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  • 2044-6055 · 44
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3 ["Investigating the possible causal association of smoking with depression and anxiety using Mendelian randomisation meta-analysis: the CARTA consortium"] 10.1136/bmjopen-2014-006141 http://dx.doi.org/10.1136/bmjopen-2014-006141 2014-10-08T06:07:47Z [] 0 53 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To investigate whether associations of smoking with depression and anxiety are likely to be causal, using a Mendelian randomisation approach.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Mendelian randomisation meta-analyses using a genetic variant (rs16969968/rs1051730) as a proxy for smoking heaviness, and observational meta-analyses of the associations of smoking status and smoking heaviness with depression, anxiety and psychological distress.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Current, former and never smokers of European ancestry aged ≥16 years from 25 studies in the Consortium for Causal Analysis Research in Tobacco and Alcohol (CARTA).</jats:p></jats:sec><jats:sec><jats:title>Primary outcome measures</jats:title><jats:p>Binary definitions of depression, anxiety and psychological distress assessed by clinical interview, symptom scales or self-reported recall of clinician diagnosis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The analytic sample included up to 58 176 never smokers, 37 428 former smokers and 32 028 current smokers (total N=127 632). In observational analyses, current smokers had 1.85 times greater odds of depression (95% CI 1.65 to 2.07), 1.71 times greater odds of anxiety (95% CI 1.54 to 1.90) and 1.69 times greater odds of psychological distress (95% CI 1.56 to 1.83) than never smokers. Former smokers also had greater odds of depression, anxiety and psychological distress than never smokers. There was evidence for positive associations of smoking heaviness with depression, anxiety and psychological distress (ORs per cigarette per day: 1.03 (95% CI 1.02 to 1.04), 1.03 (95% CI 1.02 to 1.04) and 1.02 (95% CI 1.02 to 1.03) respectively). In Mendelian randomisation analyses, there was no strong evidence that the minor allele of rs16969968/rs1051730 was associated with depression (OR=1.00, 95% CI 0.95 to 1.05), anxiety (OR=1.02, 95% CI 0.97 to 1.07) or psycho… 62 [] ["Amy E Taylor", "Meg E Fluharty", "Johan H Bj\u00f8rngaard", "Maiken Elvestad Gabrielsen", "Frank Skorpen", "Riccardo E Marioni", "Archie Campbell", "Jorgen Engmann", "Saira Saeed Mirza", "Anu Loukola", "Tiina Laatikainen", "Timo Partonen", "Marika Kaakinen", "Francesca Ducci", "Alana Cavadino", "Lise Lotte N Husemoen", "Tarunveer Singh Ahluwalia", "Rikke Kart Jacobsen", "Tea Skaaby", "Jeanette Frost Ebstrup", "Erik Lykke Mortensen", "Camelia C Minica", "Jacqueline M Vink", "Gonneke Willemsen", "Pedro Marques-Vidal", "Caroline E Dale", "Antoinette Amuzu", "Lucy T Lennon", "Jari Lahti", "Aarno Palotie", "Katri R\u00e4ikk\u00f6nen", "Andrew Wong", "Lavinia Paternoster", "Angelita Pui-Yee Wong", "L John Horwood", "Michael Murphy", "Elaine C Johnstone", "Martin A Kennedy", "Zdenka Pausova", "Tom\u00e1\u0161 Paus", "Yoav Ben-Shlomo", "Ellen A Nohr", "Diana Kuh", "Mika Kivimaki", "Johan G Eriksson", "Richard W Morris", "Juan P Casas", "Martin Preisig", "Dorret I Boomsma", "Allan Linneberg", "Chris Power", "Elina Hypp\u00f6nen", "Juha Veijola", "Marjo-Riitta Jarvelin", "Tellervo Korhonen", "Henning Tiemeier", "Meena Kumari", "David J Porteous", "Caroline Hayward", "P\u00e5l R Romundstad", "George Davey Smith", "Marcus R Munaf\u00f2"] [""] [""] [""]
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"] [""] [""] [""]
6 ["What\u2019s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland"] 10.1136/bmjopen-2017-018023 http://dx.doi.org/10.1136/bmjopen-2017-018023 2017-10-16T22:16:03Z [] 0 19 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital doctors in Ireland.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex, marital status), work grade (consultant, higher/basic specialist trainee), specialty and work hours and completed well-being questionnaires (the Depression Anxiety Stress Scale, WHO Well-being Index, General Health Questionnaire) and single-item scales on self-rated health and self-stigma.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Irish publicly funded hospitals and residential institutions.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>1749 doctors (response rate of 55%). All hospital specialties were represented except radiology.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Half of participants were men (50.5%). Mean hours worked per week were 57 hours. Over half (52%) rated their health as very good/excellent, while 50.5% reported positive subjective well-being (WHO-5). Over a third (35%) experienced psychological distress (General Health Questionnaire 12). Severe/extremely severe symptoms of depression, anxiety and stress were evident in 7.2%, 6.1% and 9.5% of participants (Depression, Anxiety, Stress Scale 21). Symptoms of distress, depression, anxiety and stress were significantly higher and levels of well-being were significantly lower in trainees compared with consultants, and this was not accounted for by differences in sociodemographic variables. Self-stigma was present in 68.4%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The work hours of doctors working in Irish hospitals were in excess of European Working Time Directive’s requirements. Just over half of hospital doctors in Ireland had positive well-being. Compared with international e… 5 [] ["Bl\u00e1naid Hayes", "Lucia Prihodova", "Gillian Walsh", "Frank Doyle", "Sally Doherty"] [""] [""] [""]
14 ["Study protocol for a randomised controlled trial evaluating the effect of prenatal omega-3 LCPUFA supplementation to reduce the incidence of preterm birth: the ORIP trial"] 10.1136/bmjopen-2017-018360 http://dx.doi.org/10.1136/bmjopen-2017-018360 2017-09-26T00:10:18Z [] 0 10 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Introduction</jats:title><jats:p>Preterm birth accounts for more than 85% of all perinatal complications and deaths. Seventy-five per cent of early preterm births (EPTBs) occur spontaneously and without identifiable risk factors. The need for a broadly applicable, effective strategy for primary prevention is paramount. Secondary outcomes from the docosahexaenoic acid (DHA) to Optimise Mother Infant Outcome trial showed that maternal supplementation until delivery with omega-3 (ω-3) long chain polyunsaturated fatty acid (LCPUFA), predominantly as DHA, resulted in a 50% reduction in the incidence of EPTB and an increase in the incidence of post-term induction or post-term prelabour caesarean section due to extended gestation. We aim to determine the effectiveness of supplementing the maternal diet with ω-3 LCPUFA until 34 weeks’ gestation on the incidence of EPTB.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This is a multicentre, parallel group, randomised, blinded and controlled trial. Women less than 20 weeks’ gestation with a singleton or multiple pregnancy and able to give informed consent are eligible to participate. Women will be randomised to receive high DHA fish oil capsules or control capsules without DHA. Capsules will be taken from enrolment until 34 weeks’ gestation. The primary outcome is the incidence of EPTB, defined as delivery before 34 completed weeks’ gestation. Key secondary outcomes include length of gestation, incidence of post-term induction or prelabour caesarean section and spontaneous EPTB. The target sample size is 5540 women (2770 per group), which will provide 85% power to detect an absolute reduction in the incidence of preterm birth of 1.16% (from 2.45% to 1.29%) between the DHA and control group (two sided α=0.05). The primary analysis will be based on the intention-to-treat principle.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>Australia and New Zealand Clinical Trial Registry Num… 7 [] ["Shao J Zhou", "Karen Best", "Robert Gibson", "Andrew McPhee", "Lisa Yelland", "Julie Quinlivan", "Maria Makrides"] [] ["National Health and Medical Research Council"] ["10.13039/501100000925"]
18 ["Post-traumatic growth and its relationship to quality of life up to 9 years after liver transplantation: a cross-sectional study in Spain"] 10.1136/bmjopen-2017-017455 http://dx.doi.org/10.1136/bmjopen-2017-017455 2017-09-17T00:10:22Z [] 0 7 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objective</jats:title><jats:p>Little is known concerning post-traumatic growth (PTG) after liver transplantation. Against this backdrop the current study analysed the relationship between PTG and time since transplantation on quality of life. Furthermore, it compared PTG between liver transplant recipients and their caregivers.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Cross-sectional case–control study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>University Hospital in Spain.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>240 adult liver transplant recipients who had undergone only one transplantation, with no severe mental disease, were the participants of the study. Specific additional analyses were conducted on the subset of 216 participants for whom caregiver data were available. Moreover, results were compared with a previously recruited general population sample.</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>All participants completed the Posttraumatic Growth Inventory, and recipients also filled in the 12-Item Short-Form Health Survey. Relevant sociodemographic and clinical parameters were also assessed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the sample of 240 recipients, longer time since transplantation (&gt;9 years) was associated with more pain symptoms (p=0.026). Regardless of duration, recipients showed lower scores on most quality of life dimensions than the general population. However, high PTG was associated with a significantly higher score on the vitality quality of life dimension (p=0.021). In recipients with high PTG, specific quality of life dimensions, such as bodily pain (p=0.307), vitality (p=0.890) and mental health (p=0.353), even equalled scores in the general population, whereas scores on general health surpassed them (p=0.006). Furthermore, liver transplant recipients (n=216) compared with their caregivers showed higher t… 7 [] ["Mar\u00eda \u00c1ngeles P\u00e9rez-San-Gregorio", "Agust\u00edn Mart\u00edn-Rodr\u00edguez", "Mercedes Borda-Mas", "Mar\u00eda Luisa Avargues-Navarro", "Jos\u00e9 P\u00e9rez-Bernal", "Rupert Conrad", "Miguel \u00c1ngel G\u00f3mez-Bravo"] [] ["Spanish Ministry of Economy and Competitiveness"] [[""]]
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"]
26 ["Relationship between estimated cardiovascular disease risk and insulin resistance in a black African population living with HIV: a cross-sectional study from Cameroon"] 10.1136/bmjopen-2017-016835 http://dx.doi.org/10.1136/bmjopen-2017-016835 2017-08-11T20:25:24Z [] 0 4 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>Cardiovascular disease (CVD) and metabolic diseases are growing concerns among patients with HIV infection as a consequence of the improving survival of this population. We aimed to assess the relationship between CVD risk and insulin resistance in a group of black African individuals with HIV infection.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This cross-sectional study involved patients with HIV infection aged 30–74 years and followed up at the Yaoundé Central Hospital, Cameroon. Absolute CVD risk was calculated using the Framingham and the DAD CVD risk equations while the HOMA-IR index was used to assess insulin resistance (index ≥2.1).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 452 patients (361 women; 80%) were screened. The mean age was 44.4 years and most of the respondents were on antiretroviral therapy (88.5%). The median 5-year cardiovascular risk was 0.7% (25th−75th percentiles: 0.2–2.0) and 0.6% (0.3–1.3) according to the Framingham and DAD equations respectively. Of all participants, 47.3% were insulin resistant. The Framingham equation derived absolute CVD risk was significantly associated with insulin resistance; while no linear association was found using the DAD equation.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The relationship between cardiovascular risk and insulin resistance in black African patients with HIV infection seems to depend on the cardiovascular risk equation used.</jats:p></jats:sec> 13 ["http://orcid.org/0000-0001-8018-6279", "http://orcid.org/0000-0001-6155-235X"] ["Steve Raoul Noumegni", "Jean Joel Bigna", "Vicky Jocelyne Ama Moor epse Nkegoum", "Jobert Richie Nansseu", "Felix K Assah", "Ahmadou Musa Jingi", "Magellan Guewo-Fokeng", "Steve Leumi", "Jean-Claude Katte", "Mesmin Y Dehayem", "Liliane Mfeukeu Kuate", "Andre Pascal Kengne", "Eugene Sobngwi"] [""] [""] [""]
28 ["GCAT|Genomes for life: a prospective cohort study of the genomes of Catalonia"] 10.1136/bmjopen-2017-018324 http://dx.doi.org/10.1136/bmjopen-2017-018324 2018-03-28T06:10:36Z [] 0 4 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Purpose</jats:title><jats:p>The prevalence of chronic non-communicable diseases (NCDs) is increasing worldwide. NCDs are the leading cause of both morbidity and mortality, and it is estimated that by 2030, they will be responsible for 80% of deaths across the world. The Genomes for Life (GCAT) project is a long-term prospective cohort study that was designed to integrate and assess the role of epidemiological, genomic and epigenomic factors in the development of major chronic diseases in Catalonia, a north-east region of Spain.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>At the end of 2017, the GCAT Study will have recruited 20 000 participants aged 40–65 years. Participants who agreed to take part in the study completed a self-administered computer-driven questionnaire, and underwent blood pressure, cardiac frequency and anthropometry measurements. For each participant, blood plasma, blood serum and white blood cells are collected at baseline. The GCAT Study has access to the electronic health records of the Catalan Public Healthcare System. Participants will be followed biannually at least 20 years after recruitment.</jats:p></jats:sec><jats:sec><jats:title>Findings to date</jats:title><jats:p>Among all GCAT participants, 59.2% are women and 83.3% of the cohort identified themselves as Caucasian/white. More than half of the participants have higher education levels, 72.2% are current workers and 42.1% are classified as overweight (body mass index ≥25 and &lt;30 kg/m<jats:sup>2</jats:sup>). We have genotyped 5459 participants, of which 5000 have metabolome data. Further, the whole genome of 808 participants will be sequenced by the end of 2017.</jats:p></jats:sec><jats:sec><jats:title>Future plans</jats:title><jats:p>The first follow-up study started in December 2017 and will end by March 2018. Residences of all subjects will be geocoded during the following year. Several genomic analyses are ongoing, and metabolomic and genomic integrations will be performed t… 13 ["http://orcid.org/0000-0003-4646-3513"] ["Mireia Ob\u00f3n-Santacana", "Mireia Vilardell", "Anna Carreras", "Xavier Duran", "Juan Velasco", "Iv\u00e1n Galv\u00e1n-Femen\u00eda", "Teresa Alonso", "Llu\u00eds Puig", "Lauro Sumoy", "Eric J Duell", "Manuel Perucho", "Victor Moreno", "Rafael de Cid"] [] ["\u2019Ram\u00f3n y Cajal' action from the Spanish Ministry of Economy and Competitiveness", "Ag\u00e8ncia de Gesti\u00f3 d\u2019Ajuts Universitaris i de Recerca (AGAUR)", "Acci\u00f3n de Dinamizaci\u00f3n del ISCIII-MINECO", "Ministry of Health of the Generalitat of Catalunya", "the Catalan Government DURSI"] [[""], [""], [""], [""], [""]]
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"] [""] [""] [""]
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"] [""] [""] [""]
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"]
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"]
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"]

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