bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and risk factors of incontinence‐associated dermatitis among patients in the intensive care unit
Authors: Wang Xinran , Zhang Yu , Zhang Xiaoxue , Zhao Xiaowei , Xian Hongtao
Published: July 2018

Objective

To investigate the incidence of incontinence‐associated dermatitis (IAD) among patients in the intensive care unit (ICU) and to identify potential risk factors to establish a reference for clinical nursing work.

Background

Patients in the ICU are susceptible to IAD. IAD is painful, reduces the patient's quality of life and adds to the workload of clinical medical staff. However, risk factors associated with IAD may differ between countries and healthcare settings.

Design

Prospective cohort study

Methods

From November 2016 to November 2017, a prospective cohort study was conducted among109 patients in three Class 3, Grade A hospitals (comprising 9 ICUs in total) in Beijing. The Incontinence‐associated Dermatitis and Its Severity (IADS) instrument in Chinese was applied to assess IAD. Univariate and multivariate logistic regression analyses were performed to identify risk factors for IAD.

Results

The study population had 29 community‐acquired and 80 nosocomial infections, and 26 (incidence: 23.9%) of these had IAD. On univariate analysis, a significant difference was observed between patients with and without IAD with respect to the following indices: Barthel index, Braden scale score, Nutritional Risk Screening 2002 (NRS2002) score, serum albumin level, occurrence of infection, faecal incontinence, frequency of faecal incontinence, stool property and double (faecal and urinary) incontinence and perineal assessment tool (PAT) score (p < 0.05). Multivariate logistic regression analysis showed that three factors entered the regression equation—that is, the Braden Scale Score, serum albumin level and double incontinence. Of these, the Braden Scale Score and serum albumin level were protective factors for IAD. Thus, the higher the Braden Scale Score, the lower the risk of IAD (OR = 0.678, 95% confidence interval [CI] = 0.494–0.931); a higher level of serum albumin implies a lower risk of IAD, provided it is within the normal range (OR = 0.884, 95%CI = 0.797–0.981). Double incontinence was an independent risk factor for IAD (OR = 10.512, 95% CI = 2.492–44.342).

Conclusion

A higher morbidity of IAD is seen in the ICU. Specific preventive and nursing measures are required to maintain the skin integrity of critically ill patients in daily nursing practice to improve patient quality of life and the quality of nursing care.

Relevance to clinical practice

Incontinence‐associated dermatitis is characterised by inflammation and tissue damage due to prolonged/repeated exposure to urine and/or stool. Not every patient with urine and/or stool incontinence develops IAD. Medical staff can use research‐based evidence to identify ICU patients at risk of IAD to reduce morbidity and improve health outcomes.
Relatives’ strategies in subacute brain injury rehabilitation: The warrior, the observer and the hesitant
Authors: Guldager Rikke , Willis Karen , Larsen Kristian , Poulsen Ingrid
Published: July 2018

Background

Relative involvement is crucial in rehabilitation when patients are incapable of being involved due to cognitive and functional dysfunction. However, studies have shown that this is complex because of differing understandings of the meaning of involvement as well as diverse needs to be involved.

Aims and objectives

To explore the experience of the rehabilitation process from the perspectives of relatives of patients with a traumatic brain injury. The aim of the study was, through a theoretical‐empirical analysis, to identify relatives’ strategies and practices in the rehabilitation process as evidenced in meetings with providers.

Design

A longitudinal study with a qualitative approach, drawing on the theory of Pierre Bourdieu.

Methods

Data were generated using participant observation and semi‐structured interviews. Participants were eleven relatives of patients with a severe traumatic brain injury, followed through in‐patient rehabilitation varying from 9–12 weeks. Analysis was undertaken using both an inductive and deductive approach.

Findings

Drawing on Bourdieu's concept of strategy, three relative positions were identified, the warrior, the observer and the hesitant. These positions illustrate how different relative positions and their related dispositions influence the strategies used by relatives of patients with a severe traumatic brain injury evidenced in how they act, participate and relate to both the patient and the providers during the course of rehabilitation.

Conclusions

Acknowledging the relatives’ positions during the rehabilitation process enables better understanding and support of the relatives in the rehabilitation process to meet their (and thus the patients’) diverse needs.

Relevance to clinical practice

The findings have practical implications in informing how clinicians meet, interact, communicate and involve relatives of adult patients’ with traumatic brain injury in decision‐making during rehabilitation.
In Vitro Evaluation of Adhesion of Candida albicans on CAD/CAM PMMA‐Based Polymers
Authors: Murat Sema , Alp Gülce , Alatalı Canan , Uzun Meltem
Published: July 2018

Purpose

To compare the amount of adherent Candida albicans to different CAD/CAM poly(methyl methacrylate) (PMMA)‐based polymers and conventional heat‐polymerized PMMA after long‐term thermal cycling.

Materials and Methods

The specimens were subjected to 10,000 thermal cycles (5‐55°C) and divided into two groups, uncoated and pellicle‐coated. Surface roughness and contact angles of the specimens were measured. The surface morphology was observed with scanning electron microscopy (SEM). An adhesion test was performed by incubating the disk specimens in C. albicans suspensions at 37°C for 2 hours, and the adherent cells were counted under an optical microscope. The data were analyzed statistically using a variance analysis and Tukey HSD post hoc comparison test. The correlation between measurements was tested using a Pearson correlation analysis (α = 0.05).

Results

CAD/CAM polymers generally showed statistically significant lowest Ra and contact angle values, whereas conventional PMMA showed the highest Ra and contact angle values in the uncoated group (p < 0.05). Pellicle coating essentially increased contact angle of all materials and reduced the differences in a number of Candida cells on the materials (p < 0.05). Candida adhesion was statistically significantly greatest on conventional PMMA when compared to CAD/CAM polymers. A strong positive correlation was found between the surface roughness of the specimens (p < 0.05) and the amount of adhered cells, whereas no correlation was found between hydrophobicity of the specimens and the amount of adhered cells (p > 0.05).

Conclusions

CAD/CAM PMMA‐based polymers may be preferable to reduce Candida‐associated denture stomatitis in long‐term use.
Effects of pearl millet silage ammoniation with urea on carcass and meat quality of lambs
Authors: de Carvalho Gleidson G. P. , de Freitas Poliane Meire D. , Santos Edson M. , Araújo Gherman G. L. , de Oliveira Juliana S. , Rodrigues Thomaz Cyro G. de C. , de Araujo Maria Leonor G. M. L. , de Assis Dallyson Yehudi C. , Roça Roberto de O. , de Delbem Nara Laiane C. , Lomele Renata L. , Leite Laudi C. , Rodrigues Carlindo S.
Published: June 2018

This study aimed to evaluate the effect of pearl millet silage ammoniated with urea on lamb carcass characteristics and meat quality. Thirty‐two noncastrated crossbred lambs at 4–5 months of age, with an average initial body weight of 17.39 ± 2.16 kg, were distributed into four treatments in a randomized block experimental design with eight animals per treatment. Experimental diets were composed of pearl millet silage ammoniated with four levels of urea (0%, 2%, 4% and 6%, on dry matter basis (DM). Carcass conformation and fatness decreased linearly (p < 0.05). Except for the fat content, the proximate composition was not influenced (p < 0.05) by the diets. Meat lightness and yellowness increased linearly (p < 0.05). There was no effect of diets (p > 0.05) on cooking losses or shear force. The levels of oleic and erucic fatty acid levels in the meat decreased linearly (p < 0.05), whereas linoleic and eicosadienoic acids, polyunsaturated fatty acids, PUFA:SFA ratio and ω6 contents increased (p < 0.05). Pearl millet silage ammoniated with urea allows for the production of good‐quality lamb meat, with greater concentrations of polyunsaturated fatty acids. However, lambs fed diets with pearl millet ammoniated with up to 6% lead to a reduction of carcass characteristics without significantly affecting loin‐eye area possibly associated with low palatability of the additive used. The lower acceptance of the silages with higher levels of urea is due to the ammonia retention in the material is attributed to the ammonization process. Thus, in spite of the benefits on lamb meat quality, it is suggested that the use of this additive in the ammonization of tropical forages be carried out with care, in limits of up to 6%.
Prevalence, extent and severity of peri‐implant diseases. A cross‐sectional study based on a university setting in Brazil
Authors: Matarazzo F. , Sabóia‐Gomes R. , Alves B. E. S. , de Oliveira R. P. , Araújo M. G.
Published: July 2018

Background and objective

Peri‐implant diseases are a growing concern among clinicians. Epidemiological studies following recently recommended case definitions for peri‐implant diseases are emerging worldwide. Although a small number of studies on the prevalence of peri‐implant diseases has been conducted in Brazil, no information on the extent and severity of the condition has been made available so far. The objective of this study was to estimate the prevalence, extent and severity of peri‐implant diseases in patients treated in a university setting in Brazil.

Material and methods

Patients with dental implants with at least 1 year in function were clinically and radiographically examined and classified according to recently recommended case definitions. A descriptive analysis on the prevalence, extent and severity of the peri‐implant status at patient and implant level was performed. Risk indicators for peri‐implantitis were also identified with binary logistic regression analysis.

Results

Of the 211 participating individuals, 4 (1.9%) presented peri‐implant health, 8 (3.8%) clinical stability, 115 (54.5%) mucositis and 84 (39.8%) peri‐implantitis. Of the 748 implants analyzed, 47 (6.3%) presented peri‐implant health, 30 (4%) clinical stability, 518 (69.2%) mucositis and 153 (20.5%) peri‐implantitis. The extent of implants with peri‐implantitis and peri‐implant mucositis was 41.5% and 90.4%, respectively. Severe peri‐implantitis was found in 36 patients (17.1%) and 67 implants (9%). Gender male, number of implants ≥4, implants installed in the maxilla, cemented prosthesis and keratinized mucosa width <2 mm were significantly associated with the event peri‐implantitis.

Conclusion

In the studied population, the prevalence, extent and severity of the peri‐implant diseases were similar to those reported elsewhere. Peri‐implant diseases were a common finding, with only 5.7% of patients and 10.3% of implants presenting peri‐implant health or clinical stability. About 17% of patients studied presented the severe form of peri‐implantitis.
Certification of fitness to drive in sleep apnea patients: Are we doing the right thing?
Authors: Grote Ludger , Svedmyr Sven , Hedner Jan
Published: July 2018

New European Union (EU) regulations state that untreated moderate to severe obstructive sleep apnea (OSA) coincident with excessive daytime sleepiness (EDS) constitutes a medical disorder leading to unfitness to drive. However, fitness to drive can be re‐established by successful treatment of OSA and EDS. The aim of the current study was to compare patients undergoing the certification process with those of an unselected OSA patient cohort. The study compared consecutive patients in the certification group (n = 132) with a representative group of OSA patients with a current driving license and an Apnea Hypopnea Index (AHI) ≥ 15 n/h (n = 790). The adherence to positive airway pressure (PAP) therapy and the change in EDS (Epworth Sleepiness Scale [ESS] score) with treatment were analysed. Patient characteristics and severity of sleep apnea did not differ significantly between groups (certification/reference group: BMI 30 ± 5/31 ± 5 kg/m2, AHI 33 ± 20/36 ± 20 n/hr, ESS 12 ± 6/11 ± 5). However, the certification group was oversampled with elderly drivers (70–85 years: 22% vs. 9%, p = 0.001). PAP compliance was higher in the certification group than in the reference group (PAP use ≥ 4 hr/night in 96% vs. 53%, p = 0.001) and mean ESS reduction was ‐8.0 (‐8.9 – ‐7.1) versus ‐4.0 (‐4.4 – ‐3.5), respectively (p < 0.001). Patients attending the fitness to drive evaluation reported almost complete adherence to continuous positive airway pressure (CPAP) and elimination of EDS symptoms. Besides possible baseline differences, this strong response may be explained by factors such as a selection process of elderly patients, a self‐rating component in the assessment of the treatment response and the threat of a driving license suspension. Our data suggest that an improved certification process with objective rather than subjective components, along with a reduced selection bias, is warranted.
Road Damage Detection and Classification Using Deep Neural Networks with Smartphone Images
Authors: Maeda Hiroya , Sekimoto Yoshihide , Seto Toshikazu , Kashiyama Takehiro , Omata Hiroshi
Published: June 2018

Research on damage detection of road surfaces using image processing techniques has been actively conducted. This study makes three contributions to address road damage detection issues. First, to the best of our knowledge, for the first time, a large‐scale road damage data set is prepared, comprising 9,053 road damage images captured using a smartphone installed on a car, with 15,435 instances of road surface damage included in these road images. Next, we used state‐of‐the‐art object detection methods using convolutional neural networks to train the damage detection model with our data set, and compared the accuracy and runtime speed on both, using a GPU server and a smartphone. Finally, we demonstrate that the type of damage can be classified into eight types with high accuracy by applying the proposed object detection method. The road damage data set, our experimental results, and the developed smartphone application used in this study are publicly available (https://github.com/sekilab/RoadDamageDetector/).
Pediatric tracheomalacia and the perioperative anesthetic management of thoracoscopic posterior tracheopexy
Authors: Masaracchia Melissa M. , Polaner David M. , Prager Jeremy D. , DeBoer Emily M. , Dewberry Lindel C. , Somme Stig , Wine Todd , Janosy Norah R.
Published: July 2018

Tracheomalacia is a broad term used to describe an abnormally compliant trachea that can lead to exaggerated collapse and obstruction with expiration. We describe the perioperative management of a complex pediatric patient undergoing a posterior tracheopexy which is a relatively new surgical treatment, with a novel surgical approach—thoracoscopy. This procedure has competing surgical and anesthetic needs and presents unique challenges to the physicians involved in caring for these patients. We also review the current literature on pediatric tracheomalacia and examine the newest treatment options to highlight the potential anesthetic challenges and pitfalls associated with management.
Basal cell carcinoma in a 17 year‐old organ transplant recipient
Authors: Borges‐Costa João
Published: July 2018

Skin cancer is among the most frequent cancers in pediatric organ transplant recipients. We report a 17‐year‐old Caucasian girl who had had a kidney transplant 6 years before and was referred to our outpatient clinic for a basal cell carcinoma of the scalp. This case emphasizes the importance of teaching sun‐protective behavior to transplant recipients and their parents and having a high index of suspicion and arrange for early referral for dermatologic care if skin changes are observed.
Genotype‐phenotype correlation in type 1 neurofibromatosis: pMet992del mutation and milder disease
Authors: Batalla Ana , Iglesias‐Puzas Álvaro , Freire‐Bruno José , Herrero‐Hermida Javier , Flórez Ángeles
Published: July 2018

A few genotype‐phenotype correlations have been described in type 1 neurofibromatosis. One deletion, p.Met992del, seems to be responsible for a mild form of the condition, in which there is absence of externally visible neurofibromas. We report a mother and a son with this mutation.
Applications of plant ingredients for tropical and subtropical freshwater finfish: possibilities and challenges
Authors: Ghosh Koushik , Ray Arun K. , Ringø Einar
Published: June 2018

The demand for cultured finfish has increased tremendously during the last decades, but the success of intensive farming is dependent on several factors, namely management, dietary supplementations and welfare. During the last decades, increasing demand, high price and limited supply of fishmeal have emphasized the need for alternative protein sources in aquafeeds, but plant proteins possess a series of endogenous antinutritional factors (ANFs; e.g. protease inhibitors, tannin, mimosine, phytic acid, nonstarch polysaccharides), and they must be destroyed or inactivated. Inclusion of alternative protein sources has resulted in production losses and is a concern for farmers. However, the problem with ANFs might be solved using advanced processing techniques. The present review, focusing on tropical and subtropical freshwater finfish, will discuss findings on applications of conventional methods, as well as fermentation technology for deactivation of endogenous ANFs, and the use of probiotics with ANF degrading potential when plant ingredients are included in fish feeds.
Detection of temperature variability and trends in the lower troposphere over Delhi: A study of joint influence of ENSO and Land use/ Land cover during 1980–2015
Authors: Janmaijaya Mansi , Singh RB , Dhaka SK
Published: July 2018

A study of radiosonde observations for temperature at 850 hPa over Delhi for a period of 35 years was conducted. The influence of atmospheric oscillations and geophysical events like El Niño‐Southern Oscillation (ENSO) on tropospheric temperature variability showed indicative trends for changing urban climate in Delhi. The inter‐annual variation in surface temperature and its relationship with land use changes and land cover changes (LULCC) was also examined. LULCC and urban expansion into peripheral areas of Delhi (towards the West, North, North‐West and South) at the cost of agricultural and wasteland was found to be extensive. The upper range of the surface temperature has shifted by ~6°C. The post‐monsoon and winter months from November to February have experienced a considerable increase in the average temperature in the period examined. The monsoon months from June to September have undergone cooling of ~0.5°C–1°C at 850 hPa. An inverse relationship exists between the Southern Oscillation Index (SOI) and the monthly averaged temperature. The temperature of the atmosphere over Delhi at 850 hPa has increased only marginally (~ 0.3°C) for the time period 1980–2015. Bi‐modal peaks were the most peculiar features observed in mean monthly temperature variation during 2000–2009.
Examination of muscle morphology and neuromuscular function in normal weight and overfat children aged 7‐10 years
Authors: Herda Trent J. , Ryan Eric D. , Kohlmeier Martin , Trevino Michael A. , Gerstner Gena R. , Roelofs Erica J.
Published: June 2018

Neuromuscular function in young overweight/obese (OF) children is not well described.

Aim

This study examined isometric and isokinetic leg extensor strength, muscle size (mCSA) and tissue composition as measured via echo intensity (mEI), and motor unit (MU) firing rates in normal weight (NW) and OF children aged 7‐10 years.

Methods

Fourteen NW (eight girls and six boys, BMI: 15.8 ± 1.4 kg/m2) and 15 OF (10 girls and five boys, BMI: 20.8 ± 2.3 kg/m2) children volunteered to perform this study. Percentage body fat (%BF) was measured, and mCSA, mEI, and subcutaneous fat (sFAT) of the vastus lateralis (VL) was assessed. MU mean firing rates (MFRs) in relation to recruitment threshold (RT) of the VL were assessed during submaximal isometric contractions. Maximal isokinetic contractions were performed at 1.05 and 4.20 rad/s. The 95% confidence intervals (CI) from the statistical tests are presented.

Results

The OF children had greater %BF (95% CI = −15.1 to −7.2), mCSA (95% CI = −4.1 to −1.2), mEI (95% CI = −22.3 to −5.9), and sFAT (95% CI = −0.5 to −0.1), greater rate of strength loss with increasing isokinetic velocities (95% CI = 0.4 to 5.4), and a smaller range of MFRs (95% CI = 0.007 to 7.136) at the steady torque than the NW children.

Conclusions

The OF children had poorer muscle tissue composition, greater velocity‐related impairments in muscle strength, and a smaller range of MFRs at the targeted torque that may suggest altered MU recruitment strategies. Interventions in OF children should include exercises and recruit higher‐threshold MUs, such as high‐intensity resistance exercises.
Combustion Model for a Homogeneous Turbocharged Gasoline Direct-Injection Engine
Authors: Tolou Sedigheh , Vedula Ravi Teja , Schock Harold , Zhu Guoming , Sun Yong , Kotrba Adam
Published: July 2018

Homogeneous charge is a preferred operation mode of gasoline direct-injection (GDI) engines. However, a limited amount of work exists in the literature for combustion models of this mode of engine operation. Current work describes a model developed to study combustion in a homogeneous charge GDI engine. The model was validated using experimental data from a 1.6 L Ford EcoBoost® engine, tested at the U.S. EPA. The combustion heat release was approximated using a double-Wiebe function, to account for the rapid initial premixed combustion followed by a gradual diffusion-like state of combustion, as observed in this GDI engine. Variables of Wiebe correlations were adjusted into a semipredictive combustion model. The effectiveness of semipredictive combustion model was tested in prediction of in-cylinder pressures. The root-mean-square (RMS) errors between experiments and numerical results were within 2.5% of in-cylinder peak pressures during combustion. The semipredictive combustion model was further studied to develop a predictive combustion model. The performance of predictive combustion model was examined by regenerating the experimental cumulative heat release. The heat release analysis developed for the GDI engine was further applied to a dual mode, turbulent jet ignition (DM-TJI) engine. DM-TJI is a distributed combustion technology with the potential to provide diesel-like efficiencies and minimal engine-out emissions for spark-ignition engines. The DM-TJI engine was observed to offer a faster burn rate and lower in-cylinder heat transfer compared to the GDI engine.
Music complexity prediction for cochlear implant listeners based on a feature-based linear regression model
Authors: Nagathil Anil , Schlattmann Jan-Willem , Neumann Katrin , Martin Rainer
Published: July 2018

This paper presents a model for predicting music complexity as perceived by cochlear implant (CI) users. To this end, 10 CI users and 19 normal-hearing (NH) listeners rated 12 selected music pieces on a bipolar music complexity scale and 5 other perception-related scales. The results indicate statistically significant differences in the ratings between CI and NH listeners. In particular, the ratings among different scales were significantly correlated for CI users, which hints at a common, hidden scale. The median complexity ratings by CI listeners and features accounting for high-frequency energy, spectral center of gravity, spectral bandwidth, and roughness were used to train a linear principal component regression model for an average CI user. The model was evaluated by means of cross-validation and using an independent database of processed chamber music signals for which music preferences scores by CI users were available. The predictions indicate a clear linear relationship with the preference scores, confirming the negative correlation between music complexity and music preference for CI users found in previous studies. The proposed model is a first step toward an instrumental evaluation procedure in the emerging field of music processing for CIs.
Is It Time for Systematic Voriconazole Pharmacogenomic Investigation for Central Nervous System Aspergillosis?
Authors: Danion François , Jullien Vincent , Rouzaud Claire , Abdel Fattah Manal , Lapusan Simona , Guéry Romain , Bigé Naïke , Morgand Marjolaine , Pallet Nicolas , Lanternier Fanny , Lortholary Olivier
Published: July 2018

Voriconazole is the standard treatment for invasive aspergillosis but requires therapeutic drug monitoring to optimize therapy. We report two cases of central nervous system aspergillosis treated with voriconazole.
Qualitative study of perspectives concerning recent rehospitalisations among a high-risk cohort of veteran patients in Connecticut, USA
Authors: Antony Sheila M , Grau Lauretta E , Brienza Rebecca S
Published: June 2018

Objectives

Veterans Affairs (VA) patients are at risk for rehospitalisation due to their lower socioeconomic status, older age, poor social support or multiple comorbidities. The study explored inpatients’ perceptions about factors contributing to their rehospitalisation and their recommendations to reduce this risk.

Design

Thematic qualitative data analysis of interviews with 18 VA inpatients.

Setting

VA Connecticut Healthcare System, West Haven Hospital medical inpatient units.

Participants

All were aged 18+ years, rehospitalised within 30 days of most recent discharge, medically stable and competent to provide consent.

Measurements

Interviews assessed inpatients’ health status after last discharge, reason for rehospitalisation, access to and support from primary care providers (PCP), medication management, home support systems and history of substance use or mental health disorders.

Results

The mean age was 71.6 years (11.1 SD); all were Caucasian, living on limited budgets, and many had serious medical conditions or histories of mental health disorders. Participants considered structural barriers to accessing PCP and limited PCP involvement in medical decision-making as contributing to their rehospitalisation, although most believed that rehospitalisation had been inevitable. Peridischarge themes included beliefs about premature discharge, inadequate understanding of postdischarge plans and insufficiently coordinated postdischarge services. Most highly valued their VA healthcare but recommended increasing PCPs’ involvement and reducing structural barriers to accessing primary and specialty care.

Conclusions

Increased PCP involvement in medical decision-making about rehospitalisation, expanded clinic hours, reduced travel distances, improved communications to patients and their families about predischarge and postdischarge plans and proactive postdischarge outreach to high-risk patients may reduce rehospitalisation risk.
Association between recreational drug use and sexual practices among people who inject drugs in Southwest China: a cross-sectional study
Authors: Su Shu , Zhang Lei , Cheng Feng , Li Shunxiang , Li Shifu , Jing Jun , Fairley Christopher Kincaid , Chen Liang , Zhao Jinxian , Mao Limin
Published: June 2018

Objective

To describe the differences in sexual practices among individuals with various drug administration patterns.

Setting

A detoxification centre in Southwest China, a part of the Chinese national sentential surveillance network for hepatitis C virus (HCV), HIV and syphilis infections, was recruited.

Participants

A total of 610 newly enrolled injection drug users (IDUs) from detoxification centre were included during 2015.

Primary and secondary outcome measures

Self-reported sexual activities, drug-related practices and laboratory-confirmed HCV, HIV and syphilis infection status were collected.

Results

Of the 610 IDU, 295 (48.4%) used heroin only, 277 (45.4%) poly-drug users reported the mixed use of synthetic drugs (SDs) with heroin and 38 (6.2%) used SDs only. The average daily drug injection frequency for poly-drug users (3.3±1.2 times) was the highest, followed by heroin-only (2.2±0.8 times) and SD-only users (1.2±0.4 time). SD-only drug users reported the highest proportion (86.8%) of engaging in sexual activities in the previous month, with more than half (54.5%) reporting any condomless sex. A higher frequency of daily injecting in heroin-only users was significantly correlated with the less likelihood of sex, condomless sex in the past month, having sex with fixed partners, condomless commercial sex in the previous 12 months (all p<0.01). In poly-drug users, who injected drugs two times per day was associated with the highest proportion of people who engaged in sex and commercial sex (p<0.05). For SD-only users, increased drug use was not associated with reducing sexual risk (p>0.05). Different patterns of HCV, HIV and syphilis infections prevalence rates were shown among the IDU depending on the roles and length of exposure.

Conclusions

The daily drug injecting frequency of heroin-only and poly-drug users was negatively associated with sexual activities, but SD-only users kept a high frequent engagement in sex. The interventions for relevant diseases should adapt to characteristics of IDU.
Factors associated with continued smoking after the diagnosis of type 2 diabetes: a retrospective study in the Korean cohort
Authors: Cho Mi Hee , Kim Sung Min , Lee Kiheon , Park Sang Min , Chang Jooyoung , Choi Seulggie , Kim Kyuwoong , Koo Hye-Yeon , Jun Ji-Hye
Published: June 2018

Objective

To investigate the factors associated with continued smoking in patients newly diagnosed with type 2 diabetes.

Design

Retrospective study using the Korean National Health Insurance Service-National Health Screening Cohort (2002–2013) database.

Participants

Male patients newly diagnosed with type 2 diabetes between 1 January 2004 and 31 December 2011.

Measurement

Change in smoking behaviour after the diabetes diagnosis was assessed using a self-reported questionnaire, which was administered before and after the diagnosis. To identify the factors associated with continued smoking after diabetes diagnosis, a multivariate-adjusted logistic regression was conducted using only the variables with statistical significance from the univariate analyses.

Results

Younger age, lower economic status, heavier smoking habit, lower Charlson Comorbidity Index and comorbid hypertension were identified as factors associated with continued smoking after the diagnosis of type 2 diabetes. Older patients (adjusted OR (aOR) 0.71, 95% CI 0.63 to 0.79) and patients with longer diabetic duration (1–2 years OR 0.88, 95% CI 0.80 to 0.98, ≥3 years OR 0.63, 95% CI 0.55 to 0.73) were more likely to quit smoking. Contrastingly, smokers in the lower economic status (aOR 1.29, 95% CI 1.18 to 1.42) and heavier smoking habit (moderate: aOR 1.53, 95% CI 1.35 to 1.72; heavy: aOR 1.90, 95% CI 1.67 to 2.17) categories were more likely to continue smoking after the diagnosis.

Conclusions

It is important to identify the factors associated with smoking behaviour in patients with type 2 diabetes. Recognising the factors that contribute to the vulnerability of patients to continued smoking will be helpful in developing policies and intervention strategies in future. Vulnerable patients may require intensive education and encouragement to quit smoking. We recommend physicians to take a more proactive approach, such as encouraging frequent clinical sessions for behavioural counselling and even early pharmacological interventions, when they encounter patients with the factors outlined in this study.
Systematic review and meta-analysis of the effect of SGLT-2 inhibitors on microvascular outcomes in patients with type 2 diabetes: a review protocol
Authors: Dorsey-Treviño Edgar Gerardo , Contreras-Garza Belinda Maricela , González-González José Gerardo , Álvarez-Villalobos Neri , Salcido-Montenegro Alejandro , Díaz González-Colmenero Alejandro , Farrell Ann M , González-Nava Victoria , Rodríguez-Tamez Giselle , Montori Victor M , Rodriguez-Gutierrez René
Published: June 2018

Introduction

Sodium glucose cotransporter 2 (SGLT-2) inhibitors are a relatively new drug-class of glucose-lowering medications. Several trials and systematic reviews have demonstrated their beneficial effect on some macrovascular outcomes. Their effect on microvascular outcomes has been reported as positive in several trials, however, their effect remains uncertain. Therefore, we report the protocol of a systematic review and meta-analysis aimed at determining the effect of SGLT-2 inhibitors regarding patient-important and surrogate microvascular outcomes in patients with type 2 diabetes.

Methods and analysis

A comprehensive search will be conducted to find eligible articles from each database’s earliest inception to November 2017. These databases will include Ovid, MEDLINE, EMBASE, Web of Science, and Scopus. We will search for randomized controlled trials (RCTs) that compare any of the SGLT-2 inhibitors with any other active treatment or placebo assessing microvascular outcomes in either their primary or secondary outcomes. Reviewers working independently and in duplicate will review all abstracts, and full-text manuscripts for eligibility, and will systematically extract the data and will assess the risk of bias in the included studies. Random-effects models will also be used.

Ethics and dissemination

The results of the systematic review will be disseminated via publication in a peer-reviewed journal regardless of outcome and will be presented at relevant conferences. The data we will use do not include individual patient data, so ethical approval is not required

PROSPERO registration number

CRD42017076460.
Quality of life among individuals with rugby-related spinal cord injuries in South Africa: a descriptive cross-sectional study
Authors: Badenhorst Marelise , Brown James Craig , Lambert Mike I , Van Mechelen Willem , Verhagen Evert
Published: June 2018

Objectives

Rugby-related spinal cord injuries (SCIs) are rare but life altering and traumatic events. Little is known about the long-term consequences and outcomes of players who have sustained these injuries. This study investigated current quality of life (QoL) and factors associated with QoL, among individuals with rugby-related SCI in South Africa, by using the International Classification of Functioning, Disability and Health (ICF) framework.

Design

Descriptive cross-sectional study.

Setting

Rugby-related SCI population of South Africa, as captured in the BokSmart/Chris Burger Petro Jackson Players’ Fund database.

Participants

Ninety (n=90) of the 102 eligible players on the database agreed to participate in the study.

Main outcome measure

The relationship between QoL, as measured with the WHO Quality of Life questionnaire (WHOQOL-BREF) and specific independent variables (demographic information, level of independence and participation in various activities and life roles) was investigated. Variables that were significantly associated with QoL in bivariate analyses were included in multiple linear regression analyses.

Results

The mean score and SD of the WHOQOL-BREF was 15.1±2.3 arbitrary units. Participation (an ICF framework construct) and income were significantly associated with overall QoL (p<0.001). Participation was the only variable significantly associated with all QoL subdomains (p<0.001). Additionally, number of health concerns, type of healthcare (public vs private) and level of education were significantly associated with various QoL domains (p<0.001).

Conclusions

On average, these individuals with rugby-related SCI presented with higher QoL scores than other comparable SCI studies. However, lower levels of participation and income, certain levels of education, increased health concerns and use of public healthcare were associated with lower levels of QoL. Sporting bodies have a responsibility to optimise player welfare, by acting on the modifiable factors associated with QoL.
What can make things better for parents when babies need abdominal surgery in their first year of life? A qualitative interview study in the UK
Authors: Hinton Lisa , Locock Louise , Long Anna-May , Knight Marian
Published: June 2018

Objectives

To understand the experiences of parents of infants who required surgery early in life. To identify messages and training needs for the extended clinical teams caring for these families—including paediatric surgeons, neonatologists, nurses, obstetricians, midwives and sonographers.

Setting

UK-wide interview study, including England, Wales and Scotland.

Participants

In-depth interviews were conducted with 44 parents who had a baby who underwent early abdominal surgery. Conditions included those diagnosed antenatally (eg, exomphalos, gastroschisis, congenital diaphragmatic hernia) or those which were detected postnatally (eg, Hirschsprung’s disease, necrotising enterocolitis). Interviews were video and audio recorded and analysed using a modified grounded-theory approach.

Results

While some parents reported experiencing excellent communication and felt they were listened to and involved by the care team, this was not always the case. Dealing with large, complex medical and surgical teams could result in conflicting messages, uncertainty and distress. Parents wanted information but also described being overwhelmed and wanting to distance themselves to maintain hope. Information and support from other parents in hospital and online groups were highly valued. Of particular concern was support when going home and caring for their baby after discharge; an open access policy for readmission offered a helpful safety net.

Conclusions

Listening to the experience of parents provides rich data to enhance clinical understandings on how to improve information and communication with parents, and ameliorate the deep and lasting distress and anxiety that some parents feel when their infants face early surgery. We suggest that the writings of Bourdieu could have resonance in interpreting the experiences of parents as they enter the world of highly technical neonatal medicine and surgery and the knowledge of the professionals who work in these environments.
Mindful Self-Care and Resiliency (MSCR): protocol for a pilot trial of a brief mindfulness intervention to promote occupational resilience in rural general practitioners
Authors: Rees Clare , Craigie Mark , Slatyer Susan , Heritage Brody , Harvey Clare , Brough Paula , Hegney Desley
Published: June 2018

Introduction

The Mindful Self-Care and Resiliency (MSCR) programme is a brief psychosocial intervention designed to promote resilience among various occupational groups. The intervention is based on the principles of mindfulness and also incorporates an educational self-care component. The current paper presents the protocol for a pilot study that will evaluate the effectiveness of this programme among general practitioners working in rural Queensland, Australia.

Methods and analysis

We will measure the impact of the MSCR programme on levels of employee resilience (Connor-Davidson Resilience Scale; State-Trait Assessment of Resilience STARS), compassion satisfaction and compassion fatigue (Professional Quality of Life Scale), self-compassion (Self-Compassion Scale) and mood (Positive and Negative Affect Scale). We will also assess the impact of the programme on job satisfaction (The Abridged Job in General Scale), absenteeism/presenteeism (The WHO Health and Work Performance Questionnaire) and general well-being (WHO Five Well-being Index). Repeated measures analysis of variance will be used to analyse the impact of the intervention on the outcome measures taken at pre, post, 1-month, 3-month and 6-month follow-ups. We will conduct individual interviews with participants to gather data on the feasibility and acceptability of the programme. Finally, we will conduct an initial cost-effectiveness analysis of the programme.

Ethics and dissemination

Approval for this study was obtained from the Curtin University Human Research ethics committee and the study has been registered with the Australian Clinical Trials Registry. Results will be published and presented at national and international congresses.

Trial registration number

ACTRN12617001479392p; Pre-results.
Facilitators and barriers to the effective implementation of the individual maternal near-miss case reviews in low/middle-income countries: a systematic review of qualitative studies
Authors: Lazzerini Marzia , Ciuch Margherita , Rusconi Silvia , Covi Benedetta
Published: June 2018

Background

The maternal near-miss cases review (NMCR), a type of clinical audit, proved to be effective in improving quality of care and decreasing maternal mortality in low/middle-income countries (LMICs). However, challenges in its implementation have been described.

Objectives

Synthesising the evidence on facilitators and barriers to the effective implementation of NMCR in LMICs.

Design

Systematic review of qualitative studies.

Data sources

MEDLINE, LILACS, Global Health Library, SCI-EXPANDED, SSCI, Cochrane library and Embase were searched in December 2017.

Eligibility criteria for selecting studies

Qualitative studies exploring facilitators and/or barriers of implementing NMCR in LMIC were included.

Data extraction and synthesis

Two independent reviewers extracted data, performed thematic analysis and assessed risk of bias.

Results

Out of 25 361 papers retrieved, 9 studies from Benin, Brazil, Burkina Faso, Cote D’Ivoire, Ghana, Malawi, Morocco, Tanzania, Uganda could be included in the review. The most frequently reported barriers to NMCR implementation were the following: absence of national guidelines and local protocols; insufficient training on how to perform the audit; lack of leadership, coordination, monitoring and supervision; lack of resources and work overload; fear of blame and punishment; poor knowledge of evidenced-based medicine; hierarchical differences among staff and poor understating of the benefits of the NMCR. Major facilitators to NMCR implementation included: good leadership and coordination; training of all key staff; a good cultural environment; clear staff’s perception on the benefits of conducting audit; patient empowerment and the availability of external support.

Conclusions

In planning the NMCR implementation in LMICs, policy-makers should consider actions to prevent and mitigate common challenges to successful NMCR implementation. Future studies should aim at documenting facilitators and barriers to NMCR outside the African Region.
How do care home staff understand, manage and respond to agitation in people with dementia? A qualitative study
Authors: Rapaport Penny , Livingston Gill , Hamilton Olivia , Turner Rebecca , Stringer Aisling , Robertson Sarah , Cooper Claudia
Published: June 2018

Objectives

Little is known about how care home staff understand and respond to distress in residents living with dementia labelled as agitation. The aim of this study was to describe how care home staff understand and respond to agitation and the factors that determine how it is managed.

Design

We conducted a qualitative thematic analysis.

Setting

We recruited staff from six care homes in South East England including residential and nursing homes of differing sizes run by both the private and charity sector and located in urban and rural areas.

Participants

We interviewed 25 care home staff using purposive sampling to include staff of either sex, differing age, ethnicity, nationality and with different roles and experience.

Results

We identified four overarching themes: (1) behaviours expressing unmet need; (2) staff emotional responses to agitation; (3) understanding the individual helps and (4) constraints on staff responses. Staff struggled with the paradox of trying to connect with the personhood of residents while seeing the person as separate to and, therefore, not responsible for their behaviours. Staff often felt powerless, frightened and overwhelmed, and their responses were constrained by care home structures, processes and a culture of fear and scrutiny.

Conclusions

Responding to agitation expressed by residents was not a linear process and staff faced tensions and dilemmas in deciding how to respond, especially when initial strategies were unsuccessful or when attempts to respond to residents’ needs were inhibited by structural and procedural constraints in the care home. Future trials of psychosocial interventions should support staff to identify and respond to residents’ unmet needs and include how staff can look after themselves.
Intra-articular botulinum toxin A for base-of-thumb osteoarthritis: protocol for a randomised trial (RHIBOT)
Authors: Gil Charlotte , Abdoul Hendy , Campagna Raphaël , Guerini Henri , Ieong Estelle , Chagny Franck , Bedin Catherine , Roren Alexandra , Lefèvre-Colau Marie-Martine , Poiraudeau Serge , Feydy Antoine , Rannou François , Nguyen Christelle
Published: June 2018

Introduction

Recent studies have suggested that intra-articular injection of botulinum toxin A (BTA) may have analgesic effects in degenerative joint diseases. We aim to assess the efficacy of intra-articular injection of BTA associated with splinting in patients with trapeziometacarpal osteoarthritis (TMC OA).

Methods and analysis

We will conduct a randomised double-blind controlled trial. Overall, 60 individuals with TMC OA fulfilling adapted 1990 American College of Rheumatology criteria for hand OA will be recruited in one tertiary care centre in France and randomised to receive splinting + a single ultrasound-guided injection in the TMC joint of 50 Allergan Units of BTA resuspended in 1 mL saline or splinting +1 mL saline. Randomisation will be centralised. The allocation ratio will be 1:1. The primary outcome will be the mean change from baseline in base-of-thumb pain on a self-administered 11-point Numeric Rating Scale in 10-point increments at 3 months after injection. Secondary outcomes will be the mean change in base-of-thumb pain at 1 and 6 months, mean change in hand-specific activity limitations assessed by the self-administered Cochin Hand Function Scale, proportion of responders assessed by the Osteoarthritis Research Society International -Outcome Measures in Rheumatology (OMERACT) criteria and consumption of analgesics and non-steroidal anti-inflammatory drugs assessed by a self-administered 4-class scale at 3 and 6 months. Cointerventions will be allowed in both groups and will be self-reported. Adverse events will be recorded at 3 and 6 months. Participants, care providers and statisticians will be blinded to the allocated treatment.

Ethics and dissemination

The RHIBOT trial has been authorised by the Agence Nationale de Sécurité du Médicament and approved by the Comité de Protection des Personnes de Tours Ouest-1. The findings of the study will be disseminated in peer-reviewed journals and at conferences. If the results are positive, intra-articular BTA could be an efficient and safe complementary therapeutic option for patients with TMC OA.

Date and version identifier of the protocol

8 January 2018, V. 2.0.

Trial registration number

NCT03187626; Pre-results.
Transitions and touchpoints in idiopathic pulmonary fibrosis
Authors: Swigris Jeffrey J
Published: June 2018

Patients with idiopathic pulmonary fibrosis (IPF) face a poor prognosis and endure intrusive symptoms that impair quality of life. Many patients with IPF will require supplemental oxygen (O2) at some point in the course of their illness, and although it can improve blood oxygen and symptoms, O2creates physical and emotional challenges for patients and their loved ones. Four events in the course of IPF—the first occurs at the time of diagnosis and the other three are related to O2—herald periods of transition for patients and their caregivers and mark touchpoints when they need extra care and support from practitioners.