for patients eligible for PHBP at these 11 services and in the whole UK were 313 and 794 patients per year, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><ja… 8 [] ["David N Naumann", "James M Hancox", "James Raitt", "Iain M Smith", "Nicholas Crombie", "Heidi Doughty", "Gavin D Perkins", "Mark J Midwinter"] [""] [""] [""]
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"]
30 ["Inter-rater reliability of published flow diversion occlusion scales"] 10.1136/neurintsurg-2015-012193 http://dx.doi.org/10.1136/neurintsurg-2015-012193 2016-01-20T23:04:34Z ["Surgery", "Clinical Neurology", "General Medicine"] 14 3 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Background</jats:title><jats:p>With increasing use of flow-diverting stents for the treatment of intracranial aneurysms, standardized methods and a common language to evaluate angiographic outcomes are needed. Multiple grading scales have been developed for this purpose but none has been widely adopted.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To analyze these scales to determine interobserver reliability.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Four independent assessors scored the intraprocedural angiograms of patients who underwent flow-diverting stent deployment for an intracranial saccular or fusiform aneurysm at our institution between October 2012 and June 2015. Angiographic outcome immediately after flow-diverting stent deployment was scored using three grading scales (Kamran–Byrne (KB), Simple Measurement of Aneurysm Residual after Treatment (SMART), and O'Kelley, Krings, Marotta (OKM)). Statistical analysis was performed using Light's κ for multiple raters (κ), Kendall's coefficient of concordance (W), and intraclass correlation (ICC).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included the angiograms of 50 consecutive patients (mean age 58 years, range 30–79) who underwent flow-diverting stent deployment for an intracranial aneurysm (40 saccular, 10 fusiform). Six aneurysms were located in the posterior circulation. The inter-rater reliability was typically poor or fair: SMART aneurysm filling (κ=0.30, W=0.36, ICC=0.12), SMART parent vessel stenosis (κ=0.07, W=0.33, ICC=0.12), KB axis I (κ=0.24, W=0.50, ICC=0.25), KB axis II (κ=0.07, W=0.30, ICC=0.06), OKM aneurysm filling (κ=0.23, W=0.45, ICC=0.13), OKM contrast stasis (κ=0.36,W=0.71, ICC=0.54).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Existing flow-diverting stent grading scales have low inter-rater reliability for most categories.</jats:p></jats:sec> 5 [] ["Marcus D Mazur", "Philipp Taussky", "Lubdha M Shah", "Blair Winegar", "Min S Park"] [""] [""] [""]
31 ["Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset"] 10.1136/bmjopen-2018-026396 http://dx.doi.org/10.1136/bmjopen-2018-026396 2019-05-02T08:39:22Z ["General Medicine"] 50 3 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Open cohort study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>A representative sample of 550 Australian general practices contributing data to the MedicineInsight programme.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>ILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>ILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p&lt;0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p&lt;0.05), antibiotic (30.7% vs 23.4%, p&lt;0.05) and antiviral (34.2% vs 13.5%, p&lt;0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation r… 3 ["http://orcid.org/0000-0001-6998-6419", "http://orcid.org/0000-0002-7153-2878", "http://orcid.org/0000-0002-9018-0361"] ["Carla De Oliveira Bernardo", "David Gonzalez-Chica", "Nigel Stocks"] [""] [""] [""]
37 ["Palliative care research centre's move into social media: constructing a framework for ethical research, a consensus paper"] 10.1136/bmjspcare-2015-000889 http://dx.doi.org/10.1136/bmjspcare-2015-000889 2016-01-29T03:54:13Z ["Medicine (miscellaneous)", "Oncology(nursing)", "Medical\u2013Surgical", "General Medicine"] 13 2 ["2045-435X", "2045-4368"] BMJ Supportive & Palliative Care <jats:sec><jats:title>Background</jats:title><jats:p>Social media (SM) have altered the way we live and, for many, the way we die. The information available on even the rarest conditions is vast. Free from restrictions of mobility, time and distance, SM provides a space for people to share experiences of illness, death and dying, and potentially benefit from the emotional and practical support of others n similar positions. The communications that take place in these spaces also create large amounts of ‘data’ which, for any research centre, cannot be ignored. However, for a palliative care research centre the use of this ‘data’ comes with specific ethical dilemmas.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This paper details the process that we, as a research, went through in constructing a set of ethical guidelines by which to work. This involved conducting two consensus days; one with researchers from within the centre, and one with the inclusion of external researchers with a specific interest in SM.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The primary themes that emerged from the consensus meetings includes; SM as a public or private space; the status of open and closed groups; the use of historical data; recruiting participants and obtaining informed consent and problems of anonymity associated with dissemination.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These are the themes that this paper will focus on prior to setting out the guidelines that we subsequently constructed.</jats:p></jats:sec> 12 [] ["Noreen Hopewell-Kelly", "Jessica Baillie", "Stephanie Sivell", "Emily Harrop", "Anna Bowyer", "Sophia Taylor", "Kristen Thomas", "Alisha Newman", "Hayley Prout", "Anthony Byrne", "Mark Taubert", "Annmarie Nelson"] [""] [""] [""]
39 ["Immunohistochemistry for the detection of BRCA1 and BRCA2 proteins in patients with ovarian cancer: a systematic review"] 10.1136/jclinpath-2019-206276 http://dx.doi.org/10.1136/jclinpath-2019-206276 2019-11-12T22:15:46Z ["Pathology and Forensic Medicine", "General Medicine"] 65 1 ["0021-9746", "1472-4146"] Journal of Clinical Pathology <jats:sec><jats:title>Background</jats:title><jats:p>Loss of function in either breast cancer type 1 susceptibility protein (BRCA1) or breast cancer type 2 susceptibility protein (BRCA2) is a major risk factor for epithelial ovarian cancer (EOC) development. BRCA1 or BRCA2 deficiencies are associated with short-term prognosis and might have importance for the treatment of women with the disease. However, the screening of all possible mechanisms of dysfunction is expensive, time-consuming and difficult to apply in clinical practice. On the other hand, immunohistochemistry (IHC) is a simple and reliable method to access the expression of several proteins in tumour tissues.</jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p>This systematic review aims to evaluate the current usage of IHC to detect BRCA1 and BRCA2 deficiencies in EOC. We searched and evaluated all primary literature on the use of IHC for evaluating BRCA1 and BRCA2 proteins expression in EOC. The main concepts for the search were: ovarian neoplasms, IHC, BRCA1 and BRCA2.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Forty-four studies from 925 unique titles were included. A total of 4206 tumour samples were evaluated for BRCA1 and 1041 for BRCA2 expression. Twelve BRCA1 primary antibodies were used in 41 studies, and the most common was the MS110 clone (75.6%). Seven BRCA2 primary antibodies were used in ten studies. Using the cut-off of 10%, 47.0% of EOCs are associated with loss of BRCA1 and 34.5% with the loss of BRCA2 expression.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>IHC was effective to detect loss of BRCA1 protein expression in EOC; however, data on BRCA2 expression were heterogeneous and difficult to interpret.</jats:p></jats:sec> 2 ["http://orcid.org/0000-0003-1053-2046", "http://orcid.org/0000-0001-5758-5917"] ["Lorena Alves Teixeira", "Francisco Jose Candido dos Reis"] ["303210/2018-4", "130162/2017-5"] ["Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico"] ["10.13039/501100003593"]
41 ["Therapeutic hypothermia in acute traumatic spinal cord injury"] 10.1136/jramc-2017-000792 http://dx.doi.org/10.1136/jramc-2017-000792 2017-10-13T00:25:27Z ["General Medicine"] 117 1 ["0035-8665", "2052-0468"] Journal of the Royal Army Medical Corps <jats:p>Therapeutic hypothermia is already widely acknowledged as an effective neuroprotective intervention, especially within the acute care setting in relation to conditions such as cardiac arrest and neonatal encephalopathy. Its multifactorial mechanisms of action, including lowering metabolic rate and reducing acute inflammatory cellular processes, ultimately provide protection for central nervous tissue from continuing injury following ischaemic or traumatic insult. Its clinical application within acute traumatic spinal cord injury would therefore seem very plausible, it having the potential to combat the pathophysiological secondary injury processes that can develop in the proceeding hours to days following the initial injury. As such it could offer invaluable assistance to lessen subsequent sensory, motor and autonomic dysfunction for an individual affected by this devastating condition. Yet research surrounding this intervention’s applicability in this field is somewhat lacking, the majority being experimental. Despite a recent resurgence of interest, which in turn has produced encouraging results, there is a real possibility that this potentially transformational intervention for treating traumatic spinal cord injury could remain an experimental therapy and never reach clinical implementation.</jats:p> 1 [] ["James Collis"] [""] [""] [""]
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"]
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"] [""] [""] [""]
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"] [""] [""] [""]
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 ["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 ["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"] [""] [""] [""]
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 ["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"] [""] [""] [""]
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 [""] [""] [""] [""] [""]
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"]
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 ["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 ["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 ["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"]
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 [""] [""] [""] [""] [""]
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 ["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"]
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 [""] [""] [""] [""] [""]
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 ["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"]
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 [""] [""] [""] [""] [""]

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