bluuebunny/crossref_metadata_2025 huggingface dataset:
Blastema formation and periosteal ossification in the regenerating adult mouse digit
Authors: Dawson Lindsay A. , Schanes Paula P. , Kim Patrick , Imholt Felisha M. , Qureshi Osama , Dolan Connor P. , Yu Ling , Yan Mingquan , Zimmel Katherine N. , Falck Alyssa R. , Muneoka Ken
Published: August 2018

While mammals cannot regenerate amputated limbs, mice and humans have regenerative ability restricted to amputations transecting the digit tip, including the terminal phalanx (P3). In mice, the regeneration process is epimorphic and mediated by the formation of a blastema comprised of undifferentiated proliferating cells that differentiate to regenerate the amputated structures. Blastema formation distinguishes the regenerative response from a scar‐forming healing response. The mouse digit tip serves as a preclinical model to investigate mammalian blastema formation and endogenous regenerative capabilities. We report that P3 blastema formation initiates prior to epidermal closure and concurrent with the bone histolytic response. In this early healing response, proliferation and cells entering the early stages of osteogenesis are localized to the periosteal and endosteal bone compartments. After the completion of stump bone histolysis, epidermal closure is completed and cells associated with the periosteal and endosteal compartments blend to form the blastema proper. Osteogenesis associated with the periosteum occurs as a polarized progressive wave of new bone formation that extends from the amputated stump and restores skeletal length. Bone patterning is restored along the proximal–distal and medial digit axes, but is imperfect in the dorsal–ventral axis with the regeneration of excessive new bone that accounts for the enhanced regenerated bone volume noted in previous studies. Periosteum depletion studies show that this compartment is required for the regeneration of new bone distal to the original amputation plane. These studies provide evidence that blastema formation initiates early in the healing response and that the periosteum is an essential tissue for successful epimorphic regeneration in mammals.
Empirical Measure of Wealth Effects in Household Consumption: The Case of Congo
Authors: OKOMBI Idrys Fransmel
Published: August 2018

The purpose of this article is to determine the impact of wealth in household consumption, by focusing on wealth under monetary form. In this way, the correction error model ARDL type is used. The outcome estimations show a significant existence of wealth effect on a period 1991.Q1-2016.Q1. In this way, the marginal propensity to consume wealth equals 0,476 to a short term. However, this marginal propensity to consume wealth, though being significant and positive is down to the marginal propensities to consume income available in the long term that are up to 0,695 and 0,777 as regard the short and long term. Nevertheless, to improve the households’ consumption level, the Congolese government can boost the monetary wealth by decreasing prices. More specifically, the government needs to lower value added tax (VAT).
Determinants of Nominal Effective Exchange Rate in Uganda (2000-2017): A Vecm Approach
Authors: Nakijoba Sawuya
Published: August 2018

This study analyses the main determinants of the nominal effective exchange rate using quarterly time series data covering the period 2000 to 2017. The Augmented Dickey Fuller test confirms that all the with the exception of interest rate were non stationary in levels. This study employs the reduced form Vector Auto-regression (VAR) and Johansen and Juselius cointegration to estimate the long run relationship between exchange rate and other key variables. The VAR is used following the Mundell-Fleming model which argues that, in an open economy with external trade and financial transactions the key macro variables interact and influence each other with lags. The impulse response functions are used to investigate the monetary policy transmission mechanism (MPTM). The study indicates that money supply, terms of trade and inflation were negative while gross domestic product and interest rate were positively related to exchange rate . The variables were found to have a long run relationship.  The estimate of the speed of adjustment indicates that when nominal effective exchange rate deviates from the equilibrium, it returns to the equilibrium quickly because of its coefficient of adjustment which is 0.25.
Adherence to activity monitoring devices or smartphone applications for improving physical activity in adults with cardiovascular disease: a systematic review protocol
Authors: Kourbelis Constance , Franzon Julie , Foote Jonathon W. , Brown Alex , Daniel Mark , Coffee Neil T. , Newman Peter , Ganesan Anand , Nicholls Stephen , Clark Robyn A.
Published: August 2018

Review question:

The question of this review is: what is the adherence to the use of activity monitoring devices or applications to improve physical activity in adults with cardiovascular disease?

Specifically, the review objectives are:

i) To quantify the extent of adherence (as specified by the study protocol) in the use of activity monitoring devices in the last five years.

ii) To determine if the extent of adherence differs by gender, age, length of study, types of device and/or how the device is worn.

iii) To determine if wearing an activity tracking device changes participants’ level of physical activity.

iv) To determine the perceived acceptability (satisfaction) of participants using an activity monitoring device or application to change levels of physical activity.
Effectiveness of non-pharmacological interventions for pain and physical function in adults with rib fractures: a systematic review protocol
Authors: Weinberg Beverley , Roos Ronel , van Aswegen Heleen
Published: August 2018

Review question/objectives:

The review question is: what are the effects of non-pharmacological therapeutic interventions on pain and physical function in adults with rib fractures?

The objectives of this systematic review are to determine:

What non-pharmacological therapeutic interventions are used in addition to pharmacological management strategies (standard care) for pain following acute rib fractures.

The effects of non-pharmacological therapeutic interventions on pain levels in adults following acute rib fractures.

The effects of non-pharmacological therapeutic interventions on physical and respiratory function in adults following acute rib fractures.
Evolving systems biology approaches to understanding non‐coding RNAs in pulmonary hypertension
Authors: Harvey Lloyd D. , Chan Stephen Y.
Published: August 2018

Our appreciation of the roles of non‐coding RNAs, in particular microRNAs, in the manifestation of pulmonary hypertension (PH) has advanced considerably over the past decade. Comprised of small nucleotide sequences, microRNAs have demonstrated critical and broad regulatory roles in the pathogenesis of PH via the direct binding to messenger RNA transcripts for degradation or inhibition of translation, thereby exerting a profound influence on cellular activity. Yet, as inherently pleiotropic molecules, microRNAs have been difficult to study using traditional, reductionist approaches alone. With the advent of high‐throughput –omics technologies and more advanced computational modelling, the study of microRNAs and their multi‐faceted and complex functions in human disease serves as a fertile platform for the application of systems biology methodologies in combination with traditional experimental techniques. Here, we offer our viewpoint of past successes of systems biology in elucidating the otherwise hidden actions of microRNAs in PH, as well as areas for future development to integrate these strategies into the discovery of RNA pathobiology in this disease. We contend that such successful applications of systems biology in elucidating the functional architecture of microRNA regulation will further reveal the molecular mechanisms of disease, while simultaneously revealing potential diagnostic and therapeutic strategies in disease amelioration.

image
Scattering from a finite ribbed plate with attached oscillators
Authors: Tran-Van-Nhieu Michel , Pham Thi Mai , Divay Laurent , Maze Gérard , Décultot Dominique , Léon Fernand , Chati Farid , Lardat Raphael , Hladky Anne-Christine , Croenne Charles , Dubus Bertrand
Published: August 2018

Double layer structures consisting of stainless steel and polymer rods are designed to blur and attenuate Bragg and Bloch-Floquet scattering from a periodically ribbed plate in a given frequency bandwidth. These structures can be considered as ribbed plate-spring-mass systems, the resonance frequencies of which are obtained from random and circular permutations of five basic oscillators. Analytical and finite element methods are used to find their parameters and tank tests have been carried out to ensure the accuracy of the numerical results and validate the relevance of such a model. It has been found that the typical features associated with the periodicity of the ribs are replaced by a “Christmas tree” appearance when the far field pressure backscattered from the model is displayed in the (frequency, aspect angle) plane. An analysis of backscattering patterns is presented and comparisons with Naval Research Laboratory results are made.
Draft Genome Sequence of Enterobacter cloacae 3F11 (Phylum
Proteobacteria
)
Authors: Dumigan Christopher R. , Perry Gregory E. , Pauls K. Peter , Raizada Manish N.
Published: August 2018

Presented here is the draft genome sequence of
Enterobacter cloacae
3F11. This seed endophyte solubilizes rock phosphate and was isolated from
Zea nicaraguensis
.
Draft Genome Sequences of Isolates from Sediments of the River Elbe That Are Highly Tolerant to Diclofenac
Authors: Quesada José Miguel , Aguilar Inés , de la Torre Jesús , Wittich Regina-Michaela , van Dillewijn Pieter
Published: August 2018

Here, we report the genome sequences of one
Achromobacter
and four
Pseudomonas
strains isolated from sediments of the River Elbe which are highly tolerant toward the xenobiotic target compound diclofenac, a nonsteroidal anti-inflammatory drug (NSAID) and emerging contaminant.
Draft Genome Sequence of Salinisphaera sp. Strain KSM-18, an Obligately Halophilic Bacterium Isolated from a Triassic Salt Mine
Authors: Kelly Stephen A. , Megaw Julianne , Gilmore Brendan F.
Published: August 2018

Here, we report the draft genome sequence of
Salinisphaera
sp. strain KSM-18.
Draft Genome Sequences of Sporulating (CIDEFI-213) and Nonsporulating (CIDEFI-212) Strains of Stemphylium lycopersici
Authors: Medina Rocio , Franco Mario Emilio Ernesto , Lucentini Gustavo , Saparrat Mario Carlos Nazareno , Balatti Pedro Alberto
Published: August 2018

Stemphylium lycopersici(Pleosporales) is a pathogenic fungus found on a broad range of plant hosts. It is one of the causal agents of gray leaf spot disease in tomato that causes severe yield reductions and economic losses worldwide.
Immunological failure in HIV-infected adults from 2003 to 2015 in Southwest Ethiopia: a retrospective cohort study
Authors: Gesesew Hailay Abrha , Ward Paul , Woldemichael Kifle , Mwanri Lillian
Published: August 2018

Objective

To assess the prevalence, trend and associated factors for immunological failure (IF), and the magnitude of antiretroviral therapy (ART) shift among adults infected with HIV in Southwest Ethiopia.

Setting

A retrospective cohort study was undertaken using the data from ART clinic at Jimma University Teaching Hospital from 21 June 2003 to 15 March 2015.

Participants

Retrospective analysis of 4900 HIV-infected adult patient records dating from June 2003 to March 2015 was conducted.

Primary outcome measure

The primary outcome was IF defined when cluster for differentiation 4 (CD4) count falls to the baseline (or below) or persistent CD4 levels below 100 cells/mm3after 6 months of ART treatment. The analyses included descriptive and inferential statistics.

Results

546 (19.5%) adults had developed clinical failure (CF), 775 (19.7%) adults had developed IF and 1231 (25.1%) had developed either CF or IF or both. The prevalence of IF was consistently high throughout the decade. Age 25 to ≤50 years adjusted OR (AOR 1.5, 9% CI 1.2 to 2.4), being female (AOR 1.8, 95% CI 1.3 to 1.9), late presenter for HIV care (AOR 2.2, 95% CI 1.6 to 2.7) and having baseline CD4 count below 200 cells/mm3(AOR 5.5, 95% CI 4.1 to 7.4), and having no history of HIV testing before diagnosis (AOR 0.7, 95% CI 0.5 to 0.9) were the predictors for IF. Only 29 (0.9%) adults infected with HIV were shifted to second-line ART regimen.

Conclusions

The magnitude of CF or IF or both was found significant and consistently high throughout the calendar year although ART shift was found minimal. HIV-infected adult patients with IF were early age adults, females, late presenters for HIV care, and those who had low baseline CD4 counts and history of HIV testing before diagnosis.
Risk of metabolic disorders in childless men: a population-based cohort study
Authors: Bungum Ane Berger , Glazer Clara Helene , Bonde Jens Peter , Nilsson Peter M , Giwercman Aleksander , Søgaard Tøttenborg Sandra
Published: August 2018

Objective

To study whether male childlessness is associated with an increased risk of metabolic disorders such as metabolic syndrome (MetS) and diabetes.

Design

A population-based cohort study.

Setting

Not applicable.

Participants

2572 men from the population-based Malmö Diet and Cancer Cardiovascular Cohort.

Interventions

None.

Main outcome measures

From cross-sectional analyses, main outcome measures were ORs and 95% CIs for MetS and diabetes among childless men. In prospective analyses, HRs and 95% CI for diabetes among childless men.

Results

At baseline, in men with a mean age of 57 years, the prevalence of MetS was 26% and 22% among childless men and fathers, respectively. Similarly, we observed a higher prevalence of diabetes of 11% among childless men compared with 5% among fathers. In the cross-sectional adjusted analyses, childless men had a higher risk of MetS and diabetes, with ORs of 1.22 (95% CI 0.87 to 1.72) and 2.12 (95% CI 1.34 to 3.36) compared with fathers. In the prospective analysis, during a mean follow-up of 18.3 years, we did not see any increase in diabetes risk among childless men (HR 1.02 (0.76 to 1.37)).

Conclusion

This study provides evidence of an association between male childlessness and a higher risk of MetS and diabetes. However, as these associations were found in cross-sectional analyses, reverse causation cannot be excluded.
Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomised controlled trial
Authors: Mansfield Avril , Aqui Anthony , Danells Cynthia J , Knorr Svetlana , Centen Andrew , DePaul Vincent G , Schinkel-Ivy Alison , Brooks Dina , Inness Elizabeth L , Mochizuki George
Published: August 2018

Objectives

No intervention has been shown to prevent falls poststroke. We aimed to determine if perturbation-based balance training (PBT) can reduce falls in daily life among individuals with chronic stroke.

Design

Assessor-blinded randomised controlled trial.

Setting

Two academic hospitals in an urban area.

Interventions

Participants were allocated using stratified blocked randomisation to either ‘traditional’ balance training (control) or PBT. PBT focused on improving responses to instability, whereas traditional balance training focused on maintaining stability during functional tasks. Training sessions were 1 hour twice/week for 6 weeks. Participants were also invited to complete 2 ‘booster’ training sessions during the follow-up.

Participants

Eighty-eight participants with chronic stroke (>6 months poststroke) were recruited and randomly allocated one of the two interventions. Five participants withdrew; 42 (control) and 41 (PBT group) were included in the analysis.

Primary and secondary outcome measures

The primary outcome was rate of falls in the 12 months post-training. Negative binomial regression was used to compare fall rates between groups. Secondary outcomes were measures of balance, mobility, balance confidence, physical activity and social integration.

Results

PBT participants reported 53 falls (1.45 falls/person-year) and control participants reported 64 falls (1.72 falls/person-year; rate ratio: 0.85(0.42 to 1.69); p=0.63). Per-protocol analysis included 32 PBT and 34 control participants who completed at least 10/12 initial training sessions and 1 booster session. Within this subset, PBT participants reported 32 falls (1.07 falls/person-year) and control participants reported 57 falls (1.75 falls/person-year; rate ratio: 0.62(0.29 to 1.30); p=0.20). PBT participants had greater improvement in reactive balance control than the control group, and these improvements were sustained 12 months post-training. There were no intervention-related serious adverse effects.

Conclusions

The results are inconclusive. PBT may help to prevent falls in daily life poststroke, but ongoing training may be required to maintain the benefits.

Trial registration number

ISRCTN05434601; Results.
Ginkgo biloba extract for prevention of acute mountain sickness: a systematic review and meta-analysis of randomised controlled trials
Authors: Tsai Tou-Yuan , Wang Shih-Hao , Lee Yi-Kung , Su Yung-Cheng
Published: August 2018

Objective

Trials of ginkgo biloba extract (GBE) for the prevention of acute mountain sickness (AMS) have been published since 1996. Because of their conflicting results, the efficacy of GBE remains unclear. We performed a systematic review and meta-analysis to assess whether GBE prevents AMS.

Methods

The Cochrane Library, EMBASE, Google Scholar and PubMed databases were searched for articles published up to 20 May 2017. Only randomised controlled trials were included. AMS was defined as an Environmental Symptom Questionnaire Acute Mountain Sickness-Cerebral score ≥0.7 or Lake Louise Score ≥3 with headache. The main outcome measure was the relative risk (RR) of AMS in participants receiving GBE for prophylaxis. Meta-analyses were conducted using random-effects models. Sensitivity analyses, subgroup analyses and tests for publication bias were conducted.

Results

Seven study groups in six published articles met all eligibility criteria, including the article published by Leadbetteret al, where two randomised controlled trials were conducted. Overall, 451 participants were enrolled. In the primary meta-analysis of all seven study groups, GBE showed trend of AMS prophylaxis, but it is not statistically significant (RR=0.68; 95% CI 0.45 to 1.04; p=0.08). The I2statistic was 58.7% (p=0.02), indicating substantial heterogeneity. The pooled risk difference (RD) revealed a significant risk reduction in participants who use GBE (RD=−25%; 95% CI, from a reduction of 45% to 6%; p=0.011) The results of subgroup analyses of studies with low risk of bias, low starting altitude (<2500 m), number of treatment days before ascending and dosage of GBE are not statistically significant.

Conclusion

The currently available data suggest that although GBE may tend towards AMS prophylaxis, there are not enough data to show the statistically significant effect of GBE on preventing AMS. Further large randomised controlled studies are warranted.
Process evaluation of a randomised controlled trial of a pharmacological strategy to improve hypertension control: protocol for a qualitative study
Authors: Salam Abdul , Webster Ruth , Patel Anushka , Godamunne Pavithra , Pathmeswaran Arunasalam , de Silva H Asita , Rogers Anthony , Jan Stephen , Laba Tracey-Lea
Published: August 2018

Introduction

Globally, the prevalence of uncontrolled hypertension is high, particularly in low- and middle-income countries. There is a critical need for strategies to improve hypertension control. The early use of a fixed low-dose combination of three antihypertensive drugs (triple pill) has the potential to significantly improve hypertension control. TheTRIple Pill vs.Usual careManagement forPatients with mild-to- moderateHypertension (TRIUMPH) randomised controlled trial (RCT) is designed to test the effects of this strategy compared with usual care in patients with mild-to-moderate hypertension. This paper reports the protocol of a process evaluation of the TRIUMPH RCT. The objectives are to understand factors related to implementation of the intervention, mechanisms of effect, contextual factors that underpin the effectiveness of the triple pill strategy and the potential barriers and facilitators to implementing the strategy in clinical practice.

Methods and analysis

Face-to-face semistructured in-depth interviews with a purposive sample of TRIUMPH RCT participants and healthcare professionals in Sri Lanka will be conducted. Healthcare professionals will include physicians and their staff who were involved in conducting the TRIUMPH RCT. Interviewees will be recruited sequentially until thematic saturation is achieved. Interviews will be audio recorded, transcribed verbatim and analysed in NVivo using framework analysis methods.

Ethics and dissemination

The TRIUMPH RCT and process evaluation have received approval from the relevant Ethics Review Committee. All participants will be asked to provide written consent before participation. Findings from the study will be disseminated through publications and conference presentations.

Trial registration number

ACTRN12612001120864 , SLCTR/2015/020 ; Pre-results.
Enhancing peer support experience for patients discharged from acute psychiatric care: protocol for a randomised controlled pilot trial
Authors: Urichuk Liana , Hrabok Marianne , Hay Katherine , Spurvey Pamela , Sosdjan Daniella , Knox Michelle , Fu Allen , Surood Shireen , Brown Robert , Coulombe Jeff , Kelland Jill , Rittenbach Katherine , Snaterse Mark , Abba-Aji Adam , Li Xin-Min , Chue Pierre , Greenshaw Andrew J , Agyapong Vincent I O
Published: August 2018

Introduction

This study will evaluate the effectiveness of an innovative peer support programme. The programme incorporates leadership training, mentorship, recognition and reward systems for peer support workers, and supportive/reminder text messaging for patients discharged from acute (hospital) care. We hypothesise that patients enrolled in the peer support system plus daily supportive/reminder text messages condition will achieve superior outcomes in comparison to other groups.

Methods and analysis

This is a prospective, rater-blinded, four-arm randomised controlled trial. 180 patients discharged from acute psychiatric care in Edmonton, Alberta, Canada will be randomised to one of four conditions: (1) enrolment in a peer support system; (2) enrolment in a peer support system plus automated daily supportive/reminder text messages; (3) enrolment in automated daily supportive/reminder text messages alone; or (4) treatment as usual follow-up care. Patients in each group will complete evaluation measures (eg, recovery, general symptomatology and functional outcomes) at baseline, 6 months and 12months. Patient service utilisation data and clinician-rated measures will also be used to gauge patient progress. Patient data will be analysed with descriptive statistics, repeated measures and correlational analyses. The peer support worker experience will be captured using qualitative methods.

Ethics and dissemination

The study will be conducted in accordance with the Declaration of Helsinki (Hong Kong Amendment) and Good Clinical Practice (Canadian Guidelines). The study has received ethical clearance from the Health Ethics Research Board of the University of Alberta (Ref # Pro00078427) and operational approval from our regional health authority (AHS- (PRJ) #35293). All participants will provide informed consent prior to study inclusion. The results will be disseminated at several levels, including patients/peer supports, practitioners, academics/researchers, and healthcare organisations.

Trial registration number

NCT03404882; Pre-results.
Digital health app development standards: a systematic review protocol
Authors: Van Velthoven Michelle Helena , Smith James , Wells Glenn , Brindley David
Published: August 2018

Introduction

There is currently a lack of clear and accepted standards for the development (planning, requirement analysis and research, design and application testing) of apps for medical and healthcare use which poses different risks to developers, providers, patients and the public. The aim of this work is to provide an overview of the current standards, frameworks, best practices and guidelines for the development of digital health apps. This review is a critical ’stepping stone’ for further work on producing appropriate standards that can help mitigate risks (eg, clinical, privacy and economic risks).

Methods and analysis

A systematic review identifying criteria from applicable standards, guidelines, frameworks and best practices for the development of health apps. We will draw from standards for software for medical devices, clinical information systems and medicine because of their relatedness and hope to apply lessons learnt to apps. We will exclude other types of publications, and those published in languages other than English. We will search websites of relevant regulatory and professional organisations. For health apps, we will also search electronic research databases (eg, MEDLINE, Embase, SCOPUS, ProQuest Technology Collection and Engineering Index) because relevant publications may not be found on other websites. We will hand-search reference lists of included publications. The review will focus on international, USA, European and UK standards because these are the markets of primary interest to the majority of app developers currently. We will provide a narrative overview of findings and tabular summaries of extracted data. Also, we will examine the relationship between different standards and compare USA and European Union standards.

Ethics and dissemination

No ethics approval is required. The review will be disseminated through peer-reviewed publications, conference presentations and inform efforts that aim to improve the quality of health apps through existing links with relevant organisations.
Factors contributing to practitioner choice when declining involvement in legally available care: A scoping protocol
Authors: Brown Janine , Goodridge Donna , Thorpe Lilian , Chipanshi Mary
Published: August 2018

Introduction

As legislation addressing medical treatments continues to evolve, there are several circumstances (eg, abortion, assisted dying) in which health practitioners may choose to not provide legally available care options. It is not always clear what underlies practitioner choice, as some research has suggested non-participation in care provision is not always due to an ethical abstention but may represent other factors. This results in tension between a practitioner’s right to refrain from practices deemed morally objectionable by the practitioner, and the care recipient’s right to access legally available treatments. The aim of this systematic scoping review is to identify the current knowledge regarding all the factors influencing practitioner’s choices when declining involvement in legally available healthcare options.

Methods and analysis

Arksey and O’Malley’s scoping framework in concert with Levacet al’s enhancements will guide the systematic scoping review methodological processes. English language documents from 1 January 1998 to current will be sought using Medline, CINAHL, JSTOR, EMBASE, ProQuest Dissertations and Theses Global, PsychINFO and Sociological Abstracts. MeSH headings, keywords and synonyms will be adjusted using an iterative search process. Theses and dissertations will be included in the search protocol; however, other grey literature will be accessed only as required. Two research team members will screen the abstracts and full articles against inclusion criteria. Article information will be extracted via a data collection tool and undergo thematic analysis. Descriptive summary (visual summary and study contextual information) and a presentation of analytical themes will align findings back to the research question.

Ethics and dissemination

Ethics approval is not required. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be used to support transparency and guide translation of findings. Findings will be disseminated through professional networks, in peer-reviewed journals and conferences via abstract and presentation.
Clinical and cost-effectiveness of one-session treatment (OST) versus multisession cognitive–behavioural therapy (CBT) for specific phobias in children: protocol for a non-inferiority randomised controlled trial
Authors: Wright Barry D , Cooper Cindy , Scott Alexander J , Tindall Lucy , Ali Shehzad , Bee Penny , Biggs Katie , Breckman Trilby , Davis III Thompson E , Gega Lina , Hargate Rebecca Julie , Lee Ellen , Lovell Karina , Marshall David , McMillan Dean , Teare M Dawn , Wilson Jonathan
Published: August 2018

Introduction

Specific phobias (intense, enduring fears of an object or situation that lead to avoidance and severe distress) are highly prevalent among children and young people. Cognitive–behavioural therapy (CBT) is a well-established, effective intervention, but it can be time consuming and costly because it is routinely delivered over multiple sessions during several months. Alternative methods of treating severe and debilitating phobias in children are needed, like one-session treatment (OST), to reduce time and cost, and to prevent therapeutic drift and help children recover quickly. Our study explores whether (1) outcomes with OST are ‘no worse’ than outcomes with multisession CBT, (2) OST is acceptable to children, their parents and the practitioners who use it and (3) OST offers good value for money to the National Health Service (NHS) and to society.

Method

A pragmatic, non-inferiority, randomised controlled trial will compare OST with multisession CBT-based therapy on their clinical and cost-effectiveness. The primary clinical outcome is a standardised behavioural task of approaching the feared stimulus at 6 months postrandomisation. The outcomes for the within-trial cost-effectiveness analysis are quality-adjusted life years based on EQ-5D-Y, and individual-level costs based of the intervention and use of health and social service care. A nested qualitative evaluation will explore children’s, parents’ and practitioners’ perceptions and experiences of OST. A total of 286 children, 7–16 years old, with DSM-IV diagnoses of specific phobia will be recruited via gatekeepers in the NHS, schools and voluntary youth services, and via public adverts.

Ethics and dissemination

The trial received ethical approval from North East and York Research Ethics Committee (Reference: 17/NE/0012). Dissemination plans include publications in peer-reviewed journals, presentations in relevant research conferences, local research symposia and seminars for children and their families, and for professionals and service managers.

Trial registration number

ISRCTN19883421;Pre-results.
Self-management, self-management support needs and interventions in advanced cancer: a scoping review
Authors: Budhwani Suman , Wodchis Walter P , Zimmermann Camilla , Moineddin Rahim , Howell Doris
Published: August 2018

Patients with advanced cancer can experience illness trajectories similar to other progressive chronic disease conditions where undertaking self-management (SM) and provision of self-management support (SMS) becomes important. The main objectives of this study were to map the literature of SM strategies and SMS needs of patients with advanced cancer and to describe SMS interventions tested in this patient population. A scoping review of all literature published between 2002 and 2016 was conducted. A total of 11 094 articles were generated for screening from MEDLINE, Embase, PsychINFO, CINAHL and Cochrane Library databases. A final 55 articles were extracted for inclusion in the review. Included studies identified a wide variety of SM behaviours used by patients with advanced cancer including controlling and coping with the physical components of the disease and facilitating emotional and psychosocial adjustments to a life-limiting illness. Studies also described a wide range of SMS needs, SMS interventions and their effectiveness in this patient population. Findings suggest that SMS interventions addressing SMS needs should be based on a sound understanding of the core skills required for effective SM and theoretical and conceptual frameworks. Future research should examine how a patient-oriented SMS approach can be incorporated into existing models of care delivery and the effects of SMS on quality of life and health system utilisation in this population.
11 Filling the void: preparing future junior doctors for challenging conversations
Authors: Costelloe Hannah , Copley Alice , Greenhalgh Andrew , Foster Andrew , Solanki Pratik
Published: August 2018

Evidence demonstrates that medical students have limited experience in developing ‘higher-order communication skills’ (Kaufmanet al.2000). Anecdotally many do not feel confident in their ability to conduct difficult conversations often due to a lack of exposure to such scenarios in practice or a pervasive notion that these scenarios are inappropriate for students and beyond the scope of a junior doctor’s role and thus not a focus of curriculums (Nobleet al.2007). There is however a correlation between level of clinical experience and improved confidence for medical students (Morgan and Cleave-Hogg 2002).

We surveyed a group of final year medical students to assess their confidence using a 10-point Likert scale in tackling common palliative and end of life care scenarios. Our intervention comprised a study day of 10 practical small-group teaching simulation and OSCE-style stations designed to provide exposure to common experiences in a controlled setting. We reassessed the confidence of students after delivery and objectively explored the impact of the day by asking participants to complete a validated assessment before and after the course. All results showed significant improvement on t-testing: confidence in end of life communication in an OSCE setting improved by 42.2% and assessment marks improved by 24.7% (p=0.039).

Palliative care is an area in which students approaching the end of undergraduate training feel underprepared. Our findings demonstrate that small group sessions improve confidence by facilitating communication practice in a controlled environment and providing crucial exposure to common palliative care scenarios they will face as doctors.

References

. Kaufman D, Laidlaw T, Macleod H. Communication skills in medical school: Exposure confidence and performance.Academic Medicine[online] 2000;75(10):S90–S92. Available at https://journals.lww.com/academicmedicine/Fulltext/2000/10001/Communication_Skills_in_Medical_School__Exposure.29.aspx [Accessed: 30 May 2018]

. Morgan P, Cleave-Hogg D. Comparison between medical students’ experience confidence and competence. Medical Education [online] 2002;36(6):534–539. Available at https://doi.org/10.1046/j.1365-2923.2002.01228.x [Accessed: 30 May 2018]

. Noble L, Kubacki A, Martin J, Lloyd M. The effect of professional skills training on patient-centredness and confidence in communicating with patients. Medical Education [online] 2007;41(5):432–440. Available at https://doi.org/10.1111/j.1365-2929.2007.02704.x [Accessed: 30 May 2018]
12 Feasibility of an online implementation toolkit for palliative care services seeking to implement a carer-centred process of assessment and support
Authors: Diffin Janet , Ewing Gail , Rowland Christine , Grande Gunn
Published: August 2018

Introduction

The Carer Support Needs Assessment Tool (CSNAT) intervention requires a change in practice to a carer-centred process of assessment and support.1-3An online toolkit was developed to guide palliative services through the process of implementing the CSNAT intervention.

Aims

Explore the feasibility and acceptability of delivering implementation training through an online toolkit format.

Methods

The online toolkit has two learning components: (1) Individual: knowledge for practitioners to use the intervention; (2) Organisational: to assist a project team to plan pilot and sustain implementation. Five UK palliative care services participated; 2–4 practitioners from each completed the toolkit. Online survey administered upon completion of each learning component for feedback on content followed by telephone interview.

Results

15 practitioners completed ‘Learning component 1’ survey 14 completed ‘Learning component 2’ survey and 13 were interviewed. Feedback on content was positive. Online learning suitability was influenced by resource availability the nature/size of the team and individual learning styles. Variation in location of completion (work/home or both) was partly explained by availability of IT equipment space and time within the organisation. Whilst the majority of participants saw the value of online learning some had a preference for face-to-face delivery and so blended learning to include group discussions was deemed appropriate.

Conclusions

Whilst online learning is welcomed by practitioners organisations need to ensure sufficient resources are available to enable completion and that it is given the same priority as attendance at face-to-face workshops. Blended learning may help accommodate different learning preferences.

Funder

NIHR CLARHC Greater Manchester

References

. Ewing G, Grande G. Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: A qualitative study. Palliative Medicine2013;27(3):244–56.

. Ewing G, Brundle C, Payne S, Grande G. The Carer Support Needs Assessment Tool (CSNAT) for use in palliative and end-of-life care at home: A validation study. Journal of Pain and Symptom Management2013;46(3):395–405.

. Ewing G, Austin L, Diffin J, Grande G. Developing a person-centred approach to carer assessment and support. British Journal of Community Nursing2015;20(12):580–4.
15 Triggers for the pharmacological management of delirium in palliative care: a mixed methods study
Authors: Fairfield Catherine L , Finucane Anne M , Spiller Juliet A
Published: August 2018

Introduction

Delirium is a serious neurocognitive disorder with a high prevalence in palliative care and debate regarding its management is ongoing.

Aims

To describe how delirium and its symptoms is documented in patient records

To determine the use of delirium screening tools and how these are viewed by staff

To identify triggers for pharmacological intervention in delirium management in a terminally ill population.

Methods

A retrospective case-note review concerning all patients admitted to a hospice inpatient setting between 1–17th August 2017 and semi-structured interviews with 7 hospice doctors and nurses.

Results

21 patients were reviewed. 62% were screened for delirium using the 4AT on admission. 76% had documented symptoms of delirium and of these 81% died without delirium resolution. There were inconsistencies in the documentation of delirium and the term itself was used infrequently. Non-pharmacological measures were poorly documented. Midazolam was the most commonly used medication. Triggers for pharmacological intervention included failure of non-pharmacological measures distress agitation and risk of patient harm. Nursing staff recognised delirium in its severe form but were less likely to do so in milder cases.

Conclusions

Triggers for pharmacological intervention are in-keeping with guidelines however the level of understanding of delirium’s presentation varied between participants. This along with the high prevalence of delirium frequent use of midazolam and limited awareness and documentation of non-pharmacological measures (e.g. structured family support) highlights the need for further training and research.
16 Delirium care of hospice patients: a qualitative interview study with staff and volunteers
Authors: Featherstone Imogen , Johnson Miriam , Jones Lesley , Coppo Eleonora , Hosie Annmarie , Bush Shirley H , Siddiqi Najma , Taylor Johanna , Teodorczuk Andrew
Published: August 2018

Introduction

Delirium is a distressing condition which is commonly experienced by hospice patients. Although delirium can be prevented by around one-third in hospital inpatients (Siddiqiet al.2016) there has been little research into effective strategies to prevent and manage delirium in hospices. Greater insight into the current practice attitudes and understanding of hospice staff and volunteers would inform the development of interventions that are tailored to improve delirium care in hospices.

Aim

To explore the understanding attitudes and practice of hospice staff and volunteers regarding the care of patients with delirium.

Methods

36 qualitative semi-structured interviews were conducted at two hospices. Participants were purposively sampled to include different disciplines (9 health care assistants, 8 nurses, 5 doctors, 4 volunteers, 3 board members, 2 allied health professionals, 2 managers, 2 domestic workers and 2 fundraisers). A topic guide and case vignettes prompted participants to describe their experiences in relation to delirium prevention recognition assessment and management. Three researchers are conducting thematic analysis to identify analyse and interpret themes from the interview data.

Results

Provisional results include themes of: ‘Supporting the distressing experience of delirium’; ‘Management strategies’ and ‘The burden of delirium care.’ Gaps in current practice relate to delirium prevention recognition and screening. Potential facilitators for developing interventions in hospices include education flexibility in staffing the role of volunteers and a supportive staff culture.

Conclusion

This study will provide important insights into staff and volunteers’ current practice which will inform the development of a targeted intervention to improve delirium care in hospices.

Reference

. Siddiqi N, Harrison J, Clegg A, Teale E, Young J, Taylor J, Simpkins S. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database of Systematic Reviews2016;(3). Art. No.: CD005563. doi:10.1002/14651858.CD005563.pub3
20 Validation of the support needs approach for patients (SNAP) tool to enable patients with advanced copd to identify and express their support needs to healthcare professionals
Authors: Gardener Carole , Ewing Gail , Farquhar Morag
Published: August 2018

Introduction

Patient identified need is key to delivering a person-centred approach in supportive and palliative care. The support needs approach for patients (SNAP) tool aims to enable patients with advanced COPD to identify and express their support needs to healthcare professionals (HCPs) but its validity is unknown.

Aim

To establish the face content and criterion validity of the SNAP tool in advanced COPD.

Methods

Two-stage mixed method primary care study involving patients with advanced COPD and their carers. Stage 1: Face and content validity assessed though focus groups involving patients and carers (n=12) considering appropriateness relevance and completeness of the SNAP tool. Thematic data analysis within a Framework Approach. Stage 2: Content and criterion validity assessed in a postal survey through patient self-completion of the SNAP tool and disease impact measures (chronic respiratory questionnaire COPD assessment test and hospital anxiety and depression scale). Content validity assessed using summary statistics; criterion validity via correlations between tool items and impact measures.

Results

The SNAP tool has good face content and criterion validity. Patients and carers found the tool patient-friendly with potential clinical utility. No tool items were redundant. Clear correlations were found between tool items and the majority of items/sub-scales of the impact measures.

Discussion

The SNAP tool has good face content and criterion validity. It has the potential to support the delivery of supportive and palliative care in advanced COPD by enabling patients to identify and express their support needs to HCPs. Future work will pilot SNAP in clinical practice.
21 Identification and management of delirium in the palliative inpatient unit
Authors: Gill Andrew , Rayment Clare , Kane Chris
Published: August 2018

Introduction

Delirium is an acute confusional state. The incidence of delirium in palliative care units is estimated between 13% and 42% (Hosie 2014). Delirium is associated with an increase in mortality and length of hospice stay yet it is poorly identified. Up to 50% of cases of delirium are reversible (Lawlor 2000) as such early identification and impeccable assessment and treatment could relieve the suffering.

Aim

To assess identification and management of delirium in two hospices.

Methods

Retrospective notes analysis to identify patients with delirium whether they were coded with a delirium diagnosis and whether the management of delirium followed best practice.

Results

77 inpatients across two hospices were assessed in one month in 2018. There were 37 episodes of possible delirium only five were coded as delirium none had assessment with a recognised delirium tool. Reversibility was considered for 48 episodes; it was not clear from the documentation that this was all possible reversible causes. Family were kept informed 94% of the time. A management plan was documented for five patients.

Conclusion

Delirium was being considered but not documented a common problem in medical notes. Documentation of a management plan was poor but when there was a plan best practice was followed with non-pharmacological management then low dose antipsychotic with stronger sedation reserved for terminal agitation. An education feedback loop formal training on delirium and design of an electronic medical record template to prompt the management of delirium is ongoing. Practice will be reassessed three months after this intervention.

References

. Hosie A, Davidson P, Agar M, et al. Delirium prevalence incidence and implications for screening in specialist palliative care inpatient settings: A systematic review. Palliative Medicine2013;27(6):486–498.

. Lawlor P, Gagnon B, Mancini I, et al. Occurrence causes and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine2000;160(6):786–794.